Quality and Safety in Transitional Urologic Care

  • Jessica H. Hannick
  • Martin A. KoyleEmail author


In recent years, our understanding about how to manage pediatric urology patients has improved substantially. This has resulted in this population receiving better long-term care, thus allowing these patients to live well into adulthood. This chapter explores how well the medical community has been adapting to this evolution in pediatric medicine, both in the broad context of complex pediatric care as well as within the realm of pediatric urology. Several existing initiatives for transitional pediatric and pediatric urologic care will be discussed, along with opportunities for collaboration to generate novel innovations specific to the pediatric urologic patient approaching transition into adulthood. Finally, the basic tenets of quality improvement work and its applicability to transitional care will be reviewed. Recommendations will be provided regarding how to develop, measure, refine, and spread quality improvement initiatives.


Transition to adult care Transitional care Healthcare transitions Continuity of patient care Quality improvement Quality of health care Urology Pediatric urology Adolescent urology Transitional urology 


  1. 1.
    American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine. A consensus statement on health care transitions for young adults with special health care needs. Pediatrics. 2002;110(6):1304–6.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention; National Institute on Disability and Rehabilitation Research; US Department of Education. Disability and secondary conditions. Healthy People 2010. Washington, DC. 2000. Accessed 5 Aug 2018.
  3. 3.
    Prevention D of H and HSC for DC and 2005-2006 National Survey of Children with Special Health Care Needs. 2007. Accessed 5 Aug 2018.
  4. 4.
    No Title. Healthy People 2020. Washington, DC. 2014. Accessed 5 Aug 2018.
  5. 5.
    McManus MA, Pollack LR, Cooley WC, McAllister JW, Lotstein D, Strickland B, et al. Current status of transition preparation among youth with special needs in the United States. Pediatrics. 2013;131(6):1090–7.CrossRefGoogle Scholar
  6. 6.
    American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, Transitions Clinical Report Authoring Group, Cooley WC, Sagerman PJ. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128(1):182–200.CrossRefGoogle Scholar
  7. 7.
    Hsieh MH, Wood HM, Dicianno BE, Dosa NP, Gomez-Lobo V, Mattoo TK, et al. Research needs for effective transition in lifelong care of congenital genitourinary conditions: a workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Urology. 2017;103:261–71.CrossRefGoogle Scholar
  8. 8.
    Got Transition. Six Core Elements of Health Care Transition 2.0: Side-by-Side Version. 2014;1–2. Accessed 5 Aug 2018.
  9. 9.
    World Health Organization. International classification of functioning, disability and health—children & youth version. Geneva: Switzerland; 2007.Google Scholar
  10. 10.
    Woodhouse C. Adolescent urology and transitional care. Eur Urol. 2015;68(5):745–6.CrossRefGoogle Scholar
  11. 11.
    Moynihan M, Saewyc E, Whitehouse S, Paone M, Mcpherson G. Assessing readiness for transition from paediatric to adult health care: revision and psychometric evaluation of the Am I ON TRAC for Adult Care questionnaire. J Adv Nurs. 2015;71(6):1324–35.CrossRefGoogle Scholar
  12. 12.
    Vaks Y, Bensen R, Steidtmann D, Wang TD, Platchek TS, Zulman DM, et al. Better health, less spending: redesigning the transition from pediatric to adult healthcare for youth with chronic illness. Healthc (Amst). 2016;4(1):57–68.CrossRefGoogle Scholar
  13. 13.
    Prior M, McManus M, White P, Davidson L. Measuring the “Triple Aim” in transition care: a systematic review. Pediatrics. 2014;134(6):e1648–61.CrossRefGoogle Scholar
  14. 14.
    Fair C, Cuttance J, Sharma N, Maslow G, Wiener L, Betz C, et al. International and interdisciplinary identification of health care transition outcomes. JAMA Pediatr. 2016;170(3):205–11.CrossRefGoogle Scholar
  15. 15.
    Gorter JW, Stewart D, Cohen E, Hlyva O, Morrison A, Galuppi B, et al. Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study. BMJ Open. 2015;5(5):e007553.CrossRefGoogle Scholar
  16. 16.
    Nagra A, McGinnity PM, Davis N, Salmon AP. Implementing transition: ready steady go. Arch Dis Child Educ Pract Ed. 2015;100(6):313–20.CrossRefGoogle Scholar
  17. 17.
    “Ready Steady Go” and “Hello to adult servies” developed by the Transition Steering Group led by Dr. Arvind Nagra, paediatric nephrologist and clinical lead for transitional care at Southampton Children’s Hospital, University Hospital Southampton NHS Foundation.Google Scholar
  18. 18.
    Tanaka ST, Kaufman MR, Brock JW. The aging pediatric urology patient: obstacles and opportunities in transition care. J Urol. 2012;187(4):1159–60.CrossRefGoogle Scholar
  19. 19.
    Szymanski KM, Misseri R, Whittam B, Large T, Cain MP. Current opinions regarding care of the mature pediatric urology patient. J Pediatr Urol. 2015;11(5):251.e1–4.CrossRefGoogle Scholar
  20. 20.
    Shalaby MS, Gibson A, Granitsiotis P, Conn G, Cascio S. Assessment of the introduction of an adolescent transition urology clinic using a validated questionnaire. J Pediatr Urol. 2015;11(2):89.e1–5.CrossRefGoogle Scholar
  21. 21.
    Grimsby GM, Burgess R, Culver S, Schlomer BJ, Jacobs MA. Barriers to transition in young adults with neurogenic bladder. J Pediatr Urol. 2016;12(4):258.e1–e.5.CrossRefGoogle Scholar
  22. 22.
    Szymanski KM, Cain MP, Hardacker TJ, Misseri R. How successful is the transition to adult urology care in spina bifida? A single center 7-year experience. J Pediatr Urol. 2017;13(1):40.e1–6.CrossRefGoogle Scholar
  23. 23.
    Koyle MA, Golda N, Hillis C, Oldershaw B, Demelo M, Uyeno J. A proposed solution to a urological tightrope walk: the challenge of transition of spina bifida patients from pediatric to adult care in Ontario. Can Urol Assoc J. 2016;10(9–10):E340–1.CrossRefGoogle Scholar
  24. 24.
    Woodhouse CRJ, Neild GH, Yu RN, Bauer S. Adult care of children from pediatric urology. J Urol. 2012;187(4):1164–71.CrossRefGoogle Scholar
  25. 25.
    Misseri R. Comparing transition of care from adolescence to adulthood for patients with congenital urological conditions in Canada and the U.S. Can Urol Assoc J. 2016;10(9/10):311–2.CrossRefGoogle Scholar
  26. 26.
    Duplisea JJ, Romao RLP, MacLellan DL, Cox AR, Anderson PA. Urological follow-up in adult spina bifida patients: is there an ideal interval? Urology. 2016;97:269–72.CrossRefGoogle Scholar
  27. 27.
    Anderson PAM. “If you build it…”: Creating an adequate support system to transition the care of pediatric patients with spina bifida into adulthood. Can Urol Assoc J. 2016;10(9–10):313.CrossRefGoogle Scholar
  28. 28.
    Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759–69.CrossRefGoogle Scholar
  29. 29.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. 2001. Accessed 5 Aug 2018.
  30. 30.
    Balik B, Conway J, Zipperer L, Watson J. Achieving an exceptional patient and family experience of inpatient hospital care. IHI innovation series white paper. Cambridge, MA: Institute for Healthcare Improvement. 2011. Accessed 5 Aug 2018.
  31. 31.
    Carman K, Dardess P, Maurer MEA. Patient and family engagement. Canada Found Healthc Improv. 2013;2:223–31.Google Scholar
  32. 32.
    Epstein R, Street R. Patient-centered care for the 21st century: physicians’ roles, health systems and patients’ preferences. Philadelphia: American Board of Internal Medicine Foundation; 2008.Google Scholar
  33. 33.
    Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007;335(7609):24–7.CrossRefGoogle Scholar
  34. 34.
    Charmet P, Frampton S. Building the business case for patient-centered care. Healthc Financ Manage. 2008;62(3):80–5.Google Scholar
  35. 35.
    Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD. How are patients’ specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians? J Gen Intern Med. 2002;17(1):29–39.CrossRefGoogle Scholar
  36. 36.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence (Review). Cochrane Database Syst Rev. 2008;(2):2–4.Google Scholar
  37. 37.
    Meterko M, Wright S, Lin H, Lowy E, Cleary PD. Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine. Health Serv Res. 2010;45(5 PART 1):1188–204.CrossRefGoogle Scholar
  38. 38.
    Bate P, Robert G. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Qual Saf Heal Care. 2006;15(5):307–10.CrossRefGoogle Scholar
  39. 39.
    Institute for Health Care Improvent. A guide to measuring the triple aim: population health, experience of care and per capita cost. 2012. Accessed 5 August 2018.
  40. 40.
    Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Accessed 18 Jun 2018.
  41. 41.
    Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Source. 2009;82(4):581–629.Google Scholar
  42. 42.
    Massoud M, Nielsen G, Nolan K, Nolan T, Schall M, Sevin C. A framework for spread: from local improvements to system-wide change. IHI Innovation Series White paper. Cambridge, MA: Institute for Healthcare Improvement; 2006.
  43. 43.
    Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11(1):1–11.Google Scholar
  44. 44.
    Coleman KJ, Magnan S, Neely C, Solberg L, Beck A, Trevis J, et al. The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease. Gen Hosp Psychiatry. 2017;44:69–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pediatric UrologyMcMaster University Children’s HospitalHamiltonCanada
  2. 2.Division of Pediatric UrologyThe Hospital for Sick ChildrenTorontoCanada

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