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Barriers and Facilitators Encountered During Transition of Care for Adult Patients with Congenital Chronic Genitourinary Conditions

Saturday, October 20, 2012: 1:57 PM
Grand Ballroom A/B (Hilton Riverside)
Pramod Reddy, MD1, James Donovan, MD2, Ayman Mahdy, MD2 and Eugene Minevich, MD1, (1)Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Division of Urology, University of Cincinnati, Cincinnati, OH

Purpose

Advances in medicine and multidisciplinary care have resulted in increased life expectancy and improved quality of life for patients with chronic health conditions.  In the 1970s less than 1/3rd of patients with Spina Bifida (SB) survived to age 20.  Nowadays survival for patients with SB, bladder exstrophy and genitourinary (GU) cancers into adulthood approaches 80%.  There are currently no model systems established to ensure appropriate transition of care (TOC) for these patients.  Recently we undertook the creation of a multi-institutional program to optimize the TOC for patients with chronic GU conditions from pediatric to adult urology providers.  We present various barriers and facilitators that we encountered during this process.

Methods

A steering committee consisting of faculty from both the University and Childrens hospital was established to oversee the creation of a multi-institutional TOC program.  After a comprehensive review of the literature and identifying the barriers and facilitators of TOC, the committee established urological pathways for TOC to be implemented in the partnering institutions.

Results

In our experience we identified that, for the successful development of a multi-institutional TOC program, there must be a collective relinquishing of individual subspecialty authority to the TOC program by the healthcare team and the patient's family.  Additional barriers and facilitators that we identified and addressed are presented in the table below.

Conclusions

True clinical integration and collaboration in the creation of TOC programs is an example of “disruptive innovation” that will positively impact patients with chronic GU conditions, the healthcare professionals that care for them and translational research. The intent of this article is to aid other programs as they develop and implement TOC programs that can provide seamless, world class patient-centered care to the aging population of individuals with congenital GU conditions.  On a national scale, institutions seeking to develop TOC programs need to engage policy makers to create national guidelines and funding mechanisms for TOC systems.

Barriers to Developing a TOC Program

Facilitators of a Successful TOC Program

    Lack of evidence about what really works

    Lack of funding

    Administrative indifference

    Turf battles/Territorial boundaries

    Disciplinary ethnocentrism (sense of unique knowledge and skills possessed by ones subspecialty)

    Unclear goals and mission

    Structural and cultural differences amongst Pediatric and Adult Hospitals

    Reluctance of patients to transfer care away from pediatric providers

    Failure to integrate essential administrative and financial functions

    Leadership

    Administrative sanction and support

    Shared/participative governance

    Common business plan

    Complementary mission

    Aligned and well stated goals

    Process of professional socialization

    Faculty development

    Interdisciplinary curriculum for participants (i.e. pre-clinic huddles and grand rounds)