The Transition Care Index: Standardizing comprehensive transition and transfer for young adults with inflammatory bowel disease.

OBJECTIVES

In young adults with inflammatory bowel disease (IBD), the time following transfer to adult care is high-risk for adverse outcomes. We used quality improvement (QI) methods to standardize care, decrease variation, and improve preparation of young adults during the transition/transfer process.

METHODS

We created the IBD Transition Care Index (TCI), a list of 10 variables whose completion was felt to represent a more comprehensive transition/transfer process. Variables were organized into three domains: Disease Control/Physical Health, Psychosocial Well-being, and Transition/Transfer Preparation. We educated patients, caregivers, and providers on the value of completing the TCI to deliver complete, multidisciplinary preparation. We recorded variable completion in a database, reviewed results regularly with providers, and compared rates of variable completion between IBD-focused and general gastroenterology (GI) physicians.

RESULTS

Three hundred twenty-two patients transferred to adult care during the project period (211 pre-intervention and 121 post-intervention). In the overall cohort, the mean percentage of TCI variables completed increased from a baseline of 62%-71% in the post-intervention period, with a significant increase in the rate of multidisciplinary IBD annual visit (IBD AV) attendance (51% vs. 62%, p = 0.03). Patients cared for by general GI physicians had significantly increased rates of both overall TCI variable completion (54% vs. 72%, p = 0.02) and IBD AV attendance (34% vs. 57%, p = 0.02) in the pre- versus post-intervention period.

CONCLUSIONS

Care Indexes such as the TCI can be used to reduce variability and standardize complex clinical processes like transition/transfer for young adults with IBD, with the goal of improving patient outcomes.