July 27, 2023

Transitions of Care working Group

Meeting 1, July 27, 2023

Attendees: Holly Hardison, Sarah Corathers, Faisal Malik, Shivani Agarwal, Amy Ohmer, Inas Thomas, Siham Accacha, Mark Clements, Beth Edwards, Ming Hong, Andrew Welch, Meredith Wilkes, Ines Guttmann Bauman, Don Buckingham, Laura Jacobsen

Agenda

• Introductions
• Core Transitions Figure sharing
• Smart Aim Targeted Discussion

6 Core Transitions Elements Pediatric

• Element 1 – Transition and Care Policy/Guide
• Element 2 – Tracking and Monitoring
• Element 3 – Transition Readiness
• Element 4 – Transition Planning
• Element 5 – Transfer of Care
• Element 6 – Transfer Completion

6 Core Transition Elements Adult

• Element 1 – Transition and Care Policy/Guide
• Element 2 – Tracking and Monitoring
• Element 3 – Orientation into Adult Practice
• Element 4 – Integration into Adult Practice
• Element 5 – Initial Adult Practice Visit
• Element 6 – Ongoing Care

Who initiates the transition of care from peds to adults?

• This group can help in determining roles and process for best implementation of the framework
  • Cincinnati will assign swim lanes based on topic area and expertise

Deliverables:

• Find adult counterpart and invite to the working group meetings
• On adult side, receive knowledge of patient that is coming into your care
• More expansion on all 6 elements
• Developing a “Pathway to Transfer” a clear policy for next steps

Link to Best Practices:

 https://docs.google.com/spreadsheets/d/1Q4Xr8v8fZ-HO6Kgbs4ZMTn5qkqzozn4mtju2TFOrTYs/edit?usp=sharing

Link to recording:

https://us02web.zoom.us/rec/share/NcVt0Pe6wnRMKZnjTRXcDdonzQROUYQw4yhmUbcrh-lL7DKketF02obO0fxknWAt._ESGA5p7zPD_RBmd?startTime=1690484490000

Passcode: m^r!Rag4