Evaluation of Healthcare Transition Outcome Predictors for Adolescents/Young Adults Living with Chronic Medical Conditions

Abstract

Medical advances have resulted in increased survival rates for patients with chronic, pediatric-onset medical conditions. As these patients require long-term medical follow-up, pediatric providers must help prepare them for the transition into the adult healthcare system. Transition preparation involves assessing and helping patients develop the relevant skills and knowledge that they need to manage their conditions independently and function effectively in the adult healthcare system. Both the development of psychometrically sound transition readiness measures and the identification of factors influencing transition success are needed to develop empirically-grounded healthcare transition models that can inform the delivery of transition services. The current study evaluated the psychometric properties of the Transitioning Preparedness Survey (TPS), a generic transition readiness measure, and attempted to explore potential predictors of transition success. Data collection included a retrospective medical record review of 152 patients with chronic medical conditions or a history of cancer who had received pediatric transition preparation services and a follow-up phone survey completed by nine patients who had transitioned out of pediatric care. Results supported the internal consistency of the TPS 18+ Version (n = 110, ordinal α = 0.93) and TPS 15-17 Version (n = 42, ordinal α = 0.93). The TPS 18+ Version’s concurrent and convergent validity were supported by intercorrelations among its subscales, positive correlations with patient age, and higher scores among patients with lower risk of neurocognitive difficulties compared to patients at higher risk. Results also indicated limited support for the TPS 15-17 Version’s concurrent and convergent validity. The small number of patients who provided transition outcome data precluded quantitative evaluation of the predictive validity of the TPS 18+ Version and the relationships of socio-demographic factors, medical characteristics, and indicators of engagement in pediatric services with transition outcomes. Survey completers’ responses suggested that health insurance coverage in adulthood, parental support, self-perceived transition readiness, and self-advocacy skills may be additional potential predictors of transition outcomes to investigate in future studies. The TPS measures showed promise as clinically useful measures of transition readiness. Recommendations were provided for continued development of the TPS and of a model of empirically determined predictors of transition outcomes.