A Novel Receivership Model for Transition of Young Adults With Diabetes: Experience From a Single-center Academic Transition Program

Abstract

Objective: The transition from pediatric to adult care for young adults with diabetes represents an important but often challenging time characterized by a shift from a family-centered care model of pediatrics to a patient-centered care model of adult medicine. We developed a structured transition program based on an adult receivership model at a large academic medical center to improve care coordination and patient satisfaction with the transition process.

Methods: From 2016 to 2020, we implemented a series of quality improvement efforts for young adults aged 18 to 23 years with diabetes by incorporating best practices from the American Diabetes Association guidelines on care for emerging adults. We measured transition orientation attendance, patient satisfaction, hemoglobin A1c (HbA1c) pre- and post-transfer, and care gaps to determine the impact of the program.

Results: In this study, 307 individuals with type 1 diabetes and 16 individuals with type 2 diabetes were taken care of by the adult endocrinology department at the University of Michigan between January 1, 2016 and October 31, 2020. We observed high attendance rates (86% among internal transfers) and favorable patient satisfaction scores for the transition orientation session. Despite the glycemic challenges posed during the transition, HbA1c modestly yet significantly improved 1-year after transfer (-0.4%, P < .01).

Conclusion: We successfully established and maintained a young adult diabetes transition program using a quality improvement approach. Future work will focus on reducing care gaps at the time of transfer, assessing long-term retention rates, and enhancing care coordination for patients referred from outside the health network.

Keywords: adolescent; care transfer; diabetes; quality improvement; transition; young adult.

Figure 1:

Transition orientation attendance based on referral source (internal vs external) for patients with type 1 diabetes. For internal referrals, 2016 n=5, 2017 n=32, 2018 n=35, 2019 n=49, 2020 n=47; total = 168. For external referrals, 2016 n=11, 2017 n=37, 2018 n=31, 2019 n=32, 2020 n=17; total = 128. Abbreviations: Peds = pediatric; CDE = certified diabetes educator; SW = social work; pt = patient; PEHL = Patient Education and Health Literacy Program; T1DM = type 1 diabetes

Figure 2:

Time (in months, listed as mean +/− SD) between final pediatric endocrinology visit and first adult endocrinology visit for patients with T1D who transferred care following internal referral. For 2016 n=11, 2017 n=32, 2018 n=35, 2019 n=49, 2020 n=47, total = 174. Abbreviations: SD = standard deviation; T1D = type 1 diabetes

Figure 3.

Baseline and 1-year post-transition HbA1c for patients with T1D. (A) HbA1c (mean +/− SD) by year the patient established care with adult endocrinology. For 2016 n=27, 2017 n=62, 2018 n=60, 2019 n=62, 2020 n=45. (B) Box plot of HbA1c at baseline vs 1-year post-transition (n=256). Notches represent 95% confidence interval. *p<0.01. Abbreviations: HbA1c = hemoglobin A1c; T1D = type 1 diabetes; SD = standard deviation

Figure 4:

Diabetes technology use at time of transfer of care in young adult patients with T1D Abbreviations: T1D = type 1 diabetes; CGM = continuous glucose monitor; CSII = continuous subcutaneous insulin infusion