Transition Tracking and Monitoring
- Establish criteria and process for identifying transitioning youth/young adults and enter their data into a registry.
- Utilize individual flow sheet or registry to track youth/young adults' transition progress with the Six Core Elements.
- Incorporate the Six Core Elements into clinical care process, using EHR if possible.
Establishing a mechanism to track progress of youth and young adults as they receive the Six Core Elements is the second element in these health care transition quality recommendations. An individual flow sheet within the chart or EHR can be used to track individual patient progress with the Six Core Elements. Information from an individual flow sheet can be used to populate a registry and help to monitor the transition progress within a larger population. Practices may elect to start monitoring transition progress with a subset of youth and young adults with chronic conditions. The long-term goal is to track health care transition progress among all youth ages 12 and older, with and without chronic conditions.