Integrating Young Adults into Adult Health Care
For use by Internal Medicine, Family Medicine, and Med-Peds Clinicians
Ongoing Care
Ongoing Care is the sixth element in the Six Core Elements of Health Care Transition™ (HCT). This includes confirming transfer completion, coordinating referrals to adult specialists, assessing consumer experience with transition, and providing ongoing care management. Confirming with the pediatric practice that the adult clinician has taken on responsibility for the young adult's health care is important, given their high rates of loss to follow-up. Since many young adults transfer to an adult primary care clinician first, helping them to select new adult specialist clinicians may be necessary. In addition, evaluating the success of the HCT process and the young adult's experience with care, with a mechanism to obtain and incorporate the feedback, will improve the practice's approach to integrating young adults into the practice.
Implementation
Read more information on the QI framework and methods in our Quality Improvement Primer.
Implementation: Ongoing Care
For each core element, we have created an implementation guide to assist you in establishing a structured transition approach in your practice/clinic/health system. It offers quality improvement (QI) guidance on what information and processes should be considered when undertaking each core element, with examples from different care settings or patient populations.
Before starting, we recommend you read How to Implement the Six Core Element of Health Care Transition, which provides a set of practical start-up steps and tips to guide your health care transition approach. In addition, if you have more questions about the QI aspects of this implementation guide, there are links within it to a Quality Improvement Primer that offers further explanations for common examples of QI tools.