@Article{chd.12604,
AUTHOR = {Albert C. Hergenroeder, Douglas S. Moodie, Daniel J. Penny, Constance M. Wiemann, Blanca Sanchez-Fournier, Lauren K. Moore, Jane Head},
TITLE = {Functional classification of heart failure before and after implementing a healthcare transition program for youth and young adults transferring from a pediatric to an adult congenital heart disease clinics},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {4},
PAGES = {548--553},
URL = {http://www.techscience.com/schd/v13n4/39022},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> To describe changes in functional status between the last pediatric and first adult
congenital heart disease (CHD) clinic visits in patients with moderate to severe CHD after
implementing a healthcare transition (HCT) planning program.<br/>
<b>Design:</b> Quasi-experimental design. Patients were followed prospectively following the implementation of the intervention; Control patients transitioned from the Pediatric CHD Clinic into Adult
CHD Clinic before the intervention.<br/>
<b>Setting:</b> Texas Children’s Hospital (TCH).<br/>
<b>Patients:</b> Sixteen to 25-year-olds, cognitively normal, English speaking patients with moderate to
severe CHD who transitioned from the Pediatric to the Adult CHD clinic.<br/>
<b>Interventions:</b> An EMR-based transition planning tool (TPT) was introduced into the Pediatric
CHD Clinic. Two nurses used the TPT with eligible patients. Independent of the intervention, two
medicine-pediatric CHD physicians and one nurse practitioner were added to the ACHD Clinic to
address growing capacity needs.<br/>
<b>Outcome Measures:</b> The New York Heart Association Functional Classification of Heart Failure
(NYHAFS).<br/>
<b>Results:</b> Control patients waited 26 ± 19.2 months after their last pediatric clinic visit for their
first adult visit. Intervention patients waited 13 ± 8.3 months (P = .019). Control and Intervention patients experienced a lapse in care greater than two (50% vs 13%, P = .017) and three
(30% vs 0%, P = .011) years, respectively. The difference between the recommended number
of months for follow-up and the first adult appointment (15.1 ± 17.3 Control and 4.4 ± 6.1
Intervention months) was significant (P = .025). NYHAFS deteriorated between the last
Pediatric visit and the first ACHD visit for seven (23%) Control patients and no Intervention
patients (P = .042). Four of seven Control patients whose NYHAFS declined had a lapse of care
of more than two years.<br/>
<b>Conclusions:</b> There is a need for improved HCT planning for patients with moderate to severe
CHD, otherwise, lapses of care and adverse outcomes can ensue.},
DOI = {10.1111/chd.12604}
}