• Peter Chira, Tova Ronis, Stacy Ardoin, and Patience White.
• From the Department of Pediatrics, Section of Pediatric Rheumatology, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Pediatric Rheumatology Division, George Washington University School of Medicine, Washington, DC; Departments of Medicine and Pediatrics, Adult and Pediatric Rheumatology, Ohio State University, Columbus, Ohio; Joint Health and Autoimmune Diseases, George Washington University School of Medicine and Health Sciences and the Arthritis Foundation, Washington, DC, USA.
• J Rheumatol. 2014 Apr 1; 41 (4): 768-79.

ObjectiveTo assess North American pediatric rheumatology providers' perspectives on practices, barriers, and opportunities concerning the transition from pediatric-centered to adult-centered care.MethodsChildhood Arthritis and Rheumatology Research Alliance (CARRA) members completed a 25-item survey assessing current transition practices, transition policy awareness, and transitional care barriers and needs. Results were compared to the American Academy of Pediatrics (AAP) 2008 survey on transitional care.ResultsOver half (158/288, 55%) of CARRA members completed the survey. Fewer than 10% are very familiar with AAP guidelines about transition care for youth with special healthcare needs. Eight percent have a formal written transition policy, but 42% use an informal approach. Patient request (75%) most frequently initiates transfer to adult care. Two major barriers to transition are fragmented adult medical care and lack of sufficient time to provide services. Compared with AAP survey participants, pediatric rheumatology providers are significantly more likely to help youth find an adult specialist (63% vs 45%) and discuss confidentiality and consent before age 18 (45% vs 33%), but are less likely to help with medical summary creation (16% vs 27%) or find a primary care provider (25% vs 47%). Outcomes ranked as "very important" in defining a successful transition are survival (76%), seeing an adult rheumatologist within 6 months of final pediatric rheumatology visit (66%), and maintaining insurance coverage (57%).ConclusionThis comprehensive survey of North American pediatric rheumatology providers regarding transitional care practices demonstrates deficiencies in education, resources, and a formalized process. Respondents support development of standardized rheumatology-specific transition practices.

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