Increasing Documented Provider Discussion of Transition from Pediatric to Adult Epilepsy Care: A Retrospective Chart Review

INTRODUCTION: As pediatric patients with epilepsy approach adulthood, pediatric neurology providers are expected to discuss the need for transitioning to adult epilepsy care with these patients and their families. To aid providers in these discussions, the Comprehensive Epilepsy Center at Children's Medical Center in Dallas has implemented various resources, including informational transition booklets, EPIC SmartPhrases prompting provider discussion and documentation of transition, and educational "Transition Day" events for patients and families. This study examines the frequency with which providers conducted and documented transition discussions. In addition, the introduction of transition resources was evaluated for increasing the frequency of these documented transition discussions. METHODS: This retrospective chart review examined the documented transition process of 402 patients previously followed for epilepsy at the Comprehensive Epilepsy Center who were 17- to 23-years old at their last clinic visit. Associations between availability of transition resources and documented provider discussion of transition were evaluated using chi-squared analysis. RESULTS: From September 2009-June 2014, providers documented discussing transition of care by the last clinic visit with 328 of the total eligible patients (82%) and at the planned penultimate clinic visit with 293 of the total eligible patients (73%). Documented discussion of transition by the last clinic visit increased from 58% of patients in 2010 to 81% in 2011, 79% in 2012, 94% in 2013, and 96% in 2014. Similarly, documented discussion of transition at the planned penultimate clinic visit increased from 42% of patients in 2010 to 71% in 2011, 75% in 2012, 86% in 2013, and 87% in 2014. The combined availability of transition booklets and SmartPhrases beginning in 2011 was found to be positively associated with the frequency of documented discussion of transition by the last clinic visit (P=0.0015) and at the planned penultimate clinic visit (P<0.0001). Availability of "Transition Day" events starting in 2013 was also found to be positively associated with the frequency of documented discussion of transition by the last clinic visit (P=0.0002) and at the planned penultimate clinic visit (P=0.0033). CONCLUSION: Documented discussion of transition by providers at the Comprehensive Epilepsy Center has increased in recent years. This increase is strongly associated with the introduction of new transition resources, including transition booklets, specific SmartPhrases prompting discussion of transition, and "Transition Day" family events.