Abstracts

Rationale: Improvements in health care have led to 90% of children with special medical care needs surviving to adulthood. This success necessitates that approximately 500 000 youth with congenital or chronic medical concerns transfer from the pediatric to the adult care model each year 1, including the 30-50% of youth with active epilepsy.  3 , 2 Transition, a gradual process preparing youth with epilepsy for transfer to an adult epilepsy provider, is a complex process.  During an ideal transition, adolescents gradually acquire disease-specific knowledge, self-management, self-advocacy and health care decision making skills.  This process occurs while patients are within the family centered pediatric care model, in anticipation of transfer, which is a high risk period for young people with epilepsy due to an increased risk of non-adherence and being lost to follow up.Our team has created a transition and transfer clinic with the goal of addressing the critical features of effective transition and facilitating successful transfer.  Methods: Following the assessment of our current transition process using the Got Transition rubric 6, we utilized the identified weaknesses to develop action points. Additionally, we focused on addressing the key features identified during the 2nd Symposium on Transition in Epilepsies including appropriate parent involvement, promotion of self-efficacy, and meeting the adult team prior to transfer. 4  Results: Our Transition Clinic is an extension of the Nationwide Children’s Hospital Outpatient Epilepsy Center, a multidisciplinary clinic, staffed by pediatric epileptologists and midlevel providers, neuropsychologists, psychologists, social workers, pharmacists and a liaison from the Epilepsy Alliance Ohio.   Patients and families are given transition information at age 14, after which the multidisciplinary team guides them through the transition process, using Epilepsy Transition Readiness Questionnaires (Epi-TRAQ), and a Transition Tracking Tool incorporated into the electronic medical record.  Education and referral resources for providers aid in managing co morbidities and facilitate the establishment of an adult medical home during this longitudinal process.   Once per month, an adult epileptologist from The Ohio State Medical Center joins our clinic for the initial appointment with youth prepared for transfer.  The adult provider is encouraged to access the resources available within the multidisciplinary clinic to address identified unmet transition needs.   Pediatric neurologists do not participate in medical decision making during this encounter, however, a face-to-face “hand off” endorses their support of the transfer process. Prior to discharge, Epilepsy Alliance Ohio contact is established, and follow up at the adult facility is scheduled.Follow-up appointment compliance is tracked via linked electronic medical records, and post visit surveys gather data for objective evaluation of this process.   Conclusions: At present, no clear evidence exists regarding the clinical or cost effectiveness of transition programs, or the ideal model for transition of epilepsy patients to adult providers. 5 We submit this model as a comprehensive means of addressing the needs of this unique and medically vulnerable population. Funding: No funding