Health Transitions of Care November Quarterly Learning Collaborative Meeting

The November Health Transitions of Care learning collaborative had 16 participants join to listen and share patient and family experience, available resources, and best practices around what is helpful in improving care coordination for youth that are transitioning from pediatric to adult care.

Stephanie Trafka, RIPIN Family Voices, kicked off the meeting speaking about family experiences. The shared family feedback highlighted the many difficulties that families face throughout the transition process, including a lack of adult PCPs accepting new patients, reductions in service coverage based on the age of the youth (changing from entitlement to eligibility), and gaps in care for behavioral health and specialty care.

Kathleen Kuiper, RIDOH, introduced the Medical Home Portal and provided a live website demonstration and many of the resources available for families and clinicians. View the presentation here.

Three practices shared updates on their work with increasing transitions of care knowledge within their system of care or spreading transition activities to additional providers and residents. And the four new participating practices discussed their progress on identifying patients for transition, sharing the medical summary, tracking patient transitions, and patient surveys.

The meeting recording can be viewed here and the presentation slides can be viewed here.