2023 PCS Annual Report: The Year of the Team 2023 | Page 49

ImPACT Navigation Hub Improves Pediatric to Adult Care Transitions

Children ’ s Colorado cares for children and families with complex medical conditions across the span of birth to adolescence . Many of these complex conditions require multiple specialty care teams , and advances in healthcare mean more of these patients are living longer and requiring continued care into adulthood . As patients age out of pediatric care , the transition to adult care can pose many challenges .
Barbara Hepp , BSN , RN , clinical specialty coordinator with Children ’ s Colorado ’ s special care clinic , recognized the impact of a fraught pediatric to adult care transition . She knew there had to be a smoother process for patients and their families and for current and future care providers . She collaborated with child neurology associate professor Jennifer Disabato , DNP , CPNP-PC , and William Anderson , MD , associate professor , pediatric allergy and immunology , to create the Improving Pediatric to Adult Care Transition ( ImPACT ) project . This work includes a multidisciplinary team to build relationships with adult care providers and help coordinate the transition of care , as well as the creation of the ImPACT Navigation Hub , an online resource that includes many electronic health record ( EHR ) tools that provide information and aid in the transition process for these patients . The ImPACT Navigation Hub also includes a wealth of educational resources for families to help them understand this process .
The Project ImPACT team connects the expertise of medicine , nursing , social work , care coordination , family navigation , hospital leadership , EHR support and any additional service line involved in the patient ’ s care . Children ’ s Colorado and the ImPACT Navigation Hub team partner with regional adult care providers and other state providers to identify an adult provider , facilitate the transfer of medical records , match coverage of the patient ’ s health plans and conduct a hand-off session to discuss the unique needs of each patient . Through this process , the group collaborates to address transition challenges and barriers and advocates for the patient and family in their healthcare journey , facilitating successful transitions to adult specialty care teams for patients requiring ongoing complex care .
To date , the ImPACT team has worked closely with 22 Children ’ s Colorado specialty care clinics , with plans to expand and continue to meet the needs of additional patients as the organization grows . As of fall 2023 , 85 patient referrals have been successfully processed and 94 patients and families have successfully transitioned to an adult care provider . Across healthcare , as treatments continue to advance and medically complex pediatric patients become more likely to live well into adulthood , the services provided by the ImPACT team will prove invaluable in ensuring improved outcomes and better quality of life across the patient ’ s lifespan .

85

Patient referrals have been successfully processed

94

Patients and families have successfully transitioned to an adult care provider
BARBARA HEPP , BSN , RN
Clinical Specialty Coordinator
JENNIFER DISABATO , DNP , CPNP-PC
Neurology Associate Professor
WILLIAM ANDERSON , MD
Associate Professor , Pediatric Allergy and Immunology
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