A novel score for transition success of pediatric rheumatology patients

Success of transition from pediatric to adult care depends on many factors. Various scores for transition readiness have been developed, but few patient-level transition success scores exist. Without such a metric, it is difficult to assess the impact of programmatic interventions to improve the process of healthcare transition. We created a novel transition success score for pediatric rheumatology patients. Pediatric rheumatologists consulted the literature and adolescent health experts. Four components were included in the final score: attending a first adult appointment in the time frame designated by the pediatric rheumatologist (component 1), refilling medications with the adult provider within 3 months of the first adult appointment (component 2), no rheumatology-related emergency department visits in the first year after transition (component 3), and attending a second adult appointment (component 4). Scores were determined via retrospective electronic medical record (EMR) review. Each component was weighted as one-quarter of the total transition success score. From 2017–2024, we identified 357 patients with a final visit to pediatric rheumatology using a combination of direct provider notification of transition and EMR review. Of those, EMR records were available to score transition success for 198 patients. Optimal transition success (ie achievement of all 4 components of successful transition) was accomplished by 72/198 (36 %) patients; 77/198 (39 %) patients scored 75 %. Only 3 patients (1.5 %) scored 0 %. When considered by component, 113 patients (57 %) met component 1, 150 (76 %) met component 2, 165 (83 %) met component 3, and 159 (80 %) met component 4. We were unable to document attendance at a second adult rheumatology appointment for a surprising 20 % (39/198) of transitioned patients. We have developed a transition success score and applied it to an initial cohort of patients who transitioned from our pediatric rheumatology clinic. Although 149/198 patients (75 %) fulfilled 3 or 4 out of 4 components of successful transition, we have identified clear opportunities for improvement. Our next steps include evaluating components of our transition program, such as patient self-reported transition readiness or receipt of a transition summary letter, against the transition success score to better understand which factors predict successful transition. • We propose a novel definition for successful rheumatology healthcare transition. • Only 36 % of patients in this historical cohort achieved optimal transition success. • A surprising 20 % of patients did not attend a 2nd adult rheumatology appointment. • Successful transition is measurable and, presumably, targetable.