Guidelines for providing care during the transition from pediatric to adult health care emphasize the importance of regular follow-up for adolescents and young adults (AYA) with chronic health needs. In bariatric programs, retention rates are low. This is a significant problem among AYA who are at increased risk for nutrient deficiencies following surgery. Needed is a pragmatic and coordinated system that tracks retention and appropriate transition to adult bariatric programs. To describe the development an electronic health record (EHR)-based retention and transition registry within a quality improvement framework in an adolescent bariatric surgery. Setting: A Midwest Children’s Hospital
Over a two-year period, the retention rate following bariatric surgery was low at 33%, with the decline occurring most often after the first year. Based on the baseline data, the program developed a Key Driver Diagram (KDD) that outlined a specific goal of 75% retention rate at 2 years, key drivers required to achieve the goal, and corresponding interventions which included an EMR-based patient registry (Figure 1). Using EMR in real-time, the registry is structured to proactively identify attendance at specified time intervals, guide patient follow-up and trigger a transition plan at the appropriate time. Within 12 months of implementation, rate of loss-of-follow up has improved.
The use of an EMR-based registry embedded in a quality improvement framework offers an innovative and cost effective approach to using technology in addressing retention and transition to adult care challenges.