762 - Pediatric to Adult Inpatient Transition Policies: Rubric Development and Initial Validity Testing

National guidelines recommend that pediatric health systems have written policies or guidelines (hereafter policies) addressing their approach to the pediatric to adult healthcare transition (HCT), but there is little direction behind HCT policies in the inpatient setting. Meanwhile, an increasing number of adults with childhood-onset conditions are being admitted to pediatric hospitals.

Objective: We aimed to develop and validate a rubric to evaluate pediatric hospital policies addressing the inpatient care of transitional adult patients.

Design/Methods: HCT experts conducted a cross-sectional analysis of pediatric hospital policies addressing inpatient care of adults from 2019 using convenience sampling via professional connections and online platforms. HCT experts created a 40-item rubric (Table 1) through an iterative process informed by validity evidence from the 6 core elements of HCT and a published inpatient transition framework. Four independent reviewers evaluated de-identified policies using the rubric. Two authors involved in rubric development made the final determination when reviewers did not reach consensus regarding presence of a rubric item in the policy. We used thematic analysis to examine policy content not captured by the rubric.

Results: Ten policies were submitted for review. Interrater percent agreement varied by rubric component (Table 1). Thirty-nine out of forty components had a percent agreement of at least 75%. Determining if a policy addressed HCT had the lowest percent agreement (69.4%) amongst HCT experts. While many policies addressed admission criteria (e.g., age, diagnosis, and availability of adult acute care facility or subspecialists), most did not directly address inpatient transition planning or transfer of care. Thematic analysis highlighted two additions: splitting of diagnosis complexity and acute illness severity as two distinct rather than overlapping rubric components, and completion of hospitalization regardless of age for the duration of an admission (e.g., no transfer unless specific indication).

Conclusion(s): The rubric had acceptable interrater agreement for most components and we identified two potential additional components through thematic analysis. However, we faced challenges in defining what it means to address HCT in the inpatient setting. Next steps include developing consensus on how inpatient care should fit within the larger HCT process, which would allow for creation of more directed and standardized policies to facilitate smooth transition of pediatric patients into adult healthcare systems.