Applying Implementation Science to Improve Transitions from Pediatric to Adult Care for Adolescents and Young Adults with Type 1 Diabetes

About This Grant

PROJECT TITLE: Applying Implementation Science to Improve Transitions from Pediatric to Adult Care for Adolescents and Young Adults with Type 1 Diabetes PROJECT SUMMARY The objective of this project is to improve transitions from pediatric to adult care for adolescents and young adults (AYAs) with type 1 diabetes (T1D). The transition from adolescence to adulthood, when people begin to take responsibility for their own healthcare, is a time of increased vulnerability to lapses in routine care. These lapses can lead to worsening health outcomes and increased emergency healthcare use. Transition interventions have been shown to improve rates of successful transition to adult care but are often resource- intensive, inaccessible, and rely heavily on clinician-level or system-level changes. We conducted a human- centered design process to develop a patient-centered virtual intervention to improve the transition process. Our intervention components include peer mentorship, education around navigating the healthcare system and managing diabetes independently, and developing a written transition plan. The proposed research builds on this preliminary work and will provide a strong basis for a future multicenter hybrid effectiveness- implementation trial. We propose three specific aims: Aim 1: Develop implementation strategies using an implementation mapping process grounded in the Capacity, Organization, Motivation- Behavior (COM-B) theoretical constructs. Aim 2: Pilot test a randomized trial of a patient-centered virtual intervention for the transition from pediatric to adult care for AYAs with T1D. Aim 3: Conduct a nationally representative survey of pediatric endocrinology practices to identify the availability, types, and reach of T1D transition resources and to identify barriers to scaling the transition intervention. Together, these aims will result in a well-developed patient-centered intervention based in behavior change theory and knowledge of how to test and scale this intervention in future multisite studies. To ensure the successful completion of the proposed research aims, the candidate has assembled a mentorship team with expertise in implementation science, diabetes clinical trials, diabetes management and education, and survey methodology. The candidate has also proposed a training plan that will leverage her rigorous training in epidemiology and health services research, while allowing her to achieve her long-term career objective of becoming an independent investigator leading research focused on the development, implementation, and evaluation of evidence-based strategies to improve health outcomes for adolescents and young adults with T1D.