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Up to 25% of inflammatory bowel diseases (IBD) present in childhood and adolescence. Eventually, these patients transition from pediatric to adult gastroenterology practices. Poor transition of care in pediatric IBD patients has been associated with increased hospitalization rates, medication nonadherence, and lower psychosocial function.1, 2 In 2002, NASPGHAN published guidelines on the transition of care of patients with IBD from pediatric to adult care; other organizations and medical societies including the Canadian IBD Network and European Crohn's and Colitis Organization (ECCO) subsequently made similar recommendations.3-5 However, barriers exist that prevent effective transfer of care including patients' poor knowledge of their IBD medical history, lack of communication between pediatric and adult gastroenterologists, and physician resources.6 Seamless communication between providers is critical to successful transition of care, and is one of the Six Core Elements of Health Care Transition™.7 In a 2016 survey performed by Gray et al. 68.1% of pediatric gastroenterologists (PGI) provided support for transition and transfer of care of their IBD patients. Only 59.6% communicated with an adult GI provider (AGI) to coordinate care and 38.3% provided patients with a medical summary.8 A separate survey of AGI reported poor medical communication as one of the greatest challenges in transfer of care.9 Medical records received are often lengthy, redundant, irrelevant, and/or incomplete. Instead, the IBD medical history should be both complete and concise, encompassing information regarding medication and surgical history, extraintestinal complications, and health maintenance. We describe the multidisciplinary development and testing of a standardized pediatric IBD medical transfer summary template (PIBD-MTS) as a tool to improve the handoff of patient care. The study was approved by the IRBs of institutions who tested the PIBD-MTS. ImproveCareNow (ICN) is a multicenter network of pediatric IBD centers using quality improvement methodology and multidisciplinary stakeholders to improve pediatric IBD outcomes.10 The global aim of the ICN Transition and Transfer Committee is ensuring smooth and effective transitioning skills and transfer of care for patients with IBD. The goals in creating the PIBD-MTS template were to provide a clear, concise yet comprehensive document to be shared between AGI, PGI and patients which would include a clear understanding of the unique disease and healthcare needs of the patient and family. The template would also provide information considered standard in IBD care. The ICN Transition and Transfer Committee includes (PGI), pediatric psychologists, young adult members of the Patient Advisory Council who transferred to adult GI care, members of the Parent Family Advisory Council, and quality improvement experts. Drafts were created and edited by interested committee members during and between scheduled video meetings, and semi-annual ICN conferences. Committee membership is open to any ICN center. From 2015 to 2022, members discussed ideal elements of a transfer summary, drafted the PIBD-MTS, and gathered iterative feedback after completion with individual patients. PGIs also garnered qualitative feedback from their respective AGI collaborators; these AGIs reviewed drafts of the template and/or completed medical summaries during transfer of care of patients. From July 2022 to November 2023, the PIBD-MTS and associated experience surveys were distributed to gastroenterology providers for formal quantitative and qualitative feedback during the transfer of patients. Initial draft versions included information regarding initial presentation (symptoms, serology, disease location, and phenotype [for Crohn's disease]), IBD medication history, relevant surgical history, current treatment regimen, and recent test results. We included IBD health maintenance items such as ophthalmology and dermatology assessments, DEXA scan, and vaccine titers.11 Initial drafts included the short PCDAI (Pediatric Crohn's Disease Activity Index) and PUCAI (Pediatric Ulcerative Colitis Activity Index) as disease activity indices, but were replaced with Physician Global Assessment (PGA) as AGIs would not use the same indices. Details of IBD medical history included special needs for medication administration, phlebotomy or IVs, and mental health history. Socioeconomic questions included post-high school plans, pertinent insurancee, or family concerns. Subsequent drafts included more detail regarding diet (intolerances, supplemental nutrition, specialized IBD diets), growth and weight history, and mental health (medication history, hospitalizations, learning disabilities, and drug abuse). The social and mental health questions were intended to be completed by the provider with direct patient input. Information regarding specialty pharmacies and/or infusions (premedication or rescue medications), and infectious disease (chronic tuberculosis and Hepatitis B results, vaccine titers, vaccinations) were included in subsequent drafts. Final edits were made during the formalized testing. The template was created in both document and EPIC software forms (File S1). Centers where PGI and AGI had direct collaboration in IBD transfer of care and shared Institutional Review Boards (IRB) tested the PIBD-MTS in a quantitative and qualitative manner with patients transferring care. The PGI provided their AGI collaborator a completed PIBD-MTS in a document format or within their institutional electronic medical record. Feedback surveys devoid of specific patient information were created in RedCap for both providers to complete with each patient encounter. PGIs were queried on format utilized, time spent completing the PIBD-MTS, reasons for longer completion times, and overall satisfaction as a succinct and complete summary. When a PGI completed a survey, they provided an email for the AGI collaborator to receive a linked survey. After the first clinic visit with the patient, AGIs were queried on time reviewing the summary, whether the information was received prior to the clinic visit, adequacy of information provided, and overall satisfaction (File S2). Between July 2022 and November 2023, 29 PGI surveys regarding the experience with the PIBD-MTS were completed. 90% of the summaries were completed by hand or word processing software. Nine summaries (31%) were completed in 10–20 min, 19 (66%) completed in 20–30 min, and 1 summary (3%) required >30 min (Figure 1). Participants took longer if they did not utilize an existing IBD note template, if a patient's medical history was chronologically long and/or medical complex, and if they completed the summary by hand. Regarding components of the PIBD-MTS, 29 participants (100%) reported that the information was necessary. Participants suggested including COVID status and the ability to write a summary paragraph. With regards to overall satisfaction with the summary, 22 (76%) reported good satisfaction, and 7 (24%) reported excellent satisfaction (Figure 2). Of 29 pts transferred, 20 AGI surveys were completed. Thirteen (65%) participants reported they communicated with the patient's pediatric GI provider prior to the patient's initial visit. Eighteen participants (90%) were able to review the summary in 1–5 min and two (10%) were able to review the summary in 6–10 min (Figure 1). 95% reported the summary contained an adequate amount of information and 100% felt the summary helped understand the patient's disease and clinical status. Suggested additions included abnormal IBD serologies at diagnosis, Ebstein Barr Virus titers, and due date for next screening colonoscopy. Some participants reported they did not routinely check vaccine titers or DEXA scans. Overall, 95% reported excellent satisfaction and 5% reported good satisfaction with the PIBD-MTS (Figure 2). The PIBD-MTS is the first multicenter and multidisciplinary IBD-focused transition summary template created as a communication tool between pediatric and adult gastroenterologists, patients, and their families with real-world testing of efficacy and clinician experience. Its succinct nature allows AGIs to review information within 10 min, in contrast to typically sifting through copious disorganized notes that may be redundant, at times irrelevant or missing key information. Its comprehensive nature includes prompts for disease monitoring, health maintenance, nutrition as well as mental health and socioeconomic factors that may affect IBD care. The strengths of the PIBD-MTS lie in its creation by multidisciplinary stakeholders (gastroenterologists, psychologists, patients, and caregivers) from multiple institutions. A standardized template increases the likelihood of PGIs providing complete and organized IBD summaries. Benchimol et al. published a summary template created with Canadian PGI and AGI focus groups but was not tested in real world practice.12 By testing the PIBD-MTS in real time, we showed the template to be relevant, complete, and time-saving. The PIBD-MTS also includes items regarding diet therapies and intolerances, therapeutic drug monitoring, and annual influenza and COVID vaccines. Using a standardized summary template may improve healthcare delivery by PGIs, particularly for providers and trainees who infrequently care for patients with IBD. For instance, questions regarding therapeutic drug monitoring, DEXA screens, dermatology and eye exams, and timing of colonoscopies may ensure earlier detection of complications. Our study had several limitations. For the purposes of IRB approval, quantitative feedback was limited to AGIs and PGIs from the same academic institution. Feedback may have been different if we included private practitioners or different centers. Participating PGIs routinely cared for patients with IBD and often had a standardized clinic note format. PGIs who do not use a standardized format would likely spend 20+ minutes to complete the summary, and 30+ minutes for patients with longstanding and/or complex disease. Although patients and caregivers co-created the template, we recognize there are several opportunities that we did not examine in the transfer process. The social and mental health questions were intended to be completed with direct patient input prior to transfer. The frequency of this occurring, and patient perception was not studied. Opportunities to test the relevance of the summary from a patient and caregiver perspective may include when sensitive material is transmitted through the summary versus verbally with the AGI, and whether reviewing the summary aids the patient in understanding their IBD and self-management. Over time, the template should be modified to reflect the evolution of IBD care, including newer diagnostics, therapies, or disease monitoring. In summary, we describe the multidisciplinary creation of the PIBD-MTS that provides a succinct yet thorough medical summary of a pediatric patient with IBD, with excellent real world feedback from PGI and AGI. Marc Schaefer, MD; Penn State Health; Nancy McGreal, MD; Duke University; Sandy Kim, MD; Cleveland Clinic; Michelle Maddux, PhD; Childrens Mercy Kansas City; Howard Baron, MD; Pediatric Gastroenterology and Nutrition Associates; Marc Tsou, MD; Children's Hospital of The King's Daughters; Sami Kennedy, MD; Nemours Children's Hospital, Florida; Jill Horan; Children's Hospital of Philadelphia; Jill Plevinsky, PhD; Children's Hospital of Philadelphia; Julie Massie; ImproveCareNow; Theresa Todd; ImproveCareNow; Diane Eskra; ImproveCareNow. The authors declare no conflicts of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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