CARE-PROCESS DETERMINANTS OF HEALTHCARE TRANSITION SERVICES AMONG US ADOLESCENTS WITH SPECIAL HEALTH CARE NEEDS: ANALYSIS OF THE 2022-2023 NATIONAL SURVEY OF CHILDREN’S HEALTH
Author(s)
Ahmad Furqan Kazi, PharmD, MS1, Matthew C. Scanlon, MD, MS2, Rebecca L. Steuart, MD, MS2, Ephrem Abebe, PhD3;
1Purdue University, PhD Candidate in Health Outcomes, Services, and Policy, Indianapolis, IN, USA, 2Medical College of Wisconsin, Department of Pediatrics, Milwaukee, WI, USA, 3Purdue, Pharmacy Practice, Indianapolis, IN, USA
1Purdue University, PhD Candidate in Health Outcomes, Services, and Policy, Indianapolis, IN, USA, 2Medical College of Wisconsin, Department of Pediatrics, Milwaukee, WI, USA, 3Purdue, Pharmacy Practice, Indianapolis, IN, USA
OBJECTIVES: To assess the associations between parental nativity and the receipt of guideline-consistent healthcare transition (HCT) services among US adolescents with special health care needs (CSHCN), addressing a gap where immigration status is often proxied by language and to identify care-process factors independently related to HCT.
METHODS: This cross-sectional study analyzed data from the combined 2022-2023 National Survey of Children’s Health. The analytic sample included 12,257 CSHCN (weighted N~7.13 million) aged 12-17 years. The primary outcome was a composite measure of HCT service receipt (transition readiness counseling, private time with provider, and transition planning). The primary exposure was parental nativity (all parents US-born vs at least one foreign-born parent). Survey-weighted multivariable logistic regression estimated associations between nativity and HCT receipt, adjusting for sociodemographic factors, health system engagement, transition processes (written care plan, insurance planning, care coordination, medical home) and family context.
RESULTS: Overall, 22.3% of CSHCN received adequate HCT services. In adjusted models, parental nativity was not significantly associated with HCT service receipt (AOR=0.860; 95% CI 0.666-1.109 for any foreign-born parent vs. all US-born). Sociodemographic factors, including poverty and insurance status, were also non-significant. In contrast, care processes were strongly associated with higher odds of receiving transition services: written care plan (AOR=1.596; 95% CI 1.348-1.890), discussing future insurance needs (AOR=1.638; 95% CI 1.390-1.930), and receiving needed care coordination (AOR=1.742; 95% CI 1.391-2.183).
CONCLUSIONS: In this nationally representative sample of US CSHCN, healthcare transition preparation remains low and did not differ by parental nativity. Instead, actionable clinical processes, specifically care planning, insurance discussions, and effective care coordination, were the strongest drivers of successful healthcare transition preparation. Interventions should prioritize standardizing these workflows in clinical practice to improve transition readiness for all families, regardless of nativity, while offering concrete, system-level targets for implementation, quality improvement, and monitoring of pediatric-to-adult care transitions.
METHODS: This cross-sectional study analyzed data from the combined 2022-2023 National Survey of Children’s Health. The analytic sample included 12,257 CSHCN (weighted N~7.13 million) aged 12-17 years. The primary outcome was a composite measure of HCT service receipt (transition readiness counseling, private time with provider, and transition planning). The primary exposure was parental nativity (all parents US-born vs at least one foreign-born parent). Survey-weighted multivariable logistic regression estimated associations between nativity and HCT receipt, adjusting for sociodemographic factors, health system engagement, transition processes (written care plan, insurance planning, care coordination, medical home) and family context.
RESULTS: Overall, 22.3% of CSHCN received adequate HCT services. In adjusted models, parental nativity was not significantly associated with HCT service receipt (AOR=0.860; 95% CI 0.666-1.109 for any foreign-born parent vs. all US-born). Sociodemographic factors, including poverty and insurance status, were also non-significant. In contrast, care processes were strongly associated with higher odds of receiving transition services: written care plan (AOR=1.596; 95% CI 1.348-1.890), discussing future insurance needs (AOR=1.638; 95% CI 1.390-1.930), and receiving needed care coordination (AOR=1.742; 95% CI 1.391-2.183).
CONCLUSIONS: In this nationally representative sample of US CSHCN, healthcare transition preparation remains low and did not differ by parental nativity. Instead, actionable clinical processes, specifically care planning, insurance discussions, and effective care coordination, were the strongest drivers of successful healthcare transition preparation. Interventions should prioritize standardizing these workflows in clinical practice to improve transition readiness for all families, regardless of nativity, while offering concrete, system-level targets for implementation, quality improvement, and monitoring of pediatric-to-adult care transitions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD91
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Pediatrics