Implementation Resources

Implementation Resources from the National Center for Medical Home Implementation

Additional Implementation Resources

 Partners and National Initiatives

Partners and National Initiatives

 Interview with a Healthy Tomorrows Partnership for Children Program Grantee

​Interview with a Healthy Tomorrows Partnership for Children Program Grantee

The "Transition Health Care for Children and Youth with Special Health Care Needs" program is a Healthy Tomorrows Partnership for Children Program grantee in Houston, Texas. Coordinated by Baylor College of Medicine and Texas Children's Hospital, the program aims to customize successful transition strategies developed within the hospital setting to a network of primary care practices.

The program recruits two pediatric primary care practices annually to participate in a quality improvement initiative focused on transitions of care. Each practice team, led by a pediatrician, participates in quality improvement training. The program provides additional support through the following opportunities:

  • Attendance at an annual conference held in Texas focused on transitions between pediatric and adult health care
  • Tools from the Got Transition (National Center for Health Care Transition Improvement)
  • Coaching and assistance to build a portfolio of adult providers and practices who could care for pediatric patients, particularly those with special health care needs, once they reach adulthood
  • Recommended strategies to enhance buy-in from practice staff, such as hosting lunch-and-learns focused on transitions of care
  • Training for administrative/front desk staff to identify youth who may benefit from a transition planning visit within each participating community pediatric practice

To further encourage buy-in, sustainability, and spread, the program is creating an electronic "dashboard" to demonstrate team progress on specific pre-identified metrics related to transitions of care. Future efforts of the program will focus on engaging and educating families on transitions of care through a one-day transition family conference, recruitment of families to participate on the program's advisory board, and partnership with the state's Parent to Parent organization. For more information, visit the Healthy Tomorrows Partnership for Children Program Web site or the National Center for Medical Home Implementation Texas State Page.