Background: The transition from pediatric to adult health care for adolescents and emerging adults (AEA) with chronic conditions is a complex time, associated with gaps in care, poor treatment adherence, and increases in emergency department (ED) visits. Various tools are available to assess AEA readiness to transition, such as the Transition Readiness Assessment Questionnaire (TRAQ). Research is needed to better understand the association between TRAQ scores and transition outcomes and identify gaps that remain in accurately and comprehensively assessing transition readiness. The objectives of this study were to quantitatively examine the associations between TRAQ scores and ED visit rates and utilization of a navigator intervention, as well as qualitatively explore the experiences of AEA related to social-ecological factors of transition readiness. Methods: A patient-oriented, embedded mixed methods study was conducted, with quantitative priority. This study was guided by the Social-Ecological Model of Adolescents and young adults’ Readiness to Transition (SMART) as identified by our patient partners. This model encompasses individual-level factors and the reciprocal interactions between AEA and their surrounding systems, including family, caregivers, healthcare providers, and medical system. Data was obtained from the Transition Navigator Trial (TNT), a pragmatic randomized controlled trial evaluating the effectiveness of a patient navigator for AEA undergoing transition from pediatric to adult healthcare in Alberta, Canada. Results: Quantitatively, higher TRAQ scores were associated with increased ED visit rates. A similar relationship was observed pre-pandemic, with higher TRAQ scores associated with higher navigator utilization. However, post-pandemic onset, higher TRAQ scores were associated with lower navigator utilization. TRAQ scores did not differ across sociodemographic factors such as age, sex, socioeconomic status, ethnicity, immigration status, urban/rural residence, and the presence of a co-occurring mental health condition. Qualitative results highlighted factors extending beyond what was assessed by TRAQ, including insurance barriers, psychosocial impacts of health condition, and the importance of relationships when undergoing transitions in care.
Conclusion: This study underscored the multifaceted nature of transition readiness and the gaps in current readiness measures such as TRAQ. Patient partners advocated for improvements in readiness measures, developing recommendations regarding assessing insurance, mental health, skill development, contextual factors, and relationships in readiness measures
