There are similarities and differences in the perceived transition needs of a diverse group of adolescents and adults with CHD. Both cohorts desire additional information during the transition process, including interest in use of a transition checklist to learn about managing their CHD. Adolescents are interested in interactions with other teens and adult mentors with CHD and are open to Internet-based interventions. Web-based initiatives could deliver CHD information and provide a platform for social media mentorship.

This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews.

Background: Congenital heart diseases (CHDs) are the most common type of birth defects.Improvements in CHD care have led to roughly 1.4 million survivors reaching adulthood. This emerging "survivor" population are often palliated but not cured. Thus successful transition from pediatric to adult care for CHD patients is crucial. Of adults with CHD, <30% are seen by adult CHD physicians. Transition and Transfer rates are even worse for minority and lower socioeconomic status (SES) populations. Few clinically based CHD transition programs exist, necessitating creation of a tool to assist in the transition to adult care for a diverse CHD population. Objective: The objective of this project was to first complete a stakeholder needs assessment to inform the educational content and design of our mobile application; second, we aimed to develop the design, functional, and baseline educational components for a mobile application guided by an adolescent CHD expert panel. Methods: To inform our mobile application, we conducted a literature search regarding best practices in transition medicine, adolescent mobile applications, as well as expert CHD guidelines. We also conducted individual interviews in the cardiology clinic with CHD adolescents to understand possession of mobile phones, knowledge gaps, and missing transition readiness skills. We then partnered with 2 adolescent CHD expert panels, pediatric and adult cardiologists, and transition experts to further determine our educational content and mobile application design. Results: We completed 327 individual interviews with CHD adolescents ages 15-22 years. Of these, 78.2% had moderate or severe CHD complexity; 41.6% of CHD adolescents were female; 12.7% were African American; and 35.8% were Latino. Of these patients, 36.5% had public insurance. Most patients had minimal understanding of their CHD, but expressed an interest in learning (42.2% of aged 15-17 years and 47.9% aged 18-22 years). Average transition readiness scores reflected an average of 49.4% readiness for those aged 15-17 and 58.6% for those aged 18-22. Of the adolescents, 95.8% had access to a smartphone. The adolescent expert panel expressed the need for an application tailored to their specific CHD, for quick access to specific educational questions (eg, "can I exercise"), for a forum to tell their stories or hear from others with CHD, to have mentorship, and to have a checklist so they could know what needed to be done during their transition. They also desired to make CHD clinic appointments and have a way to ask questions on the application. We subsequently built a mobile application incorporating assessments of transition readiness and knowledge, a CHD diagram, a medical summary, as well as the recommended blog, checklist, and question/answer space. Conclusions: Based on our data of average CHD knowledge and transition readiness scores, CHD adolescents are largely not prepared for the transition and transfer to adult care. The vast majority of adolescents possess a smartphone, regardless of...

Purpose: The majority of childhood cancer survivors do not followup for long-term risk-based screening for recurrent illness and treatment late effects, despite a high prevalence of secondary morbidities. The primary aim of this study was to investigate factors that influence long-term follow-up for survivorship care, from the perspectives of providers, patients, and caregivers. Materials and Methods:A semistructured interview was designed to elicit stakeholder perspectives on factors that facilitate or impede routine clinic visits after completion of cancer therapy. Results were analyzed using a qualitative framework method.Results: Providers, patients, and caregivers identified a wide range of factors that might influence long-term follow-up for care. All respondents noted the importance of efficient clinical operations, resources such as parking, provider behaviors, rapport/attachment, and patient/family logistics. Compared with patients/caregivers, providers more frequently mentioned institutional operations, their own education and skills, patient/family understanding and motivation, and interpersonal processes such as communication style. Families more frequently mentioned clinic environment, and patients more frequently noted the importance of having a family member present, something neither providers nor caregivers reported.Conclusions: Providers, patients, and patient caregivers have different perspectives regarding factors that may influence follow-up for long-term survivorship care. Understanding these differences can help inform efforts to improve follow-up.