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Transition from pediatric to adult health care systems presents unique challenges for adolescents with autism spectrum disorder who often have complex medical and mental health needs. Without a coordinated transition plan, pediatric providers often continue to provide care to young adults with autism spectrum disorder beyond the scope of their medical training. Adult providers may be unwilling and untrained to accept care for young adults with autism spectrum disorder. This quality improvement study identified baseline transition-related practices within a pediatric medical home practice and developed a model to promote transition to adult heath care for patients with autism spectrum disorder. Participants were 251 patients with autism spectrum disorder aged 12–21 years. Baseline data revealed limited and inconsistent communication directed to patients and families regarding transition. An evidence-based and replicable transition checklist, templated documentation, and resources geared to patients aged 12–21 years were developed. While improvement was noted in number of visits addressing transition, medical providers skipped or deferred transition discussion in approximately half of well visits for targeted patients. Challenges in implementing the transition process included finding time to discuss transition-related issues with patients/families, preference of medical providers to defer to social work to address transition, and difficulty identifying adult providers with whom to collaborate regarding care needs. Lay abstract As adolescents become adults, they typically change from seeing a pediatric health care provider to seeing a health care provider who specializes in working with adults. Adolescents with autism spectrum disorder may have more difficulty finding an adult health care provider who is trained to address the varied needs and medical and mental health issues that often are seen with autism spectrum disorder. Without careful planning for transition to adult health care, patients may continue to be seen by pediatric providers who may not be familiar with adult health needs. This quality improvement project focused on improving transition to adult health care by creating varied supports for the patient, family, and the health care team and putting them into action within a pediatric medical practice that serves over 250 adolescent and young adult patients with autism spectrum disorder. Before the supports were put into place, patients and families received limited and inconsistent communication to help them with transition. While the supports helped increase the amount and quality of help patients and families received, medical providers skipped or put off transition discussion in approximately half of well visits for targeted patients. Challenges in implementing the transition process included finding time to discuss transition-related issues with patients/families, preference of medical providers to have social workers discuss transition, and difficulty identifying adult health care providers for patients. This suggests more work is needed to both train and partner with patients, families, and health staff to promote smooth and positive health transitions.

Background Self-care is important at all stages of life and health status to promote well-being, prevent disease, and improve health outcomes. Currently, there is a need to better conceptualize self-care in the general adult population and provide an instrument to measure self-care in this group. Therefore, the aim of this study was to develop and evaluate the Self-Care Inventory (SCI), a theory-based instrument to measure self-care in the general adult population. Methods Based on the Middle Range Theory of Self-Care, the 20-item SCI was developed with three scales: Self-Care Maintenance (8 items), Self-Care Monitoring (6 items), and Self-Care Management (6 items). A cross sectional study with a US-based sample (n = 294) was conducted to test the SCI. Internal validity was assessed with Confirmatory Factor Analysis. Internal consistency reliability was assessed with Cronbach alpha for unidimensional scales or composite reliability and the global reliability index for multidimensional scales. Construct validity was investigated with Pearson correlation to test the relationship between general self-efficacy, positivity, stress, and self-care scores. Results The Self-Care Maintenance and Management scales were multidimensional and the Self-Care Monitoring scale was unidimensional. The global reliability index for multidimensional scales was 0.85 (self-care maintenance) and 0.88 (self-care management). Cronbach alpha coefficient of the self-care monitoring scale was 0.88. Test-retest reliability was 0.81 (self-care maintenance), 0.91 (self-care monitoring), and 0.76 (self-care management). The General Self-Efficacy Scale was positively related to all three self-care scale scores: self-care maintenance r = 0.46, p < 0. 001, self-care monitoring r = 0.31, p < 0. 001, and self-care management r = 0.32, p < 0. 001. The positivity score was positively related to self-care maintenance (r = 0.42, p < 0. 001), self-care monitoring (r = 0.29, p < 0. 001), and self-care management (r = 0.34, p < 0. 001) scores. The perceived stress was positively related to the self-care management (r = 0.20, p < 0. 001) score. Conclusions The SCI is a theoretically based instrument designed to measure self-care in the general adult population. Preliminary evidence of validity and reliability supports its use in the general adult population.

Mixed methods is an innovative research approach that can be applied to understand complex cardiovascular phenomena. A mixed methods study involves collecting both quantitative and qualitative data and intentionally integrating the data to provide a better understanding of the phenomena than can be achieved by using a quantitative or qualitative approach alone. Conducting a mixed methods study requires planning and careful attention to methodological rigour in the data collection, analysis, and integration phases. This paper provides an overview of the mixed methods approach and describes its application to cardiovascular nursing science.