Navigating New Frontiers: The Pediatric-to-Adult Transition at Stanford Health
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Kian Keyashian, MD, leads a team of providers who help adolescents with inflammatory bowel disease transition from pediatric to adult care.
“I can’t go to the hospital now. I have a math test tomorrow!”
That was Sofia Laiton’s reaction to her father’s insistence that he take her to seek care immediately for her worsening inflammatory bowel disease (IBD) symptoms. She was 15 then and had recently been diagnosed with Crohn’s disease (a type of IBD). “In my junior year in high school, I had every symptom in the book: fatigue, blood loss, weight loss – it was scary,” she recalls.
Her father took her to Valley Children’s Hospital in Madera, California, a part of the Stanford Health Care system. What she thought would be an overnight stay turned into a 10-day admission for tests and treatment of an infection.
“I was in my worst condition back then,” she says. She was taking several medications, including monthly infusions of infliximab, an anti-inflammatory medication. “But over time I’ve come to see IBD as a journey. I couldn’t run to the finish line, but I could live a stable life by adapting and defining a new normal for me.”
In 2022, when Laiton was 21, her pediatric gastroenterologist suggested that she transition to adult care at Stanford Health Care. That was when she participated in the Pediatric-to-Adult IBD Transition Program and became a patient in the adult gastroenterology division.
Pediatric and Adult Care Are Different
Adolescence is a time of transition that is often fraught with emotional ups and downs. Teens begin to evolve from a state of total dependence on their parents into independent adults who are responsible for their own finances, health care, housing, and other segments of everyday life.
When you add coping with a chronic condition such as IBD to the list of skills needed to stay healthy without parental supervision, the transition to adulthood may become even more daunting.
Most teenagers with IBD are cared for by a pediatric gastroenterologist. But as these patients become young adults, their health care needs change too. At Stanford Health Care, the Pediatric-to-Adult Transition Program for IBD patients supports these changing needs for how, where, and when to seek a gastroenterologist who cares for adult IBD patients.
“Young adults who have IBD are at high risk for flares and lapses in treatment if they aren’t guided across the gap from pediatric to adult care,” says Kian Keyashian, MD. “I’m proud of what we have achieved in the first four years of this transition program.” Keyashian is a clinical associate professor of gastroenterology and hepatology, and clinical director for inflammatory bowel disease.
Inflammatory bowel disease is a chronic condition that is often accompanied by fatigue, pain, blood loss, diarrhea and other gastrointestinal symptoms.
“Young adults who have IBD are at high risk for flares and lapses in treatment if they aren’t guided across the gap from pediatric to adult care. I’m proud of what we have achieved in the first four years of this transition program.”
– Kian Keyashian, MD
Since the IBD Pediatric-to-Adult Transition Program was launched in 2020, more than 35 IBD patients, including Sofia Laiton, have made a smooth transition from pediatric to adult care, under the leadership of Keyashian and Rachel Bensen, MD, a clinical associate professor of gastroenterology at Stanford Medicine Children’s Health.
The need for this kind of support arises from some key differences between pediatric and adult healthcare delivery:
- Pediatric care is family-centered, with parents serving as decision makers on behalf of the patient. Adult care is focused on the individual patient who acts on his or her own behalf.
- Pediatric care is often multidisciplinary and team-based; adult care is usually driven by a single provider who taps into subspecialty care as needed.
How the Transition Program Works
The foundation for the Stanford IBD Transition Program is a joint video meeting with the pediatric and adult gastroenterologists, and other members of the team as appropriate. These may include a pediatric social worker, psychologist, and registered dietitian, as well as an adult gastroenterologist nurse.
With the patient and parents present, the team reviews the patient’s history, most recent visit, work or school issues, patient concerns, and other relevant topics. The adult gastroenterologist explains what to expect from his or her practice. The nurse in the adult practice walks the patient through MyChart, a patient portal that allows people to view and manage their health information and to message their physician and care team.
Laiton says that she is “very grateful for the meeting we had with all the providers on one call. They made me feel I was in a safe space where I could ask questions and provide input. I felt respected.”
“In the past, we would do our best to collect and assess a new patient’s records,” notes Keyashian. “But it often felt as though we were either starting from scratch or playing catch-up.”
Now, the joint visit creates a true transition. Patients are free to have a final check-in after the adult visit with the pediatric social worker before becoming a full-fledged adult patient.
Laiton, now 23, graduated from the University of California, Davis, in 2022. She works in a high school as a student assistance specialist. She still needs medication to manage her condition, but with Keyashian’s help she’s down to one infusion every six weeks and no oral medications. Her Crohn’s disease is in remission.
Patient Feedback Is Positive
The frontier has been opened for establishing this program as the standard. Now, physicians are considering how to analyze available data to demonstrate outcomes and effectiveness of this way of providing care.
“I love this program,” declares Keyashian. “It’s what I’d want for my own kid.”
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