Exploring the pediatric-to-adult health care transition for children with medical complexity

The National Institute of Child Health and Human Development awarded The Trustees of The Stevens Institute of Technology $254,249 on September 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to explore safety hazards and resilience strategies in the pediatric-to-adult health care transition for children with medical complexity.

The project applies human factors methodologies to investigate how care teams identify and mitigate safety risks during transition from pediatric to adult settings, typically occurring between ages 18 and 22. The research will evaluate information transfer quality and cognitive workload associated with the transition process, and assess patterns in health outcomes, patient safety events, and care utilization before and after transition using comprehensive chart reviews. The work addresses documented gaps in implementation of existing transition guidelines and aims to identify strengths and weaknesses in coordination between pediatric and adult care systems, which often lack the interdisciplinary structure present in pediatric settings.

The award carries a period of performance from September 1, 2026, through August 31, 2028, with place of performance in Hoboken, New Jersey. This is a project grant, the assistance type for individual research projects within the NICHD extramural research portfolio.

Abstract

Children with medical complexity (CMC) are living longer due to advances in medical care, but they face substantial challenges when transitioning from pediatric to adult healthcare. These patients-often dependent on medical technology and continuous caregiver support-require highly coordinated, interdisciplinary care. CMC accounts for nearly one-third of pediatric healthcare resources, underscoring its clinical and systemic importance. The transition to adult care, typically occurring between ages 18 and 22, presents unique vulnerabilities. Unlike pediatric systems, which are built around team-based care, adult care settings often lack the structure and coordination necessary to meet the multifaceted needs of CMC. This fragmentation leads to increased risks for medical errors, hospitalizations, poorer health outcomes, and heightened anxiety for families. Although guidelines exist to support the transition of CMC to adult care, their implementation is often inconsistent due to systemic barriers. Furthermore, few studies have explored the specific safety hazards or resilience strategies associated with this critical transition. This project addresses these gaps by applying human factors methodologies to investigate safety risks and resilience strategies during care transition. IT will also examine healthcare outcomes patterns through the transition using comprehensive chart reviews. Specifically, we aim to: 1) identify safety hazards, resilience, and mitigation strategies used by any member of the care team during the transition of CMC from pediatric to adult settings. 2) evaluate strengths and weaknesses in information transfer and assess the cognitive workload associated with the care transition process. 3) assess patterns in health outcomes, patient safety events, and care utilization for CMC patients before and after the transition using retrospective chart review data.