Background: Transitional urology provides specialized medical services to young adults with congenital urologic conditions. The Transition Readiness Assessment Questionnaire (TRAQ) is a validated tool that evaluates adolescents’ and young adults' ability to manage their own health care. Our Transitional Urology Clinic (TUC) includes patients over age 16 with complex urologic conditions. Cognitively able patients are asked to complete the TRAQ at each visit, which is then reviewed with the patient and family, emphasizing any areas with low scores for improvement. The objective of this study was to assess which components of TRAQ differ between those who successfully transitioned to adult urology and those who did not.
Methods: A retrospective review was completed of all patients evaluated in our TUC from 1/2016 to 6/2023. The TRAQ consists of 29 questions rated on a Likert scale of 1 to 5 with 1=“No, I do not know how” and 5 =“Yes, I always do this when I need to” (score range 29-145). Mean TRAQ scores and individual question scores of patients at their most recent TUC visit were compared between those who did and did not transition to adult urology.
Results: Over the past 7 years, 85 patients completed at least one TRAQ. 26 transitioned to adult urology and 59 are still followed in TUC or were lost to follow up. Demographics were similar between the two groups, Table 1. Those who transitioned were seen longer in TUC (766 days vs 442, p=0.0161) and had attended more TUC visits (3.5 vs 2.5, p=0.0046). Patients who transitioned had a significantly higher overall mean TRAQ score than those who did not (120.7 vs 98.4, p= 0.025), Table 2. Of the 29 questions, 8 showed significantly different scores between those that did and did not transition. These included questions regarding medication side effects (question 2, p=0.024), following up on referrals (question 11, p=0.025), calling the doctor about health changes (question 13, 0.034), managing money (question 16, p=0.02), filling out medical forms (question 17 p=0.002), keeping a calendar of appointments (question 18, p=0.016), and asking questions to health care workers (question 21 and 22, p=0.011, 0.033), Table 2.
Conclusion: Our data suggests that TRAQ is a reliable tool to assess which TUC patients are ready to graduate to an adult urologist, as those who successfully transitioned had significantly higher TRAQ scores than those who did not. TRAQ is also a useful tool to pinpoint specific transition skills that patients are struggling to master. Assessing weaknesses in TRAQ scores may be an important mechanism for providers to successfully transition patients to adult urology.
| Table 1: Demographics of Transitional Urology Clinic Patients between those who transitioned and those who did not | ||||
| All TUC patients (N=85) | Transitioned with TRAQ (N=26) | Have not transitioned or lost to follow-up (N=59) | p-value | |
| Mean age at first TUC appointment (STD) | 21.3 (11.7) | 22.8 (3) | 20.6 (13.9) | 0.2528 |
| Mean age at last TUC appointment (STD) | 22.8 (11.7) | 24.9 (2.9) | 21.9 (13.8) | 0.1218 |
| Female sex (%) | 49 (58%) | 17 (65%) | 32 (54%) | 0.4753 |
| Non-English speaking | 5 (5.6%) | 2 (7.7%) | 3 (5.2%) | 0.6392 |
| Race (%)-White-Hispanic/Latino-Black/African American-Asian-Unknown | 45 (53%)32 (38%)5 (6%) 2 (2%)1 (1%) | 14 (54%)10 (38%)1 (4%) 01 (4%) | 31 (52%)22 (37%)4 (7%) 2 (3%)0 | 0.6392 |
| Insurance status (%)-Public-Private-Both | 40 (47%)22 (26%)23 (27%) | 15 (58%)7 (27%)4 (15%) | 25 (42%)15 (25%)19 (32%) | 0.2517 |
| BMI (STD) | 26.8 (8.1) | 27.7 (7.1) | 26.8 (7.8) | 0.6200 |
| History of spinal surgery (%) | 28 (32%) | 10 (38%) | 18 (31%) | 0.6170 |
| History of VP shunt (%) | 24 (28%) | 11 (42%) | 23 (39%) | 0.8232 |
| Wheelchair user (%) | 39 (46%) | 15 (58%) | 24 (41%) | 0.1641 |
| Mean length of time attending TUC in days (STD) | 538 (586) | 766 (497) | 442 (596) | 0.0161 |
| Mean/median number of TUC visits (STD) | 2.8, 2 (1.7) | 3.5, 3 (1.7) | 2.5, 2 (1.7) | 0.0046 |
| Means were compared with t-test, proportions with Fisher’s, and medians with Wilcoxon | ||||
| Table 2. Comparison of Final TRAQ scores in patients who transitioned to adult urology versus those who did not | |||
| Question on TRAQ | Transitioned(N=26) | Did not transition(N=59) | p-value |
| Managing Medications | |||
| 1.Did you fill a prescription if you needed to? | 4.1, 5 (1.4) | 3.8, 4 (1.4) | 0.349 |
| 2.Do you know the side effects or bad reactions of each medication, and what to do if you are having a bad reaction? | 4.8, 5 (0.51) | 3.8, 4 (1.4) | 0.024 |
| 3.Do you pay or arrange payments for your medications? | 3.4, 4 (1.7) | 2.4, 1.5 (1.6) | 0.063 |
| 4.Do you take medications correctly and on your own? | 4.6, 5 (1.2) | 4.2, 5 (1.2) | 0.163 |
| 5.Do you reorder medications before they run out? | 4.3, 5 (1.5) | 3.9, 4 (1.4) | 0.317 |
| 6.Do you use and take care of medical equipment and supplies? | 4.9, 5 (0.43) | 4.1, 5 (1.4) | 0.105 |
| 7.Do you call the suppliers when there is a problem with the equipment? | 4.3, 5 (1.3) | 3.2, 4 (1.6) | 0.050 |
| 8.Do you order medical equipment before they run out? | 4.2, 5 (1.3) | 3.4, 4 (1.6) | 0.275 |
| 9.Do you arrange payment for the medical equipment and supplies? | 3.0, 3 (1.8) | 2.0, 1 (1.3) | 0.105 |
| Appointment Keeping | |||
| 10.Do you call the doctor’s office to make an appointment? | 4.4, 5 (1.0) | 3.9, 4 (1.3) | 0.701 |
| 11.Do follow up on any referrals for tests or check-ups or labs? | 4.6, 5 (0.86) | 3.6, 4 (1.4) | 0.025 |
| 12.Do you arrange for your ride to medical appointments? | 3.6, 5 (1.8) | 3.3, 4 (1.8) | 0.254 |
| 13.Do you call the doctor about unusual changes in your health? | 4.5, 5 (0.86) | 3.4, 4 (1.6) | 0.034 |
| 14.Do you apply for insurance if you lose your current coverage? | 3.1, 3 (1.8) | 2.3, 2 (1.5) | 0.112 |
| 15.Do you know what your health insurance covers? | 4.1, 5 (1.1) | 3.0, 3 (1.4) | 0.025 |
| 16.Do you manage your money & budget household expenses? | 4.5, 5 (0.62) | 3.3, 4 (1.5) | 0.020 |
| 17.Do you fill out the medical history form, including a list of your allergies? | 4.8, 5 (0.64) | 3.6, 4 (1.4) | 0.002 |
| 18.Do you keep a calendar or list of medical and other appointments? | 4.7, 5 (0.64) | 3.9, 4 (1.3) | 0.016 |
| Talking with Providers | |||
| 19.Do you tell the doctor or nurse what you are feeling? | 5.0, 5 (0.22) | 4.5, 5 (0.86) | 0.087 |
| 20.Do you answer questions that are asked by the nurse, doctor, or staff? | 4.9, 5 (0.30) | 4.5, 5 (0.95) | 0.298 |
| 21.Do you ask questions of the doctor, nurse, or clinic staff? | 4.9, 5 (0.48) | 3.9, 4.5 (1.4) | 0.011 |
| 22.Do you make a list of questions before the doctor’s visit? | 3.8, 4.5 (1.5) | 2.7, 3 (1.4) | 0.033 |
| Managing Daily Activities | |||
| 23.Do you request and get accommodations and support you need at school or work? | 4, 5 (1.4) | 3.4, 4 (1.7) | 0.595 |
| 24.Do you apply for a job or work or vocational services? | 4.2, 5 (1.3) | 3.0, 3 (1.7) | 0.063 |
| 25.Do you get financial help with school or work? | 2.5, 1 (1.9) | 2.4, 1 (1.7) | 0.461 |
| 26.Do you help plan or prepare meals/food? | 4.2, 5 (1.3) | 3.5, 3.5 (1.4) | 0.220 |
| 27.Do you keep home/room clean or clean-up after meals? | 4.6, 5 (0.97) | 4.2, 5 (1.1) | 0.066 |
| 28.Do you use neighborhood stores and services? | 4.7, 5 (0.90) | 4.2, 5 (1.3) | 0.372 |
| 29.Do you call on and use community support services and advocacy services when you need them? | 2.8, 2.5 (1.8) | 2.2, 1 (1.6) | 0.656 |
| Total TRAQ score | 120.7, 122 (18.3) | 98.4, 103 (24.5) | 0.025 |
| Survey responses presented as mean, median (SD). | |||
