TABLE 1.

The six core elements: Integrating young adult liver transplant recipients into adult transplant healthcare

Core element	Strategies	Resources
I. Transition and care policy guide	• Adapt pediatric policy to adult health care practice. • Discuss the adult approach to care, privacy, and consent. • Discuss policy with YA at first visit	https://gottransition.org/6ce/?integrating-policy
II. Tracking and monitoring	• Decide on data to be tracked. • Create flowsheet through EMR, REDCap, or Excel. • Define responsibilities for data entry and review. • Confirm that the YA has established care with a PCP	https://gottransition.org/6ce/?integrating-flow-sheet https://www.gottransition.org/6ce/?integrating-registry
III. Orientation to adult practice	• Welcome packet or website with adult team information, contact numbers, and FAQs. • Define team members’ responsibilities for developing content, providing information, and tracking completion	https://www.gottransition.org/6ce/?integrating-welcome-orientation https://gottransition.org/resource/?sample-welcome-Atrium
IV. Integration into adult practice	• Review the transfer package, including medical summary, TRA, and legal documents. • Conduct routine meetings with the pediatric team to review YAs in the queue for transfer (affiliated centers). • Make previsit contact with the YA (phone, email, text, portal, and Meet and Greet)	Telehealth Toolkit (gottransition.org)
V. Initial visit	• Clarify adult approach to care and privacy/consent. • Set expectations for adherence and methods of communication. • Address YA concerns regarding transfer of care and practice changes. • Conduct self-care skills assessment. • Collaborate with YA on the plan of care and future goals	https://gottransition.org/resource/?turning-18-english https://www.gottransition.org/6ce/?integrating-self-care-assessment Vittorio et al (2023), Table 4, pp. 96–97 3
VI. Ongoing care	• Provide information about transfer completion to the pediatric team. • Link YA to adult specialty care. • Build collaborative partnerships with PCP and specialists. • Seek feedback from the YA on their transition experience. • Send reminders for laboratory appointments and other required tests for at least one year	https://gottransition.org/6ce/?integrating-feedback-survey-young-adults

Abbreviations: EMR, electronic medical record; PCP, primary care physician; TRA, transition readiness assessment; YA, young adult.