Sucheta M. Joshi, MD

"The whole idea is to not unload this like a ton of bricks at the last minute. But actually, make this a very slow process and do 1 thing at a time.”

A lack of awareness or guidance in the process of patients seeing a pediatric epilepsy care specialist to an adult care specialist can make the transition process for a patient with epilepsy difficult. Sucheta M. Joshi, MD, MS, described it as “a truck hitting you,” for those who come into the transition process with little to no understanding of what next steps they might be taking in their care.

Joshi, along with Nicholas Beimer, MD, were part of a study that 

, an epilepsy-based transition tool that helps patients go through that process by checking off parts of their disease management that they should be informed about. The point of the tool is to not only help patients become more aware of the process, but also enforce the need for pediatric epilepsy specialists to have those conversations earlier in their care process, so that patients are not as blindsided by the responsibilities they may incur.

Joshi, a clinical professor of pediatrics and medical director of pediatric epilepsy, and Beimer, an assistant professor of epilepsy, both at Michigan Medicine, sat down with 

 to discuss the importance of starting the transition process earlier for patients with epilepsy, and why EpiTRAQ is designed to do just that.

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Sucheta M. Joshi, MD, MS, FAES, FAAP, and Nicholas Beimer, MD, discussed the reasons why EpiTRAQ may influence earlier discussions with patients prior to the epilepsy transition process.

Early Awareness Towards Epilepsy Transition

"We are hoping that it will be something that can be integrated into electronic medical records. Therefore, will be a tool that clinicians can use longitudinally to track performance and their own management of epilepsy over time.”

EpiTRAQ’s validity as a resourceful transition readiness assessment tool for patients with epilepsy who are transitioning to adult care during their adolescent years was recently proven by multiple repeated validation tests in a 

. While the study outlines the reliability of the tool, it mainly served as groundwork for future studies that may use EpiTRAQ to their advantage.

To date, there is no data on clinical outcomes or long-term outcomes of how patients on EpiTRAQ handle disease management in comparison to those not on the tool. Additionally, there aren’t any data on how this tool may impact different populations, or how results may vary based on gender or race. Sucheta M. Joshi, MD, MS, FAES, FAAP, and Nicholas Beimer, MD, investigators in the study, feel as though there is untapped potential with EpiTRAQ and admitted there is future research on the horizon.

, Joshi, a clinical professor of pediatrics and medical director of pediatric epilepsy, and Beimer, an assistant professor of epilepsy, both at Michigan Medicine, discussed how the tool can open the door for more clinical research that examines the effects of a smooth transition process. In addition, the 2 touched on what adjustments they would make to the tool for future studies.

Sucheta M. Joshi, MD, MS, and Nicholas Beimer, MD, outline how EpiTRAQ may be incorporated in future studies and what outcomes may be observed.

EpiTRAQ in Future Epilepsy Research Studies

"You can really empower patients in management of their disease by showing how their transition readiness is improving.”

Results from a recent study evaluating EpiTRAQ demonstrated the transition tool’s validity, with over 80% of adolescents and young adults giving themselves higher ratings on at least 3 items at repeat validation 6 months after the initial benchmark. The tool is multifaceted for both the clinician and patient experience and incorporates epilepsy-relevant items based on concepts in current epilepsy quality measures.

On 1 hand, patients can learn more about a multitude of disease management care topics such as handling their condition, medications, and what to do during a seizure, among others. On the other, clinical hand, EpiTRAQ gives physicians greater confidence that the patient will be able to handle all of their disease management when they take a step such as going off to college or leaving home for work.

Sucheta M. Joshi, MD, MS, FAES, FAAP, and Nicholas Beimer, MD, investigators in the study, claim that the tool does a great job at asking questions that may not be so commonplace at a doctor’s visit, such as pregnancy or rescue medications. Joshi, a clinical professor of pediatrics and medical director of pediatric epilepsy, and Beimer, an assistant professor of epilepsy, both at Michigan Medicine, sat down with 

 to discuss the ways EpiTRAQ can improve clinician care for the future.

Sucheta M. Joshi, MD, MS, and Nicholas Beimer, MD, detail the potential benefit the EpiTRAQ tool has from both a patient and clinician perspective. 

The Clinical Care Potential of EpiTRAQ

"You can specifically look at where someone is not doing well and then design intervention measures around those areas.”

EpiTRAQ, a transition readiness assessment tool that includes epilepsy-relevant items based on concepts in current epilepsy quality measures, was designed to help transition adolescents with epilepsy from their pediatric care physician to an adult care specialist. It was shown to have good 

validity and reliability in a recent study

 that analyzed result patterns for 153 patients who completed 2 or more EpiTRAQ forms.

Sucheta M. Joshi, MD, MS, FAES, FAAP, and Nicholas Beimer, MD were among the study investigators that witnessed the benefits of EpiTRAQ in its early stages. Joshi, a clinical professor of pediatrics and medical director of pediatric epilepsy, and Beimer, an assistant professor of epilepsy, both at Michigan Medicine, understand the impact that a smooth transition can have on a patient’s quality of life following a care change.

, Joshi and Beimer detail the findings from the study, including observations that were particularly interesting to them. They touch on how the transition tool can help identify a patient’s preparedness regarding areas such as seizure control, sudden death in epilepsy (SUDEP) risk, and social isolation.

Sucheta M. Joshi, MD, MS, and Nicholas Beimer, MD, discuss their experience with EpiTRAQ and the role it can play in optimizing the epilepsy care transition.

Optimizing Care Transition for Adolescents With Epilepsy

“It’s not uncommon to have conversations with the parents along with the adolescent. Whereas the adult model of care often is having conversations with the patient first and caregiver second.”

Making the transition from a pediatric specialist to an adult specialist can be difficult for patients with epilepsy. Adolescents are oftentimes faced with the challenge of taking on responsibility for their medications, learning how to handle their disease, and tackling situational issues without the help of their pediatric specialist who has helped them since diagnosis.

Sucheta M. Joshi, MD, understands the complexities that adolescents must navigate when they are forced to change doctors. She currently serves as a pediatric neurologist at Hurley Medical Center of the University of Michigan Hospitals-Michigan Medicine, and was recently involved in a 

, a transition readiness assessment tool that includes epilepsy-relevant items based on concepts in current epilepsy quality measures.

, Joshi discussed the impact that the EpiTRAQ tool can have on the transition process for patients, and detailed some of the problems that adolescents with epilepsy face during this transition into the adult care system.

The pediatric neurologist at Hurley Medical Center of the University of Michigan Hospitals-Michigan Medicine, detailed the challenges those with epilepsy face when transitioning to adult care.

Sucheta M. Joshi, MD

Articles

Early Awareness Towards Epilepsy Transition

EpiTRAQ in Future Epilepsy Research Studies

The Clinical Care Potential of EpiTRAQ

Optimizing Care Transition for Adolescents With Epilepsy

Sucheta M. Joshi, MD: Challenges in Transitioning to Adult Epilepsy Care

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