Measuring the “Triple Aim” in Transition Care: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVES: Without adequate support, adolescents transitioning from the pediatric to the adult health care system are at increased risk for poor health outcomes. Numerous interventions attempt to improve this transition, yet few comprehensively evaluate efficacy. To advance evaluation methods and ultimately the quality of transition services, it is necessary to understand the current state of health care transition measurement. This study examines and categorizes transition measures by using the “Triple Aim” framework of experience of care, population health, and cost of care. METHODS: Ovid Medline and the Cumulative Index to Nursing and Allied Health Literature were searched for articles published between 1995 and 2013. Two reviewers independently screened studies and included those that evaluated the impact of a health care transition intervention. Measures were subsequently classified according to population health, experience of care, and costs of care. RESULTS: Of the 2282 studies initially identified, 33 met inclusion criteria. Population health measures were used in 27 studies, with disease-specific measures collected most frequently. Fifteen studies measured cost, most often service utilization. Eight studies measured experience of care, with satisfaction assessed most commonly. Only 3 studies examined all 3 domains of the “Triple Aim.” Transition interventions described in the gray literature were not reviewed. CONCLUSIONS: Transition programs are inconsistently evaluated in terms of their impact on population health, patient experience, and cost. To demonstrate improvement in the transition from pediatric to adult health care, a more robust and consistent set of measures is needed.

EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases

“…The expert group recognised the need for a greater evidence base to inform best practice, the best metrics for measuring ‘success’ and ‘outcome’ of transitional care programmes and the impact of such programmes on YP with jRMDs 7 37 38. The agenda for research needs to include:

the transition programme evaluation as a complex intervention,75

the effectiveness of the transition process35 and how this can be measured,

the timeliness of interventions and validation of readiness tools,69–73 82

the outcome measures of transition,37–39 41 83

predictors for transition outcomes,

cohort studies and registries from paediatric rheumatology to extend into adult life,

an agreed ‘core transition dataset’ for routine practice in paediatric and adult rheumatology centres to inform and foster future research initiatives, facilitate a standardised approach in transitional care and enable comparative assessment of care across Europe.

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Health Care Use During Transfer to Adult Care Among Youth With Chronic Conditions

“…[1][2][3] Transfer of youth with chronic health conditions to adult care is often suboptimal due to factors such as emotional and cognitive developmental challenges, lack of individual and family-centered social supports, communication and coordination challenges between health care sectors, and a lack of appropriately trained adult health care providers. 4 Decline in health after transfer of care to adult health care providers is well described, possibly due to lapses in adherence, follow-up, and/or insurance coverage 5 ; however, most studies reporting this phenomenon have focused on single populations such as those with sickle cell disease, 6 diabetes mellitus, 7 or organ transplantation, 8,9 and relatively little is known about those with chronic mental health 10 and neurodevelopmental conditions. Population-level description of health care use and mortality during transfer may illuminate the pervasiveness of this problem among broad groups of youth transferring to adult care.…”

A Systematic Review of Transitional Care for Emerging Adults with Diabetes

“…(Prior, McManus, White, & Davidson, 2014) completed a systematic review based upon the Triple Aim framework developed by the Institute for Health Care Improvement (Berwick, Nolan, & Whittinghton, 2008). This framework is organized around three interdependent goals: improving the individual experience of health care, improving the health of populations, and reducing the per capital costs of care (Berwick, et al, 2008) (Prior, et al, 2014). Prior et al evaluated transition interventions for youth with chronic conditions (n=33), 12 of which included patients with type 1 diabetes.…”