Transition Care: Future Directions in Education, Health Policy, and Outcomes Research

Abstract

All youth must transition from pediatric to adult-centered medical care. This process is especially difficult for youth with special health care needs. Many youth do not receive the age-appropriate medical care they need and are at risk during this vulnerable time. Previous research has identified barriers that may prevent effective transition, and protocols have been developed to improve the process. Health outcomes related to successful transition have yet to be fully defined. Health care transition can also be influenced by education of providers, but there are gaps in medical education at the undergraduate, graduate, and postgraduate levels. Current changes in federal health policy allow improved health care coverage, provide some new financial incentives, and test new structures for transitional care, including the evolution of accountable care organizations (ACO). Future work must test how these systems changes will affect quality of care. Finally, transition protocols exist in various medical subspecialties; however, national survey results show no improvement in transition readiness, and there are no consistent measures of what constitutes transition success. In order to advance the field of transition, research must be done to integrate transition curricula at the undergraduate, graduate, and postgraduate levels; to provide advance financial incentives and pilot the ACO model in centers providing care to youth during transition; to define outcome measures of importance to transition; and to study the effectiveness of current transition tools on improving these outcomes.

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

“…30 Evidence of how deliberate management of transitions affects patients' experiences and health outcomes is scarce. 26,31,32 How to improve transition readiness is left to individual practices. Transition readiness, a multidimensional concept, some facets of which differ across diseases, has proven difficult to gauge.…”

Transition: A concept of significance to nursing and health care professionals

“…It is clear from the work being done in the field that there are implications not only for professional practice, but also for the organsisation of healthcare, for research, and for curricula underpinning educational programmes. Improving the quality of different aspects of healthcare in isolation has traditionally improved the quality of experience for service users, but this is self limiting and as care moves towards a seamless, more integrated approach through for example team-based care [12] it is evidently time to focus on the quality of transitioning from one part of the service to another, through the development of minimum standards. In time best practice in managing these difficult, and at times stressful transitions will be informed by evidence from research which ought to filter through to more appropriate models of care, policies, guidelines and pathways.…”

“…Effective transition services ought to provide a means of exchanging information between patients and healthcare professionals in the clinical setting [41][42][43][44] through a comprehensive and coordinated approach, involving all professional groups in the process. [12] The role of family and other supporting social networks are crucial elements of the transition service. [41,45,46] More strategically there is a need to train and continuously develop healthcare professionals especially on issues related to communication to be more explicit on care required during transition.…”

“…It is recognized that transition can be improved through being actively managed, [10] and models and frameworks to facilitate effective management already exist, [11] with calls for further work in this area. [12] Healthcare professional's encounters with patients and family have obvious significance during periods of health-illness transitions. This paper will discuss the concept of transition, arguing for its special recognition within the healthcare setting.…”

Transitionsmedizin

“…Nach verschiedenen Studien wird die Häufig-keit chronischer Erkrankungen bei unter 6-Jährigen mit 9 % angegeben, bei 12-bis 17-Jährigen mit 17 %. Bedingt durch die zunehmend bessere Versorgung erleben über 90 % der Kinder und Jugendlichen mit chronischen Erkrankungen das Erwachsenenalter [1]. Die Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KIGGS-Studie) hat erhoben, dass etwa 40 % der Kinder an chronischen Erkrankungen leiden und 14 % der unter 18-Jährigen einen besonderen Bedarf an Gesundheitsversorgung haben [2].…”