1. In a systematic review of the literature, 25 empirical studies were identified that evaluated transition of care interventions for children with special health care needs (CSHCN).
2. The most commonly studied patients were adolescents with diabetes, followed by organ transplant recipients; common transition interventions included use of a transition coordinator, specialized young adult clinics, and patient education.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Approximately 750 000 CSHCN transition from pediatric- to adult-centered heath care each year, highlighting the need for continuous and developmentally-appropriate care for this population. This study evaluated the current state of health care transition in CSHCN by interviewing experts and conducting a literature search. Twenty-five empirical studies evaluating care transition interventions for CSHCN were identified. Patient populations most commonly studied were adolescents with diabetes and organ transplant recipients. Some common transition interventions utilized among the studies included use of a transition coordinator, specialized young adult clinics, and patient education and skill-building. This review was limited by the low number of included studies and their generally poor methodology. Nonetheless, effective transition care for CSHCN remains a critical topic, necessitating further research on specific components of interventions that lead to transition success in these patients.
Study Author, Dr. Melissa McPheeters, PhD, MPH, talks to 2 Minute Medicine: Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health; Nashville, Tennessee.
“We know the number of children with special health care needs is growing and that more of these children will survive to adulthood. They will transition from pediatric care into an adult care system that may or may not be prepared to handle their complex needs. We reviewed the available literature on this topic and wrote a technical brief of the state of the science on how transition programs can help, and what research is needed to move forward. There are some models for transitioning to adult care, but few high quality studies have evaluated these programs yet. The most established general rubric for providing transition care is laid out in the American Academy of Pediatrics Got Transition model. When studies have been conducted, they typically do not use a comparison group, have small numbers, are at single centers and rely on historical data to assess the program. Even so, our review and others suggest that there can be benefits from specific transition programs, and also that there is an urgent need for more research. Physicians who care for children with special health care needs – or who are in positions in which they will receive these children into adult services as they grow up should know that there are some models to improve the process of care, but that a lot more research is needed to understand which models work best.”
In-Depth [systematic review]: A total of 25 studies were identified in 30 peer-reviewed publications to evaluate systems for care transition in CSHCN; 2 of these were randomized controlled trials. Eight studies evaluated transition care for adolescents with diabetes, while 5 focused on organ transplant patients and 2 on patients with sickle cell disease. The remaining 10 evaluated transition care for other conditions, including HIV, epilepsy, cystic fibrosis, and inflammatory bowel disease. Most studies defined successful transition as attendance in adult care, indicating successful transfer, or continued adherence to medication. Few studies used a control or comparison group and most outcomes were patient-reported. In the most commonly studied group of transitioning youth, those with diabetes, interventions included use of a transition coordinator (n = 2), pediatrician attendance at adult care visits (n = 2) and skill-building (n = 3), specialized clinics for young adults (n = 4), and technology use for education and reminders (n = 2). Transition care programs for organ transplant patients and other CSHCN used these and other interventions, such as joint pediatric-adult clinics and multidisciplinary teams.
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