Elsevier

The Journal of Pediatrics

Volume 188, September 2017, Pages 263-269.e15
The Journal of Pediatrics

Original Articles
Outcome Evidence for Structured Pediatric to Adult Health Care Transition Interventions: A Systematic Review

https://doi.org/10.1016/j.jpeds.2017.05.066Get rights and content

Objective

To identify statistically significant positive outcomes in pediatric-to-adult transition studies using the triple aim framework of population health, consumer experience, and utilization and costs of care.

Study design

Studies published between January 1995 and April 2016 were identified using the CINAHL, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases. Included studies evaluated pre-evaluation and postevaluation data, intervention and comparison groups, and randomized clinic trials. The methodological strength of each study was assessed using the Effective Public Health Practice Project Quality Assessment Tool.

Results

Out of a total of 3844 articles, 43 met our inclusion criteria. Statistically significant positive outcomes were found in 28 studies, most often related to population health (20 studies), followed by consumer experience (8 studies), and service utilization (9 studies). Among studies with moderate to strong quality assessment ratings, the most common positive outcomes were adherence to care and utilization of ambulatory care in adult settings.

Conclusions

Structured transition interventions often resulted in positive outcomes. Future evaluations should consider aligning with professional transition guidance; incorporating detailed intervention descriptions about transition planning, transfer, and integration into adult care; and measuring the triple aims of population health, experience, and costs of care.

Section snippets

Methods

Following the PRISMA checklist,22 we conducted a search strategy of articles published between January 1995 and April 2016 using the CINAHL, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases. Only English-language articles were included, and a combination of medical subject headings and keywords were used, as described in the Figure (available at www.jpeds.com).

Included studies described a transition intervention for youths transferring from pediatric to adult outpatient health care.

Results

This systematic review examined the evidence from 43 articles out of 3844 articles initially identified (Figure). Table II provides a summary of each study's characteristics. All but 5 studies26, 27, 35, 41, 52 evaluated transition interventions for youths with a single condition, most often type 1 diabetes, followed by kidney or liver transplants and juvenile idiopathic arthritis. Among the handful of multiple-condition studies, only 1 study31 included youths with neurodevelopmental

Discussion

This systematic review found that almost two-thirds of transition evaluation studies (28 of 43) had statistically significant positive outcomes. Twenty studies found improvements in population health, 8 studies reported benefits in terms of consumer experience or reduction in transition barriers, and 9 studies cited positive service utilization impacts. Only 3 studies examined costs, but none found significant savings.

In an analysis of studies that received moderate to strong quality ratings

References (69)

  • D.P. Orr et al.

    Glycemic control and transfer of health care among adolescents with insulin dependent diabetes mellitus

    J Adolesc Health

    (1996)
  • G.S. Sawicki et al.

    Development and validation of the adolescent assessment of preparation for transition: a novel patient experience measure

    J Adolesc Health

    (2015)
  • K.C. Garvey et al.

    Transition experience and health care utilization among young adults with type 1 diabetes

    Patient Prefer Adherence

    (2013)
  • K.A. Kuhlthau et al.

    Health care transition services for youth with autism spectrum disorders: perspectives of caregivers

    Pediatrics

    (2016)
  • M.A. McManus et al.

    Current status of transition preparation among youth with special needs in the United States

    Pediatrics

    (2013)
  • C.B. Montano et al.

    Discontinuity in the transition from pediatric to adult health care for patients with attention-deficit/hyperactivity disorder

    Postgrad Med

    (2012)
  • T. Refaeli et al.

    Continuity and discontinuity in the transition from care to adulthood

    Br J Soc Work

    (2017)
  • T.D. Simon et al.

    Who will care for me next? Transitioning to adulthood with hydrocephalus

    Pediatrics

    (2009)
  • R.A. Annunziato et al.

    Adherence and medical outcomes in pediatric liver transplant recipients who transition to adult services

    Pediatr Transplant

    (2007)
  • K.C. Garvey et al.

    Health care transition in patients with type 1 diabetes: young adult experiences and relationship to glycemic control

    Diabetes Care

    (2012)
  • K.L. Shaw et al.

    Young people's satisfaction of transitional care in adolescent rheumatology in the UK

    Child Care Health Dev

    (2007)
  • J.E. McDonagh et al.

    The impact of a coordinated transitional care programme on adolescents with juvenile idiopathic arthritis

    Rheumatology (Oxford)

    (2007)
  • R. Fish et al.

    Mortality in perinatally HIV-infected young people in England following transition to adult care: an HIV Young Persons Network (HYPNet) audit

    HIV Med

    (2014)
  • W.C. Cooley et al.

    Supporting the health care transition from adolescence to adulthood in the medical home

    Pediatrics

    (2011)
  • M. McPheeters et al.

    Transition care for children with special health needs. Technical brief no. 15

    (2014)
  • Institute of Medicine and National Research Council

    Investing in the health and well-being of young adults

    (2014)
  • J. Bhawra et al.

    Primary care interventions to improve transition of youth with chronic health conditions from paediatric to adult healthcare: a systematic review

    BMJ Open

    (2016)
  • F. Campbell et al.

    Transition of care for adolescents from paediatric services to adult health services

    Cochrane Database Syst Rev

    (2016)
  • R. Crowley et al.

    Improving the transition between paediatric and adult healthcare: a systematic review

    Arch Dis Child

    (2011)
  • M. Prior et al.

    Measuring the “triple aim” in transition care: a systematic review

    Pediatrics

    (2014)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    BMJ

    (2009)
  • B.H. Thomas et al.

    A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions

    Worldviews Evid Based Nurs

    (2004)
  • R.A. Annunziato et al.

    Can transition to adult care for transplant recipients be improved by intensified services while patients are still in pediatrics?

    Prog Transplant

    (2015)
  • C.L. Betz et al.

    Testing the transition preparation training program: a randomized controlled trial

    Int J Child Adolesc Health

    (2010)
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    Supported by the Maternal and Child Health Bureau (U39MC25729 HRSA/MCHB) to The National Alliance to Advance Adolescent Health. M.M. and P.W. led the development of the Six Core Elements of Health Care Transition (2.0) in 2014. The other authors declare no conflicts of interest.

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