Practical guidance for clinicians a highlight of updated joint report on transition
Patience H.White, M.D., M.A., FACP, FAAP
AAP Clinical Report
The 2016 National Survey of Children’s Health showed that only 15% of 12- to 17-year-olds
received the support they needed in transitioning to an adult health care provider.
These results remain low even with reports from the Academy and other national professional
associations on improving the transition from pediatric to adult care in the medical
Youths, families and providers continue to experience the barriers to a smooth transfer
and are looking for guidance on how to improve the transition process. As a result,
the AAP — along with the American Academy of Family Physicians and American College
of Physicians — have released an update of the 2011 clinical report Supporting the Health Care Transition from Adolescence to Adulthood in the Medical
Authored by a multidisciplinary group of pediatricians, internists, family and medicine-pediatric
physicians, parents, young adults and nursing experts, the document reviews the growing
transition literature since 2011. The guidance affirms the previous age-based algorithmic
format, which begins with action steps at age 12 and extends through the transfer
of care to an adult medical home.
While focusing on health care transition for allyouths, the report also addresses the needs of special populations, such as those
with medical complexity, intellectual and developmental disabilities, and behavioral
health challenges. The report numerates principles of health care transition, including
individual differences and complexities of youths and young adults that affect the
transition process and a need for a distinct population health approach for these
Structured approach beneficial
New data show that a structured transition approach significantly improves population
health outcomes related to the following:
adherence to care (self-care skills, quality of life, self-reported health),
patient satisfaction (reduction in barriers to care) and
utilization (decrease in time between last pediatric and first adult visit, increase
in adult visits, decrease in emergency department visits and hospitalizations).
The report describes an evidence-informed, structured process with practical tools
called the Six Core Elements of Health Care Transition that guide providers on how
to offer transition services using the following approach:
Tracking and monitoring
Transition readiness/orientation to adult practice
Transition planning/integration into adult approach to care/practice
Transfer of care/initial visit
Transition completion/ongoing care
This framework has been shown to improve health care transition processes in primary
care, subspecialty care, school-based health clinics and Medicaid managed care. In
addition, the approach encompasses all three components for this critical transition:
preparation, transfer and integration into adult health care.
Three versions of transition “packages” are outlined in the Six Core Elements approach:
transitioning youths to an adult health care provider, transitioning to an adult approach
to care without changing providers, and integrating young adults into adult health
care. The packages also clarify the roles of pediatric, family medicine, medicine-pediatrics
and adult providers in the process. Practices can customize all of the free tools
based on patient needs and available resources.
The report concludes with broad recommendations for the future regarding infrastructure,
education and training, payment and research.
Dr. White, a lead author of the report, co-chaired the Transitions Clinical Report
Revision Authoring Group. She is co-director of Got Transition: Center for Health
Care Transition Improvement.