title: Health care transition for youth with special health care needs.
abstract: OBJECTIVE
  Youth with special health care needs (YSHCN) increasingly live into adulthood, and approximately 500,000 U.S. youth transition from pediatric to adult health care systems annually. Through a systematic literature review, we sought to (1) determine adult outcomes for YSHCN who have no special transition interventions and (2) identify evidence for strategies that lead to better outcomes, in particular, access to adult health care.
  
  
  METHODS
  We searched the medical, nursing, psychology, and social science literature and reviewed selected articles' reference lists. Transition experts also recommended relevant articles. Search criteria included health conditions, transition-related activities, and health care and related outcomes. We selected English-language articles published from 1986 to 2010, with an abstract, description of transition-related interventions (objective 2), and posttransition outcomes. Investigators abstracted study design, population, sample size, description of intervention, data collection methods, and findings.
  
  
  RESULTS
  The search yielded 3,370 articles, of which 15 met study criteria. Although many YSHCN appear to make the transition to adult health providers successfully, some experience serious gaps in outcomes; those with more complex conditions or with conditions affecting the nervous system appear to have less good transitions. Some evidence supports introducing YSHCN to adult providers before leaving the pediatric system; one study supports using care coordinators to improve outcomes.
  
  
  CONCLUSIONS
  Evidence regarding programs to facilitate transition for YSHCN is inconclusive. Weak evidence suggests that meeting adult providers before transfer may facilitate posttransition access to care. We recommend additional studies with strong research designs to guide best practice in preparing YSHCN for adulthood.
authors.affiliation: Center for Child and Adolescent Health Policy, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, USA. sbloom1@partners.org
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Bloom
authors.forename: Karen
authors.initials: K
authors.lastname: Kuhlthau
authors.forename: Jeanne
authors.initials: J
authors.lastname: Van Cleave
authors.forename: Alixandra A
authors.initials: AA
authors.lastname: Knapp
authors.forename: Paul
authors.initials: P
authors.lastname: Newacheck
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
mesh_terms: D000293:Adolescent; D002908:Chronic Disease / Q000628:therapy*; D006801:Humans; D060305:Transition to Adult Care / Q000458:organization & administration; D055815:Young Adult