title: 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.
authors.affiliation: Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass. Electronic address: nsharma5@partners.org.
authors.forename: Niraj
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass.
authors.forename: Kitty
authors.initials: K
authors.lastname: O'Hare
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Antonelli
authors.affiliation: Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Mass.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sawicki
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration; D000293:Adolescent; D000295:Adolescent Medicine / Q000193:education; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease / Q000628:therapy; D002983:Clinical Competence; D004501:Education, Medical / Q000458:organization & administration*; D005544:Forecasting; D006291:Health Policy; D006801:Humans; D007388:Internal Medicine / Q000193:education; D017063:Outcome Assessment, Health Care; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D010372:Pediatrics / Q000193:education; D060305:Transition to Adult Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D014481:United States; D055815:Young Adult
keywords: health care financing; health policy; medical education; outcomes research; transition; youth with special health care needs