title: Measuring the "triple aim" in transition care: a systematic review.
abstract: OBJECTIVE
  Without adequate support, adolescents transitioning from the pediatric to the adult health care system are at increased risk for poor health outcomes. Numerous interventions attempt to improve this transition, yet few comprehensively evaluate efficacy. To advance evaluation methods and ultimately the quality of transition services, it is necessary to understand the current state of health care transition measurement. This study examines and categorizes transition measures by using the "Triple Aim" framework of experience of care, population health, and cost of care.
  
  
  METHODS
  Ovid Medline and the Cumulative Index to Nursing and Allied Health Literature were searched for articles published between 1995 and 2013. Two reviewers independently screened studies and included those that evaluated the impact of a health care transition intervention. Measures were subsequently classified according to population health, experience of care, and costs of care.
  
  
  RESULTS
  Of the 2282 studies initially identified, 33 met inclusion criteria. Population health measures were used in 27 studies, with disease-specific measures collected most frequently. Fifteen studies measured cost, most often service utilization. Eight studies measured experience of care, with satisfaction assessed most commonly. Only 3 studies examined all 3 domains of the "Triple Aim." Transition interventions described in the gray literature were not reviewed.
  
  
  CONCLUSIONS
  Transition programs are inconsistently evaluated in terms of their impact on population health, patient experience, and cost. To demonstrate improvement in the transition from pediatric to adult health care, a more robust and consistent set of measures is needed.
authors.affiliation: The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and Georgetown University School of Medicine, Washington District of Columbia mlp59@georgetown.edu.
authors.forename: Megan
authors.initials: M
authors.lastname: Prior
authors.affiliation: The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and.
authors.forename: Margaret
authors.initials: M
authors.lastname: McManus
authors.affiliation: The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and.
authors.forename: Patience
authors.initials: P
authors.lastname: White
authors.affiliation: Georgetown University School of Medicine, Washington District of Columbia.
authors.forename: Laurie
authors.initials: L
authors.lastname: Davidson
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D003431:Cross-Cultural Comparison; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics* / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D060305:Transition to Adult Care / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: adolescent; cost of care; evaluation; patient experience; population health; quality improvement; transition to adult care