title: Health system strategies supporting transition to adult care.
abstract: BACKGROUND
  The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system 'disintegration'.
  
  
  OBJECTIVE
  (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues.
  
  
  METHODS
  An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies).
  
  
  RESULTS
  Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare.
  
  
  CONCLUSIONS
  Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies.
authors: Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Paediatrics, Child Health Policy Initiative, University of Toronto, Toronto, Ontario, Canada.
authors: Charlotte Moore
authors: CM
authors: Hepburn
authors: Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Paediatrics, Child Health Policy Initiative, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Eyal
authors: E
authors: Cohen
authors: Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Jasmin
authors: J
authors: Bhawra
authors: Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Natalie
authors: N
authors: Weiser
authors: Department of Paediatrics, Child Health Policy Initiative, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Robin Z
authors: RZ
authors: Hayeems
authors: Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Paediatrics, Child Health Policy Initiative, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Astrid
authors: A
authors: Guttmann
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration*; D005060:Europe; D005260:Female; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009520:New Zealand; D015397:Program Evaluation; D013222:State Medicine / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D060305:Transition to Adult Care / Q000458:organization & administration*; D014481:United States
keywords: Adolescent Health; General Paediatrics; Health services research; Paediatric Practice