title: Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness.
abstract: Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Loma Linda University Children's Hospital, United States. Electronic address: yavaks@gmail.com.
authors.forename: Yana
authors.initials: Y
authors.lastname: Vaks
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bensen
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Family Medicine, University of Colorado School of Medicine, United States.
authors.forename: Dana
authors.initials: D
authors.lastname: Steidtmann
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Wang
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States.
authors.forename: Terry S
authors.initials: TS
authors.lastname: Platchek
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States; Division of General Medical Disciplines, Stanford University School of Medicine, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, United States.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Malcolm
authors.affiliation: Clinical Excellence Research Center, Stanford University School of Medicine, United States.
authors.forename: Arnold
authors.initials: A
authors.lastname: Milstein
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D002648:Child; D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006302:Health Services Research; D019456:Health Transition; D006801:Humans; D012648:Self Care; D060305:Transition to Adult Care
keywords: Adolescent medicine; Affordability; Care transition; Chronic illness; Health care delivery