title: Evaluating Continuity During Transfer to Adult Care: A Systematic Review.
abstract: Appropriate outcomes are required to evaluate transition programs' ability to maintain care continuity during the transfer to adult care of youths with a chronic condition.
  
  
  
  To identify the outcomes used to measure care continuity during transfer, and to analyze current evidence regarding the efficacy of transition programs.
  
  
  
  PubMed (1948-2014), Web of Science (1945-2014), Embase (1947-2014), and the reference lists of the studies identified.
  
  
  
  Screening on titles and abstracts; full-text assessment by 2 reviewers independently.
  
  
  
  By 2 reviewers independently, by using a Cochrane form adapted to observational studies, including bias assessment.
  
  
  
  Among the 23 studies retrieved, all but 5 were monocentric, 16 were cohorts (15 retrospective), 6 cross-sectional studies, and 1 randomized trial. The principal disease studied was diabetes (n = 11). We identified 24 indicators relating to 2 main aspects of continuity of care: engagement and retention in adult care. As designed, most studies probably overestimated engagement. A lack of adjustment for confounding factors was the main limitation of the few studies evaluating the efficacy of transition programs.
  
  
  
  The assessment of bias was challenging, due to the heterogeneity and observational nature of the studies.
  
  
  
  This review highlights the paucity of knowledge about the efficacy of transition programs for ensuring care continuity during the transfer from pediatric to adult care. The outcomes identified are relevant and not specific to a disease. However, the prospective follow-up of patients initially recruited in pediatric care should be encouraged to limit an overestimation of care continuity.
authors.affiliation: Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Department of Epidemiology and Public Health, Paris-Sud University Hospital, and Paris Sud University, Le Kremlin-Bicêtre, France; antoine.rachas@inserm.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rachas
authors.affiliation: Department of Social Epidemiology, INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France;
authors.forename: Delphine
authors.initials: D
authors.lastname: Lefeuvre
authors.affiliation: Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Department of Epidemiology and Public Health, Paris-Sud University Hospital, and Paris Sud University, Le Kremlin-Bicêtre, France;
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.affiliation: General Pediatrics, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Paris 7 Denis Diderot University, Sorbonne Paris Cité, Paris, France; INSERM UMR 1123, Paris, France;
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.affiliation: French National Reference Center for Primary Immune Deficiencies, and Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades University Hospital, and INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France;
authors.forename: Nizar
authors.initials: N
authors.lastname: Mahlaoui
authors.affiliation: Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Institut National d'Etudes Démographiques, Paris, France;
authors.forename: Elise
authors.initials: E
authors.lastname: de La Rochebrochard
authors.affiliation: Center for Research in Epidemiology and Population Health, UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France; Department of Epidemiology and Public Health, Paris-Sud University Hospital, and Paris Sud University, Le Kremlin-Bicêtre, France;
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Informatics and Public Health, Georges Pompidou European Hospital, Paris, France; and INSERM Cordeliers Research Center UMRS 872, Paris Descartes University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
mesh_terms: D000293:Adolescent; D006801:Humans; D011785:Quality Assurance, Health Care; D060305:Transition to Adult Care / Q000592:standards*; D055815:Young Adult