Guidance Updated on Transition of Youth to Adult Health Care

October 31, 2018 08:48 am Chris Crawford

The National Survey of Children's Health(www.childhealthdata.org) found that only 15 percent of youth receive assistance from their health care professionals in planning the transition from pediatric, parent-supervised care to more independent adult care.

[female physician showing something to patient on laptop]

To address this gap, the AAFP joined the American Academy of Pediatrics (AAP) and American College of Physicians (ACP) in updating a joint clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home,"(pediatrics.aappublications.org) which calls on clinicians to establish a structured process to ensure a planned transition from pediatric to adult health care as part of routine care for adolescents and young adults.

Published online Oct. 22 in Pediatrics, this clinical report updates the three medical organizations' 2011 clinical report of the same name and provides new practice-based quality improvement guidance on key elements of transition: planning, transfer and integration into adult care.

"Youth do not instantly become adults when they turn age 18, regardless of their new legal status," said (then) AAFP President Michael Munger, M.D., of Overland Park, Kan., in a news release.(www.aap.org) "It is important to continue to build self-care skills and greater engagement in care with young adults. This report provides a framework to help make that happen."

Clinical Report Details

The 2018 report describes an evidence-informed, structured health care transition process called the "Six Core Elements of Health Care Transition,"(www.gottransition.org) which was developed by Got Transition/Center for Health Care Transition Improvement (a cooperative agreement between the Maternal and Child Health Bureau and The National Alliance to Advance Adolescent Health).

Story Highlights
  • The AAFP joined the American Academy of Pediatrics and American College of Physicians in updating a joint clinical report on the health care transition from adolescence to adulthood.
  • Published online Oct. 22 in Pediatrics, this clinical report updates a 2011 clinical report from the organizations and provides new practice-based quality improvement guidance.
  • The new report describes an evidence-informed, structured health care transition process.

This process has been tested with the Institute for Healthcare Improvement's learning collaborative quality-improvement methodology. It guides clinicians in the development of transition services, clarifies family medicine's role in the transition and has been shown to improve health care transition processes in primary care, subspecialty care, school-based health clinics and Medicaid managed care.

Additionally, the clinical report summarizes how prepared U.S. youth are for the health care transition, common transition barriers, and preferences youth and families have during the process.

"Research has shown that without a structured transition process, youth and young adults are more likely to have problems with medical complications, limitations in health and wellbeing, difficulties with treatment and medication adherence, discontinuity of care, preventable emergency department and hospital use, and higher costs of care," the groups said in the release.

The groups noted in the report that the transition from pediatric to adult health care is especially important for youth and young adults with special needs or chronic conditions.

The clinical report addresses the needs of special populations, including those with medical complexity, intellectual and developmental disabilities, behavioral health conditions and social complexity.

"This new 2018 clinical report is an exciting extension of the thoughtful work of the AAP, AAFP and ACP to offer practical assistance to their members regarding needed transition services for adolescent and young patients. It also identifies where further work is needed in the transition field," Patience White, M.D., lead author of the report, said in the release.

Update Details

Laura Pickler, M.D., M.P.H., chief of family medicine at Children's Hospital Colorado in Aurora, participated as a member of the authoring group for both the 2011 and 2018 clinical reports.

Pickler told AAFP News the new clinical report reaffirms the 2011 version.

"It was based in a thorough literature review and developed by an expert authoring group representing diverse professionals, including physicians from all three provider organizations, nursing, government officials, youth and families, and went through an extensive vetting process at the AAFP, AAP and ACP," she said.

Since the 2011 clinical report was issued, Pickler said, there has been new evidence that showed a structured health care transition process can significantly improve population health (adherence to care, self-care skills, quality of life, self-reported health), experience of care (satisfaction, reduction in barriers to care) and utilization (decrease in time between last pediatric and first adult visit, increase in adult visits, decrease in ER use and hospitalization).

"This evidence all points to the transition to adult care process as being integral to ensuring that our patients are informed consumers of health care as well as good partners in ensuring that their own health needs are met," Pickler said.

Important updates since the 2011 report, Pickler said, include the new clinical report outlining recommendations for related infrastructure, education and training, payment and research.

The new report also outlines the three types of transition in the Six Core Elements approach:

  • transitioning to an adult physician (such as in pediatrics),
  • transitioning to an adult approach to care without changing physicians (such as in family medicine) and
  • integrating young adults into adult health care.

"It's not enough for a pediatrician to just make a referral -- there needs to be a warm handoff to ensure young adults actually land in a family medicine practice and are integrated into that practice," Pickler said.

This new clinical report acknowledges the Six Core Elements process of health care transition is a complex health care intervention that requires customization by practices according to the needs of their patients and the resources available, she said.

"This is the personalized aspect of medicine for this patient population," Pickler said. "What we do as family physicians can't be assembly-lined."

Finally, Pickler said the transition for adolescents and young adults is important to ensure that they move from having health care done to them to becoming partners with their family physician.

"This move toward independence is happening in all areas of their lives," she said. "Health care is no exception."

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More From AAFP
American Family Physician: Graham Center Policy One-Pager: Health Care Transition Counseling for Youth with Special Health Care Needs
(12/1/2012)

American Family Physician: Adolescent Health Screening and Counseling
(12/15/2012)