School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK.
J Health Serv Res Policy. 2012 Jul;17(3):140-8. doi: 10.1258/JHSRP.2011.011044. Epub 2012 Jul 5.
To identify the continuity mechanisms central to a smooth transition from child to adult diabetes care, the service components through which these can be achieved and their inter-relations in different contexts.
A realistic evaluation study of five models of transition in England comprising: organizational analysis (semi-structured interviews with 38 health care professionals and selected observations); case studies of 46 young people under-going transition and 39 carers (three qualitative interviews over a 12-18 month period, medical record review and clinical interviews); surveys of 82 (32% response rate at least once and 11% response rate at two time points) young people in the population approaching, undergoing or less than 12 months post-transition, and their carers (questionnaires included psychosocial outcome measures); and a costs and consequences analysis.
Seven continuities contribute to smooth transition: relational, longitudinal, management, informational, flexible, developmental and cultural. Relational, longitudinal, flexible and cultural continuity are the most important. Models with high levels of relational, longitudinal, flexible and cultural continuity achieve smooth transition with relatively informal, low-cost informational and management continuity mechanisms. Models with low levels of relational and longitudinal continuity need to invest in more formal interventions to facilitate management, flexible and informational continuity so that smooth transition is not compromised.
Focusing on continuity mechanisms, their inter-relations and the effectiveness of different constellations of service components in achieving smooth transition has furnished evidence to inform the development of innovative models which build on the logic of these findings but are sensitive to local context. Further studies are needed to confirm the quantitative findings from a broader range of services and patients.
确定儿童到成人糖尿病护理平稳过渡的核心连续性机制、实现这些机制的服务组成部分以及它们在不同环境中的相互关系。
对英国五种过渡模式进行了真实评估研究，包括：组织分析（对 38 名医疗保健专业人员进行半结构化访谈和选择观察）；对 46 名正在过渡和 39 名照顾者的案例研究（在 12-18 个月期间进行了三次定性访谈、病历审查和临床访谈）；对接近、正在过渡或少于 12 个月的人群中的 82 名（至少一次回应率为 32%，两次回应率为 11%）年轻人及其照顾者进行调查（调查问卷包括心理社会结果衡量标准）；以及成本和后果分析。
有七种连续性有助于平稳过渡：关系、纵向、管理、信息、灵活、发展和文化。关系、纵向、灵活和文化连续性是最重要的。具有高水平关系、纵向、灵活和文化连续性的模型通过相对非正式、低成本的信息和管理连续性机制实现平稳过渡。关系和纵向连续性水平较低的模型需要投资更多的正式干预措施，以促进管理、灵活和信息连续性，从而确保平稳过渡不受影响。
关注连续性机制、它们之间的关系以及实现平稳过渡的不同服务组成部分的有效性，为制定基于这些发现逻辑的创新模式提供了证据，但要考虑到当地的情况。需要进一步研究来确认更广泛服务和患者的定量发现。
