Center for Child and Adolescent Health Policy, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, USA.
J Adolesc Health. 2012 Sep;51(3):213-9. doi: 10.1016/j.jadohealth.2012.01.007. Epub 2012 Mar 22.
Youth with special health care needs (YSHCN) increasingly live into adulthood, and approximately 500,000 U.S. youth transition from pediatric to adult health care systems annually. Through a systematic literature review, we sought to (1) determine adult outcomes for YSHCN who have no special transition interventions and (2) identify evidence for strategies that lead to better outcomes, in particular, access to adult health care.
We searched the medical, nursing, psychology, and social science literature and reviewed selected articles' reference lists. Transition experts also recommended relevant articles. Search criteria included health conditions, transition-related activities, and health care and related outcomes. We selected English-language articles published from 1986 to 2010, with an abstract, description of transition-related interventions (objective 2), and posttransition outcomes. Investigators abstracted study design, population, sample size, description of intervention, data collection methods, and findings.
The search yielded 3,370 articles, of which 15 met study criteria. Although many YSHCN appear to make the transition to adult health providers successfully, some experience serious gaps in outcomes; those with more complex conditions or with conditions affecting the nervous system appear to have less good transitions. Some evidence supports introducing YSHCN to adult providers before leaving the pediatric system; one study supports using care coordinators to improve outcomes.
Evidence regarding programs to facilitate transition for YSHCN is inconclusive. Weak evidence suggests that meeting adult providers before transfer may facilitate posttransition access to care. We recommend additional studies with strong research designs to guide best practice in preparing YSHCN for adulthood.
有特殊医疗需求的青年（YSHCN）越来越多地进入成年期，每年约有 50 万美国青年从儿科医疗保健系统过渡到成人医疗保健系统。通过系统的文献回顾，我们旨在：（1）确定没有特殊过渡干预措施的 YSHCN 的成年结果；（2）确定导致更好结果的策略的证据，特别是获得成人保健的机会。
我们搜索了医学、护理、心理学和社会科学文献，并审查了选定文章的参考文献。过渡专家还推荐了相关文章。搜索标准包括健康状况、与过渡相关的活动以及医疗保健和相关结果。我们选择了 1986 年至 2010 年期间以英文发表的、有摘要、描述过渡相关干预措施（目标 2）和过渡后结果的文章。调查人员提取了研究设计、人群、样本量、干预描述、数据收集方法和发现。
搜索结果产生了 3370 篇文章，其中 15 篇符合研究标准。尽管许多 YSHCN 似乎成功地过渡到了成人医疗保健提供者，但有些人在结果方面存在严重差距；那些病情更复杂或影响神经系统的人似乎过渡情况较差。有一些证据支持在离开儿科系统之前向成年提供者介绍 YSHCN；一项研究支持使用护理协调员来改善结果。
关于促进 YSHCN 过渡的方案的证据尚无定论。证据表明，在转移之前与成年提供者会面可能会促进过渡后的护理机会。我们建议进行更多具有强大研究设计的研究，以指导为 YSHCN 成年做准备的最佳实践。
