Division of Adolescent Medicine/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts 20115, USA.
Curr Opin Pediatr. 2013 Aug;25(4):439-46. doi: 10.1097/MOP.0b013e3283623d2f.
The purpose of the present article is to review recent national guidelines regarding healthcare transition (HCT) planning for adolescents with special healthcare needs (SHCN) and to describe practical tools for use by the primary care pediatrician to implement these guidelines.
Approximately one in five adolescents in the United States has SHCN. Achieving successful transitions from child-oriented to adult-oriented healthcare for these patients can be difficult. Despite numerous barriers to HCT, innovations in healthcare delivery, including the patient-centered medical home and accountable care payment structures, may help overcome challenges. The American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians have provided explicit practice-level guidance for supporting HCT. The National Healthcare Transition Center developed the Six Core Elements of Healthcare Transition, recommending six detailed action steps for transitions from pediatric settings. Steps reflect guidelines and, along with novel patient-centered information technologies, may help support individuals and families navigating complex transitions.
It is time to integrate transition planning into the medical home. Further evidence is needed to identify transition strategies that improve outcomes. Although innovations in care delivery, payment structures, and information technologies may support HCT, pediatricians can and should implement already available and recommended transition steps.
目的：本文旨在回顾最近关于特殊医疗需求（SHCN）青少年医疗保健过渡（HCT）规划的国家指南，并描述初级保健儿科医生实施这些指南的实用工具。
发现：在美国，大约五分之一的青少年有 SHCN。对于这些患者来说，从以儿童为中心的医疗保健成功过渡到以成人为中心的医疗保健可能具有挑战性。尽管 HCT 存在诸多障碍，但医疗服务提供方面的创新，包括以患者为中心的医疗之家和责任制医疗付费结构，可能有助于克服挑战。儿科学会、美国家庭医师学会和美国医师学院为支持 HCT 提供了明确的实践水平指导。国家医疗保健过渡中心制定了医疗保健过渡的六个核心要素，建议从儿科环境过渡的六个详细行动步骤。这些步骤反映了指南，以及新颖的以患者为中心的信息技术，可能有助于支持个人和家庭应对复杂的过渡。
总结：是时候将过渡计划纳入医疗之家了。需要更多的证据来确定改善结果的过渡策略。尽管医疗服务提供、支付结构和信息技术方面的创新可能支持 HCT，但儿科医生可以并且应该实施已经可用和推荐的过渡步骤。
