Trivedi Itishree, Holl Jane L, Hanauer Stephen, Keefer Laurie
Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St Clair, Suite 1400, Chicago, IL, 60611, USA.
Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street (20th floor), Chicago, IL, 60611, USA.
Curr Gastroenterol Rep. 2016 May;18(5):21. doi: 10.1007/s11894-016-0495-z.
Planned healthcare transition, initiated in pediatric care, is a gradual process aimed at fostering the adolescent patient's disease knowledge and skills with the ultimate objective of preparing patients and families for adult-centered care. The process is critical in inflammatory bowel diseases (IBD) where there is an increased risk of non-adherence, hospitalizations, and emergency department use as young adult patients graduate from pediatric to adult-centered care. While evidence for healthcare transition in IBD is mounting, important gaps remain in the understanding of this process from the perspective of the adult gastroenterologist. This paper summarizes what is known about healthcare transition in IBD and explores the unanswered questions-a conceptual and methodological framework for transition interventions, relevant outcomes that define successful transition, and key stakeholder perspectives. For the adult gastroenterologist managing the young adult patient population, this paper presents the paradigm of "care integration"-a process of ongoing, multi-modality support for the patient, initiated in the adult care setting, with the goal of improving self-management skills and active participation in medical decision-making.
计划中的医疗保健过渡始于儿科护理，是一个渐进的过程，旨在培养青少年患者的疾病知识和技能，最终目标是让患者及其家庭为以成人为主导的护理做好准备。在炎症性肠病（IBD）中，这一过程至关重要，因为随着年轻成年患者从儿科护理过渡到以成人为主导的护理，不依从、住院和急诊就诊的风险会增加。虽然IBD医疗保健过渡的证据越来越多，但从成人胃肠病学家的角度来看，对这一过程的理解仍存在重要差距。本文总结了IBD医疗保健过渡的已知情况，并探讨了未解决的问题——过渡干预的概念和方法框架、定义成功过渡的相关结果以及关键利益相关者的观点。对于管理年轻成年患者群体的成人胃肠病学家来说，本文提出了“护理整合”的模式——在成人护理环境中启动的、对患者进行持续多模式支持的过程，目标是提高自我管理技能并积极参与医疗决策。
