Everitt Ian K, Gerardin Jennifer F, Rodriguez Fred H, Book Wendy M
Emory University School of Medicine, Atlanta, Georgia, USA.
Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Congenit Heart Dis. 2017 May;12(3):242-250. doi: 10.1111/chd.12463.
The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease-specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients.
随着先天性心脏病诊断和管理水平的提高，使患者寿命延长，从儿科护理向成人护理的过渡和转诊变得越来越重要。过渡是一个复杂且持续的过程，需要精心规划。过渡不当会对患者、其家庭及医疗服务提供系统产生不利影响。目前，当青少年转向成人护理时，患者护理方面存在显著差距，且几乎没有数据可用于指导青少年先天性心脏病患者护理过渡和转诊的明智管理。已证明适当的先天性心脏病护理可降低成年人群的死亡率。本文回顾了护理过程的过渡和转诊，概述了美国当前针对先天性心脏病的具体指南，并将这些建议与加拿大和欧洲的指南进行比较。然后回顾了成功过渡存在的感知障碍和实际障碍，并确定了向成人先天性心脏病护理转诊期间成功的预测因素。最后，探讨了如何利用疾病特定的结局标志物和质量指标来指导其他儿童慢性疾病护理的过渡和转诊，并确定了在改善先天性心脏病患者护理过渡和转诊管理方面现有的知识差距和结构障碍。
