Mahan John D, Betz Cecily L, Okumura Megumi J, Ferris Maria E
Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, OH.
University of Southern California Center for Excellence in Developmental Disabilities, University of Southern California Keck School of Medicine, Los Angeles, CA.
Pediatr Rev. 2017 Jul;38(7):305-319. doi: 10.1542/pir.2016-0074.
As health care continues to evolve, the need for more effective health care transition (HCT) for all youth, but particularly children with chronic conditions and special health care needs, becomes even more important. With more than 90% of adolescents with chronic medical conditions now surviving into adulthood, suboptimal transition can lead to poorer quality of life and less successful adulthood.Through a series of clinical vignettes, the challenges of HCT are presented herein and accompanied by comments that underscore how these adolescents can best be helped to transition to successful adulthood. Several methods are presented to assess the readiness of adolescents and young adults (AYA) for transition. The process of transition can be divided into 3 stages: 1) setting the stage: initiation of HCT services and transition readiness assessment, 2) moving forward: ongoing provision of HCT services, and 3) reaching the goal: transfer of care and transition to adulthood.Several valuable suggestions for incorporating the HCT process into the health care system and improving HCT programs through a quality improvement (QI) approach are outlined. Future challenges in HCT include developing more precise assessments of transition status or transition readiness, better understanding the status and specific needs of AYA with chronic health care needs, continued program evaluation and QI efforts, and more reliance on patients and families to teach us about the challenges and methods in HCT that most effectively work for them.
随着医疗保健不断发展，为所有青少年，尤其是患有慢性病和有特殊医疗需求的儿童提供更有效的医疗保健过渡（HCT）变得愈发重要。如今，超过90%患有慢性疾病的青少年存活至成年期，过渡不佳会导致生活质量下降，成年后的发展也不那么顺利。通过一系列临床案例，本文阐述了HCT面临的挑战，并附带评论，强调如何最好地帮助这些青少年顺利过渡到成年期。文中介绍了几种评估青少年和青年成人（AYA）过渡准备情况的方法。过渡过程可分为三个阶段：1）搭建阶段：启动HCT服务和过渡准备情况评估；2）向前推进：持续提供HCT服务；3）达成目标：护理交接和向成年期过渡。文中概述了将HCT流程纳入医疗保健系统并通过质量改进（QI）方法改进HCT项目的若干宝贵建议。HCT未来面临的挑战包括对过渡状态或过渡准备情况进行更精确的评估，更好地了解有慢性医疗需求的AYA的状况和具体需求，持续进行项目评估和QI工作，以及更多地依靠患者及其家庭，让他们告诉我们对他们最有效的HCT挑战和方法。
