Kolehmainen Niina, McCafferty Sara, Maniatopoulos Gregory, Vale Luke, Le-Couteur Ann S, Colver Allan
Institute of Health and Society, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
BMJ Paediatr Open. 2017 Sep 11;1(1):e000085. doi: 10.1136/bmjpo-2017-000085.
We explored what constitutes successful commissioning for transition and what challenges are associated with this. We aimed: (1) to identify explicit and implicit organisational structures, processes and relationships that drive commissioning around transition; (2) to identify challenges faced by commissioners; and (3) to develop a conceptual model.
A qualitative interview study.
Commissioning and provider organisations across primary and secondary care and third sector in England, UK.
Representatives (n=14) from clinical commissioning groups, health and well-being boards and local authorities that commission national health services (NHS) for transition from children's to adults' services in England; NHS directors, general practitioners and senior clinicians (n=9); and frontline NHS and third sector providers (n=6).
Both commissioners and providers thought successful transition is personalised, coordinated and collaborative with a focus on broad life outcomes and actualised through building pathways and universal services. A multitude of challenges were described, including inconsistent national guidance, fragmented resources, incompatible local processes, lack of clear outcomes and professional roles and relationships. No single specific process of commissioning for transition emerged-instead complex, multi-layered, interactive processes were described.
The findings indicate a need to consider more explicitly the impact of national policies and funding streams on commissioning for transition. Commissioners need to require care pathways that enable integrated provision for this population and seek ways to ensure that generalist community providers engage with children with long-term conditions from early on. Future research is needed to identify a core set of specific, meaningful transition outcomes that can be commissioned, measured and monitored.
我们探讨了促成成功的过渡性委托的因素以及与之相关的挑战。我们的目标是：（1）确定围绕过渡推动委托工作的明确和隐含的组织结构、流程及关系；（2）确定委托方所面临的挑战；（3）建立一个概念模型。
一项定性访谈研究。
英国英格兰初级和二级医疗保健及第三部门的委托和服务提供机构。
来自临床委托小组、健康与福祉委员会以及地方当局的代表（n = 14），这些机构在英格兰委托国家医疗服务体系（NHS）提供从儿童服务到成人服务的过渡；NHS主任、全科医生和高级临床医生（n = 9）；以及NHS和第三部门的一线服务提供者（n = 6）。
委托方和服务提供方都认为，成功的过渡是个性化、协调且协作的，关注广泛的生活成果，并通过建立路径和通用服务来实现。描述了众多挑战，包括国家指导不一致、资源分散、地方流程不兼容、缺乏明确的成果以及专业角色和关系。没有出现单一特定的过渡性委托流程，而是描述了复杂、多层次、交互式的流程。
研究结果表明需要更明确地考虑国家政策和资金流对过渡性委托的影响。委托方需要要求提供能够为这一人群提供综合服务的护理路径，并寻求方法确保全科社区服务提供者从早期就与患有长期疾病的儿童接触。未来需要开展研究，以确定一套可委托、测量和监测的核心特定且有意义的过渡成果。
