Fremion Ellen, Morrison-Jacobus Melissa, Castillo Jonathan, Castillo Heidi, Ostermaier Kathryn
Center for Transition Medicine, Baylor College of Medicine, Houston, TX, USA.
Texas Children's Hospital Spina Bifida Transition Clinic, Houston, TX, USA.
J Pediatr Rehabil Med. 2017 Dec 11;10(3-4):243-247. doi: 10.3233/PRM-170451.
Providing comprehensive transition care for adolescents and young adults with spina bifida (AYASB) requires a structured approach to addressing chronic condition management, self-management, care coordination, and health care navigation that is adaptable to the various levels of cognitive ability, physical function, and family/community environments within the population. This commentary (1) highlights AYASB transition program needs identified in the literature and within a local community, (2) analyzes advantages and limitations of published AYASB transition care models in addressing these needs, (3) demonstrates how a spina bifida (SB) transition clinic used the Chronic Care Model (CCM) to develop a comprehensive AYASB transition program, and (4) examines the potential feasibility in adapting this model to other SB clinics. A SB-specific transition clinic based on the CCM model facilitates the complex chronic care management and transition planning for AYASB. Further study is needed to evaluate health care outcomes using the CCM for SB transition.
为患有脊柱裂的青少年和青年（AYASB）提供全面的过渡性护理，需要一种结构化的方法来处理慢性病管理、自我管理、护理协调以及医疗保健导航，这种方法要能适应该人群中不同的认知能力、身体功能以及家庭/社区环境。本评论（1）强调了文献和当地社区中确定的AYASB过渡项目需求，（2）分析了已发表的AYASB过渡性护理模式在满足这些需求方面的优缺点，（3）展示了一家脊柱裂（SB）过渡诊所如何利用慢性病护理模式（CCM）来制定全面的AYASB过渡项目，以及（4）探讨了将该模式应用于其他SB诊所的潜在可行性。基于CCM模型的特定于SB的过渡诊所，有助于为AYASB进行复杂的慢性病护理管理和过渡规划。需要进一步研究以评估使用CCM进行SB过渡的医疗保健结果。
