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Healthc (Amst). 2016 Mar;4(1):57-68. doi: 10.1016/j.hjdsi.2015.09.001. Epub 2015 Oct 21.

Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness.

Author information

1
Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Loma Linda University Children's Hospital, United States. Electronic address: yavaks@gmail.com.
2
Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States.
3
Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Family Medicine, University of Colorado School of Medicine, United States.
4
Clinical Excellence Research Center, Stanford University School of Medicine, United States.
5
Clinical Excellence Research Center, Stanford University School of Medicine, United States; Division of General Medical Disciplines, Stanford University School of Medicine, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, United States.

Abstract

Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.

KEYWORDS:

Adolescent medicine; Affordability; Care transition; Chronic illness; Health care delivery

PMID:
27001100
PMCID:
PMC4805882
[Available on 2017-03-01]
DOI:
10.1016/j.hjdsi.2015.09.001
[Indexed for MEDLINE]
Free PMC Article

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