More than 10 years after the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Society of Internal Medicine published a consensus statement about transitioning pediatric patients into adult care, progress is still somewhat limited.
However, the rise of patient-centered care, recognition standards for patient-centered medical homes, and new payment scenarios may necessitate the creation of high-quality transfers of care.
“It’s not simple,” admits Peggy McManus, president of the National Alliance to Advance Adolescent Health and co-project director for Got Transition, a collaboration between McManus’ organization and the Maternal and Child Health Bureau to improve transitions from pediatric to adult health care. “But, it is absolutely essential.”
According to the AAP, young adults should transition to adult-based health care between the ages of 18 and 21 years. This means that they—and their parents—should begin thinking about this transition in their mid-to-late teens.
In 2014, Got Transition published its nationally recognized Six Core Elements of Health Care Transition, which align with the AAP/AAFP/ACP transition principles for pediatric, family medicine, and internal medicine providers. Those recommendations are summarized below.
Create a Policy
Develop a transition policy that describes your practice’s approach to accepting new young adults. Make sure to address cultural competency.
Establish a Tracking Mechanism
Determine criteria for identifying transitioning young adults. Integrate the Six Core Elements of Health Care into your clinical care process and use a registry to track care.
Design an Orientation
Identify the physicians in your practice interested in caring for young adults, and create an orientation process for these patients. Consider offering young adult–friendly information online and initial “get-acquainted” appointments.
Request a Transfer Package
Reach out to your patient’s pediatric provider for transfer package materials, which may include a readiness assessment, plan of care, and medical summary.
Welcome the Patient
Review the transfer package and make an appointment-reminder call to your new patient. Clarify your approach to care during the first appointment, which may include topics like shared decision making or privacy and consent.
Assess Patient Needs
Determine the need for access to adult specialists or other support services, and help your patient connect with these providers if necessary. Be sure to request feedback from new patients and tailor ongoing care accordingly.
In the Long Term
Note that you don’t need to tackle all of these areas at once. McManus recommends starting small to establish a process. “In the long term, this will streamline care,” says McManus.