The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews |
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| Institution: | 1. Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Department of Pediatrics, Section of Medical Education, Pediatric Resident, Medical College of Wisconsin, Milwaukee, Wisconsin;1. Department of Sociology, University of Texas at Austin, Austin, Texas;2. Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas;1. Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts;2. Women and Health Initiative, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts;3. Division of Adolescent and Young Adult Medicine, Boston Children''s Hospital, Boston, Massachusetts;4. Harvard University Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts;1. Adolescent Substance Use and Addiction Program, Boston Children''s Hospital, Boston, Massachusetts;2. Division of Developmental Medicine, Boston Children''s Hospital, Boston, Massachusetts;3. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;4. Division of Adolescent/Young Adult Medicine, Boston Children''s Hospital, Boston, Massachusetts;5. Computational Health Informatics Program, Boston Children''s Hospital, Boston, Massachusetts;6. Division of Immunology, Rheumatology Program, Boston Children''s Hospital, Boston, Massachusetts;7. Division of Respiratory Diseases, Boston Children''s Hospital, Boston, Massachusetts;8. Division of Endocrinology, Boston Children''s Hospital, Boston, Massachusetts;9. Division of Immunology, Boston Children''s Hospital, Boston, Massachusetts;10. Division of Gastroenterology, Boston Children''s Hospital, Boston, Massachusetts;11. Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California |
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| Abstract: | PurposeInternational guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes?MethodsWe included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded.ResultsInitial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer.ConclusionWe found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction. |
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| Keywords: | Adolescent Health-care transition Systematic review Transition Transfer Long-term condition Chronic condition |
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