Pediatric Transitions

Due to the success of Neonatal Intensive Care Units (NICUs), childhood cancer treatment, and organ transplantation technology, a growing population of young people with complex chronic disease are now surviving into adulthood. It is estimated that they will soon comprise almost 10% of young adults, compared to approximately 1% of young adults prior to these advances in treating childhood diseases. 

When pediatric patients with complex disease transfer to adult care, the triple threat of serious disease, immature executive judgment, and loss of usual care sources cause surges in preventable disability, hospitalization, and health care spending. 

Projects and Outcomes

CERC’s care redesign team found three addressable failure points in current methods to manage the transition of patients with complex chronic illness to adult care, summarized in the table below. Team members address these failure points via a new Care Model with three core elements: 

  1. For patients and their caregivers, development of the knowledge, beliefs, and skills to successfully self-manage their illness in a less nurturing adult care system

  2. Provision of close support for a safe on-boarding in the adult care system

  3. The establishment of tele-mediated connections between patients’ prior pediatric specialty providers and the patients’ new adult care providers, who are often unfamiliar with severe childhood-acquired illnesses

Providing a smooth transfer helps families avoid unnecessary worsening of disease (e.g. transplant organ rejection) and the concomitant costs associated with emergency room use and hospitalization.

Publications and News