Elsevier

Nursing Outlook

Volume 64, Issue 3, May–June 2016, Pages 229-243
Nursing Outlook

Article
Practice
Systematic review: Health care transition practice service models

https://doi.org/10.1016/j.outlook.2015.12.011Get rights and content

Abstract

Background

Nearly 750,000 adolescents and emerging adults with special health care needs (AEA-SHCN) enter into adulthood annually. The linkages to ensure the seamless transfer of care from pediatric to adult care and transition to adulthood for AEA-SHCN have yet to be realized.

Purpose

The purpose of this systematic review was to investigate the state of the science of health care transition (HCT) service models as described in quantitative investigations.

Methods

A four-tier screening approach was used to obtain reviewed articles published from 2004 to 2013. A total of 17 articles were included in this review.

Discussion

Transfer of care was the most prominent intervention feature. Overall, using the Effective Public Health Practice Project criteria, the studies were rated as weak. Limitations included lack of control groups, rigorous designs and methodology, and incomplete intervention descriptions.

Conclusion

As the findings indicate, HCT is an emerging field of practice that is largely in the exploratory stage of model development.

Introduction

The health care transition (HCT) of adolescents and emerging adults (AEA) with special health care needs (SHCN) has been widely acknowledged as a major health care challenge as the service demands far exceed the current service capacity of both the pediatric and adult systems of health care (refer to Box 1 for definition of terms; Bloom et al., 2012, Lotstein et al., 2009, Lotstein et al., 2008, McManus et al., 2013). It is estimated that nearly 750,000 AEA-SHCN reach the developmental stage of adulthood every year and enter an adult health care system that lacks the service capacity and expertise to care for them (Scal & Ireland, 2005). As a result, efforts are under way in pediatric health centers of local communities to develop, implement, and test models of care that are responsive to the needs of this generation of AEA-SHCN, and of those who follow, to facilitate their successful transfer to adult care and transition to adulthood.

This collective endeavor can be best described as in the seminal stages of development as there is limited evidence to support the creation of clinical guidelines or standards of care. It is therefore appropriate to review and analyze the state of the science pertaining to HCT service model development and its application to practice. The aim of this article was to present the findings of a systematic literature review of HCT service models as described in quantitative investigations. This review was conducted to investigate the following issues: (a) what is the state of the science pertaining to the implementation of HCT service models? (b) what is the quality of the reviewed quantitative studies using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool? (c) what HCT interventions have demonstrated effectiveness in producing positive HCT outcomes for AEA-SHCN? and (d) what evidence can be used to support the implementation of HCT interventions in practice?

Section snippets

Methods

The 10-year period of this search, from 2004 to 2013, was selected because the primary author had previously published an HCT review of the literature that extended up to 2003 (Betz, 2004). The articles in this review were obtained using three methods, based on guidelines for systematic reviews (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009). First, articles were located using the EBSCO, MEDLINE (Ovid), and PsycINFO databases because these are the reference sources used by authors

Results

In this initial section on findings, a summary of the research investigations is presented, which includes the countries where the studies were conducted and the research designs and methodologies. A profile of the samples based on the diagnostic categories and demographic data of the AEA-SHCN included in these investigations is presented in Table 2. Summary findings of the HCT interventions reported as to the type of services provided are presented in Table 3. Descriptions of service models

Discussion

The Discussion section is organized according to the four issues that were investigated in this review. The implications for research and practice are discussed, as well. The conclusions drawn from this review are cited at the end of this article.

Conclusion

As the findings of this review demonstrate, the testing of HCT intervention models is in the early stages of development. Evaluation of the reviewed studies, using the EPHPP criteria, revealed that the quality of the studies was weak. The limitations of the studies include the lack of rigorous research designs, the use of tools with weak psychometric properties, samples that lacked sufficient size for analysis, and interventions with insufficient description for replication. Currently, guidance

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