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March 2016

Improving Health Care Transition Services: Just Grow Up, Will You Please

Author Affiliations
  • 1University of Minnesota, Medical School and School of Public Health, Minneapolis
JAMA Pediatr. 2016;170(3):197-199. doi:10.1001/jamapediatrics.2015.3268

We are not asking you to consider a series of problems with easy solutions. Our concerns are not amenable to a quick fix.

C. Everett Koop, MD, Introductory Remarks, 19891

Thirty years ago, Surgeon General C. Everett Koop opened the agenda-setting conference “Growing Up and Getting Medical Care: Youth With Special Health Care Needs” with these words. Since that time, the health and health care needs of adolescents and young adults with chronic conditions (referred to as health care transition services [HCTS]) have emerged from obscure curiosity to become important health goals in the United States and internationally.2 The current inadequate state of services for adolescents and young adults with chronic conditions demonstrates that Dr Koop understood well the difficulties in changing health care. Nonetheless, a solution, deeply rooted in the origins and institutions of pediatric care, has been within our reach. The problem that Dr Koop identified 30 years ago remains today: Too many adolescents and young adults, particularly those with chronic medical conditions, do not receive the care that they expect and need. In fact, fewer than half of youth or their families have discussed HCT with their health care professional. Despite concerted program and policy efforts, as well as considerable investments between 2002 and 2009, meaningful change has not been made in this nationally representative metric.3 Moreover, these adolescents and young adults are not engaged in preventive services and counseling, despite awareness that these services may have a greater impact for them than for other youth.4 Among young adults, realization of the Affordable Care Act has increased insurance coverage rates and the appropriate use of services.5 Yet, even with this general improvement in insurance coverage, concern remains that young adults with chronic conditions may actually lose access to affordable care owing to benefits packages that fail to meet their chronic care needs.

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