Enhancing the Role of Internists in the Transition From Pediatric to Adult Health Care
Authors: M. Carol Greenlee, Lawrence D'Angelo, Stacey R. Harms, Alice A. Kuo, Michael Landry, Margaret McManus, Gregg M. Talente, Patience White
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions21 February 2017Enhancing the Role of Internists in the Transition From Pediatric to Adult Health CareM. Carol Greenlee, MD, Lawrence D'Angelo, MD, MPH, Stacey R. Harms, MSJ, Alice A. Kuo, MD, PhD, Michael Landry, MD, MSc, Margaret McManus, MHS, Gregg M. Talente, MD, MS, and Patience White, MD, MA, for the American College of Physicians Council of Subspecialty Societies Pediatric to Adult Care Transitions Initiative Steering Committee*M. Carol Greenlee, MDFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., Lawrence D'Angelo, MD, MPHFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., Stacey R. Harms, MSJFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., Alice A. Kuo, MD, PhDFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., Michael Landry, MD, MScFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., Margaret McManus, MHSFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., Gregg M. Talente, MD, MSFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., and Patience White, MD, MAFrom Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina., for the American College of Physicians Council of Subspecialty Societies Pediatric to Adult Care Transitions Initiative Steering Committee*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0514 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The journey from adolescence to adulthood often crosses an "abyss in care." Neither pediatric nor adult medicine practices are structured to truly meet the unique needs of this "emerging adult" cohort. They also have not constructed the connections needed to ensure continuity of care for young adult patients. This gap is problematic in several ways for both the individual and society, especially with regard to the estimated 5 million youth with special health needs (YSHN) making this passage. Most young adults report not receiving the necessary preparation for this transition (1). Consequently, they are ill-prepared and at risk for adverse ...References1. Lotstein DS, Inkelas M, Hays RD, Halfon N, Brook R. Access to care for youth with special health care needs in the transition to adulthood. J Adolesc Health. 2008;43:23-9. [PMID: 18565434] doi:10.1016/j.jadohealth.2007.12.013 CrossrefMedlineGoogle Scholar2. Bryden KS, Dunger DB, Mayou RA, Peveler RC, Neil HA. Poor prognosis of young adults with type 1 diabetes: a longitudinal study. Diabetes Care. 2003;26:1052-7. [PMID: 12663572] CrossrefMedlineGoogle Scholar3. Committee on Improving the Health, Safety and Well-Being of Young Adults. Investing in the Health and Well-Being of Young Adults. Washington, DC: National Academies Pr; 2014. Google Scholar4. Quinn CT, Rogers ZR, McCavit TL, Buchanan GR. Improved survival of children and adolescents with sickle cell disease. Blood. 2010;115:3447-52. [PMID: 20194891] doi:10.1182/blood-2009-07-233700 CrossrefMedlineGoogle Scholar5. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. 2000;55:469-80. [PMID: 10842426] MedlineGoogle Scholar6. Kirzinger WK, Cohen RA, Gindi RM. Health Care Access and Utilization among Young Adults Ages 19-25: Early Release of Estimates from the National Health Interview Survey. Hyattsville, MD: National Center for Health Statistics; 2012. Google Scholar7. Reiss JG, Gibson RW, Walker LR. Health care transition: youth, family, and provider perspectives. Pediatrics. 2005;115:112-20. [PMID: 15629990] CrossrefMedlineGoogle Scholar8. Peter NG, Forke CM, Ginsburg KR, Schwarz DF. Transition from pediatric to adult care: internists' perspectives. Pediatrics. 2009;123:417-23. [PMID: 19171604] doi:10.1542/peds.2008-0740 CrossrefMedlineGoogle Scholar9. Garvey KC, Telo GH, Needleman JS, Forbes P, Finkelstein JA, Laffel LM. Health care transition in young adults with type 1 diabetes: perspectives of adult endocrinologists in the U.S. Diabetes Care. 2016;39:190-7. [PMID: 26681724] doi:10.2337/dc15-1775 CrossrefMedlineGoogle Scholar10. American College of Physicians. Pediatric to adult care transitions initiative. Accessed at www.acponline.org/clinical-information/high-value-care/resources-for-clinicians/pediatric-to-adult-care-transitions-initiative on 12 October 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Western Slope Endocrinology, Grand Junction, Colorado; Children's National Medical Center, American College of Physicians, The National Alliance to Advance Adolescent Health, and George Washington University School of Medicine and Health Sciences, Washington, DC; University of California, Los Angeles, Los Angeles, California; Tulane University School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana; and University of South Carolina, Columbia, South Carolina.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0514.Corresponding Author: Stacey R. Harms, MSJ, American College of Physicians, 25 Massachusetts Avenue Northwest, Suite 700, Washington, DC 20001; e-mail, [email protected]org.Current Author Addresses: Dr. Greenlee: Western Slope Endocrinology, 2589 F 1/2 Road, Grand Junction, CO 81505.Dr. D'Angelo: Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010.Ms. Harms: American College of Physicians, 25 Massachusetts Avenue Northwest, Suite 700, Washington, DC 20001.Dr. Kuo: UCLA Medicine–Pediatrics, 757 Westwood Plaza, Suite 7501, Los Angeles, CA 90095.Dr. Landry: Tulane University School of Medicine, 1430 Tulane Avenue, Department of Medicine SL 16, New Orleans, LA 70112.Ms. McManus and Dr. White: The National Alliance to Advance Adolescent Health, 1615 M Street Northwest, Suite 290, Washington, DC 20036.Dr. Talente: University of South Carolina, 2 Medical Park, Suite 502, Columbia, SC 29203.Author Contributions: Conception and design: L. D'Angelo, S.R. Harms, M. Landry.Analysis and interpretation of the data: L. D'Angelo.Drafting of the article: M.C. Greenlee, S.R. Harms, A.A. Kuo, M. Landry, M. McManus, G.M. Talente, P. White.Critical revision for important intellectual content: M.C. Greenlee, L. D'Angelo, A.A. Kuo, M. Landry, G.M. Talente.Final approval of the article: M.C. Greenlee, L. D'Angelo, S.R. Harms, A.A. Kuo, M. Landry, M. McManus, G.M. Talente, P. White.Administrative, technical, or logistic support: S.R. Harms.Collection and assembly of data: M. Landry.This article was published at Annals.org on 29 November 2016.* For members of the ACP CSS Pediatric to Adult Care Transition Initiative Steering Committee, see the Appendix. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEnhancing the Role of Internists in the Transition From Pediatric to Adult Health Care Sonya Dhanvanthari , Gina Riccardi , Rohit Shah , Varun Shetty , and Henry Ng Enhancing the Role of Internists in the Transition From Pediatric to Adult Health Care M. Carol Greenlee , Lawrence D'Angelo , Stacey R. Harms , Alice A. Kuo , Michael Landry , Margaret McManus , Gregg M. 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