Pediatric Chronic Illness Transition Care

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 in excess of 10% of young adults, compared to approximately 1% of young adults prior to these advances in childhood care. 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 spending.

A conservative estimate of cost savings from national implementation of the CERC transitions model is $200 million dollars in direct healthcare spending per year. Annual savings are likely to grow as more and more children with complex chronic illness survive into adulthood.

The key elements of the model include:

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.