Review article| Volume 64, ISSUE 6, P709-720, June 2019

The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews



      International guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes?


      We included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded.


      Initial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer.


      We found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.


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        • Care Quality Commission (CQC)
        From the pond into the sea: Children's transition to adult services.
        Care Quality Commission (CQC), London2014
        • Kipps S.
        • Bahu T.
        • Ong K.
        • et al.
        Current methods of transfer of young people with type 1 diabetes to adult services.
        Diabet Med. 2002; 19: 649-654
        • Wagner E.
        • Tubman J.
        • Gil A.
        Implementing school-based substance abuse interventions: Methodological dilemmas and recommended solutions.
        Addiction. 2004; 99: 106-119
        • Watson A.
        Problems and pitfalls of transition from paediatric to adult renal care.
        Pediatr Nephrol. 2005; 20: 113-117
        • Sonneveld H.
        • Strating M.
        • van Staa A.
        • Nieboer A.
        Gaps in transitional care: What are the perceptions of adolescents, parents and providers?.
        Child Care Health Dev. 2013; 39: 69-80
        • Royal College of Paediatrics and Child Health
        Bridging the gaps: Health care for adolescents.
        Royal College of Paediatrics and Child Health, London2003
        • Department of Health
        You're Welcome - quality criteria for young people friendly health services.
        Department of Health, London2011
        • American Academy of Paediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine
        A consensus statement on health care transitions for young adults with special health care needs.
        Paediatrics. 2002; 110: 1304-1306
        • Department of Health
        Transition: Moving on well.
        Department of Health, London2008
        • Royal College of Nursing
        Adolescent transition care: RCN guidance for nursing staff.
        Royal College of Nursing, London2013
        • Paul M.
        • Street C.
        • Wheeler N.
        • Singh S.
        Transition to adult services for young people with mental health needs: A systematic review.
        Clin Child Psychol Psychiatry. 2015; 20: 436-457
        • Marris S.
        • Morgan S.
        • Stark D.
        “Listening to patients”: What is the value of age-appropriate care to teenagers and young adults with cancer?.
        Eur J Cancer Care (Engl). 2011; 20: 145-151
        • Kime N.
        • Bagnell A.-M.
        • Day R.
        Systematic review of transition models for young people with long-term conditions: A report for NHS diabetes.
        Leeds Metropolitan University, Leeds2013
        • White M.
        • O'Connell M.
        • Cameron F.
        Clinic attendance and disengagement of young adults with type 1 diabetes after transition of care from paediatric to adult services (TrACeD): A randomised, open-label, controlled trial.
        Lancet Child Adolesc Health. 2017; 1: 274-283
        • Colver A.
        • McConachie H.
        • Couteur A.
        • et al.
        A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions.
        BMC Med. 2018; 16: 111
        • Acuña Mora M.
        • Sparud-Lundin C.
        • Bratt E.
        • Moons P.
        Person-centred transition programme to empower adolescents with congenital heart disease in the transition to adulthood: A study protocol for a hybrid randomised controlled trial (STEPSTONES project).
        BMJ Open. 2017; 7: e014593
        • Mackie A.
        • Rempel G.
        • Kovacs A.
        • et al.
        Transition intervention for adolescents with congenital heart disease.
        J Am Coll Cardiol. 2018; 71: 1768-1777
        • Crowley R.
        • Wolfe I.
        • Lock K.
        • McKee M.
        Improving the transition between paediatric and adult healthcare: A systematic review.
        Arch Dis Child. 2011; 96: 548-553
        • Blum R.
        • Garell D.
        • Hodgman C.
        • et al.
        Transition from child-centred to adult health-care systems for adolescents with chronic conditions.
        J Adolesc Health. 1993; 14: 570-576
        • Sawyer S.
        • Blair S.
        • Bowes G.
        Chronic illness in adolescents: Transfer or transition to adult services?.
        J Paediatr Child Health. 1997; 33: 88-90
        • National Institute for Health and Care Excellence
        NICE guideline NG43. Transition from children's to adults' services for young people using health or social care services.
        National Institute for Health and Care Excellence, London2016
        • van Staa A.
        • van der Stege H.
        • Jedeloo S.
        • et al.
        Readiness to transfer to adult care of adolescents with chronic conditions: Exploration of associated factors.
        J Adolesc Health. 2011; 48: 295-302
        • Fegran L.
        • Hall E.
        • Uhrenfeldt L.
        • et al.
        Adolescents' and young adults' transition experiences when transferring from paediatric to adult care: A qualitative metasynthesis.
        Int J Nurs Stud. 2014; 51: 123-135
        • Sawyer S.
        • Azzopardi P.
        • Wickremarathne D.
        • Patton G.
        The age of adolescence.
        Lancet Child Adolesc Health. 2018; 2: 223-228
        • Tong A.
        • Wong G.
        • Hodson E.
        • et al.
        Adolescent views on transition in diabetes and nephrology.
        Eur J Pediatr. 2013; 172: 293-304
        • Michaud P.
        • Schrier L.
        • Ross-Russel R.
        • et al.
        Paediatric departments need to improve residents' training in adolescent medicine and health: A position paper of the European Academy of Paediatrics.
        Eur J Pediatr. 2018; 177: 479-487
        • DH/Long Term Conditions
        Long term conditions compendium of information.
        ([Internet])3rd ed. Department of Health, London2012 ([cited 2018 Nov 19]. Report No.: 17485. Available at:)
        • Kung J.
        • Chiappelli F.
        • Cajulis O.
        • et al.
        From systematic reviews to clinical recommendations for evidence-based health care: Validation of revised assessment of multiple systematic reviews (R-AMSTAR) for grading of clinical relevance.
        Open Dent J. 2010; 4: 84-91
        • Betz C.
        • Lobo M.
        • Nehring W.
        • Bui K.
        Voices not heard: A systematic review of adolescents' and emerging adults' perspectives of health care transition.
        Nurs Outlook. 2013; 61: 311-336
        • Clarke T.
        • Lusher J.
        Transitioning patients with inflammatory bowel disease (IBD) from adolescent to adult services: A systematic review.
        Frontline Gastroenterol. 2016; 7: 264-270
        • Findley M.
        • Cha E.
        • Wong E.
        • Faulkner M.
        A systematic review of transitional care for emerging adults with diabetes.
        J Pediatr Nurs. 2015; 30: e47-e62
        • Heery E.
        • Sheehan A.
        • While A.
        • Coyne I.
        Experiences and outcomes of transition from pediatric to adult health care services for young people with congenital heart disease: A systematic review.
        Congenit Heart Dis. 2015; 10: 413-427
        • Lyons S.
        • Becker D.
        • Helgeson V.
        Transfer from pediatric to adult health care: effects on diabetes outcomes.
        Pediatr Diabetes. 2014; 15: 10-17
        • Doug M.
        • Adi Y.
        • Williams J.
        • et al.
        Transition to adult services for children and young people with palliative care needs: A systematic review.
        Arch Dis Child. 2011; 96: 78-84
        • Clemente D.
        • Leon L.
        • Foster H.
        • et al.
        Systematic review and critical appraisal of transitional care programmes in rheumatology.
        Semin Arthiritis Rheum. 2016; 46: 372-379
        • Schultz A.
        • Smaldone A.
        Components of interventions that improve transitions to adult care for adolescents with Type 1 diabetes.
        J Adolesc Health. 2017; 60: 133-146
        • Sheehan A.
        • While A.
        • Coyne I.
        The experiences and impact of transition from child to adult healthcare services for young people with type 1 diabetes: A systematic review.
        Diabet Med. 2015; 32: 440-458
        • Hallowell S.
        Setting the stage for development of a program for adolescent heart transplant recipients to transition to adult providers: An integrative review of the literature.
        J Spec Pediatr Nurs. 2014; 19: 285-295
        • Goossens E.
        • Bovijn L.
        • Gewillig M.
        • et al.
        Predictors of care gaps in adolescents with complex chronic condition transitioning to adulthood.
        Pediatrics. 2016; 137: e20152413
        • Betz C.
        • Nehring W.
        • Lobo M.
        Transition needs of parents of adolescents and emerging adults with special health care needs and disabilities.
        J Fam Nurs. 2015; 21: 362-412
        • Farre A.
        • Wood V.
        • McDonagh J.
        • et al.
        Health professionals' and managers' definitions of developmentally appropriate healthcare for young people: Conceptual dimensions and embedded controversies.
        Arch Dis Child. 2016; 101: 628-633
        • Wood D.L.
        • Sawicki G.S.
        • Miller M.D.
        • et al.
        The transition readiness assessment questionnaire (TRAQ): Its factor structure, reliability, and validity.
        Acad Pediatr. 2014; 14: 415-422
        • Lewis S.
        • Noyes J.
        • Mackereth S.
        Knowledge and information needs of young people with epilepsy and their parents: Mixed-method systematic review.
        BMC Pediatr. 2010; 10: 103-119
        • Campbell F.
        • Biggs K.
        • Aldiss S.
        • et al.
        Transition of care of adolescents from paediatric services to adult health services (Review).
        Cochrane Database Syst Rev. 2016; 4: CD009794
        • Skov M.
        • Teilmann G.
        • Damgaard I.
        • et al.
        Initiating transitional care for adolescents with cystic fibrosis at the age of 12 is both feasible and promising.
        Acta Paediatr. 2018; 107: 1977-1982
        • Bloom S.
        • Kuhlthau K.
        • Van Cleave J.
        • et al.
        Health care transition for youth with special health care needs.
        J Adolesc Health. 2012; 51: 213-219