Drs White and Cooley are leaders in the field of care transition whose work I highly respect. They are correct that the solution to providing care to older adolescents and young adults with chronic health problems who have required pediatric subspecialty care is multifaceted. My suggestion that pediatric subspecialists continue to care for their patients beyond some arbitrary age cutoff was intended to add to the list of available options. If the origin of the need for transition for some children is the ending of care by pediatric subspecialists, it then makes sense to go to the source for a solution. I am aware that providers of care for children with cystic fibrosis have developed specialty clinics that successfully maintain high-quality care over the life course. Training adult cardiologists to care for adults with congenital heart disease is surely one approach to transitioning care for this population, but creating new subspecialties for every chronic or complex childhood condition when pediatric subspecialists already exist seems inefficient. Their misreading of my commentary also led Drs White and Cooley to minimize the scope of the problem addressed by my essay. Indeed, complex congenital conditions comprise a small proportion of youth with special health care needs, but the number with congenital or complex conditions is substantially larger, especially when developmental conditions are included. Care transition remains a concern for large numbers of families with children and youth with special health care needs, ranking just below subspecialty access and care coordination as problems they encounter. Got Transition/Center for Health Care Transition Improvement is a valuable resource for these families and for their health care providers.
Conflict of Interest:
- Copyright © 2015 by the American Academy of Pediatrics