Affiliations: [a] Center for Transition Medicine, Baylor College of Medicine, Houston, TX, USA | [b] Texas Children’s Hospital Spina Bifida Transition Clinic, Houston, TX, USA | [c] Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Correspondence:
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Corresponding author: Ellen Fremion, Baylor College of Medicine, Center for Transition Medicine, One Baylor Plaza, M.S. 620, Houston, TX 77030, USA. Tel.: +1 832 822 4777; Fax: +1 832 835 4812; E-mail: Ellen.fremion@bcm.edu.
Abstract: Providing comprehensive transition care for adolescents and young adults with spina bifida (AYASB) requires a structured approach to addressing chronic condition management, self-management, care coordination, and health care navigation that is adaptable to the various levels of cognitive ability, physical function, and family/community environments within the population. This commentary (1) highlights AYASB transition program needs identified in the literature and within a local community, (2) analyzes advantages and limitations of published AYASB transition care models in addressing these needs, (3) demonstrates how a spina bifida (SB) transition clinic used the Chronic Care Model (CCM) to develop a comprehensive AYASB transition program, and (4) examines the potential feasibility in adapting this model to other SB clinics. A SB-specific transition clinic based on the CCM model facilitates the complex chronic care management and transition planning for AYASB. Further study is needed to evaluate health care outcomes using the CCM for SB transition.
Keywords: Spina bifida, adolescence, transition to adult care, transition clinic model, chronic care model
