Core components of a specialty-wide model of care for transition to adult healthcare services: a systematic review of guidelines.

BACKGROUND: Young people with complex healthcare needs diagnosed in childhood require transition to adult services. Without a structured process for transition, the transfer of care is a challenging event for young people during a vulnerable period of their lives. Loss to follow-up can lead to long-term health complications. We conducted a specialty-wide systematic guideline review of clinical practice guidelines on transition care to assist health organisations to develop a model of care for transition services that can apply across medical specialties by synthesising best-practice international evidence on transition care. METHODS: We searched for clinical practice guidelines published in English from 2015 until the date of searching (August 2024), using Medline/PubMed, Embase and CINAHL. Eligible guidelines included clinical practice guidelines, recommendations and consensus statements whose authors had appraised the quality of underlying evidence and the strength of each recommendation. We appraised guidelines using the Appraisal of Guidelines, Research and Evaluation (AGREE-II) instrument. We used Common Components Analysis to synthesise recurrent elements of recommendations for transition. RESULTS: Fourteen guidelines incorporating evidence appraisal met eligibility criteria, of which 10 were rated as good quality and four as acceptable quality. Just over half of the 14 guidelines were published after 2020 (n=8) and developed by European or UK organisations (n=13). Guidelines represented the specialties of rheumatology, gastroenterology, endocrinology and clinical immunology. Analysis of the recommendations identified 14 core components across recommendations from three to 13 guidelines. The 14 core components covered: involvement, individualising care, early planning, flexible timing, developmental appropriateness, gaining autonomy, healthcare integration, training of staff, coordination of care, gaining familiarity with adult services, documentation, communication, peer support and follow-up. CONCLUSIONS: Using the recommendations of 14 high-quality guidelines, we derived a 'specialty-wide individual transition care and health' (SWiTCH) model, comprising 14 core components for the transition process, spanning preparation, provision of patient-centred care, education for young people and staff, communication and follow-up. Health services may use the SWiTCH model to plan and improve transition care, and organisations may use these specialty-wide principles to assist with improving the consistency and patient-centredness of transition care across services.