Evaluating transitional care practices for adolescents with chronic conditions in two Dutch university hospitals: A mixed-methods study

BACKGROUND: The transition from paediatric to adult healthcare represents a critical period for young people with chronic conditions. Although structured transitional care is recommended both nationally and internationally, its implementation remains inconsistent across healthcare settings. This study aimed to examine the implementation of transition interventions in two Dutch university hospitals and to identify determinants shaping their implementation in routine practice.

METHODS: This convergent mixed-methods study evaluated 50 medical specialties across paediatric and/or adult services. Ninety healthcare professionals participated. Data were collected through semi-structured interviews and a structured verbal questionnaire assessing the presence of key transition interventions across preparation, transfer, and post-transfer integration phases. Interview data were analysed thematically, questionnaire data descriptively, and integrated findings were used to assess adherence to principles of transitional care.

RESULTS: Implementation varied across specialties and phases of care. A transition coordinator was reported in 31% of medical specialties. Individual transition plans were reported in 31% of paediatric services and 18% of adult services. A warm handover was reported in 53% of specialties. Key facilitators included defined roles, cross-boundary collaboration, and organisational support. Barriers comprised limited resources, insufficient adult-care involvement, and a lack of routinised processes. Principle-based scoring indicated mid-range implementation across specialties in both hospitals (range 8-27 on an 8-32 scale; median 14.5, IQR 12-20).

CONCLUSIONS: Transitional care was implemented inconsistently across medical specialties in both hospitals, with the largest gaps occurring after transfer to adult care. Stronger organisational support, explicit coordination, routinised paediatric-adult care collaboration, and shared accountability may improve consistency and developmental appropriateness.