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Six Core Elements of Health Care Transition™

Frequently Asked Questions

Is there evidence that a structured health care transition (HCT) process results in positive outcomes?
Yes, an updated systematic review of HCT studies published between May 2016 and December 2018 found statistically significant positive outcomes for youth with special health care needs (YSHCN) as a result of a structured transition process.1 The original systematic review examined studies published between 1995 and April 2016 and found similar results.2 Positive outcomes include:
  • Population health: improvement in adherence to care, disease-specific measures, self-care skills, quality of life, and self-reported health
  • Experience of care: increase in satisfaction and reduction in barriers to care
  • Utilization: decrease in time between last pediatric and first adult visit, increase in adult ambulatory visits, and decrease in hospital admissions and length of stay
  1. Schmidt A, Ilango SM, McManus MA, Rogers KK, White PH. Outcomes of pediatric to adult health care transition interventions: An updated systematic review. J Pediatr Nurs. 2020;51:92-107.
  2. Gabriel P, McManus M, Rogers K, White P. Outcome evidence for structured pediatric to adult health care transition interventions: A systematic review. J Pediatrics. 2017;188:263-269.
What are the Six Core Elements of HCT based on?
Got Transition®, the national resource center on HCT, translated the 2011 AAP/AAFP/ACP Clinical Report on HCT for clinical practice and obtained extensive involvement of pediatric, family medicine, and adult clinical and youth/family teams to develop and test the Six Core Elements in many practice settings. The Six Core Elements were tested in Quality Improvement (QI) learning collaboratives (LC) in DC*, MA, NH, WI, MN, and CO using the research-based Institute for Healthcare Improvement Breakthrough Series QI research approach.1 The learnings from LCs, along with input from transition experts including clinicians, youth, young adults, and families, were incorporated into the Six Core Elements. In 2014, the Six Core Elements 2.0 packages were released for different clinical settings (pediatrics, family medicine, med-peds, and internal medicine) along with customizable sample tools and measurement options. The Six Core Elements were incorporated into the updated 2018 AAP/AAFP/ACP Clinical Report guidance on HCT2 and further feedback was obtained from over 300 clinical and family transition experts to produce the updated Six Core Elements 3.0 in 2020.
  1. The breakthrough series: IHI's collaborative model for achieving breakthrough improvement. Cambridge, MA: Institute for Healthcare Improvement; 2003.
  2. White PH, Cooley WC, Transitions Clinical Authoring Group, American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2018;142(5).
How do I start implementing the Six Core Elements?
Please go to the Implementation page to find implementation guides that walk through each of the core elements with suggested quality improvement methods and examples.
Where have the Six Core Elements been shown to improve the HCT process?
The Six Core Elements, a structured transition process, has been used in many different models of HCT and applied in many different systems of care to improve their HCT processes. Examples of some of these systems are: primary care1 and subspecialty clinics,2 Medicaid managed care,3 professional organizations,4 care coordination programs sponsored by state Title V programs for children with special needs,5 children's hospitals,6 federally qualified health centers,7 school-based health centers,8 and behavioral health care settings.9
  1. McManus M, White P, Barbour A, Downing B, Hawkins K, Quion N, et al. Pediatric to adult transition: a quality improvement model for primary care. J Adolesc Health. 2015;56(1):73-78.
  2. Jones MR, Robbins BW, Augustine M, Doyle J, Mack-Fogg J, Jones H, et al. Transfer from pediatric to adult endocrinology. Endocr Pract. 2017;23(7):822-830.
  3. McManus M, White P, Pirtle R, Hancock C, Ablan M, Corona-Parra R. Incorporating the Six Core Elements of Health Care Transition Into a Medicaid Managed Care Plan: Lessons Learned From a Pilot Project. J Pediatr Nurs. 2015;30(5):700-713.
  4. Williams MA, van der Willigen T, White PH, Cartwright CC, Wood DL, Hamilton MG. Improving health care transition and longitudinal care for adolescents and young adults with hydrocephalus: report from the Hydrocephalus Association Transition Summit. J Neurosurg. 2018;10.3171/2018.6.JNS188:1-9.
  5. Ilango S, McManus M, Beck D. Health Care Transition in State Title V Programs: A review of 2018 block grant applications and recommendations for 2020. Washington, DC: The National Alliance to Advance Adolescent Health/Got Transition; September 2018.
  6. Hickam T, White P, Modrcin A, McManus M, Cox K. Implementing a nationally recognized pediatric-to-adult transitional care approach in a major children's hospital. Health and Social Work. 2018;43(1):3-5.
  7. Jones MR, Hooper TJ, Cuomo C, Crouch G, Hickam T, Lestishock L, et al. Evaluation of a health care transition improvement process in seven large health care systems. J Pediatr Nurs. 2019;47:44-50.
  8. White P, Caskin A, Aramburu M, Harwood C, McManus M. (2017). Adapting the Six Core Elements of Health Care Transition for Use in School-Based Health Clinics and School Health Education. Poster presented at 9th Annual Health Care Transition Research Consortium Conference. Houston, TX.
  9. Ilango S, Osborn R, McManus M, White P. (2019). Piloting Health Care Transition Supports in School-Based Mental Health Programs. Poster presented at the 11th Annual Health Care Transition Research Consortium Conference. Houston, TX.
Can I customize the Six Core Elements?
Yes, all the Six Core Elements sample tools are free and customizable, and your practice's or system's logo can be put on them. Click here to obtain permission and a customizable copy of the tools.
Are the Six Core Elements available in Spanish?
Yes! The Six Core Elements and several other resources have been translated into Spanish. Click here to find those materials.
Can the Six Core Elements be incorporated into electronic medical records?
Yes, many systems have incorporated the Six Core Elements into their electronic medical records (EMR). Please contact your health care system Information Technology department for assistance with specific EMR questions. Due to EMR proprietary rules, Got Transition is unable to provide specific assistance or share best practices.
Can health care transition services be reimbursed?
Yes, with the American Academy of Pediatrics, Got Transition each year creates an updated coding and reimbursement tip sheet with sample vignettes on HCT. See the most updated tip sheet here.
Can health care transition implementation and impact be measured?
Yes, there are Got Transition tools to measure improvements in process and experience in care outcomes.1 See measurement options here.
  1. Prior M, McManus M, White P, Davidson L. Measuring the "triple aim" in transition care: a systematic review. Pediatrics. 2014;134(6):e1648-e1661.
Have the Six Core Elements been customized for specific conditions?
Yes, Got Transition's tools have been customized by many groups. One such group is the American College of Physicians Council on Subspecialty Societies as part of their High Value Care initiative. This group customized the Six Core Elements' transition readiness assessment, self-care assessment, and medical summary for selected conditions (teams from each specialty included representatives from pediatric and adult professional and patient groups):
  • General Medicine (Intellectual and Developmental Disabilities, Physical Disabilities)
  • Hematology (Hemophilia, Sickle Cell Disease)
  • Cardiology (Congenital Heart Disease)
  • Endocrine Society (Diabetes, Turner Syndrome, Chronic Granulomatous Disease)
  • Neurology (Epilepsy)
  • Nephrology (End Stage Renal Disease)
  • Rheumatology (Juvenile Idiopathic Arthritis, Systemic Lupus Erythematosus)
Other professional groups are developing HCT tools for those with cerebral palsy, spina bifida, and hydrocephalus.
Can I use the Six Core Elements as part of NCQA certification?
Yes, an updated tip sheet on how to obtain NCQA certification by using the Six Core Elements process and sample tools can be found here.
Is Got Transition's Transition Readiness Assessment validated?
No, Got Transition's transition readiness assessment is not validated either internally or externally. It is meant to be customized to the needs of the patients in a given practice/system. There are other readiness assessments available that are internally validated, but none of the readiness assessments currently available have been shown to predict successful transition outcomes (external validation).

The purpose of the readiness assessment and the self-care skills assessment is to highlight areas for discussion and education around self-care skills for the youth/young adult. The readiness assessment should not stand alone as the only component of a transition process but should rather be part of a process of assessment, education, and reassessment that will improve the youth/young adult's ability to manage their own health and health care.
What are the reading levels of the Six Core Elements?
The reading levels of the tools are as follows, according to Flesch-Kincaid readability tests:
Tool Reading level
Pediatric transition and care policy/guide 7th grade
Family Medicine transition and care policy/guide 7th grade
Adult transition and care policy/guide 6th grade
Transition readiness assessments for youth and parents/caregivers 5th grade
Self-care assessment 5th grade
Welcome and orientation 7th grade
Feedback surveys for youth, young adults, and parents/caregivers 8th grade
How can I acknowledge that I have customized the Six Core Elements?
The following attribution statement must appear on every page, in all reproductions, of the Got Transition Work:

The Six Core Elements of Health Care Transition™ are the copyright of Got Transition®. This version of the Six Core Elements has been modified and is used with permission.
How should I cite the Six Core Elements?
White P, Schmidt A, Shorr J, Ilango S, Beck D, McManus M. Six Core Elements of Health Care Transition™ 3.0. Washington, DC: Got Transition, The National Alliance to Advance Adolescent Health; July 2020.

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