ABSTRACT

I. Introduction Investments in cystic fibrosis (CF) research and care have produced marked improvements in available treatments, the quality of life, and survival. These changes have progressively increased the number of adults with CF, and have challenged the CF community to deal with the medical and social issues related to maturation and adulthood. Perceptive caregivers at Dartmouth College, the University of Pittsburgh, the University of North Carolina, and other institutions recognized these needs and started the first adult CF programs in the early 1980s. Issues associated with transition from pediatric to adult health care were identified and addressed on the basis of local needs and resources. Transition tasks and strategies have been addressed in symposia, workshops, short courses, and consultation clinics at every North American CF Conference since 1987. A 1997 meeting of CF center directors defined four adult CF program models, and mandated that all CF centers with more than 40 adults have an accredited adult CF program by 2000. The CF Foundation has fostered this mandate through administrative funding for adult care, workshops, mentoring programs, research and clinical fellowships, and support for faculty development through the Program for Adult Care Excellence (PACE) grants. This chapter summarizes the current goals, knowledge, and methods for planning effective transition by discussing its timing, challenges, and current models of execution. The progress in these important tasks provides a sound basis for ongoing improvement. CF provides a model for health care transition in diseases that were once limited to childhood, but now include large numbers of patients who have significant or normal adult life spans.