Implementation of an academic adult primary care clinic for adolescents and young adults with complex, chronic childhood conditions.
OBJECTIVE
For the growing population of adolescents and young adults with chronic childhood conditions (AYACCC), the transition from pediatric to adult health care contains many barriers and appropriate adult-based health care options are few. In 2005, the Transition Medicine Clinic (TMC), affiliated with Baylor College of Medicine, was established in Houston, Texas. It is one of the first clinics of its kind and serves AYACCC by providing a medical home in the adult health care system. This article describes the development and implementation of the TMC, its patient population and their resource needs, and lessons learned along the way.


METHODS
We retrospectively examined the electronic health records of 332 patients that established care in the TMC prior to July, 2011. Data were collected describing multiple facets of the patient population and their resource utilization, both in aggregate and for several subgroups.


RESULTS
The most common primary diagnoses were cerebral palsy, spina bifida, Down syndrome, genetic conditions, and autism. Patient characteristics demonstrated the unique challenges faced by the clinic: more than 80% received Medicaid, 65% had an intellectual disability, 41% used a wheelchair, and most had multiple secondary diagnoses. Compared to typical adult primary care practices, a larger amount of clinical resources, medical technology, and specialists were used, especially for those with the most medically fragile conditions.


CONCLUSIONS
The results suggest that a clinic serving AYACCC requires physicians and support staff familiar with the aforementioned issues that are willing to spend a considerable amount of time and effort outside of routine office visits in health care coordination. Because many of these patients are covered by publicly funded health insurance, enhanced reimbursement must be considered to keep clinics like the TMC self-sustaining. Future research is needed to demonstrate adult-based care delivery models, develop clinical care guidelines, and evaluate key clinical outcomes.
Baylor College of Medicine, Houston, TX, USA.
John C
JC
Berens
Division of Internal Medicine and Pediatrics, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA.
Cynthia
C
Peacock
D000046:Academic Medical Centers / Q000458:organization & administration*; D000293:Adolescent; D017668:Age of Onset; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D020380:Needs Assessment / Q000706:statistics & numerical data; D015404:Nursing Methodology Research; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D060305:Transition to Adult Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Transition to adult care; adolescents; autism; cerebral palsy; chronic illnesses/conditions; down syndrome; intellectual disabilities; primary care; spina bifida; young adults