Affiliations: Division of Internal Medicine and Pediatrics, Houston,
TX, USA | Baylor College of Medicine, Houston, TX, USA
Note: [] Corresponding author: Cynthia Peacock, Baylor College of
Medicine, 1 Baylor Plaza (MS: BCM 620), Houston, TX 77030, USA. Tel.: +1 713
798 0104; Fax: +1 713 798 0198; E-mail: cpeacock@bcm.edu
Abstract: PURPOSE: 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.
Keywords: Transition to adult care, chronic illnesses/conditions, adolescents, young adults, primary care, intellectual disabilities, cerebral palsy, spina bifida, down syndrome, autism
