Project Description:
The Primary Care Clinic for Youth and Adults with Intellectual/Developmental Disabilities is in its 9th year. Integrated into the family medicine teaching clinic of the University of Arizona's Department of Family & Community Medicine, the clinic provides coordinated primary health care to patients with intellectual/developmental disabilities from ages 15 and above. Based on the "medical home" model, clinicians works in partnership with the family/patient to assure that all of the medical and non-medical needs of the patient are met. Through this partnership, the clinician can help the family/patient access and coordinate specialty care, educational services, out-of-home care, family support, and other public and private community services that are important to the overall health of the child/youth and family.
Elements include enhanced access to care, physical accessibility, case management, staff/provider education, and quality management . Dr. Bassford is the lead physician and provides quality assurance and clinical oversight for the 85-110 patients who may be enrolled at any time.
The program case manager is the first point of contact for patients an d their families/support people, and facilitates the first visit, assures transfer of records, assists with scheduling of appointments at the FMC, assists with access to sub-specialists, works with community service providers and Division of Developmental Disabilities to meet patient needs, and attends family medicine visits with patients.
This latter is to assist with behavioral/social issues identified at the visit, as well as provide modeling of patient centered care and person first language to our physical providers, many of who are residents.
Dr. Bassford provides resident education, and realtime consultation. She and the program case manager staff the panel weekly, and perform chart reviews for preventive examinations. They also provide outreach for annual flu vaccines, educational opportunities through the Sonoran UCEDD, and time-critical information (such as during the recent COVID-19 pandemic).
Each patient has an assigned primary care physician, which may be Dr. Bassford, another FM faculty member, or a FM resident under the supervision of a faculty member.
The program's impact on quality and cost has been evaluated through an analysis of Medicaid insurance claims for all enrolled IDD patients Arizona. Patients enrolled in our program, when Compared to sample of medicaid enrollees match day diagnosis, had twice as many Evaluation and Management (E/M) visits as the comparison group, and forty percent lower non-E/M professional visits. This indicated improved access to primary and cognitive care, and fewer visits for diagnostic/therapeutic procedures. This translated to a cost savings of $473 per member per month, which increased to $520 when controlled for age/gender/race-ethnicity/chronic health conditions, and IDD diagnoses.
Additionally, the program anchors educations opportunities through sub-internships for UA undergraduate students (Colleges of Science and Public health) and a required curriculum in Developmental Medicine for the South Campus Family Medicine residency. This latter includes didactic sessions, support for resident care of patients with IDD in the clinic, as described above, supervised resident home visits to patients with IDD, and resident visits to community sites relevant to the care of their patients.
While case management services were initially supported by the Sonoran Center, these are now supported by funding through Banner Medical Group.
Keyword(s):
Clinical Care, Developmental Disabilities, Medical Home, Preventive Services, Social Determinants of Health, youth adult medical home
Core Function(s):
Training Trainees, Performing Direct and/or Demonstration Services, Performing Research or Evaluation, Developing & Disseminating Information
Target Audience:
Students/Trainees (long or intermediate trainees), Professionals and Para-Professionals, Family Members/Caregivers, Adults with Disabilities
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Disadvantaged Circumstances
