Transitional Care of the Young Adult with Special Health Care Needs

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Presentation transcript:

Transitional Care of the Young Adult with Special Health Care Needs John McCormick, MD, FACP, FAAP USF MED-PEDS March 2012

Hi, you’re my new doctor! How many adult care providers are comfortable caring for pediatric onset illness? What labs, What x-rays, what cancers are they at increased risk for? What about a pediatric cancer survivor. What secondary cancers should you watch for? What changes about their CAD risk?

Transitional Care of the Young Adult A curriculum for MedPed residents in transitional care of the pediatric patient graduating to adult care Based on national and local need

National Need Survey of internists reported lack of knowledge about caring for pediatric-onset illnesses in adults (Pediatrics, 2009) 70% reported lack of training as the primary barrier (Pediatrics, 2009) IM residents are not being trained enough (Hopkins, 2007) Internist survey Resident surveys illustrate a need Large lack of training for internal medicine residents.

Local Need No current curriculum in place at USF Daily patient contact with these patient types Support medical home project Complement pediatric Transitional Care Achieve a goal for Florida HATS MAC MedPeds naturally suited for this topic Can implement easily within our current ambulatory curriculum

How I Developed Curriculum Chose a common transitional topic Did a comprehensive literature search Condensed material into smallest bites Developed test material for pretest, practice and posttest

Design of Curriculum Literature review is condensed and systems-based for organization Pearls-based, as well as EBM as available Focused for adult health care provider Will have pediatric material also for completeness

Goal of Curriculum When faced with a young adult with special healthcare needs in the ambulatory setting, the adult medical provider will be able to competently deliver: preventive care, acute care and chronic disease management, focused on the unique issues of these patients.

Congenital Heart Disease Structure of Transitional Care Curriculum Cancer Survivors Down Syndrome Cerebral Palsy Autism Sickle Cell Disease Deliver Care to Young Adults with Pediatric-Onset Special Needs Congenital Heart Disease Adult ADHD Each unit demonstrates a common disease state with which adult care providers may be unfamiliar due to their categorical adult care training. Each subunit to cover topics on for delivery of preventive care, acute care and chronic disease management issues. Independent Units Pilot Unit is DS Adolescent Maturity Spina Bifida Cystic Fibrosis

Selection of Pilot Unit Down Syndrome unit selected because: common diagnosis accepted guidelines in place evidence of lack of training for adult primary care providers

Pilot Unit Goal As a primary care provider of adult patients with Down Syndrome in an outpatient setting, the resident will competently provide: preventive care, acute care and chronic disease management services.

Pilot Unit Objective Given online written cases of adult patients with Down syndrome in the outpatient setting, the resident will correctly answer 80 percent of multiple choice questions about: preventive care, acute care and chronic disease management issues.

Pilot Unit Content Unique qualities of adult patients with Down Syndrome in terms of providing: Preventive Care Special healthcare screening Routine labs needed Screening x-rays Screening for high risk diseases states Acute Care Increased immune risks Cancer presentations Abuse potential Heart disease Chronic Disease Management Obesity Specialized needs Advance directives Financial and guardianship issues

What I Need From You 100% participation Take a pretest and survey to assess knowledge of DS and comfort level Read over didactics on DS much like in our current curriculum Meet at March 8 MedPed Grand Rounds to discuss material and to go through practice cases Take a posttest and survey

What I Need From You Self learning material is divided into systems with survey/pretest/didactic material Pretest and posttest results are not used against you Test are only to measure efficacy of curriculum All material will be on Moodle It will be fun and a good learning experience Your feedback will be used in future curriculum development projects and is needed to better our program!