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

2. 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?

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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.

12. 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.

13. 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

14. 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

15. 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!