Transition Care Pearls
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Transition Care Transition Care Pearls Pearls Alice Kuo, MD, PhD Alice Kuo, MD, PhD Med-Peds Rounds Med-Peds Rounds 12 January 2011 12 January 2011
description
Transition Care Pearls. Alice Kuo, MD, PhD Med-Peds Rounds 12 January 2011. Recall Our Model. Transition Preparation 4 components: Adult providers (including primary care) Insurance status Self-care skills Education/employment. Another Way to Think About It. Self-care skills. - PowerPoint PPT Presentation
Transcript of Transition Care Pearls
Transition Care Transition Care PearlsPearls
Alice Kuo, MD, PhDAlice Kuo, MD, PhD
Med-Peds RoundsMed-Peds Rounds
12 January 201112 January 2011
Recall Our ModelRecall Our Model
Transition Preparation 4 Transition Preparation 4 components:components: Adult providers (including primary Adult providers (including primary
care)care) Insurance statusInsurance status Self-care skillsSelf-care skills Education/employmentEducation/employment
Another Way to Think Another Way to Think About ItAbout It
Education/employment
Insurance status
Access to adult health providers
Self-care skills
Successful Transition!!
Self-care skillsSelf-care skills
Education/employment
Insurance status
Access to adult health providers
Self-care skills
Successful Transition!!
• How much responsibility can the patient take for his/her care?
• What is this patient’s trajectory to independence?
• What will it take to maximize the trajectory?
Education/employmentEducation/employment
Education/employment
Insurance status
Access to adult health providers
Self-care skills
Successful Transition!!
• What is this patient’s educational attainment goal? Trade school, junior college or 4-year university?
• Government jobs come with good benefits
• Big companies often have better benefits than smaller ones
Insurance statusInsurance status
Education/employment
Insurance status
Access to adult health providers
Self-care skills
Successful Transition!!
Ways for adults to have health insurance:
• Parents’ insurance (until 26)
• Medicaid or Medicare
• Student health
• Employer-sponsored
• [Self-purchased commercial insurance]
• [Military/veterans]
Access to Health Access to Health ProvidersProviders
Education/employment
Insurance status
Access to adult health providers
Self-care skills
Successful Transition!!
• UCLA vs. closer to home
• Don’t forget about primary care
• Mental health is tough
• Specialists depend on insurance and access
Patient-MD MatchPatient-MD Match Although many patients eligible to be Although many patients eligible to be
seen at VFC, many not willing to go to seen at VFC, many not willing to go to a free clinica free clinic
SMIMP: Medi-Cal able to be seen in SMIMP: Medi-Cal able to be seen in resident clinics—schedule with one of resident clinics—schedule with one of the internsthe interns
Your assessment of self-care skills Your assessment of self-care skills should include evaluation of how should include evaluation of how much pt and/or family can do for much pt and/or family can do for themselves (don’t have to provide themselves (don’t have to provide case management for every patient)case management for every patient)
How Much Primary Care How Much Primary Care Should We Provide?Should We Provide?
Depends on how much of a bridge we areDepends on how much of a bridge we are If pt has no PMD and has not yet connected If pt has no PMD and has not yet connected
with someone, we should refill medswith someone, we should refill meds Connecting with mental health is role of Connecting with mental health is role of
PMD, despite impact of mental health on self-PMD, despite impact of mental health on self-care skillscare skills
We are a consultative TCP model, not We are a consultative TCP model, not primary care modelprimary care model
If extensive primary care is needed, refer to If extensive primary care is needed, refer to ourselves at Simms or SMIMPourselves at Simms or SMIMP
Case #1Case #1
20 yo with SLE 20 yo with SLE stable on three stable on three medsmeds
Sophomore at Sophomore at Azusa Pacific Azusa Pacific UniversityUniversity
Case #1Case #1 20 yo with SLE stable 20 yo with SLE stable
on three medson three meds Sophomore at Azusa Sophomore at Azusa
Pacific UniversityPacific University
Self-care skills, Self-care skills, education, and insurance education, and insurance status all taken care ofstatus all taken care of
Preferred doctors closer Preferred doctors closer to schoolto school
Mom had internist who Mom had internist who would be her PMDwould be her PMD
Either call insurance Either call insurance card for rheumatologist card for rheumatologist or ask PMD to refer to or ask PMD to refer to someonesomeone
Talked about grad Talked about grad school—increase school—increase likelihood of getting job likelihood of getting job with benefitswith benefits
Case #2Case #2
25 yo with mental 25 yo with mental retardation, retardation, chromosome 18 chromosome 18 deletion, seizure deletion, seizure disorderdisorder
Osteopenia on Osteopenia on DEXA, on Vit DDEXA, on Vit D
Has straight Medi-Has straight Medi-CalCal
Dad works at a Dad works at a bakery, is 60 yobakery, is 60 yo
Case #2Case #2 25 yo with mental 25 yo with mental
retardation, retardation, chromosome 18 chromosome 18 deletion, seizure deletion, seizure disorderdisorder
Osteopenia on DEXA, Osteopenia on DEXA, on Vit Don Vit D
Has straight Medi-CalHas straight Medi-Cal Dad works at a Dad works at a
bakery, is 60 yobakery, is 60 yo
Primary care: Simms Primary care: Simms vs. SMIMPvs. SMIMP
Neurology: county vs. Neurology: county vs. UCLA fellowsUCLA fellows
Recommend adult-Recommend adult-appropriate Vit D dose appropriate Vit D dose + calcium+ calcium
When Dad turns 65 When Dad turns 65 and gets Medicare, pt and gets Medicare, pt may be able to apply may be able to apply for dependent benefitsfor dependent benefits
Case #3Case #3
STAT consultSTAT consult 21 yo Turner’s 21 yo Turner’s
syndrome on her syndrome on her birthday; would birthday; would lose CCS next daylose CCS next day
UndocumentedUndocumented Parents are Parents are
migrant farm migrant farm workers in workers in BakersfieldBakersfield
Case #3Case #3 STAT consultSTAT consult 21 yo Turner’s 21 yo Turner’s
syndrome on her syndrome on her birthday; would birthday; would lose CCS next daylose CCS next day
UndocumentedUndocumented Sophomore in Sophomore in
community collegecommunity college Parents are migrant Parents are migrant
farm workers in farm workers in BakersfieldBakersfield
Encourage pt to try to Encourage pt to try to get job with benefitsget job with benefits
Safety net systemSafety net system Community clinic for Community clinic for
primary care, medsprimary care, meds County medical center County medical center
for specialty carefor specialty care Had been seeing peds Had been seeing peds
endo since age 14; no endo since age 14; no one talked with her one talked with her about infertilityabout infertility
Case #4 (trainwreck)Case #4 (trainwreck)
20 yo with sickle 20 yo with sickle cell and asthmacell and asthma
Multiple ER visits Multiple ER visits for pain crisesfor pain crises
Complicated social Complicated social situation [discuss]situation [discuss]
Case #4 (trainwreck)Case #4 (trainwreck) 20 yo with sickle 20 yo with sickle
cell and asthmacell and asthma Multiple ER visits Multiple ER visits
for pain crisesfor pain crises Complicated social Complicated social
situation [discuss]situation [discuss]
Tried to identify PMD Tried to identify PMD and hematologist in and hematologist in SF ValleySF Valley
Had to help pt switch Had to help pt switch from Medi-Cal HMO from Medi-Cal HMO to straight Medi-Calto straight Medi-Cal
After 1 yr, pt decides After 1 yr, pt decides to keep MDs at UCLAto keep MDs at UCLA
Pt self-motivated to Pt self-motivated to go to school and to go to school and to get jobget job
Overall Approach in TCP Overall Approach in TCP ClinicClinic
Review chart on arrivalReview chart on arrival Go over two forms with patient—self-care Go over two forms with patient—self-care
skills rating and patient questionnaireskills rating and patient questionnaire Present to attendingPresent to attending Come up with plan, focused on four Come up with plan, focused on four
components of the TCP modelcomponents of the TCP model DICTATE your note; any TCP clinic note should DICTATE your note; any TCP clinic note should
be able to serve as handoff note to a new PMD; be able to serve as handoff note to a new PMD; remember to cc referring physicianremember to cc referring physician
Goal of entire encounter should be 45-60 Goal of entire encounter should be 45-60 minutesminutes
Ways to Save TimeWays to Save Time
Patient questionnaire provides most if not Patient questionnaire provides most if not all information for template of TCP noteall information for template of TCP note
Focus on connecting pt with a PMDFocus on connecting pt with a PMD Don’t need to look for individual Don’t need to look for individual
specialists all over L.A. county or beyondspecialists all over L.A. county or beyond Pt needs to take responsibility for care as Pt needs to take responsibility for care as
wellwell Bring back for return visits if necessary; Bring back for return visits if necessary;
discharge from clinic if possibledischarge from clinic if possible
TCP and Med-PedsTCP and Med-Peds
Hot topic this year on interview trailHot topic this year on interview trail Specialization within med-pedsSpecialization within med-peds Ability to bill as specialistsAbility to bill as specialists Next steps:Next steps:
Need to work with pediatric specialistsNeed to work with pediatric specialists More education for pediatrics to do More education for pediatrics to do
better transition preparation themselvesbetter transition preparation themselves More education for internists to receive More education for internists to receive
these patientsthese patients
Questions? Discussion?Questions? Discussion?
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