Effects of a Specialized Primary Care Facility on Preventive Service Use Among Autistic Adults: a Retrospective Claims Study

Abstract

BACKGROUND:While in some studies, the patientcentered medical home has been linked with increased receipt of preventive services among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. OBJECTIVE: To compare the receipt of preventive services by patients at a patient-centered medical home specifically designed for autistic adults (called the Center for Autism Services and Transition "CAST") to US national samples of autistic adults with private insurance or Medicare. DESIGN: Retrospective study of medical billing data. SAMPLE:The study sample included CAST patients (N = 490) who were propensity score matched to Medicareenrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years old, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES: The primary outcome measure was the receipt of any preventive service, as defined by the Medicare Learning Network and AAPC (formerly the American Academy of Professional Coders). Secondary outcome measures included receipt of specific preventive service types (i.e., general health and wellness services, screenings, counseling and therapies, vaccinations, and sexual/reproductive health services). KEY RESULTS: CAST patients had significantly greater odds of receiving any preventive service than Medicareenrolled (OR = 10.3; 95% CI = 7.6-13.9) and privately insured (OR = 3.1; 95% CI = 2.3-4.2) autistic adults. CAST patients were also significantly more likely to receive screenings and vaccinations than either Medicare beneficiaries (screenings OR = 20.3; 95% CI = 14.7-28.0; vaccinations OR = 5.5; 95% CI = 4.3-7.0) or privately insured beneficiaries (screenings OR = 2.0; 95% CI = 1.6-2.5; vaccinations OR = 3.3; 95% CI = 2.6-4.1). CONCLUSIONS: Autistic adults receiving care through CAST were significantly more likely to recieve preventive care services than national samples of autistic adults. Future comparative effectiveness trials are needed to rigorously assess the impact of primary care-based initiatives to improve care for autistic adults.

“They Looked at Me as a Person, Not Just a Diagnosis”: A Qualitative Study of Patient and Parent Satisfaction with a Specialized Primary Care Clinic for Autistic Adults

“…Among other clinical populations, the co-location of specialized care within primary care settings has been linked with greater patient and provider satisfaction 14 as well as improved health outcomes, such as fewer emergency department visits. 15 In our prior work, we found that autistic adults who received their health care through one primary care-embedded, specialized clinic designed with and for autistic adults had: (1) significantly higher levels of satisfaction with care 16 ; (2) better continuity of care 17 ; and (3) greater preventive care utilization 18 than national samples of autistic adults. The purpose of the present study was to add qualitative context to our prior quantitative work by characterizing factors that increased or decreased satisfaction with care among autistic adults and parents of autistic adults who receive care through this specialized clinic.…”

“…19,20 We aimed to characterize factors that increased or decreased satisfaction with health care among autistic adults and parents of autistic adults who received care through a specialized autism clinic called the Center for Autism Services and Transition (CAST). While CAST has been described in detail elsewhere, 9,18 we provide a brief overview here. CAST is located in a suburban area of Columbus, OH, USA, and is embedded in a larger primary care clinic.…”

Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis

“…To better understand autistic adults' preventive service use, it is important that future studies examine a wider array of preventive services delivered in a variety of settings. Encouragingly, recent evidence indicates that some primary care delivery models may increase receipt of dozens of preventive services among autistic adults (Hand et al, 2021). Such delivery models are critical to replicate as they may promote delivery of higher quality primary care for autistic adults and may reduce their use of tertiary healthcare services, particularly for health conditions that are sensitive to ambulatory and preventive care.…”