Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Abstract

While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults. Lay abstract There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the “medical home”. The medical home is not a residential home, but a system where a patient’s healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of 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.…”

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

“…CAST is a PCMH that was designed in partnership with autistic adults and their caregivers (e.g., parents, legal guardians, adult siblings) to minimize barriers to care. 2 Prior cross-sectional observational studies have shown that CAST patients have significantly better continuity of care 25 and higher satisfaction with care 26 than national samples of autistic adults. Supplemental Material 1 provides additional information about CAST.…”