A home base for young adults: evidence that a primary care-embedded multidisciplinary rheumatology transition clinic improved care utilization and engagement.
OBJECTIVE: To determine care outcomes and utilization patterns for rheumatology patients seen in a multidisciplinary Young Adult Rheumatology Clinic (YARC) with embedded primary care, compared to patients directly transferred (DT) from pediatric to adult rheumatology clinics. METHODS: Data were collected two years prior to and three years after transfer for YARC and similarly aged DT patients. Difference-in-differences were calculated for show rates and acute care utilization before and after transfer. Vaccination and contraception uptake were compared. Trends in anxiety and depressive symptoms were examined for YARC patients using PHQ and GAD screeners. Semi-structured interviews were conducted with a subset of YARC patients to understand perceptions of the clinic's impact. RESULTS: Twenty-two patients enrolled in the YARC were included in the study, 13 of whom have systemic lupus erythematosus (SLE), alongside 12 directly transferred SLE patients. The show rate for patients seen in the YARC increased by 14%, whereas the DT show rate decreased by 13%. Emergency department visits and hospital admissions increased post-transfer only in the DT group post-transfer. YARC patients were more likely to be up to-date on TDaP and HPV vaccines and to use highly effective contraception. Anxiety and depressive symptoms remained stable post-transfer in YARC patients. Patients also reported appreciating the efficiency benefits of the patient-centered medical home (PCMH) model inherent in the YARC. CONCLUSION: Compared with traditional transfer to adult rheumatology, the YARC reduced acute care utilization and improved the no-show rate. Additionally, young adult rheumatology patients valued the PCMH model and were more likely to adhere to recommended preventive care practices.
