NYMC Student Theses and Dissertations

Adults with I/DD and Secondary Gastrointestinal Conditions: An Analysis of Healthcare Utilization Patterns and Clinical Characteristics, and Implications for Patient-Centered Delivery Innovations

Kerry Watson
Kenneth Knapp, New York Medical College
Patricia Patrick, Westchester Institute for Human Development
Fredric Daum, SUNY Stony Brook
Rosemarie Arena, Westchester Institute for Human Development


An innovation imperative exists to transform care provision and research design for populations with intellectual and developmental disabilities (I/DD). This study’s 2 objectives addressed this innovation imperative. Latent Class Analysis (LCA) was used to classify, describe, and compare clinically heterogeneous subpopulations underlying an adult I/DD population with secondary gastrointestinal (GI) conditions. An infrastructure assessment was used to determine the extent of GI-focused care provided at WIHD that was aligned with the PCMH model for disorders of gut-brain interaction (DGBI-PCMH). LCA results revealed two subgroups underlying the single study sample: a High Comorbidity Burden subgroup (38%), and a High GI Burden subgroup (62%). The former subgroup had higher probabilities of obesity, hypertension, hypercholesterolemia, diabetes, epilepsy/seizure disorder, being verbal, and was more likely to take six of the eleven medications linked to inducing GI disorders. The latter subgroup was more likely to sustain 3 of the 4 GI diagnosis categories studied and to have obsessive-compulsive disorder. DGBI-PCMH assessment revealed the need for a physician champion, preventive care protocols, and team-based care dynamics. Reconstructing care protocols to target each subgroup’s different healthcare profiles by using a GI physician champion, team-based care, and by incorporating the biopsychosocial model to restructure care protocols can facilitate improved healthcare delivery and quality of life outcomes for adult-GI patients serviced by WIHD.