Date of Award

4-22-2020

Document Type

Doctoral Dissertation - Restricted (NYMC/Touro only) Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Kenneth Knapp

Second Advisor

Tricia Patrick

Third Advisor

Fredric Daum and Rosemarie Arena

Abstract

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.

Additional Files
Kerry-O-Watson-Thesis-Permission-Form.pdf (176 kB)
Dissertation Permission Form
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