A Patient-Centered Multidisciplinary Medical HOME for Persons With Intellectual and Developmental Disabilities.

Innovative models of medical and psychiatric care are necessary to address the complex needs of individuals with intellectual and developmental disabilities (IDD), including autism. This article describes a subspecialty medical home program that has provided accessible, comprehensive, coordinated, patient- and family-centered care for this high-needs, underserved patient population. For more than two decades, the University of Utah Huntsman Mental Health Institute Neurobehavior HOME Program (HOME) has provided primary and behavioral health care for individuals with IDD across their lifespan. Program highlights include integrated medical and behavioral health, a unique funding structure, innovative care delivery, and case management. HOME is a clinical setting as well as a Medicaid managed care plan that has blended medical and psychiatric funding streams. This unique funding structure has demonstrated the fiscal sustainability of focusing care on preventive and proactive management of health concerns and responding to crises using a coordinated and comprehensive approach. Rethinking health care delivery and adopting models that are both financially sustainable and provide quality care to this vulnerable population is greatly needed.

Reflectance spectrophotometer: the dermatologists' sphygmomanometer for skin phototyping?

To date, human skin phototype (SPT) has been determined subjectively by self- or trained investigator assessment using sun burning and/or sun tanning responses, ethnicity, hair, and eye color. This study evaluated objective reflectance spectrophotometer (RS) assessment of SPT in 353 males or females (18-72 years old with Fitzpatrick SPT I-VI) using the area-under-the-intensity curve (AUIC) over the 450-615 nm wavelength interval of reflected light (AUIC). Photoprotected constitutive skin color sites produced higher AUIC values than photo-exposed facultative skin color sites. Constitutive skin color at the upper volar arm was equal to the buttocks. Within-site and between-site AUIC reproducibility of constitutive skin color at the upper volar arm was 3 and 5% coefficient of variation (CV), respectively, which was similar to seasonal variability (8% CV). AUIC values decreased proportionately at both constitutive and facultative sites as a function of increasing SPT from I to VI (r=0.8). RS-measured constitutive skin color at the upper volar arm fit a quadratic equation (r(2)=0.94) that differentiated (P<0.05) between each of the six SPTs and agreed +/-1 SPT category with clinician-assessed SPT. Thus, RS assessment of constitutive skin color at the upper volar arm provides a quick, noninvasive, precise, and accurate method to objectively determine SPT.