Outpatient Clinical Programs

In addition to adult care innovation through Medicaid Comprehensive Primary Care and Medicare’s Comprehensive Primary Care Plus programs, our Med-Peds primary care team participates in CPC+ Kids. Through CPC+ Kids, we create a medical home for our pediatric patients with our interdisciplinary team of physicians, nurse practitioners, nurses, pharmacists, medical assistants, social workers, dieticians, and collaborating specialists whenever needed. Our robust care team allows us to identify and outreach to high risk patients as well as identify those who may be due for routine care. Each clinic is engaged in quality improvement efforts to improve the quality of care, decrease hospital and emergency service utilization, and improve the patient experience.

We have created a novel clinical model for Adolescent and Young Adult (AYA) and transition care incorporating Med-Peds primary care, Med-Peds hospital medicine, subspecialty partners, collaborative telehealth based care. We are building co-located primary care/ subspecialist care models (virtual and physical) and launching a Med-Peds hospitalist service to coordinate with our outpatient AYA care teams.

Our Med-Peds Section leads the Mom-Baby Dyad program, a clinical program caring for postpartum moms and infants in tandem, with special care coordination after pregnancy affected by high risk conditions. We partner with colleagues from across OSUWMC, Nationwide Children’s Hospital, and community to create seamless transitions from obstetric care to primary care for women and their infants after pregnancy. Our partners include Obstetrics and Gynecology, Family Medicine, Neonatology, Psychiatry,  Moms2B, and the Ohio Better Birth Outcomes Collaborative. Evaluation of our Dyad program has been supported by the Ohio Department of Health and Ohio Department of Medicaid. The Dyad program is currently expanding its clinical care sites beyond Med-Peds to Family Medicine and select subspecialty sites. We are also expanding telehealth services to engage postpartum mothers who have had preterm delivery in primary care. For more information, please contact Seuli Brill, MD (Director, Mom-Baby Dyad Program) at Seuli.Brill@osumc.edu.

We partner with the AYA Cancer Care team at the James CCC to care jointly for AYA cancer survivors. In this clinical program we provide expansive interdisciplinary primary care to complement AYA oncology care, including access to clinical pharmacy and embedded mental health care.

A multidisciplinary network which focuses on providing comprehensive, timely, and patient-centered care for adults with cystic fibrosis (CF), starting as early as age 16. The concept is centered around primary care and a close network of specialists who are experts of common extra-pulmonary complications of CF. Through the program, patients have access to care for common complications adults with CF face, including mood disorders, cystic fibrosis related diabetes, pancreatic insufficiency, GI disorders, liver disease and cirrhosis, osteopenia and osteoporosis, antibiotic allergies, chronic sinus disease, pulmonary hypertension, and more. This group of providers with CF expertise work collaboratively to deliver care by keeping in mind unique limitations faced by this population, such as time and distance. Multiple innovative care models have been developed, with telemedicine at the forefront of care delivery.

The Ohio State University is one of the very few integrated primary care/sickle cell clinics in the world.  The goal of this program is being the first sickle cell program globally with a solid partnership between primary care providers and hematologists that 1) advances clinical care using the chronic care model throughout the lifespan, 2) addresses the national crisis of the scarcity of knowledgeable providers to care for adults with sickle cell disease by educating the next generation of hematologists and primary care providers to care for this population, and 3) promotes a research agenda to help demonstrate ideal treatment for this vulnerable population. In the clinic, individuals with sickle cell disease are co-managed with primary care providers and hematologists and seen by both primary care and hematology during the same clinic visit. A transition program also helps adolescents and young adults transition from pediatric to adult sickle cell centers with the same primary care providers. This program also has a very unique home visiting program where a primary care provider goes out and provides care for individuals with sickle cell disease within their home.