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Meeting Patients Where They Need Care Most

Jan. 27, 2020

This post is by Larissa Herold, the digital content intern for Dell Medical School’s communications team. Herold is a Plan II and mechanical engineering junior at The University of Texas at Austin.

At the Austin State Supported Living Center, 200 residents with intellectual and developmental disabilities receive 24-hour, campus-based health care. There — and at the 12 other living centers across Texas that the Texas Health and Human Services Commission operates — delivering care can be a challenge. Residents often have complex medical histories and may have difficulty getting to specialists.

That’s where Kavitha Kumbum, M.D., assistant professor in the Department of Internal Medicine at Dell Medical School, comes in. As a gastroenterologist, Kumbum makes monthly facility visits, bringing gastrointestinal care directly to Austin SSLC’s residents.

“If we were to schedule residents to go to the clinic or the hospital for their visits, they may not make it there in the first place,” Kumbum said. “When I go to the Austin SSLC, they bring all the patients that have GI issues to the clinic in one location and I address their problems from there.”

Teri Newsom, RN, a nurse practitioner at Austin SSLC, cares for the residents every day. She agrees that Kumbum’s visits have increased access to care.

“We have found that it is difficult to get specialized appointments in a traditional outpatient clinic setting,” Newsom said. “Individuals with intellectual and developmental disabilities can often be upset or knocked off equilibrium when their routines are changed. By having Dr. Kumbum come here, she is able to provide expert, highly specialized care in as close to the home environment for the individual as is possible.”

Taking a Tailored Approach

Kumbum doesn’t just bring routine care to Austin SSLC residents — she has also improved that care to generate better outcomes. She commonly performs colonoscopies, which are examinations of the large intestine used to detect colon cancer early. The preparation prior to the procedure is meant to enable the physician to see the colon clearly, but such prep can be challenging to complete for patients at Austin SSLC. When Kumbum realized this, she designed and initiated a protocol for a more comprehensive colonoscopy prep.

“Having this more intensive prep protocol led to actually finding colon cancer in a patient who had previously had a suboptimal colonoscopy due to poor prep,” Kumbum said. “It's quite possible that a polyp was missed and turned into cancer. If we had done a better job the first time around, we probably would have been able to catch it sooner rather than later.”

When new protocols aren’t an option, it may just take more time to gather information. Kumbum said listening deeply is often the best way to learn what the residents’ health care needs are.

“Dr. Kumbum has a calm demeanor and she’s very unflappable,” Newsom said. “So she is able to sit with an individual who might be perturbed by having a stranger poke them in the belly and proceed with her exam and her questioning in a calm manner that is soothing to the residents, reassuring to the staff and ultimately very effective.”

Kumbum’s determination to address residents’ health care needs comes from her desire to give back to the community.

“This is a special patient population,” Kumbum said. “They’re not always able to express if you’re making them feel better. I felt like I should try to do my best to make at least a little difference, both for the patients and for the providers.”