Making the leap from one hospital to another through UAB’s STEP Program

Carlie Stein Somerville, M.D., an associate professor in the Division of General Internal Medicine, turned an HSF-GEF grant into a nationally recognized program that provides multidisciplinary support to help young adults transition to adult care. Four years later, “we have been able to show the impact that we can make with patients and families,” she said.When Carlie Stein Somerville, M.D., presents on her nationally recognized STEP Program at conferences, she often hears the same response. “Nobody will give us seed funding to get something like this up and running,” people say. “How did you get that?” The answer: UAB’s unique, annual Health Services Foundation General Endowment Fund grants program.

Unlike in many major academic medical centers, there are crosswalks directly linking Children’s of Alabama and UAB. Somerville wanted to help patients get from one building to another, when it comes to care. “I was at UAB, and I would see young adults get admitted with diseases of childhood like spina bifida or cerebral palsy, and many of the adult doctors would express discomfort in caring for these patients,” said Somerville, an associate professor in the Division of General Internal Medicine. In partnership with Betsy Hopson, then the program director for the UAB and Children’s of Alabama Spina Bifida Program, Somerville launched the UAB Staging Transition for Every Patient, or STEP, Program, in 2020, to help patients across the health system make the leap. Their program was funded by an HSF-GEF grant in 2019.

As a third-year medical student at UAB, Somerville thought she would become a pediatrician, then fell in love with medicine after rotating through UAB’s famous Tinsley Harrison internal medicine service. The next year, she knew she would become a pediatrician, but then reaffirmed her love for internal medicine when she rotated back through the Tinsley Harrison service. So she did both, specializing in internal medicine-pediatrics, better known as med-peds. As she completed her training and went on to become director of UAB’s Med-Peds residency program, she further specialized in chronic and complex diseases of childhood, including autism spectrum disorder, intellectual disabilities, cerebral palsy and Down syndrome.

“In the first years of my practice, I saw there was a gap at UAB for patients between 18 and 21 years old,” Somerville said. “Who were the right doctors who would understand how to help patients and their families when they have complex diseases of childhood, which bring a lot of medical needs and caregiver needs even as they grow up? We didn’t have a place for those patients to land. We are so fortunate to have crosswalks from Children’s to the ‘adult hospital’ in UAB. I wanted to create streamlined transition care from one hospital to the other.”

Somerville and Hopson’s collaboration created the STEP clinic. “This is an outpatient primary care clinic where patients and their caregivers can meet a multidisciplinary team to work through the pieces of transition,” Somerville said. The grant funding allowed her to hire Hopson as administrative director and a nurse to staff the clinic.

Four years later, “we have been able to show the impact that we can make with patients and families,” Somerville said. The initial concept has evolved into “a very multidisciplinary clinic, with three med-peds-trained physicians and seven specialists who come to the clinic and see the patients with us,” she said. These include specialists in psychiatry, psychology, pulmonary, endocrinology, neurology, epilepsy, rehabilitation medicine, physical therapy and social work.

Gathering all these specialists in a single clinic, who can see patients during a single clinic visit, “helps with navigating Birmingham and parking decks and traveling with all the equipment that these patients often require,” Somerville said. “They get coordinated care and connect to all the adult subspecialists they need. We try to help improve their plans for where to go if they have an emergency, to plan for what happens if they get admitted, and now we are working to build pathways if they are admitted as well.”

The providers have also benefited. “Any doctor who needs help transitioning a complex patient” can work with the STEP clinic, Somerville said. “We cannot be the ones to take care of every adult with a disability,” she noted. But “we have the skills to make those families feel heard and to teach learners and other physicians how to better care for these patients.” Somerville said to other physicians, “As someone who has been a primary care doctor myself, my goal is to empower others to be comfortable taking care of these patient populations, to know about STEP and what we offer, and that they can call us.”

The success of her clinic also allowed Somerville to make a case for permanent funding after her HSF-GEF grant period. “We were able to share the story of the patient experience and provider experience in the clinic, to show that we were meeting gaps in needs, and we were able to continue funding to grow through the shared support of Children’s, UAB Funds Flow and UAB Prime Care and the support of the departments of Medicine and Pediatrics,” Somerville said. “There are no other programs like this in the region and only a handful in the country. Now we are up to 550 patients, and we are seeing patients from all over the state who travel to us to get this level of care, because they can’t find providers in their areas.”