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Introduction

Your primary care practice serves as the “home” where the family and child or youth:

  • Feel recognized and supported
  • Find a centralized base for their medical care
  • Find connection to other medical and non-medical community resources

The medical home approach values and supports families in their role as primary care giver and expert on their individual child. Primary health care providers bring their experience with larger numbers of children with similar conditions and the medical expertise to help families understand and integrate recommendations from a variety of health care providers. Together, families, health care professionals and community service providers identify and access medical and non-medical services needed to help the child and family.

Assuring that all children with chronic health care conditions or disabilities have a medical home is a goal for the US Maternal and Child Health Bureau, the American Academy of Pediatrics and the State of Washington. While many primary care practices provide the key elements of a medical home. . . You don’t have to do it all by yourself!

Benefits of the Medical Home – Effectiveness, Efficiencies, Equity!

When they receive services in a medical home, families of children with special health care needs report experiencing an improved relationship with their physician, missing fewer days at work and having an easier time obtaining letters of medical necessity and referral to specialists. They are better able to understand their child’s condition, get prescriptions filled and telephone calls returned, access resources and set goals for their child. Their children experienced decreased rates of hospitalization. (Palfrey and Sofis) The savings on reduced hospitalizations results in a savings of $10.50 for every $1 invested (Liptak, 1998). Among the benefits outlined by the authors cited below:

Family and Health Care Practice Benefits:

  • Increased patient and family satisfaction
    • Decreased family needs
    • Decreased caregiver strain
  • Decreased school absences
  • Establishment of a forum for problem-solving
  • Improved coordination of care
  • Enhanced efficiency for children and families
  • Efficient use of limited resources
  • Increased wellness resulting from comprehensive care
  • Equity/reduction of disparities in health between socially advantaged and socially disadvantaged populations
  • Increased professional satisfaction

Cost/Quality Benefits:

  • Increased patient compliance (linked to collaborative decision-making and increased trust in the patient/physician relationship)
  • Better preventive care and better patient outcomes
  • Enhanced opportunities for outcomes-based clinical improvement
  • Decreased parental missed days from work
  • Cost Savings from:
    • Reduced hospitalizations
    • Reduced hospital length of stay
    • Reduced utilization of the emergency department
    • Avoided health care visits

References:

    • Cooley, W.C., McAllister, J.W., Sherrieb, K., Khulthau, K. Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care. Pediatrics 2009;124;358-364.
      Jeanne W. McAllister, BSN, MS, MHA;, Kathleen Sherrieb, MS, Dr.PH; W. Carl Cooley, MD Improvement in the Family-Centered Medical Home Enhances Outcomes for Children and Youth with Special Healthcare Needs. J Ambulatory Care Management, July/September 2009, Vol 32 No.3 pp. 188-196.
    • The effects of specialist supply on population’s health: Assessing the evidence Starfield B, et al. Health Affairs March 15, 2005 Web exclusive.Starfield B, Shi L. The medical home, access to care, and insurance: A review of evidence. Pediatrics. 113(5);193-1498, 2004.
    • Palfrey JS, Sofis LA et al. The Pediatric Alliance for Coordinated Care: Evaluation of a Medical Home Model . Pediatrics. 113(5):1507-1516, 2004.
    • Hakim RB, Bye BV. Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries. Pediatrics. 108(1):90-97, 2001.
    • Christakis DA, Mell L et al. Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics. 103(3):524-529, 2001.
    • Christakis DA, Wright JA et al. Is greater continuity of care associated with less emergency department utilization? Pediatrics. 103(4):738-742, 1999.
    • Farmer JE, Clark MJ et al. Comprehensive primary care for children with special health care needs in rural areas. Pediatrics. 116(3):649-656, 2005.
    • Solberg L. Effect of improved primary care access on quality of depression care. Annals Fam Med. 4:69-74, 2006.
    • Gill JM, Fagan HB et al. Impact of providing a medical home to the uninsured: Evaluation of a statewide program. J Health Care for Poor and Underserved. 16(3):515-535. 2005.
    • McBurney PG, Simpson KN, Darden PM. Potential cost savings of decreased emergency department visits through increased continuity in a pediatric medical home. Ambulatory Pediatr. 4:204-208, 2004.
    • Piette JD, Heisler M, et al. The role of patient-physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med. 165:1749-1755, 2005.
    • Liptak GS, Burns CM et al. Effects of providing comprehensive ambulatory services to children with chronic conditions. Arch Pedatri Adolesc Med. 152:1003-1008, 1998.

 

Getting Started: Stay in Touch with Your Partners

1. Families

  • Listen to families with care and respect, and problem-solve together.
  • Assure that families have access to community services, parent support programs, and specialty care providers.

2. Community Service Providers

Know the two key resource coordinators for children with special needs in your county:

  • The Public Health Nurse Children with Special Health Care Needs (CSHCN) Coordinator
    • CSHCN Coordinators are public health nurses or social workers in local health departments who can assist families who have children with special needs from birth to age 18. CSHCN Coordinators can:
      • Help families access needed services for their child, such as medical care and other interventions.
      • Refer families to health insurance programs and information, both private insurance and the state funded Medicaid program.
      • Help families support each other through parent support organizations.
      • Help with concerns such as feeding, nutrition, growth, development and behavior.
      • Provide screening and assessment for your child.
      • This link takes you to a guide with information on how to refer families to public health nurse CSHCN Coordinators.
        The guide also includes contact information by county for each CSHCN Coordinator in Washington State.
  • The Lead Family Resources Coordinator (FRC)
    • Serves children birth to 36 months
    • Can help families: arrange for further developmental testing to verify eligibility for early intervention (EI) services, explain EI services and systems, access community support programs, and discuss possible funding sources for EI services.
    • Is funded by Washington State Early Support for Infants and Toddlers Program (ESIT)(IDEA Part C)

3. Washington State Medical Leadership Network

In Washington we have a statewide network of expert, community-based volunteer teams available to provide consultation on medical homes. Typically a MHLN team is composed of a physician, public health nurse CSHCN coordinator, Family Resources Coordinator and a parent of a child with special needs. Your community medical home team can help you identify practical tools and strategies to support key elements of a medical home in your office.

Key First Steps to Improving “Medical Homeness”

Everyone has limited time and resources. What are the most important steps a busy primary care practice can take to make the biggest impact on degree of “medical homeness”?

The Center for Medical Home Improvement recommends several initial steps to primary care practices interested in improving how they deliver services to children with special health care needs and their families.

These recommendations are based on many years of experience working with primary care practices across the country, including two national Medical Home Learning Collaboratives. The recommendations are:

  1. Engage parents as partners at the practice level
  2. Identify children and youth with special health care needs in your practice {flu list, computer runs, memory, prospectively)
  3. Use planned visit encounters
  4. Develop strategy and identify specific roles for care coordination and communication at the practice level

To see the full one page list of recommendations and additional information on this topic, please see our Quality Improvement and Medical Homes page.

Steps to Develop a Medical Home

Sadof MD, Nazarian BL. Caring for Children Who Have Special Health-care Needs: A Practical Guide for the Primary Care Practitioner. Pediatrics in Review. 28(7):e36-e42, July 2007.

    1. Develop a database of CSHCN
    2. Develop a chart identification system (e.g. color-coding)
    3. Designate a care coordinator
    4. Change forms in the chart (e.g. care plans, problem lists)
    5. Train staff about the needs of CSHCN and the medical home concept
    6. Consider an advisory board for the practice
    7. Develop resource guidelines

 

Practice Transformation Toolkits

The Patient-Centered Primary Care Collaborative has gathered and organized a collection of information and resources to assist in implementing elements of a medical home.
The Practice Transformation Toolkit

Sections include:

    • Improving Access to Care
    • Improving Patient/Family/Caregiver Engagement
    • Implementing Team Based Care
    • Implementing Care Coordination
    • Improving Practice Workflow
    • Improving Office Design
    • Implementing/ Maximizing EHR/HIT
    • Implementing Population Health and Proactive Primary Care
    • Implementing Comprehensive Primary Care – Behavioral Health, Etc.
    • Evaluating Your Medical Home and Certification/Recognition
    • Quality Improvement

  • Linking Your PCMH to a Larger System (ACOs, etc.)

Infographic- What is the Patient Centered Medical Home?

PCMH-PCPCC-Infographic-Web