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About Medical Home

What is a Medical Home?

A Medical Home is not a house, office, or hospital, but rather an approach to providing comprehensive primary care. In a medical home, a pediatric clinician works in partnership with the family/patient to assure that the medical and non-medical needs of the child/youth are met. Through this partnership, the clinician can help the family/patient access and coordinate specialty care, educational services, out-of-home care, family support, and other public and private community services that are important to the overall health of the child and family.
The American Academy of Pediatrics (AAP) describes the ideal Medical Home as one that provides "accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective care." Though many Medical Home implementations focus on children with special health care needs, "every child deserves a Medical Home." AAP Policy Statements ([American: 2004], [Rushton: 2005], [Cooley: 2004], [Council: 2005]) have codified the role of pediatricians and other primary care clinicians in providing comprehensive care for children with chronic and complex conditions and defined the Medical Home concept. A 2007 article emphasized the importance of care coordination in providing a medical home. [McAllister: 2007]
In 2007, the AAP, American Academy of Family Physicians, American College of Physicians, and American Osteopathic Association developed the Joint Principles of the Patient-Centered Medical Home(PDF Document 37 KB). Key components that have particular applicability to pediatric settings include (from www.medicalhomeinfo.org):
  • Family-centered partnership: Trusting, collaborative, working partnership with families, respecting their diversity and recognizing that they are the constant in a child's life,
  • Community-based system: Family-centered, coordinated collaborations designed to promote the healthy development and well being of children and their families,
  • Transitions: Provision of high-quality, developmentally appropriate, health care services that continue uninterrupted as the individual moves along and within systems of services and from adolescence to adulthood, and
  • Value: A high-performance health care system requires appropriate financing to support and sustain medical homes that promote system-wide quality care with optimal health outcomes, family satisfaction, and cost efficiency.
Information about integrating the Medical Home concept into your practice is available through Building Your Medical Home Toolkit (AAP) and the Center for Medical Home Improvement, as well as at Building a Medical Home and elsewhere throughout this Medical Home Portal.

Who are Children and Youth with Special Health Care Needs?

Children and Youth with Special Health Care Needs (CYSHCN) are "those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally." [McPherson: 1998] Studies have found the prevalence of children in the United States meeting these criteria to be 12.8% [van: 2004] to 15.6% [Newacheck: 2005]. The National Survey of Children with Special Health Care Needs 2009/2010 found 15.1% of the nation's and 13% of Utah's children met this definition of children with special health care needs. For information about the study and data from each state, see CSHCNdata.org.

For More Detailed Information:

Information about the Medical Home concept, implementation, and related topics, is available at the National Center for Medical Home Implementation, sponsored by the American Academy of Pediatrics. The site offers access to comprehensive information about national and local resources related to Medical Home and CSHCN.
The mission of the Center for Medical Home Improvement is to establish and support networks of parent/professional teams to improve the quality of primary care medical homes for children and youth with special health care needs and their families. Useful tools, assessments, and resources are available on their web site.
In 2009, the AAP released the Building Your Medical Home Toolkit (AAP) to support development and/or improvement of pediatric Medical Homes. It also prepares practices to apply for and potentially meet the National Committee for Quality Assurance (NCQA) Physician Practice Connections® Patient Centered Medical Home (PPC-PCMHTM) Recognition program requirements (see the link below).

Resources

Information & Support

For Professionals

National Center for Medical Home Implementation
The National Center for Medical Home Implementation is a cooperative agreement between the Maternal and Child Health Bureau (MCHB), http://mchb.hrsa.gov/, and the American Academy of Pediatrics (AAP), http://www.aap.org/. The National center works to ensure that all children and youth, including children with special needs, have access to a medical home by providing medical home resources, technical assistance, and support to physicians, families, and other medical and non-medical providers who care for children.

Center for Medical Home Improvement
at the Crotched Mountain Foundation, Concord, New Hampshire, the site offers useful guides, tools, assessments, and other resources.

Digital Navigator
The Digital Navigator is a web-based software application that will help to guide patient care decisions, promote family and patient education, and support administrative functions to ensure successful implementation of the Patient and Family-Centered Medical Home model of care based on the 2011 NCQA Standards.

Joint Principles of the Patient-Centered Medical Home(PDF Document 37 KB)
A 2007 consensus statement from the AAP, AAFP, ACP, and AOA.

Patient-Centered Primary Care Collaborative
An organization of employers, physician organizations, trade associations, health benefits companies, and others advocating for wide-spread implementation of the patient-centered medical home.

Patient-Centered Medical Home Intro (Video)
Looking for a better approach to healthcare? Watch this 4-minute video about the Patient Centered Medical Home, from the Patient-Centered Primary Care Collaborative.

Building Your Medical Home Toolkit (AAP)
A guide to building a medical home in practice, aimed at achieving recognition by the NCQA, from the American Academy of Pediatrics.

NCQA Patient-Centered Medical Home Recognition Program
A program of the National Committee on Quality Assurance to "recognize" practices as Medical Homes.

National Association for State Health Policy (NASHP)
An independent academy of state health policymakers, "dedicated to helping states achieve excellence in health policy and practice and providing a forum for constructive work across branches and agencies of state government on critical health issues." NASHP has sponsored a number of programs to support states in fostering and implementing medical homes.

Medical Home Literature
An extensive bibliography of Medical Home related publications.

For Parents and Patients

Family Voices
Family Voices aims to achieve family-centered care for all children and youth with special health care needs and/or disabilities. Through our national network, we provide families tools to make informed decisions, advocate for improved public and private policies, build partnerships among professionals and families, and serve as a trusted resource on health care. Family Voices is national non-profit family-led organization with state affiliates in 42 states.

How to Partner with Your Physician (AAP)
From the American Academy of Pediatrics' National Center for Medical Home Implementation; provides background information, links, and other resources.

Authors

Authors: Alfred Romeo, RN, PhD - 4/2012
Chuck Norlin, MD - 3/2008
Content Last Updated: 4/2012

Page Bibliography

American Academy of Pediatrics Medical Home Initiatives for Children With Special Needs Project Advisory Committee.
Policy statement: the Medical Home.
Pediatrics. 2004;113(5 Suppl):1545-7. PubMed abstract / Full Text

Cooley WC.
Providing a primary care medical home for children and youth with cerebral palsy.
Pediatrics. 2004;114(4):1106-13. PubMed abstract / Full Text

Council on Children with Disabilities.
Care coordination in the medical home: integrating health and related systems of care for children with special health care needs.
Pediatrics. 2005;116(5):1238-44. PubMed abstract / Full Text

McAllister JW, Presler E, Cooley WC.
Practice-based care coordination: a medical home essential.
Pediatrics. 2007;120(3):e723-33. PubMed abstract

McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck PW, Perrin JM, Shonkoff JP, Strickland B.
A new definition of children with special health care needs.
Pediatrics. 1998;102(1 Pt 1):137-40. PubMed abstract

Newacheck PW, Kim SE.
A national profile of health care utilization and expenditures for children with special health care needs.
Arch Pediatr Adolesc Med. 2005;159(1):10-7. PubMed abstract

Rushton FE Jr.
The pediatrician's role in community pediatrics.
Pediatrics. 2005;115(4):1092-4. PubMed abstract / Full Text

van Dyck PC, Kogan MD, McPherson MG, Weissman GR, Newacheck PW.
Prevalence and characteristics of children with special health care needs.
Arch Pediatr Adolesc Med. 2004;158(9):884-90. PubMed abstract