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Home Sweet Medical Home
Transcript of Home Sweet Medical Home
Medical Home? 5. How does the Medical Home fit into the Health Care System? 1. Where did the Medical Home come from? 1967
AAP Council on
Pediatric Practice (COPP)
Standards of Health Care 1970s-80s
Dr. Calvin Sia 1992
AAP Policy Statement
Children with Special Health Care Needs (CSHCN) 2002 & 2004
AAP Revised Policy Statement
All pediatric patients 2007
Patient Centered Medical Home (PCMH)
AAP, AAFP, ACP, AOA 2008 & 2011
National Committee for Quality Assurance (NCQA)
Standards & Guidelines for PCMH Recognition Method of providing primary care from a community level
Addressing the needs of the total child and family in relationship to health, education, family support, and the social environment
Focus on prevention, wellness, and early intervention Comprehensive care should include:
1. Preventative Care
2. Acute illness care 24/7/52
4. Facilitate subspeciality consultation
5. Interaction with school and community agencies
6. Maintenance of central record and database 1. Accessible
2. Family Centered
7. Culturally effective Physical Location of a Patient's Complete Centralized
Medical Record Medical Home and
Vaccine Coverage Smith, PJ. Santoli, JM. Chu, SY. Ochoa, DQ. Rodewald, LE. Pediatrics 2005; 116; 130 Medical Home
Implementation in Primary Care Cooley, WC. McAllister, JW. Sherrieb, K. Kuhlthau, K.
Pediatrics 2009; 124; 358 43 primary care practices in 5 states
Health care utilization for 6 chronic conditions (asthma, diabetes, cerebral palsy, epilepsy, ADHD, and autism)
"Medical Homeness" measured by Medical Home Index (MHI)
1. Organizational capacity
2. Chronic-condition management
3. Care coordination
4. Community outreach
5. Data management
6. Quality improvement Personal physician
Coordinated and integrated care
Emphasis on quality and safety
Payment should recognize added value 1. Enhance Access and Continuity
2. Identify and Manage Patient Populations
3. Plan and Manage Care
4. Provide Self-Care Support and Community Resources
5. Track and Coordinate Care
6. Measure and Improve Performance > 24, 500 children age 19 to 35 months of age sampled by the National Immunization Survey (NIS)
Medical home = a doctor, nurse, or PA who provided ongoing routine care 45% of children sampled were VFC-eligible
VFC-eligible children were:
Less likely to be UTD (71% vs 78%)
Less likely to have a medical home (82% vs 95%)
Among VFC-eligible children:
Those with medical home more likely to be UTD (72% vs 64%) Among VFC-eligible children who had a medical home:
If used medical home to receive all of their vaccines more likely to be UTD (75% vs 66%)
Among VFC-eligible children who received all doses from their medical home:
Vaccination coverage rate not significantly different from non-VFC eligible children after controlling for differences in sociodemographic factors Review of the Evidence
for the Medical Home for CSHCN Homer, CJ. Klatka, K. Romm, D. Kuhlthau, K. Bloom, S. Newacheck, P. Van Cleave, J. Perrin, JM. Pediatrics 2008; 122; e922. Systematic review of the medical literature, examined 33 articles that reported on 30 distinct studies
None of the studies examined the medical home in its entirety; over half the articles studied <2 MH components and only 9 studies observed >4 MH components 28 of the articles found some significant positive relationship between the medical home and desired outcomes
Including better health status, timeliness of care, family centeredness, and improved family functioning Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management associated with fewer hospitalizations
When controlling for chronic condition, higher chronic-condition management scores were associated with lower emergency department use >21, 000 children aged 0 to 17 years
Analysis of the 2004-2006 Medical Expenditure Panel Survey (MEPS)
Definition of a medical home = accessible, family-centered, comprehensive, and compassionate Medical Home, Preventative Care Screenings, and Anticipatory Guidance Romaire, MA. Bell, JF. Academic Pediatrics. Vol 10, No 5, September-October 2010. 49% of study sample had a medical home
Having a medical home associated with increased odds of:
Receiving weight, height and blood pressure screenings
Receiving anticipatory guidance on several topics (advice on dental checkups, diet, exercise, car and bike safety) Medical Home and Health Care Access Strickland, BB. Jones, JR. Ghandour, RM. Kogan, MD. Newacheck, PW. Pediatrics 2011; 127; 604-611. >83, 000 children aged 1 to 17 years
Data from 2007 National Survey of Children’s Health (NSCH)
Medical home measure = usual source of care, having a personal physician or nurse, receiving all needed referrals for specialty care, receiving help as needed in coordinating health care, receiving family-centered care 57% of US children received care in a medical home
Children more likely to have medical homes were:
English as primary language
Live in “safe” neighborhoods
Maternal education beyond high school
Income >400% of federal poverty threshold
Reported to be in excellent or very good health
Differences remained significant with multivariate analysis Children who received care in medical homes:
Less likely to have unmet medical and dental needs
More likely to have annual medical visits for preventative care
Differences remained after accounting for sociodemographic variables Medical Home and Children Without Special Health Care Needs Long, WE. Bauchner, H. Sege, RD. Cabral, HJ. Garg, A. Pediatrics 2012; 129; 87-98. >70, 000 children age <18 without special health care needs
Data from 2003 National Survey of Children’s Health
Medical home definition = 6 of the 7 AAP components of a medical home (all except continuity) 58% of children without special health care needs had a medical home
Same sociodemographic characteristics were found to be different between the two groups
Having a medical home was associated with:
Increased preventative care visits
Decreased outpatient sick visits
Decreased emergency department sick visits
Excellent/very good child health according to parents
Health promoting behaviors such being read to daily, getting sufficient sleep daily, helmet use, and decreased screen time
All remained significant after controlling for covariates Commonwealth Fund’s
Safety Net Medical Home Initiative (SNMHI) Eight Change Concepts:
1. Engaged Leadership
2. Quality Improvement Strategy
4. Continuous and Team-Based Healing Relationships
5. Organized, Evidenced-Based Care
6. Patient-Centered Interactions
7. Enhanced Access
8. Care Coordination CCHMC Primary Care Redesign Initiatives:
1. Preventative Care
2. Ill Care Access
3. Chronic Care A Neighborhood for the Medical Home The Program Directors The Housestaff Ladies The Chiefs Dr. Mansour Dr. Pero, Dr. Schaengold, Dr. Doyne All my friends and co-residents Roxy Dan!!! References: Sia, C. Tonniges, TF. Osterhus, E. Taba, S. History of the Medical Home Concept. Pediatrics 2004; 113; 1473.
Ad Hoc Task Force on Definition of the Medical Home. The Medical Home. Pediatrics Vol. 98 No. 5 November 1992.
Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The Medical Home. Pediatrics 2002; 110; 184.
Policy Statement: Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children. The Medical Home. Pediatrics 2004; 113; 1545.
Morehous, J. VanGinkel, J. Brown, C. How Every Child Succeeds and Pediatric Medical Homes Can Work Together to Improve Outcomes for At Risk Children. CCHMC Pediatric Grand Rounds. 9/4/2012.
AAFP, AAP, ACP, AOA. Joint Principles of the Patient-Centered Medical Home. February 2007. www.pcpcc.net/joint-principles. Accessed 9/29/12.
PCMH Advisory Committee. NCQA’s Patient-Centered Medical Home (PCMH) 2011. November 21, 2011.
Smith, PJ. Santoli, JM. Chu, SY. Ochoa, DQ. Rodewald, LE. The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program. Pediatrics 2005; 116; 130.
Homer, CJ. Klatka, K. Romm, D. Kuhlthau, K. Bloom, S. Newacheck, P. Van Cleave, J. Perrin, JM. A Review of the Evidence for the Medical Home for Children With Special Health Care Needs. Pediatrics 2008; 122; e922.
Cooley, WC. McAllister, JW. Sherrieb, K. Kuhlthau, K. Improved Outcomes Associated with Medical Home Implementation in Pediatric Primary Care. Pediatrics 2009; 124; 358.
Romaire, MA. Bell, JF. The Medical Home, Preventative Care Screenings, and Counseling for Children: Evidence from the Medical Expenditure Panel Survey. Academic Pediatrics. Vol 10, No 5, September-October 2010.
Strickland, BB. Jones, JR. Ghandour, RM. Kogan, MD. Newacheck, PW. The Medical Home: Health Care Access and Impact for Children and Youth in the United States. Pediatrics 2011; 127; 604-611.
Long, WE. Bauchner, H. Sege, RD. Cabral, HJ. Garg, A. The Value of the Medical Home for Children Without Special Health Care Needs. Pediatrics 2012; 129; 87-98.
Wager, EH. Coleman, K., Reid, RJ. Phillips, K. Sugarman, JR. Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes. The Commonwealth Fund. February 2012.
Mansour, Mona. Personal interview. September 21, 2012.
CCHMC. Primary Care Redesign-Project Overview. Summer 2012.
American Hospital Association Committee on Research. Accountable Care Organizations-AHA Research Synthesis Report. June 2010.
Hester, J. Lewis, J. McKethan, A. The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health. The Commonwealth Fund. May 2010.
Merlis. M. Health Policy Brief-Accountable Care Organizations. Health Affairs. July 27,2010.
McClellan, M. McKethan, AN. Lewis, JL. Roski, J. Fisher, ES. A National Strategy to Put Accountable Care Into Practice. Health Affairs. 29:5. May 2010. 982-99.
American Academy of Pediatrics Department of Federal Affairs. AAP Health Reform Implementation Fact Sheets & Resources. http://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Documents/ACAImplementationFactSheets.pdf. Accessed September 5, 2012.
Association of Maternal & Child Health Programs. The Patient Protection and Affordable Care Act-Summary of Key Maternal and Child Health Related Highlights with Updates on Status of Implementation. July 2012. Useful Websites:
National Center of Medical Home Initiatives for Children with Special Needs
Patient-Centered Primary Care Collaborative www.pcppc.net
NCQA Patient-Centered Medical Home http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx 1. Local accountability for a defined population of patients
2. Payment reform based on shared savings
3. Performance measurement, including patient experience data, clinical process and outcome measures Accountable Care Organization (ACO) The Patient Protection & Affordable Care Act