Creating a Medical Home

Getting Started

Parent Partnership

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Practice Improvement Methods:
Practice Assessment

Consumer Awareness

Practice Improvements

Acute Illness Management

Preventive Care Management

Chronic Condition Management

Diagnosis Modules

Transition Information

Community Resources

Medical Home Reimbursement

Quality Improvement

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Medical Home Primer for Physicians

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Medical Home Information for Families

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Additional Resources

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The medical home model promotes high quality health care in all aspects of the primary care practice, which also includes acute care management. First, practical strategies that have been tried and proven beneficial in medical home practices will be described. Then, professional policies and best practice guidelines are presented as a guide to develop standard protocols in the management of several acute health conditions that are presented as examples. Less than 50% of policies and best practice guidelines are implemented by primary care practices. Doing so will result in better patient outcomes, more efficient management, and ultimately will reduce health care costs.

Practical Strategies

Bulletin boards in the waiting area - to share educational information with families as well as post information about helpful community resources. Suggested topics could include information about ear infections, upper respiratory infections and how to treat the flu. Educational handouts on these issues may also be helpful.

Internet access for families - to support those families that do not have internet access. Some practices have placed a computer in the waiting area, so families are able to obtain diagnosis-specific information, family support networks, and additional state and local resource information. Web sites could be saved as favorites on topics related to many of the acute illnesses that occur in children.

Visit Preparation - to assist families in preparing for the child’s office visit provides benefits for the child and family as well as the practice staff. The primary benefit is improved communication to promote proactive primary care. Practices gather individualized information about the strengths and needs of families at office visits to better meet these needs and more effectively coordinate services.

Available tools for this Preparation

1. Medical Home Visit Card - a handout for families that addresses important points to prepare for the child’s medical appointment, “Make each doctor’s appointment work for you!” (one side in English and one side in Spanish)
   
   
2. Pre-visit questionnaire - this questionnaire is given to patients and families to complete in the waiting room prior to the appointment. It lists areas of concern and or discussion. Office staff can review the survey before the child sees the physician so that they can prepare for specific needs/concerns such as the need for care coordinator assistance or educational materials. Families are asked if assistance is needed in completing the form. This sample was developed by Exeter Pediatrics, VT and is included in the Medical Home Improvement Toolkit created by the Center for Medical Home Improvement.
   
   
3. Today’s Visit Form - this tool can be used to help families document their concerns and issues about their child’s health (changes in medication, referral needs, updated therapy or specialty visits, etc) they wish to discuss at the visit.
   
   
4. Visit Summary Form - this form, developed by Pediatric Health Associates, IL, can be used to outline the treatment plan and what follow-up care is needed. Both the family and the practice staff receive a copy of the Visit Summary to help clarify "next steps" and define follow-up responsibilities. This helps to promote family-centered, comprehensive and coordinated health care.
   
   
5. Post-visit questionnaire - a companion to the pre-visit questionnaire allows families the opportunity to provide feedback on the office visit and how well the needs and concerns were addressed. This sample was developed by Exeter Pediatrics, VT and is included in the Medical Home Improvement Toolkit created by the Center for Medical Home Improvement.

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Policies and Best Practice Guidelines

The following is a brief list of the more pertinent clinical policies and best practice models that can be used as a guide to make change and improve quality of health care in the three components of a primary care medical home practice. Recognizing that practices are already busy providing care and that change is challenging, choose one at a time and slowly integrate the recommendations into your practice setting.

Bronchiolitis
Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is one of the first policies to be converted by the PPI process.

Febrile Seizures
Long-term Treatment of the Child with Simple Febrile Seizures is a practice guideline designed to assist pediatricians by providing an analytic framework for the treatment of children with simple febrile seizures. Technical Report: Treatment of the Child with Simple Febrile Seizures provides pertinent evidence on the individual therapeutic agents studied including study results and dosing information.

The Neurodiagnostic Evaluation of the Child with a First Simple Febrile Seizure is a practice parameter designed to assist pediatricians by providing an analytic framework for the evaluation and treatment of this condition including interventions of direct interest: lumbar puncture, electroencephalography, blood studies, and neuroimaging.

Otitis Media
In May 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) jointly released the first national clinical practice guideline on appropriate diagnosis and treatment for Acute Otitis Media (AOM). The guideline outlines steps for more accurate diagnosis, encouraging pain relief, reducing antibiotic-related adverse effects, and targeting antibiotics for children likely to receive the most benefit.

The clinical practice guideline on Otitis Media with Effusion (OME) was also released in May 2004 by the AAP, AAFP, and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) to provide evidence-based recommendations on diagnosing and managing OME in children. The OME guideline emphasizes appropriate diagnosis and provides management options including observation, medical intervention and referral for surgery for children who are not at risk.

The follow-up care of children in whom tympanostomy tubes have been placed is shared by the pediatrician and the otolaryngologist. Guidelines are provided for routine follow-up evaluation, perioperative hearing assessment, and the identification of specific conditions and complications that warrant urgent otolaryngologic consultation. These guidelines have been developed by a consensus of expert opinions.

Urinary Tract Infections
The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children provides strategies for the diagnosis, management, and follow-up evaluation of infants and young children with unexplained fever, who are later found to have a diagnosed UTI. Accurate diagnosis is extremely important for two reasons: to permit identification, treatment, and evaluation of the children who are at risk for kidney damage and to avoid unnecessary treatment and evaluation of children who are not at risk. Consequently, negating the need for interventions are costly and potentially harmful but provide no benefit.

Educational Programs

Both the Illinois Chapter of the American Academy of Pediatrics (ICAAP) and the Illinois Academy of Family Physicians (IAFP) provide opportunities for ongoing educational training. In addition to professional development experience, participation in these programs allows practices to promote healthy patients and families and also instructs families on your commitment to quality care.

The Illinois Chapter of the American Academy of Pediatrics provides an office-based educational program on asthma. For more information about the asthma program and other available preventive-type educational programs, refer to the ICAAP website.

Illinois Academy of Family Physicians provides continuing medical education (CME) programs throughout Illinois and with the national Academy. The website provides a listing of all IAFP meetings, including many CME opportunities, the AAFP courses and conferences, and CME meetings around the state. For more information about these programs, refer to the IAFP website.

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