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Practice Accommodations for
Acute Care Management
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
- 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)
- 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.
- 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.
- 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.
- 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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