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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A medical home revolves around a family-professional partnership that is the foundation for wellness, acute and chronic condition management. Medical home is not a program adopted by a practice for children with special health care needs. Although some of the aspects of a medical home are specifically for children with special health care needs, a medical home actually represents quality health care that focuses on family-physician partnerships for all children. "All children deserve a medical home" is one of the Healthy People 2010 national health objectives.

Regardless whether a family brings their child to see a physician for acute health care, preventive care or for management of a chronic health condition, they want to have a trusting collaborative relationship with their child’s doctor. This family-professional partnership should prevail in whatever type of care they are seeking. This partnership is the foundation of the medical home model. Without this trusting collaborative partnership, the family does NOT have a medical home. Beyond this partnership, the medical home model provides a blue print for practices to incorporate best practice models and evidence-based medicine as much as possible. This means knowing community resources, communicating effectively with sub-specialists, implementing professional policy guidelines like developmental screening, immunization schedules and Bright Futures Guidelines in well child care.

Families can be valuable assets when you decide to develop a formal approach to improving quality in your practice. Seeking input from families who have a child with special health care needs provides valuable first-hand experiences that primary care physicians would otherwise not realize. Practice staff can learn a lot from families when they engage them in discussing the day-to-day issues, barriers and challenges they face in caring for and meeting the many needs of their child and family.

Physicians need to reach out and actively encourage parents to become “parent partners” with the practice. This can be done as part of an organized Quality Improvement Team (QIT) or through family surveys, focus groups or simply through everyday communication with families. Impromptu communication is a good tool, but planned communication efforts are more consistent and meaningful over time.

Practices often recognize the value but fail to elicit family input. Families understand the “little things” that make a visit to the physician effective and beneficial. This can include such things as how the practice has trained staff to answer an initial phone call, to how the practice can schedule additional time to treat children with special health care needs. By asking families “what could be done better”, or “what can we do to make your appointment more beneficial”, these simple questions can provide opportunities for families to help improve the quality of health care delivery within the practice.

Practices that have incorporated family involvement have seen changes that have enhanced the quality of care. Numerous practices across Illinois have made changes as a result of family involvement. Some of these changes include:

• Use of specific phone scripts at the point of initial contact to help make the appointment go smoothly for the family. These scripts often ask for family input on accommodations needed to improve their visit experience, such as waiting in the waiting room versus being placed immediately in the exam room.
  
• Assistance getting into and out of the office, when needed.
  
• Extended appointment times for children with special health care needs.
  
• Routinely asking for family feedback in the form of surveys or questionnaires.
  
• Providing resources in the practice, like internet access or distributing specific health related materials.
  
• Providing parent to parent connections by way of support groups or after hours informational meetings.

The list can go on and on. The important fact to remember is that these suggestions require the input of families within your practice to identify and meet their relative needs. Based on a survey reported by Liptak and Revell, both parents and physicians were asked what services families most needed. The following table displays the comparative differences in priorities between physicians and parents.

Survey Results:
Physicians’ and Parents’ Ranking of Needed Services

Families who participated in the survey listed "information about community resources" as the number one need whereas physicians listed "respite care". Families focused on information and the physicians on services. The important point to remember is that without family involvement, a practice may focus on changes that represent different priorities than those of the parents they serve.

Why is family involvement the cornerstone of the Medical Home in your practice? Because each partner - the family, the primary care provider and other office staff - brings their unique perspective to the process. Each partner has important viewpoints to contribute to the process, so each has uniquely meaningful ways to enhance the delivery of quality health care.

 

Unity is strength... when there is teamwork and collaboration, wonderful things can be achieved.
Mattie Stepanek

Alone we can do so little; together we can do so much.
Helen Keller

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