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 process of quality improvement is a self-directed process in partnership with families. Determining which activities will have the most benefit for the practice, and the families served, is an important step to improving care. This section emphasizes that the Primary Care Medical Home Model applies to acute illness management, preventive care management and chronic condition management.

There are numerous activities described here to enhance quality health care within the Primary Care Medical Home Model. Bright Futures provides quality guidelines for well child care. Policies and best practice models provide guidance for improving care in all three components of the Primary Care Medical Home Model. In addition, some practical strategies developed by medical home practices are also shared in this section.

Integrating Health and Related Systems of Care for Children with Special Health Care Needs is an important role of providing a medical home for all children, wherein primary care physicians have a vital role in the process of care coordination, in concert with the family. Medical homes for children with special health care needs incorporate the same elements of health supervision, community-based preventive care, developmental surveillance, and anticipatory guidance used in the ongoing care of all children. Care should be accessible, comprehensive, continuous, compassionate, culturally effective, and family-centered. The medical home reinforces care coordination activities by the primary care practice team: the primary care physicians in collaboration with nurses, families, and support staff. In pediatrics, family-centered care is based on the understanding that the family is the child’s primary source of strength and support. Further, this approach to care recognizes that the perspectives and information provided by families, children, and young adults are important in clinical decision making.

The following activities describe ways to enhance quality health care in the three components of the primary care medical home model. Determining which activities will have the most benefit for your practice, and the families served, is an important step to improving care.

Practice Accommodations
The Primary Care Medical Home Model can be used to describe suggestions for practice change based on 1) practical strategies, including educational programs provided by professional organizations and 2) AAP/AAFP-endorsed policies and best practice guidelines. The goal in developing practice accommodations is to facilitate a more family-centered approach to primary care in a practice along with organizing office procedures to proactively provide care for CYSHCN. Families of CYSHCN have many challenges in their daily lives, and obtaining appropriate health care and related services for their child should not be one of them. We have provided guidelines and suggestions for implementing practice accommodations for acute care management, preventive care services and chronic condition management. Each of these components of health care delivery can have strategies for improvement that are unique, as well as general improvement efforts that span all types of health care delivery. You can access information about improvement strategies for each of these 3 components of health care from the menu on the left side of the page.

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In addition to a practical strategies approach for change, a practice might consider using policies and best practice guidelines to structure change. In 2005 the AAP developed the Partnership for Policy Implementation (PPI). “A growing body of research continues to demonstrate the distinct role of health information technology (HIT) in facilitating quality improvement efforts and putting standards of care into practice. It is the AAP’s belief that in order to meet this growing trend, AAP statements must be “operationalized” to provide HIT standard-developing groups and software designers with specific, unambiguous content. The PPI aims to ensure that HIT implementations are designed to meet the specific needs of child health professionals by facilitating creation of some of the fundamental building blocks of electronic health record (EHR) systems during the process of statement development”.

As of 2007 three policies have been developed using the PPI approach. The policies are Developmental Screening, Bronchiolitis and Flu Shots. As more policies are converted to the new PPI standards, they will be identified.

The goal in developing practice accommodations is to facilitate a more family-centered approach to primary care in a practice along with organizing office procedures to more proactively provide care for CSHCN.

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