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Creating a Medical Home
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The medical home model promotes high quality health care in all aspects of the primary care practice, which also includes preventive 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 for health promotion and screening 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. This section concludes with applicable educational programs on preventive care management. 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 educational programs allows practices to promote healthy patients and families and also instructs families on your commitment to quality care. 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 growth and development, immunization schedules and preventing the spread of infections. 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 health prevention measures for children and families. 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
Policies and Best Practice Guidelines This section addresses the many choices a practice has to improve quality health care based on Policies and Best Practice Models developed by professional organizations, like the AAP and the AAFP. Such guidelines represent the best judgment of a team of experienced clinicians and methodologists addressing the scientific evidence for a particular clinical topic. Primary care practices implement less than 50% of their professional organization’s policies and best practice models. The reason is lack of time during a visit. Some claim that a well child visit would have to last at least 45 minutes or longer in order to include all policies and best practice models. 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 preventive component 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. Immunizations
Developmental Surveillance and Screening Bright Futures A good resource is the Bright Futures Well-Child Care Curriculum , a series of 10 modules that address the content and delivery of well-child care, the core competencies of health promotion and disease prevention, and documentation of health care services. Each module is augmented with supplementary materials and resources. Users may concentrate on one particular subject, choose several related topics for a tailored training, or progress through the entire curriculum module-by-module. The following is a brief list of additional pertinent medical situations where policies and best practices models can be used as a guide to improve quality of health care in the preventive component 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. Lead Screening Physicians and other health care providers have conducted 2.4 million lead tests and reported about 270,000 children with elevated lead levels. The numbers of elevated and normal test results are used to identify areas where effort is needed to combat lead poisoning. Every physician licensed to practice shall screen children 6 months through 6 years of age for lead poisoning using a blood lead measurement for children residing in high risk areas. Children residing in low risk areas should be assessed for their risk for lead exposure by providing the information contained in the Childhood Lead Risk Assessment Questionnaire. Autism Screening and Diagnosis Screening and Diagnosis of Autism reviews the available empirical evidence and gives specific recommendations for the identification of children with autism. This approach requires a dual process: 1) routine developmental surveillance and screening specifically for autism to be performed on all children to first identify those at risk for any type of atypical development, and to identify those specifically at risk for autism; and 2) to diagnose and evaluate autism to differentiate autism from other developmental disorders . The Centers for Disease Control and Prevention's Learn the Signs - Act Early campaign is encouraging physicians to reach out to communities to help raise awareness of the importance of monitoring a child's developmental milestones. Obesity
An Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity, made up of representatives from fifteen health professional organizations, was convened by the AMA to develop strategies to help physicians more effectively work with families, school health professionals, public health organizations and community groups to reduce overweight and obesity and to eliminate racial and ethnic disparities in childhood obesity. In June 2007, the committee released 22 recommendations on the treatment of pediatric obesity for health care professionals to apply in their practices . 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 office-based educational programs on developmental screening, autism recognition, immunizations, maternal depression, medical home, oral health, social-emotional health, and tobacco cessation. In following the recommendations set forth in these programs, it sends a message to families that these are important screenings and protocols. For more information about these programs, refer to the ICAAP website . Oral Health Practices in Cook County that complete the training receive a “starter
kit” for fluoride varnish application and are eligible for reimbursement
through Medicaid for fluoride varnish application. Physicians will be
paid for providing this service to any patient in All Kids (formerly Medicaid
and KidCare) – including those in capitated managed care plans.
Refer to the ICAAP website on educational programs to schedule a Bright
Smiles from Birth program presentation for your practice. 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 . |
last modified: 27 May 2008