Creating a Medical Home
Getting Started
Parent Partnership
Practice Improvement Methods:
Practice Assessment
Consumer Awareness
Practice Improvements
Acute Illness Management
Preventive Care Management
Chronic Condition Management
Transition Information
Community Resources
Medical Home Reimbursement
Quality Improvement
Medical
Home Primer for Physicians
Medical Home Information
for Families
Additional Resources
Practice Assessment:
Using data to determine where to begin
One of the quickest and easiest ways to determine where to begin is to objectively assess your practice's model of health care delivery using a standardized assessment tool. Assessment tools can be very comprehensive or very general, look at process outcomes or procedural detail and other possible variables that define optimal care. Some are lengthy and time consuming to administer while others are concise and can be quickly completed.
Practice Assessment
The Medical
Home Index (MHI), developed by Dr. Carl Cooley and Jeanne McAllister
of the Center for Medical Home Improvement, is a nationally validated
primary care self-assessment tool designed to translate the broad indicators
defining the medical home into observable, tangible behaviors and processes
of care within in any office setting. The MHI is based on the premise
that medical home is a work in progress rather than a fully realized status
for most practice settings. The 25-item MHI measures a practice's quantitative
progress in this process and can be used to periodically assess improvement
efforts.
The Center for Medical Home Improvement is working on developing a Medical Home Index-Short Version, which will soon be available for public distribution. The 10-item Short Version was derived from the original Medical Home Index (MHI). The short version can be used as an interval measurement in conjunction with the original MHI, or it can be used as a quick “report card” or snapshot of practice quality for periodic measurement and/or when it is not feasible to use the full MHI.
Another tool that provides an objective approach to self-assessment is the Practice Assessment Checklist, developed by the Illinois Medical Home Project. This tool is designed to measure pre- and post- medical home quality improvement outcomes at a practice and can be administered by an independent evaluator during a site visit to the practice.
If you are interested in assessing your practice's cultural diversity and cultural competency, you can utilize the Self-Assessment Checklist for Personnel that is found on the Medical Home Measurements web page listed above. Or, for more information and resources on cultural competency, go to the Georgetown University Center for Child and Human Development - National Center for Cultural Competence. The Center web site contains, among other things, many online resources and tools including:
- a web-based practice assessment tool and
- a downloadable practice self-assessment checklist.
The American Academy of Family Physicians has developed a Web-based training program entitled “Quality Care for Diverse Populations” to assist physicians and other health care professionals in becoming more culturally proficient in the provision of care to their patients. The program includes five video vignettes depicting simulated physician-patient visits in an office setting as a means to explore ethnic and socio-cultural issues found in today's diverse health care environment.
Another good reference for cultural competence is the Think Cultural Health web site developed by the Department of Health and Human Services, Office of Minority Health . This site offers the latest resources and tools to promote cultural competency in health care. You may access free online courses accredited for continuing education credit as well as supplementary tools to help your practice promote respectful, understandable, and effective care to your increasingly diverse patients.
There are a number of other measurement tools developed to help you objectively assess where you stand and help you to begin contemplating where you want to go. You can find more examples of these measurement tools on the National Center for Medical Home Initiatives web site, on the Medical Home Measurements page in the Tools section.
Family Feedback
In a survey reported by Liptak
and Revell, parents and physicians were both asked what services families
most needed. Families who participated in the survey listed "information
about community resources" as their number one need, whereas physicians
listed "respite care" as a family's greatest need. The study
revealed that although families identifed information as their greatest
need, physicians believed their greatest needs to be 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 actually serve.
Regardless of where you choose to begin, parent involvement is essential to successful improvement. Parents can be involved in providing feedback about service delivery, office hours, access to the office, or a variety of other aspects of care delivery.
The Medical Home Family Index, developed by the Center for Medical Home Improvement (CMHI), is intended to be used in conjunction with the MHI, described above. This tool uses 25 questions to capture the family perspective about the practice's health care delivery system. In Illinois, we have adapted the Medical Home Family Index (MHFI) to correlate more closely with the Medical Home Index completed by the practice. This Illinois version has reorganized the instrument into the 6 domains defined in the MHI, so that analysis of both instruments more easily lends to identifying correlation and/or discrepancy. Family feedback can then more easily be compared to your practice's self-assessment, outlining areas where both were in agreement, as well as areas where responses were discordant. These variations in perspective can provide opportunities to consider action for future improvement.
Another measurement tool developed by the CMHI is the Family/Caregiver Survey. This extensive assessment of family needs looks at the impact of chronic health conditions, satisfaction with care, utilization of services, and unmet needs. Gaining this feedback from families provides a comprehensive profile of needs and can assist in identifying priority areas for improvement.
The Illinois Medical Home Project has combined the Medical Home Family Index with the Caregiver Survey to create the Illinois Medical Home Family Feedback Tool. This tool, available in both English and Spanish, is being used to provide more comprehensive feedback and input from families on their perceptions about the care received within their primary care medical home.
Bright Futures has developed a Cultural Competence Assessment tool that you can use to get feedback from families. This tool will provide families the opportunity to share their experiences and perceptions about the health care received within your practice.
