Illinois Medical Home Model

Better Lives for Children - Every Child Deserves a Medical Home

Medical Home Information for Physicians

Medical Home Information for Families

Creating a Medical Home

Parent Partnership

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

Practice Accommodations for
Preventive Care Management

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

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

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
The annual recommended immunization schedules for children and adolescents in the United States reflect current recommendations for use of vaccines licensed by the US Food and Drug Administration. The following schedule and guidelines outline the current recommendations for children and adolescents.

Developmental Surveillance and Screening
Identifying Infants and Young Children With Developmental Disorders in the Medical Home provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age at every well-child preventive care visit. This is an example of another one of the first policies to be converted by the AAP Partnership for Policy Implementation process. To obtain free copiesof the entire policy statement, including the algorithm, contact screening@aap.org.

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Bright Futures
Initiated by the Maternal and Child Health Bureau (MCHB) over a decade ago, Bright Futures is a philosophy and approach that is dedicated to the principle that optimal health involves a trusting relationship between the health professional, the child, the family, and the community. As part of this initiative, Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents was developed to provide comprehensive health supervision guidelines, including recommendations on immunizations, routine health screenings, and anticipatory guidance.

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
In 1993, state-mandated screening for childhood lead poisoning in children 6 years of age and younger began. Federal mandates and Illinois Department of Healthcare and Family Services policy recommend that all children enrolled in the department's Medical Programs be considered at risk for lead poisoning and receive a screening blood lead test at 12 and 24 months. Children over the age of 24 months, up to 7, for whom no record of previous screening blood lead test exists, should also receive a screening blood lead test. All children enrolled in the department's Medical Programs are expected to receive a blood test regardless of where they live.

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
The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children policy statement serves to familiarize the pediatrician with currently accepted criteria defining the spectrum of autism, strategies used in making a diagnosis, and conventional and alternative interventions.

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.

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Obesity
Documented trends in the increasing prevalence of overweight children and, correspondingly, the lack of physical exercise and activity mean that pediatricians must focus preventive efforts on childhood obesity with its associated co-morbid conditions in childhood and likelihood of persistence into adulthood. These trends pose an unprecedented burden in terms of children’s health as well as present and future health care costs. The following practice guidelines and policies outline strategies to foster prevention and early identification of overweight and obesity in children.

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
Bright Smiles from Birth is the newest of ICAAP’s educational and technical assistance programs. The program is focused on improving the oral health of infants and young children. Participating practices receive a 90-minute in-office program that trains providers and office staff to incorporate oral health screenings into their well-child exams. The program also assists providers in taking appropriate steps once high-risk patients are identified, which may include patient education, referral to dental homes, and application of fluoride varnish. There is no cost for the program and participating practices are provided with a resource kit containing professional and patient education materials as well as continuing medical education (CME) credit.

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 .

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last modified: 19 July 2007

Practice Accommodations for Preventive Care Management

Practice Accommodations for
Preventive Care Management