Creating a Quality

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Medical Home . . .
Presented by Kathy Sanabria, MBA August 25, 2005
Creating a Quality Improvement Process
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Creating a Medical Home while . . .
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Todays Topics

• Define Children with Special Health Care Needs
  (CSHCN)
• Define Medical Home
• Describe Illinois Medical Home Model
• Provide Links to Medical Home Resources
• Describe Mission and Focus of Illinois Chapter,
  American Academy of Pediatrics (ICAAP)
• Describe Illinois Medical Home Project (IMHP)
  Grant Goals Objectives for Years 1-2
• Describe IMHP Evaluation Plan
• Identify Medical Home Quality Improvement Teams
  in Illinois
• Conduct Outreach to Other Organizations

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Who Are CSHCN?
90 Survive to adulthood
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Federal Definition of CSHCN
CSHCN are those who have or are at increased
risk for a chronic physical, developmental,
behavioral, or emotional condition and who also
require health and related services of a type or
amount beyond that required by children
generally.
Defined by the Maternal and Child Health Bureau
(July 1998)
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Goal 6

• All children with special health care needs will
  receive coordinated, ongoing, comprehensive care
  within a medical home.

Estimated Proportion of CSHCN Meeting Goal 52.7
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• National household survey conducted by telephone
  for CDC
• Screened 200,000 families to identify CSHCN
• 40,000 CSHCN 750 in each state
• Conducted from Oct 2000 to March 2002
• Planned repetition in 2006 and 2010

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80 of Health Care Cost
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AAP Periodic Survey 44

• Purpose Explore provision of elements of a
  Medical Home
• Initiated by CSHCNPAC COCWD
• Conducted by mail January to May 2000
• Mailed to 1,632 active AAP members in the USA
• Response rate of 57

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AAP Periodic Survey 44

• 26.9 - estimated number of patients in their
  primary practice setting are CSHCN
• 70.9 - high prevalence, low severity
• 20 - low prevalence, high severity
• 9.5 - technology-dependent

Patients with Special Needs
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Medical Home History
1967 The text defines a medical home as the
central source of a childs pediatric records,
and emphasizes the importance of centralized
records to children with special needs  
For children with chronic diseases or disabling
conditions, the lack of a complete record and a
medical home is a major deterrent to adequate
health supervision Wherever the child is
cared for, the question should be asked, Where
is the childs medical home? and any pertinent
information should be transmitted to that place.
Standards of Child Health Care, a text published
by the AAP Council on Pediatric Practice
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Medical Home History

• 1984 Hawaii Healthy Start home visiting
  program for the prevention of child abuse
  and neglect.
• 1985 Dr. Cal Sia in Hawaii designed the
  initial Medical Home Project (SPRANS)
• Adopted by the Hawaii Medical Association and
  the Hawaii Chapter of the American Academy
  of Pediatrics (AAP), to provide child health
  care through a medical home that would
  provide comprehensive services and focus on
  the whole child within the context of the
  family and the community (Sia Breakey, 1985).
• 1986 Zero to Three program for the education
  of the handicapped infant and toddler was
  launched.

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Medical Home continues

• Early 90s AAP Maternal Child Health
  Bureau (MCHB)
• began discussion and development of
  collaborative projects to implement medical
  homes for all children with special health care
  needs.
• 1998 MCHB Mandated Performance Measures
  for Children with Special Health Care Needs
  (CSHCN) Programs in every state.

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Primary Health Care Setting
Preventive Health Care
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Primary Health Care Setting
Preventive Health Care
Acute Health Care
70 80
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Primary Health Care Setting
Preventive Health Care
Acute Health Care
Chronic Health Care
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Primary Health Care Setting
Preventive Health Care
Acute Health Care
Chronic Health Care
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Medical Home Model
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What is a Medical Home?

• Its an approach for
• providing access to cost-effective quality health
  care in a primary health care setting.
• Its a special relationship that a family has
  with their primary care physician

Proactiveand not Reactive Quality of Health Care
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Illinois
3 Components
Medical Home Model
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What do families mean when they say they have a
Medical Home?
1st Component
Medical Home Model
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• The primary care physician (PCP) and other
  health care providers
•    Know the childs health history
•    Listen to the parents and childs concerns
  and involves them in decision-making
•    Share a trusting, collaborative relationship
  with the family and
•    Treat the child with compassion and
  understanding
• Parents and child
• Are comfortable sharing concerns and questions
  with the childs primary care physician
  and other health providers.
•  Routinely communicate their child's needs and
  family priorities to the primary care
  physician, who facilitates communication between
  the family and other health care providers
  when necessary.
•  

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State-Specific Enhancing Elements
2nd Component
Medical Home Model
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QualityImprovement Process

• Regularly scheduled meetings (every 2-4 wks)
• Min 2 parents physician office care
  coordinator
• Baseline Medical Home Index
• Develop plans and implement change for quality
  improvement

DSCC Facilitator maintains structure and momentum
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Physicians and ParentsRanking of Services
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What do physicians mean when they say they
provide a Medical Home?
3rd Component
Medical Home Model
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Critical Supporting ElementsMedical Home Model
Standards of Pediatric Care
Standards Developed by Recognized Professional
Organizations
G U I D E L I N E S
P O L I C I E S
Basic Knowledge
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Illinois Community Resource CD
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Medical Homes in Action Series

• Condition-specific Fact Sheets
• Coming to DSCC Web Site
• ACMG/HRSA/AAP Act Sheets for NB Metabolic
  Screening

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UTAH Medical Home Project
http//www.medhomeportal.org/
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Illinois Provider Directory

• The directory includes
• general pediatricians
• family physicians
• pediatric specialists
• occupational therapists
• physical therapists
• speech pathologists
• audiologists
• mental health specialists
• pediatric dentists
• and other health care providers who serve
  Illinois children with special health care needs.
  
• A RESOURCE FOR BOTH FAMILIES AND PROVIDERS

http//www.illinoisaap.org
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Primary Care Physician

• Accessible
• Family-Centered
• Comprehensive
• Continuous
• Coordinated
• Compassionate
• Culturally-competent

• Chronic Care Management that is

and for which the PCP
Shares Responsibility
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Framework

• Develop a Quality Improvement Process
• Improve Medical Homeness
• Involve families
• Cost Effective Health Care
• Increases Community Resources
• Proactive vs. Reactive Health Care

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Additional Resources

• The National Center of Medical Home Initiatives
  for Children with Special Needs
• www.medicalhomeinfo.org

• State Resources
• Training Programs Materials
• Screening Initiatives

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Center for Medical Home Improvement

• Building a Medical Home Improvement Strategies
  in Primary Care for Children with Special Health
  Care Needs
• Improvement kit keyed to Medical Home Index
• Web site www.medicalhomeimprovement.org
• Download kit and measurement tools
• Links to other resources
• News
• Interactive self-assessment (future)

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Bright Futures

• 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 screening, and
  anticipatory guidance

http//brightfutures.aap.org/
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National Center for Cultural Competence (NCCC)

• http//gucchd.georgetown.edu/nccc/index.html

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For More Information Contact
Division of Specialized Care for
Children(DSCC) 2815 W. Washington, Suite
300 P.O. Box 19481 Springfield, IL 62794-9481
1-800-322-3722 Family Liaison Bob Cook at
rjcook_at_uic.eduMedical Home Technical Support
Team Donna Scherer at dscherer_at_uic.edu
Shelly Roat at sgroat_at_uic.edu Rita Klemm at
rkklemm_at_uic.edu
www.uic.edu/hsc/dscc
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Illinois Chapter, American Academy of Pediatrics

• Illinois Medical Home Project Contacts
• Kathy Sanabria, MBA, PMP, Project Director
• Kathryn Hawley, BS, Project Manager
• Illinois Chapter, American Academy of
  Pediatrics
• 1358 W. Randolph Street
• Suite 2 East
• Chicago, IL 60015
• 312-733-6207
• www.illinoisaap.org/medicalhome.htm