Transcript National Center for Medical Home Implementation

Disclosures
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Accreditation and Designation Statements
The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing
medical education for physicians. The AAP designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the
credit commensurate with the extent of their participation in the activity. This activity is acceptable for a maximum of 1 AAP credit. This credit can be applied
toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics. The American Academy of Physician
Assistants accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME. This program is approved for 1 NAPNAP CE contact hour of
which 0 contain pharmacology (Rx) content per the National Association of Pediatric Nurse Practitioners Continuing Education Guidelines.
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Purpose of Course
The American Academy of Pediatrics and National Center for Medical Home Implementation will be hosting a free four-part Webinar series beginning in April
2011. The purpose of the webinar series is to provide child health professionals with practical strategies for implementing medical home in practice. Each
webinar will be led by recognized experts with the goal of educating participants about the value of the family-centered primary care medical home for all
children and youth, especially in the daily delivery of preventive, acute, and chronic care. Faculty will point participants to practical tools and resources, and will
provide strategies for improving quality of care and increasing patient/family partnership and satisfaction.
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Learning Objectives
At the conclusion of this activity, participants should be able to:
Explain the primary care medical home and its relationship to Bright Futures 3rd Edition guidelines as a key preventive component
Explore key actions/roles around partnerships with health care teams, engagement of families, and practice organization in providing preventive/acute care for
children and youth
State quality improvement strategies for implementation of effective preventive/acute care in the medical home
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Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities
The AAP CME program aims to develop, maintain, and improve the competence, skills, and professional performance of pediatricians and pediatric healthcare
professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The AAP CME program
strives to meet participants' educational needs and support their life-long learning with a goal of improving care for children and families. (AAP CME Program
Mission Statement, September 2010).
The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible
conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities”
is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest
prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of
interest.
All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support:
Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a
commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and
organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented
in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.
Disclosures
Relevant Financial
Relationship(s)
Name of Commercial Interest(s)*
Disclosure of Off-Label (Unapproved)/Investigational Uses of Products
(Please indicate Yes or No)
(Please list name(s) of proprietary entity) AND
Nature of Relevant Financial
Relationship(s)
(Please list: Research Grant, Speaker's
Bureau, Stock/Bonds excluding mutual
funds, Consultant, Other - identify)
AAP CME faculty are required to disclose to the AAP and to learners when they plan to
discuss or demonstrate pharmaceuticals and/or medical devices that are not
approved by the FDA and/or medical or surgical procedures that involve an
unapproved or “off-label” use of an approved device or pharmaceutical.
(Do intend to discuss or Do not intend to discuss)
Yes
Progenitor Cell Therapy, Amorcyte
Do not intend to discuss
Linda Lindeke, PhD, RN, CNP, Planning Committee
Member
No
None
Do not intend to discuss
Marie Y. Mann, MD, MPH, FAAP, Planning Committee
Member
No
NovoNordisk,Baxter Healthcare
Do not intend to discuss
William Schwab, MD, FAAP, Planning Committee
Member
No
None
Do not intend to discuss
Jill Rinehart, MD, FAAP, Faculty
No
None
Do not intend to discuss
Kristy Trask, RN, Planning Committee Member
No
None
Do not intend to discuss
Michelle Esquivel, MPH, AAP Staff, Planning Committee
Member
No
None
Do not intend to discuss
Angela Tobin, AM, AAP Staff, Planning Committee
Member
No
None
Do not intend to discuss
Corrie Pierce, AAP Staff, Planning Committee Member
No
None
Do not intend to discuss
Name/Role
Thomas Kliztner, MD, PhD, FAAP, Physician
Representative, Planning Committee Member
Partnering with Patients and Families
in the Medical Home
2011 CME Webinar Series
brought to you by the National Center for Medical Home Implementation
The Role of the Medical Home in
Preventive and Acute Care
Jill Rinehart, MD, FAAP
Kristy Trask, RN
April 27, 2011
Disclosures
We have no relevant financial relationships with the
manufacturers(s) of any commercial products(s)
and/or provider of commercial services discussed in
this CME activity.
I do not intend to discuss an
unapproved/investigative use of a commercial
product/device in my presentation.
Webinar Objectives
By the end of this webinar, the participant will be able to:
 Explain the medical home and its relationship to Bright
Futures 3rd Edition guidelines as a key preventive component
 Explore key actions/roles around partnerships with health
care teams, engagement of families, and practice organization
in providing preventive/acute care
 State quality improvement strategies for implementation of
effective preventive/acute care in the medical home
Our Medical Home Program
 Three pediatricians, Dr. Joseph Hagan, Dr. Jill
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Rinehart, Dr. Greg Connolly
Two Pediatric Nurse Practicioners, Maryann Lisak
&Tonya Wilkinson
One main RN Care Coordinator Kristy
Office manager, Scheduling manager, two office
assistants, four additional part-time nurses, one
medical assistant
~5000 Active Patient List
Medical Home History
 1967: First published reference to Medical home
was in the AAP’s Council on Pediatric Practice’s
Standards of Child Health Care
 Defined Medical Home as the respository of
medical records for a child, emphasized the
importance especially for CSHCN
Medical Home History
 1970’s: AAP first addresses the policy
implications of the term “medical home”
 1977: “Fragmentation of Health Care Services for
Children,” Clarified the concept of single medical
home for every child
 1980’s: The first Medical Home is attributed to
Hawaii Pediatrician, Dr. Cal Sia.
 1992: AAP published first policy statement
defining the medical home
Medical Home History
1998: Called for “imaginative methods,
backed by insurance and government
funding [that] must be developed and
used to improve financing for care
coordination and other needs…”
~Polly Arango and Merle McPherson
“New Definition of Children with Special Health Needs,”Pediatrics,1998
Medical Home History
 2002: Medical Home Policy Statement was published that
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defines the concept of Medical Home we use today
2002-2004 in VT: Medical Home Improvement Project
Applied PDSA cycles to improving our practice towards
medical home standards
Created (formal) parent partnerships to advise our progress
2006: ACP created “The Advanced Medical Home: A
Patient-Centered, Physician-Guided Model of Health Care”
promoting an “evidence based” medical home
2007: Bright Futures embraces the concept of Medical
Home for all children and states that the Medical Home is
the most effective model for the provision of health
supervision.
Medical Home History
 Joint effort led to the National Center for Quality
Assurance’s (NCQA) creation of Physician Practice
Connections-Patient-Centered Medical Home
(PPC®PCMH™)
 Created 2008 PPC®PCMH™ Standards
 March 2011 new PCMH guidelines
Medical Home Definition
 Accessible
 Culturally Effective
 Continuous
 Comprehensive
 Coordinated
 Compassionate
 Family Centered
Medical Home Definition
The Medical Home is the model for 21st
century primary care, with the goal of
addressing and integrating high quality
health promotion, acute care and chronic
condition management in a planned,
coordinated and family-centered manner…
~National Center for Medical Home
Implementation
What the Julius Medical Home Was at HRC
 Incredible reputation
 Amazing Physicians
 24/7 Coverage
 Nurses that were lactation specialists
 Integrated approach and interest in
Matt’s whole life
Our Medical Home Until 1:30pm 2/15/01
FAMILY
Support
Family &
Friends
MEDICALHOME
PRIMARY DOCTOR
CARE COORDINATOR
DAYCARE
And Then…Along Came the
Amazing Miss Kate
 Congenital Hydrocephalus
 Multiple revisions, infections, complications
 Cerebral Palsy, Epilepsy
 Downright remarkable
Our Medical Home
Post Diagnosis
1:35 pm 2/15/01
Specialists
Neurosurgery
Neurology
Physiatrist
Endocrinology
FAMILY
Support
Family,
Friends, Groups,
Advocacy
Respite
Medicaid
Aris
FIT
Funding
MEDICALHOME
PRIMARY DOCTOR
CARE COORDINATOR
On-Going Care Team
Social Worker
OT/PT/SLP Therapists
Daycare Staff & Aide
Insurers
Medicaid
FIT
CSHN
CSHN
Clinics
Funding
Equipment
National Study-CSHN, 2005-6
Surveyed 40,840 Children
Measured 5 core medical home components:
1)
2)
3)
4)
Having a usual source of care
Having a personal doctor or nurse
Receiving all needed referrals for specialty care
Receiving help as needed in coordinating healthrelated care
5) Receiving family-centered care
“New Findings from the 2005-06 NS-CSHN,” Strickland, B.et.al.Pediatrics, June
26, 2009 Vol. 123
National Study-CSHN 2005-6
Good News:
• 90% of CSHN and their peers had “usual source
of care” and a personal MD or nurse
BUT only half of CSHN and peers had access to
medical home in all 5 aspects
• As family income increases, access to medical
home increases
•
Access is affected by race/ethnicity, health
insurance status, severity of child’s condition
“New Findings from the 2005-2006 NS-CSHN,” B.Strickland, et.al.Pediatrics, June 26,
2009Vol. 123
Access to Medical Home
•
Parents of CSHN who do have medical homes
report less delayed or forgone care and significantly
fewer unmet needs for health care and family
support services
•
But limited improvements since success rates first
measured in 2001 NS-CSHN
“New Findings from the 2005-2006 NS-CSHN,” B.Strickland, et.al., Pediatrics, June 26,
2009 Vol. 123
Care Coordination: What Does It Look Like?
 A plan of care developed by the physician, CYSHCN, and
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family
A central record with pertinent medical information kept in
the primary care office
When CYSHCN is referred for a consultation, the medical
home assists the CYSHCN and family in communicating
clinical issues
The medical home evaluates and interprets the consultant’s
recommendations for the CYSHCN and the family
The care plan is coordinated with other community
agencies
Developmental
Delay
P overty
Food Shortage
Children’s
Integrated
Services : WIC,
EEE, Headstart,
Family Rooms
Pediatric Community Connections
(Chittenden County VT)
Howard
Center
Dev. Disabilties
First Call
IFBS
Autism
Developmental
Disability
Mental Health Crisis
Substance Abuse
Pe di atri c Me di calHome
Hagan, Rinehart &Connolly
~5000 patients
ADHD
Obesity
Asthma
Ve n dors:
S ch ools:
Nurses
School Based
Clinicians,S.W.,
Counsellors,
VNA, Rehab,
Medical store,
RD
Care Coordination
Typical Children
DCF
CSHN
Family
Depression
Autism
ADHD
VT Center for
Children,
Youth &
Families
Family
Wellness Coach
P hysicalAbuse
Medical Neglect
Sexual Abuse
CSHN clinics
Autism Eval.
Neuropsychtesting
Child Dev. Clinic
RD
Orthopedics
Cranio-fa cial
P sychiatry
Intellectual
Disability
VT Children’s
Hospital
P sychology
P ediatric
Subspecialists
P sychiatry
Jill S. Rinehart, MD, FAAP
March, 2011
What is Bright Futures?
• Gold standard for pediatric care provides detailed
information on well-child care for health care
practitioners.
• A national health promotion and disease prevention
initiative that addresses children's health needs in the
context of family and community
Bright Futures and Medical Home
Bright Futures is an evidenced based
approach to preventive health care, that is
best delivered in the medical home.
Medical Home: Health Supervision
At any given time we have 2 distinct populations in
Pediatrics:
1.
Relatively healthy: need preventive health care,
education and community support and,
2.
The pretty sick: who need preventive health care,
education, community support AND chronic care
management
Medical Home Definition
 Accessible
 Culturally Effective
 Continuous
 Comprehensive
 Coordinated
 Compassionate
 Family Centered
Medical Home and Health Supervision
Coordinated, Continuous
• Lacation Consultation
• Nurse phone call follow up
• First touchpoint with office after infant born
• Past 24 hours (stools, swallowing, engorgement)
• Feeding, jaundice
• Explore supports
• “Baby blues”
Medical Home and Health Supervision
Comprehensive
 11 year old boy, Bright Futures Visit
 BMI: 87%, SMA II
 Strengths based assessment
H-ome
E-ducation
A-ctivities
D-rugs
S-ex
S-uicide
S-afety
Medical Home and Health Supervision
Family Centered, Comprehensive
Parent Concerns:
Mom concerned about anxiety around swim meets and whether
divorce adjustment ok
Youth Concerns:
Warts-hands and fingers, biggest kid in 5th grade
Physician Concerns:
Elevated BMI, needs Immunizations, puberty
Medical Home and Health Supervision
 Strengths Based Assessment, developmental
milestones of pre-adolescent
Generosity: likes younger kids, book buddy has special
needs
Independence: self-reliance, supervises younger
brother at Dad’s
Mastery: qualified New England’s 9 swim events
Belonging: loves school, has friends, loves Vermont
Medical Home and Health Supervision
Anticipatory Guidance:
Physical Growth/Development: puberty, BMI
Emotional Well-being: decision making, dealing with
stress, mental health concerns, puberty
Risk reduction : parents know friends
Violence and Injury Prevention: helmet, no guns,
bullying
Health Supervision in the Medical Home
 Conclude with readiness to change steps--switch from
chocolate milk to skim at school, review healthy choices for
food in all settings, identify opportunity for role as a
babysitter/mother’s helper in the neighborhood
 Support psychotherapy around divorce issues
 Immunizations: HPV, Tdap, Menactra
Medical Home Definition
 Accessible
 Culturally Effective
 Continuous
 Comprehensive
 Coordinated
 Compassionate
 Family Centered
Family-Centered
 McKayla is a 12 year old with Nonketotic
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Hyperglycinemia
Developmental Delay
Choreoathetosis
Seizures
Dysphagia (G-Tube)
Friend, classmate, daughter, niece
Compassionate
Admitted for aspiration pneumonia
Comprehensive
 Physician facilitates essentially all aspects of care
 Pediatric Resident communicates with
neurometabolism program to adjust feedings/meds
 Family as experts: provides medication lists, dietary
history, clinical expertise:“She’s herself again!”
Evidence for Medical Home
 Comprehensive care for high-risk
infants resulted in more outpatient
visits, but fewer life-threatening
illnesses, PICU admissions and
PICU days
Broyles RS, Tyson JEH, Heyne ET, et al. “Comprehensive followup care and life-threatening illnesses among high-risk infants: a
randomized controlled trial,” JAMA. 2000;284 (16):2070 –2076
Evidence for Medical Home
 For children with Asthma a
decreased continuity of care is
shown to increase hospitalizations
Christakis D, Mell L, Koepsell TD, Zimmerman FJ, Connell RA.
Association of lower continuity of care with greater risk of
emergency department use and hospitalization in children.
Pediatrics. 2001;107 (3):524 –529
Coordinated Care
 Teagan is a 2 year old with Kabuki (Make-up) Syndrome
 Had a Nissen and G-Tube placed in infancy for severe
aspiration, oral aversion
 Late last fall, she presented with seizures associated
with hypoglycemia
 Difficult IV access
 Sister, clown, cousin
Coordinated Care
 PICC placed by anesthesia
 Dr. Mingin renal calculi surgery
 Labs coordinated by genetics, endocrine, GI, me
(some first a.m., fasting, hypoglycemic,etc.)
Comprehensive
 Pediatric Medical Home:
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Dr. Rinehart (HRC)
Pediatric Resident Team
Dr. Guillot Pediatric
Nephrology
Dr. D’Amico Pediatric
Gastroenterology
Dr. Kacer Endocrinology
Dr. Burke Pediatric
Genetics
 Dr. Modlinsky Anesthesia
 Dr. Mingin Pediatric Urology
 Dr. Hubble Pediatric ENT
 Dr. Sartorelli Pedi Surgery
 Dr. Hastings Pediatric
Opthalmology
 Dr. Bingham Pediatric
Neurology
 Dr. Soll Neonatology
Comprehensive
Review of evidence base for medical home
model found that 28 of 33 articles reported
benefits of medical home over a range of
outcomes
Homer CJ, Klatka K, Romm D, et al. “A review of the evidence for
the medical home for children with special health care needs.”
Pediatrics. 2008;122 (4)
Comprehensive
Having a medical home is associated with
increased ease of use of community services by
families
Baruffi G, Miyashiro L, Prince CB, Heu P. Factors associated with ease of
using community-based systems of care for CSHCN in Hawaii. Matern
Child Health J. 2005;9 (suppl 2):S99
Comprehensive
 2 brothers live with their dad and paternal Grandma in
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Burlington
Scotty is 6, has CP
Sam is 7 has Autism
Chief Complaint: Truancy
Scotty unable to get a power chair because home is not
accessible
Accessible “units” not possible due to Sam’s sleep
dysfunction
Coordinated
 Care Conferences: Kidsafe Collaborative, Burlington
Housing Authority, Howard Center, Bridge Program,
Burlington School district, Shelburne School District,
psychologist, CSHN social worker, school nurses, PT,
OT, SLP
Compassionate
 BHA found a house in Shelburne, needed indoor
modifications and a ramp
 Generous donor--donated supplies, labor
 Family moved in on March 29!
CMHI National Outcomes Study
Cost/Utilization
Medical Home Index; 43 Practices, 7 Plans/5 States
 Higher overall MHI scores or higher domain
scores for care coordination, chronic condition
management, office organizational capacity
 Lower hospitalization rates
 Higher Chronic Condition Management domain
scores
 Fewer ER visits
Cooley, McAllister, Sherrieb, Kuhlthau, Pediatrics, July
2009
Why is Care Coordination Important?
Families spend 11+ hrs/wk coordinating care for
CYSHCN, which has consequences for:
- Emotional/mental/ behavioral health of
family and CYSHCN
- Finances
- Employment
MCHB/NCHS. National Survey of Children with Special Health Care Needs. 2002
National Study of Care Coordination in Medical Home
Rich Antonelli, MD
 Hagan & Rinehart counted unreimbursed care
coordination activities (2004)
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39 workdays
602 encounters
422 unique patients
 Level 1: typical child, no psychosocial aspect
 Level 2: CYSHCN, no psychosocial aspect
 Level 3: typical child, with psychosocial aspect
 Level 4: CYSHCN with psychosocial aspect
Encounters by Level (HRP)
Encounters by Level
Level 4
23%
Level 1
41%
Level 1
Level 2
Level 3
Level 4
Level 3
21%
Level 2
15%
Encounters by Staff Type (HRP)
MD
14%
Clerical
8%
MD
Clerical
LPN
RN
53%
NP
RN
LPN
23%
NP
2%
Direct Cost of CC by Staff Type
Staff Type
Encounter
%
Total
Time %
Cost $
Total Cost %
Average
Cost per
encounter
Physician
16
18
13,713
46
21.63
PNP
2
2
472
2
6.74
RN
32
33
8419
28
6.77
LPN
6
4
619
2
2.80
Clerical
32
25
3423
11
2.79
MA
7
8
1030
3
3.69
MSW
4
7
1436
5
10.18
Parent
Advocate
1
3
865
3
22.76
Results
 Most care coordination done for typical children, not
CYSHN
 Major cost driver is care coordination done by
physicians
 Office based nurses resulted in less ED use and less
unplanned office visits
Antonelli RC, Stille CJ,Care , Antonelli DM, “Coordination for CYSHCN: A
descriptive Multisite Study of Activities, Personnel Costs, and Outcomes,”
Pediatrics, Vol. 122 No. 1 July 2008
Signs of Success
Measuring the Medical Home
 Quality Assurance—Do you meet standards?
 National Committee for Quality Assurance (NCQA)
10 Standards; Levels 1, 2, and 3
 Basic requirement for many pilots
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 Quality Improvement—Where are you on the
medical home continuum?
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CMHI Medical Home Index (Validation Study 2003)
Medical Home Family Index & Survey
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Pediatric & adult versions: long & short forms
Jeanne McAllister
Measuring the Medical Home
 Quality Assurance—Do you meet standards?
 National Committee for Quality Assurance (NCQA)
10 Standards; Levels 1, 2, and 3
 Basic requirement for many pilots

 Quality Improvement—Where are you on the
medical home continuum?
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CMHI Medical Home Index (Validation Study 2003)
Medical Home Family Index & Survey

Pediatric & adult versions: long & short forms
Jeanne McAllister
NCQA Process
 VCHIP Project administrator, EHR representative
(PCC), Office Administrator, Physician leader
 Create a binder- that proves you do what you say you
do
 Your Choice: 3 clinical conditions for which you have
evidenced based guidelines incorporated into your
record (Health Supervision, ADHD, Depression,
Asthma, Obsesity) and have had for 3 months
NCQA Process
Benefits:
 Self-evaluation:
Call return time
Policies: lab, patient scheduling,
prescriptions, E.H.R.
 Identify areas for improvement
 PPPM reimbursement
NCQA Process
Challenges:
• AAP just put together a by element
response to the new 2011 NCQA
guidelines
• This is Health Reform in Vermont
• Future: Patient/Family feedback
required (Medical Home Index?)
Blueprint for Pediatrics
 Medical home
 NCQA
scoring
 Access to Community Health Team
 Data Collection/submission/Docsite
 Electronic health record
 Per member per month
Signs of Success
How do we build quality
into our Medical Home?
Quality Improvement Strategies
• Practice Improvement Partnerships (Vchip)
• Medical Home EQIPP Course
• Bright Futures EQIPP Course
• PDSA cycles on building a team, ways to engage
families, implementing clinical guidelines (Bright
Futures, acute conditions, implementing a
recall/reminder system)
• Self-assessment! (Medical Home Index)
Building Medical Home Teams
• Care Coordinator
• Team Huddles
• Provider Meetings
• Staff Meetings
• Co-located Psychologist
• Pediatric Psychiatrist-Case consults every 2-3 weeks
• New alliances: Community Health Team, Medical social
worker, Pediatric Registered Dietician
Engaging Patients and Families
• Motivational Interviewing
• Family Centered Care
• Team building
• Empowering parents as experts and partners
• Medical Home Index
• Family Advisory Board
Practice Organization
• Preparing for Office Visits (pre-visit forms)parent, youth
• Patient Registry-flag in E.H.R. for CSHN, or
“more time needed”
• Access to clinical guidelines
• Care coordinator(nurse): connects with family after birth,
ED visit, discharge from NICU, or Children’s Hospital
• Care Conferences: brings families, communities together
Take Home Points
 NCQA evolved from AAP medical home-Blueprint is health
care reform in pediatrics in Vermont
 Care Coordination: You are already doing it, and might as
well get reimbursed for it
 Health Supervision for all children best done the Medical
Home
Thank You to Our Parent Partners
 Carolyn Brennan
 Kimberly Cookson
 Sandy Julius
 Scott Metevier
 Peggy Mann Rinehart
 Wendy Ruggles
 Theresa Soares
 Kate & Michael Stein
Resources
Antonelli RC, Stille CJ,Care , Antonelli DM, “Coordination for
CYSHCN: A descriptive Multisite Study of Activities, Personnel
Costs, and Outcomes,” Pediatrics, July 2008
Baruffi G, Miyashiro L, Prince CB, Heu P. “Factors associated with
ease of using community-based systems of care for CSHCN in
Hawaii,” Maternal Child Health J, 2005
Broyles RS, Tyson JEH, Heyne ET, et al. “Comprehensive follow-up
care and life-threatening illnesses among high-risk infants: a
randomized controlled trial,” JAMA. 2000
Christakis D, Mell L, Koepsell TD, Zimmerman FJ, Connell RA.
Association of lower continuity of care with greater risk of
emergency department use and hospitalization in children.
Pediatrics. 2001
Cooley C, McAllister J, “CMHI National Outcomes Study
Cost/Utilization,” Pediatrics, July 2009
Resources
Christakis D, Mell L, Koepsell TD, Zimmerman FJ, Connell RA.
Association of lower continuity of care with greater risk of
emergency department use and hospitalization in children.
Pediatrics. 2001
Hagan, J.F, Duncan, P., Shaw, J., Bright Futures: Guidelines for
Health Supervision of Infants, Children and Adolescents, p.4
Homer CJ, Klatka K, Romm D, et al. “A review of the evidence for
the medical home for children with special health care needs.”
Pediatrics. 2008
MCHB/NCHS. National Survey of Children with Special Health
Care Needs, 2002
National Center for Medical Home Implementation “Building Your
Medical Home Toolkit,”
website:http://www.pediatricmedhome.org/
Strickland, et.al.,“New Findings from the 2005-2006 NS-CSHN,”
Pediatrics, June 26, 2009
Questions?
Got Medical Home?
Have a specific question or need
regarding medical home?
Contact us!
[email protected]
800/433-9016 ext 7605