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The Medical Home in Pediatric Practice. Forrest C. “Curt” Bennett, MD A. Chris Olson, MD, MHPA Carla Salldin Kate Orville, MPH Children’s Hospital & Regional Medical Center Grand Rounds May 13, 2004. What is a Medical Home?. A. A long-term care facility

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the medical home in pediatric practice

The Medical Home in Pediatric Practice

Forrest C. “Curt” Bennett, MD

A. Chris Olson, MD, MHPA

Carla Salldin

Kate Orville, MPH

Children’s Hospital & Regional Medical Center

Grand Rounds May 13, 2004

slide2

What is a Medical Home?

  • A. A long-term care facility
  • B. A physician providing care out of his/her home
  • C. A physician making house calls
  • D. A concept or model of care provision
slide3

A Medical Home Is…

  • NOT just a building or place but a way of providing health care services that are:
      • Accessible
      • Family-centered
      • Coordinated
      • Comprehensive
      • Continuous
      • Compassionate
      • Culturally Sensitive
slide4

In a Medical Home…

  • Children and their families receive the care that they need from a pediatrician or other PCP whom they know and trust.
  • The pediatric health care professionals and parents act as partners to identify and access all the medical and non- medical services needed to help children and their families achieve their maximum potential.
slide5

While all children can benefit from a medical home, it is particularly important for children with special health care needs and their families.

slide6

Children with Special Health Care Needs

  • “Children 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.”
  • Adopted by the AAP (October 1998). McPherson M, Arango P,
  • Fox HB, A new definition of children with special health care
  • needs. Pediatrics 1998; 102:137-140
slide7

Medical Home Leadership Network

  • Coordinated,statewide network of families and professionals who promote the availability and accessibility of medical homes for CYSHCN in their communities
  • Started 1994 --Funded by DOH CSHCN Program and US MCHB
  • Housed at UW Center on Human Development & Disability
slide8

MHLN Teams

  • Volunteer
  • Interdisciplinary
  • Community-based
slide9

MHLN Team Composition

  • Parent of CSHCN
  • Pediatrician / Family Physician
  • Public Health Nurse
  • Family Resources Coordinator (0-3)
  • Plus: Reps from mental health, schools, oral health and others
slide10

Washington State

Medical Home Leadership Network

PEND

OREILLE

WHATCOM

FERRY

OKANOGAN

SAN JUAN

SKAGIT

STEVENS

SNOHOMISH

CLALLAM

CHELAN

ISLAND

DOUGLAS

SPOKANE

JEFFERSON

LINCOLN

KITSAP

KING

MASON

GRAYS

HARBOR

GRANT

ADAMS

KITTITAS

PIERCE

WHITMAN

THURSTON

FRANKLIN

GARFIELD

PACIFIC

YAKIMA

LEWIS

COLUMBIA

WAHKIAKUM

BENTON

COWLITZ

WALLA

WALLA

ASOTIN

SKAMANIA

KLICKITAT

CLARK

Regions

Northwest

Central

King & Pierce

East

Southwest

Regional Resource Teams

slide11

State Medical Home Partners

  • MAA (Medicaid)
  • Parent to Parent
  • Fathers Network
  • Family Voices
  • Molina Healthcare
  • CHPW
  • Pediatric Dentistry
  • Adolescent Health Transition Project
  • WA Dept. of Health, CSHCN Program
  • US MCHB
  • UW CHDD- CTU & LEND
  • American Academy of Pediatrics (WA & US)
  • Infant Toddler Early Intervention Program
  • CHRMC/Center for Children with Special Needs
slide12

How do we achieve a medical home for every child by 2010 ?

  • MCHB/AAP: Need for state-based, systemic approach
  • National Medical Home Mentorship Network
  • Washington State selected as one of 12 teams January 2001
  • Each state team: Title V, AAP leadership, community pediatrician, CATCH Coordinator, Family Rep, Family Physician, other
  •  Washington State Medical Home Plan
slide13

Washington State Goal 1

  • Families, providers, leaders of statewide initiatives, policymakers, insurers and others involved with children and adolescents will understand and endorse the medical home concept.
    • Identify which groups need to understand medical home concept & what medical home activities already exist
    • Assemble/develop medical home materials
    • Disseminate information
slide14

Washington State Goal 2

  • PCPs and their office staff will have the skills, interest, and knowledge to participate as partners in medical homes
    • Support WA MHLN teams
    • Expand pool of providers and office staff available & skilled as medical home partners
slide15

Washington State Goal 3

  • Families will have the skills, interest, and knowledge to participate as partners in medical homes
    • Expand pool of family organizations and individuals promoting concept and strategies to families and health care providers
slide16

The Medical Home in Pediatric Practice

A. Chris Olson, MD, MHPA

Spokane, WA

the medical home in pediatric practice17
The Medical Home in Pediatric Practice
  • Olson Pediatrics
  • Data Collection
  • Care Coordination
  • Family-Centered Care
  • Marketing Pediatric Care
olson pediatrics
Olson Pediatrics
  • Spokane Medical Community
  • Two Pediatricians
  • Three Mid-level providers
  • Office Staff of 10 FTE’s
  • Approx. 9,000 patients
  • 1212 CYSHCN
mid level providers
Mid-Level Providers
  • Nursing background
  • Parents of CYSHCN
  • Lower costs
  • Timeline to train
  • Liability
associated staff
Associated Staff
  • Physical Therapist
  • In office services
  • Communication issues
  • Mental Health services
data collection
Data Collection
  • Data person
  • FACCT survey criteria
  • Excel spreadsheet/Access
  • Disease specific data collection
  • Insurance plans
care coordination
Care Coordination
  • Office coordinator
  • Inservice presentations
  • Care Plans
  • Specialty follow up
  • Chronic Care visits
    • Reminder system
  • Care Coordination costs
cost of care coordination
Cost of Care Coordination
  • 774 encounters/not reimbursed services
  • Most complex consumed 25% of the time
  • 11% of the patients
  • 51% of the encounters not medical
  • Cost of time spent coordinating
    • $22,809 to $33,048
  • Efforts to finance unreimbursable care coordination
family centered care
Family centered care
  • Family is the constant in the care of the patient
  • Connecting families
    • Newsletter
    • Bulletin board
  • Family advisory council
  • Asking families/surveys
medical home index
Medical Home Index
  • Office/Family
  • Organizational capacity
  • Community outreach
  • Chronic condition management
  • Data management
  • Care coordination
  • Quality improvement
the marketing of pediatric care
The Marketing of Pediatric Care
  • Differentiate pediatric care
  • Family practice
  • Future of pediatric care
  • Data/care coordination/family centered
  • Principles of change/NICHQ
slide31

Medical Home isour “PEACE” of Mind

  • Partnership
    • Education
      • Action
      • Care
      • Expertise
slide32

Building the Medical Home Puzzle

One “Peace” at a time

slide33

Adam Born October 30, 1995 (10 weeks early)

The beginning…

The first day I held my son, November 17th, 1995.

slide34

PEACEPartnership Story

  • Family story
    • Problem
    • Tells Story/ gives details
    • Medical problem/concern
    • What do we do next
    • Family needs
  • Medical story
    • Symptoms
    • Vitals
    • Medical specialists
    • Referral to Intervention
    • Community Supports

Questions and answers, partnership, responsibility and teamwork. We have PEACE of Mind, knowing our Primary Care Doctor listens to us, and we listen to her.

slide35

Adam’s Medical home…

  • Core Partnership
    • Adam
    • Parents
    • Pediatrician
  • Other partners
    • Medical Specialist
    • Interventionist/Therapists
    • School
    • Community programs
  • Friends and Family
  • Other Families
slide36

Successful Medical Home

Carla, Adam and Dan Salldin

Adam 8-1/2 years old

Dr. Donna Smith and

Virginia Mason

Sandpoint Pediatrics

Together as a Team, Family and Pediatrician, we have our PEACE of mind.

slide37

Success of Adam by Nature of his Medical Home

  • Health
  • Self esteem
  • Social well being
  • Academics
  • Physical activities
  • Future….
    • Adolescence, adult, and College?
slide39

Building a Successful Medical Home is like…..

  • a Miracle,
    • it happens over time and
  • a Puzzle
    • one PEACE at a time
slide40

Medical Home Tools and Support

for Washington State

Health Care Providers and Families

Kate Orville, MPH

Co-Director, MHLN

tools to support coordinated family centered care
Tools to Support Coordinated, Family-Centered Care
  • Links to community resources
  • Information and organizers for families
  • Website resources
    • Medical Home
    • Quality Improvement
one number to call
One Number to Call?
  • ASK Line- Answers for Special Kids

1-800-322-2588

  • Hotline for parents and providers looking for resources for CSHCN
  • Health, development, care, insurance parenting support, recreation, local & national disability-related orgs +
  • Sponsored by Healthy Mothers, Healthy Babies- Support from DOH
3 key local resources
3 Key Local Resources

1. Public Health Nurse CSHCN Coordinator

  • -- Serves children with or at risk for special needs ages 0-18 years.
  • -- Can provide or help families connect to: public health nursing, funding sources, & family support
  • -- Funded in part by DOH & works in your local health department
slide44

2. Family Resources Coordinator (FRC)

    • -- Serves children 0-3 years
    • -- Can help families:arrangefor further developmental testing toverify eligibility for early intervention (EI) services, explain EI services and systems, access community support programs, anddiscuss possible funding sources for EI services.
    • -- Funded by ITEIP (IDEA Part C)
key resources continued
Key Resources Continued…

3. Family to Family Support-

  • Parent to Parent
  • Fathers Network
  • PAVE
  • Diagnosis-specific support groups
slide46

Family and Child/Youth Self-Care Tools

  • Family Care Notebook
  • County Resource Lists & Starting Point
  • Medical Home Toolkit
  • Adolescent Health Transition Notebook
website resources
Website resources
  • Center for Children with Special Needs– CHRMC

www.cshcn.org

  • National Center for Medical Home Initiatives (AAP)

www.medicalhomeinfo.org

  • WA State Medical Home Leadership Network (up July, 2004)

www.medicalhome.org

  • Adolescent Health Transition Project

www.depts.washington.edu/healthtr/

support for quality improvement
Support for Quality Improvement
  • Center for Medical Home Improvement

-Medical Home Index

www.medicalhomeimprovement.org

  • National Initiative for Children’s Healthcare Quality (NICHQ)

www.nichq.org

  • Improving Chronic Illness Care (RWJ)

www.improvingchroniccare.org

contact information
Contact Information
  • Forrest C. “Curt” Bennett, MD

206-685-1356 fbennett@u.washington.edu

  • A. Chris Olson, MD

509-489-5110 olsonac@shmc.org

  • Carla Salldin 206-987-2063

carla.salldin@seattlechildrens.org

  • Kate Orville, MPH

206-685-1279 orville@u.washington.edu