Materials for this week:
- Case discussion
- A review of the evidence for the medical home for children with special health care needs, Pediatrics 2008
- AAP Medical home resources and AAP Information for Parents on Medical Home
- What are the principles and goals of a “medical home”? The “medical home” (or “health care home” to encompass health maintenance and health promotion) is a model promoted by national agencies including the AAP to provide comprehensive, family-centered, community-based care for patients, especially Children with Special Health Care Needs (CSHCN). The medical home model seeks to provide care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective. A key part is to overcome barriers of fragmented services and provide care that is proactive, not always reactive.
- How many qualify as “Children with Special Health Care Needs (CSHCN)? Large population-based surveys estimate that 13% to 20% of children and youth meet the definition of CSHCN, as defined by parent report. This is probably an underestimate, and many children have two or more conditions.
- How does socioeconomic status affect prevalence of CSHCN? Unfortunately, there remain large inequities in chronic health conditions, access to health care services, and unmet specialty care needs based on social determinants of health. National data indicate higher odds for special needs among children living in poverty.
- Who should be involved within a medical home? Being an effective medical home requires a team approach. The primary care physician often develops the plan of care, with implementation and coordination managed by nurses, care coordinators, social workers, and the family. Collaboration with school nurses, visiting nurses, and home health aides is also crucial.
- What does a care plan include? One of the recommended strategies to help coordinate services for CSHCN is to develop care plans. Suggested care plan components include diagnoses/problem list, care team contact information, patient and family strengths and challenges, prior surgeries and/or procedures, recent lab and other diagnostic studies, assistive technology, and patient and family goals.