Coordinated, Patient-Centered Care Through the Medical Home

Medical Home

January 19, 2014
Fill in the Blank: If You Don’t Improve, You _________

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December 14, 2013
Why I Participate: By Parent Partner Ziva Mann
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November 15, 2013
How and Why to Include the Patient Perspective
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Providing comprehensive, quality care to all children and youth is a difficult task. This goal is made all the more challenging by the fact that different health providers often don’t share information about patients they have in common. This lack of care coordination can lead to duplication of efforts, wasted resources, and diminished quality of patient care. The medical home seeks to address and resolve these recurring problems in America’s healthcare system by bringing the focus back to centralized primary care.

What Is a Medical Home?

“Medical home” is a model of patient and family-centered, community-based care that provides continuity of care from childhood through adolescence and facilitates a smooth transition to adult services. The American Academy of Pediatrics (AAP) developed the medical home model to deliver primary care that is accessible, compassionate, and culturally effective to all children and youth. Medical home is an approach to care that creates a comprehensive and collaborative working relationship between numerous clinicians, their patients, and the patients’ families. It is a key strategy to address the needs of Children and Youth with Special Healthcare Needs (CYSHCN)

In this short video, NICHQ’s CEO, Charles Homer, explains what a medical home is and why people are excited about it.


How Does a Medical Home Work?

The medical home is the organizational setting that integrates preventive services, acute illness management, and chronic condition management. To be effective, the medical home includes the following components:

  • Patient- and Family-Centered Care: The medical home seeks to identify the broad spectrum of a child and family’s needs at a given point in time (including preventive care and psychosocial items), as well as to anticipate and design care to address future needs.
  • Coordination of Care: The medical home coordinates among agencies and services in the child’s community (termed “horizontal coordination”) and within the health care system (“vertical coordination”) to address current health needs.
  • Continuity of Care: The medical home provides continuity over time to address future health needs; care in a medical home spans childhood through adolescence and facilitates a smooth transition to adult services.
  • Patient Education: The medical home fosters competence in patients and families as its key strategy to achieve positive results.

What Does a Medical Home Look Like?

  • The Center for Medical Home Improvement created a measurement tool, which defines specific criteria for a medical home.
  • The AAP produced an excellent video, which offers a glimpse into working at and receiving care in a medical home.

Learn More

NICHQ has a lengthy history as a national leader in the implementation of medical home through the use of Learning Collaboratives.

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