Care Model for Child Health
The Care Model for Child Health is a modification of the work of Ed Wagner, MD, and his colleagues at Improving Chronic Illness Care at Group Health of Puget Sound, who analyzed hundreds of studies relating to the care of the chronically ill to determine the characteristics of successful programs. NICHQ has made modest modifications to this model to make it consistent with children’s health care. The result is a conceptual framework we call the Care Model for Child Health that has been used in many of NICHQ’s improvement programs:
Using the Care Model as a framework, we can develop strategies for change in each of its six components:
Healthcare System and Organization
The care children receive in individual practice settings is strongly affected by the environmental context and the practice’s organizational setting and policies.
The lives and well-being of children and families are tightly intertwined with their communities. Day care, Head Start, schools, and after-school programs are just some of the essential community resources that must be integrated with health care to address the needs of children.
Family and Self-Management Support
Although physicians prescribe treatment, patients decide whether to follow these recommendations. Family and self-management support focuses on the need for the healthcare system to support and enable the ability of children and families to manage their own care. This includes emphasizing the family’s role in managing their child’s well-being and illness and providing support to the child so s/he is able to manage his/her care in a developmentally appropriate way. Ultimately, collaborating with families in setting shared goals for child and family well-being and providing educational materials and resources to support them in reaching their goals is at the heart of this component.
Delivery System Design
Preventive care, care for children with chronic conditions, and care for children with special healthcare needs is most effectively delivered by a multidisciplinary team with clear understanding of roles and how each contributes to a child’s care. Team members should all have sufficient training for their roles and should communicate often. Care should be delivered in planned encounters rather than in purely reactive, acute visits. Encounters may be in person, but can also use alternative approaches, such as group visits and non-visit care such as phone or email.
Practices should embrace evidence-based guidelines where they are available. These guidelines should be embedded in documentation systems such as charts and electronic medical records to minimize reliance on individual recollection. Primary care practitioners should have access to specialty expertise, either through referral or specialty consultation and supervision.
Clinical Information Systems
Information technology can be used to identify entire populations of children with specific needs, assess practice performance, target high-risk populations, and plan for future needs.