Medical Home Toolkit

Evaluation Tools for Clinicians

The recommended measurement tools for evaluating a team’s successful integration of Medical Home into their clinical practice are the Medical Home Index (MHI) and the Family Survey of the Perception of Medical Home. The Medical Home Index is a measure of the practice’s perception of themselves. The Family Survey is a measure of the parents’ perception of the practice. Only obtaining both viewpoints gives the triangulated view.

The Care Model for Child Health in a Medical Home highlights the desired outcomes of a strong medical home: family-centered, timely, efficient, evidenced-based, safe and coordinated care offered by a prepared, proactive, practice team in partnership with an informed, activated, patient and family, in the context of a supportive, integrated, community. While this is a tall order, making changes in the six arenas will enable practices working to improve their medical home to build their system and offer this kind of car by periodically repeating the Medical Home Index will quickly show teams their enhanced scores in areas such as having a quality improvement process in place, learning from parent partners, knowing who their population of CYSHCN are, having a developed care coordination capacity, and offering visits which are better planned and more family-focused. A look at the MHI also builds the team’s vision for where they want to be as a medical home, and thus where they want focus next.

Project Resources

Pediatric Medical Home Index (MHI)
The Pediatric MHI is available in both a full version and a short version on the Center for Medical Home Improvement (CMHI) website.

List of Medical Home Tools [.doc]
This document lists the tools and resources identified by the participants, faculty and staff from the NICHQ Medical Home Learning Collaboratives I & II; by the Center for Medical Home Improvement; and by the National Center of Medical Home Initiatives for Children with Special Needs. They represent an initial set of resources that may be offered to practices.

How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
Becoming a medical home is a radical change, requiring both a new mental model for primary care and the skills and resources to accomplish it. Although numerous reports indicate practice change is feasible—particularly with technical support and either insulation from or alignment with financial incentives—sustained transformation appears difficult. We identified the following critical success factors: leadership, financial resources, personal and organizational relationships, engagement with patients and families, competence in management, improvement methods and coaching, health information technology properly applied, care coordination support, and staff development. Each factor raises researchable questions about what policies can facilitate achieving success so that transformation becomes mainstream rather than the province of the innovative few.

  • Citation: Homer CJ and Baron RJ. "How to Scale Up Primary Care Transformation: What We Know and What We Need to Know." Journal of General Internal Medicine. Volume 25 Issue 6 (2010): 625-629.

A Review of the Evidence for the Medical Home for Children With Special Health Care Needs
The receipt of health care in a medical home is increasingly touted as a fundamental basis for improved care for persons with chronic conditions, yet the evidence for this claim has not been systematically assessed. Our goal was to determine the evidence for the federal Maternal and Child Health Bureau recommendation that children with special health care needs receive ongoing comprehensive care within a medical home.

  • Citation: Homer CJ, Klatka K, Romm D, Kuhlthau K, Bloom S, Newacheck P, Van Cleave J and Perrin JM. "A Review of the Evidence for the Medical Home for Children With Special Health Care Needs." Pediatrics. Volume 122 Issue 4 (2008): e922-e937.

Other Resources

Many organizations have developed tools in the course of their improvement efforts - for example, successful protocols, order sets and forms, instructions and guidelines for implementing key changes - and are making them available on the NICHQ website for others to use or adapt to their own organizations.

Medical Home Crosswalk to Reimbursement
This reimbursement tool identifies the range of relevant codes that could be used to finance components of a medical home and contains an index of medical home codes and selected vignettes.

Home Medication List
This is a template for providers, patients and parents to create their own or a patients medical list. This can be carried in a wallet for quick reference in an emergency or when talking to a pharmacist.

The Five Steps
Recent research into medical errors has resulted in the recommendation and mention of using home medication lists as way to prevent such errors. It is one of the Five Steps to Safer Health Care for patients published by the Agency for Healthcare Research and Quality (AHRQ Publication No. 03-M007) and developed in conjunction with the American Hospital Association and the American Medical Association.

Measures

Medical Home Family Evaluation Survey
This survey is a measure of the parents’ perception of the practice. It should be used in conjunction with the Medical Home Index. Only by obtaining data from both viewpoints can you get the full, triangulated view of your practice.

Outcome and Process Measures
These outcome and process measures were constructed by NICHQ with the involvement of the teams participating in the Medical Home Learning Collaborative II.

Changes

The Care Model for Child Health in a Medical Home highlights the desired outcomes of a strong medical home: family-centered, timely,efficient, evidence-based, safe and coordinated care offered by a prepared, proactive, practice team in partnership with an informed, activated, patient and family, in the context of a supportive, integrated, community. While this is a tall order, making changes in the six arenas will enable practices working to improve their medical home to build their system and offer this kind of care.

The Improvement Ideas for Medical Home, based on the Care Model, outline features of the ideal system for medical home and a set of evidence-based strategies proven to be effective in achieving improvements ("change-concepts"). The ability to develop, test, and implement changes is essential for any practice that wants to improve. After selecting specific changes, practices should run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. If they do, practices may expand the tests and gradually incorporate larger smaples until they are confident that the changes can be adopted more widely across the practice.

 

 

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