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Medical Home Index

Toolkits 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 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.

Evaluating their progress 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.

Resources

How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
Volume 25, Number 6 / June, 2010
Charles J. Homer, MD, MPH and Richard J. Baron, MD

Abstract 
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.

To access the full article, please click here.

The Medical Home Index can be downloaded from the Center for Medical Home Improvement (CMHI) Web site.

Read "A Review of the Evidence for the Medical Home for Children With Special Health Care Needs," an article co-authored by NICHQ CEO Charles Homer, MD and published in the Oct. 08, 2008 issue of Pediatrics dicussing the needs Of medical Home for Children with Special Health Care Needs.

Medical Home Tools
The table available above provides tools and resources identified by the participants in the NICHQ Medical Home Learning Collaboratives I & II, by NICHQ faculty and staff, 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 that may be offered to practices.

In addition, 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 NICHQ.org 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 isone 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                                                                                                     

Outcome and Process Measures
The outcome and process measures available were constructed by NICHQ with the involvement of teams 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.

Improvement Ideas
The change package for Medical Home, based on the Care Model for Child Health in a Medical Home, outlines 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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