Lost? Finding Your Medical Home!


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Lost? Finding Your Medical Home!

  1. 1. Lost? Finding Your Medical Home Colleen A. Kraft, M.D., FAAP Harry L. Gewanter, M.D., FAAP, FACR
  2. 2. Care Partnership <ul><li>What are my goals? Goals for my child? </li></ul><ul><li>What should I expect from my physicians and my community? </li></ul><ul><li>How can I enable our medical and community resources to provide the best care for (me) or my child? </li></ul>
  3. 3. Care Partnership <ul><li>Healthy People 2020 Goals </li></ul><ul><li>Medical Home </li></ul><ul><li>Community </li></ul>
  4. 4. Healthy People 2020 Goals <ul><li>Goals and Priorities for our Nation </li></ul><ul><li>Particular Goals for Special Populations </li></ul>
  5. 5. Healthy People 2020 <ul><li>All children should be served in a Medical Home </li></ul><ul><li>Families should have access to the insurance necessary to care for their children </li></ul>
  6. 6. Healthy People 2020 <ul><li>Families should be satisfied with the care they receive </li></ul><ul><li>Community Resources should be available to help any family in need </li></ul><ul><li>Community Resources should be easily accessible to families </li></ul>
  7. 7. Healthy People 2020 <ul><li>Youth with special health care needs should be able to transition to adult health care, insurance, and employment </li></ul>
  8. 8. Medical Home <ul><li>Structure and Process of Care </li></ul><ul><li>Recognizes home as </li></ul><ul><ul><li>Headquarters for care </li></ul></ul><ul><ul><li>A place for children and families to feel welcomed and recognized </li></ul></ul><ul><ul><li>Link to community services </li></ul></ul>
  9. 9. Medical Home…Background <ul><li>1980’s…Clinic based care </li></ul><ul><li>Recognition for need to </li></ul><ul><ul><li>Coordinate care </li></ul></ul><ul><ul><li>Involve families needs and expertise </li></ul></ul><ul><ul><li>Develop community partnerships </li></ul></ul>
  10. 10. Medical Home <ul><li>1992 AAP Policy Statement </li></ul><ul><li>Maternal and Child Health Bureau definition of CSHCN </li></ul><ul><ul><li>Those who have or are at risk for chronic physical, developmental, behavioral, or emotional condition </li></ul></ul><ul><ul><li>Require more frequent and/or intensive health and related services </li></ul></ul>
  11. 11. Medical Home Benefits <ul><li>Increased satisfaction </li></ul><ul><li>Forum for problem solving </li></ul><ul><li>Coordination of care </li></ul><ul><li>Efficiency of time and resources for </li></ul><ul><li>families </li></ul><ul><li>5. Increased wellness due to comprehensive care </li></ul>
  12. 12. Medical Home…Common Elements <ul><li>Accessible </li></ul><ul><li>Family Centered </li></ul><ul><li>Comprehensive </li></ul><ul><li>Continuous </li></ul><ul><li>Coordinated </li></ul><ul><li>Compassionate </li></ul><ul><li>Culturally effective </li></ul>
  13. 13. Access <ul><li>Care provided in child’s community </li></ul><ul><li>Range of insurances accepted </li></ul><ul><li>Public Transportation </li></ul><ul><li>Families may speak directly with Primary Care Provider </li></ul><ul><li>Physically Accessible </li></ul>
  14. 14. Family Centered <ul><li>Physician known to child and family </li></ul><ul><li>Mutual responsibility and trust </li></ul><ul><li>Family recognized for its expertise </li></ul><ul><li>Information and options shared with families </li></ul><ul><li>Families play a central role in care coordination </li></ul>
  15. 15. Continuous <ul><li>Care from infancy through young adulthood </li></ul><ul><li>Assistance with transitions </li></ul><ul><li>Hospital discharge planning </li></ul>
  16. 16. Comprehensive <ul><li>Care delivered and directed by a well trained practitioner </li></ul><ul><li>Round the clock access by phone </li></ul><ul><li>Primary Care </li></ul><ul><ul><li>Immunizations </li></ul></ul><ul><ul><li>Growth and Development </li></ul></ul><ul><ul><li>Anticipatory Guidance </li></ul></ul>
  17. 17. Comprehensive <ul><li>Medical, Psychosocial, Educational, Developmental needs addressed </li></ul><ul><li>Information and Community Links </li></ul><ul><ul><li>Early Intervention </li></ul></ul><ul><ul><li>Title V Programs </li></ul></ul><ul><ul><li>SCHIP </li></ul></ul><ul><ul><li>SSI </li></ul></ul><ul><ul><li>Medicaid </li></ul></ul>
  18. 18. Coordinated <ul><li>Care among multiple providers, specialists, therapists </li></ul><ul><li>Central records kept </li></ul><ul><li>Plan of care developed with family or youth </li></ul><ul><li>Plan of care coordinated and shared with schools, community resources, other agencies involved in care </li></ul>
  19. 19. Compassionate <ul><li>Concern and respect for individual, family </li></ul><ul><li>Understand and empathize </li></ul><ul><ul><li>Child or youth perspective </li></ul></ul><ul><ul><li>Family perspective </li></ul></ul>
  20. 20. Culturally Effective <ul><li>Patient’s and family’s cultural background respected </li></ul><ul><ul><li>Beliefs </li></ul></ul><ul><ul><li>Rituals </li></ul></ul><ul><ul><li>Customs </li></ul></ul>
  21. 21. Culturally Effective <ul><li>Written materials in patient’s language </li></ul><ul><li>Interpreters available </li></ul><ul><li>Family understands care plan </li></ul>
  22. 22. Medical Home <ul><li>Understand the concept of a Medical Home </li></ul><ul><li>Understand how the Medical Home is an ideal venue for setting your (your child’s) goals </li></ul><ul><li>Understand how the Medical Home is an ideal venue for communication and teamwork between physicians, families, and the “Medical Village” </li></ul>
  23. 23. Medical Home <ul><li>Empower families as the “expert” in the overall care of their child </li></ul><ul><li>Understand what physicians need to know from parents in caring for their children </li></ul>
  24. 24. What do Physicians need from families? <ul><li>“ Expert” for your child </li></ul><ul><li>Community Link for Resources </li></ul><ul><li>Advocacy </li></ul>
  25. 25. Families as Experts <ul><li>Parents as care coordinators </li></ul><ul><ul><li>Medical </li></ul></ul><ul><ul><li>Social </li></ul></ul><ul><ul><li>Educational </li></ul></ul>
  26. 26. Care Coordination Role <ul><li>Documentation and Communication </li></ul><ul><li>Summary Notebook </li></ul><ul><ul><li>Physicians/Specialists </li></ul></ul><ul><ul><li>Therapists </li></ul></ul><ul><ul><li>IFSP/IEP </li></ul></ul><ul><ul><li>Educator Conferences/Notes </li></ul></ul><ul><ul><li>Pictures </li></ul></ul>
  27. 27. Care Coordination <ul><li>Communication between specialists, therapists, schools </li></ul><ul><li>Best option for care </li></ul><ul><ul><li>You have a right to have options, and the Medical Home should provide the venue </li></ul></ul>
  28. 28. Communication <ul><li>New Needs </li></ul><ul><li>Transition and Milestones </li></ul>
  29. 29. Community Involvement <ul><li>“ The inferior physician treats the disease; the good physician treats the person; the superior physician treats the community” </li></ul><ul><ul><ul><ul><ul><li>Chinese Proverb </li></ul></ul></ul></ul></ul>
  30. 30. Complementary Roles <ul><li>Physicians provide medical knowledge and information to community resources </li></ul><ul><li>Community resources provide avenues to help patients and families outside the office </li></ul><ul><li>Families are the link! </li></ul>
  31. 31. Link to Community Resources <ul><li>Families as Experts in “Navigating the System” </li></ul><ul><li>Role in Community Organizations </li></ul><ul><li>Parent Consultants </li></ul>
  32. 32. Medical Home Plus <ul><li>Information, Support, Resources for Parents and Professionals </li></ul><ul><li>Training </li></ul><ul><li>Technical Assistance </li></ul>
  33. 33. Enrich your community <ul><li>Join local, statewide, and national networks </li></ul><ul><ul><li>Family Voices </li></ul></ul><ul><ul><li>Arthritis Foundation </li></ul></ul><ul><ul><li>Parent to Parent </li></ul></ul><ul><ul><li>Down Syndrome Society </li></ul></ul><ul><ul><li>The Autism Society </li></ul></ul>
  34. 34. Enrich your community <ul><li>Parent Training </li></ul><ul><ul><li>Partners in Policymaking </li></ul></ul><ul><ul><li>Insurance and Waiver Training </li></ul></ul><ul><ul><li>As They Grow </li></ul></ul><ul><ul><li>Conferences </li></ul></ul><ul><ul><li>Parent Education, Advocacy, and Training Center (PEATC) courses </li></ul></ul>
  35. 35. Enrich your community <ul><li>Understand your own developmental level as a parent </li></ul><ul><li>Start small </li></ul><ul><li>Use your experience as an advocate for your child to someday help another family </li></ul>
  36. 36. Advocacy <ul><li>Community Organization Events </li></ul><ul><ul><li>ARC March </li></ul></ul><ul><ul><li>Call to Action </li></ul></ul><ul><li>Visiting Legislators </li></ul><ul><li>Tell your story </li></ul><ul><ul><li>We need to hear it! </li></ul></ul>
  37. 37. Care Partnership <ul><li>Role in the Medical Home </li></ul><ul><li>Role as Care Coordinator and Advocate for your child </li></ul><ul><li>Community </li></ul>
  38. 38. Thank you!