Is There A Medical Home in Your Community?
As you have read in a previous newsletter (Fall 1999), a medical home is not a building, house, or hospital, but rather an approach to providing health care services in a high-quality and cost-effective manner. According to the American Academy of Pediatrics (AAP), the goal of the Medical Home initiative is for physicians and parents to partner in identifying and accessing medical and non-medical services needed to help children and their families achieve their maximum potential. It is estimated that at least 20% of the pediatric population has a chronic health condition or disability. The majority of these children live at home and attend local schools.

"I continue to be most struck by parents needs and wishes for their child's doctor to be more involved in advocating alongside parents for optimal school programming for their/our children. I had always thought that I did a good job in this area. Now I know I need to try and do better." -Dr. Harris

Families need a central place where their children receive care from knowledgeable and supportive professionals. As partners with providers, families benefit from collaborative relationships that support their essential caregiving role.

Pediatric and Family Practices have found it helpful to partner with families to enhance their capacity to offer family resources, education and information, and to establish collaborative links with schools and other agencies.

The Department of Maternal and Child Health Bureau has contributed funding, through the AAP, to support projects in the country to implement a model of care that assures every family a place to receive comprehensive, coordinated, family-centered care- a Medical Home. The Rural Medical Home Improvement Project is one of the projects that received this type of funding.

The Rural Medical Home Improvement Project (RMHIP) supports pediatric practices in the implementation of primary care medical homes for children with chronic health conditions or disabilities by emphasizing:

Pediatrics, Children's Hospital at Dartmouth, Lebanon, NH. Parent to Parent of VT is a consultant on this project. The RMHIP assists four rural practices, two from New Hampshire and two from Vermont, as they blend parent insight, professional knowledge, and enhanced care coordination skill to build quality medical homes.

Our Vermont pediatric physicians are Dr. Mark Harris along with Dr. Tom Creighton from Upper Valley Pediatrics in Bradford, and Dr. Louis DiNicola from Gifford Pediatrics in Randolph. Each practice has a "core team" made up of: a physician, an enhanced care coordinator, and at least two parents, that have been working the last three years to provide an improved medical home in their community. Both practices have gone to their families and communities to identify needs. These teams have implemented significant office changes in response to expressed needs for improved health and community services. Though these practices can look very different, based on identified needs, there are many common elements between them.

Dr. DiNicola, from Gifford Pediatrics, comments that the best part of this project is how it empowers parents. "This approach puts everyone on an equal level, bringing in their own strengths. Most of my learning has come from my parents and my patients." Dr. Harris, from Upper Valley Pediatrics, comments, "I continue to be most struck by parents needs and wishes for their child's doctor to be more involved in advocating alongside parents for optimal school programming for their/our children. I had always thought that I did a good job in this area. Now I know I need to try and do better."
 

Imagine five physicians (four of them specialists) and no one talking to each other. Even if one visit can be eliminated then a family has been helped.

Both practices identified the importance of building on the strengths of families and supporting their advocacy. Parents know best the needs and concerns of their child and family and should be prepared to "set the agenda" for at least part of the office, community, or school visit. Although this model of care is very time consuming and hard to do well, especially in a profession where time is money, both agree that this has worked because of the team commitment. Families and physicians are certain that increased communication and collaboration can improve care. The worst case scenario for a family is to have fragmented services. Imagine five physicians (four of them specialists) and no one talking to each other. Even if one visit can be eliminated then a family has been helped. For this reason, support among physicians, hospitals, parents, and staff is essential. Increased communication and collaboration can improve care.

Both practices emphasize the need for the whole picture, not just the ear infection that is flaming today. How are things at school? How are things at home? What needs do you have that aren't being met? Can we brainstorm for solutions? They can be the point-of-referral for all needs, medical or non-medical. Crucial to the success of this model is the enhanced care coordinator and the family support/community resource link. The enhanced care coordinator communicates with parents, providers, and schools. She/he helps with continuity of care and family needs, attends and coordinates meetings, and gives the parent one person to call.

Parent to Parent of Vermont's participation on the RMHIP, combined with funding from the A.K. Watson Trust, to provide a Family Support Coordinator located in Orange County, fosters a unique model of physician/family partnership and provide support for the Upper Valley. Both physicians' practices have graciously donated space, supplies, and time to make this happen. Hilde Hyde is the Family Support Coordinator working closely with both practices to connect families with appropriate resources and information to meet their needs. Hilde is located at the Community Outreach Center at Gifford Medical Center and can be reached at 728-2263. She travels to Bradford one day a week and can be reached at Upper Valley Pediatrics at 222-4722 on Wednesday mornings. Both teams are working with local schools to improve communication, information, and resources for those children whose health problems impact their learning and school performance. This project has gained New England and national attention. Dr. DiNicola feels the idea of a medical home is mostly supported, except that many providers are too busy in their practices to have the time to make changes.

For further information on medical homes, check out the American Academy of Pediatrics website, www.aap.org (under Community Pediatrics), or contact Nancy DiVenere at Parent to Parent 1-800-800-4005. ©

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