The Medical Home

A recent AP piece caught my eye: “Medical home concept catching on in U.S.” The medical home idea is one I’ve spoken about quite a bit as a paradigm for pediatric primary care, as many of its tenets parallel and complement those of integrative pediatrics.

What is a medical home? Here’s the American Academy of Pediatrics definition, from its Medical Home website:

“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.”

Comprehensive, primary care does not simply entail doing annual checkups and making sure all the physical exam boxes are checked off. It’s about caring for the whole child in the context of their family, their culture and their community. Sound familiar? It’s all basically in the integrative pediatrics primer (see my definition post from 7/4/05).

Well, this all sounds ideal, right? How close are we to the ultimate goal of 100% of families being able to identify a medical home for their children? Not very, according to “The Health and Well-Being of Children: A Portrait of States and the Nation 2005,” a report published last year by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The report, based on the 2003 National Survey of Children’s Health, notes that only 46% of children can be identified as having a medical home; these kids meet criteria by “having had at least one preventive visit in the past year, having had little or no problem with access to specialty care, and reported having a personal doctor or nurse who usually or always spent enough time and communicated clearly with families, provided telephone advice or urgent care when needed, and followed up with the family after the child’s specialty care visits.” Furthermore, although children with special health care needs (CSHCN) need medical homes perhaps even more than those without, only 44% are identified as having them. The report goes on to point out further racial and socioeconomic disparities in access to medical homes.

Not coincidentally, the rates of CAM (complementary and alternative medicine) use in CSHCN and homeless children are higher than in the general population. Reasons cited include poor access to conventional care and dissatisfaction with existing physician relationships. Many of the families using CAM therapies do not divulge such use to their primary care providers. Pediatricians need to take heed; we must reach out those that are most vulnerable, and learn from the medical home paradigm how to provide the best primary care we can. Those interested in taking the next step should visit the excellent site, “Center for Medical Home Improvement,” and examine the medical home improvement kit and other resources.