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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1499-1506

SUPPLEMENT ARTICLE

Building Medical Homes: Improvement Strategies in Primary Care for Children With Special Health Care Needs

W. Carl Cooley, MD and Jeanne W. McAllister, BSN, MS, MHA

From the Center for Medical Home Improvement, Hood Center for Children and Families, Children's Hospital at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

Families and professionals agree that children and adolescents need access to community-based medical homes. This is especially true for children with special health care needs (CSHCN). Most primary care practices are designed for children's routine preventive and acute care needs. CSHCN benefit from care that is integrated with well-child and acute care; coordinated and actively co-managed with specialists, therapists, and educators; and offered in a planned, anticipatory manner. As the primary caregiver and decision maker, families need to be supported in a culturally effective way. Families want community resources that are integrated with care processes. Primary care practices that serve CSHCN require a practical and effective improvement method to become fully realized medical homes. A change method, which blends improvement strategies with progressive measurement, must be perceived by practices as practical and helpful, and it must be supported. The Center for Medical Home Improvement has developed and tested an effective model of medical home improvement and tools to measure the status of a practice and its progress of change.

Key Words: children with special health care needs • medical home • quality improvement • primary care • care coordination • family-centered care

Abbreviations: CSHCN, children with special health care needs • MCHB, Maternal and Child Health Bureau • AAP, American Academy of Pediatrics • CMHI, Center for Medical Home Improvement • MHI, Medical Home Index • MHFI, Medical Home Family Index • CVC, clinical value compass




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