AMERICAN ACADEMY OF PEDIATRICS |
The Medical Home
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMedical Home Initiatives for...ConsultantsStaffREFERENCES |
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The American Academy of Pediatrics proposed a definition of the medical home in a 1992 policy statement. Efforts to establish medical homes for all children have encountered many challenges, including the existence of multiple interpretations of the "medical home" concept and the lack of adequate reimbursement for services provided by physicians caring for children in a medical home. This new policy statement contains an expanded and more comprehensive interpretation of the concept and an operational definition of the medical home.
Abbreviations: AAP, American Academy of Pediatrics
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMedical Home Initiatives for...ConsultantsStaffREFERENCES |
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The American Academy of Pediatrics (AAP) believes that the medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated,1 compassionate, and culturally effective.2 It should be delivered or directed by well-trained physicians who provide primary care3 and help to manage and facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them. These characteristics define the "medical home." In contrast to care provided in a medical home, care provided through emergency departments, walk-in clinics, and other urgent-care facilities, though sometimes necessary, is more costly and often less effective. Although inadequate reimbursement for services offered in the medical home remains a very significant barrier to full implementation of this concept,4,5 reimbursement is not the subject of this statement. It deserves coverage in other AAP forums.
Physicians should seek to improve the effectiveness and efficiency of health care for all children and strive to attain a medical home for every child in their community.6 Although barriers such as geography, personnel constraints, practice patterns, and economic and social forces create challenges, the AAP believes that comprehensive health care for infants, children, and adolescents should encompass the following services:
- Provision of family-centered care through developing a trusting partnership with families, respecting their diversity, and recognizing that they are the constant in a child’s life.
- Sharing clear and unbiased information with the family about the child’s medical care and management and about the specialty and community services and organizations they can access.
- Provision of primary care, including but not restricted to acute and chronic care and preventive services, including breastfeeding promotion and management,7 immunizations, growth and developmental assessments, appropriate screenings, health care supervision, and patient and parent counseling about health, nutrition, safety, parenting, and psychosocial issues.
- Assurance that ambulatory and inpatient care for acute illnesses will be continuously available (24 hours a day, 7 days a week, 52 weeks a year).
- Provision of care over an extended period of time to ensure continuity. Transitions, including those to other pediatric providers or into the adult health care system, should be planned and organized with the child and family.
- Identification of the need for consultation and appropriate referral to pediatric medical subspecialists and surgical specialists. (In instances in which the child enters the medical system through a specialty clinic, identification of the need for primary pediatric consultation and referral is appropriate.) Primary, pediatric medical subspecialty, and surgical specialty care providers should collaborate to establish shared management plans in partnership with the child and family and to formulate a clear articulation of each other’s role.
- Interaction with early intervention programs, schools, early childhood education and child care programs, and other public and private community agencies to be certain that the special needs of the child and family are addressed.
- Provision of care coordination services in which the family, the physician, and other service providers work to implement a specific care plan as an organized team.
- Maintenance of an accessible, comprehensive, central record that contains all pertinent information about the child, preserving confidentiality.
- Provision of developmentally appropriate and culturally competent health assessments and counseling to ensure successful transition to adult-oriented health care, work, and independence in a deliberate, coordinated way.
Medical care may be provided in various locations, such as physicians’ offices, hospital outpatient clinics, school-based and school-linked clinics, community health centers, and health department clinics. Regardless of the venue in which the medical care is provided, to meet the definition of medical home, a designated physician must ensure that the aforementioned services are provided (see Table 1 for more details).
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The need for an ongoing source of health care—ideally a medical home—for all children has been identified as a priority for child health policy reform at the national and local level. The US Department of Health and Human Services’ Healthy People 2010 goals and objectives state that "all children with special health care needs will receive regular ongoing comprehensive care within a medical home"8 and multiple federal programs require that all children have access to an ongoing source of health care. In addition, the Future of Pediatric Education II goals and objectives state: " Pediatric medical education at all levels must be based on the health needs of children in the context of the family and community" and "all children should receive primary care services through a consistent ‘medical home.’"9 Over the next decade, with the collaboration of families, insurers, employers, government, medical educators, and other components of the health care system, the quality of life can be improved for all children through the care provided in a medical home.
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MEDICAL HOME INITIATIVES FOR CHILDREN WITH SPECIAL NEEDS PROJECT ADVISORY COMMITTEE, 2000–2001 |
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TOPABSTRACTINTRODUCTIONMedical Home Initiatives for...ConsultantsStaffREFERENCES |
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- Calvin J. Sia, MD, Chairperson
- Richard Antonelli, MD
- Vidya Bhushan Gupta, MD
- Gilbert Buchanan, MD
- David Hirsch, MD
- John Nackashi, MD
- Jill Rinehart, MD
- Richard Antonelli, MD
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CONSULTANTS |
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TOPABSTRACTINTRODUCTIONMedical Home Initiatives for...ConsultantsStaffREFERENCES |
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- Antoinnette Parisi Eaton, MD
- Merle McPherson, MD, MPH
- Maureen Mitchell
- Bonnie Strickland, PhD
- Trish Thomas
- Merle McPherson, MD, MPH
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STAFF |
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TOPABSTRACTINTRODUCTIONMedical Home Initiatives for...ConsultantsStaffREFERENCES |
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Thomas F. Tonniges, MD
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REFERENCES |
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TOPABSTRACTINTRODUCTIONMedical Home Initiatives for...ConsultantsStaffREFERENCES |
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1. American Academy of Pediatrics, Committee on Children With Disabilities. Care coordination: integrating health and related systems of care for children with special health care needs. Pediatrics.1999; 104 :978 –981
2. American Academy of Pediatrics, Committee on Pediatric Workforce. Culturally effective pediatric care: education and training issues.
Pediatrics.1999; 103
:167
–170
3. American Academy of Pediatrics, Committee on Pediatric Workforce. Pediatric primary health care. AAP News. November 1993;11:7. Reaffirmed June 2001
4. American Academy of Pediatrics, Committee on Child Health Financing. Guiding principles for managed care arrangements for the health care of newborns, infants, children, adolescents, and young adults.
Pediatrics.2000; 105
:132
–135
5. American Academy of Pediatrics, Committee on Children With Disabilities. Managed care and children with special health care needs: a subject review.
Pediatrics.1998; 102
:657
–660
6. American Academy of Pediatrics, Committee on Community Health Services. The pediatrician’s role in community pediatrics.
Pediatrics.1999; 103
:1304
–1306
7. American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the use of human milk.
Pediatrics.1997; 100
:1035
–1039
8. US Department of Health and Human Services, Health Resources and Services Administration. Measuring Success for Healthy People 2010: National Agenda for Children with Special Health Care Needs. Washington, DC: US Department of Health and Human Services; 1999. http://www.mchb.hrsa.gov/html/achieving_measuringsuccess.html. Accessed September 19, 2001
9. American Academy of Pediatrics, Task Force on the Future of Pediatric Education. The Future of Pediatric Education II. Organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century. Pediatrics.2000; 105 :157 –212
10. Americans With Disabilities Act. Pub L No. 101–336 (1990)
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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Statement of reaffirmation:
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AAP Publications Reaffirmed and Retired, February and May 2008
Pediatrics 122: 450-450.[Full Text]
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Committee on Child Health Financing Scope of Health Care Benefits for Children From Birth Through Age 21 Pediatrics, March 1, 2006; 117(3): 979 - 982. [Abstract] [Full Text] [PDF]
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E. E. Hartmann, G. E. Bradford, P. K. Nottingham Chaplin, T. Johnson, A. R. Kemper, S. Kim, W. Marsh-Tootle, and Writing Committee, Submitted on behalf of PUPVS Pa Project Universal Preschool Vision Screening: A Demonstration Project Pediatrics, February 1, 2006; 117(2): e226 - e237. [Abstract] [Full Text] [PDF]
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A. R. Elwy All Parents Need Family Pediatrics Pediatrics, January 1, 2006; 117(1): 218 - 219. [Full Text] [PDF]
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Council on Children With Disabilities Care Coordination in the Medical Home: Integrating Health and Related Systems of Care for Children With Special Health Care Needs Pediatrics, November 1, 2005; 116(5): 1238 - 1244. [Abstract] [Full Text] [PDF]
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C. Lewis, A. S. Robertson, and S. Phelps Unmet Dental Care Needs Among Children With Special Health Care Needs: Implications for the Medical Home Pediatrics, September 1, 2005; 116(3): e426 - e431. [Abstract] [Full Text] [PDF]
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 L. M. Olson, S.-f. S. Tang, and P. W. Newacheck Children in the United States with Discontinuous Health Insurance Coverage N. Engl. J. Med., July 28, 2005; 353(4): 382 - 391. [Abstract] [Full Text] [PDF]
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P. J. Smith, J. M. Santoli, S. Y. Chu, D. Q. Ochoa, and L. E. Rodewald The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program Pediatrics, July 1, 2005; 116(1): 130 - 139. [Abstract] [Full Text] [PDF]
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Committee on Pediatric Emergency Medicine Pediatric Care Recommendations for Freestanding Urgent Care Facilities Pediatrics, July 1, 2005; 116(1): 258 - 260. [Abstract] [Full Text] [PDF]
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Committee on Pediatric Workforce Pediatrician Workforce Statement Pediatrics, July 1, 2005; 116(1): 263 - 269. [Abstract] [Full Text] [PDF]
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Committee on Child Health Financing Medicaid Policy Statement Pediatrics, July 1, 2005; 116(1): 274 - 280. [Abstract] [Full Text] [PDF]
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D. S. Lotstein, M. McPherson, B. Strickland, and P. W. Newacheck Transition Planning for Youth With Special Health Care Needs: Results From the National Survey of Children With Special Health Care Needs Pediatrics, June 1, 2005; 115(6): 1562 - 1568. [Abstract] [Full Text] [PDF]
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P. Scal and M. Ireland Addressing Transition to Adult Health Care for Adolescents With Special Health Care Needs Pediatrics, June 1, 2005; 115(6): 1607 - 1612. [Abstract] [Full Text] [PDF]
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G. Randolph, B. Fried, L. Loeding, P. Margolis, and C. Lannon Organizational Characteristics and Preventive Service Delivery in Private Practices: A Peek Inside the "Black Box" of Private Practices Caring for Children Pediatrics, June 1, 2005; 115(6): 1704 - 1711. [Abstract] [Full Text] [PDF]
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M. L. Wolraich, C. J. Wibbelsman, T. E. Brown, S. W. Evans, E. M. Gotlieb, J. R. Knight, E. C. Ross, H. H. Shubiner, E. H. Wender, and T. Wilens Attention-Deficit/Hyperactivity Disorder Among Adolescents: A Review of the Diagnosis, Treatment, and Clinical Implications Pediatrics, June 1, 2005; 115(6): 1734 - 1746. [Abstract] [Full Text] [PDF]
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 C. J. Stille, A. Jerant, D. Bell, D. Meltzer, and J. G. Elmore Coordinating Care across Diseases, Settings, and Clinicians: A Key Role for the Generalist in Practice Ann Intern Med, April 19, 2005; 142(8): 700 - 708. [Abstract] [Full Text] [PDF]
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Committee on Community Health Services The Pediatrician's Role in Community Pediatrics Pediatrics, April 1, 2005; 115(4): 1092 - 1094. [Abstract] [Full Text] [PDF]
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Committee on Community Health Services Providing Care For Immigrant, Homeless, and Migrant Children Pediatrics, April 1, 2005; 115(4): 1095 - 1100. [Abstract] [Full Text] [PDF]
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 H. M. Feldman Evaluation and Management of Language and Speech Disorders in Preschool Children Pediatr. Rev., April 1, 2005; 26(4): 131 - 142. [Full Text] [PDF]
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R. J. Haggerty and C. A. Aligne Community Pediatrics: The Rochester Story Pediatrics, April 1, 2005; 115(4/S1): 1136 - 1138. [Abstract] [Full Text] [PDF]
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L. J. Shipley, S. M. Stelzner, E. A. Zenni, D. Hargunani, J. O'Keefe, C. Miller, B. Alverson, and N. Swigonski Teaching Community Pediatrics to Pediatric Residents: Strategic Approaches and Successful Models for Education in Community Health and Child Advocacy Pediatrics, April 1, 2005; 115(4/S1): 1150 - 1157. [Abstract] [Full Text] [PDF]
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J. Goldhagen Integrating Pediatrics and Public Health Pediatrics, April 1, 2005; 115(4/S1): 1202 - 1208. [Abstract] [Full Text] [PDF]
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Section on Breastfeeding Breastfeeding and the Use of Human Milk Pediatrics, February 1, 2005; 115(2): 496 - 506. [Abstract] [Full Text] [PDF]
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C. P. Johnson, T. A. Kastner, and and the Committee/Section on Children With Disabil Helping Families Raise Children With Special Health Care Needs at Home Pediatrics, February 1, 2005; 115(2): 507 - 511. [Abstract] [Full Text] [PDF]
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 K. D. Jaffee, G. C. Liu, J. Canty-Mitchell, R. A. Qi, J. Austin, and N. Swigonski Race, Urban Community Stressors, and Behavioral and Emotional Problems of Children With Special Health Care Needs Psychiatr Serv, January 1, 2005; 56(1): 63 - 69. [Abstract] [Full Text] [PDF]
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 M. B. Bruder, G. L. Harbin, K. Whitbread, M. Conn-Powers, R. Roberts, C. J. Dunst, M. Van Buren, C. Mazzarella, and G. Gabbard Establishing Outcomes for Service Coordination: A Step Toward Evidence-Based Practice Topics in Early Childhood Special Education, January 1, 2005; 25(3): 177 - 188. [Abstract] [PDF]
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R. Srivastava, C. Norlin, B. C. James, S. Muret-Wagstaff, P. C. Young, and A. Auerbach Community and Hospital-Based Physicians' Attitudes Regarding Pediatric Hospitalist Systems Pediatrics, January 1, 2005; 115(1): 34 - 38. [Abstract] [Full Text] [PDF]
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