BY LESLIE CHAMPLIN
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Sick patients don't want to go shopping for doctors. They don't want a first date or -- worse -- a blind date experience every time they see a doctor. They want to go home. Far too few do so because far too many are "medically homeless." Their plight underlies today's uneven quality in health care.
Patients need a personal medical home "that serves as the focal point through which all individuals -- regardless of age, sex, race or socioeconomic status -- receive a basket of acute, chronic and preventive medical care services," says the Future of Family Medicine project report, released March 30.
Building the concept with children
The American Academy of Pediatrics coined the term medical home in 1967. Over the decades, the concept has evolved to its current form, elucidated through the AAP's National Center of Medical Homes Initiatives for Children with Special Needs.
"When children have a complicated illness, they often have to travel for their care," says FP Leslie Waters, M.D., whose medical group in Colville, Wash., is a partner in the state's medical homes initiative.
"Often, the diagnosis was made a hundred miles away and that's where the follow-up appointments are," says Waters, noting that small communities don't have the panel of subspecialists a child may require.
Waters cares for a rural Washington community that includes about 50 children with special needs. Their conditions range from complex genetic syndromes to severe asthma.
A member of the children's medical home team, Waters ensures that subspecialists, rehabilitation therapists, mental health professionals and educators have a complete picture of each child's condition.
"We developed a team so some of the care for the child can be done locally," she says. "They may still have to travel for some of the care, but at least they can get their well-child services, physical therapy, speech therapy and other services at home. The system ensures that everyone involved in the child's care is on the same page."
Expanding to all populations
AAP's initiative succeeds because most agree that children, particularly those with complex problems, need medical homes, according to FP Steven Wolfe, M.D., medical director for the University of Iowa Community Medical Services Clinics in Iowa City.
"It's easier to sell children's issues than it is to sell other issues," says Wolfe, who works with the Iowa Medical Home Project, spearheaded by the Iowa AFP. "But once you understand the concept of a medical home, you can make it fit other populations."
FPs can build medical homes for their patients by adapting resources from AAP and the Center for Medical Home Improvement at Children's Hospital at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
Among them: the Medical Home Index, which enables physicians to assess their practices according to the medical home standards. (Go to http://www.medicalhomeimprovement.org/outcomes.htm, and click on "The Medical Home Index" under "Medical Home Measurements.")
The results can be eye-opening, says Wolfe. He compared the stringent standards of the Medical Home Index with the way his own 10-physician practice in Spencer, Iowa, operated.
"If you'd asked whether we did these things well, I'd have said yes. But if you look at how we did when compared to the Medical Home Index, I'd have to say we were probably in the 30th to 40th percentile," he says.
The Future of Family Medicine project's new model of practice -- which includes patient-centered care, a team approach, elimination of barriers to access, and a focus on quality and safety -- expands the medical home concept beyond children with special needs and includes all patients.
"It's an easy transition from providing those elements to special needs children to providing it to other populations," says Wolfe. "These key concepts are valid."
To reach writer Leslie Champlin, email lchampli@aafp.org.
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