It’s 10 O’Clock – Do You Know Where Your Doctor Is?

June 27, 2009

Your Doctor Should Be:

• Family Centered– Mutual responsibility and trust exists between

YOU and the doctor– YOU are recognized as the main caregiver

and center of strength and support for your child

– Clear, unbiased, and complete information and options are shared on an ongoing basis with YOU

Your Doctor Should Be:

• Accessible– Care is provided in YOUR community– YOUR insurance, including Medicaid, is

accepted and changes are accommodated– YOU are able to speak directly to YOUR

doctor when needed

Your Doctor Should Provide:

• Continuous Care– YOUR doctor is available from infancy

through adolescence and young adulthood– Assistance with transitions (to school, home,

adult services) is provided to YOU– YOUR doctor participates to the fullest extent

allowed in care and discharge planning when YOUR child is hospitalized or care is provided at another facility or by another provider

Your Doctor Should Be:

• Comprehensive– Health care for YOUR child is available 24

hours a day, 7 days a week– Preventive, primary, and specialty needs are

addressed for YOU– YOUR doctor advocates for YOUR child and

YOU in obtaining comprehensive care and shares responsibility for the care that is provided

Your Doctor Should Be:

• Coordinated– A plan of care is developed by YOUR doctor,

YOUR child, and YOU and is shared with other providers, agencies, and organizations involved with the care of YOUR child

– A central record or database containing all pertinent medical information about YOUR child, including hospitalizations and specialty care, is maintained at the practice

Your Doctor Should Be:• Compassionate

– Concern for the well-being of YOUR child and YOU is expressed and demonstrated in verbal and nonverbal interactions

– Efforts are made to understand

and empathize with the feelings

and perspectives of YOUR family

as well as YOUR child or youth

Your Doctor Should Be:• Culturally Effective

– All efforts are made to ensure that YOUR child and YOU understand the results of the medical visit and the care plan, including offering (para) professional translators or interpreters, as needed

– Written materials are provided

in YOUR primary language

What did we just describe?

A Medical Home!

No, it’s not a house!• A Medical Home is health care that is:

– Family Centered– Accessible– Continuous– Comprehensive– Coordinated– Compassionate– Culturally Competent

If your Doctor

isn’t there

yet……

Steps to improving your relationship with your

child’s doctor

Bring a list of questions or concerns to discuss at each visit

Share information on how your child is changing (progressing, regressing, etc.)

Ask about resources that

may help your child and

family

Ask about how

to get care

after hours if needed

Ask to meet the office

staff that will be

working with you

and your child

Offer suggestions or

comments on what

would make things

easier for you

Show appreciation

Parent / professional

teamwork is a key part of

developing

“medical homes”

for all children

Why you would want a“Medical Home”?

• Decrease Emergency Room Visits

• Address the “WHOLE” Child

• Find Needed Services

• Provide Support To the Family

In a Medical Home…• Your child and family

– Receive care from a Primary Care Physician (PCP)

• whom YOU know and trust.

• PCPs and You – Act as partners

• to identify and access the medical and some of the non- medical services

• common goal is to help Your child and family achieve the maximum potential.

Medical Homes for CSHCN means

• Decreased ER visits– NICHQ MHLC-II: percent of CSHCN with at least one

ER visit in previous 3 months decreased from 36% to 20%.

• Decreased hospitalizations– NICHQ MHLC-I: unplanned hospitalizations for

CSHCN decreased 13-18% across practices– NICHQ MHLC-II: percent of CSHCN with one or more

unplanned hospitalizations in previous 3 months dropped from 19% to 7%

Medical Homes for CSHCN means

• Fewer Missed Work/School Days– NICHQ MHLC-II: Percent of parents/CSHCN

with a missed work/school day in previous 3 months decreased from 58% to 30%

– Palfrey: Percent of parents missing > 20 days of work/yr decreased from 26% to 14% (Pediatrics 113:1507, 2004)

Medical Home – is primary care

• It is not a primary care “project” but

– The kind of care we all want for

• our families• ourselves

Center for Medical Home Improvement

Participating in the Center for Medical Home Improvement Medical Home Study

Outcomes Study Point in Time Look…

• Recruit - 5 Medicaid/1 Private Plan – Plans recruit practices, identify children/youth

• Final Analysis - 35 practices in five states –Texas, California, NC, Oregon & NH– Practice MHI, Phone Interview

• Compare Medical Home Index (MHI) scores with:– Utilization data for children w/6 conditions for prior 12

months (Asthma, Autism, CP, ADHD, Diabetes, Epilepsy)

– 30 families surveyed in each practice

Texas Children’s Health Plan (TCHP) Results

All Practices in Plan- MHI Scores & Transformed Score & Six Domain Scores• The medical home index (total) score transforms these data

into a 1-100 scale; you will see that the mean total transformed score is 42 (out of 100%) for the 43 practices participating in this research effort.

Medical Home Index Mean Standardized Score

4246

0

10

20

30

40

50

60

70

80

90

100

All Practices in Study (n=43) Texas Health Plan (n=6)

TCHP ResultsAll Practices in Plan- MHI Scores & Transformed Score & Six Domain Scores

Medical Home Index Results• The medical home index scores six domains; 25 indicators within

these domains are scored on a 1-8 point scale. Scores reported below show the mean score for each of the six domains.

Medical Home Index Mean Domain Scores

4.1 4.0 3.93.5

4.1

3.2

4.44.1

4.8

3.4 3.3 3.4

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Org Capacity CC Mgt Care Coord Comm Outreach Data Mgt QI

"all practices" (n=43) Texas Health Plan (n=6)

RESOURCES

• www.dshs.state.tx.us/cshcn/medhome.shtm

• www.medicalhomeinfo.org• www.medicalhomeimprovement.org• www.txp2p.org

Created and Presented by:

Carol HarveyTexas DSHS / CSHCN SP

carol.harvey@dshs.state.tx.us

Austin, Texas512-458-7111 ext. 3406

Jeanine Pinner Training & Outreach Coordinator / Texas Parent to Parent jeanine@txp2p.org 512-217-3558    (cell)

Angelo P. Giardino, MD, PhD, MPHMedical Director, Texas Children’s Health Plan

Clinical Associate Professor, Pediatrics, Baylor College of Medicine,

Houston, TX