Medical Home

The NC "Medical Home" Campaign
Materials
Medical Home Initiative for Children/Youth with Special Health Care Needs
Recommended Reading

The NC "Medical Home" Campaign

North Carolina recently launched a medical home initiative for all North Carolina children called "The Right Call Every Time: Your Medical Home." The campaign builds upon the ideas and messaging of the American Academy of Pediatrics' Medical Home Initiative for Children with Special Health Care Needs. (Please note: The AAP Medical Home website is now available in Spanish http://www.medicalhomeinfo.org/tools/spanishportal.html)

A medical home is the one place a child goes for all his or her healthcare. It is where children can get comprehensive, continuous, and coordinated care from healthcare professionals who know the child and the child's health history.

Through Carolina ACCESS and the Community Care of NC (Access II/III) Initiative, primary care physicians and case management staff have been working closely with children enrolled in Health Check (Medicaid) and NC Health Choice to encourage parents to call the doctor first for treatment of primary care illnesses.

The top three illnesses that result in inappropriate use of the emergency room (particularly for children from birth to age five) are

fever
colds, the flu and other upper respiratory infections
ear infections

The Medical Home materials give parents guidance on when and where to seek medical attention for these illnesses. In addition they promote utilization of preventative services, articulate the importance of having a consistent source of primary care services, and emphasize the importance of a medical home for children with special health care needs.

All concepts and materials were developed using focused interviews with health care providers and families. Many thanks to Chuck Willson, M.D., and Laura Gerald, M.D., who assisted with the development of the medical content for these pieces and to John Baker, M.D., Chris Collins, M.S.W. and Betsy Tilson, M.D. for their ideas and their review.

The Medical Home Campaign is brought to you by the following partnering organizations:

NC DHHS/Division of Public Health/ Women's and Children's Health Section
NC Foundation of Advanced Health Programs, Inc.and Community Care of North Carolina
N.C. Healthy Start Foundation
Epley Associates

Materials

List and description of "Medical Home" Campaign materials

Medical Home Initiative for Children/Youth with Special Health Care Needs

The Medical Home Initiative for Children with Special Health Care Needs (CSHCN) in North Carolina has been designed to provide a comprehensive approach to the development of the Medical Home concept. It will integrate with the existing Title V and primary care infrastructure and use processes and approaches demonstrated effective in building systems of care for children and their families in this state. It is a multi-faceted approach that will require adjustment as time progresses. At this current stage of development, the Initiative can be segmented into seven dimensions of complementary planning.

Dimensions of the plan include:

Title V Staff support
Advisory Board to the Medical Home Initiative for C/YSHCN
Public Education Campaign
Parent Training and Education
Provider Training and Education
Demonstration Project to continue the learning of the National Collaborative
Demonstration Project through the NC Office of Research, Demonstrations and Rural Health Development.

The Specialized Services Unit Manager has the responsibility to ensure integrated development of medical home and other systems building activities for C/YSHCN. The Family Liaison Specialist serves to ensure a family-centered approach at the state and community level. This is in conjunction with the Women’s and Children’s Health Section Family Advisory Council and the Family Support Network-NC. The Specialized Services Unit Transition Coordinator, the C/YSHCN Medical Consultant, the Health Check/Health Choice Minority Outreach Consultant and the Health Check/Health Choice Clinical Coordinator have medical home project activities integrated into their work plans.

The NC Commission on C/YSHCN has agreed to embrace Medical Home as part of its official charge. In addition, an Advisory Board for the Medical Home Initiative for C/YSHCN in NC will be developed.

The NC Healthy Start Foundation has been engaged to develop additional Medical Home Campaign materials for use in the Health Choice/Health Check project sites and in the state “The Right Call Every Time” Campaign. This initiative focuses on the integration of C/YSHCN into the existing campaign and will also develop other specific educational resources for parents of C/YSHCN.

The Family Support Network-NC has been engaged to develop the capacity to train parents on different aspects of promoting the Medical Home Initiative for C/YSHCN. This includes: integrating educational information and referral resources on Medical Homes for C/YSHCN into the Central Directory of Resources and toll free hotline and website; and serving as a trainer, mentor and coordinator for parent team members of community-based practices participating in the Medical Home Initiative for C/YSHCN.

Collaborative work is ongoing with the North Carolina Center for ChildCare Health Improvement and the NC Pediatrics Society to develop and provide training for providers regarding Medical Homes for C/YSHCN.

One practice-based initiative the NC Title V program is designed to continue the learning from the 15-month Learning Collaborative on Medical Home for C/YSHCN. Chapel Hill Pediatrics through Jennifer Lail, MD and her practice team demonstrated significant emergency department usage reduction and increased staff and patient satisfaction.

Another practice-based activity is occurring in collaboration with the NC Office of Research, Demonstrations and Rural Health Development to support the Community Care Network in NC to develop capacity to serve as Medical Homes for CSHCN. Guilford Child Health, through the leadership of Dr. Marion Earles, has agreed to be the first Community Care network to accept this challenge. Dr. Earles is the physician champion of the NC Assuring Better Child Development (ABCD) Initiative. Engaging one network as an initial partner and then expanding to other sites is the process historically used by the Office of Research, Demonstrations and Rural Health Development in introducing innovation in the Community Care Networks.

Submitted by:
Cathy Kluttz
Specialized Services Unit Manger
Division of Public Health
1928 Mail Service Center
Raleigh, NC 27699-1928

Emergency Room Use

Seton Healthcare Network's
"Out of the Emergency Room: Communicating Healthcare Options to Low-Income Texans":
"A team of child health advocates saw a need for educational resources designed to encourage parents of children enrolled in Medicaid and CHIP to find and use a medical home, and to learn about and use alternatives to the ER for treating routine childhood illness. This study seeks to penetrate what lies beneath the endless stream of children whose parents think their best health care option for a primary care treatable illness is the emergency department of a hospital. It poses a central question: What drives the parent's health care decisions? And finally, it investigates what parents think will help them use their health care benefits in the way the benefits were designed: to have a primary care provider and a medical home."

The Medical Home

North Carolina Partnership for Children (Smart Start) publication
"Effective Practices: The Medical Home -- Every Child Deserves One!"
"Health is a cornerstone of development, particularly in young children. For this reason, the health benefits of children should be one of the principal goals of a comprehensive early childhood initiative. The objective of this paper is to provide a better understanding of what a medical home is and its importance to the overall health of children. Community strategies are included to help promote a medical home for every child." Written by Tom Vitaglione and edited by Vickie Newell.