The Patient/Family Centered Medical Home

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The Patient/Family Centered Medical Home

• Carolyn J. Allshouse
• Sr. Program Planner-Minnesota Department of
  Health
• State Coordinator, Family Voices of Minnesota
• Carolyn.allshouse_at_state.mn.us

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Family Voices a national network focused on
family-centered care

• Family Voices aims to achieve family-centered
  care for all children and youth with special
  health care needs and/or disabilities. Through
  our national network, we
• Provide families tools to make informed
  decisions,
• Advocate for improved public and private
  policies,
• Build partnerships among professionals and
  families, and
• Serve as a trusted resource on health care.

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Patient/Family-Centered Medical Home in Minnesota

• Medical Home Learning Collaborative began in 2004
  focused on children with chronic, complex health
  conditions and disabilities
• Based upon the NICHQ (National Initiatives for
  Child Health Quality) Medical Home Collaborative
• Consumers and families as quality improvement
  partners, supporters and drivers

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Defining Patient/Family Centered Care

• Patient and family centered care redefines
  relationships in health care.
• It means having meaningful partnerships with
  patients and families at the clinical level
  with the experience of care ...
• AND

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The concept of patient/family-centered
partnerships means

• Partnerships with patients and families in
  quality improvement and in policy and program
  development, health care redesign, education of
  physicians and other health professionals, and
  research
• Institute for
  Family-Centered Care

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Defining Patient/Family-Centered Care

• Recognizes that everyone has unique expertise and
  experience that has equal value.
• Family-centered care utilizes
• this expertise as programs are
• developed, implemented,
• evaluated and, in the care of
• individual patients

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Patient/Family Centered Care in Quality
Improvement

• Making patients and their families truly the
  force that drives everything else in health care
  is perhaps the most revolutionary tool of all.
  Its importance is evident at the system level,
  but it comes through even more strongly at the
  personal level.
• Donald Berwick, CEO The Institute for Healthcare
  Improvement

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Utilize all your resources

• Consumers and families are resources to
• Evaluate systems and services
• Suggest creative ideas for improvements
• Explain how services really work
• Help professionals understand other systems
• Energize and support health professionals

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Strategies for PFCC

• Include consumers and families on all quality
  improvement teams
• Implement consumer/family advisory councils
• Connect with consumer/family advisory councils in
  the community
• Utilize consumers and families in training staff
• Utilize patient/family perception surveys

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Medical Home - A patient and family-centered
approach to an otherwise chaotic system

• The Quality Standard for 21st Century Primary
  Care
• A medical home is a community-based primary care
  setting which provides and coordinates high
  quality, planned, patient and family-centered
  health promotion, acute illness care and chronic
  condition management.
• 
  CMHI 2008

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Medical Home Learning Collaborative in Minnesota

• 25 Teams across the State working to improve the
  quality of care provided to children with special
  health care needs
• Each team includes
• A primary care provider, a clinic based care
  coordinator and at least two parents of children
  with special health care needs
• Teams expand to include others Parents, other
  clinic staff, school and community

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Measuring improvement

• Medical Home provider and parent index
• Self rating tool that measures Medical
  Homeness, filled out once each year
• Parent surveys are collected that ask the
  family/patient about their health care experience
• Monthly reports number of children identified,
  number of care plans, what they are working on.
• Learning Session evaluations how will they apply
  what they learn

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Medical Home Family Index completed by Team
Parent Partners
Never Sometimes Often Always
Use and follow through with care plans they have created 6 24 29 41
Review and update the care plan with me regularly 6 24 47 24
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Family Perception of Medical Home

• Child visited an emergency room. (previous 3
  months)
• 46 of the medical home teams showed improvement
  that is a decline in ED use.
• Child missed school or adult missed work due to
  childs poor health (previous 12 months)
• 69 of the participating clinics improved in this
  area that is fewer missed school / work days.

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Family Perception of Medical Home Services
Provided

• Help or advice over the phone
• 54 improved in the ability to consistently
  provide needed advice
• Discuss what happened at a specialist visit
• 62 improved in following up with families after
  specialty care was received
• Ease in accessing specialty care
• 46 of the teams saw improvement

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Whats Different Now

• Care coordinator identified
• Systematic way of identifying patients with
  complex needs and implementing improvements for
  them
• Care Plans developed and updated
• Improved scheduling
• Longer appointments
• Planned Care Visits
• Direct rooming when needed
• Pre-visit planning

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Whats Different Now

• Improved Access
• Direct numbers / e-mail
• Changes in physical environment
• Direct access to lab
• Added evening clinic
• Linguistically Diverse Materials

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Whats Different Now

• Engaged Supported Patients and Families
• Engaged communities connecting with clinics
• Improved communication with specialty care

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We have a care plan that is always with us, the
hospital and clinic are aware of the special
needsand openly give Miriam that much needed
extra time and gentleness. All these little
changes are making a significant difference not
only for Miriam, but for our family.
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Being a part of the Medical Home team has been a
very rewarding experience. It has been an honor
to share some of our experiences and help
structure services and resources for other
families. Claire (Codys mom)