Elsevier

Academic Pediatrics

Volume 10, Issue 4, July–August 2010, Pages 211-217
Academic Pediatrics

APA Policy Statement
The Family-Centered Medical Home: Specific Considerations for Child Health Research and Policy

https://doi.org/10.1016/j.acap.2010.05.002Get rights and content

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The Need to Articulate the Family-Centered Medical Home for Pediatrics

The medical home model of care has been defined by several organizations during the past 2 decades. The American Academy of Pediatrics defined the medical home in its policy statements of 1992 and 2002 as care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective; delivered or directed by well-trained physicians who provide primary care and manage and facilitate essentially all aspects of pediatric care, with a physician known to

Issues Unique to Children and Adolescents: The 5 D's

Forrest and colleagues13 conceptualized unique issues for children compared to adults in health services research as the 4 D's: developmental change, dependency, differential epidemiology, and demography. Financing of child health services (the fifth D: dollars), while more of an external characteristic, is different as well. These differences influence how the FCMH is operationalized for child versus adult health care systems (Table).

Payor Differences

Major differences exist in health care financing as compared with adults, especially those with low socioeconomic status. While the overall costs of health care for children are small compared with the adult population, they are a critical investment that may result in substantial savings over the life span.21 Services are provided by a diverse mix of private insurers and state Medicaid and Children's Heath Insurance Program funds, rather than Medicare, and funding for mental health and oral

Care Coordination

Care coordination, an essential element of the pediatric and adult medical home, focuses on assuring that patients and families have access to needed care in a timely fashion, maximizing appropriate and efficient resource use while minimizing duplication of effort. In all age groups, there exist challenges with coordinating care between care settings, among community-based services, and with state and local service agencies.30 To address these challenges, coordination of diverse services by

APA Current Policy and Advocacy Activities Related to the FCMH

In 2008, the APA Task Force on the Family-Centered Medical Home was convened to participate in the planning of a PCMH conference, a collaborative effort of APA, the Society of General Internal Medicine, and Society of Teachers of Family Medicine. The conference was held in July 2009 in Washington, DC, with over 150 researchers, policymakers, and funders in attendance. The conference goal was to develop a policy-relevant research agenda to advance the PCMH. Five papers were commissioned

Conclusions and Recommendations

Growing attention to the medical home in health care reform and new financing has helped to highlight some of the key issues for both pediatric and adult medicine. Major similarities exist between the PCMH and the FCMH: both call for care models involving coordination, consumer involvement and education; multidisciplinary teams; patient registries; and systematic application of best clinical practice standards. Nonetheless, clinical differences and differences in financing for children's health

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References (36)

  • R.E.K. Stein et al.

    Framework for identifying children who have chronic conditions: the case for a new definition

    J Pediatr

    (1993)
  • I.B. Horn et al.

    Child health disparities: framing a research agenda

    Ambul Pediatr

    (2004)
  • Pediatric records and a “medical home.” In: Standards of Child Care

    (1967)
  • American Academy of Pediatrics. The medical home

    Pediatrics

    (2002)
  • American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians...
  • R.A. Paulus et al.

    Continuous innovation in health care: implications of the Geisinger experience

    Health Aff

    (2008)
  • J.M. Perrin et al.

    The increase of childhood chronic conditions in the United States

    JAMA

    (2007)
  • J.M. Perrin et al.

    Benefits for employees with children with special needs: findings from the Collaborative Employee Benefit Study

    Health Aff

    (2007)
  • National Initiative on Child Healthcare Quality. Spread of the medical home concept. Comprehensive final report....
  • C.J. Homer et al.

    A review of the evidence for the medical home for children with special health care needs

    Pediatrics

    (2008)
  • P.A. Nutting et al.

    Initial lessons learned from the first national demonstration project on practice transformation to a patient-centered medical home

    Ann Fam Med

    (2009)
  • Blumenthal D. The federal role in promoting health information technology. The Commonwealth Fund Web site. January 26,...
  • Davis K, Stremikis K. Health information technology: key lever in health system transformation. The Commonwealth Fund...
  • L.M. Kern et al.

    HEAL NY: promoting interoperable health information technology in New York State

    Health Aff

    (2009)
  • C.B. Forrest et al.

    Child health services research: challenges and opportunities

    JAMA

    (1997)
  • Children's Health, the Nation's Wealth: Assessing and Improving Child Health

    (2004)
  • E.C. Perrin et al.

    Issues involved in the definition and classification of chronic health conditions

    Pediatrics

    (1993)
  • R.E.K. Stein et al.

    Operationalizing a conceptually-based noncategorical definition: a first look at US children with chronic conditions

    Arch Pediatr

    (1999)
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    Division of General Pediatrics, University of Massachusetts Medical School, Worcester, Mass (Dr Stille); Special Programs, St. Christopher's Hospital for Children, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa (Dr Turchi); Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, Pa (Dr Turchi); Children's Hospital Boston Integrated Care Organization, Children's Hospital Boston, Harvard Medical School, Boston, Mass (Dr Antonelli); Philip R. Lee Institute for Health Policy Studies, Division of General Pediatrics, University of California, San Francisco, Calif (Dr Cabana); Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University, Baltimore, Md (Dr Cheng); Division of General Pediatrics, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY (Dr Laraque); and Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass (Dr Perrin)

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