APA Policy StatementThe Family-Centered Medical Home: Specific Considerations for Child Health Research and Policy
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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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2022, Academic PediatricsCitation Excerpt :The life course approach to care emphasizes the impact of childhood events on the trajectory of childhood development and long-term childhood and adult outcomes. The Bright Futures principles of care emphasize the importance of promoting growth and development for all children, including CYSHCN, with health equity as an underlying foundation.3,25 Achieving health equity in pediatrics also entails addressing underlying structural racism and other determinants of health, targeting historical social constructs and drivers.26
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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)