The Medical Home
The American Academy of Pediatrics has defined a medical home as “primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective.” Rather than a location, it refers to a way of practicing medicine and caring for children that reaches beyond medical needs to consideration of the non-medical needs of the children and their families. It is focused on assisting families in providing the best care for their children. Thus, the patient and family are active members of the decision making processes. The diagram below frames the medical home concepts with a foundation of physician-patient interactions, which when successful open the door to a family centered partnership within the health care system. You will explore each topic (culture in health care, family centered partnership and navigating the healthcare system) through a series of cases that use resources to help you explore the key concepts and printable tools to help you bring these concepts to the bedside.
Culture in Health Care
Culture is a broadly defined term with definitions varying by the context in which it is used. Anthropologists define it as a set of systems, values, beliefs and behaviors shared by a group of people through which they view the world and one another. Culture is acquired through experiences with one’s environment, not inherited through genetics. Thus it is a learned process that influences an individual belief system. Within any medical encounter, there are at least two perspectives on the cause and appropriate treatment of the presenting problem: that of the patient and of the provider. The patient perspective is framed within his or her cultural perspectives, as is the provider's (most notably the medical culture). The goal of providing culturally effective care is to maximize the common ground between these different perspectives.
http://eclipps.org/culture_home.htmFamily Centered Partnership
Creating a family centered partnership builds on the principals of providing culturally effective care by placing the family and their needs at the center of the medical home. This means that the provider listens to and values the opinions of the family members and works to make treatment plans that will benefit the patient within the context of not only his or her medical need, but also the rest of his or her life. To achieve this goal requires thinking more broadly than the patient’s medical problems. It requires that the medical provider 1) knows who the key members of the family are with regard to care of the patient, 2) knows what the family values are with regard to goals for the patient and 3) involves the family in decision making for the patient.
http://eclipps.org/family_centered.htmNavigating the Health Care System
Helping families to navigate the health care system is essential for a true family centered partnership, since system complexities can prevent optimal care if they are not understood by families. A good medical home will coordinate specialty care, transportation, educational resources, community services and other supports. However, it is not enough to simply coordinate these services, the medical home must help families to understand the role of each and ensure that all are working together to provide chronic, acute and preventative services. Preventative services have been shown to improve the quality of patient care while decreasing the overall cost. The responsibility to ensure that all children have a medical home lies with the primary care physician who oversees this process.
http://eclipps.org/nav_health_sys.htm
