JULY2002

What does the term "Medical Home" mean?

The term "Medical Home" was originally proposed by the American Academy of Pediatrics (AAP) in 1992 to be used in reference to care for infants, children, adolescents and young adults ages birth through 21 years. The AAP updated their 1992 policy statement on the Medical Home in July 2002. The Medical Home is a concept, rather than a particular place. The care may be provided in a variety of locations such as providers' offices, hospital outpatient clinics, school-based and school-linked clinics that provide comprehensive health care, community health centers, and health department clinics. It should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective. Well-trained providers, who provide primary care, including preventive care such as health histories, complete physical examinations and immunizations, should deliver it. The provider should also help to manage and facilitate all aspects of care including preventive care, diagnostic and treatment services for both acute and persistent health problems (e.g. asthma).

The AAP believes that comprehensive health care for infants, children and adolescents should encompass the following services:

 1. Provision of family-centered care through developing a trusting partnership with families, respecting their diversity, and recognizing that they are the constant in a child's life. 

2. Sharing clear and unbiased information with the family about the child's medical care and management and about the specialty and community services and organizations they can access.

3. Provision of primary care, including but not restricted to acute and chronic care and preventive services, including breastfeeding promotion and management,** immunizations, growth and developmental assessments, appropriate screenings, health care supervision, and patient and parent counseling about health, nutrition, safety, parenting, and psychosocial issues.

4. Assurance that ambulatory and inpatient care for acute illnesses will be continuously available (24 hours a day, 7 days a week, 52 weeks a year).

5. Provision of care over an extended period of time to ensure continuity. Transitions, including those to other pediatric providers or into the adult health care system, should be planned and organized with the child and family.

6. Identification of the need for consultation and appropriate referral to pediatric medical subspecialists and surgical specialists. (In instances in which the child enters the medical system through a specialty clinic, identification of the need for primary pediatric consultation and referral is appropriate.) Primary, pediatric medical subspecialty, and surgical specialty care providers should collaborate to establish shared management plans in partnership with the child and family and to formulate a clear articulation of each other's role.

 7. Interaction with early intervention programs, schools, early childhood education and child care programs, and other public and private community agencies to be certain that the special needs of the child and family are addressed.

8. Provision of care coordination services in which the family, the physician, and other service providers work to implement a specific care plan as an organized team.

9. Maintenance of an accessible, comprehensive, central record that contains all pertinent information about the child, preserving confidentiality.

10. Provision of developmentally appropriate and culturally competent health assessments and counseling to ensure successful transition to adult-oriented health care, work, and independence in a deliberate, coordinated way.

 ** (Sia, C., Antonelli, R., Gupta,V, et.al. (2002). The Medical Home. Pediatrics 110 (1), 184-186.)