The Patient/Family Centered Medical Home Carolyn J. Allshouse Sr. Program Planner-Minnesota Department of Health State Coordinator, Family Voices of Minnesota Carolyn.allshouse@state.mn.us

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.

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 Initially pediatricians, then family physicians and nurse practioners

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

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

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

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. It’s 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

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

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

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

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

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

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 47%

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 child’s poor health (previous 12 months): 69% of the participating clinics improved in this area – that is fewer missed school / work days.

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

What’s 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

What’s Different Now Improved Access Direct numbers / e-mail Changes in physical environment Direct access to lab Added evening clinic Linguistically Diverse Materials

What’s Different Now Engaged Supported Patients and Families Engaged communities connecting with clinics Improved communication with specialty care

We have a care plan that is always with us, the hospital and clinic are aware of the special needs…and 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.

“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 (Cody’s mom)