1. Its 10 OClock – Do You Know Where Your Doctor Is? June 27, 2009

2. Your Doctor Should Be: Family Centered –Mutual responsibility and trust exists between YOU and the doctor –YOU are recognized as the main caregiver and center of strength and support for your child –Clear, unbiased, and complete information and options are shared on an ongoing basis with YOU

3. Your Doctor Should Be: Accessible –Care is provided in YOUR community –YOUR insurance, including Medicaid, is accepted and changes are accommodated –YOU are able to speak directly to YOUR doctor when needed

4. Your Doctor Should Provide: Continuous Care –YOUR doctor is available from infancy through adolescence and young adulthood –Assistance with transitions (to school, home, adult services) is provided to YOU –YOUR doctor participates to the fullest extent allowed in care and discharge planning when YOUR child is hospitalized or care is provided at another facility or by another provider

5. Your Doctor Should Be: Comprehensive –Health care for YOUR child is available 24 hours a day, 7 days a week –Preventive, primary, and specialty needs are addressed for YOU –YOUR doctor advocates for YOUR child and YOU in obtaining comprehensive care and shares responsibility for the care that is provided

6. Your Doctor Should Be: Coordinated –A plan of care is developed by YOUR doctor, YOUR child, and YOU and is shared with other providers, agencies, and organizations involved with the care of YOUR child –A central record or database containing all pertinent medical information about YOUR child, including hospitalizations and specialty care, is maintained at the practice

7. Your Doctor Should Be: Compassionate –Concern for the well-being of YOUR child and YOU is expressed and demonstrated in verbal and nonverbal interactions –Efforts are made to understand and empathize with the feelings and perspectives of YOUR family as well as YOUR child or youth

8. Your Doctor Should Be: Culturally Effective –All efforts are made to ensure that YOUR child and YOU understand the results of the medical visit and the care plan, including offering (para) professional translators or interpreters, as needed –Written materials are provided in YOUR primary language

9. What did we just describe? A Medical Home!

10. No, its not a house! A Medical Home is health care that is: –Family Centered –Accessible –Continuous –Comprehensive –Coordinated –Compassionate –Culturally Competent

11. If your Doctor isnt there yet……

12. Steps to improving your relationship with your childs doctor

13. Bring a list of questions or concerns to discuss at each visit

14. Share information on how your child is changing (progressing, regressing, etc.)

15. Ask about resources that may help your child and family

16. Ask about how to get care after hours if needed

17. Ask to meet the office staff that will be working with you and your child

18. Offer suggestions or comments on what would make things easier for you

19. Show appreciation

20. Parent / professional teamwork is a key part of developing medical homes for all children

21. Why you would want a Medical Home? Decrease Emergency Room Visits Address the WHOLE Child Find Needed Services Provide Support To the Family

22. In a Medical Home… Your child and family –Receive care from a Primary Care Physician (PCP) whom YOU know and trust. PCPs and You –Act as partners to identify and access the medical and some of the non- medical services common goal is to help Your child and family achieve the maximum potential.

23. Medical Homes for CSHCN means Decreased ER visits –NICHQ MHLC-II: percent of CSHCN with at least one ER visit in previous 3 months decreased from 36% to 20%. Decreased hospitalizations –NICHQ MHLC-I: unplanned hospitalizations for CSHCN decreased 13-18% across practices –NICHQ MHLC-II: percent of CSHCN with one or more unplanned hospitalizations in previous 3 months dropped from 19% to 7%

24. Medical Homes for CSHCN means Fewer Missed Work/School Days –NICHQ MHLC-II: Percent of parents/CSHCN with a missed work/school day in previous 3 months decreased from 58% to 30% –Palfrey: Percent of parents missing > 20 days of work/yr decreased from 26% to 14% (Pediatrics 113:1507, 2004)

25. Medical Home – is primary care It is not a primary care project but – The kind of care we all want for our families ourselves Center for Medical Home Improvement

26. Participating in the Center for Medical Home Improvement Medical Home Study Outcomes Study Point in Time Look… Recruit - 5 Medicaid/1 Private Plan –Plans recruit practices, identify children/youth Final Analysis - 35 practices in five states –Texas, California, NC, Oregon & NH –Practice MHI, Phone Interview Compare Medical Home Index (MHI) scores with: –Utilization data for children w/6 conditions for prior 12 months (Asthma, Autism, CP, ADHD, Diabetes, Epilepsy) –30 families surveyed in each practice

27. Texas Childrens Health Plan (TCHP) Results All Practices in Plan- MHI Scores & Transformed Score & Six Domain Scores The medical home index (total) score transforms these data into a 1-100 scale; you will see that the mean total transformed score is 42 (out of 100%) for the 43 practices participating in this research effort.

28. TCHP Results All Practices in Plan- MHI Scores & Transformed Score & Six Domain Scores Medical Home Index Results The medical home index scores six domains; 25 indicators within these domains are scored on a 1-8 point scale. Scores reported below show the mean score for each of the six domains.

29. RESOURCES www.dshs.state.tx.us/cshcn/medhome.shtm www.medicalhomeinfo.org www.medicalhomeimprovement.org www.txp2p.org

30. Created and Presented by: Carol Harvey Texas DSHS / CSHCN SP carol.harvey@dshs.state.tx. us Austin, Texas 512-458-7111 ext. 3406 Jeanine Pinner Training & Outreach Coordinator / Texas Parent to Parent jeanine@txp2p.org 512-217-3558 (cell) Angelo P. Giardino, MD, PhD, MPH Medical Director, Texas Childrens Health Plan Clinical Associate Professor, Pediatrics, Baylor College of Medicine, Houston, TX