• Center For Medical Home Improvement: http://www.medicalhomeimprovement.org/
• Building Your Medical Home: http://www.pediatricmedhome.org/

As we quickly move past the first decade of the twenty-first century, health care reform and the need to transform primary care practice has never been more urgent. The health care reform bill contains Medical Home as the model of primary care needed to improve patient care and stop spiraling costs. A medical home is the working relationship between a child's family and a physician's practice that supports both excellent health care and family satisfaction. It includes good communication at office visits, between office visits and regarding visits to other specialists as well as oral health, health education, family support and anything else important to a child's overall health. Medical Homes are accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. The Institute of Medicine and others have stated that system change is needed to make this transformation. System change within a practice is best done through quality improvement processes. Experiences by members of the AAP have demonstrated that "learning collaboratives" help start and maintain this process.

The Medical Home Learning Collaborative (MHLC) is a joint project between the IU School of Medicine and an IN Community Integrated Systems of Services Grant (CISS) grant from the IN State Department of Health. The MHLC has been working to improve Medical Home concepts in primary care practices since the Fall of 2009. The current practices in the Collaborative are:

• IU Health Ball Memorial Hospital - Muncie, IN
• Blackburn Health Center – Indianapolis, IN
• IU Health Arnett – Lafayette, IN
• Foundations Family Medicine – Austin, IN
• HealthNet Pediatric Adolescent Care Center – Indianapolis, IN
• Riley MSA-1– Indianapolis, IN
• Linwood Health Center - – Indianapolis, IN
• Meridian Pediatrics – Carmel, IN
• Pecar Health Center– Indianapolis, IN
• Ridge Medical Center – Linton, IN
• St. Francis Neighborhood Health Center– Indianapolis, IN
• St. Vincent Faculty Practice– Indianapolis, IN
• St. Vincent Family Medicine Residency Clinic– Indianapolis, IN
• St. Vincent Pediatric Primary Care Clinic– Indianapolis, IN
• St. Vincent Physician Network – Bohon / Craton – Bedford, IN
• St. Vincent Physician Network – Lira – Mitchell, IN
• Shipshewana Family Medicine - Shipshewana, IN
• Wishard Primary Care Pediatrics– Indianapolis, IN

Conference calls, site visits, group meetings and other correspondence allow the MHLC to share ideas for quality improvement with other practices in the collaborative.  Successes at the practices include:

• Improved patient access through brochures, same day scheduling, modified telephone systems and email communication
• Better team communication through huddles and QI meetings
• Parent and family involvement on quality improvement issues
• Creation of registry for complex patients
• Use of a care coordinator

Edited by Angela Paxton, Parent Consultant, MHLC, December 2010

The Medical Home Learning Collaborative, an Indiana Community Integrated Systems of Services (IN CISS) grant encourages participating practices to engage their patients by having parent partners identified and engaged. This includes inviting them to practice quality improvement meetings, actively soliciting their input to practice materials, and making them a part of the group educational meetings for the learning collaborative. The organizers of the learning collaborative have designed a tool for providers to aid them in seeking parent partner participation and have been successful in recruiting 18 parent partners in 18 practices. This fulfills a key component of developing a medical home within a practice of Care Partnership Support which is the first building block in the Medical Home tool box which can be viewed at the following link: http://www.pediatricmedhome.org/.

The Learning Collaborative also has the following elements:

• Family medicine and pediatric practices working, sharing and learning together
• Parent Consultant employed as part of the Resource Team; both the Parent Consultant and the Project Facilitator have children with special needs
• One of the main goals of the project is to sustain support for Indiana primary care practices that want to implement and maintain a Medical Home
• Bi-weekly conference calls and face-to-face site visits to build productive relationships and support their quality improvement effort
• The collaborative reaches primary care practices all over the state, not just central Indiana.
• The Medical Home Learning Collaborative Resource Team consists of both physicians and parents of children with special needs

Edited by Angela Paxton, Parent Consultant, MHLC, December 2010

Highest level of health outcomes

Highest level of self-advocacy

Highest level of community inclusion

Multidisciplinary team - Family advocates, social workers, nurses, physicians and community resource representatives

Preparation ages 11-18 yrs.:

Comprehensive medical and socio-emotional assessment

Transition planning

Counseling to address socio-emotional and health education needs

Primary Care Medical Home coordination and support

Resource referrals to anticipate and prepare for needs

Transition 18-22 yrs.

Portable medical summary

Patient- and Family-centered transition goals shared

Initial assessments began in April 2007

450 patients to date

Average age - 18 yrs. (range 12-22 yrs.)

Highest activity areas to date

Health insurance transitions

Access to community resources

Parent-child dynamics

Oversupervision vs.undersupervision vs. “just right”

Self-management skills

Behavioral issues

School accommodations

School to work preparation

Supplement adolescent preventive healthcare

In an effort to sustain the child health improvement work of the MHLC, our core partners have elected to adopt a child health improvement partnership model.  CHIP IN for Quality will continue to support the system changes necessary to improve quality within the Medical Home and optimize the health and health care of Indiana’s children and youth through collaborative, measurement-based, quality improvement initiatives.