Medical Home Concept Catching on in U.S.

Donna Dunlap cheers up her daughter Elena at her home in Hopkinton, N.H. Thursday, May 11, 2006. Elena suffers from a complex history of seizures and other neurological problems and has no diagnosis, can't talk or walk and relies on her parents for all her basic needs. Most of her medical needs are taken care of at her home. (AP Photo/Jim Cole) (Jim Cole - AP)

CONCORD, N.H. -- The frustration used to start on the phone. Every time Donna Dunlop called her daughter's pediatrician, she started from scratch, describing the girl's complex history of seizures and other neurological problems to someone in a remote office who had never heard of her.

Specialists arrived at appointments clutching Elena Spahr's medical history _ a stack of bulging folders well over a foot high _ yet failing to grasp the bigger picture. An oblivious X-ray technician once asked her mother, "Can you just have her stand over here?"

"The kid's in a wheelchair and completely unable to do that," Dunlop said. "It seems small, and yet I can't tell you how hard it is when no one has been clued into the reality that child faces."

Several years later, Elena, 9, still has no diagnosis, can't talk or walk and relies on her parents for all her basic needs. But her parents now can rely on her pediatrician's office to help them connect the complicated dots between specialists, schools and various support networks.

"It was a pretty typical medical practice then," she said. "Now, it really is a medical home."

The term "medical home" describes not just a physical place, but the people who provide care and how they do it. In an ideal medical home, patients and parents feel respected. Staffers take a proactive, team approach to helping families coordinate information from multiple providers and direct them to other resources in the community.

In the words of the American Academy of Pediatrics, patient care in a medical home is "accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective."

It sounds like common sense, but it's not common practice, said Dr. Joseph Hagan, co-chairman of the academy's Bright Futures Education Center. In guidelines it is writing for the federal government, the center will recommend that well-child visits for patients up to age 21 be provided in the context of a medical home.

"The idea of a medical home is maybe not one-stop shopping on-site, but one place or group of people you can count on to help you address whatever the medical issue is," said Hagan, a pediatrician in Burlington, Vt.

Though the academy coined the term "medical home" in the 1960s, and formally defined it in 1992, the concept didn't start catching on until the academy adopted it as its standard of care in 2002. Since then, certifying organizations for family physicians and internists have embraced the model.

The U.S. Maternal Child and Health Bureau has made the medical home part of its national agenda for states, and ensuring that every child with special health care needs has a medical home is one of six top objectives for states under the president's New Freedom Initiative.

"The medical home is the brand name for 21st century primary health care," said Dr. Carl Cooley. "It's no longer a decision to become a medical home. You are a medical home, and it's a question of how good of a medical home do you want to become?"