"Medical Home” Program Helps Families Reduce ER Visits

A novel concept in health care reform called the "medical home" offers parents a way to simplify, organize, and coordinate the complexities of a medically fragile child's health care needs.

Researchers at the University of California Los Angeles (UCLA; USA) collected data between 2004 and 2007 from the Pediatric Medical Home Project at UCLA for children with special healthcare needs who were selected for the program according to preestablished guidelines. The researchers then analyzed the data to determine comprehensive care coordination by measuring the use of outpatient, urgent, emergency department (ED), and inpatient services. The researchers found that the average number of ED visits per patient decreased from 1.1 visits before enrollment to 0.5 visits after medical home enrollment, representing a decrease of 55%; however, no significant change was found in the use of any of the other health care resources examined. The study was published in the March 11, 2010, online edition of the Journal of Pediatrics.

"We were pleasantly surprised to learn that we could run an effective program in a teaching clinic and create medical efficiencies that decreased the overall cost of medical care by reducing emergency department visits,” said lead author Thomas Klitzner, M.D., chief of the division of pediatric cardiology and executive director of the medical home project at UCLA. "The parents told us that they felt empowered by the pediatric residents, supervising faculty, and medical home staff to use scheduled outpatient primary care and specialty visits rather than using the emergency department to get care.”

The "medical home” is not a location, but an approach to care coordination designed to provide a constant trusted source of care, typically by a general pediatrician. The program guidelines established by the American Academy of Pediatrics (AAP) include four basic components: a formal 60-minute intake appointment, follow-up appointments of 40 minutes (twice the length of standard appointments), access to a bilingual family liaison to help families navigate the medical system, and a family binder or notebook that keeps all a child's medical information in one place.

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