Meeting the needs of children in foster care with a primary care medical home

While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults. Lay abstract There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the “medical home”. The medical home is not a residential home, but a system where a patient’s healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.

Download Full-text

Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy

10.1542/9781610020862-part05-providing_a ◽

2017 ◽

pp. 1479-1479

Keyword(s):

Primary Care ◽

Cerebral Palsy ◽

Medical Home ◽

Children And Youth ◽

Primary Care Medical Home

Download Full-text

Providing a Primary Care Medical Home for Children and Youth With Spina Bifida

10.1542/9781610020190-part05-providing02 ◽

2016 ◽

pp. 1339-1339

Keyword(s):

Primary Care ◽

Spina Bifida ◽

Medical Home ◽

Children And Youth ◽

Primary Care Medical Home

Download Full-text

Coordinated Primary Care (“Medical Home” Model)

Clinical Scholars Review ◽

10.1891/1939-2095.2.2.60 ◽

2009 ◽

Vol 2 (2) ◽

pp. 60-64 ◽

Cited By ~ 2

Author(s):

Mary Petermann Garnica

Keyword(s):

Primary Care ◽

Health Care ◽

Nurse Practitioners ◽

Medical Home ◽

Primary Care Physicians ◽

Team Leaders ◽

Care Nurse ◽

Medical Home Model ◽

Primary Care Practices ◽

Primary Care Medical Home

Health care is inaccessible and too expensive for a large segment of the U.S. population. In addition, the past decade has produced many reports of significant problems related to safety, quality, and effectiveness in U.S. health care. The future of primary care is in question because of a current and projected worsening shortage of primary care physicians. A physician-led coordinated primary care model has been endorsed by major physicians groups as having the potential to address many of these problems. The model, also known as the “medical home,” has gained momentum and appears likely to play a central role as the nation moves forward to reform health care. Nurse practitioners have traditionally practiced “coordinated primary care” and are ideally suited to lead practices adopting this model of care. This article provides rationale for nurse practitioners to be fully recognized as team leaders of coordinated primary care practices.

Download Full-text

Racial and Ethnic Disparities in Indicators of a Primary Care Medical Home for Children

Academic Pediatrics ◽

10.1016/j.acap.2009.01.011 ◽

2009 ◽

Vol 9 (4) ◽

pp. 221-227 ◽

Cited By ~ 52

Author(s):

Jean L. Raphael ◽

B. Ashleigh Guadagnolo ◽

Anne C. Beal ◽

Angelo P. Giardino

Keyword(s):

Primary Care ◽

Medical Home ◽

Ethnic Disparities ◽

Racial And Ethnic Disparities ◽

Primary Care Medical Home

Download Full-text

A centralized, primary care medical home survivorship model at the GW Cancer Center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.45 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 45-45

Author(s):

Elizabeth Hatcher ◽

Farzana L. Walcott ◽

Cam Ha ◽

April Barbour

Keyword(s):

Primary Care ◽

Physical Therapy ◽

Cancer Survivors ◽

Weight Management ◽

Care Coordination ◽

Medical Home ◽

Survivorship Care Plan ◽

Survivorship Care ◽

The Impact ◽

Primary Care Medical Home

45 Background: Models for survivorship care are often oncology-based. George Washington (GW) Adult Cancer Survivorship Clinic (ACS) has developed a unique, centralized model for survivorship care delivery staffed by internal medicine providers. The objective is to provide care to survivors that encompass the broad array of chronic issues they face, in addition to guidance on cancer surveillance and prevention. Methods: We implemented a centralized, primary care, consultative model of survivorship care, emphasizing care coordination. A personalized, evidence based survivorship care plan (SCP) is provided to each patient. Patients with complex needs may be seen for follow-up. A copy of the SCP is sent to the patient’s primary care provider (PCP). Referrals are made to our network of specialists within the GW system including: cardiology, neurology, weight management, genetic counseling, dermatology, physical therapy, integrative medicine, psycho-oncology, sexual health, and oncofertility. Referrals are tracked to specialty services using the electronic medical record (EMR). Results: Based on preliminary data, from January 2016 to October 2017, 261 cancer survivors were seen in the survivorship clinic. The majority were breast cancer survivors (166). Referral records were available for 225 patients. Most common were dermatology for baseline skin cancer screening (28%), physical therapy (16%), social work and psycho-oncology (15%), and weight management (15%). Conclusions: Our clinic is based on a primary care medical home model for each survivor, which includes care coordination and referral to specialty services. Limitations include inconsistent referral tracking methods with our EMR and incomplete data for all survivorship patients. Future research plans include assessing the impact of referrals on patient-reported outcomes and morbidity.

Download Full-text