A medical home is not a physical place, but rather an ideological framework supported by the American Academy of Pediatrics that aims to provide comprehensive care for an ill child and his or her family. A medical home is thus a theory on the medical practice and on how quality of care can be streamlined and improved. The medical home method attempts to be holistic by understanding all of the different factors which can affect care.
The following components create a medical home: Partnership between the family and health care provider, creating relationships based on trust, establishing connections with support groups and auxiliary care facilities, support of families, access to care providers at all times, respect for differing religions and cultures, and coordination of all services by the primary care physician and office.
Through the primary care team, the medical home is established. It is only as successful as the primary care physician’s efforts to support and respect the decisions of the parents.
For example a chronically ill child with parents who are Jehovah’s Witnesses requires surgery. In most cases, surgery involves giving blood products, strictly prohibited by the Jehovah’s Witness religion. Some surgeons have developed complex “bloodless” surgeries, so children who need surgery will be able to get it, with respect to the religion of the family. The primary care physician of the medical home ideology, in this case, knows which doctors can perform a bloodless surgery and refer the patients accordingly.
If a bloodless technique is not available, the physician would carefully review other options with the parents, and would ultimately show respect for the parents even if not having surgery meant the death of the child. In most cases, the physician would search as many alternate routes as necessary to help prevent this, yet a decision to allow a child to die would not be cause for the physician to abuse the parents. If the decision cannot involve surgery and will result in the child’s death, then the physician will involve hospice or other care programs to support the family during this difficult time.
In the medical home, the decisions and needs of the parents are very important. They are part of the team that will help direct an ill child’s care. Parents have a unique perspective as being the people who best know their children. Physicians in the medical home make decisions respective of the parents’ wishes, and also in consideration of the parents’ abilities. Where there are language barriers, the primary care physician will coordinate the use of a translator so the parents can be fully involved in decisions regarding their child’s care.
Additionally, the medical home must be willing to address the financial needs of the family. Medical home physicians must be willing to take federal or state covered insurance like Medicaid. This is something that many doctors will not do because compensation is so much lower. However, in the medical home setting, all believe that children are entitled to the best care regardless of economic background.
In a recent survey, over 40% of families with a child who has a health problem recognize that the illness has created financial problems for the family. Additionally, parent coordination of care for ill children often takes an average of 11 hours per week, which represents either a loss of time available to work, or a loss to time available to care for the family. By shifting the coordination issues to the physician, the parent is able to focus on the important aspects of providing financial stability and quality care for his or her child.
Medical home philosophy is seldom a reality, though there are a few places where it has been successful. Notably, the Shriners’ Hospitals throughout the US are excellent at providing a medical home for children, but they are able to do so through private donations. Larger hospitals that offer partnerships between primary care physicians and specialists are more likely to be able to embrace the medical home. This leaves most people in suburban and rural areas out of the loop, because care coordination is difficult over distances, and particularly rural physicians may not have access to translators.
The medical home is a fantastic concept, yet one that cannot be fully realized without total cooperation by hospitals, physicians, and associated caregivers. It may be that the medical home is more accessible in a universal health care setting, since this will naturally place all doctors in partnership with each other.
