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Vital Signs


Vital Signs

Winter 2011

Innovative Program Offers Medical Home for Children with Complex Conditions


For parents of children with complex medical conditions, keeping up with the numerous doctors’ appointments, diagnostic tests, medications and medical equipment can be overwhelming. Faced with the need to see a myriad of specialized physicians, they sometimes struggle to find answers to the questions that inevitably arise between appointments — and often end up relying on the emergency room, the nation’s most expensive form of care.

In an effort to better coordinate the care of these patients — including children with cancer, heart disease, spina bifida and other musculoskeletal abnormalities, craniofacial abnormalities and severe gastrointestinal disorders — Mattel Children’s Hospital UCLA established the Pediatric Medical Home Program at UCLA. The program is the first of its kind and has demonstrated impressive results that have placed it at the forefront of a national effort to transform primary care for children.

In the first study to look at the benefits of the medical-home concept in a specialized children’s hospital, UCLA researchers have found that participation in the program reduced emergency room visits by 55 percent, as well as improved patient satisfaction levels.

“The medical-home model stresses the importance of continuous, accessible outpatient care,” says pediatric cardiologist Thomas Klitzner, M.D., executive director of the Pediatric Medical Home Program at UCLA, which conducted the study. “Parents told us that when they had a concern that they might have previously thought would require an emergency room visit, they now had someone to call. They felt empowered to use scheduled outpatient primary care and specialty visits rather than using the emergency department to get care.”

The medical-home concept does not refer to a physical location; it is an approach to medical care that is accessible, compassionate, continuous, comprehensive, coordinated, culturally effective and family centered. The child’s pediatrician and parents act as partners in identifying and accessing necessary medical and nonmedical services. The UCLA program, based on guidelines established by the American Academy of Pediatrics, includes 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 that keeps all of a child’s medical information in one place.

VS-Winter11-Medical Home 2Dr. Klitzner decided to launch the program after concluding it could not only improve the quality of care but could reduce costs by eliminating unnecessary services. The findings of his pilot study have drawn considerable interest.

Kellie Ernzen Kruger, M.D., an internist and pediatrician at UCLA Medical Center, Santa Monica, says she has noticed significant improvement in the quality of care complex patients are provided through the medical-home concept. “When you are a primary care provider trying to coordinate care for patients with complicated medical issues, it’s very helpful to have access to all of the information from the specialists and to be able to communicate easily and effectively with them,” Dr. Kruger explains. “The medical home helps to foster that kind of communication, which translates to better care and greater satisfaction among patients and their families.”

For more information about the Pediatric Medical Home Program at UCLA, go to: www.uclahealth.org/medicalhome

The video above is also available in Windows Media at: http://streaming.uclahealth.org/medicalhome

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