The 130th Annual Meeting of APHA

Abstract #48361

W. Carl Cooley, MD¹, Jeanne W. McAllister, RN, MS, MHA², Kathleen A. Sherrieb, RN, MS, MPH², and Robin Clark, PhD³. (1) Center for Medical Home Improvement, Hood Center for Children and Families, Department of Pediatrics, Dartmouth Medical School, 1 Medical Center Drive, Colburn Hill, Lebanon, NH 03756, (2) Center for Medical Home Improvement Hood Center for Children and Families, Department of Pediatrics, Dartmouth Medical School, 1 Medical Center Drive, Colburn Hill, Lebanon, NH 03756, 603-653-1480, Carl.Cooley@CrotchedMountain.org, (3) Dartmouth/New Hampshire Psychiatric Research Group, Dartmouth Medical School, 1 Medical Center Drive, Department of Psychiatry, Lebanon, NH 03756

Healthy People 2010’s Children with Special Health Care Needs agenda (HP, 2010, CSHCN) includes all CSHCN having a medical home. States need tools to determine if practices are medical homes and set standards for guiding improvements. The Center for Medical Home Improvement’s (CMHI) Medical Home Index (MHI) captures and quantifies tangible/observable behaviors of medical homes at specific points in/across time. It is designed to translate the American Academy of Pediatrics (AAP) descriptions (accessible, family-centered, coordinated, etc.) into measurable indicators. Six domains/twenty-five themes of the MHI address additional HP 2010, CSHCN elements, including service coordination, family partnerships, and transitions to adulthood. The Medical Home Family Index provides a companion consumer perspective/practice corroboration. CMHI’s objective to develop and validate a quality measurement and classification tool utilized a three-phased approach 1) expert content validation 2) refinement of methodology and tools using regional responses and 3) establishment of internal and inter-rater reliability with regional and national data. Content validation provided support for tool composition. Internal consistency (coefficient alpha=0.96) and inter-rater reliability (kappa range=0.51-0.83) were established for the MHI. MHI continuums capture four levels of practice on a scale of 1-8; scores ranged from 58-157 (possible range 25-200) with a mean of 102 (SD 28). This demonstrates that the MHI has the ability to capture a wide spread of variation in practices while measuring capacity. Evidence supports the MHI as a valid, reliable and objective classification tool for assessing "medical homeness" of pediatric primary care practices and its faithfulness to the AAP concepts.

Learning Objectives: Objectives

As a result of this presentation learners will
• Gain an understanding of the methodology used to validate the Medical Home Index as an evaluation and research tool with uses for classifying and quantifying the progress of a primary care pediatric practice along a continuum of "medical homeness"
• Develop skills in the use of the Medical Home Index and its consumer companion piece the Medical Home Family Index for state, regional and single practice settings and compare scores against national benchmarks.
• Link domain/thematic scores to needed medical home quality improvements, implications for correlated family outcome and models for improvement.

Keywords: Community-Oriented Primary Care, Quality Improvement

Related Web page: www.medicalhomeimprovement.org

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

CSHCN Access to a Medical Home

The 130th Annual Meeting of APHA