Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117709

Natoshia M. Askelson, MPH¹, Keri L. N. Mercer, MPH, CHES², Anne Wallis, PhD³, Jeffrey G. Lobas, MD⁴, Andrew J. Penziner, MD, MS⁴, and Dennis Affholter, MA³. (1) College of Public Health, Department of Community and Behavioral Health, Iowa Center for Evaluation Research, University of Iowa, 4256 Westlawn, Iowa City, IA 52245, 3193383988, natoshia-askelson@uiowa.edu, (2) Center for Public Health Program Evaluation, Department of Community and Behavioral Health, College of Public Health, Iowa Cente, University of Iowa, 4256 Westlawn, Iowa City, IA 52242, (3) Dept. of Community & Behavioral Health, Center for Public Health Program Evaluation, University of Iowa, College of Public Health, 4258 Westlawn, Iowa City, IA 52242, (4) Child Health Specialty Clinics, University of Iowa Health Care, 247 CDD, Iowa City, IA 52242

The Iowa Medical Home Initiative (IMHI) promotes the medical home model through a rapid-cycle change approach to continuous quality improvement within clinical practices. In the first part of the initiative, IMHI staff worked intensively with two practices to help them use rapid-cycle change to implement the medical home model. Our evaluation involves two case studies of this facilitated approach to medical home model implementation. One pediatric practice serves patients largely from middle class families mostly covered by private insurance. This practice focuses broadly on children with special health care needs. The other pediatric practice is a federally-supported community health clinic serving children mostly covered by Medicaid. This practice focuses specifically on children with ADHD. We will describe the practice-level outcomes in each of these two practices, the financial implications for each practice of adopting the medical home model, and families' reactions to experiences with the medical home approach. We will use the case studies to describe how the medical home model evolves in practice settings and to what extent the evolving models conform to a standard definition (e.g., the AAP definition) of medical home. Results to date suggest the indispensability of a practice-based champion; the difficulty of generalizing focused practice improvements to other aspects of practice; and persistent uncertainty about how best to motivate efficient and effective practice-based quality improvement.

Learning Objectives: From information contained in our presentation, the participant (learner) will be able to

• Recognize and describe rapid-cycle change as one approach to continuous quality improvement.
• Analyze the characteristics of a pediatric practice in terms of what constitutes a medical home for children with special health care needs and their families.
• Assess and discuss the benefits and challenges of implementing a medical home.

Keywords: Children With Special Needs, Quality Improvement

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation