Practice Redesign to Achieve Patient-Centered Medical Home Recognition: Pediatric Challenges and Guidance

In an era of health reform, many practices are considering Medical Home certification program participation to promote patient-centeredness, satisfaction and improve care outcomes and reimbursement. However, these programs' early focus on adult care results in little guidance for pediatric practices attempting to meet NCQA Patient Centered Medical Home (PCMH) standards. To achieve PCMH recognition, practices may have to engage in substantial redesign to meet evolving standards for access and care management. This study used PDSA cycles and collaborative learning model to guide seven pediatric primary care health centers through redesign critical to achieving Level III NCQA PCMH. There are two key aims: establish patient-centered guidelines to improve access and communication for families; and increase documentation compliance to meet NCQA standards. Phase I involved gap-analysis of each clinic and determination of interventions needed for NCQA certification. The study specifically addressed documentation of vital signs and usage of evidence-based templates for management of three clinically important conditions: well child care, asthma and obesity. Phase II used a similar learning collaborative model to examine successes and barriers to increasing required documentation, and to implement guidelines for patient-centered access and care. Phase II successes include improvement of height and weight documentation, which in turn has enabled identification, tracking, and management of patients at risk for obesity. Submission of NCQA PCMH application and focus on continued improvement is planned for Phase III to ensure practices continue to improve the patient experience and care outcomes.