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The Medical Home Index - Short Version:
Measuring the Organization and Delivery of Primary Care for Children with Special Health Care Needs
The Medical Home Index - Short Version (MHI-SV) represents ten indicators which have been derived from the Center for Medical
Home Improvement’s (CMHI) original Medical Home Index (MHI). This short version can be used as an interval measurement in
conjunction with the original MHI or it can be used as a quick “report card” or snapshot of practice quality. CMHI recommends the use of
the full MHI for practice improvement purposes but offers this short version for interval or periodic measurement and/or when it is not
feasible to use the full MHI.
The Medical Home Index is a nationally validated self-assessment tool designed to quantify the “medical homeness” of a primary care
practice. The MHI contains twenty-five indicators which detail excellent, pro-active, comprehensive pediatric primary care. It functions
both as a quality improvement tool and as a self education medium relevant to the medical home.
The Medical Home Index: Short Version (MHI-SV) is a brief representation of the more complete measurement tool. It scores a
practice on a continuum of care across three levels:
Level 1 is good, responsive pediatric primary care.
Level 2 is pro-active pediatric primary care (in addition to Level 1)
Level 3 illustrates pediatric primary care at the most comprehensive levels (it is in addition to Levels 1 and 2).
As the reporter for your entire practice and in response to each of the ten indicators - please score your medical home at: Level 1,
Level 2 “partial”, Level 2 “complete”, Level 3 “partial”, or Level 3 “complete”.
Both the full 25-item Medical Home Index and this 10-item Medical Home Index – Short Version can be downloaded from the
CMHI website at www.medicalhomeimprovement.org.
© CMHI 2006, all rights reserved.
Center for
Medical Home
Improvement
Medical Home Index – Short Version (MHI-SV)
#1
Family
Feedback
Level 1
Level 2 (in addition to level 1)
Level 3 (in addition to level 2)
Pediatric primary care
without the elements
detailed in levels 2 and 3.
Feedback from families of CSHCN regarding their
perception of care is gathered through systematic
methods (e.g. surveys, focus groups, or interviews);
there is a process for staff to review this feedback and to
begin problem solving.
An advisory process is in place with families of CSHCN
which helps to identify needs and implement creative
solutions; there are tangible supports to enable families
to participate in these activities (e.g. childcare or parent
stipends).
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
Materials are available and appropriate for non-English
speaking families, those with limited literacy; these
materials are appropriate to the developmental level of
the child/young adult.
Family assessments include pertinent cultural
information, particularly about health beliefs; this
information is incorporated into care plans; the practice
uses these encounters to assess patient & community
cultural needs.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
A CSHCN list is generated by applying a definition
(see pg. 6), the list is used to enhance care +/or define
practice activities (e.g. to flag charts and computer
databases for special attention or identify the population
and its subgroups).
Diagnostic codes for CSHCN are documented,
problem lists are current, and complexity levels are
assigned to each child; this information creates an
accessible practice database.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
Requires both MD &
key non-MD staff
person’s perspective.
(# 1.5 MHI-Full
Version)
#2
Cultural
Competence
(# 1.6 MHI-FV)
#3
Identification
of Children in
the Practice
with Special
Health Care
Needs
(# 2.1 MHI-FV)
❒ Level 1
Pediatric primary care
without the elements
detailed in levels 2 and 3.
❒ Level 1
Pediatric primary care
without the elements
detailed in levels 2 and 3.
❒ Level 1
(The Medical Home Index – SV – Page 2)
© CMHI 2006, all rights reserved
Center for
Medical Home
Improvement
Medical Home Index – Short Version (MHI-SV)
#4
Care Continuity
(# 2.2 MHI-FV)
#5
Cooperative
Management
Between
Primary Care
Provider (PCP)
and Specialist
(# 2.4 MHI-FV)
Level 1
Level 2 (in addition to level 1)
Level 3 (in addition to level 2)
Pediatric primary care
without the elements
detailed in levels 2 and 3.
The team (including PCP, family, and staff) develops
a plan of care for CSHCN which details visit
schedules and communication strategies; home,
school and community concerns are addressed in this
plan. Practice back up/cross coverage providers are
informed by these plans.
The practice/teams use condition protocols; they include
goals, services, interventions and referral contacts. A
designated care coordinator uses these tools and other
standardized office processes which support children and
families.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
The PCP and family set goals for referrals and
communicate these to specialists; together they
clarify co-management roles among family, PCP and
specialists and determine how specialty feedback to
the family and PCP is expressed, used, and shared.
The family has the option of using the practice in a strong
coordinating role; parents as partners with the practice
manage their child’s care using specialists for consultations
and information (unless they decide it is prudent for the
specialist to manage the majority of their child’s care).
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
❒ Level 1
Pediatric primary care
without the elements
detailed in levels 2 and 3.
❒ Level 1
(The Medical Home Index – SV – Page 3)
© CMHI 2006, all rights reserved
Center for
Medical Home
Improvement
Medical Home Index – Short Version (MHI-SV)
#6
Supporting the
Transition to
Adulthood
(# 2.5.1 MHI-FV)
#7
Care
Coordination
/Role Definition
(# 3.1 MHI-FV)
Level 1
Level 2 (in addition to level 1)
Level 3 (in addition to level 2)
Pediatric primary care
without the elements
detailed in levels 2 and 3.
Pediatric and adolescent PCPs support youth & family
to manage their health using a transition timeline &
developmental approach; they assess needs & offer
culturally effective guidance related to:
• health & wellness
• education & vocational planning
• guardianship and legal & financial issues
• community supports & recreation
When youth transition from pediatrician to adult
provider:
Pediatricians help to identify an adult PCP and
sub-specialists and offer ongoing consultation to youth,
family and providers during the transition process.
Adult Providers offer an initial “welcome” visit and a
review of transition goals.
Progressively from age 12, youth, family and PCP develop a
written transition plan within the care plan; it is made available
to families and all involved providers.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
Care coordination activities are based upon ongoing
assessments of child and family needs; the practice
partners with the family (and older child) to accomplish
care coordination goals.
Practice staff offer a set of care coordination activities, their level
of involvement fluctuates according to family needs/wishes. A
designated care coordinator ensures the availability of these
activities including written care plans with ongoing monitoring.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
❒ Level 1
Pediatric primary care
without the elements
detailed in levels 2 and 3.
❒ Level 1
(The Medical Home Index – SV – Page 4)
Youth and families receive coordination support to link their
health and transition plans with other relevant adolescent and
adult providers/services/agencies (e.g. sub-specialists,
educational, financial, insurance, housing, recreation
employment and legal assistance).
© CMHI 2006, all rights reserved
Center for
Medical Home
Improvement
Medical Home Index – Short Version (MHI-SV)
#8
Assessment of
Needs/ Plans
of Care
(# 3.4 MHI-FV)
#9
Community
Assessment of
Needs for
CSHCN
(# 4.1 MHI-FV)
#10
Quality
Standards
(structures)
(# 6.1 MHI-FV)
Level 1
Level 2 (in addition to level 1)
Level 3 (in addition to level 2)
Pediatric primary care
without the elements
detailed in levels 2 and 3.
The child with special needs, family, and PCP review
current child health status and anticipated problems or
needs; they create/revise action plans and allocate
responsibilities at least 2 times per year or at
individualized intervals.
The PCP/staff and families create a written plan of care that
is monitored at every visit; the office care coordinator is
available to the child and family to implement, update and
evaluate the care plan.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
Providers raise their own questions regarding the
population of CSHCN in their practice
community(ies); they seek pertinent data and
information from families and local/state sources and
use data to inform practice care activities.
At least one clinical practice provider participates in a
community-based public health need assessment about
CSHCN, integrates results into practice policies, and shares
conclusions about population needs with community & state
agencies.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
The practice has its own systematic quality
improvement mechanism for CSHCN; regular
provider and staff meetings are used for input and
discussions on how to improve care and treatment for
this population.
The practice actively utilizes quality improvement (QI)
processes; staff and parents of CSHCN are supported to
participate in these QI activities; resulting quality standards
are integrated into the operations of the practice.
❒ PARTIAL ❒ COMPLETE
❒ PARTIAL ❒ COMPLETE
❒ Level 1
Pediatric primary care
without the elements
detailed in levels 2 and 3.
❒ Level 1
Pediatric primary care
without the elements
detailed in levels 2 and 3.
❒ Level 1
(The Medical Home Index – SV – Page 5)
© CMHI 2006, all rights reserved
Center for Medical
Home
Improvement
The Medical Home Index - Short Version:
Measuring the Organization and Delivery of Primary Care for Children with Special Health Care Needs
DEFINITIONS OF CORE CONCEPTS (Words in italics throughout the document are defined below.)
Children with Special Health Care Needs (CSHCN):
Children with special health care needs are defined by the US Maternal and Child Health Bureau as those who have, or are at increased risk for
chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that
required by children generally (USDHHS, MCHB, 1997).
Medical Home:
A medical home is a community-based primary care setting which provides and coordinates high quality, planned, family-centered health promotion
and chronic condition management. According to the American Academy of Pediatrics (AAP) “medical home” is accessible, family-centered, continuous,
comprehensive, coordinated, compassionate, and culturally competent.
Family-Centered Care (US Maternal and Child Health Bureau, 2004):
Family-Centered Care assures the health and well-being of children and their families through a respectful family-professional partnership. It honors the
strengths, cultures, traditions and expertise that everyone brings to this relationship. Family-Centered Care is the standard of practice which results in high
quality services.
(The Medical Home Index – SV – Page 6)
© CMHI 2006, all rights reserved
Center for
Medical Home
Improvement
The Medical Home Index – Short Version:
Measuring the Organization and Delivery of Primary Care for Children with Special Health Care Needs
GLOSSARY OF TERMS (continued)
Care Coordination Activities:
Care and services performed in partnership with the family and providers by health professionals to:
1) Establish family-centered community-based “Medical Homes” for CSHCN and their families.
-Make assessments and monitor child and family needs
-Participate in parent/professional practice improvement activities
2) Facilitate timely access to the Primary Care Provider (PCP), services and resources
-Offer supportive services including counseling, education and listening
-Facilitate communication among PCP, family and others
3) Build bridges among families and health, education and social services; promotes continuity of care
-Develop, monitor, update and follow-up with care planning and care plans
-Organize wrap around teams with families; support meeting recommendations and follow-up
4) Supply/provide access to referrals, information and education for families across systems.
-Coordinate inter-organizationally
-Advocate with and for the family (e.g. to school, daycare, or health care settings)
5) Maximize effective, efficient, and innovative use of existing resources
-Find, coordinate and promote effective and efficient use of current resources
-Monitor outcomes for child, family and practice
Chronic Condition Management (CCM):
CCM acknowledges that children and their families may require more than the usual well child, preventive care, and acute illness interventions.
CCM involves explicit changes in the roles of providers and office staff aimed at improving:
1) Access to needed services
2) Communication with specialists, schools, and other resources, and
3) Outcomes for children and families.
(The Medical Home Index – SV – Page 7)
© CMHI 2006, all rights reserved
Center for
Medical Home
Improvement
The Medical Home Index – Short Version:
Measuring the Organization and Delivery of Primary Care for Children with Special Health Care Needs
GLOSSARY OF TERMS* (continued)
Quality:
Quality is best determined or judged by those who need or who use the services being offered. Quality in the medical home is best achieved when one learns
what children with special health care needs and their families require for care and what they need for support. Health care teams in partnership with families
then work together in ways which enhance the capacity of the family and the practice to meet these needs. Responsive care is designed in ways which
incorporate family needs and suggestions. Those making practice improvements must hold a commitment to doing what needs to be done and agree to
accomplish these goals in essential partnerships with families.
Office Policies
Definite courses of action adopted for expediency; “the way we do things”; these are clearly articulated to and understood by all who work in the office
environment.
Practice:
The place, providers, and staff where the PCP offers pediatric care
Primary Care Provider - (PCP):
Physician or pediatric nurse practitioner who is considered the main provider of health care for the child
United States Maternal and Child Health Bureau - (USMCHB):
A division of Health Resources Services Administration
Requires both MD and key non-MD staff person’s perspective - you will see this declaration before select themes; the project has found that
these questions require the input of both MD and non MD staff to best capture practice activity.
(The Medical Home Index – SV – Page 8)
© CMHI 2006, all rights reserved
| File Type | application/pdf |
| File Title | Microsoft Word - MHI short version 1.5 lr.doc |
| Author | lreed |
| File Modified | 2011-03-16 |
| File Created | 2006-10-09 |