Medical home model gains momentum

Centralized care coordination may be a solution to many of the medical system's ills.

By Victoria Stagg Elliott, AMNews staff. Aug. 9, 2004.

Greg Prazar, MD, a general pediatrician from Exeter, N.H., doesn't hesitate to screen for depression or attention-deficit/hyperactivity disorder, two challenging diagnoses some physicians avoid because they may not have the resources to deal with the results.

"The questions you were afraid to ask, you're not afraid any more when you know you've got support," he said.

This example is just one of the many ways adopting the "medical home" model, originally developed to coordinate care for children with significant disabilities, benefits all of his patients, according to Dr. Prazar.

His practice acts as the center of care. All medical records are managed there. A care coordinator handles referrals for a wide array of problems, even for nonmedical ones, such as transportation difficulties or issues with the child's school. He also has parent collaborators heavily invested in making his practice work better for them.

"Doing this kind of work allows you lots of wonderful opportunities to make meaningful positive changes in your practice," he said. "And you learn about complex conditions from the experts in your practice -- the parents."

Dr. Prazar is part of a trend in which more and more physicians are turning to the medical home model to improve the quality of care. The phenomenon is also getting the attention of medical societies.

In March, the American Academy of Family Physicians proposed a version of this model as the future of their specialty. More recently, the American Academy of Pediatrics hosted the July Community Access to Child Health and Medical Home National Conference in Chicago, which brought together doctors, nurses, social workers, and, for the first time, parents and patients to develop practical skills to aid them in building and strengthening the medical home concept.