The team established a complexity score to define children with special needs. They opted not to designate all children with ADHD or asthma as having chronic conditions. Instead, they reserved this definition for more severe problems, including diabetes, cerebral palsy, and autism.
“We literally labeled the kids by putting a sticker on the front of the chart, and an identifier on the computer screen that comes up when the name is entered,” he explained. “That identification process was important because it helped us know who the child was whenever the parent called with a question or to make an appointment,” he added. Dr. Gardner's practice currently includes 90 children with chronic conditions for whom they serve as a medical home.
Another successful project was creating a telephone script for use by the receptionist when the parent of a special needs child calls. The receptionist has a specific set of questions to ask, such as whether the visit will take extra time, or whether the child prefers to wait in a quiet exam room rather than a crowded waiting room. The office manager of the practice serves as a “care coordinator,” for these patients, and helps manage referral letters, letters of medical necessity, and insurance coverage, which removes some of the paperwork burden from the physicians. Feedback from the parents on the quality improvement team in Dr. Gardner's practice led to the creation of two additional features.
First, the office has a picture guidebook available for nonverbal patients, which includes pictures of the front door, the waiting room, the different doctors, and the different pieces of equipment. Pictures in this format, also known as picture exchange cards, are often used by parents of nonverbal autistic children, and such pictures have been shown to reassure children who might be anxious about the office visit, Dr. Gardner explained.
Second, children with chronic conditions or special needs have a written care plan, condensed to both sides of a single sheet of paper, that lists all of the child's diagnoses, medications, recent hospitalizations, therapist visits—“everything that goes on with this child,” Dr. Gardner said. “We put this page in the front of the chart, and parents have a copy that they can keep with them.”
For more information about the medical home concept and ideas for incorporating its strategies into your practice, visit www.medicalhomeimprovement.org
Creating a medical home is about practice-wide improvement and being open to change. DR. COOLEY
The definition 'chronic conditions' is for problems such as diabetes, cerebral palsy, and autism. Dr. gardner