Home Sweet Medical Home

Photo courtesy of Flickr user @cdharrison (CC).

Photo courtesy of Flickr user @cdharrison (CC).

from the American Academy of Pediatrics National Conference and Exhibition

 If the medical home model of health care ever comes to be, it looks like it’s the pediatricians who will get there first.  At least that’s the way it sounds based on comments of outgoing AAP president Dr. David T. Tayloe Jr., during one of the plenary sessions.

“When most of my adult friends become ill, they cannot get same-day sick appointments with their primary care physicians. They seek care from an urgent care facility or a hospital emergency department,” he noted. If these adults are very sick, they’re admitted to a hospital for care by a hospitalist team that is employed by the hospital or they are referred out of town for a higher level of care.  “None of these entities share the longitudinal health records of my adult friends. So their care is very fragmented and expensive,”  he pointed out.

“Contrast this adult medicine example, however, with the health care situation that exists in our community for the children and grandchildren of my adult friends,” Dr. Tayloe said. These children transition from the newborn nursery directly into pediatric practices, “where they DO receive comprehensive 24/7 care.”

Children “can have same-day sick appointments to avoid fragmentation of primary care.  They may be cared for in a hospital emergency department if all of our offices are closed … but the family has the opportunity to talk with one of our physicians before going to the emergency department,” he said. “If the emergency department staff needs to be seen by a pediatrician, our on-call pediatrician goes to the [ED].  If they’re sick enough to be admitted to the hospital, our staff provides hospital care such that the patient has a current, longitudinal record,” at the practice. Likewise, if pediatric patients require subspecialty care elsewhere, we make those arrangements and expect efficient communication from our subspecialty colleagues.”

“I realize that there are some underlying reasons for the failure of the adult medicine system to adopt the medical home concept,”  Dr. Tayloe conceded. These include primary care physician shortages and payment issues. “Even so, the mind-set of adult medicine is not the same as that of those of us in pediatrics. We are way ahead of them … in providing real medical homes for our patients.”

—Kerri Wachter, @knwachter on Twitter

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Filed under Emergency Medicine, health reform, Pediatrics, Practice Trends, Primary care

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