Quality Coordinated Health Care for the High-Risk Infant: The Evolving Concept of the Medical Home

Abstract

Sick neonates that are treated in the neonatal intensive care unit are at high risk of health, developmental, and social problems. The complexities of managing such high-risk infants can be overwhelming for a single primary care provider. These infants require input from multiple specialties and agencies. Delivering quality care includes coordination of these multiple agencies and professionals that is best provided by means of a patient-centered medical home. There is growing evidence that such a model improves patient outcomes and reduces readmissions to the hospital. Team communication and coordination is at the heart of the medical home model. In an ideal setting, patient interaction and provider communication with the child’s medical home should begin before discharge from the NICU and should be a part of the NICU discharge process. This is especially important as survival of extremely sick and fragile infants is improving and a number of infants are reliant on medical technologies for a prolonged period of time following discharge for their survival. A medical home should not only deal with the medical problems of the individual child but should also address the psychosocial impact of caring for a sick child and should keep the child and the family at the center of its care. The child’s medical home can maintain close coordination with the high-risk infant follow-up clinic and can help the primary care provider in navigating subspecialty services. There are numerous barriers to the medical home model. Key among these are logistic difficulties and a lack of resources in coordinating services. The American Academy of Pediatrics (AAP) has set out a number of guidelines to overcome these issues. The medical home model is expected to be more efficient while at the same time decreasing health-care costs by reducing unnecessary duplication of services. Medical homes should function as a team with each member having formal responsibilities. Such a model will not only improve patient care but will also result in greater satisfaction among patients and their families. Increasingly, funding sources are recognizing the benefits of the medical home model through payments given specifically for care coordination services.