Transcript View Case 1 - University of Hawaii

Medical Home Module
Case 1
University of Hawai’i Integrated Pediatric Residency Program
Continuity Care Program
Case 1
14 year old boy with asthma presents to your clinic
complaining of a chronic cough. His PMH is
significant for recurrent ER visits for asthma
exacerbations with multiple hospitalizations. He
has been non-compliant with his preventive
asthma medications. His parents are immigrants
from the Marshall Islands, and have been giving
him “herbal tea” instead of Flovent. No parents
are at work, and not currently present.
What are the problems in this case?
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Chronic cough
Recurrent ER visits for asthma
Multiple past hospitalizations
Parents and patient non-compliant with meds
Parents giving “herbal tea”
No parent present during this visit
What is the Medical Home?
A partnership approach with families to provide
primary health care that is accessible, familycentered, coordinated, comprehensive,
continuous, compassionate, and culturally
effective.
What is Family Centered Care?
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Family can identify PCP as personal physician
Mutual responsibility and trust exists in relationship
Family is recognized as the principal caregiver and
center of strength and support for child
Information & options are routinely shared with family
Families, youth and physicians share responsibility in
decision making
Family is recognized as the expert in their child’s care,
and youth are recognized as the experts in their own
care.
How would you provide Family
Centered Care for this case?
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Identify yourself as this patient’s PCP.
Ask open ended questions to identify both patient
and parent concerns about cough.
Call parent(s) to elicit parent concerns.
Ask the patient and parent why they thinks he is
coughing or if he thinks his asthma is inadequately
controlled .
Educate both patient and parent.
Include patient and family in decision making process
for management and treatment.
What is Compassionate Care?
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Concern for the well being of the child or
youth and family is expressed and
demonstrated in verbal and nonverbal
interactions.
Efforts are made to understand and
empathize with the feelings and perspectives
of the family as well as the child or youth.
How would you demonstrate
compassion in this case?
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Be aware of non-verbal communication: sit down
while questioning patient, use good eye contact, allow
patient time to think.
Ask what has made it difficult for this patient to
comply with medication regimen.
Ask patient if there is anything about his cough or his
asthma that worries him.
Screen for underlying issues or social problems.
Express empathy when appropriate.
What is Accessible Care?
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All insurance, including Medicaid, is accepted.
Changes in insurance are accomodated.
Practice is accessible by public transportation,
where available.
Families or youth are able to speak directly to
the physician when needed (24 hours/d, 7
days/wk, 52 wks/yr)
The practice is physically accessible and meets
ADA requirements.
How would you demonstrate your
accessibility in this case?
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Ask how far patient lives from your clinic.
Assess method and ease of transportation.
Ask patient if insurance or medical coverage is
a barrier to seeking routine care or obtaining
meds.
Educate patient how to access emergency care.
Educate patient how to call for after hours
care.
Culturally Effective Care
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Cultural background, beliefs, rituals, and
customs, are recognized, valued, respected
and incorporated into the care plan
PCP ensures the child and family understand
the results of medical encounter and care plan
Provision of (para) professional translators or
interpreters are utilized if needed
Written materials are provided in the family’s
primary language if possible
How would you address cultural
differences in this case?
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Learn about patient’s cultural beliefs:
Determine content and purpose for “herbal
tea.”
Explain medical rationale for plan of care to
family in understandable language, use
interpreter if necessary.
Recognize difference in cultural approach to
care and make recommendations for plan of
care in a respectful manner.
What is Continuity of Care?
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Same primary pediatric health care professional
sees patient from infancy through the
adolescence and young adulthood
Physician assists with transitions whenever
possible
Physician participates in all aspects of care,
including hospitalizations, ER visits, or care that
is provided at another facility or by another
provider.
How would you ensure continuity of
care in this case?
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Discuss long term goals with patient and plan for
scheduled monitoring of asthma.
Tell patient he should be requesting to see you for all
clinic visits.
Give patient your business card to keep so that he can
identify you as his PCP and ask that you be contacted
in future hospital or ER visits.
Call or fax clinic notes to referring health care
providers.
Follow up consultant reports with patient.
What is Comprehensive Care?
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Physician manages and facilitates essentially all aspects of
care:
-ambulatory and inpatient care for ongoing and
acute illnesses and maintenance of comprehensive
central record that contains all pertinent information
Physician provides preventive care which includes:
-immunizations, growth and development
assessments, appropriate screenings, health care
supervision, and patient and parent counseling
about health, safety, nutrition, parenting and
psychosocial issues.
How would you ensure
comprehensive care for this patient?
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Review patient’s chart to ensure all aspects of
care are addressed and updated.
Schedule routine health maintenance visits.
Address financial and social needs to help
improve access to care and follow-up.
Enlist appropriate community resources and
referrals to optimize health needs.
What is Coordinated Care?
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Plan of care is discussed or shared with other
providers, agencies and organizations
involved with the care of the patient.
Consultation reports and other medical
information is shared with patient.
All pertinent medical information, including
hospitalizations and specialty care is
maintained at the practice.
How would you ensure coordinated
care in this case?
1. Involve nursing or respiratory care staff to help
educate patient on use of preventive asthma
meds:
-communicate concerns to staff
-review nursing/RT findings or reports
2. Call parents to review findings and discuss
plans of care.
3. If referring to specialist, call or fax chart notes
or patient summary to consultant.
Medical Home Elements:
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Family centered
Accessibility
Coordinated
Continuous
Compassion
Comprehensive
Culturally Effective
Which of the following definitions of
Medical Home is most accurate?
a. a place where all medical information about a patient can be
coordinated and easily obtained
b. a compassionate physician who provides coordinated home
visits to treat patients who are unable to come to medical
centers
c. a mobile van which serves as an accessible home for
underserved patients in need of medical care
d. a family-centered approach to provide compassionate medical
care that is comprehensive, accessible, and culturally effective
e. a systems based approach to providing cost-effective medical
care for homeless patients
Answer: d
Which of the following statements regarding the
medical home is LEAST accurate?
a. family centered care involves developing a trusting
partnership with parents
b. comprehensive care includes maintaining central record
containing all pertinent patient information
c. accessible care includes assurance that ambulatory and
inpatient care will be available 24 hours a day, 5 days a
week, 48 weeks a year
d. continuity of care includes visiting patients when they
are hospitalized
e. culturally effective care involves recognition and
incorporation of family customs into the care plan
Answer: c