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Objective. National health goals include ensuring that all children have a medical home. Historically, medical home has been determined by the presence of a usual or primary source of care, such as a pediatrician or a family physician. More recent definitions expand on this simplistic notion of medical home. A definition of medical home set forth by the American Academy of Pediatrics (AAP) includes 7 dimensions and 37 discrete concepts for determining the presence of a medical home for a child. Standardized methods to operationalize these definitions for purposes of national, state, health plan, or medical practice level reporting on the presence of medical homes for children are essential to assessing and improving health care system performance in this area. The objective of this study was to identify methods to measure the presence of medical homes for all children and for children with special health care needs (CSHCN) using existing population-based data sets. Methods. Methods were developed for using existing population-based data sets to assess the presence of medical homes, as defined by the AAP, for children with and without special health care needs. Data sets evaluated included the National Survey of Children With Special Health Care Needs, the National Medical Expenditures Panel Survey, the Consumer Assessment of Health Plans Study Child Survey (CAHPS), and the Consumer Assessment of Health Plans Study Child Survey--Children With Chronic Conditions (CAHPS-CCC2.0H). Alternative methods for constructing measures using existing data were compared and results used to inform the design of a new method for use in the upcoming National Survey of Children's Health. Data from CAHPSCCC2.0H are used to illustrate measurement options and variations in the overall presence of medical homes for children across managed health care plans as well as to evaluate in which areas of the AAP definition of medical home improvements may be most needed for all CSHCN. Results. Existing surveys vary in their coverage of concepts included in the AAP definition of medical home and, therefore, in their capacity to evaluate medical home for children with and without special health care needs. Using data from CAHPS-CCC2.0H, the overall proportion of children who were enrolled in managed care health plans and met criteria for having a medical home varied from 43.9% to 74% depending on the specific scoring method selected for these items. Wide variations across health plans were observed and were most prominent in the areas of "accessible care" and "comprehensive care." Performance was uniformly poorest in the area of "coordinated care" and for CSHCN. Although children with a personal doctor or nurse were more likely to meet the AAP criteria for having a medical home, simply having a personal doctor or nurse was not highly predictive of whether a child experienced the other core qualities of a medical home (positive predictive value: .50; negative predictive value: .59). Conclusions. Despite differences across existing surveys and gaps in concepts represented, we believe that the AAP definition of medical home can be well represented by the small subset of concepts represented in the National Survey of Children With Special Health Care Needs and the CAHPS-CCC2.0H. A less comprehensive yet still worthwhile measure is possible using the Medical Expenditures Panel Survey. The varying degrees of empirical evidence and consensus for each of the AAP definition domains for medical home suggest the need for constructing measures that also vary in terms of criteria for determining that a child does or does not have a medical home. In addition to a simple "yes or no," or rate-based, measure, a continuous medical "homeness" score that places a child or group of children on a continuum of medical "homeness" is also valuable. Findings indicate that health plans have an important role to play in ensuring medical homes for children in addition to medical practices and those who set policies that guide the design and delivery of health care for children. Overall, using existing population-based data, a measure of medical home that is aligned with the AAP definition is feasible to include in the annual National Healthcare Quality Report, in state reports on the quality of Medicaid, State Children's Health Insurance Program, and Title V programs as well as to evaluate performance on the Healthy People 2010 objectives and the President's New Freedom Initiative. Pediatrics 2004;113:1529-1537; medical home, children, health care quality, children with special health care needs. ABBREVIATIONS. AAP, American Academy of Pediatrics; National Survey of CSHCN, National Survey of Children with Special Health Care Needs; National MEPS, National Medical Expenditures Panel Survey; CAHPS-CCC2.0H, Consumer Assessment of Health Plans Survey--Children With Chronic Conditions; CSHCN, children with special health care needs; NSCH, National Survey of Children's Health; PDN, personal doctor or nurse., National health goals include ensuring that children have a medical home. (1) Historically, medical home has been determined by the presence of a usual or primary source of care, such [...]

Families and professionals agree that children and adolescents need access to community-based medical homes. This is especially true for children with special health care needs (CSHCN). Most primary care practices are designed for children's routine preventive and acute care needs. CSHCN benefit from care that is integrated with well-child and acute care; coordinated and actively co-managed with specialists, therapists, and educators; and offered in a planned, anticipatory manner. As the primary caregiver and decision maker, families need to be supported in a culturally effective way. Families want community resources that are integrated with care processes. Primary care practices that serve CSHCN require a practical and effective improvement method to become fully realized medical homes. A change method, which blends improvement strategies with progressive measurement, must be perceived by practices as practical and helpful, and it must be supported. The Center for Medical Home Improvement has developed and tested an effective model of medical home improvement and tools to measure the status of a practice and its progress of change. Pediatrics 2004;113:1499-1506; children with special health care needs, medical home, quality improvement, primary care, care coordination, family-centered care. ABBREVIATIONS. CSHCN, children with special health care needs; MCHB, Maternal and Child Health Bureau; AAP, American Academy of Pediatrics; CMHI, Center for Medical Home Improvement; MHI, Medical Home Index; MHFI, Medical Home Family Index; CVC, clinical value compass., Most families and professionals agree that children need access to a medical home. (1,2) The medical home is a health care model for all children, but for children with special [...]

This paper describes the use of a participatory approach to community assessment and planning in Ethiopia. The purpose of the assessment was for government health staff and community members to jointly identify and prioritize maternal and child health problems and develop a plan to solve them. Activities were conducted in five woredas (districts) in the Southern Nations and Nationalities People's Region (SNNPR) of Ethiopia. Some of the key features of the approach were: 1) use of a limited number of maternal and child health behaviors as a 'menu' to guide planning; 2) use of an integrated household survey that measures indicators of caretaker behaviors which must be changed to reduce the most important causes of childhood morbidity and mortality; 3) implementation by a team of community volunteers and health staff; 4) collection of data that can be used at the community level for planning and at district, zonal, and regional levels for project monitoring and evaluation; and 5) an emphasis on immediate use of information by community members and health staff to produce joint action plans. The community planning process resulted in: 1) community action plans for the communities in five districts; 2) baseline data on key behaviors for monitoring and evaluation; and 3) trained staff at regional, zonal, and district levels. Community action plans included activities at both the facility and community levels, such as training of health workers, integration of health facility services, health education, and involvement of community organizations. The quantitative data were aggregated to provide baseline indicators for monitoring and evaluation. Follow-up data show changes in key child health behaviors. Key words: community participation, child health, community planning, Ethiopia

The genocidal campaign in Rwanda has had a disastrous impact on children. More than 100,000 were orphaned or separated from their parents. Survivors are deeply traumatized from the violence they suffered or witnessed and from grief. Children have also suffered the most from malnutrition and diarrheal illnesses in refugee camps. Organizations are trying to match children with missing relatives, but the task is Herculean. Orphanages have been set up, but crowding and lack of individual attention also pose risks to physical and psychological health. Rwanda desperately needs assistance from the international community.

School represents an important partner as public health nurses (PHNs) work to promote the health of youth.[1] Traditionally, PHNs in school settings focused on interaction with school personnel, students, and [...]

Communities seeking to implement an integrated school-based health service program must address several important issues. School-based health service programs attempt to identify needs and resources in the areas of education, health care, and social services and develop a delivery system to meet those needs. Formation of an integrated school health services council is the first step in this process. Community members and providers must unite to establish communication within the community, assess needs, and define required services. A comprehensive community needs assessment conducted by the council will identify unmet needs and available community resources, and define the population who will receive services. The health care delivery system must be structured to meet the unique needs of the community. Health care financing methods should be developed to ensure quality and care continuity. Resources must support regular program evaluation efforts.

Reformed health care policies must include programs that meet the unique health needs of pregnant women, children and adolescents. Children and adolescents face health risks such as low birth weight, prematurity, lead exposure, injury, abuse, sexually transmitted diseases, pregnancy, substance abuse and a host of chronic illnesses and developmental disabilities that require a combination of public and private, community-based services. The move toward universal insurance coverage under health care reform may not provide the public funding necessary for the growth and development of community services. Insurance-based systems may not provide adequate access to comprehensive health services and social and economic barriers to obtaining care may still persist. Health care financing must be combined with community-based programs and public health efforts to provide the special care needed by children, adolescents and pregnant women.

Success of the US school enrollment-based health insurance (SEBHI) movement coincided with earlier child health insurance initiatives nationwide to influence approval of the State Children's Health Insurance Program (SCHIP). In [...]

EFFICIENCY VERSUS EQUITY: STRATEGIC CHOICES In recent years, feminist scholarship has transformed the field of international development by articulating a strong case for the inclusion of women in development planning. […]

ABBREVIATION. AAP, American Academy of Pediatrics. The American Academy of Pediatrics (AAP) recently published a policy statement on the use of the smallpox vaccine in children. (1) This commentary expands [...]

THE GOVERNMENT is proposing a radical shake up of education and services for children with special education needs and disabilities. Children's minister Sarah Teather outlined the plan in a green [...]

FAMILIES WITH young children will be offered better support, according to plans to 'expand and rejuvenate' the health visiting service. The Health Visitor Implementation Plan sets out a range of [...]

The loss of health visiting as a legally defined occupation has been a calamity for the profession and for the UK's child protection and safeguarding policies. The health visitor title [...]

Urgent care staff launched a publicity campaign last month to highlight the centralisation of children's emergency care services at Leeds General Infirmary (LGI). The move, which is advertised on local [...]

Zoe Wilkes, nurse consultant for children's palliative care at Rainbows Children's Hospice, Leicestershire, has been awarded 2,500 £ by the Queens Nursing Institute to develop and implement personal resuscitation plans [...]

Children in England aged between four months and six years are to be offered a booster vaccine against Haemophilus influenzae type b (Hib). The move follows an increase in the [...]