Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, Calif.
Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, Calif.
Acad Pediatr. 2017 Aug;17(6):581-588. doi: 10.1016/j.acap.2017.04.010. Epub 2017 Apr 27.
The medical home has been widely promoted as a model of primary care with the potential to transform the health care delivery system. Although this model was initially focused on children with chronic conditions, the American Academy of Pediatrics has endorsed a generalization of the model, promoting the statement, "Every child deserves a medical home." Recently, other major professional and governmental organizations have embraced this more inclusive vision, and the medical home concept has been promoted in provisions of the Affordable Care Act. Yet, rigorous evaluations of the value of the medical home, within pediatrics and beyond, have been limited, and the results have been mixed. Early results from large demonstration projects in adults have generally noted modest improvements in quality without accompanying reductions in cost. At this critical period in health care, with widespread interest in health care delivery and payment reform, these results present a potential threat to the medical home. Understanding possible reasons for these early findings is crucial to sustaining the spread of the medical home beyond its first 50 years. With this aim, we review the history of the medical home and trends in child health, and we explore the concepts of value and complexity as they pertain to pediatric health care delivery. We propose that, because of the demographic characteristics and economics of child health and current policy imperatives with regard to health care, a strong value proposition for the medical home in pediatrics involves children with medical complexity.
医疗之家作为一种初级保健模式已被广泛推广，具有改变医疗服务体系的潜力。虽然该模式最初专注于患有慢性疾病的儿童，但美国儿科学会已认可该模式的推广，提出“每个孩子都应拥有一个医疗之家”的主张。最近，其他主要专业和政府组织也接受了这种更具包容性的愿景，医疗之家的概念已被纳入《平价医疗法案》的条款中。然而，医疗之家在儿科和其他领域的价值的严格评估一直有限，结果也参差不齐。在成人的大型示范项目中的早期结果普遍指出质量有适度改善，但没有伴随成本降低。在医疗保健的这个关键时期，人们普遍对医疗服务和支付改革感兴趣，这些结果对医疗之家构成了潜在威胁。了解这些早期发现的可能原因对于维持医疗之家在其成立 50 多年后的传播至关重要。为此，我们回顾了医疗之家的历史和儿童健康的趋势，并探讨了与儿科医疗服务相关的价值和复杂性概念。我们提出，由于儿童健康的人口统计学特征和经济学特征以及当前医疗保健政策的要求，医疗之家在儿科领域的一个强有力的价值主张涉及患有医疗复杂性的儿童。
