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The Medical Home Index (MHI) is a validated self-assessment and classification tool designed to translate the broad indicators defining the medical home (accessible, family-centered, comprehensive, coordinated, etc.) into observable, tangible behaviors and processes of care within any office setting. It is a way of measuring and quantifying the "medical homeness" of a primary care practice. The MHI is based on the premise that "medical home" is an evolutionary process rather than a fully realized status for most practices. The MHI measures a practice's progress in this developmental process.

The MHI defines, describes, and quantifies activities related to the organization and delivery of primary care for all children and youth. A population of vulnerable children and youth, including those with special health care needs, benefit greatly from having a high quality medical home. The medical home model represents the standard of excellence for pediatric primary care; this means the primary care practice is ready and willing to provide well, acute and chronic care for all children and youth, including those affected by special health care needs or who hold other risks for compromised health and wellness.

The MHI-Revised Short Form (MHI-RSF) is a subset of 14 items from the MHI. The numbers in bold denote the 14 items on the MHI-RSF, and the numbers that are not in bold are the original item numbers from the MHI. You will be asked to rank the level (1-4) of your practice in six domains: organizational capacity, chronic condition management, care coordination, community outreach, data management and quality improvement/change. Most practices may not function at many of the higher levels (Levels 3 and 4). However, these levels represent the kinds of services and supports which families report that they need from their medical home. A frank assessment of your current practice will best characterize your medical home baseline, and will help to identify needed improvement supports.

A companion survey to the Medical Home Index, the Medical Home Family Index (MHFI), is intended for use with a cohort of practice families (particularly those who have children/youth affected by a chronic health condition). The MHFI is to be completed by families whose children have received care from a practice for over a year. The MHFI provides the practice team with a valuable parent/consumer perspective on the overall experience of care.

Clinic Contact Information

Date: _____________

Clinic Name: ___________________________________________

Street Address: __________________________________________

City: __________________________________________________  State: ___________ Zip Code: ___________

Phone: ____________________        Fax: ____________________

Email: _______________________________

Who took the lead in completing this form?  ______________________________

Title/Position/Role: ____________________________

Who should we contact at your clinic if we have questions about your responses, or if responses are missing/incomplete?

Name (if different than the person who completed this form): ___________________________

Title/Position/Role: __________________________

Best phone number to reach contact, if different than above: _______________________

Contact Email: ___________________________

Describe your practice type/model: __________________________

Number of:   MD's _____    ARNPs _____ PA' s_____ Other ______

Is there a care coordinator working at your practice who supports children, youth, and families?    __ Yes       __ No

What is the estimated number of children that your practice cares for? ______

What is your patient panel size? _____

Can you estimate the percentage (total should = 100%) of children you care for who have:

1) Public insurance only (Medicaid/Medicare)         ____%

2) Private & Medicaid/Medicare                             ____%

3) Self/No pay                                                        ____%

4) Private insurance only                                          ____%

5) Other                                                                  ____%

How familiar/knowledgeable are you about the concept of a medical home as defined by the American Academy of Pediatrics?

1) __ No knowledge of the concepts

2) __ Some knowledge/not applied

3) __ Knowledgeable/concept sometimes applied in practice

4) __ Knowledgeable/concepts regularly applied in practice

How familiar/knowledgeable are you about the elements of family-centered care as defined by the US Maternal and Child Health Bureau?

1) __ No knowledge of the concepts

2) __ Some knowledge/not applied

3) __ Knowledgeable/concept sometimes applied in practice

4) __ Knowledgeable/concepts regularly applied in practice

INSTRUCTIONS:

This instrument is organized under six domains: 1) Organizational Capacity, 2) Chronic Condition Management, 3) Care Coordination, 4) Community Outreach, 5) Data Management, 6) Quality Improvement

Each domain has anywhere from 1-4 themes; these themes are represented with progressively comprehensive care processes and are expressed as a continuum from Level 1 through Level 4. For each theme please do the following:

First:

Read each theme across its progressive continuum from Levels 1 to Level 4.

Second:

Select the LEVEL (1, 2, 3 or 4) which best describes how your practice currently provides care for patients with chronic health conditions.

Third:

When you have selected your Level, please indicate whether practice performance within that level is:

"PARTIAL" (some activity within that level) or "COMPLETE" (all activity within that level).

For the example below, "Domain 1: Organizational Capacity, Theme 1. 1 "The Mission..." the score for the practice is: "Level 3", "PARTIAL".

Italicized terms are included in the glossary at the end of this page.

EXAMPLE

Please make certain you have chosen a Level (1-4).

Also indicate whether your practice performance within that level is "partial" (some activity within that level) or "complete" (all activity within the level). Thank You.

Glossary of Terms (Words in italics throughout the document are defined below.)

Children with Special Health Care Needs (CSHCN):

Children with special health care needs are defined by the US Maternal and Child Health Bureau as those who have, or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that required by children generally.

Medical Home:

The Center for Medical Home Improvement defines the medical home as a community-based primary care setting which provides and coordinates high quality, planned, patient/family-centered: health promotion (acute, preventive) and chronic condition management.

Family-Centered Care:

Family-centered care, as defined by the US Maternal and Child Health Bureau, assures the health and well-being of children and their families through a respectful family-professional partnership. It honors the strengths, cultures, traditions and expertise that everyone brings to this relationship. Family-centered care is the standard of practice which results in high quality services.

Practice-Based Care Coordination

Care and services performed in partnership with the family and providers by health professionals to:

1) Establish family-centered community-based medical homes for CSHCN and their families.

-Make assessments and monitor child and family needs.

-Participate in parent/professional practice improvement activities.

2) Facilitate timely access to the Primary Care Provider (PCP), services and resources.

-Offer supportive services including counseling, education and listening.

-Facilitate communication among PCP, family and others.

3) Build bridges among families and health, education and social services; promotes continuity of care.

-Develop, monitor, update and follow-up with care planning and care plans.

-Organize wrap around teams with families; support meeting recommendations and follow-up.

4) Supply/provide access to referrals, information and education for families across systems.

-Coordinate inter-organizationally.

-Advocate with and for the family (e.g. to school, day care, or health care settings).

5) Maximize effective, efficient, and innovative use of existing resources.

-Find, coordinate and promote effective and efficient use of current resources.

-Monitor outcomes for child, family and practice.

Chronic Condition Management (CCM):

CCM acknowledges that children and their families may require more than the usual well child, preventive care, and acute illness interventions. CCM involves explicit changes in the roles of providers and office staff aimed at improving:

1) Access to needed services,

2) Communication with specialists, schools, and other resources, and

3) Outcomes for patients, families, practices, employers and payers.

Quality:

Quality is best determined or judged by those who need or who use the services being offered. Quality in the medical home is best achieved when one learns what children with special health care needs and their families require for care and what they need for support. Health care teams in partnership with families then work together in ways which enhance the capacity of the family and the practice to meet these needs. Responsive care is designed in ways which incorporate family needs and suggestions. Those making practice improvements must hold a commitment to doing what needs to be done and agree to accomplish these goals in essential partnerships with families.

Practice:

The place, providers, and staff where the PCP offers pediatric care.

Primary Care Provider (PCP):

Physician or pediatric nurse practitioner who is considered the main provider of health care for the child.

Maternal and Child Health Bureau (MCHB):

A division of Health Resources Services Administration.