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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Developmental Screening.

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Strategy. Medical Homes

Approach. Support the implementation of a quality improvement initiative to establish a medical home system of care within pediatric primary care clinics

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Overview. Medical homes provide continuous, comprehensive, whole person primary care (NCQA-PCMH, AHRQ-PCMH). In this model of care, primary care providers and their teams coordinate care across the healthcare system, working with patients to address all their preventive, acute, and chronic health care needs, and arranging care with other qualified health professionals as needed. Medical homes offer enhanced access, including expanded hours and easy communication options for patients. They also practice evidence-based medicine, measure performance, and strive to improve care quality (AHRQ-PCMH). The medical home model is particularly well-suited to incorporating developmental screening as a routine component of well-child care, ensuring that screening occurs at recommended intervals and that families receive coordinated follow-up when concerns are identified. Title V programs can support medical homes by providing resources, training, and quality metrics related to developmental screening implementation.

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Clinic self-assessment scales for medical home adoption
  • QI initiative progress tracking logs
  • Clinic feedback surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of pediatric primary care clinics participating in the medical home quality improvement (QI) initiative. (Measures the reach and scale of the intervention)
  • Number of medical home tools, templates, and resources disseminated to participating clinics. (Measures the provision of implementation supports)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of participating clinics that complete a comprehensive medical home self-assessment and gap analysis. (Assesses the use of data-driven planning and prioritization in the QI process
  • Percent of clinic staff who participate in medical home training and demonstrate increased knowledge and skills. (Measures the reach and effectiveness of staff development efforts)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of payers and health plans that provide financial incentives for support for clinics to achieve medical home status. (Measures the alignment of payment models with medical home goals)
  • Number of community partnerships established by participating clinics to connect families to resources. (Assesses the development of medical home linkages to upstream supports)
  • Number of pediatric emergency department visits and hospitalizations avoided due to effective medical home care at participating clinics. (Shows the impact on appropriate health care utilization and cost savings)
  • Number of children with special health care needs served by participating clinics who have a shared care plan and coordinated services across providers. (Assesses the impact on a population with complex health needs that benefits significantly from medical home care)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of participating clinics that serve predominantly people with limited financial resources. (Assesses the focus and reach of the medical home initiative)
  • Percent of medical home implementation resources and tools that are reachable and tailored for various patient populations. (Measures the responsiveness of the intervention materials)
  • Percent reduction in gaps in medical home access and quality measures between different groups served by participating clinics. (Measures the initiative's impact on reach and access)
  • Percent of all children in the community who have access to a high-quality medical home through the participating clinics for referral networks. (Assesses the reach of the medical home model as a universal standard of pediatric primary care)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.