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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Family Centered Care.

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Strategy. Medical Home Models

Approach. Implement medical home models to enhance family-centered care for children and families

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Overview. The medical home model is a patient-centered approach to providing comprehensive and coordinated primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.[1] Family-centered care builds a collaborative partnership between health professionals and parents.[2, 3] This improved rapport leads to more continuity and improved communication.[4, 5] It is essential that this communication be culturally sensitive, nonbiased, and nonjudgmental.[6] Family-centered care is associated with increased family satisfaction and quality of life, better health outcomes and family follow-up, decreased burden of care, and improved efficiency of resource utilization.[7, 8]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

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

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

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

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

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

PROCESS MEASURES:

  • Number of pediatric practices implementing medical home models aligned with family-centered care standards. (Measures adoption of medical home approach)
  • Number of children and families, particularly those with complex needs, engaged through medical home approaches. (Assesses reach of medical home efforts)

OUTCOME MEASURES:

  • Number of children and families experiencing improved care coordination through medical home participation. (Measures impact on family experience of care)
  • Number of children with complex needs receiving comprehensive care management in medical homes. (Assesses impact on populations with significant health challenges)

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

PROCESS MEASURES:

  • Percent of medical home initiatives engaging families as active partners in program design and implementation. (Measures family engagement in medical home efforts)
  • Percent of medical home team members trained in family-centered communication and shared decision-making. (Assesses workforce competencies for family-centered practice)

OUTCOME MEASURES:

  • Percent of parents reporting feeling valued as partners in their child's care within medical homes. (Measures family-reported experience with medical home care)
  • Percent of children receiving recommended preventive and developmental services through medical homes. (Assesses quality of care delivery in medical homes)

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

PROCESS MEASURES:

  • Number of family advocacy organizations engaged in designing medical home initiatives. (Measures partner engagement in medical home efforts)
  • Number of policies established to support pediatric medical home implementation. (Assesses enabling conditions for medical home models)

OUTCOME MEASURES:

  • Number of communities achieving improvements in child health outcomes through widespread medical home adoption. (Measures population health impact of medical home spread)
  • Number of medical home innovations recognized as best practices and adapted for diverse settings. (Assesses scaling of successful medical home models)

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

PROCESS MEASURES:

  • Percent of medical home initiatives prioritizing needs of children from communities experiencing health inequities. (Measures equity focus of medical home efforts)
  • Percent of medical home resources allocated to building capacity in under-resourced communities. (Assesses equity orientation of medical home investments)

OUTCOME MEASURES:

  • Percent reduction in disparities in care access and outcomes for children engaged in medical home initiatives. (Measures impact of medical homes on advancing child health equity)
  • Percent of families from diverse backgrounds reporting culturally responsive care in medical homes. (Assesses inclusivity in medical home practices)

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.

References

[1] Adams S, Nicholas D, Mahant S, Weiser N, Kanani R, Boydell K, Cohen E. Care maps and care plans for children with medical complexity. Child Care Health Dev. 2019 Jan;45(1):104-110. doi: 10.1111/cch.12632. PMID: 30462842.

[2] Reeder J, Morris J. Becoming an empowered parent. How do parents successfully take up their role as a collaborative partner in their child's specialist care? J Child Health Care. 2021 Mar;25(1):110-125. doi: 10.1177/1367493520910832. Epub 2020 Mar 6. PMID: 32141316.

[3] Bogetz JF, Revette A, DeCourcey DD. Clinical Care Strategies That Support Parents of Children With Complex Chronic Conditions. Pediatr Crit Care Med. 2021 Jul 1;22(7):595-602. doi: 10.1097/PCC.0000000000002726. PMID: 33813549.

[4] Lewis H, Trowbridge A, Jonas D, Rosenberg AR, Bogetz JF. A Qualitative Study of Clinicians and Parents of Children with Severe Neurological Impairment on Tools to Support Family-Centered Care. J Palliat Med. 2022 Sep;25(9):1338-1344. doi: 10.1089/jpm.2021.0579. Epub 2022 May 20. PMID: 35593900; PMCID: PMC9639233.

[5] Lemmon ME, Glass HC, Shellhaas RA, Barks MC, Bansal S, Annis D, Guerriero JL, Pilon B, Wusthoff CJ, Chang T, Soul JS, Chu CJ, Thomas C, Massey SL, Abend NS, Rau S, Rogers EE, Franck LS; Neonatal Seizure Registry. Family-Centered Care for Children and Families Impacted by Neonatal Seizures: Advice From Parents. Pediatr Neurol. 2021 Nov;124:26-32. doi: 10.1016/j.pediatrneurol.2021.07.013. Epub 2021 Jul 30. PMID: 34509000; PMCID: PMC8523194.

[6] Koch, Amie DNP, FNP-C, RN, ACHPN; Grier, Kimberlee BSN, RN, CHPPN, CHPN. Communication and Cultural Sensitivity for Families and Children With Life-Limiting Diseases: An Informed Decision-Making Ethical Case in Community-Based Palliative Care. Journal of Hospice & Palliative Nursing 22(4):p 270-275, August 2020. | DOI: 10.1097/NJH.0000000000000654

[7] Pfeifauf KD, Snyder-Warwick AK, Scheve S, Grellner CL, Skolnick GB, Wilkey A, Foy J, Naidoo SD, Patel KB. One Multidisciplinary Cleft and Craniofacial Team's Experience in Shifting to Family-Centered Care. Cleft Palate Craniofac J. 2020 Jul;57(7):909-918. doi: 10.1177/1055665619899518. Epub 2020 Jan 17. PMID: 31950854; PMCID: PMC7299812.

[8] Lewandowski RA, Lewandowski JB, Ekman I, Swedberg K, Törnell J, Rogers HL. Implementation of Person-Centered Care: A Feasibility Study Using the WE-CARE Roadmap. Int J Environ Res Public Health. 2021 Feb 24;18(5):2205. doi: 10.3390/ijerph18052205. PMID: 33668083; PMCID: PMC7956736.

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.