Clinical Care Information and Organization

Clinical care information and organization addresses the use of standards of care and implementation of evidence-based resources, such as problem lists, growth charts, and age appropriate developmental screening tools. Providing a high quality medical home means that your practice has well-organized medical records with all pertinent clinical information. Below are examples of resources and tools to enhance the organization of clinical care information.

Please note that this page provides additional resources as to what is provided in the Clinical Care Information section of the Building Your Medical Home toolkit.

Preventive Care

Bright Futures
Released in 2008, the Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition, provides detailed information on well-child care for health care practitioners. This text is considered the gold standard for pediatric care, and its accompanying Pocket Guide boils down the information to its most basic points for quick reference.

Bright Futures reflects the recently revised Recommendations for Preventive Pediatric Health Care PDF.  These guidelines represent a consensus by the American Academy of Pediatrics (AAP) and Bright Futures and emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care. All children and families are unique. Additional visits may become necessary if circumstances suggest variations from expected development, behavior, or care. For example, children with developmental, psychosocial or chronic disease; children needing to catch up on preventive care; or other child or family circumstances may indicate the need for additional counseling and treatment visits or a different schedule of preventive care visits. 

  • Bright Futures Web site
    This site hosts a three volume set of materials that will facilitate implementation of Bright Futures in the office setting using quality improvement strategies. This comprehensive resource is free. You can download the entire set or selectively download the elements most applicable to your office system.
  • Meeting the Promise of ACA: How Bright Futures Is Being Used by State MCH Programs
    This article in the June 2011 issue of AMCHP Pulse discusses how public health leaders and communities are drawing from Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition, to create a common approach to improving the health of infants, children, youth, and families.

Promising Practices

  • Promoting Bright Futures as a Standard of are in Illinois
    The Illinois Chapter, American Academy of Pediatrics (ICAAP) has partnered with the Illinois Department of Healthcare and Family Services (HFS) to promote Bright Futures as a standard of care in Illinois. This partnership also aims to assist in integrating Bright Futures into state programs like Medicaid in order to increase adherence to Bright Futures across systems. This has partnership enabled ICAAP to review and submit recommendations to HFS that will make the Handbook for Providers of Healthy Kids Services and other HFS policy more consistent with Bright Futures guidelines and best practices, enable HFS-enrolled providers to more easily implement Bright Futures, and promote some key elements of Bright Futures, such as anticipatory guidance and care coordination, to providers and payers alike. As part of this effort, ICAAP convened a committee that made content and policy recommendations to help assure compliance and improve the distribution of Bright Futures tools. ICAAP will work to create educational materials and provider notices for physicians and other healthcare professionals, and will communicate the Bright Futures guidelines and recommendations to private insurers. ICAAP will develop similar resources and promotional materials for stakeholder groups including HFS contractors, advocates, and families to increase awareness of Bright Futures across systems and communities.

Early Brain and Child Development
Promotion of optimal early brain and child development is essential for the health and well-being of children. During these critical first few years of life, safe, stable, and nurturing relationships are critical to healthy brain development. The AAP has published a Web site on Early Brain and Child Development (EBCD) that contains information on toxic stress, basic developmental science of EBCD, translating the science into clinical practices, advocacy and education tools, provider and family resources, and more.

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Evidence-based Guidelines

Evidence-based guidelines are available for many common acute illnesses and chronic conditions. The use of such guidelines has been shown to improve quality and reduce costs. The following portals are good access points:

Promising Practices

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Screening Resources

Developmental Screening
By incorporating developmental surveillance and screening into preventive health care visits, the pediatrician has the ideal opportunity to offer anticipatory guidance to the family about supporting their child's development and to facilitate early detection of a disorder. Understanding the importance of medical home in identifying developmental/behavioral issues ensures early treatment, access to early intervention programs, better school placement, and ultimately better developmental outcomes.

Time Out for Genetics Fact Sheets
Created by the Genetics in Primary Care Institute, three companion fact sheets provide an overview of each 30-minute webinar in the Time Out for Genetics webinar series. Each fact sheet provides key insights into topics such as genetics and coding, building an accurate family history, and ordering the right tests.

Vision Screening
The pediatric medical home should play an important role in ensuring chlidren receive timely eye examinations, vision screenings, and, when necessary, eye examinations as well as treatment for vision conditions. Medical home providers may need to educate families about typical vision milestones and ask them to report any atypical behaviors they see.

The Role of the Medical Home in Vision and Eye Health: A Fact Sheet for Medical Professionals PDF
The National Center for Medical Home Implementation and the National Center for Children's Vision & Eye Health

Vision Screening is Key to Healthy Development
PDF

Vision Screening is Key to Healthy Development (Spanish version)PDF
Vision Screening is Key to Healthy Development (Traditional Chinese version)PDF
The National Center for Medical Home Implementation and the National Center for Children's Vision & Eye Health
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Adolescent Health

Bright Futures for the Busy Clinical Practice PDF
Duncan, P. Pirretti, A. Adolescent Health Update—A Clinical Guide for Pediatricians. 2009;22(1).
Previous editions of Adolescent Health Update have discussed health supervision and preventive care in the context of the pediatrician/adolescent relationship. This issue will take a step back to offer a systems-oriented view of the medical home and present tools to improve adolescent preventive care in contemporary office practice.

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Adolescent Medicine: State of the Art Reviews (AM:STARS)
The AM:Stars series helps pediatricians stay up-to-date in key areas of the clinical practice of adolescent medicine.

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Medical Home Innovations: Where Do Adolescents Fit? PDF
National Alliance to Advance Adolescent Health
This report provides a summary of the activities underway in 12 innovative medical home programs and discusses how the health needs of adolescents are being addressed in these programs.

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Office of Adolescent Health
US Department of Health and Human Services (HHS)
This site include information on adolescent health issues including physical, mental and reproductive health, substance abuse and healthy relationships. The Web site features national and state fact sheets, information and tips for parents and adults about talking with adolescents, research summaries, adolescent health resources from across federal agencies, and opportunities to review the latest news in adolescent health.

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Sample Parent Letter on Adolescent Privacy DOC
American Academy of Pediatrics—Pediatric Care Online

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Sample Welcome Letter to Teens/Young Adults DOC
American Academy of Pediatrics—Pediatric Care Online

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Health Information Technology

Health care providers across the country and around the world are feeling pressure to convert their paper medical records to electronic health records (EHRs). A good pediatric EHR must be designed from the beginning with pediatric requirements in mind.

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Registries

The use of a patient registry can help primary care providers effectively manage a patient population as part of a successful medical home, especially in the management of chronic conditions. Registries vary in format, from simple Excel spreadsheets to more advanced electronic record systems. If implementing registries for the first time, it is recommended to start with one condition or area in which the practice would like to improve on care delivery.

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Complexity Scores

The complexity score is a component of a practice registry for children and youth with special health care needs (CYSHCN) to help improve chronic condition management. The benefit of assigning a complexity score is that it allows a practice to not only quantify but qualify their population and to plan for care coordination needs and staffing.

There is not a universal definition or coding system that defines complexity. As with defining who has special health care needs, it is up to the practice to decide what level of complexity to assign a patient, as well as how to establish and interpret its own guidelines.

Promising Practices

  • North Arlington Pediatrics—Illinois
    This practice uses a fairly basic scoring system of 1-3, with three being the most complex and requiring the greatest number of resources. Typical patients without an on-going diagnosis are not added to their CYSHCN registry and are not assigned a code. Each patient has a five digit practice identifier code.  When patients with special needs are added to the registry, they add MH (medical home) 1,2, or 3 to their 5 digit identifier, ie 55555-MH3. The practice also keeps a separate spread sheet to generate patient lists. They went right to their list of MH3s (most complex patients) when deciding who was to receive their first H1N1 vaccine shipment.

    The practice also has a dropdown window in their scheduling program where special accommodations or needs can be listed. When an appt. is made, the receptionist will see the code and ask the parent about any special accommodations needed for the visit. Their weekly and daily schedules are reviewed for the medical home patients (those with special needs). This allows the practice to assure that a given patient has the appropriate time needed and make schedule adjustments if necessary and allows providers to prepare for a visit if labs or letters need to be reviewed or a problem researched. Their care coordinator identifies patients who may need a pre-visit consultation by phone based on need and complexity and knows to be available at that visit before the provider arrives. In the morning, the nurses assess the days work load and prepare for patients based on their pre-identified complexity and allocate staff and resources accordingly. By qualifying the level of complexity, their practice can allocate resources a little better, improve efficiency, make the day a little less stressful and, most importantly, provide a more customized and satisfying experience for patients and families.

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