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David Geffen School of Medicine
The Cutting Edge

There's No Place Like Home

FOR PARENTS OF CHILDREN with multiple medical problems, keeping up with doctors’ appointments, ongoing tests and a variety of medications can be overwhelming, especially for those in challenging socioeconomic situations. As a result, families often wind up using the emergency room, the country’s most expensive form of care delivery, to get help for their kids.

But a growing concept in healthcare reform called the “medical home” offers parents a way to simplify, organize and coordinate the complexities of their medically fragile child’s healthcare needs. In the first quantitative study to look at the benefits of utilizing the medical home concept in a resident-education outpatient clinic at a specialized children’s hospital, UCLA researchers found that participation in the program reduced families’ use of the emergency room by 55 percent.The findings were published online in Journal of Pediatrics.

The medical home program at UCLA includes four basic components: a formal 60-minute intake appointment, follow-up appointments of 40 minutes (twice the length of standard appointments), access to a bilingual family liaison to help families navigate the medical system, and a family binder that keeps all of a child’s medical information in one place.

In addition to examining the program’s effect on emergency room visits, the UCLA study focused on the need to train future pediatricians in the principles of the medical home. “While the medical home concept has been shown to be effective in community pediatric practices, it has not been a standard part of the educational curriculum for our country’s future pediatricians,” notes lead author Thomas Klitzner, M.D., chief of the UCLA Division of Pediatric Cardiology and executive director of the medical home program at Mattel Children’s Hospital UCLA. “We set up a pilot program within our outpatient pediatric resident teaching clinic to develop a working model while building the required curriculum.We were pleasantly surprised to learn that we could run an effective program in a teaching clinic and create medical efficiencies that decreased the overall cost of medical care by reducing emergency department visits.

“The parents told us that they felt empowered by the pediatric residents, supervising faculty and medical home staff to use scheduled outpatient primary care and specialty visits rather than using the emergency department to get care,” Dr. Klitzner says.


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