Medical Home Basics

Checklist and Tools

Learning Collaborative

Medical Home Measures

Identifying Patients with Special Needs

Developmental Surveillance & Screening

Care Coordination

Partnering With Families

Family to Family Support

Accessing Community Resources

Culturally Effective Care

Sharing Sensitive News

Transition

Oral Health

Office Organization and Management

Finances and Data Management

Quality Improvement

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Washington Healthcare Improvement Network

The Washington Healthcare Improvement Network (WHIN) offers training, technical assistance, and quality improvement supports to primary care teams working to establish or refine patient and family centered medical homes. WHIN is an initiative of the Washington State Department of Health. WHIN serves all interested primary care practice teams and is committed to being responsive to the needs of pediatric teams, in addition to family and internal medicine. The emphasis is on practical, tangible tools and examples from peer teams with successful improvements.

WHIN works with clinics in specific regions and communities and is currently kicking off work in Whatcom County working with Whatcom Alliance for Health Advancement. An initiative in Thurston, Mason and Lewis counties will begin this spring, and WHIN is partnering with CHOICE Regional Health Network in this region. Regional and community work will continue to cycle around the state, with tentative plans to add new regions in fall, 2013.

For the state regions not currently being served by WHIN’s community based approach, a self- paced pathway to medical home called WHIN Institute offers a package of services to support medical home development. Resources are continually being developed to add to the platform.  Resources available to all Institute participants include: 

• Supported use of a validated assessment tool to measure the clinic’s current level of medical home development. Re-measurement at six month intervals is encouraged to mark progress.
• A library of interactive e-learning modules supports clinics working on NCQA-PCMH or other medical home certifications. Most modules are designed for the entire clinic team. ( Category 1 CME credit or certificate with contact hours  available)
• Frequent webinars on topics customized to the group of enrolled clinics;
• Documents/toolkits provide more information on various aspects of a Patient Centered or Family-Centered Medical/Health Home.
• Links to resources at other organizations which are high quality and useful to clinics.
• Support for population measures and quality improvement.
• Linkage to peer teams working on similar medical home improvements.

For more information, please visit http://www.doh.wa.gov/whin , email WHIN@doh.wa.gov or call WHIN Manager Pat Justis in the Practice Improvement Section at the Department of Health at 360-236-3793.

Additional learning opportunities for healthy communities

Earlier Medical Home Learning Collaborative Efforts in WA

Washington Patient-Centered Medical Home Collaborative (2009-11)

The Washington Patient-Centered Medical Home Collaborative, a joint project of the Washington State Department of Health and the Washington Academy of Family Physicians from 2009-11, offered proven tools for pediatric and family medical practices  to improve outcomes for their patients.

The Patient-Centered Medical Home Collaborative was a learning process for medical teams to improve primary care for their patients. Through 2011, 33 teams in Washington worked together to create patient-centered medical homes.

In a medical home the physician and care team build strong relationships with the patient and the patient’s family. The team coordinates care with specialists or other health providers. Patient-centered care makes the patient a partner in health care decisions.

Learning Collaborative to Improve Outcomes for Patients with Chronic Diseases (2008-09)

Strategies From Jeanne McAllister, Co-Director - Center for Medical Home Improvement

Top Four Strategies for Becoming a Medical Home:

1.  Engage parents as partners at the practice level.

2.  Identify children and youth with special health care needs (CYSHCN) - Build and use a registry; Use a chart coding system; Stratify by levels of complexity.

3. Use planned visit encounters.

4.  Develop care coordination and communication at the practice level.

Methods:

•  Establish family advisory groups for the practice

         See Skagit Pediatrics presentation

•  Institute care coordination and designate a care coordinator

          See: http://www.medicalhome.org/physicians/coordinating_care.cfm

                 http://www.medhomeportal.org/about/care-coordination

•  Co-manage care with specialists and determine information exchange method

See: Enhancing Collaboration Between Primary and Subspecialty Care Providers for CYSHCN Workbook

Antonelli, R., Stille, C., and Freeman, L. , Georgetown University Center for Child and Human Development, Washington, DC, 2005.         

•  Implement a care planning process

          See: http://cshcn.org/planning-record-keeping

•  Catalogue local resources and contact persons

          See: http://www.medicalhome.org/resources/resource_info.cfm

•  Identify and share evidence-based practices

•  Meet with community partners, e.g. lunch and learns