Nurse practitioner/pediatrician collaboration: Try a pediatric health care/medical home model

I practice at Beacon Pediatrics, a large, busy primary care practice in Rehoboth Beach, Del., which is a rural area with limited local pediatric subspecialists and resources. We have been working with a state consultant to apply changes to the practice with the intention of moving toward a PHC/MHM. The pediatricians, myself, the nurses, and office staff are involved in changing structure and practices to adapt to the needs of patients and their families. Identifying children with higher medical risk, creating systems like walk-in sick hours, offering an open office 7 days a week, as well as the ability for parents to communicate via EHR email, are some of the changes that have evolved as the practice has become more patient and family focused. I serve as the liaison between the consultant and the practice, and there are plans to document quality, patient satisfaction, and perhaps some financial savings in applying a PHC/MHM to primary care.

At the University of California, Los Angeles, Mattel Children’s Hospital, the pediatric medical home program provides primary care services and care coordination for more than 300 children, adolescents, and young adults with medical complexity. Nurse practitioner Siem Ia oversees the coordination of care for these patients, and collaborates with a team of four attending physicians, resident physicians, care coordinators, and an administrative assistant. These children have multisystem problems requiring multiple specialty services, and frequent hospitalizations. Ms. Ia works with her colleagues to ensure patients and families are provided with care that is aligned with the AAP and NAPNAP medical home principles. This team is now involved in a national collaborative project that aims to improve health outcomes for children with medical complexity, and enhance family partnerships to support the health of the child and promote family well being. She also has provided clinical expertise for the recently completed randomized, controlled trial aimed at reducing utilization for children with medical complexity through care coordination and health education.

These are just a few examples of the possibilities when pediatricians and NPs collaborate to influence and change models of primary patient care. The medical care of any child can be multifaceted, with increasing complexity, and require vigilance and thoughtful planning to be successful. Outcomes from these attempts documented in the literature include opportunities for certification and accreditation, insurance reimbursement at incentive levels, and, most importantly, patient and family satisfaction.
 

Dr. Haut is a PNP at Beacon Pediatrics, a large primary care practice in Rehoboth Beach, Del. She also works part time for Pediatrix Medical Group, serving the pediatric intensive care unit medical team at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore and as adjunct faculty at the University of Maryland School of Nursing, also in Baltimore.