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Medical Home Screening Tool Development and Validation Among a Sample of Infants and Young Children
Caitlin Bradley1,2, Stacey Cook3,4, Cheryl Toole1
1Neonatal Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
A new Pediatric Medical Home Screening Tool (PMHST) helps identify children with medical complexity for early referrals to a medical home (MH). This tool improves care transitions and patient safety.
Area of Science:
- Pediatric Healthcare
- Healthcare Quality Improvement
- Care Coordination
Background:
- The medical home (MH) model offers comprehensive primary care, enhancing communication and coordination.
- A lack of standardized screening tools hinders identification of children with medical complexity (CMC) for timely MH referrals.
- Inconsistent referrals can negatively impact care transitions for CMC.
Purpose of the Study:
- To develop and validate a screening tool for identifying CMC.
- To facilitate early MH referrals for CMC prior to hospital discharge.
- To improve the consistency and effectiveness of MH referrals.
Main Methods:
- Mixed-methods research combining e-Delphi methodology and retrospective chart review.
- Development of the Pediatric Medical Home Screening Tool (PMHST) through four e-Delphi rounds.
- Validation of the PMHST with a sample of infants and young children.
Main Results:
- The PMHST was developed by 23 healthcare professionals across various disciplines.
- The tool comprises four sections and 20 criteria.
- Reliability testing showed 82% agreement in categorizing medical complexity.
Conclusions:
- The PMHST has the potential to improve care transitions and patient safety for CMC.
- Early validation in infants and young children suggests clinical utility.
- Further testing with a broader pediatric population is planned.
Background:
Medical home (MH) is a financially viable, all-inclusive primary care model that can enhance communication, improve care coordination and support patients, families and healthcare providers. No standard screening tool exists for use by hospital-based healthcare providers to identify children with medical complexity (CMC), which can result in inconsistent MH referrals. The purpose of this research was to develop and validate a screening tool for use in identifying CMC who would benefit most from early MH referrals prior to hospital discharge home.
Methods:
This mixed-methods research utilized e-Delphi methodology and retrospective chart review to develop and validate a screening tool for MH referrals.
Results:
Twenty-three nurses, nurse practitioners, physicians, social workers and case managers participated in four e-Delphi rounds to develop the Pediatric Medical Home Screening Tool (PMHST). The PMHST consists of four sections and 20 criteria. Reliability testing of the PMHST revealed 82% agreement with medical complexity categorization of infants and young children.
Conclusion:
The PMHST may enhance future care transitions, improve quality of care and reduce the risks of safety events. The PMHST was validated in a sample of infants and young children and will be tested with a broader sample of children in the future.
