Dr. Matthew B. McDonald III leads the state’s first pediatric medical home for children with special healthcare needs. He spoke with Symptoms & Cures about this unique practice, which is part of Children’s Specialized Hospital.
Pediatric primary care at Children’s Specialized Hospital has received a medical home designation. We usually think of medical homes as places for adults. How does this model work for children?
We know that children with medical complexity have a higher percentage of ER visits and hospital admissions than typical children. We also know once these children go to the ER they have a higher rate of hospital admission. We work to improve their care and keep them out of the hospital through care coordination, prevention services, and also by building relationships with qualified providers in the community who understand the needs of these children. We help our children beyond the walls of our practice.
Can you give me an example of the kind of child whose care would change with your model?
We take care of children with special health care needs such as children with progressive disease, multi-system involvement, rare genetic disorders or those dependent on technology. Here’s one example. We saw a pre-teen boy whose care was totally dis-coordinated despite the well-meaning efforts of his doctors. He was not in contact with a proper pulmonologist. His scoliosis and cardiac disease were not well monitored. His wheelchair did not fit. In his first visit, our Care Coordinator was able to help him navigate the system and get the testing, appointments and equipment he needed. Here’s another example. At 10 am, we learned a patient with a home ventilator had a significant respiratory illness. Our social worker, an amazing advocate for children, removed a barrier to care and was able to schedule same-day transportation. The patient was seen in the office on the same day, treated and avoided an ER visit and potential hospitalization. These cases highlight some of what we try to do.
How do you partner with specialists?
We try to make sure the child is getting the specialists they need — and only the specialists they need. We partner with specialists for expertise and focused testing. Often, complex kids get sent to too many sub-specialists. We want sub-specialists to be able to practice at the top of their licensure. Over-utilization creates an additional burden on the family, care team and healthcare system. We often can support the child within our practice. For instance, my colleague Dr. Ott and I will often manage gastrostomy-feeding regimens to ensure nutrition goals are met. We also coordinate the care plan changes made by sub-specialists to ensure that families and other care team members, such as home nurses, are up to date.
Are you collecting data to determine if you are indeed improving care while reducing hospital visits and admissions?
We do collect data within the National Committee for Quality Assurance (NCQA) Medical Home standards and guidelines. I would like to be more robust in collecting utilization data. We are looking forward to partnering with payers to see if we can have an impact on quality outcomes and costs. We believe there is an opportunity to decrease cost and improve care particularly in children with medical complexity.
How are parents responding?
The response has been very positive. Often, new parents tell me they have really been looking for something like this for their child. We are afforded more time with patients and their families. The families really appreciate having that extra time. We could not do this work in the construct of a typical pediatrician’s office. We are every family’s first point of contact — for preventive visits, medication re-fills, vaccinations, urgent visits and anything else. Additionally, we take care of siblings in our practice. While the focus of our practice is on children with special healthcare needs, we know we must work with the entire family. Parents have seemed to appreciate this as well. We’ve been established in Mountainside for almost a decade and now we have a new practice in Hamilton. Thus far, parents in the Hamilton location have been happy with our practice.