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Marcia Wirt, MD, and parent, Janice Cooney, discuss why a Comprehensive Care Plan and Summary is so important for CYSHCN, and particularly vital for emergency care.
- Medical Home
Introduction - Medical Home Strategies
- Engage Families as Partners
- Identify Children & Youth with Special Health Care Needs
- Use Planned Encounters
- Improve Care Coordination:
Create Care Plans - Support Adolescent
Transitions - Collaborate with
Community Resources - Refine Coding &
Reimbursement Practices - Find Regional Centers
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Site last updated:
October 15, 2009
Wisconsin Resources
Pediatric Pulmonary Center, University of Wisconsin Madison
- Electronic Medical Home Care Plan (link)
National Resources
Center for Medical Home Improvement
Practice-Based Care Coordination: A Medical Home Essential, McAllister, J., Presler, E., Cooley, W.C. Pediatrics. 2007.
ACEP/AAP Emergency Information Forms
National Center of Medical Home Initiatives for Children with Special Needs
Healthy Ready to Work Portable Medical Summary
The Physician's Guide to Caring for Children with Disabilities and Chronic Conditions
Enhancing Collaboration between Primary and Sub-specialist Care (PDF)
Agency for Healthcare Research and Quality (AHRQ)
A Critical Analysis of Care Coordination Strategies for CSHCN, June 2007
The Role of the Pediatrician in Rural EMSC, Pediatrics. 2005 (link)
Care Coordination in the Medical Home: Integrating Health and Related Systems of Care for Children with Special Health Care Needs, Pediatrics.2005 (link)
A comprehensive medical summary/care plan is essential for children/youth with special health care needs who may have complex and lengthy medical records. A careplan provides:
- Parents, patients, medical, educational and other care teams one consistent information source;
- Facilitating emergency care; and
- Providing an action plan that the care team can use to prioritize goals, assign tasks, implement and assess care.
Videos
Parents and physicians discuss why the care plan is the ‘cornerstone’ of a good Medical Home.
Medical Home Resources
Care plans from Wisconsin and nationally developed templates can be found in this resource section. The National Center for Medical Home Initiatives has created a Build Your Own Care Notebook section on their Web site. There is a link to a set of condition-specific care plans and a guidebook focusing on building effective communication between the primary care doctor, the specialist and the family. More care plans supporting transition to adulthood can be found in the following section.