Building the Medical Home Concept in Pediatrics at Memorial Hospital

Memorial Hospital is part of Fremont history, and belongs to the community and its people. That is the principle that guides our daily practice at the hospital. We are always looking for areas of improvement that meet your expectations and needs. We are committed to providing comprehensive and compassionate medical care to children and their families.

Our Memorial Hospital pediatric services - outpatient, inpatient and emergency care visits - have been the target of those changes. First, let me mention that all changes we implement are in compliance with recommendations from American Academy of Pediatrics. We work daily with our Memorial Hospital ER physicians; as a result, we were able to implement Pediatric ER protocols for the most common diseases that required your child’s visit to emergency room. In addition, the primary care provider, in other words your child’s doctor, maintained close communications with our ER physicians, a practice that has greatly improved patient care and minimized medical errors.

Subsequently, if your child requires admission, our staff is specially trained in pediatric care .We believe our children are not "little adults" and they deserve an appropriate care model that meets their psychosocial needs. Recently, we have approved new pediatric quality core indicators, in other words, every child admitted at Memorial Hospital will have a comprehensive evaluation that will include not only the disease for what he or she was admitted for but also an evaluation of his or her whole health status, such as nutrition, immunizations, and so on that we then communicate to you and your child’s doctor. Our highly skilled physicians and nurses maintain a philosophy that our children both deserve and require a special level of care.

The American Academy of Pediatrics (AAP) believes and promotes that the medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate, essentially, all aspects of pediatric care. This is the concept of Medical HOME, which we believe and follow at Memorial Hospital. But a medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care at all levels.

The Medical HOME concept endorsed by AAP should encompass the following service:

1. Sharing clear and unbiased information with the family about the child’s medical care and management and about the specialty and community services and organizations they can access.
2. Provision of primary care, including but not restricted to acute and chronic care and preventive services, including breastfeeding promotion and management, immunizations, growth and developmental assessments, appropriate screenings, health care supervision, and patient and parent counseling about health, nutrition, safety, parenting, and psychosocial issues.
3. Assurance that ambulatory and inpatient care for acute illnesses will be continuously available (24 hours a day, 7 days a week, 52 weeks a year).
4. Provision of care over an extended period of time to ensure continuity. Transitions, including those to other pediatric providers or into the adult health care system, should be planned and organized with the child and family.
5. Identification of the need for consultation and appropriate referral to pediatric medical subspecialists and surgical specialists. (In instances in which the child enters the medical system through a specialty clinic, identification of the need for primary pediatric consultation and referral is appropriate.) Primary, pediatric medical subspecialty, and surgical specialty care providers should collaborate to establish shared management plans in partnership with the child and family and to formulate a clear articulation of each other’s role.
6. Interaction with early intervention programs, schools, early childhood education and child care programs, and other public and private community agencies to be certain that the special needs of the child and family are addressed.
7. Provision of care coordination services in which the family, the physician, and other service providers work to implement a specific care plan as an organized team.
8. Maintenance of an accessible, comprehensive, central record that contains all pertinent information about the child, preserving confidentiality.
9. Provision of developmentally appropriate and culturally competent health assessments and counseling to ensure successful transition to adult-oriented health care, work, and independence in a deliberate, coordinated way.
10. Provision of family-centered care through developing a trusting partnership with families, respecting their diversity, and recognizing that they are the constant in a child’s life.

These are the goals we work toward at Memorial Hospital; our physicians, nurses, board members and administrators believe that following these goals is the best route to accomplish the best for care for our children. When it comes to providing medical care to our children, we know what matters most! We strive to provide the very best for our patients everyday. As a Memorial Hospital pediatrician I feel very fortunate to be able to go to work happy, because I love my job and I always try to give my best.

About the Author:
Dr. Arevalo is Memorial Health Care Pediatrician who specializes in Pediatric Infectious Disease. She received her medical education from the Cayetano Heredia University of Lima, Peru. Her residency training in Pediatrics took place at Lincoln Medical Center, Cornell University of New York. Dr. Arevalo completed a Fellowship in Pediatric Infectious Diseases and Immunology at University School of Medicine in New York.

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