Most of the chronic conditions of childhood occur relatively rarely, and many of those rare conditions require complex care. Children with the most complex conditions comprise 5% or less of the paediatric population but account for as much as 70% of paediatric care expenditures. These children are particularly vulnerable to the effects of fragmented care and services resulting in less than optimal health outcomes and higher health care costs. Developed by paediatricians, the medical home model has been promoted by the United States Maternal and Child Health Bureau and the American Academy of Paediatrics as a locus of proactive, coordinated care in the context of an integrated system of child health services and supports. The medical home has now been adopted as a model of care across the life span and occupies a critical position in United States health care reform efforts. This presentation provides an overview of the medical home model and its place in an integrated care model of child health for children with rare and complex conditions. The critical functions of care coordination, written and shared care plans, and explicitly articulated co-management roles for primary care providers, specialists, other ancillary service providers, and families will be explained.
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