Medical home
Encyclopedia
The medical home, also known as the patient-centered medical home (PCMH), is defined as "a health care setting that facilitates partnerships between individual patient
s, and their personal provider
s, and when appropriate, the patient’s family". It is "an approach to providing comprehensive primary care
for children, youth and adults". The provision of medical homes may allow better access to health care, increase satisfaction with care, and improve health.
in 1967. In 1992 that Academy published a policy statement defining a medical home, and in 2002 they expanded and operationalized the definition.
In 2002, seven U.S. national family medicine
organizations created the Future of Family Medicine project to "transform and renew the specialty of family medicine." Among the recommendations of the project was that every American should have a "personal medical home" through which to receive his or her acute
, chronic, and preventive
services. The services should be "accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid, and satisfying to both patients and their physicians."
As of 2004, one study estimated that if the Future of Family Medicine recommendations were followed (including implementation of personal medical homes), "health care costs would likely decrease by 5.6%, resulting in national savings of 67 billion dollars per year, with an improvement in the quality of the health care provided." A review of the literature published the same year determined that medical homes are "associated with better health, ... with lower overall costs of care and with reductions in disparities in health."
By 2005, the American College of Physicians
had developed an "advanced medical home" model. The model involved the use of evidence-based medicine
, clinical decision support tools, the Chronic Care Model, medical care plans, "enhanced and convenient" access to care, quantitative indicators of quality, health information technology, and feedback on performance. Payment reform was recognized as important to implement the model.
IBM
and other organizations started the Patient-Centered Primary Care Collaborative in 2006 to promote the medical home model. As of 2009, its membership included "some 500 large employers, insurers, consumer groups, and doctors."
In 2007, the American Academy of Family Physicians
, American Academy of Pediatrics
, American College of Physicians
, and American Osteopathic Association
— the largest primary care physician organizations in the United States — released the Joint Principles of the Patient-Centered Medical Home. The principles listed were:
A survey of 3,535 U.S. adults released in 2007 found that 27% of the respondents reported having "four indicators of a medical home." Furthermore, having a medical home was associated with better access to care, more preventive screenings, higher quality of care, and fewer racial and ethnic disparities.
Important 2008–2010 developments concerning medical homes included:
(CCNC), which was started under the name "Carolina Access" in the early 1990s. CCNC consists of 14 community health networks that link approximately 750,000 Medicaid
patients to medical homes. It is funded by North Carolina's Medicaid office, which pays $3 per member per month to networks and $2.50 per member per month to physicians. CCNC is reported to have improved healthcare for patients with asthma and diabetes. Non-peer-reviewed analyses cited in a peer-reviewed article suggested that CCNC saved North Carolina $60 million in fiscal year 2003 and $161 million in fiscal year 2006. However, an independent analysis asserted that CCNC cost the state over $400 million in 2006 instead of producing savings.
The Rhode Island Chronic Care Sustainability Initiative (CSI-RI) is a community-wide collaborative effort convened in 2006 by the Office of the Health Insurance Commissioner to develop a sustainable model of primary care that will improve the care of chronic disease and lead to better overall health outcomes for Rhode Islanders. CSI-RI is focused on improving the delivery of chronic illness care and supporting and sustaining primary care in the state of Rhode Island through the development and implementation of the patient-centered medical home. The CSI-RI Medical Home demonstration officially launched in October 2008 with 5 primary care practices and was expanded in April 2010 to include an additional 8 sites. Thirteen primary care sites, 66 providers, 39 Family Medicine residents, 68,000 patients (46,000 covered lives), and all Rhode Island payers are participating in the demonstration. Further, its selection to participate in the Centers for Medicare and Medicaid Services' Multi-Payer Advanced Primary Care Practice demonstration, CSI-RI is one few medical home demonstrations in the nation with virtually 100% payer participation. Since the start of the demonstration, CSI-RI sites have implemented a series of delivery system reforms in their practices, aimed at becoming patient-centered medical homes, and in turn receive a supplemental per-member-per-month payment from all of Rhode Island's insurers. Each participating practice site also receives funding from participating payers for an on-site nurse care manager, who can work with all patients in the practice, regardless of insurance type or status. All 5 original pilot sites achieved NCQA level 1 PPC-PCMH recognition in 2009, and all 8 expansion sites achieved at least level 1 PPC-PCMH recognition in 2010. As of December 2010, all of the pilot sites and two of the expansion sites have been recognized by NCQA as level 3 patient-centered medical homes.
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s, and their personal provider
Provider
The provider model is a design pattern formulated by Microsoft for use in the ASP.NET Starter Kits and formalized in .NET version 2.0. It is used to allow an application to choose from one of multiple implementations or "condiments" in the application configuration, for example, to provide access...
s, and when appropriate, the patient’s family". It is "an approach to providing comprehensive primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
for children, youth and adults". The provision of medical homes may allow better access to health care, increase satisfaction with care, and improve health.
History
The concept of the medical home has evolved since its introduction by the American Academy of PediatricsAmerican Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
in 1967. In 1992 that Academy published a policy statement defining a medical home, and in 2002 they expanded and operationalized the definition.
In 2002, seven U.S. national family medicine
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
organizations created the Future of Family Medicine project to "transform and renew the specialty of family medicine." Among the recommendations of the project was that every American should have a "personal medical home" through which to receive his or her acute
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....
, chronic, and preventive
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
services. The services should be "accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid, and satisfying to both patients and their physicians."
As of 2004, one study estimated that if the Future of Family Medicine recommendations were followed (including implementation of personal medical homes), "health care costs would likely decrease by 5.6%, resulting in national savings of 67 billion dollars per year, with an improvement in the quality of the health care provided." A review of the literature published the same year determined that medical homes are "associated with better health, ... with lower overall costs of care and with reductions in disparities in health."
By 2005, the American College of Physicians
American College of Physicians
The American College of Physicians is a national organization of doctors of internal medicine —physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in...
had developed an "advanced medical home" model. The model involved the use of evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
, clinical decision support tools, the Chronic Care Model, medical care plans, "enhanced and convenient" access to care, quantitative indicators of quality, health information technology, and feedback on performance. Payment reform was recognized as important to implement the model.
IBM
IBM
International Business Machines Corporation or IBM is an American multinational technology and consulting corporation headquartered in Armonk, New York, United States. IBM manufactures and sells computer hardware and software, and it offers infrastructure, hosting and consulting services in areas...
and other organizations started the Patient-Centered Primary Care Collaborative in 2006 to promote the medical home model. As of 2009, its membership included "some 500 large employers, insurers, consumer groups, and doctors."
In 2007, the American Academy of Family Physicians
American Academy of Family Physicians
The American Academy of Family Physicians was founded in 1947 to promote the science and art of family medicine. It is one of the largest medical organizations in the United States, with over 100,000 members...
, American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
, American College of Physicians
American College of Physicians
The American College of Physicians is a national organization of doctors of internal medicine —physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in...
, and American Osteopathic Association
American Osteopathic Association
The American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...
— the largest primary care physician organizations in the United States — released the Joint Principles of the Patient-Centered Medical Home. The principles listed were:
- Personal physician: "each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care."
- Physician directed medical practice: "the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients."
- Whole person orientation: "the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals."
- Care is coordinated and/or integrated, for example across specialists, hospitals, home health agencies, and nursing homes.
- Quality and safety are assured by a care planning process, evidence-based medicineEvidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
, clinical decision-support tools, performance measurement, active participation of patients in decision-making, information technology, a voluntary recognition process, quality improvement activities, and other measures. - Enhanced access to care is available (e.g., via "open scheduling, expanded hours and new options for communication").
- Payment must "appropriately recognize[s] the added value provided to patients who have a patient-centered medical home." For instance, payment should reflect the value of "work that falls outside of the face-to-face visit," should "support adoption and use of health information technology for quality improvement," and should "recognize case mix differences in the patient population being treated within the practice."
A survey of 3,535 U.S. adults released in 2007 found that 27% of the respondents reported having "four indicators of a medical home." Furthermore, having a medical home was associated with better access to care, more preventive screenings, higher quality of care, and fewer racial and ethnic disparities.
Important 2008–2010 developments concerning medical homes included:
- The Accreditation Association for Ambulatory Health CareAccreditation Association for Ambulatory Health CareThe Accreditation Association for Ambulatory Health Care , founded in 1979, is an American organisation which accredits ambulatory health care organizations, including ambulatory surgery centers, office-based surgery centers, endoscopy centers, and college student health centers, as well as managed...
(AAAHC) began accrediting medical homes in 2009 and is the only accrediting body to conduct on-site survey for organizations seeking Medical Home accreditationAccreditationAccreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...
. - The National Committee for Quality AssuranceNational Committee for Quality AssuranceThe National Committee for Quality Assurance is an independent 501 non-profit organization in the United States designed to improve health care quality. It was established in 1990 with support from the Robert Wood Johnson Foundation. NCQA manages voluntary accreditation programs for individual...
released Physician Practice Connections–Patient-Centered Medical Home (PPC-PCMH), a set of voluntary standards for the recognition of physician practices as medical homes. - In answering a 2008 survey from the American Academy of Family Physicians, then-presidential candidate Barack ObamaBarack ObamaBarack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
wrote "I support the concept of a patient-centered medical home" and that as president he would "encourage and provide appropriate payment for providers who implement the medical home model". - The New England Journal of MedicineNew England Journal of MedicineThe New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
published recommendations for the success of medical homes that included increased sharing of information across health care providers, the broadening of performance measures, and the establishment of payment systems that share savings with the physicians involved. - Guidance for patients and providers on operationalizing the Joint Principles was made available.
- The American Medical AssociationAmerican Medical AssociationThe American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
expressed support for the Joint Principles. - A coalition of "consumer, labor and health care advocacy groups" released nine principles that "allow for evaluation of the medical home concept from a patient perspective."
- Initial findings of a medical home national demonstration project of the American Academy of Family Physicians were made available in 2009. A final report on the project, which began in 2006 at 36 sites, will be published in 2010.
- By 2009, 20 bills in 10 states had been introduced to promote medical homes.
- In 2010, 7 key health information technology domains were identified as necessary for the success of the PCMH model: telehealth, measurement of quality and efficiency, care transitions, personal health records, and, most important, registries, team care, and clinical decision support for chronic diseases.
- On January 31, 2011, the National Committee for Quality Assurance (NCQA) released new standards for its Patient-Centered Medical Home (PCMH) program. The new standards call on medical practices to be more patient-centered, and reinforce federal “meaningful use” incentives for primary care practices to adopt health information technology.
Scientific evidence
Recent peer-reviewed literature that examines the prevalence and effectiveness of medical homes includes:- In 2007, researchers from the Centers for Disease Control and PreventionCenters for Disease Control and PreventionThe Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
published a study involving interviews with 5400 parents; the authors concluded that continuous primary care in a medical home was associated with higher rates of vaccinations for the respondents' children. - Schoen and colleagues (2007) surveyed adults in seven countries, using the answers to four questions to categorize the respondents as having a medical home or not. Having a medical home was associated with less difficulty accessing care after hours, improved flow of information across providers, a positive opinion about health care, fewer duplicate tests, and lower rates of medical errors.
- A review of 33 articles by Homer et al. on medical homes for children with special health care needs published in 2008 "provide[d] moderate support for the hypothesis that medical homes provide improved health-related outcomes."
- A 2008 review by Rosenthal determined that peer-reviewed studies show "improved quality, reduced errors, and increased satisfaction when patients identify with a primary care medical home."
- In a survey of parents or legal guardians of children with special health care needs published in 2009, 47.1% of the children had a medical home, and the children with a medical home had "less delayed or forgone care and significantly fewer unmet needs for health care and family support services" than the children without a medical home.
- Reid et al. (2010) showed within the Group Health system in Seattle that a medical home demonstration was associated with 29% fewer emergency visits, 6% fewer hospitalizations, and total savings of $10.30 per patient per month over a twenty-one month period.
International comparisons
In a study of 10 countries, the authors wrote that in most of the countries "health promotion is usually separate from acute care, so the notion[] of a... medical home as conceptualized in the United States... does not exist." Nevertheless, the seven-country study of Schoen et al. found that the prevalence of medical homes was highest in New Zealand (61%) and lowest in Germany (45%).Comparison with “gatekeeper” models
Some suggest that the medical home mimics the managed care “gatekeeper” models historically employed by HMOs; however, there are important distinctions between care coordination in the medical home and the “gatekeeper” model. In the medical home, the patient has open access to see whatever physician they choose. No referral or permission is required. The personal physician of choice, who has comprehensive knowledge of the patient’s medical conditions, facilitates and provides information to subspecialists involved in the care of the patient. The gatekeeper model placed more financial risk on the physicians resulting in rewards for less care. The medical home puts emphasis on medical management rewarding quality patient-centered care.Organizations criticizing the model
The medical home model has its critics, including the following major organizations:- The American College of Emergency PhysiciansAmerican College of Emergency PhysiciansThe American College of Emergency Physicians is the first and largest professional organization of emergency medicine physicians in the United States. It was founded in 1968 and is now headquartered in Irving, Texas. As of 2009 ACEP has over 28,000 physician members.The college exists to support...
expresses cautions such as "a shifting of financial and other resources to support the PCMH model could have adverse effects on sectors of the health care system" and "there should be proven value in health care outcomes for patients and reduced costs to the health care system before there is widespread implementation of this model." - The American Optometric AssociationAmerican Optometric AssociationThe American Optometric Association represents optometrists nationally in the USA. It consists of State Optometric Associations, which are made up of local optometric societies.-AOA mission:...
is concerned that medical homes "may restrict access to eye and vision care" and requests "that optometry be recognized as a principal provider of eye and vision care services within the PCMH" - The American Psychological AssociationAmerican Psychological AssociationThe American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
states that Congress should ensure that "careful consideration is paid to the role of psychologists and non-physician providers in the medical home model, which should be more appropriately named the 'health home model'."
Ongoing medical home projects
One notable implementation of medical homes has been Community Care of North CarolinaNorth Carolina
North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...
(CCNC), which was started under the name "Carolina Access" in the early 1990s. CCNC consists of 14 community health networks that link approximately 750,000 Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
patients to medical homes. It is funded by North Carolina's Medicaid office, which pays $3 per member per month to networks and $2.50 per member per month to physicians. CCNC is reported to have improved healthcare for patients with asthma and diabetes. Non-peer-reviewed analyses cited in a peer-reviewed article suggested that CCNC saved North Carolina $60 million in fiscal year 2003 and $161 million in fiscal year 2006. However, an independent analysis asserted that CCNC cost the state over $400 million in 2006 instead of producing savings.
The Rhode Island Chronic Care Sustainability Initiative (CSI-RI) is a community-wide collaborative effort convened in 2006 by the Office of the Health Insurance Commissioner to develop a sustainable model of primary care that will improve the care of chronic disease and lead to better overall health outcomes for Rhode Islanders. CSI-RI is focused on improving the delivery of chronic illness care and supporting and sustaining primary care in the state of Rhode Island through the development and implementation of the patient-centered medical home. The CSI-RI Medical Home demonstration officially launched in October 2008 with 5 primary care practices and was expanded in April 2010 to include an additional 8 sites. Thirteen primary care sites, 66 providers, 39 Family Medicine residents, 68,000 patients (46,000 covered lives), and all Rhode Island payers are participating in the demonstration. Further, its selection to participate in the Centers for Medicare and Medicaid Services' Multi-Payer Advanced Primary Care Practice demonstration, CSI-RI is one few medical home demonstrations in the nation with virtually 100% payer participation. Since the start of the demonstration, CSI-RI sites have implemented a series of delivery system reforms in their practices, aimed at becoming patient-centered medical homes, and in turn receive a supplemental per-member-per-month payment from all of Rhode Island's insurers. Each participating practice site also receives funding from participating payers for an on-site nurse care manager, who can work with all patients in the practice, regardless of insurance type or status. All 5 original pilot sites achieved NCQA level 1 PPC-PCMH recognition in 2009, and all 8 expansion sites achieved at least level 1 PPC-PCMH recognition in 2010. As of December 2010, all of the pilot sites and two of the expansion sites have been recognized by NCQA as level 3 patient-centered medical homes.
Projects evaluating medical home concepts
As of December 31, 2009, there were at least 26 pilot projects involving medical homes with external payment reform being conducted in 18 states. These pilots included over 14,000 physicians caring for nearly 5 million patients. The projects are evaluating factors such as clinical quality, cost, patient experience/satisfaction, and provider experience/satisfaction. Some of the projects underway are:- Division B, Section 204 of the Tax Relief and Health Care Act of 2006 outlined a MedicareMedicare (United States)Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
medical home demonstration project. This three-year project will involve care management reimbursement and incentive payments to physicians in 400 practices in 8 sites. It will evaluate the health and economic benefits of providing "targeted, accessible, continuous and coordinated, family-centered care to high-need populations." As of July 2009, however, the project had not yet started recruiting practices.
- In 2008, CIGNA and Dartmouth-HitchcockDartmouth-Hitchcock Medical CenterDartmouth-Hitchcock Medical Center is New Hampshire's only academic medical center and is headquartered on a campus in the heart of the Upper Connecticut River Valley, in Lebanon, New Hampshire....
announced they had launched a pilot program in New HampshireNew HampshireNew Hampshire is a state in the New England region of the northeastern United States of America. The state was named after the southern English county of Hampshire. It is bordered by Massachusetts to the south, Vermont to the west, Maine and the Atlantic Ocean to the east, and the Canadian...
with 391 primary care providers.
- A UnitedHealth GroupUnitedHealth GroupUnitedHealth Group Incorporated is a diversified health and "well-being" company. Headquartered in Minnetonka, Minnesota, UnitedHealth Group offers a spectrum of products and services through two operating businesses: United Healthcare and Optum. Through its family of subsidiaries and divisions,...
medical home pilot in ArizonaArizonaArizona ; is a state located in the southwestern region of the United States. It is also part of the western United States and the mountain west. The capital and largest city is Phoenix...
involving 7,000 patients and 7 medical groups began in 2009 and is scheduled to end in 2011.
- The state of MaineMaineMaine is a state in the New England region of the northeastern United States, bordered by the Atlantic Ocean to the east and south, New Hampshire to the west, and the Canadian provinces of Quebec to the northwest and New Brunswick to the northeast. Maine is both the northernmost and easternmost...
provided $500,000 in 2009 for a pilot project in 26 practices.
- The New Jersey Academy of Family Physicians and Horizon Blue Cross and Blue Shield of New JerseyHorizon Blue Cross and Blue Shield of New JerseyHorizon Blue Cross Blue Shield of New Jersey, headquartered in Newark, New Jersey is the only licensed Blue Cross and Blue Shield Association plan in New Jersey, providing health insurance coverage to over 3.2 million people throughout all of North, Central, and South Jersey.It is a not-for-profit,...
implemented a pilot project in March 2009. This project is ongoing and involves more than 60 primary care practice sites and 165 primary care physicians. Specialties include family medicine/practice, internal medicine and multi-specialties in which 50% or more of the care provided is primary care.
- The Texas Medical Home Initiative, a multi-stakeholder primary-care driven organization, has launched a two year pilot involving 7 primary care practices in North and East Texas. This project involves 45 physicians and 75,000 patients. Services to the practices include practice coaching, a patient registry system, assistance with developing practice agreements with specialty practices to build the "medical neighborhood".
See also
- Orphan patientOrphan patientIn health care, an orphan patient is a patient who has been "lost" within the system or has no primary provider overseeing their care.Usually, the primary provider is a general practitioner who takes care of some of the basic health needs and then refers to a specialist for complicated medical...
- The Patient: Patient-Centered Outcomes ResearchThe Patient: Patient-Centered Outcomes ResearchThe Patient: Patient-Centered Outcomes Research is a quarterly peer-reviewed medical journal dedicated to presenting solely the patient's perspective. The journal is a joint venture between Wolters Kluwer/Adis and the Department of Health Policy and Management at the Johns Hopkins Bloomberg School...
(medical journal)
External links
- National Center for Medical Home Implementation, a "cooperative agreement between the Maternal and Child Health Bureau/HRSA and the American Academy of Pediatrics."
- Building Your Medical Home toolkit, from the National Center for Medical Home Implementation, the toolkit supports development and/or improvement of a pediatric medical home.
- Medical Home Information An overview of patient centered medical home elements.
- "What is the Patient Centered Medical Home?" http://www.pcpcc.net/content/pcmh-videos. An overview to Patient Centered Medical Homes for patients from the Patient Centered Primary Care Collaborative.
- Appleby J. Old-fashioned docs inspire new 'medical homes'. USA Today 2008 Jul 14. Accessed 2009 Jul 6.
- Center for Medical Home Improvement from the Crotched Mountain Foundation, New Hampshire.
- Guadagnino C. Implementing a medical home. Physician's News Digest 2007 Mar. Accessed 2009 Jul 2.
- Keckley PH, Underwood HR. The medical home: disruptive innovation for a new primary care model. Washington, DC: Deloitte Center for Health Solutions, 2008. Accessed 2009 Jul 6.
- Medical Home Accreditation resources from the Accreditation Association for Ambulatory Health Care (AAAHC).
- Medical Home Portal "for providers and parents of children and youth with special health care needs," from the Department of Pediatrics, University of Utah.
- Patient-Centered Medical Home resources from the American College of Physicians.
- Washington State Medical Home from the Medical Home Leadership Network, University of Washington.