Maternal and Child Health Library

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June 12, 2009

1. GUIDANCE AND TOOLS AVAILABLE TO HELP PEDIATRIC PRACTICES QUALIFY AND QUANTIFY CARE IN THE MEDICAL HOME

Building Your Medical Home is a Web site designed to support the development or improvement of a pediatric medical home (defined as primary care that addresses and integrates high-quality health promotion, acute care, and chronic-condition management in a planned, coordinated, and family-centered manner). The Web site, produced by the American Academy of Pediatrics' National Center for Medical Home Implementation, is organized into the following six building blocks: (1) care partnership support, (2) clinical care information, (3) care-delivery management, (4) resources and linkages, (5) practice-performance measurement, and (6) payment and finance. Each block contains guidance and tools for improving care while also meeting national standards for quality. The tools and related information may be used as they are provided or adapted to meet specific practice needs. The Web site is available at http://www.pediatricmedhome.org.

• There was a wide range of scores for content coverage and for the proportion of activities delivered using the appropriate instructional strategy.
• Overall, the median scores indicated that the officer instructors were stronger in covering the content of the curricula than in using appropriate instructional strategies.
• The relationship between implementation fidelity and the targeted mediators was not consistent, but higher fidelity was associated with better scores on some mediators.

• Overall, slightly over one-third of adolescents (34 percent) reported that their doctor talked to them about getting help if they felt sad or depressed.
• Younger adolescents (ages 13 to 14) were significantly less likely to report the discussion (30.6 percent) than older adolescents (ages 15 to 17; 37.0 percent).
• Female adolescents reported significantly higher rates of talking about getting help if they felt sad or depressed (36.4 percent) compared to male adolescents (30.4 percent).
• Among the racial and ethnic groups, Latino adolescents were more likely to say that their doctor talked to them about sadness or depression than their white counterparts.
• Among adolescents endorsing emotional distress, about one-third (34.7 percent) reported talking to their doctor about their emotions or mood. 
• Among distressed adolescents, female adolescents were significantly more likely than male adolescents to talk to their doctor about their emotions or mood (41.7 percent) than males (24.7 percent).

• Participants reported varying levels of confidence in the process of breastfeeding. Their confidence was affected by concerns about the ability of breastmilk to nourish and satisfy their infant, about the infant's breastfeeding ability, and about their own ability to cope with the discomfort and inconvenience that they associated with breastfeeding.
• Most pregnant women's statements about breastfeeding indicated that they wanted to breastfeed and that they intended to try it, although very few firmly stated that they definitely would breastfeed (reflecting neither confidence nor commitment).
• Only breastfeeding mothers and some pregnant women made statements that reflected "confident commitment." Breastfeeding mothers reported overcoming pain, misgivings about the quality and quantity of their milk, and negative pressure from significant others so as to maintain breastfeeding. Breastfeeding mothers made no statements reflecting lack of commitment.
• A few of the breastfeeding mothers decided to breastfeed based on the recommendations of their caregivers in the hospital but developed "confident commitment" as a result of their early breastfeeding successes.
• Most focus group participants' statements did not reflect the understanding that breastfeeding is a learned skill.