NAPNAP Position Statement on Pediatric Health Care/Medical Home: Key Issues on Delivery, Reimbursement, and Leadership
Article Outline
The National Association of Pediatric Nurse Practitioners (NAPNAP) affirms that the delivery of children's health care should be family centered, accessible, comprehensive, coordinated, culturally sensitive, compassionate, and focused on the overall well-being of children and families. All qualified pediatric health care providers should collaborate in providing health care services for children in pediatric health care/medical homes. Interventions must address the concepts of family-centered partnerships, community-based systems, and transitional care from pediatric to adult services (American Academy of Pediatrics, 2008, Duderstadt, 2008).
The pediatric health care/medical home is a model of care that promotes holistic care of children and their families where each patient/family has an ongoing relationship with a health care professional. Children receiving services in a health care/medical home receive management of both their acute and chronic health issues. They and their families also benefit from motivational and anticipatory guidance in health promotion, reinforcement of positive parenting behaviors, parent education, behavioral consultation, nutrition and safety education, developmental assessments, and referrals to community resources. Children with special health care needs (CSHCN) who receive health care within medical homes have better health outcomes than do those who receive health care in non–medical-home settings (Homer et al., 2008). The outcomes demonstrated with CSHCN strongly suggest that all children receiving health care services would benefit if they were served using the same health care/medical home model as is recommended for CSHCN. An optimal health care/medical home must meet quality standards identified by national organizations such as the National Committee for Quality Assurance (NCQA, 2008).
Pediatric nurse practitioners (PNPs) have the education, knowledge, and skills to successfully lead, coordinate, and manage care within pediatric health care/medical homes for children and their families. Advanced practice nurse education strongly focuses on care coordination, holistic care, and family well-being. PNPs deliver a variety of pediatric health-related services: disease prevention, health maintenance, acute illness and chronic condition management, and specialty care. While providing these services, PNPs create partnerships for family empowerment that support the physical and behavioral needs of children and adolescents and promote family strengths and well-being. In a demonstration project, Palfrey and colleagues (2004) found that families reported it was easier to obtain health and support services in a PNP-delivered health care/medical home model and that “with high PNP involvement, more than three quarters of the families indicated a better understanding of their child's medical condition” (p. 1514). Through unique child, family, and professional collaboration, PNPs help families access and coordinate their children's health care, receive educational and support services, and reach out to other public and community services that serve the overall health needs of children and their families (American Nurses Association, National Association of Pediatric Nurse Practitioners [NAPNAP], & Society of Pediatric Nurses, 2008).
The success of health care/medical homes is contingent on adequate reimbursement for quality health care (AAP, 2008). To be fully reimbursed, “NPs must be included in all legislation that authorizes demonstration programs, reimbursement and incentives for participation in medical homes or coordinated primary care practices” (Duderstadt, 2008, p. 392). It is imperative that all legislation and policies related to the medical home include provider-inclusive terminology.
NAPNAP affirms that:
NAPNAP acknowledges the need for additional research on the impact of pediatric health care/medical home models. NAPNAP supports the statement of the American Academy of Nursing (AAN) that calls for research to discover “evidence on the concept and potentially resultant quality improvements and cost savings …of the health home” (AAN, 2008, p. 5).
In summary, NAPNAP is an organization that promotes optimal health for children through leadership, practice, advocacy, education, and research. It remains committed to pursuing the vision that all children and their families will have access to comprehensive health services within a pediatric health care/medical home from qualified pediatric health care providers.
The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution made by the following members in the development of this statement: Margaret Brady, PhD, RN, CPNP; Barbara Deloian, PhD, RN, CPNP; Dolores C. Jones, EdD, RN, CPNP, CAE (Staff); Heather Keesing, MSN, RN, FNP-BC (Staff); Karen KellyThomas, PhD, RN, CAE, FAAN (Staff); Linda Lindeke, PhD, RN, CPNP; Jo Ann Serota, MSN, CPNP; Ann Sheehan, MA, CPNP; Allison Shuren, JD, MSN.
References
- American Academy of Nursing. (2008). The health care home debate: Opportunities for nursing. Retrieved November 10, 2008, from http://www.aannet.org/files/public/healthhomepaperFINAL0608.doc.
- American Academy of Pediatrics. (2008). The National Center for Medical Home Initiatives for Children with Special Needs. “Every child deserves a medical home” training curriculum. Retrieved January 20, 2009, from http://www.medicalhomeinfo.org/training/index.html.
- . Pediatric nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org; 2008;
- . Medical home: Nurse practitioners' role in health care delivery to vulnerable populations. Journal of Pediatric Health Care. 2008;22:390–393
- A review of the evidence for the medical home for children with special health care needs. Pediatrics. 2008;122:e922–e937
- . Position statement on access to care. Journal of Pediatric Health Care. 2007;21:35A–36A
- National Committee for Quality Assurance. (2008). Physician Practice Connections®—Patient-Centered Medical Home™ (PPC-PCMH) fact sheet. Retrieved November 24, 2008, from http://www.ncqa.org/tabid/631/Default.aspx.
- . The pediatric alliance for coordinated care: Evaluation of a medical home model. Pediatrics. 2004;113:1507–1516
Adopted by the National Association of Pediatric Nurse Practitioners' Executive Board on January 29, 2009. This statement replaces the 2003 NAPNAP Position Statement on Pediatric Health Care Home.
© 2009 National Association of Pediatric Nurse Practitioners, Cherry Hill, NJ. All rights reserved.
All regular position statements from the National Association of Pediatric Nurse Practitioners automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.
Correspondence: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.
PII: S0891-5245(09)00048-0
doi:10.1016/j.pedhc.2009.02.005
