Patient and Family-Centered Medical Home

Several AAP policies and clinical reports focus on the core components of the patient/family-centered medical home.  

• Patient and Family Centered Care and the Pediatrician’s Role (2012, reaffirmed 2018) 
• Patient and Family Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems (2014, reaffirmed 2018)   
• Shared Decision Making in Children with Disabilities: Pathways to Consensus (2017)  
• Guiding Principles for Team-based Pediatric Care (2017)  
• Nonemergency Acute Care: When It’s Not the Medical Home (2017) 
• Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home (2018)  
• Principles of Financing the Medical Home for Children (2020) 

The AAP has tools, resources, and technical assistance centers to assist pediatricians in transforming their practice into a patient/family-centered medical home.   

National Resource Center for Patient/Family-Centered Medical Home 

The National Resource Center for Patient/Family-Centered Medical Home (NRC-PFCMH), a cooperative agreement between the American Academy of Pediatrics and the Maternal and Child Health Bureau of the Health Resources and Services Administration, strengthens the systems of services for children and youth with special health care needs (CYSHCN) and their families by providing technical assistance, support, and training on the implementation of the patient/family-centered medical home to pediatricians, clinicians, state Title V programs, families and others. The NRC-PFCMH website has tools, resources, and promising practices to assist in the implementation of the medical home model of care.  

Building Your Medical Home: An Introduction to Pediatric Primary Care Transformation  

This guide developed by the NRC-PFCMH provides direction, resources, and tools to practices seeking to transform into a patient/family-centered medical home.  

Medical Home Infographics for a Changing Health Care Environment 

These medical home infographics raise awareness of rapid changes taking place at the practice, patient, family, and community levels; and actions pediatricians, child health professionals and policy makers can take to advocate for children.   

Several AAP partner organizations have tools and resources that may be helpful to pediatricians as they implement the medical home model of care.  

Primary Care Collaborative 

The Primary Care Collaborative (PCC) is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. PCC’s Shared Principles of Primary Care focus on a common vision for primary care that is family-centered, continuous, comprehensive and equitable, team-based, coordinated, accessible and high value.   

American College of Physicians 

The American College of Physicians (ACP) mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine. ACP has several resources for clinicians, including a high value care coordination toolkit and a toolkit with disease/condition specific tools to assist with transitioning young adults with chronic conditions into adult care settings.  

Got Transition  

Got Transition® is the federally funded national resource center on health care transition (HCT) focused on improving transition from pediatric to adult health care through the use of evidence-driven strategies for clinicians and other health care professionals; public health programs; payers and plans; youth and young adults; and parents and caregivers. 

National Academy for State Health Policy  

The National Academy for State Health Policy (NASHP) is a nonpartisan forum of policymakers throughout state governments, learning, leading and implementing innovative solutions to health policy challenges. The National Care Coordination Standards for Children and Youth with Special Health Care Needs outline the core, system-level components of high-quality care coordination for CYSHCN.  

Association of Maternal and Child Health Programs  

The Association of Maternal & Child Health Programs (AMCHP) is a national resource, partner, and advocate for state public health leaders and others working to improve the health of women, children, youth, and families, including those with special health care needs. AMCHP’s National Standards for Systems of Care for CYSHCN outline core components for health care providers and guidelines for state systems of care to help improve care for CYSHCN.  

Catalyst Center 

The Catalyst Center is the federally funded national resource center for health insurance and financing for children and youth with special health care needs (CYSHCN). Its goals are to promote universal, continuous, and affordable coverage for all CYSHCN; close benefit and financing gaps; promote payment for additional services; and build sustainable capacity to promote financing of care. 

Family Voices  

Family Voices is a national organization and grassroots network of families and friends of CYSHCN that promotes partnership with families–including those of cultural, linguistic and geographic diversity—in order to improve healthcare services and policies for children. 

A practice does not need medical home recognition or certification to implement and follow the medical home model of care, but for practices interested in formal recognition or certification, there are four main organizations that recognize, certify or accredit health care providers and organizations as medical homes based upon specific standards. Please note that the AAP does not endorse any specific recognition or certification program. 

• National Committee for Quality Assurance Patient-Centered Medical Home Recognition Program 
• The Joint Commission Primary Care Medical Home Accreditation Program  
• URAC Patient-Centered Medical Home Certification  
• Accreditation Association for Ambulatory Health Care Patient-Centered Medical Home Certification  

The AAP practice management pages also include many policy templates and other resources to help practices transform into a medical home.