The Medical Home Concept and Congenital Adrenal Hyperplasia: a Comfortable Habitat!

Historically, medical care systems were developed and organized to diagnose and treat acute illnesses or injuries. Health care professionals, patients, and families focused on rapid identification and resolution of the acute medical problem with infectious diseases being the prototype for this type of patient-physician interaction. Thus, mechanisms to promote and educate patient and family regarding self-management skills were not considered to be essential.With improved treatments, children with chronic illnesses now have increased survival rates. Challenges for children with chronic illnesses and their parents include dealing with symptoms, psychosocial and emotional impact, daily medications and treatments, lifestyle changes, and regular school absences for physician visits and acute medical issues [1]. The traditional "stop and go" approach to medical care encourages fragmented health care which is inefficient, expensive, and suboptimal for the care of children with chronic medical conditions such as congenital adrenal hyperplasia.The term "medical home" first appeared in a book written by the American Academy of Pediatric Council on Pediatric Practice (COPP) which emphasized the importance of a single repository for a child's medical records [2]. In 1977, the American Academy of Pediatrics issued a statement that quality medical care is best provided when all of the child's medical data are together in one place, (a medical home) and these data are readily accessible to the responsible physician or physicians [3]. Over time, this concept has evolved from merely centralized medical records to a system involving comprehensive, compassionate, well-coordinated, culturally effective, holistic, and readily accessible patient and family-centered health care in partnership with well-trained physicians and ancillary health care personnel who provide continuity of care [4].One goal of the Healthy People 2010 for Children with Special Health Care Needs is regular ongoing