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Instructions for the Pediatric and Adult Primary Care Medical Home

Medical Home Index - Full Version (MHI-FV)

The Medical Home Index Full Version (MHI-FV) is a validated¹ self-assessment and classification tool designed to translate the broad indicators defining the medical home (accessible, family-centered, comprehensive, coordinated, etc.) into observable, tangible behaviors and processes of care within any office setting. It is a way of measuring and quantifying the “medical homeness” of a primary care practice (Table 1). The MHI is based on the premise that “medical home” is an evolutionary process rather than a fully realized status for most practice settings. The MHI measures a practice’s progress in this process.

MHI – FV is available in both Pediatric and Adult Primary Care versions. Additionally, a shortened version of the Medical Home Index (MHI-SV) is available for interval or periodic measurement and/or when it is not feasible to use the MHI-FV. (MHI-SV).

Table 1

Guidelines

When using the Medical Home Index tools we request that you:

1. Inform CMHI in writing (CMHI@crotchedmountain.org) of your intent.
2. Make every effort to gain family feedback with our tool or one of your choosing. We believe that “medical homeness” cannot be fully measured without an analysis of the family perspective.
3. Consider sharing your practice and family data with us (confidential, de-identified) in order to benchmark. Please remove all practice and personal identifiers.

Instructions to Complete

First: Determine whether your practice primarily cares for pediatric or adult patients and select either the Adult or Pediatric Medical Home Index-Full Version. Practices with separate provider teams and processes may want to consider completing the MHI for each team.

Second: Read each theme across its progressive continuum from Level 1 to Level 4.

Third: Select the LEVEL (1, 2, 3, or 4) which best describes how your practice currently provides care.

Fourth: When you have selected the LEVEL, then determine whether practice performance within that level is “PARTIAL” (some activity within the level) or “COMPLETE” (all activity within that level). Check the box that best matches your practice performance.

How to Measure the MHI –FV

To measure medical home baseline and improvements, we have created a “MHI-FV Scoring Template” Excel spreadsheet to easily score and track practice MHI results.

Follow these steps to enter data into the “MHI-FV Scoring Template” excel spreadsheet.

1. Complete the Adult/Pediatric MHI-FV and have available to enter results into the Excel “MHI-FV Scoring Template”.
2. For each level selected in the MHI, a point system is applied to score the MHI.  See Table 2 below.
   

   Table 2

   Level	Partial	Complete	Medical Homeness
   1	1 point	2 points	Basic
   2	3 points	4 points	Reactive
   3	5 points	6 points	Proactive
   4	7 points	8 points	Comprehensive

   Example: MHI Domain 1: 1.1. Mission of the Practice: if “Level 2: Complete” selected, score is 4 points.

3. Open Excel file “MHI-FV Scoring Template”.
4. Open tab for either Adult or Pediatric per the completed MHI. {Note: scoring templates are the same for Adult and Pediatric}
5. Each column starting from left to right applies to responses in the MHI. {Note: the first three far left columns “A, B, and C” can be used to differentiate multiple MHI entries per date. Use a separate row for each entry.}
6. Begin with entering into column “D and E” a numeric response to the questions on page 1
   1. How familiar/knowledgeable are you about the concept of a medical home as defined by the American Academy of Pediatrics?
   2. How familiar/knowledgeable are you with the elements of family-centered care as defined by the US Maternal and Child Health Bureau?

   For response selected score as: 1) No knowledge of the concept = 1; 2) Some knowledge/not applied = 2; 3) Knowledgeable/concepts sometimes applied in practice = 3; 4) Knowledgeable/concept regularly applied in practice = 4

7. Next starting with column “F” refers to a theme in the MHI. {See tab “Column Description” for abbreviation explanation}.

   Example: OC.1.1. Organizational Capacity is Domain 1, 1.1 “The Mission of the Practice” on the Medical Home Index survey, pg. 3.

8. Enter the Level score per each theme starting with Domain 1 into each column (refer to Table 2 for scoring).
9. At the end of each Domain entry, the “MHI-FV Scoring Template” will auto calculate the sum (total points scored) per each Domain. Example: Column M “OCCSUM”.
10. The “MHI-FV Scoring Template” will auto calculate a mean (average) score per each Domain. To view, scroll to far right columns starting with column AL.
11. The higher the score, the higher the Level of reported medical “homeness”.

Benchmarking

Benchmarking is an effective way to compare your practice’s medical home assessment against a “typical” medical home learning collaborative. CMHI collected Medical Home Index – Full Version (MHI-FV) reporting data over a three year period on a cohort of ten primary care practices. Figure 1 shows the MHI mean scores at Year 1, 2, and 3 per each of the six domains. The total mean score in Figure 1 shows a 33% increase overall in “medical homeness” for 10 medical home practices.

Figure 1. Medical Home Index Results at Year 1 (T1), Year 2 (T2) and Year 3 (T3)

Figure 1. Medical Home Index Results at Year 1, 2 and 3. The MHI-FV has 25 indicators organized under six domains which include: 1) Organizational capacity 2) Chronic condition management 3) Care coordination 4) Community outreach 5) Data management, and 6) Quality improvement. Each indicator is scored on a scale of 1-8 with scores 1- 2 defined as “Level 1 – basic”, 3-4 as “Level 2-Reactive”, 5-6 as “Level 3 - Proactive” and 7-8 as “Level 4- Comprehensive”. The total mean score shows a 33% increase overall in “medical homeness” for 10 medical home practices.

¹ Cooley, W.C., McAllister, J.W., Sherrieb, K. & Clark, R. (2003). The medical home index: development and validation of a new practice-level measure of implementation of the medical home model. Ambulatory Pediatrics, 3, 173-180.