Patient-centered medical home for patients with complex congenital heart disease.
OBJECTIVE
Originally conceived by pediatricians as a model for the care of children with special healthcare needs, the 'patient-centered medical home' (PCMH) has been identified by the Affordable Care Act as a model for all future outpatient care delivery. Although few studies have demonstrated its efficacy in improving care for children with congenital heart disease (CHD), access to a PCMH is likely to improve CHD-patient outcomes, including global function and quality of life, while reducing healthcare costs.


RESULTS
To date, most patients with complex CHD have their care anchored in cardiology subspecialty-care clinics, which lack many of the attributes of a PCMH. Given that many of these patients have noncardiac morbidities, including neurocognitive impairment and multiorgan dysfunction, we believe such patients will benefit from a PCMH model of care based on primary care.


CONCLUSIONS
The PCMH based on primary care for patients with complex CHD could result in improved clinical outcomes, improved patient satisfaction and quality of life as well as decreased healthcare costs. Policy and practice reform are required to increase CHD-patient access to a PCMH, based on primary-care settings.
aDivision of Pediatric Cardiology, Department of Pediatrics bDivision of Cardiovascular Medicine, Department of Medicine cDivision of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
Susan M
SM
Fernandes
Lee M
LM
Sanders
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D006330:Heart Defects, Congenital / Q000191:economics / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D058991:Patient Protection and Affordable Care Act; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D011788:Quality of Life