Medical Home Concept

Sara Morales

Sara Morales (pseudonym) is an 11 year old Hispanic female. She lives at home with her mother, father and three younger siblings. Although Sara speaks English well, her parents prefer to speak Spanish in their home, because her grandparents, who live with the family, speak no English.

Sara and her siblings have been brought to SCHC by their mother, Esperanza, for routine well-child checks and occasional ill-child care since moving to Kansas City from Texas in late 2006. When Esperanza initially called to make an appointment for Sara, who was ill at the time, she told clinic staff that her children had no health insurance. Spanish-speaking clinic staff assisted Esperanza to complete an application for Medicaid, and assured her that her daughter would be seen at Silver City regardless of insurance status. The family’s children were later determined to be eligible for HealthWave insurance.

When Sara, her mother, three siblings and grandmother come to the clinic for a routine exam, they are greeted by name and registered by our bilingual receptionist. (Grandma Maria is well-known to our staff, since she and her husband have received care at SCHC for more than five years.) Our bilingual medical assistant obtains Sara’s vital signs and other clinical information to expedite service in behalf of the primary care provider.

Sara and her mother are then escorted into one of six exam rooms to meet with either a pediatric nurse practitioner, a family nurse practitioner or a resident physician, while her grandmother waits in the waiting room with the other children. Building on the history obtained from prior visits, Esperanza’s written responses to the Spanish pediatric medical questionnaire, and the medical assistant’s data, the provider focuses special attention on Sara’s developmental age, beginning puberty, and health education needs, including a BMI of 27. Our provider gives Esperanza anticipatory guidance on what to expect from Sara’s growth and development and what immunizations she will need over the next year before her next exam.

Because Sara is 11 years old, the provider talks with her mother about the new HPV vaccine for girls, emphasizing that this is a way to prevent possible cancer later in life and telling Esperanza that the vaccine is covered by Sara’s HealthWave insurance. Esperanza is also offered an opportunity to have Sara participate in SCHC’s pilot pediatric nutrition and physical activity program. This program offers frequent clinical visits for Sara to monitor her height, weight and blood chemistry, and provides the entire family bilingual nutrition counseling by a dietitian from the local Price Chopper grocery store, Price Chopper food vouchers, and activity passes to the YMCA.

During these discussions, our provider pays close attention to clues regarding the family’s social history and Esperanza’s ability to understand what the provider might advise for treatment (knowing that functional illiteracy is prevalent at a 4-6th grade education level in our patient population).

Routine lab work, a urinalysis, blood lead level and hemoglobin are all done in our onsite laboratory by a simple finger stick and urine sample. If needed, our interpreter and/or referral coordinator arranges for referrals for further evaluation at Children’s Mercy Hospital or community clinic.

After her mother completes the consent form for enrollment in the nutrition and physical activity pilot, Sara is then scheduled for a return visit in one week to have her fasting lab work completed, and continue counseling with the clinician. This counseling will include discussion of healthy behaviors and monitoring for co-morbidities associated with high BMI such as high blood pressure, high cholesterol, liver function problems, and diabetes.

Our staff will enter Sara’s HPV vaccination into the Kansas WebIZ system, where the data will be available for other providers in the future. At her next visit, our staff will have critical information from her well-child visit readily available, ensuring continuity and seamless care that is non-duplicative and which reinforces previous clinical teaching efforts.

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