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Project

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Patient Centered Medical Home Program

Center:
CA-USC, Childrens Hospital, UCEDD/LEND
Fiscal Year:
2018
Contact Information:
Mona Patel
[email protected]
323-361-6987
Project Description:
Patient Centered Medical Home (PCMH) program at AltaMed at CHLA provides comprehensive services to 1261 patients with complex medical needs, including developmental disabilities. Patients enrolled in the PCMH program are assigned to a case manager who works closely with the patients primary care physician to optimize management. This year, the transition process became more formalized, and a workgroup was formed among leadership from the PCMH program and the USC UCEDD, as well as adult providers in the community in order to streamline the process of transition from pediatric to adult care. Since January, 2018, 87 patients have been referred to PCMH for transition services. New partnerships with adult care providers in the community are currently being explored.
Keyword(s):
comprehensive, coordinated family-centered care
Core Function(s):
Performing Direct and/or Demonstration Services, Other Direct/Model Services
Area of Emphasis
Health-Related Activities
Target Audience:
Family Members/Caregivers, Adults with Disabilities, Children/Adolescents with Disabilities/SHCN
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Disadvantaged Circumstances
Primary Target Audience Geographic Descriptor:
Single-County
Funding Source:
COVID-19 Related Data:
N/A
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