Continuity of care and the paediatric medical home — branching viva

Stem

The examiner will move from definitions to a complex-care discharge and then to transition. [1] [7]

Branch 1 — Definitions

Examiner: What is continuity of care? [1]

Strong answer: Care experienced as connected over time. Name relational, informational and management continuity. Give a one-line example of each. [1] [1]

Examiner: Is a busy walk-in clinic a medical home? [2]

Strong answer: Not by access alone. Medical home requires continuous, comprehensive, family-centred, coordinated care with a usual team—not only open slots. [2] [3]

Branch 2 — Evidence

Examiner: Why should paediatric services invest in continuity? [4]

Strong answer: Lower continuity associates with more ED use and hospitalisation in children; higher continuity with better parent-reported quality and coordination. Adult mortality data are supportive but not a direct paediatric endpoint. [4] [3]

Branch 3 — Complex care discharge

Examiner: Mother is the only coordinator for a technology-dependent child after ward discharge. What do you set up? [5] [7]

Strong answer: Named medical home and coordinator roles; shared care plan and emergency information form; medication/device reconciliation; closed-loop specialty tracking; timed follow-up; caregiver support without unpaid labour dump. [5] [6] [7]

Branch 4 — ED interface

Examiner: Family used urgent care twice this week for asthma. [9]

Strong answer: Acute care outside the medical home may be needed for access. Require informational loop closure, review of the chronic plan, and a reachable after-hours medical-home pathway. Do not only scold ED use. [9] [5]

Branch 5 — Transition and foster care

Examiner: Sixteen-year-old with no adult plan; foster toddler with no records. [8] [10]

Strong answer: Transition is prepare–transfer–integrate in the medical home. Foster care needs rapid medical-home assignment and informational catch-up while treating acute needs. [8] [10]

Examiner extras

• Medical Home Index is practice-level, not a child bedside score.
• CCKO shows complex-care coordination can be trialled; avoid over-claiming universal effect sizes. [11]
• Barriers include workforce and financing, not only family motivation. [12]