Jennifer Lail, MD, FAAP, is a primary care pediatrician currently practicing at Chapel Hill Pediatrics and Adolescents, P.A. (CHPA) in North Carolina. In 2003, Dr Lail served as North Carolina's representative to NICHQ's Medical Home Learning Collaborative on Children with Special Health Care Needs (CSHCN). Dr. Lail continues to serve in this leadership role today as the Project Director for the NC Title V Medical Home Grant Project.
"After 25 years of clinical practice, I felt we needed cultural and care delivery improvements to better meet the needs of our growing population of children whose needs, both medical and psychological, exceeded the norm. We enlisted our parents, staff and MD's to establish a registry of our CSHCN so we could begin to identify who needed more care planning and services and to adapt our services to meet their needs. I think the registry is the foundation of building a Medical Home for CSHCN", says Dr. Lail. The registry has permitted CHPA to expand their care-coordination services and to provide adequate time and preparation for complex appointments. With the registry as a tool, CSHCN and their parents receive a pre-visit contact before physicals. The care coordinator contacts the family in advance to be sure specialists' data and information from all care providers is gathered and reviewed before the visit. Parents' concerns are identified, and lab slips prepared. If the child needs lab work, topical anesthetic is offered to make the experience easier for the child. The registry permits recall for diagnosis-based educational forums and for health services such as Synagis or flu shots. Almost 90% of parents surveyed rated their pre-visit contact as "very helpful." "We could do so much more looking forward, rather than looking back and catching up," commented one parent.
With the help of Blue Cross Blue Shield of NC, CHPA was able to gather data on Emergency Department (ED) utilization for a subset of their CSHCN. Three years of data revealed ED utilization at half of area norms, and showed a decrease in the subspecialty visits over the three years of Medical Home interventions. "I believe our Medical "Homework" has energized our practice, and we have much more to do," says Dr Lail. Close to 90% of CHPA staff report increased job satisfaction in caring for CSHCN and MD's are coding more accurately for time well spent in carefully planned visits. Insurers have noted the Medical Home efforts, and consequently permitted favorable contact renegotiations.
Dr Lail received her medical degree from the University of Kentucky and completed her Pediatric Residency at Duke University Medical Center. She remains active in her community, serving as a volunteer pediatrician at a YMCA summer camp, and on the board and committees of her children's school, Durham Academy. Dr. Lail is also involved in state and national AAP activities, and serves on the board of the Arc of Orange County, which serves people with developmental disabilities. She is a member of the NC Pediatric Society, the national Partnership for Policy Implementation project, and is a member of the newborn screening clinical report authoring committee. Dr. Lail was named in the "Best Doctors in America" listing 2004-5 and 2005-6 and was recently awarded the Distinguished Achievement Award from Transylvania University in KY in April 2005.