A medical home for children with insulin-dependent diabetes: comanagement by primary and subspecialty physicians--convergence and divergence of opinions

The purpose of this work was to examine pediatricians' and endocrinologists' views about management for routine preventive and acute care, diabetes specific care, and family education and care coordination for children with insulin-dependent diabetes. Nearly all of the respondents agreed that primary care physicians should have responsibility for routine primary care. Likewise, large majorities favored endocrinologists as leads for diabetes specific care. However, large proportions of pediatricians and endocrinologists expressed differing opinions about the primary responsibility for family education and care coordination and for specific diabetes services. An effective medical home model of care depends on establishing clear lines of responsibility between the primary care physician and subspecialist. Approaches that recognize the appropriate division of care between primary care physicians and subspecialists, facilitate co-management when it is needed, and reward the collaboration required to provide medical homes for patients should be investigated as models of care.