A "medical home" provides accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. This study implemented and evaluated the pilot phase of a pediatric practice-directed medical home quality improvement (QI) project focused on improving primary care for children and youth with special health care needs (CYSHCN). Six practices received training, QI team development and facilitation, and receipt of mini-grants for QI projects. Practice-level and parent-level evaluations were obtained at pre-intervention and post-intervention. The intervention was well-received. Many areas of improvement were found on practice-level evaluations, especially family-centered care and QI activities. Poor response rates limited the interpretation of family-level outcomes; 26% completed baseline outcome evaluations, and 64% of initial respondents completed them post-intervention. Practice education and implementation of QI teams to plan individualized strategies for the practice are feasible ways to seek to improve outcomes for CYSHCN. Modifications of evaluation strategies are needed to enhance response rates for family-level evaluations. (Am J Med Qual 2009;24:302-309).