In the early 1990s, 60 percent of the infants in New York City were born into families with incomes below 200 percent of the poverty level. Most of these families depended on storefront Medicaid offices and over-utilized hospital emergency rooms for their medical care. Lack of preventive care, and overlooked or neglected health problems, were all too often the result of episodic use of a fragmented system.
The New York City Department of Health thus undertook an effort to increase the availability and accessibility of primary health care services for underprivileged urban poor children by transforming 55 traditional well-baby clinics into primary care clinics for children from birth to adolescence. To achieve the intended reforms, the New York City Department of Health designated three major areas for attention: facilities, staff, and systems and procedures. Work began with the initiation of a systematic review of the existing strengths and weaknesses of each area. The federal Bureau of Maternal and Child Health, Region II, provided a team of consultants to assess and make recommendations for nursing, social service, medical record and clinic operations, and capital improvements.
Next, individuals with specific expertise, including a nursing director, medical records director, pharmacist, and clinic systems administrator, were hired to move clinics in new directions. The next phase has involved preparing and promulgating new procedures, scheduling staff reorientation and training (beginning with retreats for supervisors), and establishing additional management indicators to measure progress toward the planned changes.
The objective of this new approach has been to reform the clinic model to one where families have their own pediatrician to address both acute and chronic illness, as well as for preventive health care. The Department of Health’s transformed facilities have provided patients with greater continuity of care, fostering the ability to return to their personal physician. Another system improvement indicator has been the proportion of preventive relative to sick visits. The goal for the primary care clinics was to have 70 percent of all visits be preventive. In 1989, 16 percent of clinics reached that goal, and by 1994 over 55 percent of clinics boasted that achievement.