In the early 1990s, 6,000 patients received medical care from the outpatient clinics of The Veteran's Affairs Medical Center in Northport, New York. This system of clinics, each of which housed physicians with unique medical specialties, was proving itself ineffective, episodic, and limited in scope. Patients with multiple health problems had to visit multiple clinics to receive comprehensive care. The lack of coordination and consistency in this system left both patients and providers dissatisfied.
With strong support of Veteran's Affairs Medical Center (VAMC) leadership, a group of staff members began reengineering the entire outpatient care delivery process. Planning retreats served as a forum in which VAMC administrators analyzed challenges and developed improved care delivery models. Committees, composed of front line employees endowed with increased decision-making authority, first approved and then implemented new policies and procedures which came into full affect with the July 1993 launch of VAMC's new the primary care (PC) system.
Based on the dual values of care continuity and medical service integration, PC ensured that each patient had access to a regular primary care physician as well as a patient care team. Phase one of the program saw the creation of four teams, each comprised of between two and three physicians, a nurse practitioner, a licensed practical nurse, a part time registered nurse, an office manager and a clerk. This team structure allowed both patients and medical professionals to develop greater familiarity with each other, a factor which patient surveys indicate lent its self to higher satisfaction rates.
Only eighteen months after initiation, VAMC's Primary Care Program has already enjoyed great success. Over 85% of VAMC patients surveyed, report that they receive either ‘high' or ‘excellent' medical care. Additionally, VAMC has expanded its capacity, from an original cohort of 6,000 patients to now over 12,500. The final measure of success is the reduction in use of Northport's emergency room, which has fallen by 35 percent since PC implementation.