The Continuum of a Primary Care Service Infrastructure and the Development of a Community Pediatrics Program Matilde Irigoyen, Dodi Meyer, and Mary McCord Columbia University, NY

Columbia University Department of Pediatrics Tertiary care center Generalist faculty: 25 FTE 60 residents: –more than half enter specialties

The Community Demographics: Latino and African American Assets: vibrant Community-Based Organizations Needs: High levels of poverty, poor schools, injuries, and domestic violence

Community-based Primary Care: Service Infrastructure Model: the General Pediatrics Group Practice Decentralized primary care Integrated resident – faculty practices

General Pediatric Group Practice: Service 16,000 children/year 60,000 visits, scheduled and walk-ins Special health care needs children 24 hour coverage – 7 days/week Inpatient coverage

General Pediatric Group Practice: Education Leadership roles Main preceptors for residents and medical students in: –Continuity clinic –Ambulatory block –Inpatient wards

Community Pediatrics: Beyond Hospital Walls Reverses community-hospital relationship Moves away from hospital’s institutional culture Promotes knowledge of community resources Facilitates collaboration with community

Community-based Education: Service Learning Structured educational methodology Combines community service with specific goals and objectives Integrates community members as active partners in program design, implementation and evaluation

Community-based Education for Residents: Examples School health clinic Newborn home visitation program

Decentralized Primary Care: Pros Fosters mentoring of residents Allows independence and creativity of faculty and sites Closeness to community and Community-Based Organizations

Decentralized Primary Care: Challenges Maintaining standards and a unified vision Decentralized faculty and residents: logistical difficulties