EDUCATION

Community Health Centers: Innovators in Primary Care

To many people, the image of a community health center is decidedly bleak and depressing. It might involve a dilapidated building with a few dedicated yet frenzied nurses and doctors frantically moving from one patient’s acute care needs to the next, bereft of adequate medical supplies and support services. But that wasn’t the experience of 20 students from HSPH who took part in a new winter session course at the School, Managing Community Health Centers.

Photos by Betty McNally

As part of the new HSPH course Managing Community Health Centers, students spent two weeks visiting federally funded community health centers in greater Boston. Among them was the Codman Square Health Center in Dorchester, whose entrance and reception area (with visiting students) appear at top. Above left are the students listening to a presentation at Brookside Community Health Center in Jamaica Plain; they include (from left) Jane Humphries; Yoshiki Ishikawa, Genevieve Daftary, Paul Zimmer, and Yuanxin Rong. Above right, Linda Dailey of the East Boston Neighborhood Health Center gives the students a tour.

Designed by Paul Campbell, an HSPH lecturer on management, the course required students to spend two weeks in January learning about the management of community health centers through visits to some of the most innovative centers in greater Boston. Born out of the civil rights movement in the 1960s, the federally funded centers are a means to provide primary care and population-based services to largely underserved communities throughout the country. Today, more than 1,000 centers serve 15 million patients nationally, including 52 centers in Massachusetts. And while the health centers operate under a variety of models that seem as unique as their patient populations, they are united in their commitment to comprehensive, community-based care. Leaders on Beacon Hill approved plans earlier this month to boost support for community health centers as a tool to reduce costly emergency deparment visits.

It is this commitment to comprehensive, community-based services that distinguishes these centers, and Brookside Community Health Center in Jamaica Plain is one outstanding illustration of this approach. At Brookside, the entire staff has taken on the challenge of helping patients manage type 2 diabetes. Case management begins at check-in, when receptionists ensure the latest blood tests are incorporated into patient charts. It continues through all stages of the visit, which also involves nurse’s aides removing patients’ socks to remind clinicians to perform foot checks, clinician development and use of standard protocols, and patient consultations with nutritionists. Care also continues outside the health center with a full-time diabetes case manager who makes regular home visits to assist patients with self-management skills. The results of these efforts are clearly successful: more than 90 percent of Brookside’s patients have their A1c levels (a measure of blood glucose levels over time) checked twice a year, up from 40 percent when the program started. And patient A1c levels have steadily declined, to an average of 7.4 in 2004.

Harbor Health’s Elder Service Plan in Dorchester is another example of an innovative model of community-based care. Through an all-inclusive, capitated program that seeks to maintain frail elders in their communities, the Elder Service Plan supports approximately 230 patients, including 50 enrollees over age 90 still living in their communities. Elder Service Plan’s comprehensive set of services includes everything from primary and specialty medical care to meal programs and adult day health to subacute and long-term care. Because it has the incentive to manage care and prevent high-cost services, Elder Service Plan has a proactive team of interdisciplinary providers who closely monitor patient health. It, too, has demonstrated success, including a lower rate of hospitalizations and the continued management of a handful of patients over 100 years of age.

While Brookside and Harbor Health each offer a unique set of services to their communities, there are numerous examples of innovative approaches to quality primary care throughout Boston’s community health center network, including Codman Square, Geiger–Gibson, North End, Neponset, Whittier Street, and East Boston health centers. In fact Geiger–Gibson, originally called Columbia Point, was one of the first community health centers in the country, and one of its founders, Jack Geiger, earned a degree from HSPH and did training at HMS. Students in the course visited all of these health centers. An important challenge, according to Campbell, is “finding the next generation of leadership with fresh ideas, people who have both passion and expertise, and who are committed to improving the health of rural and inner-city communities. We created this course in part to respond to that challenge.”

The commitment of community health centers to comprehensive, coordinated care serves as an outstanding model of how best medicine and public health can work together to improve patient and population health and as an opportunity for anyone looking to work at the forefront of primary care delivery.

—Lindsey Cole is a master’s student in the HSPH Department of Health Policy and Management who took part in the new Managing Community Health Centers course (ID 535).

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