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Posted by Ishani Ganguli December 29, 2011 11:15 AM
How does a tertiary care hospital practice community medicine? We’ll find out soon enough.
Last week, Partners HealthCare (co-founded by Mass General and Brigham and Women’s Hospital) joined four other state institutions and 31 others nationally in adopting the accountable care organization (ACO) model as a Medicare Pioneer ACO. The ACO model is designed to improve the quality and coordination of care while reining in costs. Its success rides on a group of providers working together to take care of a defined population - in other words, a community - of patients.
Doctors have long been trained to think at the level of individual patients rather than of populations. This is changing somewhat as we are asked to evaluate ourselves on how well we take care of our panels of patients. But the next step is to think outside the four walls of our clinics and hospitals and tailor our efforts to the individual needs of the populations we serve - this is the key to effective community health care.
This theme came up again and again in the global primary care curriculum that was recently piloted by my cohort of primary care interns. Over the four week course, we discussed health systems at the level of towns and countries and learned from local and distant examples of merging public health with clinical medicine:
The MGH Chelsea Health Center serves the residents of nearby Chelsea, MA - a culturally diverse population of 35,000 packed into less than 2 square miles. Researchers found that Chelsea had higher than state average rates of colon cancer, and lower than average rates of screening for this disease. So for MGH Chelsea, community-oriented care took the form of patient navigators - community members trained to help patients schedule and attend their colonoscopies.
In Liberia’s rural Bomi County, more and more women were dying in childbirth, so local health officials investigated the barriers to good maternal care. To address these barriers, they began educational campaigns encouraging women to seek care early and used short-wave radio and motorcycle ambulances to transport women at high risk to health facilities that could support them.
A healthy community is about more than available medical care, says Joan Quinlan, Executive Director of the Mass General Center for Community Health Improvement. It is also about safety, housing, and an environment in which healthy choices are easier to make, she tells me.
This is true whether the community is defined by geography, workplace, age, or type of insurance. In the case of MGH and other tertiary care referral centers, their communities span continents. All the same, as Pioneer ACOs, these hospitals now have (at least) a financial obligation to promote the health and welfare of their communities. For the ACO model to be effective, they will do well by practicing community medicine writ large.
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