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