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Columbia University- HarIem Hospital Primary Care Network Margaret C. Heago~r~y Central Harlem is one of the most economically depressed communities in New York City. In 1978 about 30 percent of the population, predom- inantly black and Hispanic, had incomes below federal poverty standards and about 30 percent were on some form of public assistance. Twenty percent of the population was unemployed. An estimated 60 percent of the community's adolescents are unemployed. As might be expected, the mortality and morbidity rates in Harlem are also high. In 1975 the age- adjusted death rate in Central Harlem was the highest in the the United States. Columbia University-Harlem Hospital Center, an 811-bed municipal hospital, is the largest health facility within this country. As the major provider of health services the hospital embarked upon a program to deliver a decentralized yet coordinated system of primary health care services within the community. The planning for the program began in the spring of 1978, when an article in the New York Times concerning the health status of the population of Central Harlem generated considerable local and federal government interest. The local congressman established a task force to investigate the causes of these morbidity and mortality rates, and the then-secretary of Health, Education, and Welfare, Joseph Califano, established a Harlem Health Task Force to investigate the causes of and remedies for this prob- lem. Using this manifest political concern, the administration and profes- sional staff of the hospital and the administration of the New York City Health and Hospitals Corporation submitted a grant under the federal 225
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226 PART II: PRACTICAL APPLICATIONS Urban Health Initiative Program to establish several small primary care programs within the community. In the fall of 1979 the Urban Health Initiative grant was awarded to establish a primary care network administered by the Harlem Hospital Center. By sumrr~er 1980 three sites for these programs had been identified, and physicians, all members of the National Health Service Corps, were recruited to work in these clinics. The first clinic, opened in September 1980 within a moderate-sized housing pro ject, is staffed by a full-time pediatrician, a half-time obstetrician- gynecologist, and a full-time and half-time internist. The second clinic opened in an empty school annex located within a densely populated housing pro ject in November 1980. It is staffed by two pediatricians, two internists, and one full-time obstetrician-gynecologist. The third clinic, which opened in April 1981, is housed in an empty school annex and is staffed by a full- time pediatrician, a full-time internist, a half-time internist, and a part-time obstetrician-gynecologist. A fourth small clinic is scheduled to open in July 1982. To develop a new primary care program in a disadvantaged urban com- munity during an economic recession and during a general government retrenchment in its approach to social policy has required a pragmatic if not opportunistic approach tO planning and implementation. The experience in the development of this project suggests that in the contemporary climate any innovation in the health care delivery system will need not only a conceptual basis but also extraordinary flexibility, imagination, and persist- ence.
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