Children's Hospital Medical Center

Andrew Ng, Summer 2010

The strange phenomenon of Cincinnati and its public services is that they share many common goals and ideal outcomes for the same target populations, yet they operate with such a great degree of independence. The end result is a system with little cooperation and significant redundancy, to the point that resources are under-utilized and progress is slow to come by. It is a theme that I suspect is repeated in a countless number of cities across the country, and one I intimately became aware of through my summer internship at Cincinnati Children's Community and General Pediatrics.

Much of my work this summer was concerned with the operations at the Primary Pediatric Care center (PPC), a clinic within Cincinnati Children’s that sees over 35,000 visits a year and serves roughly 15,000 regular patients, a majority of who are on Medicaid (~ 90%) or uninsured (~5%). Its services include standard checkups, and screening and basic care for asthma, ADHD/ADD, lead exposure, sports and school injuries, and minor illnesses, among others. But in addition to these standards, the clinic also has taken the initiative to incorporate public and social services with nutritionists, social workers and legal aid services (LAS) available on-site. The latter, part of Child HeLP (Cincinnati Child Health-Law Partnership), is so relatively new and innovative and has been met with such great success that it has warranted an article in The New York Times.

Building on this success, Community and General Pediatrics is looking to create a network with community services with greater accountability and efficiency. Many of the patients at the PPC need help with food insecurity, poor housing conditions, are frequently unable to pay utility bills, and may lack regular schooling, all of which compound their medical conditions and which are often identified in-clinic. As such, the PPC is aggressively pursuing new standards of care that will screen for these multivariate problems in a standardized, routine manner. Furthermore, the PPC is looking to establish a stronger partnership with community leaders and services so that our patients can not only be identified, but also referred and addressed appropriately and efficiently.

As an intern, I was able to sit on numerous meetings regarding these initiatives, including the Transforming Early Childhood Community Services (TECCS) program that is designed to screen children in school for social emotional development issues as well as other presentations and grand rounds concerning various topics. For instance, I also was able to sit in on a presentation with a prominent health official from Sweden with regards to their health model and the novel approaches they have employed to tackle the same problems we face in Cincinnati. I was also able to shadow extensively, often with Dr. Kahn, but many other times with residents and attendings at various locations beyond the PPC. These included the Hopple St. Clinic, the Christ Hospital nursery and the Inpatient Care Unit at Children’s. Through these experiences I was afforded and intimate view and understanding of our patient population.

Another project I was greatly involved in was developing a website for the PPC to be used in-clinic. Current online information and websites remain largely inaccessible to our patient population for several reasons. Among them, information on websites are often unreliable, difficult to navigate, and inappropriate for our target population, while some patients lack regular internet access. As a result, the PPC is looking to produce a website that is available both online and at kiosks in-clinic with information specifically relevant to our target population.

If implemented properly, the website will greatly enhance the experience at the clinic, increase productivity of visits, and streamline patient flow. For instance, as a routine part of check-in, prompting patients with questions ahead of time through the website can lead to more insightful patient questions for physicians in return. Doctor synthesized materials can also minimize misinformation regarding procedures, and visual aides on the website can supplement handout information with visuals that are far more engaging and relatable to patients.

In developing the website, I was able to create the website and establish a framework, demo the site to patients and doctors to generate feedback, explore feasibility, generate internal interest, and explore innovative avenues and uses for information.

Overall, what I will remember most from this project is not how much I did, nor how much Community and General Pediatrics does for the community; but rather how much there still needs to be done. There is such a great amount of need, particularly in areas that have nothing visceral to do with medicine. But through this program I have come to truly appreciate the circumstances that can affect a person’s health outcomes- the reason that they present to us with conditions and situations with no magic bullet solution. I have always had the impression that there is this great divide between Public Health and medicine and I do not understand how this can be reasonably maintained. It is not just asthma or obesity that our patients are facing, but a whole range of problems, and to truly advocate good health, I believe we cannot ignore or delegate the responsibility to others. It is a cause health personnel can and should be personally invested in.