Improving Trenton’s Primary Care Systems To Better Serve Children and Families
New Jersey Pediatric Council on Research and Education (PCORE), the Foundation of the AAP NJ Chapter, provided continuing education and technical assistance to 11 pediatric practices to implement improvements in care. Together, the physicians in these practices serve more than 90% of children in Trenton, NJ. The program has been in partnership with Children’s Futures and the New Jersey Department of Health and Senior Services.
Using training modules known as EPIC—short for Educating Practices in their Communities—the physicians adopted new patient monitoring and care approaches in the areas of immunization, lead poisoning, childhood neglect and abuse, postpartum depression, and asthma. The participating practices have reported substantial improvements in rates of immunizations (up 20%) and lead screening (up 13%).
Steven Kairys, MD, medical director and chair of NJ PCORE, is pleased with the impact of EPIC training in Trenton and acknowledges Children’s Futures and the state’s role in bringing it about. “Without them, there would be no EPIC in Trenton. And, because of EPIC, these 11 practices are coordinating their efforts better with the community and with one another.”
Harriet Lazarus, Program Director noted, “It has been truly rewarding to work with the primary care practices in Trenton and see them join together to address the many health related challenges facing the children and families in their practices.”
According to Dr. Kairys, physicians in all 11 practices increased their understanding of just how severely asthma affects Trenton’s children and how important it is to monitor patients and to educate and engage parents. Asthma patients are now being seen more regularly in physicians’ offices and have fewer costly emergency room visits.
More than 7% of Trenton children have asthma and, Dr. Kairys explains, “While only one-fourth of Mercer County’s kids live in Trenton, these kids account for three fourths of the County’s pediatric hospital stays for asthma.”
The benefits of EPIC extend to the practices themselves, as well as the patients they serve.
“These are all small, inner-city practices serving an impoverished, multi-cultural population,” says Dr. Kairys. “Before EPIC, they were really on their own. They did not communicate with one another and didn’t really have a sense of the larger community they were serving. They were simply doing the best they could do.” As part of EPIC, the practices now meet quarterly to share efforts, results, and data. They have an annual meeting and present to one another. The practices are now collaborating and “understand much better the big picture of the community and its needs,” says Dr. Kairys.
In addition, Dr. Kairys credits Children’s Futures for supporting a comprehensive, holistic care model, and actively engaging organizations and agencies—pediatric and obstetrical providers, hospitals, physician practices, clinics, managed care companies, and the Department of Health, among others citywide.
The Bellevue Pediatrics Practice of Dr. Puthenmadam Radhakrishnan, known simply as Dr. Rad to his patients, is located in an older office building on the Mercer campus of Capital Health System. It’s a busy practice, logging 7,500 patient visits in 2007. Dr Rad’s second-floor office is full of bright colors and books. An aquarium with odd and interesting fish beckons small visitors.
Dr. Rad sees EPIC training as the catalyst for several innovations that have led to his practice’s embrace of the community—and vice versa. The first innovation was to adopt a family focus. As a result, he says,” I believe EPIC has helped me become a better doctor.”
Another improvement noted, Dr. Rad began screening mothers for signs of postpartum depression at the two-week well-baby visit. “We’ve picked up a number of cases that were not apparent while these moms were still in the hospital. We link them with the appropriate resources in the community or work with the obstetrical physicians to make sure they get the help they need.”
Higher levels of service like these examples have improved primary care practice and promoted the healthy development of children in many Trenton families.