Perspective: Beyond The Safety Net In Dallas

Parkland Memor ial Hospital is one of this nation’s largest, most active institutions making up the health care safety net. It has served the residents of Dallas County (Texas) for more than a hundred years. Just ten years ago, Parkland was a large, centrally located hospital, which, while recognized for its volume of service, excellence in patient care, and high-quality postgraduate medical training programs, was not known for its amenities or for having a patient-centered environment. Over the course of the past decade, Parkland has transformed itself. It is now an integrated health care system. It has created centers of excellence that make available to the entire community the latest knowledge in such areas as arrhythmia management, cerebral vascular disease, epilepsy, and gastrointestinal treatment. It also has developed its own health maintenance organization (HMO). In addition, it has gone through extensive reengineering. These efforts have produced a decline in the average length-ofstay from seven days in 1986 to fewer than five days in 1995; a reduction in emergency department visits from more than 160,000 visits in 1987 to 122,495 visits in 1995; and a reduction in average “dwell” time in the outpatient clinic, including all diagnostic studies and pharmacy services, from 7.5 hours to 2.5 hours. Parkland decentralized by developing a nationally recognized primary care delivery system based on a community-oriented primary care (COPC) model, which aims to improve care for both individuals and communities. The COPC network now includes eight community health centers, nine youth and family centers, five school-based clinics, and two mobile clinics. Parkland has learned over the past ten years that to truly improve health, it must address the social and economic determinants of disease such as lifestyle, education, and employment opportunities. This means working with school districts, housing authorities, police and fire departments, churches and synagogues, and employers. These efforts have begun to bear fruit. In 1995 a study was completed that compared COPC patients to non-COPC area residents. COPC patients were two times less likely to be admitted through the emergency department, had shorter hospital stays (3.4 days versus 5.3 days, on average), and had 50 percent lower charges.