Let's Start at the Very Beginning: Addressing the Goal of Service to the Community

All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.12.005 A cademic medical centers often are located in urban areas, and a proportion of their patients may live in the shadow of these institutions. Unfortunately, the children in those cities often are, paradoxically, medically underserved, as well as challenged by poor schools, unsafe neighborhoods, and a variety of other threats to their health and well-being. As one of those cities, Baltimore can be a challenging urban environment for children, and West Baltimore, the location of the University of Maryland Medical Center, is no exception. In Baltimore, many indicators of child health are concerning, including the teen birth rate (64.4/100 000 in 2011 vs 31.3/100 000 nationally) and the infant mortality rate (13.4/100 000 in 2009 vs 6.39/100 000 nationally). Caring for the local children should be a priority of the institutions that dominate the landscape, but, for many historical reasons, that has not always been the case. Many academic pediatric departments have successfully become integral parts of their local communities, and looking to their examples is instructive. One of the best examples of true community-based pediatrics emanating from an academic department comes from the University of Rochester. The department, led by Robert Haggerty, MD, stated as its mission to address the health of children in a defined area, and then conducted a needs assessment to determine the major health concerns among its citizens with regard to their children. They took advantage of opportunities that were presented in real time, paid close attention to measurable outcomes, such as hospitalization rates in children served by their inner-city community health center, andworked across disciplines to address the children’s needs. They incorporated all of this into their training program so that their residency graduates would be more likely to continue such efforts in their own careers. These steps mirror the four pillars of “the bridge from bedside to neighborhood” described by Sanders et al: (1) collaboration with the community in defining a specific short-term goal; (2) identification of best practices in achieving that goal; (3) collaboration with the community to adapt the best practices to their local needs; and (4) evaluation of the intervention using appropriate measures. Although efforts such as those at Rochester are inspiring, they are also daunting. For a department of pediatrics that has not historically had a large presence in its local community, how does one even begin? The Department of Pediatrics at the University of Maryland decided to take the challenge, and has begun several efforts that might provide ideas for other departments or institutions with similar dilemmas.