An Early Example of Integrated Pediatric Care

They didn’t call it integrated healthcare or MIH then, but it surely embodied the concept.

Back in the early 1990s, the Chicago Department of Public Health discovered something alarming: In the city’s hardscrabble public housing, more than 70% of African-American children between 19–35 months old hadn’t received the recommended 4:3:1 series of childhood vaccinations (i.e., four doses of diphtheria/tetanus/pertussis vaccine, three of polio-containing vaccine and one for measles/mumps/rubella). Nationally, more than three-quarters of that era’s kids got those as recommended. Even worse, among that Chicago group, 11% of children had received no immunizations at all.

Local health leaders hit upon a plan: They sent specially trained emergency medical technicians door-to-door in the city’s giant Robert Taylor Homes development with a mission to determine children’s immunization status and encourage the families of those lacking the necessary shots to get them. Then they compared before-and-after immunization rates.

The results were buoying: Of more than 1,000 kids enrolled in the study, the baseline rate of up-to-date immunizations was 37% overall (for children 3–72 months), 27% among the 19–35-month age group. When it was completed three years later, 50% of kids were current.

That was a great early example of bringing together multiple players across a system to address a persistent problem of child health. We see many more such efforts today on behalf of this vulnerable group; entire agencies and programs are now dedicated to integrating and improving the care we give our littlest patients. This issue spotlights a pair of worthy projects in Hawaii (asthma) and Florida (mental health).

The Chicago program also illustrated the value of mobile efforts, sending personnel into homes and bringing proactive care to people where they lived. That idea’s now flourishing, and bringing integrated care to such home and noninstitutional settings is the focus of another pair of articles. Note in particular the innovative programs initiated by Texas’ MedStar Mobile Healthcare, which has pioneered collaborations with partners like home health and hospice.

As always, we’re interested to hear about your innovative cross-disciplinary programs on behalf of children, complex elderly patients and other challenging groups. Tell us what you’re doing at john@ihdelivery.com.