1. Donnelly, Gloria F. PhD, RN, FAAN, Editor-in-Chief

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The waiting area of the 11th Street Family Health Services, Drexel University,* is bustling with activity.

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Moms, babies, and other patients wait to be seen by the primary care nurse practitioners for a variety of common health problems or chronic illness management. Several are waiting to be called for their dental appointment in the health center's state-of-the-art dental suite. The treadmills and stationery bikes in the Fitness Center are all in use by regular patients who are managing their hypertension and, diabetes or just trying to improve their fitness levels. In the corner of the Fitness Center is a relaxation room where patients can receive massages in a quiet, relaxing environment. Behavioral health services are offered not only through an onsite behavioral health unit but also through the integration of behavioral health into primary care, a unique way of removing the lingering stigma of behavioral health treatment still prevalent among some patients. The 11th Street Family Health Services, conceived and operated by nurses, is among those selected by the federal Agency for Healthcare Quality Research as an innovation that is increasing access to care.1 Last year, more than 23,000 visits were conducted by health center staff. Community residents come to the center because they know that they are partners with the staff in realizing health improvements for themselves and their families. Their input is solicited through a community advisory board, and their feedback is used as the basis for change and improvement.


All care activities at the health center are driven not only by the expressed needs of the community but also by data gleaned from the electronic health record. For example, given the high incidence of diabetes among the center's patients, the staff began collating data on the efficacy of care; that is, are blood glucose levels dropping as a function of care? Each month graphs that track the progress of all diabetic patients' measures are displayed in the center's hallway. The nurse practitioners teach patients how to interpret the graphs and encourage them to check progress at each visit. It is common to see thumbs up from patients checking the upward trending graphs. It is also common to witness the staff convening to figure out why a graph may be trending downward. What are they missing? What needs are going unmet? What can be improved?


The health center is a hub for community activity, a polling place during elections, and the location of an urban garden worked in the summer by local youth and harvested in the fall for community use. There are yoga classes and art classes, and dance/movement therapy is provided by faculty from Drexel's Creative Arts Therapies Program. Nursing students work in community outreach projects through their public health nursing clinical practice requirement. And all activities at the 11th Street are based on community needs, on the health demographics of the community, and on what patients are telling the staff. The care activities delivered by the 11th Street staff are not driven by pet theories or idiosyncratic interests. It is all about meeting needs. Delivering care through the lens of expressed and documented need results in high-quality, holistic care that makes a difference. It is so simple, or is it?


Gloria F. Donnelly, PhD, RN, FAAN






1. Agency for Healthcare Research and Quality. Multidisciplinary family clinic increases access to care[asymptotically equal to]for inner-city residents, leading to improved outcomes and high patient satisfaction. Accessed February 14, 2009. [Context Link]