Hospital-based group practice and comprehensive care for children of indigent families

The replacement of a community hospital's pediatric outpatient clinics with a physicians' group practice is described, and the effects of this development on the receipt of services by children of indigent families are analyzed. An expanded patient population, frequent telephone utilization, decreased emergency room use, and satisfactory parental perceptions are found. A comparative measure of effectiveness is obtained from a record review of the preventive care received by infants delivered by the hospital's staff obstetricians. The latter data show the group practice to be more successful than the clinics in initiating and maintaining well-child care in its facility, and in achieving the timed completion of immunizations and screening procedures. The experience indicates an acceptance by low-income families of an outpatient service that emphasizes the physician-patient relationship with limited use of outreach services and nonphysician providers. It also inidicates that such a system of care can be provided to a heterogeneous patient population within the same facility.