AIMing to be the Best

By Kristen Watson

The Audubon Biomedical Science and Technology Park, a new fixture in the Washington Heights neighborhood, houses the newest expansion of AIM: an additional primary care center that caters to the needs of young families, with a focus on preventive medicine. The center opened this summer in the building shown here, the Russ Berrie Medical Science Pavilion. For the past 21 years, the involvement of Columbia-Presbyterian’s Associates in Internal Medicine (AIM) group practice in the Washington Heights community has contributed to AIM’s success. AIM not only has a physical presence in the neighborhood, it is a contributing member and an active neighbor. The practice provides a unique opportunity for members of this largely minority community (70 percent Latino, 20 percent African-American, and 10 percent non-Latino white) to secure a lasting relationship with a personal primary care physician and receive state-of-the-art medical care. A personal physician is assigned during a patient’s initial visit. AIM is staffed by 26 full-time faculty members, approximately 125 residents, two nurse practitioners, and four social workers, most of whom speak both Spanish and English to reduce communication barriers. AIM’s 24-hour, seven-day-a-week availability, outpatient and inpatient care, and subspecialty referrals also help achieve continuity of care. Community Involvement AIM and the general medicine faculty of the Department of Medicine have been involved in several projects directed at enhancing the health of the community. The Washington Heights-Inwood Healthy Heart Program was conducted between 1988 and 1994 in collaboration with Presbyterian Hospital, the School of Public Health, and Columbia Teachers College. The goal of the program, funded by the New York State Department of Health, was community health education to improve heart-healthy lifestyle knowledge and behavior--diet, exercise, and smoking prevention and cessation in particular. Coalitions were created with the public school system, community-based organizations, elected officials, and community health care providers. High points of the program included health fairs, blood pressure and cholesterol screening, Joe Camel’s burial, and elementary school appearances by Low Fat Lucy, the cow who promotes low fat milk. The Columbia Center for the Active Life of Minority Elders (CALME) began in 1997 under the leadership of Dr. Rafael Lantigua, professor of clinical medicine and medical director of AIM, and with funding from the National Institute on Aging. The center supports research on functional life expectancy and other aspects of aging in the multi-racial and multi-ethnic communities of Washington Heights, Inwood, and Harlem. Health Care for Patients of All Ages AIM has more than 55,000 patient visits per year; approximately 55 percent of those visits are by patients over age 65 who are covered by Medicaid or Medicare. According to Dr. Robert Goodman, assistant clinical professor of medicine and director of the primary care residency program in medicine, 90 Key Players The following individuals have played key roles in AIM’s success: Dr. Robert Goodman, director of the Primary Care Residency Program in Medicine, developed the ambulatory block rotation for the Department of Medicine house staff and leads the clinical epidemiology portion of the Clinical Practice I course at P&S. Dr. Rafael Lantigua is the medical director of AIM and associate director of the division of general medicine. He is responsible for the day-to-day operation of AIM and for integrating education and research with AIM’s clinical mission. Rebecca Kurth ’87 is co-director of the highly successful primary care clerkship in the third year at P&S. Miriam Rabkin ’92 edited the Division of General Medicine’s “Ambulatory Care Syllabus for Primary Care Medicine,” has led the division’s program in continuing medical education for community physicians, and is responsible for the clinical supervision of Department of Medicine house staff when they see patients through AIM. Dr. Adina Schneider joined AIM in 1997 as assistant director of the primary care residency program. “This cadre of educator-clinicians has given coherence, organization, and substance to the clinical teaching efforts based in AIM,” says Dr. Shea. “They reflect AIM’s mission to provide high quality primary care to the community of Washington Heights and to teach ambulatory medicine to students and house staff.” A number of the Division of General Medicine’s faculty based in AIM also play a key role in the medical school curriculum: Carmen Ortiz-Neu ’63 directs the physical diagnosis courses in the second year. Under her leadership, this course has been invigorated and more closely integrated into the medical school curriculum. Drs. Robert Goodman and Steven Shea teach epidemiology, statistics, and clinical epidemiology in the Clinical Practice I course. Barron Lerner ’86 leads the clinical ethics program for medical students and house staff. He is a major presence in the Clinical Practice course, where he has organized the medical ethics curriculum. Dr. Rita Charon leads the Program in Humanities and Medicine based in the Division of General Medicine. She has received national recognition for her innovative teaching for medical students and house staff in the areas of empathy, compassion, and medical interviewing. She helped develop the medical interviewing component of the Clinical Practice course at P&S. percent of the Department of Medicine’s outpatient residency training is done through AIM. Because a large proportion of AIM’s patients are over 65, new advances in the health management of the elderly, such as hospice care, home care services, and treatment of incontinence, dementia, depression, and other mental disorders, have been incorporated into the curriculum. AIM also has a geriatric depression clinic and a memory disorder clinic available to patients. AIM sees patients from a variety of age ranges. The AIM practice, located on the second floor of the Vanderbilt building, expanded this summer when an additional primary care center opened in the Russ Berrie Medical Science Pavilion, part of the Audubon Biomedical Science and Technology Park. The new office will cater to the needs of young families, with a focus on preventive medicine. Services provided for younger patients will include asthma services, pelvic exams, routine medical exams, diabetes management seminars, HIV testing, social work services, anti-coagulation programs, and nutrition counseling. “AIM was started in 1977,” says Dr. Lantigua. “We embarked on this long before managed care was popular. It’s not like we jumped into this because it was fashionable. Two decades ago, we recognized the importance of providing quality of care to our underserved neighborhood.” Drs. Steven Shea and Rafael Lantigua. Dr. Shea heads the division of general medicine, the administrative home of the Associates in Internal Medicine group practice. Dr. Lantigua is AIM’s medical director. The Evolution of a Practice AIM grew out of the division of general medicine, which was created in 1977. AIM was formed in 1979 as the division’s faculty group clinical practice with the mission of providing primary care and clinical services to community residents within an academic setting of education and research. That mission remains the same today. In 1991, Dr. Myron Weisfeldt became chairman of the Department of Medicine and he made clinical research and teaching programs priorities in rebuilding the department. The following year, Steven Shea’79 was named director of the division of general medicine. Dr. Shea has taken several steps to make AIM more central to the mission of the medical school. An agreement was reached between the division of general medicine and Presbyterian Hospital for AIM to operate as an independent and accountable cost center within the Ambulatory Care Network Corporation, the hospital’s umbrella organization for ambulatory medical services. Under this agreement, the division has had financial, administrative, and clinical responsibility for the day-to-day operation of this practice, selection of clinical faculty, and overall strategic planning for the practice. According to Dr. Weisfeldt, AIM is “one example that we can survive in a cost-competitive environment.” Dr. Lantigua was named AIM’s medical director in 1995. He has brought to the position his leadership experience in the northern Manhattan community. He is founder and chairman of the board of directors of the Alianza Dominica, the largest community-based organization in northern Manhattan; past president of the Dominican Medical Society; and a board member of many other community organizations. Also, the Department of Medicine house staff clinic merged with the faculty practice of AIM to improve house staff teaching and supervision. Dr. Carmen Ortiz-Neu and 25 other full-time faculty staff the AIM practice, a faculty practice success story at Columbia-Presbyterian. Research Over the past five years the division’s clinical research program has grown to support about $2 million per year in sponsored research (mostly funded by the NIH) focusing on aging, epidemiology of cardiovascular disease, health services, and medical informatics. These programs emphasize research questions related to the health care of minorities and draw heavily on community residents who volunteer to participate in clinical studies. The success of the faculty in conducting population studies in northern Manhattan is largely due to the commitment of AIM to providing clinical services to this community. The clinical program has grown from 40,000 visits per year in 1993 to the current 55,000 annual visits. An additional 15,000 visits per year are anticipated next year with the opening of the new clinical space in Audubon Park’s Berrie Pavilion. “The success of AIM is an example of what can be achieved with strong support of the university and hospital working together,” says Dr. Shea. He attributes AIM’s success to support by the Department of Medicine; the practice’s partnership with hospital leadership; the teaching program and partnership with house staff; the recruitment, development, and creation of career paths for talented young faculty; information systems; and the training, motivation, and morale of AIM’s support staff.

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