In 1835, four years after Cook County was incorporated, a three-member Board of Commissioners established the county’s first health services for the poor. This modest public health program has evolved, 165 years later, into the Cook County Bureau of Health Services.
The development of a better-coordinated network of care began in 1991, when the Bureau of Health Services was formally established. Through its affiliates, the Bureau provides care, education, and prevention training at health centers, clinics, schools, hospitals, and other sites throughout Chicago and suburban Cook County. The Bureau offers a comprehensive range of services from preventive and primary care to emergency/trauma, acute, rehabilitation, and long-term care.
Continually assessing and monitoring health trends, the Bureau shapes services to meet community needs. Bringing healthcare to the community that is responsive, effective, and efficient requires creativity and flexibility. Serving a population of more than five million people spread over a sprawling area poses logistical challenges to ensuring access to all those in need of services.
As part of its strategic plan, the Bureau focused on the dual strategy of creating a new, world-class Cook County Hospital while simultaneously creating a seamless system of care.
At the same time that access was being increased, efforts were underway to more cohesively coordinate the Bureau’s clinical, operational, and research activities. Bureau-level oversight of key areas allows the sharing of best practice models and the most cost-effective integration of care. It also further advances the goal of sharply focusing services and resources on meeting the physical, emotional, and social service needs of patients and their families.
These efforts, key parts of a strategic plan and vision, ensure that Cook County residents can access the most appropriate care in the most timely manner, and that they will be treated within a system of quality outpatient, inpatient, and long-term care services.
The CORE Center
The virulent spread of HIV/AIDS over the past 5 years has posed a special challenge to care givers. The Bureau’s innovative response to the AIDS crisis is an example of its commitment to control infectious diseases while offering advanced, holistic care to those persons who have become infected with HIV. The CORE Center, founded by the Bureau and Rush-Presbyterian-St. Luke’s Medical Center, serves as a national outpatient care model for persons who are HIV positive or have AIDS. It offers a one-stop approach to treatment. Services include primary care, laboratory testing, infusion therapy, pediatrics, dental care, specialty consultations and screenings, and mental healthcare. Complementary medicine, counseling, and social services are also provided. The first of its kind in the United States, the CORE Center offers compassionate programming in an uplifting setting.
Opened in the fall of 1998, the four-story CORE Center was also created to meet the special needs of patients with other infectious diseases including tuberculosis, hepatitis, and sexually-transmitted diseases. To ensure an environment and service that is responsive to patient need, the facility was designed with the involvement of patients and members of the community.
The Bureau recognizes its obligation not only to create a more effective internal system, but also to facilitate the development of a more integrated healthcare system in Cook County as a whole. The Bureau has developed collaborations with the goal of expanding services at the neighborhood level while eliminating costly duplication. These partnerships have increased primary capacity for indigent patients, established community delivery sites for low-risk mothers, and expanded the access of specialty services offered by the Bureau to community providers.
The Cook County Bureau of Health Services partners with hospitals, healthcare centers and community organizations. Current hospital partnerships include Bethany Hospital, Jackson Park Hospital, Northwest Community Hospital, Rush-Presbyterian-St. Luke’s Hospital, Saint Anthony Hospital, Saint Elizabeth Hospital, Saint James Hospital, and Thorek Hospital.
The National Association of Public Hospitals and Health Systems recognized the Bureau’s community partnership initiative with its annual health system innovation award for the County’s innovative partnership program.
The Bureau also established an innovative collaboration with the Chicago Department of Public Health. In 1991, the Bureau and the Department established a countywide forum, the Chicago/Cook County Community Care Council, to address the healthcare needs of the area, particularly the needs of those communities which have limited access to health services.
The Council has mobilized local residents and providers to join together on such programs as enrolling children in the KidCare medical insurance program and addressing the problem of asthma, which disproportionately impacts poor communities.
Bureau-Wide Integration of Services
As part of the Bureau’s strategic plan, selected medical and prevention services are evolving into Bureau-coordinated departments and initiatives. In order to both maintain patient continuity of care and to most effectively utilize physician resources, the Bureau has been building an integrated medical staff for its hospitals and clinics.
As an example of how the Bureau draws from the strengths of its affiliates, an Oak Forest Hospital physiatrist and intake team are now in place at Cook County and Provident Hospitals. They work directly with treating physicians, and they facilitate transfers to Oak Forest’s rehabilitation unit. This ensures continuity of care and maximization of rehabilitation potential for persons with disabilities.
Specialists from the Cook County Hospital Departments of Medicine, OB/Gyne, Pediatrics and Surgery are now providing services at other Bureau hospitals, Cermak Health Services, and selected community clinics. Emergency medicine departments at Cook County and Provident Hospitals are now benefiting from the insight, experience, and expertise gained from Bureau-level coordination. This combined department, operating both Provident and Cook County hospital services, now represents one of the largest departments of emergency medicine in the country.
Community clinics are staffed primarily with physicians who also hold appointments in the clinical departments at Cook County, Oak Forest, and Provident Hospitals. This integration effort has prevented the duplication of specialty care physicians, increased clinical standardization among hospitals, and assured greater continuity between outpatient and inpatient settings.
Some of the Bureau-level departments have evolved into centers of excellence for the Chicago area. A few examples are profiled below.
Centers of Excellence
Since 1980, the incidence of asthma has more than doubled in the United States. Asthma is responsible for more than 70,000 visits to emergency departments in Chicago annually, a large number of them coming to the Cook County Hospital ER. Residents of poorer neighborhoods experience higher rates of asthma and disease-related mortality. However, Cook County physicians know that, with appropriate education beginning at the primary-care levels, the number of emergency room visits can be reduced and the quality of life improved for persons with asthma.
Cook County Bureau initiatives, funded in part by major grants, have taken a multi-pronged approach to treating and managing asthma. For example, the emergency department has focused on maximizing drug efficacy, while the pediatric allergy department has focused on the relationship between heightened allergy sensitivities and asthma in children.
Given the prevalence of asthma in many of the communities served by the Bureau, there has been an emphasis on provider and patient education. The Ambulatory and Community Health Network has trained practitioners to teach patients about self-care and self-monitoring to prevent th eonset of respiratory failure. Asthma patients are counseled on how to reduce or eliminate environmental catalysts such as smoking, pets, insects, and adverse irritants and toxins on the job.
By creating a seamless system of asthma care, the more serious patients are identified earlier and referred to specialists. In addition, patients are given the most appropriate level of care at the time, including the most effective medications while being provided the tools to become partners in managing their disease.
The Cook County Bureau of Health Services treats more cancer than any other system in the Chicago area. As a result, the system is consolidating its efforts at early detection, intervention, and treatment by strategically allocating resources and increasing community access to cancer services. This effort has particularly targeted breast, cervical, and prostate cancers – illnesses disproportionately affecting patient populations using the Bureau system.
Radiation therapy contracts now allow Bureau patients to receive treatment at five geographically convenient sites throughout the County, and chemotherapy services are now in place at all three Bureau hospitals. The Women’s Cancer Center of the Bureau is based at Cook County Hospital, and other multi-disciplinary cancer clinics provide coordinated treatment throughout the entire system. To assure access to mammography exams, the service was added at Oak Forest Hospital and the Prieto Health Center and expanded at Provident and Cook County hospitals. A mobile mammography van tours Cook County, offering women the opportunity to have a breast examination close to home. In addition, women are offered free breast and cervical cancer tests through the Cook County Department of Public Health.
The emergence of virulent forms of sexually transmitted diseases, hepatitis, and tuberculosis has created enormous challenges for public health efforts. In order to offer optimal treatment to infected patients, the Bureau has emphasized research and best practice models disseminated throughout the system. The consolidation of specialized infectious disease care in the CORE Center occurred at the same time that the Bureau was expanding preventive education and general treatment into additional community sites.
Expansive drug, clinical, and social medical research plays an increasingly important role in the Bureau’s infectious disease initiatives. Funded research projects include: a study to decrease the transmissions rates between mothers with HIV and their newborns; a study to increase the number of women who return for HIV test results and counseling; and a study to evaluate the effectiveness of integrating mental health services, primary care, and chemical dependency assistance for persons with HIV. Because of the credibility of its research and the reputation of its medical staff, the Bureau received a $3 million grant form the Center for Disease Control and Prevention in Atlanta to develop a long-term strategy to control infections that resist standard antibiotics. The study will develop protocols that could help physicians throughout the nation better control drug-resistant viruses.
Maternal and Infant Health
A Bureau level director for Maternal and Infant Health Services was recently appointed to coordinate a comprehensive system of care for pregnant women and their babies. The goal of the program is to assist in safe deliveries and healthy infants. Women are being offered, through the geographical expansion of maternity and specialized perinatal services, an increasing number of care and delivery options based on where they live and their individual medical, educational and social needs.
In addition to pregnant moms cared for at Bureau locations and partner hospitals, clinics for mothers with high-risk pregnancies are now offered at Cook County, Provident, Saint Anthony and Saint Elizabeth hospitals, as well as Cermak Health Services.
Creating community-based maternity options for women, many of them economically disadvantaged and living in previously underserved areas, allows them new opportunities for healthy deliveries and an increased sense of empowerment. The Bureau, in most cases, can offer a woman with a low-risk pregnancy the option of an obstetrician-gynecologist, family practice physician or midwife for her delivery. As an added benefit to facilitate a smooth delivery, women receiving prenatal care at Bureau clinics can call an ambulance to be transported to Bureau hospitals for deliveries without charge.
From the Bureau’s perspective, violence is treated as a public health problem that can be reduced through prevention strategies. It has been singled out as a prevention initiative for the Bureau because of the large number of patients, particularly in the trauma and emergency room departments, who receive Bureau services for violence-related injuries. To more effectively target the many forms of violence, the Bureau developed a task force to draw together best practice models for implementation and to share them with other community agencies and organizations. Programs are underway to train employees to identify victims of domestic violence, to assist at-risk youth in avoiding gun violence, and to reduce the likelihood of workplace violence.
Because gun violence plays an increasing role in injuries and deaths, the Bureau focused on developing a comprehensive plan to address this issue. The plan includes an educational curriculum and intervention strategies to assist gun violence patients in reducing risk factors for becoming repeat victims or offenders. Representatives of the Bureau staff and its affiliates also play an active role in advocating for changes in public policy that will reduce gun violence.
Six years ago, Cook County Hospital entered into an academic partnership with Rush Medical College. This educational partnership has resulted in innovative training programs, providing a unique scope of experience to residents and medical students. In addition, the two institutions have been able to develop joint initiatives which have expanded access to specialized services in the most efficient way possible. Also in 1994, Provident Hospital and Loyola’s Stritch College of Medicine developed an affiliation, which resulted in a joint Family Medicine Residency Program, located at Provident.
In 1993, the Bureau established a Research Development Office to encourage grant-development, to foster research that would benefit both the health system and its patients, and to assure strict compliance with research guidelines and ethics. As a result of the consolidation, grant funding has increased by more than 50% over the past five years. To better target appropriate funding sources and projects, ongoing workshops now take place in grant development at all Bureau received approval of a Multiple Project Assurance from the federal Office for Protection from Research Risk. The certification “licenses” the Bureau to carry out federally-funded research in all of the Bureau affiliates.
Unlike many academic medical centers that focus solely on clinical and basic research, the Bureau places an emphasis on social medical research and research that improves the delivery of healthcare. This includes treatment the environmental context of disease, learning how to interact with an motivate patients, creating changes in behavioral attitudes toward medical care, and assisting in managing and controlling diseases and reducing their occurrence.
These milestones are representative examples of the commitment of the Cook County Bureau of Health Services. The changes in the last few years are extensive and will have a long-lasting positive impact on the public health of Cook County. The last decade built a strong foundation to insure an effective, responsive public healthcare system well into the 21st Century.