No abstract

OBJECTIVES: This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities. METHODS: A brief questionnaire was used to ask health agencies in all 50 states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs. RESULTS: Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program. CONCLUSIONS: The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative.

An Innovative Ward Project was undertaken as part of the planning for redevelopment of the Princess AlexandraHospital. Two inpatient units (one medical and one surgical) became pilot areas for developing, implementing andevaluating innovative approaches to service delivery. The project focused on the key areas related to structuralenvironment, information technology and redesign of work practices. This paper provides an overview which includesthe key elements utilised to foster innovation. The challenges of disseminating and adopting successful innovationsbeyond the Innovative Wards are discussed.