In the 1990s, as managed care took hold, many healthcare leaders in the United States expected that healthcare systems would become integrated around patient need. This expectation stemmed in large part from the pivotal and growing role of primary care services in care management. The US Agency for International Development (USAID) entered into a cooperative agreement with the American International Health Alliance to solicit proposals for developing community-based primary care. Temple University, in Philadelphia, entered a partnership with Kyiv City Health Administration in Ukraine to pilot a demonstration. The project led to the establishment of a Family Medicine Center to provide family medicine and integrated behavioral health services in Darnitskiy Rayon, Ukraine. A key aspect of the project involved identifying the health needs of the rayon (district), in part through the use of a geographic information system (GIS) component that assessed health at a neighborhood level. The project required a considerable amount of effort, close collaboration between the center and neighborhood health centers and the rayon polyclinic (multispecialty clinic), and the retention of staff capable of data analysis and interpretation for program planning purposes.During the period of the USAID-funded project, the Family Medicine Centers physicians, nurses, social workers, psychologist, and information systems staff received extensive training to support development of their roles within an innovative community-based primary clinic. Behavioral health integration and the collection and analysis of data were successfully implemented. The project demonstrated that primary care initiatives offer feasible and effective ways to improve the health of a constituent population. However, after completion of the project and the ensuing staff turnover, the clinic reverted to more traditional medical roles, though still based on delivery of high-quality primary care.

1. Is a population health management approach to primary care sustainable? What kind of efforts are required to continually monitor the health of the population served? What resources are needed?

2. How should the Family Medicine Center use data collected from multiple sources to better serve the population in its geographic area?

3. Imagine you are the director of the Family Medicine Center. What steps would you take to sustain a community-based approach to managing the health of the population after the completion of the demonstration project?