Primary Care in Miami

Acute Care Services and Academic Health Centers 

Critical care services comprise of palliative, rehabilitative, curative, preventive, and promotive actions that are oriented towards populations or individuals, and whose aim is improving health ( Hirshon et al., 2013) . The effectiveness of the activities mainly relies on rapid intervention and time sensitivity. Acute care is the opposite of long term care or chronic care, and it pertains to patients receiving short-term active treatment for episodes of illness or severe injury when recovering from surgery, or in cases of an urgent medical condition. Further, acute care services focus on such aspects as short-term in-patient occupation and/or physical therapy for hospitalized patients. The critical care settings comprise of neonatal intensive care, cardiology, coronary care, intensive care, and the emergency department, as well as other areas where patients may fall ill and require transfer and stabilization in other higher dependency units for advanced treatment. Unlike other forms of care, including tertiary, secondary, and primary care, acute care does not imply the level of care but rather the duration of the care provided as well as the onset of a patient’s condition. 

The Lennar Foundation Medical Center incorporates primary care services in its structure and operations in various ways (The Lennar Foundation Medical Center, 2019). Primary care services refer to the day-to-day healthcare services provided by healthcare providers, who act as the critical point of continuing care as well as the initial contact with the healthcare systems ( Hirshon et al., 2013) . Typically, primary care includes optometry or eye health, dental, community pharmacy, and general practice. The Lennar Foundation is located within the University of Miami, the only academic medical center found within Miami. The health facility comprises of a fully functional ambulatory care center without the beds. It encompasses a full range of centers of excellence and clinical services that are only available on an out-patient basis. The facility is designed in a way that allows easy access for the patients from the initial contact, which involves making an appointment to the final stage, which includes a post-discharge meeting. 

The Lennar Foundation focuses on the provision of individualized, specialized care, particularly oncology, neurology, mammography, cardiology, pain management, outpatient surgery, otolaryngology, ophthalmology, sports medicine, and physical therapy among others. The foundation comprises of comprehensive diabetes centers and offers wide-ranging imaging services. The primary care services incorporated in the facility include optometry or eye services, which are located near the diabetes care to allow patients to move from one department to the other, since a large number of patients who have diabetes, demonstrate significant eye problems (The Lennar Foundation Medical Center, 2019). Besides, the facility incorporates primary care by increasing accessibility to the services offered through the use of technology. The facility has a way-finding app, created by Gozio Health, which enables clients to make appointments, get updates on changes or delays in the appointment, or look up the available care providers from the University of Miami. 

Federally Qualified Health Centers (FQHC) 

Health centers are organizations that are patient-centered and consumer-driven, serving as cost-effective and comprehensive primary healthcare options for the underserved communities in the U.S. The organizations serve everyone, irrespective of their insurance status or ability to pay. One of the primary roles of the organizations is providing integrated services and increasing access to healthcare from the unique needs of the populations that they serve (JTCHS, 2019). Four significant components describe health centers and ensure that they reach the most underserved communities in America. The ingredients include; their governing boards comprise 51% of patients, they are open to everyone, they offer a comprehensive set of services, including enabling, behavioral health, vision, dental, and medical services, and they are located in high-need areas. 

The focus of this question is the Jessie Trice Community Health System, Inc. (JTCHS). The organization serves 55 locations within Miami Dade County (JTCHS, 2019). The organization is among the health centers that are federally qualified in the region, and it mainly focuses on reducing the health disparities within the region. JTCHS incorporates primary care services in their structure and operations in some ways, including ensuring that everyone has fair access to healthcare services irrespective of whether they have insurance or can pay for their services or not (Jtchc.org, 2019). Further, the organization focuses on the provision of care services and treatments that resonate with primary care, by implementing intervention and prevention initiatives that address such conditions as dental caries in children, cancer, depression and addiction counseling among other mental disorders, immunizations, perinatal/prenatal health, hypertension, cardiovascular diseases, pediatric asthma, HIV/AIDS, and diabetes among others. 

JTCHS serve as the initial points of care for a significant number of underserved communities within Miami. Further, although the organizations provide preventive care, they primarily provide primary care mainly focusing on medical services, behavioral health, dental services, as well as vision services (Jtchc.org, 2019). The organization meets its objective, especially among individuals who cannot afford to pay for care services by partnering with Medicaid, which is the biggest insurer for disabled and low-income populations. 

Care for Military Veterans and Dependents 

Military dependents and veterans in the South Florida counties access to care via the Miami VA Healthcare System. The system is a comprehensive medical provider covering such areas as surgical, general medical, and outpatient and inpatient mental health services among others. The method comprises of a Geriatric Research, Education, and Clinical Center (GRECC), a rehabilitative center specializing in spinal cord injury, a prosthetic treatment center, and an HIV/AIDS center (Miami.va.gov, 2019). The system is primarily recognized as a chest pain center, a spinal cord injury research center of excellence, and it is also highly appreciated in the treatment of substance abuse. The Miami VA also provides specialty services, including open-heart surgery to other VA facilities in the country as well as Florida. The facility aims at honoring veterans in America by providing them with outstanding healthcare that enhances their wellbeing and improves their health. Healthcare providers working at the facility provide both highly specialized care as well as primary care to the veterans. The facility incorporates all the facets of internal medicine, including pulmonary diseases, nephrology, immunology, infectious diseases, hepatology, hematology, general medicine, gastroenterology, endocrinology, critical care, cardiology, and arthritis. 

The facility incorporates primary care services within its structure by implementing diverse program specialties that focus on the provision of primary care in addition to the specialized services. The programs include adult day healthcare (ADHC), home telehealth, medical foster homes, hospice and palliative care, home-based primary care, geriatric primary care, and a community living center (Miami.va.gov, 2019). The ADHC refers to an outpatient day program that is therapeutically oriented, which provides rehabilitative and health maintenance services to functionally impaired and frail elderly veterans within a congregate setting. The program aims at encouraging socialization between combatants within the same group. The individualized care programs are delivered through an interdisciplinary health professionals’ team and support staff while emphasizing on the need for the caregivers and participants to enhance the skills and knowledge required in managing care within the home. 

On the other hand, telehealth or care coordination focuses on the use of a team approach and technology in assisting in the coordination of care among the elderly veterans, who face a high risk of emergency department visits and hospitalization (National Association of Community Health Centers, 2018). The programs employ technology in monitoring particular chronic health conditions within the home settings. The program mainly aims at minimizing hospitalizations and emergency department visits, therefore reducing the costs of providing care, while delaying the onset of long-term care placement and enhancing the quality of the attention that the veterans access. The technologies applied include T-CARE and telephone linked care (TLC) for dementia (National Association of Community Health Centers, 2018). T-Care utilizes technology in the management of diverse chronic diseases, including chronic lung disease, heart failure, hypertension, and diabetes. On the other hand, TLC uses team effort and technology in coordinating care for veterans suffering from dementia, as well as in supporting and educating caregivers to ill veterans. 

There are four critical modalities through which veterans access healthcare services through virtual care, including VA video connect, store-and-forward telehealth, clinical video telehealth, and home telehealth. The home telehealth program applies technology to aid in monitoring the health conditions of the enrolled veterans (Miami.va.gov, 2019). With the veteran participating daily, the home telehealth technology enables the team providing healthcare to monitor the veteran’s health conditions closely, including PTSD and depression among other requirements; coordinate care as required; and support the education of the veterans focusing on self-management. Moreover, the program utilizes a secure and encrypted video conferencing system in connecting providers to veterans in real time. On the other hand, the facility has implemented a new solution to facilitate meetings between providers and veterans, named a virtual medical room (Miami.va.gov, 2019). The technology utilizes encrypted video in ensuring that each session is secure and private, as well as enabling providers to see and talk with the veteran patients located in different areas from the comfort of their offices as long as where the veterans are located have an internet connection. The technology further enables veterans to connect with their VA providers using video-capable devices from any area with an internet connection. 

On the other hand, the community living center program provides veterans with a home-like environment during their stay at the medical center. The program specializes in caring for patients who have therapeutic potential and at the maximum hospital benefit but still require supportive personal care, skilled nursing care, and the individual adjustment services (Miami.va.gov, 2019). Further, the geriatric primary care program focuses on the provision of high-quality primary care that is designed and specialized in assessing, evaluating, and establishing a comprehensive plan of care, which is specialized for the elderly patients on an out-patient basis. 

Moreover, primary care is incorporated within the geriatric evaluation and management program, which is a specialized program that targets groups of older patients to benefit from comprehensive interdisciplinary management and assessment (National Association of Community Health Centers, 2018). The team engaged in the program aims at developing a comprehensive plan of care in addressing the geriatric syndromes and other issues that relate to the elderly. Further, the home-based primary care program focuses on providing primary care to veterans suffering from multiple psychosocial and chronic medical problems within the care homes. The program offers patients and their families with an alternative to placement in the nursing home and helping to maintain social, mental, and physical functioning, as well as minimizing the frequency of hospitalization. 

The program comprises of a team of an interdisciplinary group of professionals that are hospital-based including physical therapists, social workers, dieticians, nurse practitioners, medical doctors, registered and psychiatric nurses, and psychologists. The roles of the professionals overlap in providing comprehensive primary care to veterans within the home environment. Besides, the palliative and hospice care program represents a range of supportive and comfort-oriented services offered within the inpatient and outpatient settings for individuals with diseases that are advanced and life-limiting (Miami.va.gov, 2019). The program emphasizes on relieving suffering as well as the provision of comprehensive management of the spiritual, social, emotional, psychological, and physical patient needs. Finally, the medical foster home programs comprise of a unique partnership that combines home-based primary care and adult foster homes that operate under the guidelines of the community residential care. The program involves finding caregivers within the community who are willing to host veterans in their homes and provide 24-hour personal assistance and supervision (National Association of Community Health Centers, 2018). The program entails a long-term commitment, and veterans may end up living in the homes for the rest of their lives. Veterans joining the program are expected to satisfy all the nursing home criteria. 

Community Health and Specialized Services 

The community health delivery system in Miami refers to a comprehensive and integrated model that is driven by the identified healthcare barriers and needs of the local community, including lack of insurance, poverty, the fear of deportation, linguistic, racial, and cultural diversity, adverse health beliefs and attitudes, mental health conditions, and untreated chronic disease ( Arzimanoglou et al., 2016) . The community health centers provide a broad range of services, including great care services, such as immunizations, screening, and routine check-ups among others. They also offer sick visit and emergency care for such diseases as flu and colds; management and treatment of such acute and chronic conditions as hypertension, diabetes, asthma, and arthritis. Other services include diagnostic procedures, an obstetrician and gynecological services, and such ancillary services as laboratory, radiology, and pharmacy. On the other hand, for the specialized services that the community health centers cannot manage, such as neurology and cardiology, the facilities refer patients to specialists within the region ( Arzimanoglou et al., 2016) . The significant components of the community, health care system, include the integration of behavioral and primary health care services. Mental health counselors are engaged in the screening of all patients for substance and alcohol abuse, schizophrenia, anxiety, and depression within the primary care units, and make referrals to the mental health providers. 

Jackson Health and Nicklaus Children’s Hospital are among the leading community health facilities that specialize in the provision of pediatric care. Jackson Health provides skilled nursing care to children that incorporate early interventions for children with special needs (Chang, 2019). The facility includes primary health care services, which are delivered through the primary care physician found at the facility. In cases where children require specialized care, they are referred to pediatric specialists. The specialties involved include behavioral pediatrics, adolescent medicine, general pediatrics, pediatric allergy and immunology, pediatric and congenital cardiac surgery, pediatric dermatology, pediatric endocrinology, pediatric general surgery, pediatric genetics, and adolescent and pediatric gynecology, orthopedics, neurosurgery, neurology, nephrology, intensive care, and infectious disease among others (Chang, 2019). Similarly, the Nicklaus Children’s Hospital focuses on providing specialized care to children, whereby it combines both elements of primary care services, such as general ailments affecting children, and specialized care concentrate on such aspects as neurosurgery, pediatric congenital cardiac surgery, and pediatric neurology among others ( Arzimanoglou et al., 2016) . 

Memorial Health System 

The Memorial Healthcare System is ranked among the leading institutions in the provision of high-quality healthcare to the residents of South Florida. Presently, it is ranked among the most significant public healthcare systems in the country, and it is credited for its outstanding family and patient-centered care. The system consists of six hospitals, a level 1 trauma center, one nursing home, three neonatal intensive care units, one home health agency, and seven community health centers (Mhs.net, 2019). The health system incorporates primary care services within these facilities, particularly at the hospitals and the community health centers. For instance, the Memorial Regional Hospital provides diverse and extensive health care services through the Memorial Neuroscience Institute that provides world-class physicians and innovative technology, the Memorial Cancer Institute that treats the most significant number of inpatients compared to any other facility in the region, and the Memorial Vascular and Cardiac Institute that features renowned surgeons. 

Majorly, the system incorporates primary care services in the provision of post-acute care, which is a common feature in the facilities since they are highly engaged in the management of critical medical events, including cardiac surgery and cancer among others. Moreover, the health system consists of several primary care centers that are dedicated to the provision of patient-centered, cost-effective, and high-quality primary care (Mhs.net, 2019). The primary care team works towards meeting the healthcare needs of each patient in a culturally sensitive and friendly environment. Some of the major services offered at the primary care centers include vaccinations, physical examinations, high blood pressure and diabetes management, health screenings, and treatment for minor injuries and illnesses. 

Comparing Primary Care in Miami versus the New York City 

Primary care in Miami is similar to that provided in New York City, in that in both contexts. It provides the initial point of contact for patients with the health care system. Moreover, primary care services in both cases comprise of general practice, dental, eye health, and community pharmacy. Further, primary care in both New York and Miami is incorporated within the existing health care systems which range from hospitals to the community health centers that seek to provide care to the underserved groups. All the healthcare facilities that offer specialized services also incorporate primary care services, which aim to achieve better patient outcomes. However, primary care in New York City differs from that of Miami from the perspective of the patient population that they serve. Unlike New York City, Miami's primary care mostly considers and integrates the diverse cultural, racial, and linguistic diversity, aspects of fear of deportation, and higher poverty levels. 

Reference 

(JTCHS). (2019). Jessie Trice Community Health System [Ebook]. Retrieved from http://www.fachc.org 

Arzimanoglou, A., Cross, J. H., Gaillard, W. D., Holthausen, H., Jayakar, P., Kahane, P., & Mathern, G. (2016).  Pediatric Epilepsy Surgery . John Libbey Eurotext. 

Chang, D. (2019). On the brink of disaster, Jackson turns profitable thanks to visionary CEO. Retrieved from https://www.miamiherald.com/news/health-care/article74816342.html 

Hirshon, J. M., Risko, N., Calvello, E. J., Ramirez, S. S. D., Narayan, M., Theodosis, C., & O'Neill, J. (2013). Health systems and services: the role of acute care.  Bulletin of the World Health Organization ,  91 , 386-388. 

Jtchc.org. (2019). Jessie Trice Community Health Center. Retrieved from https://www.jtchc.org/ 

Mhs.net. (2019). Memorial Primary Care. Retrieved from https://www.mhs.net/services/community-health 

Miami.va.gov. (2019). Medical Foster Home Program - Miami VA Healthcare System. Retrieved from https://www.miami.va.gov/services/MFH.asp 

Miami.va.gov. (2019). Miami VA Healthcare System. Retrieved from https://www.miami.va.gov/ 

National Association of Community Health Centers. (2018). Telehealth and Health Centers [Ebook]. nachc.org. 

The Lennar Foundation Medical Center. (2019). The Lennar Foundation Medical Center | University of Miami Health System. Retrieved from https://umiamihealth.org/locations/the-lennar-foundation-medical-center