One of the oldest of these programs, Associates in Internal Medicine (the AIM clinic), celebrated its 25th anniversary this year. AIM, which opened in 1977, provides primary care for more than 17,000 residents of Northern Manhattan, an area whose population is approximately 85 percent minorities. AIM integrates a faculty practice with a forum for training medical residents and a research setting that provides understanding of the unique health needs of urban minority populations and helps test novel community-based interventions. Neighborhood residents have access to the latest innovations in primary care medicine and clinical research, options that would be unavailable to many of them without AIM.

Through AIM, community residents are helping to assess an innovative new home diabetes management program as part of the Informatics for Diabetes Education and Telemedicine (Ideatel) clinical trial, the largest civilian telemedicine study ever funded by the federal government. An “electronic house call” system, Ideatel works via specially equipped computers installed in the homes of study participants. The devices read blood sugar, take pictures of skin and feet, and check blood pressure. The data are regularly transmitted over the Internet to AIM’s computers for physicians to review. The patients also can review their own health information and learn more about how to manage their disease. If the trial demonstrates that telemedicine can improve care for elderly people with diabetes, its model will be used to help develop more effective treatments for other diseases such as depression, obesity, asthma, and heart failure. The clinical trial includes New Yorkers in rural settings too.

Established in 2002, Columbia’s Center for Community Health Partnerships unites students and practitioners from the medical school with epidemiologists and health promotion experts from the Mailman School of Public Health. Within the center, two vigorous health promotion programs will serve as models for many more to come. The Northern Manhattan Community Voices collaborative involves faculty and students from medicine, public health, and dentistry in a variety of projects, from developing a new health insurance product for the uninsured in the community to working with community organizations to sign up more people for Medicaid and other insurance reimbursement programs. Community Voices also will work with more than 25 community-based programs to launch an ambitious series of health promotion initiatives that will focus on such issues as asthma prevention, tobacco intervention, and a mental health report for Northern Manhattan.

WASHINGTON HEIGHTS, MANHATTAN The best health care in Washington Heights may arguably be delivered at the AIM—Associates in Internal Medicine—group practice, which has been at the forefront of health care in Washington Heights since its founding 25 years ago. Medical Center neighbors receive the latest innovations in primary care and advance the research mission of Columbia through research projects that often illuminate the unique needs of minority patient populations. The clinic is also well-suited to pairing patients with clinical research opportunities. The clinic sees 70,000 patients every year at its facilities in Vanderbilt Clinic and in the Russ Berrie Medical Science Pavilion. From left are Dr. Rafael Lantigua, professor of clinical medicine and medical director of AIM; Ana Delgado, an AIM patient; and Dr. Steven Shea, the Hamilton Southworth Professor of Medicine at P&S, professor of epidemiology at the Mailman School of Public Health, and chief of the Division of General Medicine. Drs. Lantigua and Shea have overall administrative responsibility for AIM.

Two new medical education initiatives not only take medical residents into the community, but into their patients’ homes and lives in ways that offer singular insights into their families, their environments, and their health care needs. The new Primary Care Home Visit Program, supported with a grant from the Arnold P. Gold Foundation,  takes primary care residents out into the streets and neighborhoods their patients call home, helping them build closer bonds with their patients and understand the realities of their daily lives. They see the conditions in which some patients live. They learn about the difficulties of walk-up apartments, dealing with public transportation, and obtaining follow-up care when you live alone. “To listen to a patient speak about how arthritis is affecting her knees is one thing, but to watch her labor for 20 minutes to climb two flights of stairs is an understanding altogether different,” primary care resident Deepu Gowda reflected.

Now in its second year, the Community Pediatrics Program offers similar community-based experiences for pediatric residents, through interdisciplinary partnerships with the Mailman School of Public Health and with Teachers College, and in collaboration with the resources of the community. Residents work with such local groups as Project F.A.I.T.H. (Families and Individuals Towards Harmony), a borough-wide program providing services to victims of domestic violence, the Healthy Parenting Program of Children’s Hospital of New York, and the Visiting Nurse Service.

Community collaboration often leads to innovation. Working with seniors at Manhattan’s Burden Center for Aging, Columbia occupational therapy students and faculty invented “Open-It,” a new kitchen tool that will be distributed to nearly 20,000 homebound elderly across the city through a partnership with Citymeals-on-Wheels. Open-It helps people with limited mobility open cans and boxes. It’s meeting an enormous need, since as many as 7 percent of people over age 65 need help preparing meals and opening food containers.

Columbia’s partnerships also extend beyond the medical center’s immediate environs to cover the metropolitan area. A novel minority research fellowship program, in partnership with Hunter College, was so successful last year that it’s earned a permanent place at Columbia, with plans for expansion to other area colleges. The first 10 Columbia minority summer research fellows spent eight weeks studying under prominent mentors in pharmacology, cell biology, biochemistry, and molecular cardiology. The fellowship program fosters the biomedical research interests of promising young minority students and promotes closer ties between Columbia and area undergraduate schools. The program replicates, on the local level, the impressive success of the national Minority Medical Education Program, which celebrated its second year at Columbia in 2002. Columbia’s site is one of 11 MMEP programs administered by the Robert Wood Johnson Foundation. MMEP gives college students clinical exposure, intensive study in the biomedical sciences, and preparation for the MCAT exam.

Up to 50 young patients each month receive life-changing care—at no charge—through Columbia-Presbyterian’s pediatric plastic surgery clinic, the only purely pediatric plastic surgery center in the New York area set up to care for financially disadvantaged patients. The three plastic surgeons at the 2-year-old center donate their time to treat everything from simple cases of prominent moles to complex craniofacial abnormalities. The clinic’s staff, meanwhile, helps patients’ families get Medicare and Medicaid coverage to pay for hospital costs. Although most patients seen at the clinic live nearby in Washington Heights, the program accepts all pediatric referrals.

UPPER EAST SIDE, MANHATTAN At the Burden Center for Aging, seniors like Kenneth I. de Vries helped Columbia’s occupational therapy faculty and students invent a kitchen tool to help seniors open cans and boxes. The tool is being distributed to nearly 20,000 homebound elderly across the city through a partnership with Citymeals-on-Wheels, and wider distribution is planned. Photographed with Mr. de Vries at the Burden Center are Dr. Patricia Miller, the faculty member who led the project, and Jessica Pitt’03, an occupational therapy student. Research and education related to the tool are continuing. Assisted living devices often go unused unless seniors are trained in how to use them, says Dr. Janet Falk-Kessler, director of the occupational therapy programs at P&S.

In many programs, in fact, Columbia’s outreach to the community stretches well beyond its immediate environs in Washington Heights to include all five boroughs of New York City. Nowhere has that been illustrated more vividly during the past year than in the school’s leadership in responses to 2001’s terrorist attacks. Much of what we now know about the vast extent of the mental health fallout from the attacks comes from collaborative psychiatric research led by psychiatrists and epidemiologists from P&S and the Mailman School of Public Health. Armed with this knowledge, a host of projects provided solace to thousands. In one program that will serve as a model for law enforcement counseling nationwide, Columbia joined the New York City Police Department to provide counseling, stress management, and telephone hotline support to some 15,000 police officers. In another effort, faculty from Columbia P&S and the Mailman School of Public Health joined with the Columbia School of Social Work, the New York State Psychiatric Institute, government officials, and labor unions to launch “A Common Ground,” one of the largest mental health projects for ground zero recovery workers. Several bioterrorism and public health preparedness projects also are under way in response to the 2001 events.

Opened in the winter of 2000, the Columbia Center for Heart Disease Prevention already can lay claim to being one of the largest preventive cardiac care programs in the country. The center contracts with dozens of New York companies to provide screening and preventive treatment to their employees, highly individualized to each patient’s needs with a complement of preventive care education, cardiovascular health screenings, and follow-up care for heart attack patients. Located in midtown Manhattan, the program also “connects the dots” by training physicians to put prevention into practice. A three-year clinical trial will combine data from a program at Cornell with Columbia’s results to assess the effectiveness of this kind of targeted cardiac intervention.

Another nationally renowned model providing unique care and services to our neighbors in Manhattan and elsewhere in New York is the newly expanded ALS Multidisciplinary Center, one of only two multidisciplinary ALS centers in the New York area (and one of only a few in the nation). The center, started in 1987 as the Eleanor and Lou Gehrig MDA/ALS Center, now brings together under one roof all the specialties required to treat amyotrophic lateral sclerosis, a complex and devastating neurodegenerative disorder. Patients also have access to one of the leading ALS research programs in the nation, in which researchers from multiple disciplines, including genetics, neurology, and cell biology, combine their expertise to test new drugs aimed at slowing the disease and to develop new neurological tests and genetic interventions for ALS.

BRONX, NEW YORK. As part of a new house call program for primary care residents, Dr. Sarita Shah, a third-year resident, visited her patient, Eva Pruitt, at home in the Bronx. The program helps doctors in training learn more about their patients by seeing where and how they live. Dr. Shah is shown here, at right, in Ms. Pruitt’s studio apartment. Also pictured is Dr. Delphine Taylor, center, who developed the program as associate director of the primary care track of the internal medicine residency program. When Drs. Taylor and Shah visited Ms. Pruitt at home, they discovered that the assisted living facility where she lives provides additional nursing and social services. Ms. Pruitt was born at Columbia-Presbyterian and continued to seek care from the medical center even after moving to the Bronx.