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1 On March 10, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Seven months later a key feature of the bill, the Center for Medicare and Medicaid Innovation (Innovation Center), opened its doors. While the ACA looks to restructure key features of the US healthcare payment systems, the Innovation Center serves as an incubator of new ideas to deliver and pay for care that will improve quality and decrease costs. To this end, its $10 billion budget sets in motion demonstration projects to increase access to high-­ quality, cost-­ effective, and coordinated healthcare for beneficiaries of Medicare, Medicaid, and state children’s health insurance programs. Its charge is to rigorously and rapidly assess the progress of these demonstrations, and to replicate those with a “high return on investment” in communities across the country. Its first initiative, Strong Start for Mothers and Newborns, has now funded 182 demonstration projects to improve the health of mothers and babies. The intent is that the more successful of these demonstrations can be scaled up to national initiatives that will reduce early elective deliveries, decrease preterm births, test new approaches to prenatal care, and improve outcomes for mothers and babies.1 The Center for Medicare and Medicaid Services (CMS) has a thirty-­ year history of supporting such demonstration projects, most recently in value-­ based payment systems and disease management and care coordination.2 Yet demonstration projects in healthcare in the United States predate the CMS’s initiatives. Nursing with a Message examines the history of the first such demonstration projects in New York City in the 1920s and 1930s, a period commonly referred to as the interwar years. Surprisingly, historians have yet to look systematically Introduction 2 Nursing with a Message at these health demonstration projects that were testing new models of healthcare delivery in selected urban and rural communities throughout the country. The brief accounts that do exist are embedded in the histories of the foundations and philanthropies that supported the projects or in the histories of city and state public health departments that looked to them for their policy and practice implications.3 The East Harlem Nursing and Health Demonstration Project, one of New York City’s signature demonstration projects, has had some recognition for its seeming success in settling long-­ simmering debates about the best organizational structure for public as well as private public health nursing.4 But this book approaches these demonstrations in New York City as they relate to each other rather than, as in prior work, in isolation. We need to do this for two reasons. First, there exists an entrenched, yet erroneous, belief that public health prevention and treatment services had their roots in the community health movement of the 1960s. Second, and even more significantly, the United States stands ready to commit significant resources to bolster and expand the capacity of community health centers to provide comprehensive, high-­ quality, and coordinated care that will target health disparities for low-­ income individuals, racial and ethnic minorities, rural communities , and other underserved neighborhoods. It is as committed—­ as in the past—­ to identifying and using key quality improvement data to disseminate best practice models to hospitals and healthcare systems throughout the country .5 It is urgent that we understand the history of an earlier movement also committed to access, quality, care coordination, and data to more fully understand all the possibilities and the problems of a national agenda rooted in the needs of particular families and communities. Three threads, mirroring those of other health demonstration projects throughout the country, ran through all of New York City’s projects. The first involved a commitment to broaden public health initiatives to pregnant women and preschool children. These populations had been overlooked in the prewar emphasis on infants and school-­ aged children. Yet, both mothers and their very young children had, as so many do today, appalling rates of morbidity and mortality. The second centered on initiatives that would teach individuals and families to demand health as well as illness care from their own private physician or, if unable to afford such medical care, from publicly funded clinics. The third was the central place of the public health nurse as the agent who would deliver these messages in her daily rounds in neighborhoods and homes. This last thread seemed self-­ evident. Public health nurses had long considered themselves and had been considered by others as the “connecting link”—­ between patients and physicians, between and among...

Subject Headings

  • Community health nursing -- New York (State) -- New York.
  • Public health nursing -- New York (State) -- New York.
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