By Joel Abrams and Bill Walczak

The Boston Public Health Commission's (BPHC) Health of Boston Chartbook 2004 does not reflect well on the health of Dorchester. Even the relatively good news, such as the decline of overall mortality rates, and of asthma related hospitalizations for young children was tempered by their having surpassed the Boston rates.

When it came to data regarding violence, tobacco use, obesity, diabetes, low birth weight and other health conditions, the results were disturbing at a minimum and even alarming in many instances. Reactions among local health officials and community residents in Dorchester understandably have ranged from dismay to anger. Two Dorchester health centers, however, have refused to wring their hands over these disturbing trends. Instead, we have developed what we believe will prove to be among the most promising strategies for tackling these seemingly insurmountable problems. It is called DotWell.

DotWell, a 501c3 corporation, is a partnership between Dorchester House Multi-Service Center and Codman Square Health Center. It was established in 1998 as the Health Services Partnership of Dorchester to help us build and share infrastructure such as information technology and medical leadership. Since then we have expanded its scope to include shared medical, public health, environmental, civic and other community based services. The comprehensiveness of this model and the inter-disciplined nature of what we offer to our communities provide us with enormous opportunities to impact the health of those we serve.

To begin with, each health center brings to DotWell its significant financial, human and physical resources. This is not to say that the two organizations have merged. On the contrary one of the major principles in forming DotWell was that each organization would retain its corporate structure and identity, but at the same time we would look for opportunities to share and build new services to benefit our health centers and our communities. Our continuing aim is to convert these shared resources into synergy, i.e., services in which the whole becomes greater than the sum of its parts. DotWell's information technology department, for example, attracts a level of talent and engages in innovative projects that neither health center could have achieved had we maintained individual departments. Additionally, in creating programs that bridge our communities we can take advantage of facilities that offer a range of services each of which can have its own impact on health, but when related can increase that impact. This holds true for integration of clinical and non-clinical services as well.

Since health centers have traditionally offered more than medical care, including public health and outreach services, we have experience in integrating care within our organizations. It makes sense therefore to do this on a community wide level. And that is what DotWell does and on which it aims to expand. When we look at the disturbing information from BPHC about our community, therefore, we also look to DotWell as the ideal model of integrated and comprehensive programming that must be applied to meet the challenges inherent in the report.

What does that model look like? Perhaps a few examples would be illustrative. In addition to management support such as IT and shared financial leadership, we have health care management teams that address issues such as asthma, diabetes and obesity. Those teams work with youth and recreation staff to craft opportunities for those in care. Our FANtasitic Kids program (FAN=fitness and nutrition) integrates pediatrics, nutrition and recreation specifically targeted to children at risk of or demonstrating obesity. Our Kids With Asthma Can Swim program similarly integrates medical and non-medical management. We are developing a self-management program for individuals with diabetes that will complement the care we currently provide through our more traditional medical interventions. We work with community groups in the neighborhood to identify opportunities within Dorchester House and Codman Square Health Center for youth at risk of gang involvement. These opportunities may include the availability of our gymnasium and technology facilities to these at risk youth, together with a connection to adolescent health care specialists. Such a program will soon be implemented involving DotWell and the Dorchester Youth Collaborative. Another example of our ability to serve the community better through this partnership is our work in HIV and AIDS for which we received a two year one million dollar grant to conduct rapid HIV testing and HIV counseling throughout Dorchester and Mattapan.

DotWell believes that good health care must encompass a higher degree of holistic approaches than are customary. Health data demonstrate the connection between continuity of high quality primary care, managed follow up services, healthy lifestyles and good health outcomes. Our health centers, like many others, adhere closely to these principles and provide access to some of the highest quality health care available. In addition to the strength of our infrastructure, our partnerships with organizations such as Boston Medical Center and the Boston HealthNet have enabled us to build on that strength. A prominent example is our electronic health record (EHR). The EHR, is a very expensive addition to our practices, but our HealthNet collaboration was able to attract sufficient funding to make it affordable to the member health centers. The EHR enhances treatment quality while allowing us access to population-based data on treatment and outcomes. Data mining and true community based research are enabled as never before, and using DotWell's data alone can give us insight into best treatment approaches.

DotWell's purpose is to practice an extended definition of health. In so doing we are addressing health disparities, creating a healthful environment for individuals and families, meeting the complex needs of a changing Dorchester community and building social capital in and across neighborhoods. It is perhaps too early to know whether or not this approach will help to mitigate the problems revealed by the BPHC report, but this is what our two health centers and our DotWell partnership believe can make a difference.

Joel Abrams is CEO of the Dorchester House Multi-Service Center. Bill Walczak is CEO of Codman Square Health Center.