A patient-centered health care delivery system by a university obstetrics and gynecology department.

At the University of Texas Medical Branch at Galveston, we developed an off-site clinic system that offers a wide array of services to low-income women and their infants over a large geographic area. These clinics strove toward cultural sensitivity and competency. This patient-centered approach was well accepted and appreciated by our patients. The clinics offered unique, value-added services including combined location with other needed services, on-site laboratory and antepartum testing, the option for delivery at the University of Texas Medical Branch at Galveston in a Birth Center by certified nurse midwives from the clinics, 2 high-level ultrasound "hub" centers in the outlying region that offer level II ultrasound and maternal-fetal medicine specialist consultation on site, and linkage of all sites to our electronic medical record, telemedicine, and telegenetics consultation. We also developed an off-site domiciliary facility at the University of Texas Medical Branch at Galveston. From 1989 to 2004, our clinics grew from 12 to 38 (now serving 123 Texas counties). Annual patient visits increased from approximately 34,000 to 342,926. Deliveries at the University of Texas Medical Branch at Galveston grew from 3,959 in 1990 to an estimated 6,400 in 2004. Underscoring this increase was the probable loss of at least 1,500 deliveries to local hospitals that had previously denied or discouraged admission to Medicaid-eligible pregnant women. Many women chose to deliver in our hospital even although they had to travel a longer distance to reach our facility. Our experience has shown that patient-centered care can be a viable business strategy to maintain and expand patient volumes and will work even where there are serious geographic disadvantages.