New York State Health Foundation

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Greater New York Hospital Foundation, Inc., on behalf of Greater New York Hospital Association

  • Project Title: Improving Care Delivery Through Integration of Primary Care Residents with Community-Based Services
  • Priority Area: Special Projects Fund
  • Grant Amount: $297,600
  • Date Awarded: September 28, 2016
  • Region: Bronx
  • Region: New York City
  • Region: Staten Island
  • Region: Western New York
  • Website:
  • Grant Status: In Progress


Fostering collaboration among primary care providers and community-based organizations (CBOs) is critical to addressing social determinants of health. Residents at New York State teaching hospitals provide a significant proportion of primary care services to Medicaid consumers and other low-income populations. Although residents have begun to receive more education and gain experience in enhanced primary care models and population health management, they lack education and experience collaborating with social service CBOs and are not fully integrated into the delivery system reform efforts underway in New York. Additionally, residency programs have not widely incorporated training on social determinants of health into their curricula. To meet the changing needs of the health care landscape and address growing health care disparities, NYSHealth awarded a grant to the Greater New York Hospital Association (GNYHA) to create a model program for residents that provides skills and training to recognize and address social determinants of health.

Under this grant, GNYHA will create collaborations between participating residency programs and local CBOs in the Bronx, Staten Island, and Erie County to provide residents with experiential opportunities in CBO settings. As the first step, GNYHA will identify best practices and challenges to implementation and adoption from similar training programs focused on social determinants of health across the country; ascertain the current levels of residents’ engagement and interactions with CBOs; assess specific community needs in the participating regions; and identify specific CBOs to work with during project implementation. GNYHA will also convene an advisory workgroup of key stakeholders to meet throughout the course of the project and help develop the training curriculum. During implementation, GNYHA will develop and disseminate a curriculum; engage 10–15 residency programs in collaboration with CBOs across the participating three regions; and hold a concluding symposium. Lastly, GNYHA will assess the engagement of participating residency programs with CBOs and measure use of the developed curriculum by residency programs.