Table 7.

Increased continuity of care

Site	Evidence
Mid-Manhattan	• Shared medication information led to sharing of other health information across providers • By the end of the implementation year, 14 pharmacies had joined the MyMeds network
Lower Manhattan	• All diabetes linkage program enrollees visited a doctor during the implementation year • Forty-eight percent missed appointments in 2005, only 27% missed appointments in 2006, a 45% reduction
Queens	• By the end of the implementation year, the majority of residents surveyed were able to identify falls risks • Increased number of residents report telling their physician about a fall (38% in the 1st quarter, 50% in the 4th) • Increased number of residents made a change to prevent a fall (53% in the 1st quarter; 67% in the 4th) • Fewer participants reported a fear of falling (35% in 1st quarter, 20% in 4th) • Fewer participants reported discomfort speaking with providers about falls
Brooklyn	• Increased comfort talking to physicians about emotional health issues (from 12% in 1st quarter to 43% in 4th) • Increased comfort talking to NORC-SSP staff about emotional health issues (from 27% in 1st quarter; 47% in 4th) • Increased numbers of clients reported showing their passports or NORC-SSP chart stickers to physicians over time (10% in 1st quarter; 30% in 4th)