Decubitus prevention in theory and practice--a study structure with the VIPS model

In 1990, the Bureau of Dental Health Services of the New York City Department of Health launched a major initiative to modernize a network of school-based dental clinics located throughout the city. Since 1913, the bureau has provided dental care to public school children; however, the clinics were not properly maintained or upgraded, and were in a state of disrepair and obsolescence. Anticipating that the survival of the program was in question, the school program was converted to a fleet of state-of-the-art portable dental clinics permitting targeting of underserved, high-risk poor and immigrant populations. Demographics had changed dramatically over the years; the program could now situate services where they were needed most, and provide a broader array of care where access was a problem. This paper presents a six-year analysis of the program and builds a strong case to show that a portable delivery system can equal or in many ways surpass the effectiveness and capabilities of a fixed-state approach.