were raised multiple times throughout the two days. They are cross cutting because they are not role specific, but affect the AHC as a whole. These issues were:

Drivers of Change: Rapid changes in information technology and biomedical advances in health care are likely to affect all the current roles of AHCs. Scientific and technological advances can potentially permit clinical care to intervene early in a disease process by identifying and modifying personal risk. The burgeoning knowledge base will put pressure on all levels of education to use the continuously expanding evidence base and to prepare health professionals for lifelong learning. Emphasis on translational research can support the application of knowledge developed to gain benefits in practice. Another driver of change is the shifting disease burden, which affects the changing health and medical needs of the people using the health care system. More people will be faced with having and managing chronic conditions. In addition, the public's health will likely continue to be affected by communicable diseases and lifestyle-related illnesses, suggesting the need for increased attention to population health, as well as the acute and chronic care needs of people.

Defining Accountabilities: Questions about AHCs’ accountability arose repeatedly. Some participants felt the current levels of performance expectations were generally unclear or undefined, whereas others believed that the expectations were clear for some of the missions, but not all. Many participants suggested that AHCs should be accountable for meeting a broader mission. For example, the mission of AHCs might include using education, research and clinical care to improve the health of a defined population, improving the public’s health, generating and disseminating knowledge, advancing e-health, providing education to current health professionals, providing leadership in global health, providing community service and outreach, or becoming role models for delivering care that has the attributes necessary for clinical practice. However, some participants believed the current missions of education, research and patient care are still the appropriate roles of AHCs, although adaptations may be required within each to meet the changing demands and expectations of the external environment. One participant suggested a narrowing of the AHC mission to limit indigent care, or to AHCs serving as an “insurer” of last resort. Challenges have been encountered in attempts to define accountabilities, including issues related to measurement and availability of information.

Interdisciplinary Approaches Across All The Roles: This issue arose in the context of each AHC role. In terms of patient care, the demands of caring for a population with chronic conditions is expected to rely on the use of interdisciplinary teams in order to deliver the diverse set of services needed by such a population and improve both the quality and efficiency of care. In terms of the education role, interdisciplinary approaches could train people in the types of teams in which they will be expected to work. In terms of the research role, advances in biomedical science— especially genomics— could influence the demand for interdisciplinary approaches to conduct research and apply its results, including input from non-health disciplines, such as engineering or computational sciences. Therefore, discussions surrounding interdisciplinary approaches related to both integration among the disciplines within the AHC (e.g., medicine, nursing, public health and others) as well as other disciplines not typically found in AHCs, but located in other departments of a university, such as engineering, applied mathematics or ethics.

Separating Accountabilities and Integrating Functions: As noted above, integration across the disciplines and functions of the AHC was raised as an issue. However, a number of participants also suggested the need for AHCs to be able to account for each mission separately. They believed this would permit greater accountability, especially for the public dollars provided to AHCs, and could also improve the ability of AHCs to more effectively manage each mission. Separating the accounting does not necessarily imply that each function must be self-supporting,



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