Academic Health Centers Leading Change in the 21st Century (2004) / Chapter Skim
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7 Expectations for the AHC of the 21st Century
7 Expectations for the AHC of the 21st Century
Pages 110-126
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From page 110... ...
In the committee's vision of the 21st century AHC, AHCs will effectively integrate their roles so that research develops the evidence base, patient care applies and refines the evidence base, and education teaches evidence-based care, and all are designed in an overall context of and commitment to improving health.
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From page 111... ...
Although all health care organizations are affected by the trends described in this report, the choices made by AHCs will have an effect well beyond their own organizations, exerting a profound influence on what kind of health care the American people will enjoy. Decisions about how to train health professionals influence the clinical skills they use in practicing within the larger system.
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From page 112... ...
.1 The majority of this funding 1 These are estimates for the AHC enterprise. It is recognized that Medicare funds for graduate medical education are provided to the hospital, whereas much of the National Institutes of Health (NIH)
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From page 113... ...
In patient care, AHCs will need to restructure care processes to focus on health for patients and populations; improving institutionally based care for their own patients will not be sufficient. The second part of the proposed strategy addresses the AHC itself, rather than any specific role, and asks AHCs to examine how they organize,
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From page 114... ...
There is also a trade-off between the education and patient care roles. As educators, AHCs have as a primary goal providing health professionals with a broad-based education that recognizes the whole patient and the factors that affect health and illness; patient care in the acute care setting is episodic, with a procedural and specialty focus.
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From page 115... ...
By effectively capitalizing on opportunities for integration across roles, specialties, and professions, AHCs could potentially improve health outcomes, accelerate the translation of scientific discoveries into safe and effective practices, lead the way toward more efficient use of human capital and technology, improve public health, and promote healthy lifestyles. This integration involves more than the simultaneous provision of education, research, and patient care.
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From page 116... ...
Rather, a more fundamental review of the approaches, methods, and settings used in clinical education will be required. Recommendation 1: AHCs should take the lead in reforming the con tent and methods of health professions education to include the inte grated development of educational curricula and approaches that: a.
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From page 117... ...
If care is to be more patient-centered, focus on improving the health of people, and meet the needs of an aging, chronically ill, and increasingly diverse population, educational programs will require major redesign and reorientation to integrate training across the disciplines, adequately prepare and reward educators, and conduct research to expand the evidence base on health professions education. Furthermore, the clinical setting in which students are taught must be able to demonstrate care that is patient-centered and health-improving, and model practices that are evidence-based, continuously improving, and cost-efficient.
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From page 118... ...
Revisions should include consideration of whether other payers should provide specific support for the education of health professionals; examine the relationship between support for the training of physician and nonphysician clinicians; assess the appro priate recipient of support; and identify mechanisms for account ability for both the disbursement and the use of public funds. The committee recommends a two-pronged approach to address both short- and long-term issues in the financing of clinical education.
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From page 119... ...
Another option was to freeze current payments for graduate medical education and channel the amount due to inflation that would occur under the existing program into the innovation fund. Using this mechanism, about $40 million would have been made available to such a fund in 2001.2 The third option was to redirect a portion of the current funding for indirect medical education (IME)
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From page 120... ...
AHCs use these funds to support other mission-related activities, so their use varies across AHCs. In its March 2003 report to Congress, MedPAC expressed its dissatisfaction with current payment policy because there is no accountability for the use of funds beyond the amount associated with the higher patient care costs attributable to teaching activities (Medicare Payment Advisory Commission, 2003)
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From page 121... ...
b. Public and private payers, state and federal agencies, and founda tions should provide support for demonstration projects designed to test and evaluate the organizational structures and team approaches designed to improve health and prevent disease.
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From page 122... ...
and private payers (such as insurance companies and managed care organizations) need to encourage and support innovations aimed at redesigning care to improve health.
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From page 123... ...
. Another Institute of Medicine report notes the need for demonstration projects focused on improving care provided to the chronically ill by redesigning care delivery across multiple providers, supporting patient self-management, and implementing community-wide education efforts to improve population health (Institute of Medicine, 2003)
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From page 124... ...
To improve health, it will be necessary in the coming decades to place an increased emphasis on clinical, health services, and prevention research so the discoveries of basic science can be translated into improved health care for people. Clinical and health services research can help answer questions in a variety of areas, including the clinical, organizational, and cost effectiveness of new therapies as well as current practices; effective methods for promoting healthy behaviors; the design of safe, cost-efficient, and effective processes of care; and methods for incorporating best practices into various clinical settings.
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From page 125... ...
Comprehensive cancer centers conduct basic, clinical, and preventative/behavioral/population-based research, and provide outreach and education to health professionals and others in the community served. Clinical cancer centers conduct at least clinical research and may do other research as well.
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From page 126... ...
Improved communication, coordination, and opportunities for interagency funding for both programmatic and training support should enable the types of collaboration needed to answer the questions of science and health likely to be most important in the coming decades. Although some interagency funding efforts are in place, coordination would be required at the federal level among NIH, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Veterans Health Administration, the Department of Defense, the Department of Energy, the Environmental Protection Agency, the National Science Foundation, and even the National Aeronautics and Space Administration (National Science and Technology Council, 2000)
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