Academic Health Centers Leading Change in the 21st Century (2004) / Chapter Skim
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4 The Academic Health Center as a Modeler: The Patient Care Role
4 The Academic Health Center as a Modeler: The Patient Care Role
Pages 65-76
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From page 65... ...
If health care is to produce a different output, the platform for delivering that output needs to be rethought. In examining the clinical care role of AHCs, the committee finds the following: 65
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From page 66... ...
· AHCs need to play a part in redesigning care if they are to respond to the changing demands that will arise in the coming decades and be able to deliver the improved capabilities that the system will have the potential to offer. · The clinical care setting is where the AHC research and education roles intersect.
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From page 67... ...
. Among referral areas that contain at least one medical school, the age-, sex-, race-, and illness-adjusted discharge rate for medical conditions per 1,000 Medicare enrollees ranges from 285 in Jackson, Mississippi, to 165 in Salt Lake City (Center for the Evaluative Clinical Sciences at Dartmouth Medical School, 1999b)
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From page 68... ...
Evaluations of PACE programs have found that participants have better functional status, receive more primary care and preventive services, and experience fewer days in the hospital despite having greater morbidity and disability than other elderly populations, although programs exhibited considerable variation (Burton et al., 2002; Wieland et al., 2000; Mukamel et al., 1998)
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From page 69... ...
This approach is similar to disease management models that emphasize a systematic approach to care, employ interdisciplinary teams to deliver care, use practice guidelines and protocols appropriate to the target population, and can potentially include services across the entire continuum of care (Blumenthal and Buntin, 1998)
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From page 70... ...
CONTRIBUTIONS OF AHCS TO PATIENT CARE AHCs are recognized throughout the world for their specialty care. Although AHC hospitals represent just 3 percent of all hospitals in the United States, they house 33 percent of transplant services, 16 percent of neonatal units, and 15 percent of open-heart surgical units (see Appendix A)
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From page 71... ...
About half of patients with rare and uncommon conditions are cared for at AHCs and major teaching hospitals. Yet such patients represent a relatively small proportion of the volume at these centers, accounting for about 13 percent of overall admissions (The Commonwealth Fund Task Force on Academic Health Centers, 2000)
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From page 72... ...
The Commonwealth Task Force found that of the total charity care provided in 1996, 31 percent was provided by public AHC hospitals and 13 percent by private AHC hospitals, a pattern similar to that exhibited by public and private hospitals generally (The Commonwealth Task Force on Academic Health Centers, 2001)
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From page 73... ...
As noted earlier, the shifts in the needs of the population and changing composition of the workforce will necessitate better approaches to care. Furthermore, as noted in Chapter 2, the increased demand for care brought about the aging population, combined with a slow growth in the size of the labor force, can be expected to result in increased labor costs, along with demands for productivity improvements.
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From page 74... ...
Assessing patterns of care for groups of patients will demand better information technology that can aggregate data across the patient's experience, especially across settings and over time. Information and communications technology can also serve as glue that holds care teams together, getting information to people whenever and wherever it is needed.
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From page 75... ...
Achieving such redesign will require that AHCs work across all of their component organizations, including nursing schools and public schools and programs, as well as with their local communities. Implementing new models of care will also require delivery system changes that include greater reliance on information systems, patient selfmanagement that necessitates expanded health education and support, a team orientation, and decision support (Berenson and Horvath, 2003)
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From page 76... ...
For example, a pilot project at Duke University improved outcomes of care and reduced annual expenses by almost 40 percent for patients with congestive heart failure. However, Duke lost money because patients stayed out of the hospital, avoiding procedures that are relatively well reimbursed, while incurring greater expenses for ambulatory care and patient education, which are more poorly reimbursed (Williams et al., 2003)
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