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Academic practice groups: Strategy for survival

SURGERY 2000年第4期128卷 505-510页

作者： Rodriguez, JL Jacobs, DM Zera, RT Van Camp, JM Muehlstedt, SG West, MA Bubrick, MP Univ Minnesota Sch Med Hennepin Cty Med Ctr Dept Surg Minneapolis MN 55455 USA

Background. The mission of public academic health centers (puAHC) and their affiliated practice groups (APG) focuses on teaching, research, and the clinical care of at-risk populations. Resources to accomplish this mission, however, are becoming scarce. For puAHC to survive and remain competitive, innovative strategies will need to be developed by the APG. We hypothesized that the integration of a surgical academic practice of the APG with a nonacademic integrated health care delivery system (NAIDS) in a managed care environment would benefit all involved. Methods. A surgical academic practice was integrated with a NAIDS in a 95% managed care market. Faculty alone provided care the first year and third-year residents were added the following year. To assess outcome, we collected benefit and cost data for the 1-year period before integration and compared them with the two, 1-year periods after integration. Results. In the second year of integration 1-revenues from the NAIDS referrals to the puAHC and APG increased 89% and 150%, respectively. The NAIDS' general surgical and endoscopy caseload increased by 25%. Additionally, there was a 92% reduction in operating room technician cost with no increase in operating time per case. Finally, the third-year resident experienced a caseload increase of 163%. Conclusions. In an environment where resources are diminishing and managed care consists of many large NAIDS that drive referrals and revenue, the integration of a surgical academic practice with a NAIDS benefits all shareholders. Academic practice groups that develop strategies that leverage their competitive advantage will have the best chance of surviving in today's turbulent health care market.

关键词：医学科学研究中心/组织和管理卫生保健提供联合/组织和管理全体教工医学院校/组织和管理联合开业/组织和管理医院县/组织和管理实习医师和住院医师职务/组织和管理管理医疗规划/组织和管理卫生服务使用研究组织隶属关系结果评价(卫生保健) 外科学/组织和管理人类

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The health development organization: An organizational approach to achieving child health development

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MILBANK QUARTERLY 2000年第3期78卷 447-+页

作者： Halfon, N Inkelas, M Hochstein, M Univ Calif Los Angeles Sch Publ Hlth Ctr Children Families & Communities Los Angeles CA 90095 USA RAND Corp Santa Monica CA 90406 USA

The health development organization (HDO) is a new approach to the organization and delivery of children's health and social services. The HDO would combine the best features of vertically integrated HMOs with horizontally integrated, child-focused social services and longitudinally integrated health promotion strategies. Its mandate would be to develop the health of children in a community. The impetus for creating HDOs is a growing body of evidence in chronic disease epidemiology, developmental psychopathology, early intervention research, and life course cohort studies chat point to childhood as the period of life during which adult health status is determined and the opportunities for health capital formation are highest. Thus, a new kind of health care organization or framework, like the HDO, is needed to integrate a full range of critical services for promoting children's development.

关键词：儿童发育儿童保健服务/组织和管理卫生保健提供联合/组织和管理卫生服务需求模型组织管理组织目标规划技术美国儿童人类

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Placing the cornerstone for healthcare professionals' risk management education: an educational needs assessment.

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Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management 1998年第3期18卷 15-27页

作者： Seisser, M.A. Epstein, A.L. CNA HealthPro Chicago IL United States

The risk manager's performance of an educational needs assessment to assist in determining related training and development elements supports a solid, proactive risk management program designed to motivate healthcare professionals. Environmental scanning, needs assessment tool design and development, tool validation, organizational commitment and ethical considerations are examined. A sample needs assessment tool is provided.

关键词：卫生保健提供联合/组织和管理教育继续/组织和管理伦理学职业卫生人员/教育模型教育规划技术专业能力规划制订/方法问卷调查危险处理/方法美国

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A provider assessment of the Massachusetts Medicaid Managed Behavioral Health Program: Year four

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第4期25卷 411-426页

作者： Beinecke, RH Lockhart, A Suffolk Univ Dept Publ Management Boston MA 02108 USA

A stratified, random sample of 80 providers in the Massachusetts Medicaid Managed Mental Health/Substance Abuse Program were interviewed by phone to assess their views of the program in year four. Providers continued to believe that access and quality were the same or better than a year earlier, that client severity continued to increase while length of stay decreased, that readmissions and emergency room admissions were the same as a year earlier, and that aftercare was the same or better than a year earlier. Substantial problems were reported in the integration of services, in linkages with support services, and with administration of the program.

关键词：医务工作者的态度卫生保健提供联合/组织和管理卫生服务易得程度/标准住院时间/统计学和数值数据住院时间/发展趋势管理医疗规划/组织和管理马萨诸塞 Medicaid/组织和管理精神卫生服务/组织和管理方案评价卫生保健质量问卷调查州卫生计划/组织和管理物质滥用治疗中心/组织和管理美国成年人儿童人类

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Program development and integrated treatment across systems for dual diagnosis: Mental illness, drug addiction, and alcoholism (MIDAA)

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第3期23卷 288-297页

作者： Sciacca, K Thompson, CM JACKSON HILLSDALE COMMUNITY MENTAL HLTH BOARD JACKSON MI USA JACKSON HILLSDALE COMMUNITY MENTAL HLTH SERV JACKSON MI USA

Numerous bureaus of mental health, drug addiction, and alcoholism are designated to provide service to persons who have discrete singular disorders of mental illness, drug addiction, or alcoholism. Mental health and substance abuse programs (nationally and internationally) have evolved with this singular limited-service capacity. Contrasting incompatible philosophies and treatment methods across the systems have resulted in minimal services for persons with dual diagnoses. The project the authors have outlined is an example of the development of a dual/multiple-disorder program that integrates these diverse systems and provides comprehensive services within each of the programs of each delivery system. These programs are cost-effective, use existing facilities, train and cross-train existing staff correct the issues of incompatible treatment interventions, and end the dilemma of gaps in services systems and limited referral resources. As a result, the availability and quality of care for persons with dual diagnoses is greatly improved.

关键词：酒精中毒/并发症酒精中毒/治疗社区卫生计划社区精神卫生服务/组织和管理卫生保健提供联合/组织和管理诊断双重(精神病学) 在职培训精神障碍/并发症精神障碍/治疗密执安规划制订物质相关性障碍/并发症物质相关性障碍/治疗人类

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Creating linkages between incomplete abortion treatment and family planning services in Kenya

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STUDIES IN FAMILY PLANNING 1999年第1期30卷 17-27页

作者： Solo, J Billings, DL Aloo-Obunga, C Ominde, A Makumi, M Populat Council Int Programs Div New York NY 10021 USA Ipas Carrboro NC 27510 USA Kenya Minist Hlth Maternal & Child Hlth Family Planning Program Div Primary Hlth Care Nairobi Kenya

Postabortion care has received increasing emphasis as an important intervention to address part of the problem of unsafe abortion. Although a good deal of attention has been paid to improving emergency treatment of abortion complications, the other elements of postabortion care, including providing postabortion family planning services, have received less attention and are rarely found in health-care settings around the world. This report describes a study that was conducted in Kenya to test three different models of ways to provide postabortion family planning. The study shows that these new services are both feasible and acceptable to providers and patients, and also shows how effective they can be. Whereas only 7 percent of women received family planning counseling according to the baseline survey, this proportion increased to 68 percent in the postintervention period. In addition, 70 percent of women who decided to begin using contraceptives received a method, compared with only 3 percent at baseline. The provision of postabortion family planning counseling and methods on the gynecological ward by ward staff was found to be the preferred and most effective model.

关键词：流产违法/预防和控制流产不全/治疗出院后医疗/组织和管理卫生保健提供联合/组织和管理计划生育服务/组织和管理可行性研究健康知识态度实践医院公立肯尼亚模型组织管理方案评价青少年成年人女(雌)性人类妊娠

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Linking substance abuse and serious mental illness service delivery systems: Initiating a statewide collaborative

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第1期27卷 107-113页

作者： Barreira, P Espey, B Fishbein, R Moran, D Flannery, RB Massachusetts Dept Mental Hlth Clin & Profess Serv Boston MA 02114 USA Massachusetts Dept Publ Hlth Bur Substance Abuse Boston MA 02111 USA

In the past, persons with serious mental illness and substance abuse often found themselves in parallel systems of care that inadequately addressed their needs. Recent advances have seen the development of an integrated approach to care for these disorders in both the public and private sectors. While some state departments of mental health have developed integrated systems of care for public sector patients, no department appears to have developed such a system for both public and private clients, and there appears to be no published journal report of a model to induce cooperation by all stakeholders. This article outlines a two-step approach by the Massachusetts Department of Mental Health to foster stakeholder cooperation in designing an integrated system of care for both public and private clients with co-occurring disorders.

关键词：卫生保健提供联合/组织和管理马萨诸塞精神障碍/并发症精神障碍/治疗精神卫生服务/组织和管理模型组织管理物质相关性障碍/并发症物质相关性障碍/治疗人类

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Capitation funding in Australia: Imperatives and impediments

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Health Care Management Science 2000年第2期3.0卷 77-88页

作者： Peacock, Stuart Segal, Leonie Health Economics Unit Centre for Health Program Evaluation Monash University West Heidelberg Vic. 3081 PO Box 477 Australia

Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding and delivery of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model based on robust methods should become a cornerstone of Australian health system reform. © Baltzer Science Publishers BV.

关键词：澳大利亚按人收费/组织和管理卫生保健提供联合/组织和管理效率组织筹资政府/组织和管理卫生保健改革/组织和管理卫生服务易得程度/标准管理医疗规划/组织和管理模型组织管理国家卫生规划/组织和管理需求估价/组织和管理全面质量管理/组织和管理人类

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The marketing function in managed care systems

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Health Marketing Quarterly 1999年第2期17卷 43-54页

作者： Fleming, Kae Short, Mike Warren, William E. Columbia State Community College Columbia TN 38402-1315 Box 1315 United States Maury Regional Hospital Columbia TN 38401 1224 Trotwood Avenue United States Middle Tennessee State University Murfreesboro TN 37132 MTSU Box X030 United States

As managed care spreads through the health care service industry, marketing professionals are faced with the challenge of marketing highly integrated systems. This paper explores three questions related to this development: (1) what is unique about managed care marketing, (2) how has managed care impacted health care marketing, and (3) what new strategies and trends will shape these developing markets? © 1999 by The Haworth Press, Inc. All rights reserved.

关键词：卫生保健提供联合/组织和管理卫生保健部门管理医疗规划/组织和管理卫生服务使用研究/方法卫生服务使用研究/组织和管理生产线管理美国

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Physician-hospital partnerships: incentive alignment through shared governance within a performance improvement structure.

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The Joint Commission journal on quality improvement 2000年第2期26卷 59-73页

作者： Hosler, F.W. Nadle, P.A. Crouse Hospital Syracuse New13210 York United States

BACKGROUND: Producing accessible, appropriate, and accountable medical care that improves the health of the populations served requires collaborative physician-organization relationships within which performance measurement across the continuum of care occurs. Governance and shared responsibility for performance improvement (PI) through organizational structure and process have proven to be particularly complex challenges. REDESIGN OF THE PI SYSTEM: The Health Alliance of Central New York, based in Syracuse, New York, which consists in part of Crouse Hospital;ambulatory medical care sites and physicians;a physician organization, a physician-hospital organization, and an independent practice association;in February 1997 established a plan for a redesign of the PI system. IMPLEMENTING THE MODEL: In April 1998 the development of joint performance indicators, the Family of Measures, was undertaken. Recommendations for improvements necessary to correct process failures are referred to the medical staff executive committee and/or the appropriate coordinating committee, which then charges the appropriate service-line PI Council(s) with the responsibility for making those improvements. DISCUSSION: Systemwide PI with collaborative decision making by process stakeholders has been a major cultural transition requiring a degree of organizational readiness. Support of the most senior levels of management is critical. Institutional silos do not support shared, participatory decision making and cannot be overcome without strong support from senior management and in many cases the direct support and involvement of the CEO. Integrating information systems represents a considerable challenge: to find hardware and software that will interface properly to produce desired results, to successfully interface computer support personnel into the PI process, and to ensure the commitment to the financial resources to meet the information system requirements. In addition, meaningful and materi

关键词：合作行为决策组织卫生保健提供联合/组织和管理卫生保健提供联合/标准效率组织医院医生关系住院时间纽约组织状况研究组织文化病人满意度医师奖励计划医生护士关系质量指标卫生保健全面质量管理/组织和管理

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