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Electronic imaging and clinical implementation: Work group approach at Mayo Clinic, Rochester

JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 32-36页

作者： King, BF Erickson, BJ Williamson, B Reading, CC James, EM Ramthun, SK Owen, DA Mayo Med Ctr Dept Diagnost Radiol & Syst & Procedures Rochester MN 55905 USA

Electronic imaging clinical implementation strategies and principles need to be developed as we move toward replacement of film-based radiology practices. During an 8-month period (1998 to 1999), an Electronic Imaging Clinical Implementation Work Group (EICIWG) was formed from sections of our department: Informatics Lab, Finance Committee, Management Section, Regional Practice Group, as well as several organ and image modality sections of the Department of Diagnostic Radiology. This group was formed to study and implement policies and strategies regarding implementation of electronic imaging into our practice. The following clinical practice issues were identified as key focus areas: (1) optimal electronic worklist organization;(2) how and when to link images with reports;(3) how to redistribute technical and professional relative value units (RVU);(4) how to facilitate future practice changes within our department regarding physical location and work redistribution;and (5) how to integrate off-campus imaging into on-campus work-flow. The EICIWG divided their efforts into two phases. Phase I consisted of Fact finding and review of current practice patterns and current economic models, as well as radiology consulting needs. Phase II involved the development of recommendations, policies, and strategies for reengineering the radiology department to maintain current practice goals and use electronic imaging to improve practice patterns. The EICIWG concluded that electronic images should only be released with a formal report, except in emergent situations. Electronic worklists should support and maintain the physical presence of radiologists in critical areas and direct imaging to targeted subspecialists when possible. Case tools should be developed and used in radiology and hospital information systems (RIS/HIS) to monitor a number of parameters, including professional and technical RVU data. As communication standards improve, proper staffing models must be developed t

关键词：诊断显像预测医院信息系统医院联合开业/组织和管理病案连锁病案系统计算机化明尼苏达模型经济学组织目标组织方针放射科医院/组织和管理放射学信息系统转诊和会诊相对价值表远程放射学工作负荷量人类

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Academic practice groups: Strategy for survival

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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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Radiologist-patient interactions: Implications for picture archiving and communications systems and teleradiology

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 137-138页

作者： Williamson, EE Williamson, B Mayo Clin Rochester MN 55905 USA Mayo Clin Jacksonville Jacksonville FL 32224 USA

We analyzed radiologist-patient interactions and found that radiologic examinations can be classified into three categories: those involving direct interaction of the radiologist with each patient, those involving interaction of the radiologist with some of the patients, and those that do not involve interaction between the radiologist and the patient. We then analyzed the staff assignments of a large academic radiology practice and a moderate-sized radiology department. Both departments include a full range of inpatient and outpatient procedures. We concluded that about 50% of the radiologists in these practices could interpret examinations at a location independent of the site where the examination was performed. This type of analysis can be helpful in planning for the reengineering of radiology processes following implementation of picture archiving and Communications systems (PACS) and teleradiology. Copyright (C) 1999 by W.B. Saunders Company.

关键词：门诊医疗造影剂/投药和剂量诊断显像住院医院联合开业/组织和管理人员配备和时间安排医生病人关系放射学放射科医院/组织和管理放射学信息系统/组织和管理远程放射学人类

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CONTRIBUTIONS OF A CLINICAL PHARMACIST IN A PRIVATE GROUP-PRACTICE OF PHYSICIANS

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DRUG INTELLIGENCE & CLINICAL PHARMACY 1978年第4期12卷 210-213页

作者： ROBERTS, RW STEWART, RB DOERING, PL YOST, RL UNIV FLORIDA COLL PHARMGAINESVILLEFL 32601

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The best malpractice insurance of them all consumer satisfaction

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Health Marketing Quarterly 1983年第1期1卷 83-92页

作者： Sommers, Paul A. Thompson, Mark A. Gundersen Clinic Ltd. San Franciso United States

No abstract available for this article.

关键词：用户满意病人医护连续性联合开业/组织和管理医生病人关系

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Marketing Planning for Group Practices

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Health Marketing Quarterly 1983年第1期1卷 13-22页

作者： Winston, William J. School of Health Services Management of Management Golden Gate University and Managing Associate United States

No abstract available for this article.

关键词：联合开业/组织和管理卫生服务使用研究/方法规划技术

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An ethnographic study of women's experience of partnership caseload midwifery practice: the professional as a friend

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MIDWIFERY 1999年第3期15卷 165-176页

作者： Walsh, D De Montfort Univ Leicester LE2 1RQ Leics England

Objectives: to explore the experience of a known midwife for labour and birth as provided through the partnership caseload model of care in women who had a previous baby under an alternative system of care. Design: a qualitative study using an ethnographic approach. Data were collected by tape-recorded interviews. Setting: the maternity unit at Leicester Royal Infirmary NHS Trust, Leicester, UK in 1998, Participants: 10 multiparous women cared for by Birth Under Midwifery Practice Scheme (BUMPS) midwives were interviewed between eight- and 12 weeks' postpartum Key findings: women's perceptions and experiences were predominantly influenced by the relationships they had with their midwives who they described as 'friends', All other themes were filtered through these relationships, including previous negative experiences of maternity care, the valuing of a known midwife for labour and birth, their positive birth experiences, expressions of delight at their care, their liking of home antenatal care, and the appreciation of their existing children and partners meeting their midwives, Implications for practice: partnership caseload midwifery practice has significant positive impact on women's experience of childbirth,The midwife/woman relationship that has evolved in this context is highly valued by women and challenges traditional professional roles,The model should be explored in other settings to see if its benefits to women are transferable.

关键词：人类学文化健康态度社区保健护理/组织和管理英格兰联合开业/组织和管理人际关系分娩过程/心理学模型护理学母亲/心理学助产士/组织和管理助产士/心理学护士病人关系护理方法学研究问卷调查工作负荷量女(雌)性人类妊娠

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How to promote and advertise a new or existing clinic

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Health Marketing Quarterly 1983年第1期1卷 61-67页

作者： Hammer, Joan Hammer and Associates Seattle United States

No abstract available for this article.

关键词：联合开业/组织和管理卫生服务使用研究/方法单行本

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Integrating clinical performance improvement across physician organizations: the PhyCor experience.

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The Joint Commission journal on quality improvement 1999年第2期25.0卷 55-67页

作者： Loeppke, R. Howell, J.W. PhyCor Institute for Healthcare Management Nashville 37215 TN United States

BACKGROUND: There is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement;adopt local clinical and operational performance indicators;and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics. RESOURCES: Key resources supporting CPI initiatives include information/knowledge management, education and training, and patient education and consumer decision support. PRELIMINARY RESULTS AND OBSERVATIONS: Localized efforts in both the asthma care and diabetes management initiatives have led to some preliminary improvements in quality of care indicators. CRITICAL SUCCESS FACTORS AND CHALLENGES: Physician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.

关键词：联合开业/组织和管理联合开业/标准独立行医协会/组织和管理独立行医协会/标准机构管理小组领导模型组织管理组织状况研究以病人为中心医护医业管理/标准田纳西全面质量管理/组织和管理美国人类

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Basic marketing research for the group practice or, what on earth is targeting and why should i care?

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Health Marketing Quarterly 1983年第1期1卷 69-81页

作者： Hill, Robert C. Marketing Operations San Franciso United States

No abstract available for this article.

关键词：数据收集/方法联合开业/组织和管理卫生服务使用研究/方法病人人类

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