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Organizational responses to managed care: Issues for Academic Health Centers and implications for pediatric programs

Published on Apr 1, 1998in Pediatrics5.40
Chuck Norlin14
Estimated H-index: 14
,
Lucy M. Osborn12
Estimated H-index: 12
(UofU: University of Utah)
Abstract
The health care market dynamics that supported and directed the growth and development of Academic Health Centers (AHCs) have changed dramatically in the last 10 years. AHCs are struggling to adapt to new reimbursement mechanisms and to compete effectively for limited dollars, but are constrained by administrative and governance structures that are slow to evolve. Their multiple missions, including education, research, and care for complex patients and underserved populations, are at risk. Although most recognize the need for substantive reorganization, available resources and market specifics vary dramatically from one AHC to another. The current approaches to adaptation by four AHCs are described, along with some of the unique challenges confronted by academic pediatric programs.
  • References (11)
  • Citations (28)
References11
Newest
Published on Apr 1, 1998in Pediatrics5.40
Seth Frazier1
Estimated H-index: 1
,
Daniel Hyman7
Estimated H-index: 7
,
Steven Altschuler1
Estimated H-index: 1
Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and opera...
Published on Sep 4, 1996in JAMA51.27
Susan D. Block58
Estimated H-index: 58
,
Nancy Clark-Chiarelli7
Estimated H-index: 7
+ 1 AuthorsJudith D. Singer31
Estimated H-index: 31
Objective. —To describe the attitudes toward and perceptions of primary care education and practice among academic health center constituents. Design and Participants. —Descriptive study using confidential telephone interviews (October 1993 to March 1994) of national stratified probability samples of first- and fourth-year medical students, residents, clinical faculty, internal medicine and pediatrics residency training directors and chairs, and deans (N=2293). Results. —Five areas were examined...
Published on Apr 1, 1996in Academic Medicine5.08
S Abrahamson1
Estimated H-index: 1
The author maintains that the quality of medical education has been dropping for the last few decades as medical schools become less and less focused on their primary purpose of training physicians. Until the years immediately following World War II, the administration of the medical school was carr
Published on Feb 1, 1996in Academic Medicine5.08
Berns Ki1
Estimated H-index: 1
Many academic medical institutions are facing serious threats to their survival today as changes in the organization and financing of health care delivery and reductions in federal support create damaging pressures. In order for Americans to continue to have the best health care in the world, academic medicine and its crucial contributions of medical education, training, and research must receive adequate support. The author maintains that it is up to the Association of American Medical Colleges...
Published on Jan 1, 1996in Health Affairs5.71
Alain C. Enthoven31
Estimated H-index: 31
,
Sara J. Singer31
Estimated H-index: 31
Prologue: More than any other single figure, Alain Enthoven is responsible for establishing and promoting the ideas that are the intellectual underpinnings of America's rapidly transforming health care system. But the system has evolved in ways that Enthoven and his colleagues did not initially envision. They proposed a world in which organized health care delivery systems, paid on a per capita basis, would compete on price and quality. The delivery systems would be mutually exclusive, each woul...
Published on Jan 1, 1996in Academic Medicine5.08
Hash M1
Estimated H-index: 1
Published on Jan 1, 1996in Academic Medicine5.08
Schatz Ij1
Estimated H-index: 1
,
Realini Jp1
Estimated H-index: 1
,
Charney E1
Estimated H-index: 1
The generalist of the future will play an integral role in the health care delivery system, yet the three recognized generalist specialties have developed and functioned along largely separate tracks. No matter what form of generalism evolves, family practice, internal medicine, and pediatrics must begin to cooperate and collaborate in developing new graduate medical education programs that are sufficiently flexible to meet whatever emerges in the future. They must devote their energies to worki...
Published on Jan 1, 1996in Health Affairs5.71
David Blumenthal72
Estimated H-index: 72
,
Gregg S. Meyer31
Estimated H-index: 31
Prologue: In a nation that holds academic institutions in high esteem, academic health centers(AHCs) have enjoyed a place of particularly high prominence. Their academic mission, including caring for vulnerable populations, conducting biomedical research, and training the health care workforce of the future, has set them apart from other private institutions. They have long enjoyed a level of federal subsidy and other cross-subsidies that has allowed them to continue to carry out these functions...
Published on Jan 1, 1995in Pediatrics5.40
Broffman G1
Estimated H-index: 1
,
Stapleton Fb1
Estimated H-index: 1
A process of enhanced participation by community pediatricians in the programs and administration of an academic department is described. We realize that many departments incorporate volunteer faculty into their academic programs without creating a specific structure, such as our divisional classification. The customary paradigm of providing "ad hoc" opportunities and responsibilities for volunteer faculty is somewhat analogous to the traditional "quality assurance" model of management, which is...
Published on Nov 17, 1994in The New England Journal of Medicine70.67
Mark C. Rogers25
Estimated H-index: 25
(Duke University),
Ralph Snyderman76
Estimated H-index: 76
(Duke University),
Elizabeth L. Rogers3
Estimated H-index: 3
(Duke University)
Many academic medical centers are developing complex organizations of physicians and large health networks that provide managed care to large groups of people. Leaders of these centers believe that these organizations and networks will provide the financial resources that have previously been obtained through clinical care provided at the medical center itself. The rationale is that a surplus of revenues from clinical care provided by hospitals and professionals is needed to continue support for...
Cited By28
Newest
Published on Sep 10, 2019in Journal of Child Neurology2.09
Celestine H. Yeung Gregerson (UofU: University of Utah), Amanda V. Bakian13
Estimated H-index: 13
+ 5 AuthorsJoshua L. Bonkowsky24
Estimated H-index: 24
(UofU: University of Utah)
Objective:The purpose of our study was to assess whether race/ethnicity was associated with seizure remission in pediatric epilepsy.Methods:This was a retrospective population-based cohort study of...
Published on Sep 1, 2014in Health Policy2.08
Catherine French3
Estimated H-index: 3
,
Ewan Ferlie44
Estimated H-index: 44
('KCL': King's College London),
Naomi Fulop26
Estimated H-index: 26
Academic Health Science Centres (AHSCs) have been a key feature of the North American healthcare landscape for many years, and the term is becoming more widely used internationally. The defining feature of these complex organisations is a tripartite mission of delivering high quality research, medical education and clinical care. The biomedical innovations developed in AHSCs are often well documented, but less is known about the policy and organisational processes which enable the translation of...
Published on May 1, 2014in Annals of clinical and translational neurology4.66
Holly M Anderson2
Estimated H-index: 2
(UofU: University of Utah),
Jacob Wilkes7
Estimated H-index: 7
(Intermountain Healthcare)
+ 5 AuthorsJoshua L. Bonkowsky24
Estimated H-index: 24
(UofU: University of Utah)
Children with inherited leukodystrophies have high hospitalization rates, often associated with infection. We studied whether potentially modifiable risk factors (preexisting indwelling central intravenous access, urinary catheter, hardware, or mechanical ventilation; and influenza vaccine) were associated with infection-related hospitalization in children with leukodystrophy. Central intravenous access was associated with sepsis (odds ratio [OR] 9.8); urinary catheter was associated with urinar...
Published on Jan 1, 2013
Andrew Auerbach1
Estimated H-index: 1
,
Chuck Norlin14
Estimated H-index: 14
+ 1 AuthorsSharon Muret-Wagstaff13
Estimated H-index: 13
ABSTRACT. Objective. Pediatric hospitalist systemsare being implemented widely. Their implementationmay be influenced by physician attitudes, which mayvary according to practice type (eg, community or hospi-tal-based practice) and personal characteristics (eg, ageand practice location). Little evidence exists to describefactors relevant to pediatric systems. The objective of thisstudy was to determine physicians’ attitudes regardinghospitalists and associated physician and practice char-acterist...
Published on Jul 1, 2012in Journal of Hospital Medicine2.28
Gabrielle Zimbric2
Estimated H-index: 2
(UofU: University of Utah),
Joshua L. Bonkowsky24
Estimated H-index: 24
(UofU: University of Utah)
+ 2 AuthorsRajendu Srivastava30
Estimated H-index: 30
(UofU: University of Utah)
OBJECTIVE: To evaluate for adverse outcomes associated with gastroesophageal reflux disease (GERD) following an apparent life-threatening event (ALTE) and potential risk factors of these outcomes. STUDY DESIGN: Retrospective cohort study of well-appearing infants (<12 months) admitted for ALTE. Patients were followed for adverse outcomes associated with GERD (including aspiration pneumonia, failure-to-thrive, or anti-reflux surgery), second ALTE, or death. Risk factors evaluated included: age, p...
Mark W. Willis3
Estimated H-index: 3
(UofU: University of Utah),
Joshua L. Bonkowsky24
Estimated H-index: 24
+ 1 AuthorsJ. Fredrik Grimmer13
Estimated H-index: 13
(UofU: University of Utah)
Objectives To determine how often the pediatric otolaryngology service is involved in the initial care of infants with an apparent life-threatening event (ALTE), to assess the usefulness of bronchoscopy and laryngoscopy in diagnosing the underlying etiology, and to describe the long-term airway outcomes and whether these patients were seen by the pediatric otolaryngology service over a 5-year follow-up period. Design Retrospective observational study. Setting Tertiary children's hospital affilia...
Published on Mar 1, 2011in Inflammatory Bowel Diseases4.00
Stephen L. Guthery25
Estimated H-index: 25
(UofU: University of Utah),
Geraldine P. Mineau29
Estimated H-index: 29
(UofU: University of Utah)
+ 2 AuthorsRichard A. Kerber30
Estimated H-index: 30
(University of Louisville)
Background: The observed heritability of inflammatory bowel disease (IBD) is incompletely explained by known genetic risk factors. Kindred-specific genetic variants that cause IBD may be a source of “missing heritability.” Given that they have been previously difficult to identify, we sought to identify high-risk IBD kindreds. Methods: We used a large population-based database—the Utah Population Database (UPDB)—which contains genealogical and healthcare data to characterize the risk of Crohn's ...
Published on Jan 1, 2011in Inflammatory Bowel Diseases4.00
Jill C. Moore6
Estimated H-index: 6
(UofU: University of Utah),
Kimberly D. Thompson3
Estimated H-index: 3
(UofU: University of Utah)
+ 10 AuthorsMichael E. Matlak21
Estimated H-index: 21
(UofU: University of Utah)
Background: Clinical variables may identify a subset of patients with pediatric-onset ulcerative colitis (UC) (≤18 years at diagnosis) at risk for adverse outcomes. We postulated that routinely measured clinical variables measured at diagnosis would predict colectomy in patients with pediatric-onset UC. Methods: We conducted a chart review of patients with pediatric-onset UC at a single center over a 10-year period. We compared patients with and without colectomy across several variables, used p...
Published on Nov 1, 2010in The Journal of Pediatrics3.74
Elisabeth Guenther13
Estimated H-index: 13
(UofU: University of Utah),
Annie Powers2
Estimated H-index: 2
(UofU: University of Utah)
+ 1 AuthorsJoshua L. Bonkowsky24
Estimated H-index: 24
(UofU: University of Utah)
Objective To identify rates of abusive head trauma and associated clinical risk factors in patients with an apparent life-threatening event (ALTE). Study design Retrospective study of infants, 0 to 12 months, admitted for an apparent life-threatening event (ALTE; 1999–2003). Patients with abusive head trauma were identified at presentation or on follow-up; statistical analysis identified characteristics associated with abusive head trauma. Results Of 627 patients with ALTE, 48% were male. Nine (...
Published on Nov 1, 2010in Annals of Neurology9.50
David J. Sharp32
Estimated H-index: 32
(Imperial College London),
Federico Turkheimer56
Estimated H-index: 56
(Imperial College London)
+ 2 AuthorsRichard J. S. Wise36
Estimated H-index: 36
(Imperial College London)
The neural mechanism by which patients spontaneously recover cognitive function after brain injury is not understood. Here we demonstrate for the first time that aphasic patients, who have largely recovered language function, show increased frontoparietal integration. A similar change in functional connectivity is also observed when normal subjects are exposed to adverse listening conditions. Thus, compensation for inefficient language processing is associated with increased integration between ...