Primary health care in an academic medical center.

In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery (including urology and orthopedics), medicine, pediatrics, and ob/gyn. The present paper focuses on the private and public clinics of Duke University Medical Center. Data were analyzed to document differentials in sociodemographic characteristics of patients attending these two systems of care. Results showed that patients attending the private clinics are predominantly white and covered by private insurance, while patients attending the public clinics are predominantly black and heavily dependent on Medicaid coverage. The potentially detrimental effects of a two-class system of care on the health of patients, as well as on the education of students, is discussed in the context of a scant medical literature on this subject.     

Neighborhood clinics: an academic medical center-community health center partnership

This report describes a clinic run by a federally-qualified health center and an academic medical center. The clinic expands the community's primary care capacity, combining advantages of big and small settings, and of its dual affiliation. Survey data suggest the clinic prevents health care delays and lowers emergency department use.     

An assessment of the practice of preventive cardiology in an academic health center

There is evidence that attention to cardiovascular risk factors will decrease the mortality of atherosclerotic disease. The objective of this study was to ascertain how often cardiovascular risk factors were assessed and modified in inpatients and newly seen outpatients aged 10 to 50 years at the University of Missouri-Columbia Hospital and Clinics. A total of 461 randomly selected inpatient and outpatient charts were reviewed from three departments: family practice, internal medicine, and pediatrics. Each record was assessed for history of smoking, exercise, diet, stress, and familial heart disease, for blood pressure measurement, and for serum lipid profile and glucose determination. With the exception of blood pressure, the risk factors were infrequently assessed in outpatients. Again excepting hypertension, there was little evidence of any attempt to modify those risk factors identified in inpatients or outpatients. Therefore, an educational program in risk factor recognition and modification is needed for primary care physicians.     

Nevada's academic-practice collaboration: public health preparedness possibilities outside an academic center

The Nevada State Health Division developed a local academic-practice partnership with the University of Nevada Reno's Master of Public Health Program to assess the bioterrorism risk communication, information, response, and training needs of professional and public stakeholder groups throughout Nevada. Between October 16, 2002, and April 13, 2004, 22 needs assessment focus groups and 125 key informant interviews were conducted to gather information on the diverse needs of the stakeholders. The themes that emerged from these activities included the need for effective pre-event education and training; a coordinated and responsive public health preparedness infrastructure; honest, accurate, and timely communication in the event of a bioterrorism situation; and appropriate information dissemination methods and technology. The data collected through this needs assessment gave the Nevada State Health Division vital information to plan public health preparedness initiatives. The establishment of local academic-practice partnerships for states without a Centers for Disease Control and Prevention-funded Academic Center for Public Health Preparedness is an effective way for health departments to develop their public health preparedness infrastructure while simultaneously training the future public health workforce.     

A student health HMO as a partnership model within an academic medical center

The Department of Family Practice, College of Medicine, in partnership with the University of Illinois at Chicago, was responsible for the reorganization of the Student Health Service into a health maintenance organization (HMO), Campus Care. Historically, the two campuses of the University of Illinois at Chicago operated student health as an infirmary model. Reorganization of student health into the Campus Care HMO provided expanded health care services to students, preserved more health care dollars in the university system, and provided a nonincremental increase in the size and responsibility of the Department of Family Practice. One year's experience showed that while the capitation was low compared with standard HMOs, the variable and less frequent use of services by the student population resulted in a fiscally viable operation. Numerous transition difficulties were encountered, including the need for rapid systems conversion within a complex university system, reeducation of students as well as traditional university-based practitioners for operation in a managed care system, and the rapid expansion of a small family practice department. The positive experience of the University of Illinois at Chicago supports the notion that family practice is better suited to providing student health care than other primary care disciplines. Three issues are paramount to success: (1) approval, support, and protection by higher level administration from university territorialism, (2) a core family practice faculty with strong leadership and experience in high-volume clinical activity, and (3) a close examination of financial resources in light of expected utilization.     

Marketing physician services in an academic medical center

As a result of recent environmental changes in the health care industry, marketing has become a vital necessity for the survival of most hospitals. Kotler's conceptual framework is used to study and evaluate an innovative program for marketing physician services in a large urban medical center. This program was quite successful in increasing admissions and referrals and won a national award in 1984.     

Whither primary care in the academic health science center?

Five forces that shape the form and function of the future academic health center are a mandate to decrease health care costs, a surplus of physicians, intense competition for the provision of tertiary medical care, a suboptimal diagnosis-related group (DRG) case mix, and decreasing funding for manpower training and research. All five forces cause the academic health center to be much more in need of strong primary medical care services. This article describes the current relationship between primary care and the academic medical center, new contributions that primary care can make to the academic medical center, and the benefits that would accrue to both the academic medical center and primary care should a closer working relationship develop. These benefits include increased outpatient volume and revenue, a more balanced inpatient case mix, better primary medical care education, an enhanced community reputation, and greater influence by primary care on academic medical center policies. Published and personal case study experiences that show some of the potential problems with a closer working relationship between primary care and the academic medical center are described.     

Getting off the bandwagon: an academic health center takes a different strategic path

Focusing on one state university academic health center (AHC) located in a rural setting in the southeastern United States, this case study investigates the strategic response to the increasingly turbulent and competitive environment in the healthcare industry. The qualitative research reported here involved a review of pertinent documents and archival data and interviews with key informants including AHC executives and staff, community leaders, and others. Additional information was obtained from published sources, including a literature review that covers a five-year period ending in 1997 and searches conducted using the key words "academic medical or health center." The AHC in this case study demonstrates how it is possible to respond proactively to changes in the environment without sacrificing the multiple missions of the institution. This AHC implemented strategies that ensure access for both inner city and rural underserved populations while providing venues for primary care training and educational programs. In addition, the AHC positioned itself to compete more effectively by implementing a continuous quality improvement program that is aimed at maximizing quality while controlling costs. Administrators in not only AHCs but also other healthcare organizations, such as community hospitals and competing systems, should consider the findings from this case study useful in evaluating existing strategies and possible alternatives. In particular, the use of an affiliation strategy for growth in a resource-poor environment may encourage organizations located in rural areas to consider innovative expansion strategies to develop integrated systems of care.     

The academic health center and the healthy community.

US medical care reflects the priorities and influence of academic health centers. This paper describes the leadership role assumed by one academic health center, the State University at Buffalo's School of Medicine and Biomedical Sciences and its eight affiliated hospitals, to serve its region by promoting shared governance in educating graduate physicians and in influencing the cost and quality of patient care. Cooperation among hospitals, health insurance payers, the business community, state government, and physicians helped establish priorities to meet community needs and reduce duplication of resources and services; to train more primary care physicians; to introduce shared governance into rural health care delivery; to develop a regional management information system; and to implement health policy. This approach, spearheaded by an academic health center without walls, may serve as a model for other academic health centers as they adapt to health care reform.     

Increased hospitalizations of elderly patients

This issue of Emerging Infectious Diseases contains 2 articles that report increases in England in the incidence of hospitalizations for specific diseases, one on pneumonias and the other on community-acquired staphylococcal diseases. Both articles report increases in disease among those >65 years of age.     

The posthospital experience of elderly Medicare home health users

This study describes the home health experience of 295 Medicare elderly persons following hospitalization. While a subset of persons improved medically and functionally during the home health service period, some declined on one or both dimensions and many showed not change. The most heavily utilized, non-Medicare, services were personal care and homemaker/chore, reflecting the functional needs of some posthospital elderly. One-fifth of Medicare home health users were reinstitutionalized or died during the service period. Those discharged to home had a range of continuing service needs, both medical and functional, after home health discharge.     

Reorganizing an academic medical center in a period of change

On June 14, 1993, the University of Alberta Hospital was reorganized with the intention of making it more client focused. The decision to transform the organizational structure of the hospital was not taken lightly. The redesign decision was influenced by a host of factors in the external environment and the impact of changes within the organization from the implementation of a total quality management (TQM) philosophy.     

Awareness of the National Standards for Culturally and Linguistically Appropriate Services at an academic health center

The study's objectives were to (a) determine the level of familiarity of faculty and students at an academic health center with the National Standards for Culturally and Linguistically Appropriate Services (CLAS), (b) identify faculty's and students' interest and preferred method of learning Medical Spanish, and (c) determine their aptitude for working with medical interpreters. A survey was developed, piloted, and sent via e-mail to all faculty members (n = 1,025) and students (n = 1,956) currently affiliated with or enrolled at the Medical College of Georgia. Reminder e-mails were sent after 2 weeks, and responses were accepted for 1 month. The total response rate for faculty members was 29% (300/1,025), and that for students was 44% (871/1,956). Nearly 22% of the responding faculty and 23% of the responding students reported that they were less than familiar with the National Standards for CLAS. Both faculty (46%) and students (70%) were willing to spend time learning Medical Spanish. Web-based instruction was the preferred educational delivery mode for those who completed the survey; however, 18% of faculty and 5% of students strongly disagreed with this point. When questioned about how often interpreters services are used, the rates for faculty and students ranged from 34% to 39%. These results suggest that a void exists in understanding the National Standards for CLAS and that there are varying levels of willingness to learn medical Spanish.     

Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers

BACKGROUND: The purpose of this study is to compare the mental health risk profile and health utilization behaviors of adolescent school‐based health center (SBHC) users and nonusers and discuss the role that SBHCs can play in addressing adolescent health needs. METHODS: The sample included 4640 students in grades 9 and 11 who completed the California Healthy Kids Survey between fall 2000 and spring 2005 at 4 high schools in Alameda County, California. Chi‐squared tests of significance and multivariate logistic regression were used to compare characteristics of SBHC users and nonusers and identify demographic, health status, and behavioral characteristics predictive of SBHC use. RESULTS: Controlling for demographic variables and general health status, students who reported frequent feelings of sadness, trouble sleeping, suicide ideation, alcohol or marijuana use, the recent loss of a close friend or relationship, or other difficult life event were significantly more likely to seek SBHC services than their peers. Neither health insurance status nor a student's “usual” source of health care was predictive of general SBHC use, but being on public assistance or having no insurance was predictive of a student seeking SBHC mental health services. CONCLUSIONS: These findings suggest that SBHCs are able to attract students with the most serious mental health concerns and can play an important role in meeting needs that might otherwise go unmet. The provision of SBHC mental health services in particular may fill a need among adolescents with public or no insurance.     

A tale of two systems: the changing academic health center

Major changes in academic health centers (AHCs) may not be confined to the United States. Both Partners HealthCare System in Boston and University College London School of Medicine/University College Hospital Trust in London have recently undergone mergers, downsizing, and cost cutting on unprecedented scales. A comparison of the recent histories of these eminent AHCs reveals striking similarities in the clinical and academic pressures bearing down upon them and in their responses. It also reveals important differences in their situations and actions, traceable in large part to the contrasting roles of governments and markets in the health care economies of these two countries.     

Whether and where community health center users obtain screening services.

This study measures associations between minority and low socioeconomic status and the use of screening services for secondary prevention among adult community health center users. Among those who obtained timely screening services, the study also measures associations between minority and low socioeconomic status and obtaining these preventive services at a community health center. The data include 1,175 individuals ages 18 and older from a 1995 survey of community health center users. Minority and lower socioeconomic status adult community health center users were not less likely to obtain timely screening services than other adult community health center users. This differs from the trend in the general population. Minority and lower socioeconomic status community health center users who used timely screening services were more likely to obtain them at community health centers, which appear to facilitate the use of timely screening services for minority and low socioeconomic status users.