POPULATION HEALTH: Kaiser Permanente innovative model

Kaiser Permanente Oakland Medical Center is collaborating with the UC Berkeley School of Public Health in offering a population-health focused residency program.  The program is small – there are two degrees being offered and only two residents matched into each of the programs each year.  Two residents are in an Internal Medicine-Masters in Public Health (MPH) track and the other two are in a Pediatrics MPH track.  There have been a total of 16 program graduates so far.

Source: Lo, J.C., and others. (2017). Innovative partnerships to advance public health training in community-based academic residency programs. Advances in Medical Education and Practice. 8, 703-706. Click here for full text: https://www.dovepress.com/innovative-partnerships-to-advance-public-health-training-in-community-peer-reviewed-article-AMEP  Posted by AHA Resource Center, (312) 422-2003 rc@aha.org

MEDICAL SCHOOLS: Changing role of the dean

The medical school dean is evolving from the medieval guild master to a system executive.  In this contemporary version of the dean’s role, the dean is a major player in setting organizational direction for the medical school within the mission and vision of a larger system of care.”

This is a great article for anyone researching the historical role of the medical school dean and how this role may evolve in the near future.  It is informative in its content as well as providing extensive footnotes for further study.  The roles described include:

• Medical guild master
• Dean-CEOs, dean-presidents
• System dean

A key feature of the next iteration, which the authors feel will be the system dean, the dean will be less the “quasi-autonomous CEO” and more a member of “a broader leadership team.”

Source: Schieffler, D.A., and others. (2017). The evolution of the medical school deanship: From patriarch to CEO to system dean. The Permanente Journal, 21(16-069). Click here: http://www.thepermanentejournal.org/files/2017/16-069.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MEDICAL SCHOOLS: Ten largest in the U.S.

These are the ten largest medical schools in the U.S. according to the number of graduates in 2015.  In the original article the schools are divided into separate lists – one for allopathic and the other for osteopathic.  I thought it would be interesting to combine them here:

1. Lake Erie College of Osteopathic Medicine (356 graduates in 2015)*
2. Western University of Health Sciences College of Osteopathic Medicine (322)
3. Indiana University School of Medicine (313)
4. University of Illinois College of Medicine (309)
5. Michigan State University College of Osteopathic Medicine (288)
6. Wayne State University School of Medicine (284)
7. Sidney Kimmel Medical College at Thomas Jefferson University (282)
8. New York Institute of Technology College of Osteopathic Medicine (270)
9. Philadelphia College of Osteopathic Medicine (266)
10. Drexel University College of Medicine; and also Arizona College of Osteopathic Medicine of Midwestern University (both at 259)

*After writing this blog post, I was contacted by the director of communications at Lake Erie College of Osteopathic Medicine to say that, in fact, there is another branch campus in Florida that added another 187 graduates in 2015.

“Allopathic” medicine is a term not encountered so very often – it refers to the type of training and type of medicine practiced by M.D.s – as distinguished from “osteopathic” medicine.  I like the brief article on the Indiana University website that provides more background on this.

Sources:

By the numbers. (2016, July 18). Modern Healthcare, 46(29), 36.

Indiana University Bloomington. (2015). Two kinds of physicians: Allopathic and osteopathic. Click here: http://www.hpplc.indiana.edu/medicine/med-res-twokinds.shtml  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

MEDICAL GROUPS: Top 10 largest in the U.S.

This is a study of large medical group practices, comparing characteristics of academic medical groups (“gown”) with those not linked to medical schools (“town”).  A large part of the study involved developing a list of the 100 largest practices – which included those from about 500 physicians at the bottom of the list of 100 to ten times that many at the top.  An average of about one-quarter of physicians in these large practices were primary care physicians (PCPs).  However, there was a smaller percentage of PCPs in the academic practices than in the community practices.

Top 10 Largest Physician Practices: U.S. 2013

1. Northern California Permanente Medical Group (the largest with 5,634)
2. Southern California Permanente Medical Group
3. Harvard University
4. Mayo Medical School
5. Case Western Reserve University
6. University of Pittsburgh
7. University of Washington
8. University of Michigan
9. Johns Hopkins University
10. University of Texas, Houston

Source: Welch, W.P., and Bindman, A.B. (2016, July). Town and gown differences among the 100 largest medical groups in the United States. Academic Medicine, 91(7), 1007-1014.  Click here: http://journals.lww.com/academicmedicine/Abstract/2016/07000/Town_and_Gown_Differences_Among_the_100_Largest.32.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TEACHING HOSPITALS: What is the July effect? Is it real?

The “July effect” refers to the detrimental impact on patient care, efficiency and outcomes in teaching hospitals when a new class of residents comes on board each year in the summer.  This is not just scuttlebutt.  The authors note several research studies that found that patient care takes longer, is more expensive, or more likely to have errors when the patient is hospitalized in July.  What to do?  The authors, who are associated with the University of Michigan, suggest a multi-pronged plan to address the July effect.  The first steps involve identifying and incentivizing outstanding physician educators who are willing to serve as July-able attendings and also grooming senior residents to be ready for leadership and teaching responsibilities in July.  Academic health systems can also invest more in simulation-based training and improving communications.

Source: Petrilli, C.M., Del Valle, J., and Chopra, V. (2016, July). Why July matters. Academic Medicine, 91(7), 910-912.  Click here: http://journals.lww.com/academicmedicine/Fulltext/2016/07000/Why_July_Matters.12.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

PATIENT SATISFACTION: Academic medical center improves the patient experience

This is a case study of University of Utah Health Care, a four-hospital system that was created in 2004 by bringing together the School of Medicine and the University Hospitals and Clinics.  Radically different cultures hampered the ability of the organization to achieve top patient satisfaction scores until launch of an initiative in 2008.  Working on aligning culture was one of the first tasks of the Exceptional Patient Experience (EPE) initiative.  Among the other EPE activities were revision of the mission, vision, and values statements; value-based hiring, retention, and promotion; and, sharing physician-specific patient feedback data.  Besides the improvement in patient satisfaction scores, the system has seen a big drop in malpractice premium rates and an increase in employee satisfaction.

Source: Lee, V.S., Miller, T., Daniels, C., and others. (2016, Mar.). Creating the exceptional patient experience in one academic health system. Academic Medicine. 91(3), 338-344.  Click here for publisher’s website: http://journals.lww.com/academicmedicine/Fulltext/2016/03000/Creating_the_Exceptional_Patient_Experience_in_One.25.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CARE COORDINATION: Hospital leases beds at skilled nursing facilities and cuts 30-day readmission rate

UCLA Health (Los Angeles), which operates Ronald Reagan UCLA Health, and Santa Monica UCLA Health, is collaborating with local skilled nursing facilities (SNFs) through a bed leasing program.  The academic medical center pays a negotiated daily fee to hold SNF beds open so that patients ready for discharge but who have been hard to place have a postacute facility to go to.  Despite the bed lease cost, the advantages of being able to move patients out of the acute care setting and decrease the 30-day readmission rate have resulted in the program being a financial success.

Source: Bed leasing program helps hospitals discharge hard-to-place patients. (2015, Dec.). Hospital Case Management, 23(12), 158, 163.  Retrieved from http://www.ahcmedia.com/articles/136601-bed-leasing-program-helps-hospitals-discharge-hard-to-place-patients Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FUTURE: What will the academic health center look like?

A conceptual framework for the academic health center (AHC)  is proposed in this article which is part of the “New Conversations” series in the journal Academic Medicine.  The framework is built on the concept of the “three-legged stool” – which refers to the academic health center’s traditional missions of patient care, teaching, and research.  The authors overlay the three-legged stool on top of 4 aspects: health, innovation, community, and policy, and discuss what each of the 12 intersections might look like.  For example, where research intersects with community – one would look at how to integrate the AHC’s research program with community research programs.  This model is an attempt to adapt the traditional role of the academic health center to the new health care delivery system that is emerging in the wake of the Affordable Care Act.

Source: Borden, W.B., Mushlin, A.I., and others. 2015, May). A new conceptual framework for academic health centers. Academic Medicine, 90(5), 569-573.  Retrieved from http://journals.lww.com/academicmedicine/Fulltext/2015/05000/A_New_Conceptual_Framework_for_Academic_Health.14.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ACADEMIC MEDICAL CENTERS: Org charts and the future of AMCs

It is always exciting to find examples of organization charts, which explains why I led off with that fact in the title of this post.  They can be found in the second document cited below–the Profiles–which takes a look at 13 leading academic medical centers in the United States.  But these two reports are so much more than a place to find a few org charts.  They represent the report of a panel charged with taking a careful, comprehensive look at the direction that academic health centers  need to go in the near future to ensure viability in a changing health care system.  And “SYSTEM” is a key–take a look at the first theme cited:

• “The AMC of the future will be system-based, with a broad regional presence and clinical services aligned across the continuum of care.”
• Five options thatAMCs might use to achieve move toward achievement of this first theme are:
  • “Merge/affiliate with mega-system”
  • “Specialized complex care leader”
  • “High performance regional system”
  • “Public entity statewide hub”
  • “Population health manager”

There are seven more themes developed in the report.  At the end of the report are a series of questions related to each theme that can be used by AMC leaders to start a discussion, and also a self-assessment tool.

Sources: Enders, T., and Conroy, J.  Advancing the Academic Health System for the Future: A Report from the AAMC Advisory Panel on Health Care.  Washington, D.C.: Association of American Medical Colleges, 2014.  Click here for access to this report: https://www.aamc.org/initiatives/patientcare/aphc/357864/academichealthsystem.html; and, Advisory Panel for Health Care: Advancing the Academic Health System for the Future: Profiles in Academic System Leadership.  Washington, DC: Association of American Medical Colleges, Nov. 2013.  Click here for access to this report: https://www.aamc.org/initiatives/patientcare/aphc/359476/profiledinstitutions.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MERGERS: How to merge teaching hospitals successfully

Insights drawn from the mergers of teaching hospitals that resulted in the creation of the University of Pennsylvania Health System, Partners Healthcare (Boston), and New York-Presbyterian Hospital are discussed in this perspective article by three leading physicians who were involved.  They note that there was an initial wave of academic medical center merger discussions from 1993 to 1998 — and that interest is rising again today.  The success factors are categorized as follows:

• “Leadership and trust” (Who will be in charge?  What will be their roles?  Will there be a holding company?  A single board with fiduciary responsibilities?  Do the trustees display vision and commitment to the merger?)
• “Managing uncertainty” (Is there clarity and transparency of purpose?)
• “Medical staff stability” (Typically the most volatile of issues.)
• “Bridging culture” (Is there respect among the legacy organizations?  How similar is the management style and governance heritage?  How quickly will the integration be able to occur?

Source: Thier, S.O., Kelley, W.N., and others.  Success factors in merging teaching hospitals.  Academic Medicine;89(2):219-223, Feb. 2014.  Click here to access publisher’s website: http://journals.lww.com/academicmedicine/Abstract/2014/02000/Success_Factors_in_Merging_Teaching_Hospitals.13.aspx 

Posted by AHA Resource Center (312) 422-2050, rc@aha.org