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Although guidelines have existed in various forms for many years, increased interest in guidelines has sparked myriad concerns among health care professionals, policymakers, and the broader public. Among these concerns are a number of legal questions that to date have not received sufficient notice or study.
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This paper highlights for the nursing education community selected data from a recently completed study of the organization and governance of academic health centers, conducted under the auspices of the Association of Academic Health Centers and funded by the W.K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Presented and discussed are data derived from three different questionnaires used in the study. Top administrators in academic health centers were surveyed in order to produce information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made and conflicts are resolved, and the conditions which administrators envision for their institutions in the future. Deans of nursing schools were part of the survey group, and their responses are examined along with those of deans of other health professional schools.
This paper highlights for the dental education community selected data from a recently completed study of the organization and governance of academic health centers, conducted under the auspices of the Association of Academic health Centers and funded by the W. K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Data derived from three questionnaires used in the study are presented and discussed. Top administrators in academic health centers were surveyed to assemble information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made, the way in which conflicts are resolved, and the conditions that administrators envision for their institutions in the future. Dental school deans were part of the survey group, and their responses are examined along with those of deans of other health professional schools.
This paper highlights selected data from a recently completed study of the organization and governance of academic health centers. The study was conducted under the auspices of the Association of Academic Health Centers and was funded by the W.K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Data derived from three different questionnaires used in the study are presented and discussed. Top administrators in academic health centers were surveyed to produce information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made and conflicts are resolved, and the conditions that administrators envision for their institutions in the future. Deans of schools of allied health were part of the survey group, and their responses are examined along with those of deans of other health professional schools.
A survey of the 96 member-institutions of the Association of Academic Health Centers was conducted by the authors during the 1988-89 academic year to determine the number and types of contractual ties with continuing-care retirement communities (CCRCs). Of the 88 academic health centers that responded, 24% had an existing relationship with a CCRC; 26% were in the process of developing such a relationship; 7% had considered but decided against such a relationship; and 43% had not considered developing such a relationship. The authors document a rapid increase in the number of such relationships in the latter half of the 1980s and suggest that this trend is comparable to the increase in formal relationships with nursing homes begun by academic health centers in the early 1980s. Issues raised by those institutions that responded are presented, levels of possible involvement with a CCRC are described, and the contractual agreement between the University of North Carolina School of Medicine's Program on Aging and a local CCRC is presented as an example of the benefits that can be gained from such a relationship.
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The sensible response to conflicts of interest is impaired by misconceptions and sloppy usage of terminology. Apparent and potential are widely misused modifiers for conflicts. Excessive legislative focus on financial interests limits understanding of the scope and significance of researchers' conflicts of interest. There is no moral or ethical failing in having a conflict of interest; the problem occurs when conflicts are not disclosed appropriately and when conflicts are allowed to bias research, teaching, or practice. Avoidance and prevention should be applied to bias, not conflicts.
BACKGROUND: The Institute of Medicine has called for increased population-based training for healthcare professions students, and particularly medical students. For this to be effective, students should receive such training in the locations where population-based approaches to care take place, such as public health departments (HDs). However, little is known about currently existing relationships between academic health centers (AHCs) and HDs. METHODS: During the spring and summer of 2003, e-mail surveys on this topic were sent to the 104 members of the Association of Academic Health Centers, and 500 members of the National Association of City and County Health Officers and the Association of State and Territorial Health Officers. Results were received from 50 AHCs and 201 HDs. RESULTS: Survey results suggest that large numbers of healthcare professions students--residents, medical students, and others--are currently being trained in many HDs nationwide. The web of relationships between AHCs and HDs extends beyond education into research, service, and other purposes. CONCLUSIONS: These preliminary results require verification. Nevertheless, they raise questions about the types and quality of the education being offered in health departments, the impact of AHC/HD relationships on both parties, and how existing relationships may be enhanced to meet current and future national needs.
The growth of prepaid medical-care programs has caused the leaders of a number of academic medical centers to begin to have an increased interest in affiliating with or sponsoring centers in prepaid programs -- otherwise known as health-maintenance organizations (HMOs)--is motivated by a number of potential benefits. An HMO may provide an academic medical center with an additional source of patients for teaching and research; generate additional revenue; increase resources for education in primary care; increase the exposure of students, residents, and faculty to the characteristics of prepaid medical practice; and improve the delivery of health services locally. Issues of importance to the academic medical center include the pros and cons of sponsorship of, as opposed to affiliation with, an HMO and the additional costs attributable to medical education in the HMO setting. Problems may arise between HMOs and medical centers as a result of disparate styles of practice, the high cost of clinical services at the medical center, and the differing perspectives of HMO and medical-center policy makers.
The University HealthSystem Consortium (UHC) represents a strategic alliance of 169 academic health centers and associated institutions engaged in knowledge sharing and idea-generation. The use of the Internet as a tool in the delivery of UHC's products and services has increased dramatically over the past year and will continue to increase during the foreseeable future. This paper examines the current state of UHC-member institution driven tools and services that utilize the Web as a fundamental component in their delivery. The evolution of knowledge management at UHC, its management information and reporting tools, and expansion of e-commerce provide real world examples of Internet use in health care delivery and management. Health care workers are using these Web-based tools to help manage rising costs and optimize patient outcomes. Policy, technical, and organizational issues must be resolved to facilitate rapid adoption of Internet applications.
OBJECTIVE: We evaluated the association of risk factors for breast cancer with reported follow-up procedures after abnormal mammography among diverse women. METHODS: Women ages 40--80 years were recruited from four clinical sites after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. A telephone-administered survey asked about breast cancer risk factors (family history, estrogen use, physical inactivity, age of menarche, age at birth of first child, parity, alcohol use), and self-reported use of diagnostic tests (follow-up mammogram, breast ultrasound, or biopsy). RESULTS: Nine hundred and seventy women completed the interview, mean age was 56, 42% were White, 19% Latina, 25% African American, and 15% Asian. White women were more likely to have a positive family history (20%), use estrogen (32%), be nulliparous (17%) and drink alcohol (62%). Latinas were more likely to be physically inactive (93%), African Americans to have early onset of menarche (53%) and Asians first child after age 30 (21%). White women were more likely to have suspicious mammograms (40%) and to undergo biopsy (45%). In multivariate models, Latinas were more likely to report breast ultrasound, physical inactive women reported fewer follow-up mammograms, and care outside the academic health center was associated with fewer biopsies. Indeterminate and suspicious mammography interpretations were significantly associated with more biopsy procedures (OR=8.4; 95% CI=3.8-18.5 and OR=59; 95% CI=35-100, respectively). CONCLUSIONS: Demographic profile and breast cancer risk factors have little effect on self-reported use of diagnostic procedures following an abnormal mammography examination. Level of mammography abnormality determines diagnostic evaluation but variance by site of care was observed.
The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.
Traditionally, each professional school has developed its own course or department of health care informatics. We may find it more efficient and productive to establish a department of Medical Informatics to serve all health science colleges. Therefore the initial costs would be reduced and the common knowledge bank would be greatly increased. In a position paper written for the Association of Academic Health Centers lies the detailed plans for the establishment of an integrated health sciences center computer resource. The inclusion of computer courses in the curriculum can be summarized in the following action step. The chief administrative officer of the academic health center should facilitate the work of the deans of the schools of the health professions in convening faculty task forces that will address the introduction of computer literacy and computer applications in health care to the curricula. Although dental informatics is still in its infancy, we must lay a solid foundation for the controlled growth and development of this field of dental science. The problems encountered in developing a course in dental informatics are not unique to this one area. All specialties of health care are grappling with the questions posed by medical informaticians. Although each specialty has its own needs and requirements, the basic underlying principles of medical informatics remains the same. The knowledge we can gain by the exchange of experiences between all fields can greatly increase the speed and accuracy of development. The primary goal of computer literacy in dental education should be to prepare our students for the changing practice environment of the future.
In the changing paradigm of medicine, the cost of health care has become the bellwether for effective health care delivery. Managed care and case management are proposed as the only methodology suitable for this new model. The concept of early discharge is advanced as appropriate care. A Neonatal Intensive Care Unit (NICU) associated with an academic health center is seen as more costly than an NICU in a nonacademic setting. Little data exists, however, that support or refute the above assertions. Measurement of relevant processes to determine the outcome of NICU care is essential to insure the delivery of quality health care within the cost-containment model.
Vascular access thrombosis is the most common and costly complication in hemodialysis patients. The role of thrombophilia in access thrombosis is not established. A case-control study was conducted of 419 hemodialysis patients to determine whether thrombophilia was associated with arteriovenous fistula or graft thrombosis. Participants were enrolled from three in-center and five satellite dialysis units associated with a Canadian academic health science center that provides dialysis services in a catchment area of one million. Patients were tested for factor V Leiden, prothrombin gene mutation, factor XIII genotype, methylenetetrahydrofolate reductase genotype, lupus anticoagulant, anticardiolipin antibody, factor VIII, homocysteine, and lipoprotein (a) concentrations. Overall, 59 (55%) patients with access thrombosis had at least one thrombophilia compared with 122 (39%) patients without access thrombosis (unadjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.23 to 2.98). After controlling for important risk factors, the association between any thrombophilia and access thrombosis remained (adjusted OR, 2.42; 95% CI, 1.47 to 3.99). For each additional thrombophilic disorder, the odds of access thrombosis increased significantly (adjusted OR, 1.87; 95% CI, 1.34 to 2.61). This study suggests that thrombophilia is associated with access thrombosis in dialysis patients. Large, multicenter, prospective cohort studies are needed to confirm the observations from this case-control study.