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At least 19 recordsLinked to original sources
PubMed1995

Loosening the Gordian Knot of governance in integrated health care delivery systems.

A new organizational species is emerging--the integrated health care delivery system. Aligned with both the anticipated provisions of federal and state health care reform initiatives and emerging purchaser demands, integrated delivery systems could dominate many health care markets by the end of this decade. Integration is both the defining feature and key imperative of such systems. Because of the unique position of boards, governance is potentially the ultimate integrator. Yet little attention had been focused on integrated delivery system governance. Accordingly, this article will address the governance of integrated delivery systems through three questions: (1) What are the distinguishing characteristics of integrated health care delivery systems? (2) What are the distinctive issues and challenges associated with governing integrated delivery systems? and (3) What different forms of governance can be employed by these systems and what factors influence the effectiveness of these forms?

American Hospital Association↗
PubMed1999

CareWeb, a web-based medical record for an integrated health care delivery system.

With the advent of Integrated Health care Delivery Systems, medical records are increasingly distributed across multiple institutions. Timely access to these medical records is a critical need for health care providers. The CareWeb project provides an architecture for World Wide Web-based retrieval of electronic medical records from heterogeneous data sources. Using Health Level 7 (HL7), web technologies and readily available software components, we consolidated the electronic records of Boston's Beth Israel and Deaconess Hospitals. We report on the creation of CareWeb (freya.bidmc.harvard.edu/careweb.htm) and propose it as a means to electronically link Integrated Health care Delivery Systems and geographically distant information resources.

Computer Security↗
PubMed2002

Integration mechanisms and hospital efficiency in integrated health care delivery systems.

This study analyzes integration mechanisms that affect system performances measured by indicators of efficiency in integrated delivery systems (IDSs) in the United States. The research question is, do integration mechanisms improve IDSs' efficiency in hospital care? American Hospital Association's Annual Survey (1998) and Dorenfest's Survey on Information Systems in Integrated Healthcare Delivery Systems (1998) were used to conduct the study, using IDS as the unit of analysis. A covariance structure equation model of the effects of system integration mechanisms on IDS performance was formulated and validated by an empirical examination of IDSs. The study sample includes 973 hospital-based integrated health care delivery systems operating in the United States, carried in the list of Dorenfests Survey on Information Systems in Integrated Health care Delivery Systems. The measurement indicators of system integration mechanisms are categorized into six related domains: informatic integration, case management, hybrid physician-hospital integration, forward integration, backward integration, and high tech medical services. The multivariate analysis reveals that integration mechanisms in system operation are positively correlated and positively affect IDSs' efficiency. The six domains of integration mechanisms account for 58.9% of the total variance in hospital performance. The service differentiation strategy such as having more high tech medical services have much stronger influences on efficiency than other integration mechanisms do. The beneficial effects of integration mechanisms have been realized in IDS performance. High efficiency in hospital care can be achieved by employing proper integration strategies in operations.

Cross-Sectional Studies↗
PubMed1995

How big should an integrated health care delivery system be at an academic medical center?

The author defines integrated health care delivery systems and comments that there are few such systems now but many in various stages of development. The size of such a system can be described in terms of the number of patients it serves, including their health status and utilization of care, the geographic configuration of the served area, the number of physicians, and the scope and extent of the facilities network. There are a variety of factors that influence a system's size; the author concentrates on the factors that an academic medical center must consider when formulating system-size goals. He discusses (1) the influence of how the institution structures itself to survive; (2) the effects of technology, innovation, and health care costs on the size and organization of these systems; and (3) the effects of the specific characteristics of the institutions' missions of education, research, and patient care. Real numbers describing integrated systems are presented as they relate to three possible institutional goals: economic viability, academic viability, and academic leadership. The author explains why academic medical centers should not try to be only tertiary or quaternary care providers for other integrated health care delivery systems, but at the same time emphasizes that there is no easy or inexpensive way for centers to develop their own systems. Alternative structures for integrated systems are discussed, such as "disease management systems" being developed by the pharmaceutical industry, an "end-to-end linkage" approach, and various ideas to include "captive markets," such as prisoners, university students, and members of communities for the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1995

Strategic and financial considerations for integrated health care delivery.

The author predicts that most providers will realize that the benefits of integrated health care delivery, which include lower overhead costs, increased marketshare, and secure income, are well worth the change toward market principles. He outlines some of the strategic and financial factors that should be considered when setting up an integrated health care delivery system.

Delivery of Health Care↗
PubMed1998

A model for collaboration in quality improvement projects: implementing a weight-based heparin dosing nomogram across an integrated health care delivery system.

BACKGROUND: At Aurora Health Care, an integrated delivery system based in Milwaukee, a system-level clinical quality improvement department was established in 1995 to facilitate collaboration on clinical quality improvement (QI) initiatives. THE COLLABORATIVE MODEL: A model was developed to use expertise within the system and avoid unnecessary duplication of efforts, while maintaining buy-in for the project's interventions at the point of service delivery. It was believed that a single team could design the improvement efforts or guidelines, and then work at a more local level with a different group of people to implement the processes. APPLYING THE MODEL TO THE HEPARIN QI PROJECT: Anticoagulation with heparin is considered the mainstay of treatment for pulmonary embolism and deep venous thrombosis. However, a large gap was found between present anticoagulation practices and published best practice in regards to achieving a key process measure. To reduce the overall time to achieving effective anticoagulation, a system-level team created an intervention primarily consisting of a preprinted order sheet, including the weight-based heparin dosing nomogram, and an education plan for physicians and other health care professionals. Significant improvement was observed at all pilot sites with overall rates of adequate anticoagulation within the first 24 hours improving from 73% to 95%. DISCUSSION: The system was able to standardize care at four of its five major hospitals and provide for better patient outcomes to a larger segment of the community, and then to replicate the heparin project to four additional sites during a six-month period. This model has been successfully applied to other quality improvement projects.

Anticoagulants↗
PubMedDate not supplied

Integrated health care delivery system conducts ad agency search as part of its brand-launching effort.

PennState Geisinger Health System, Hershey, Pa., conducted an extensive ad agency search after its inception in 1997. The integrated health care delivery system needed to introduce its brand to an audience that was confused by the wide array of available health care options. BVK/McDonald, Milwaukee, the agency selected, has created a branding campaign that revolves around the tag-line "The power of health." PennState Geisinger will tabulate the results of BVK/McDonald's multi-million dollar campaign in 2000; at that time it will know whether its selection committee chose wisely.

Advertising↗
PubMed2003

Improving patient safety across a large integrated health care delivery system.

OBJECTIVE: Patient safety is moving up the list of priorities for hospitals and health care delivery systems, but improving safety across a large organization is challenging. We sought to create a common patient safety strategy for the Partners HealthCare system, a large, integrated, non-profit health care delivery system in the United States. DESIGN: Partners identified a central Patient Safety Officer, who then formed a Patient Safety Advisory Group with local expert members, as well as a Patient Safety Leaders Group comprised of personnel responsible for patient safety at each member institution. The latter group meets monthly to help determine future projects and to share the results of piloting and implementation. There was broad consensus that interventions should include the areas of culture change, process change, and process measurement. SETTING: A large, integrated health care delivery system in the Boston, Massachusetts, area. RESULTS: Key milestones to date include implementation of Executive WalkRounds, development of accountability principles, agreement to create a common system-wide adverse event reporting system, and agreement to implement computerized physician order entry in all hospitals. These efforts have heightened awareness of patient safety considerably within the network. Most influenced to date have been the senior leaders of the hospitals, which has resulted in substantial support for patient safety initiatives. CONCLUSIONS: This loosely integrated delivery system represents a daunting landscape for the development and institution of patient safety concepts. Many projects aimed at different components of patient safety must occur at the same time for significant change, yet culture and care-related beliefs vary substantially within the system, and measurement is especially challenging. Moreover, with many potential interventions, and limited resources, prioritization and selection is difficult. Nonetheless, consensus about some issues has been reached, in particular because of a well delineated patient safety structure. We believe the net result will be substantial improvement in patient safety.

Boston↗
PubMed1997

Evolution of computer-based information systems and networks to support integrated health care delivery systems.

As health care delivery systems become more integrated with an emphasis on community wellness and prevention, well-developed information infrastructures will be needed to support their activities. The article introduces several previously published independent models for the evolution of integrated delivery systems, computer-based patient records (CPRs), and health information networks as well as a summary model that illustrates the relationship among these entities and their somewhat parallel development.

Chronic Disease↗
PubMed2005

Sex and racial/ethnic disparities in outcomes after acute myocardial infarction: a cohort study among members of a large integrated health care delivery system in northern California.

BACKGROUND: Previous studies have documented sex and racial/ethnic disparities in outcomes after acute myocardial infarction (AMI), but the explanation of these disparities remains limited. In a setting that controls for access to medical care, we evaluated whether sex and racial/ethnic disparities in prognosis after AMI persist after consideration of socioeconomic background, personal medical history, and medical management. METHODS: We conducted a prospective cohort study of the members (20,263 men and 10,061 women) of an integrated health care delivery system in northern California who had experienced an AMI between January 1, 1995, and December 31, 2002, and were followed up for a median of 3.5 years (maximum, 8 years). Main outcome measures included AMI recurrence and all-cause mortality. RESULTS: In age-adjusted analyses relative to white men, black men (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.26-1.65), black women (HR, 1.47; 95% CI, 1.26-1.72), and Asian women (HR, 1.37; 95% CI, 1.13-1.65) were at increased risk of AMI recurrence. However, multivariate adjustment for sociodemographic background, comorbidities, medication use, angiography, and revascularization procedures effectively removed the excess risk of AMI recurrence in these 3 groups. Similarly, the increased age-adjusted risk of all-cause mortality seen in black men (HR, 1.55; 95% CI, 1.37-1.75) and black women (HR, 1.45; 95% CI, 1.27-1.66) was greatly attenuated in black men and reversed in black women after full multivariate adjustment. CONCLUSION: In a population with equal access to medical care, comprehensive consideration of social, personal, and medical factors could explain sex and racial/ethnic disparities in prognosis after AMI.

Adult↗
PubMedDate not supplied

Enterprise-wide automation in integrated health care delivery systems--has it finally turned the corner?

During the past decade, the healthcare industry has seen a marked expansion of networked delivery. The norm is no longer a stand-alone hospital, but an "Integrated Healthcare Delivery System," in which a healthcare provider may offer services from acute care, ambulatory, longterm and home health care. Along with the IHDS comes the need to integrate the vast amount of information necessary to operate the network and service the patients. This article looks at the findings of a survey of IHDS information usage and needs.

Computer Communication Networks↗
PubMed1993

Creating an integrated health care delivery system: a regional nonprofit provider case study.

The development of integrated health care systems holds many pitfalls as well as potentials. This case study describes the development of the strategy that has moved the structure, mission, and vision of a health care system. It examines the questions of what members, payers, and providers' needs are when defined around the paradigm of responsibility for the health as well as the health care of a population. It starts by examining the background of the development of the strategies used by the health system during the past decade, and the environmental climate that has led to a redefinition of the mission and vision of the organization. This movement has moved the focus on acute health services to the development of a regional integrated health care system based on collaboration and on a responsibility to improve the health of those we serve through treatment, prevention, and education. Finally, the chapter reviews the options facing all of us: do we compete, collaborate, or both?

Comprehensive Health Care↗
PubMed1995

A CNS integrated health care delivery system model.

The more complicated a client's health needs are, the higher the risk for inappropriate utilization of services, fragmentation of care and delays in system access. The challenge is to ensure that patients move appropriately from one access point to another in the most efficient, effective manner. The Integrated Health Care Delivery System is designed to meet this challenge.

Case Management↗
PubMed2006

Complications of colonoscopy in an integrated health care delivery system.

BACKGROUND: Information about colonoscopy complications, particularly postpolypectomy bleeding, is limited. OBJECTIVE: To quantify the magnitude and severity of colonoscopy complications. DESIGN: Retrospective cohort. SETTING: Kaiser Permanente of Northern California. PATIENTS: 16, 318 members 40 years of age or older undergoing colonoscopy between January 1994 and July 2002. MEASUREMENTS: Electronic records reviewed for serious complications, including hospital admission within 30 days of colonoscopy for colonic perforation, colonic bleeding, diverticulitis, the postpolypectomy syndrome, or other serious illnesses directly related to colonoscopy. RESULTS: 82 serious complications occurred (5.0 per 1000 colonoscopies [95% CI, 4.0 to 6.2 per 1000 colonoscopies]). Serious complications occurred in 0.8 per 1000 colonoscopies without biopsy or polypectomy and in 7.0 per 1000 colonoscopies with biopsy or polypectomy. Perforations occurred in 0.9 per 1000 colonoscopies (CI, 0.5 to 1.5 per 1000 colonoscopies) (0.6 per 1000 without biopsy or polypectomy and 1.1 per 1000 with biopsy or polypectomy). Postbiopsy or postpolypectomy bleeding occurred in 4.8 per 1000 colonoscopies with biopsy (CI, 3.6 to 6.2 per 1000 colonoscopies). Biopsy or polypectomy was associated with an increased risk for any serious complication (rate ratio, 9.2 [CI, 2.9 to 29.0] vs. colonoscopy without biopsy). Ten deaths (1 attributable to colonoscopy) occurred within 30 days of the colonoscopy. LIMITATIONS: 99.3% (16 204) of colonoscopies were nonscreening examinations. The rate of complications may be lower in a primary screening sample. The small number of observed adverse events limited power to detect risk factors for complications. CONCLUSIONS: Colonoscopy with biopsy or polypectomy is associated with increased risk for complications. Perforation may also occur during colonoscopies without biopsies.

Adult↗