Addressing Kentucky's Physician Shortage While Securing a Network for a Research-Intensive, Referral Academic Medical Center: Where Public Policy Meets Effective Clinical Strategic Planning.

A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year.

Securing the Future for a Major Academic Cardiovascular Program: Hardwiring a Referral Network and Preparing for a Transition to Value-Based Reimbursement.

The University of Kentucky College of Medicine and Albert B. Chandler Hospital opened over 50 years ago to serve Kentucky. After initial growth and expansion, both were struggling clinically, academically, and financially in the early 2000s.

The Role of Academic Health Centers in Addressing Health Equity and Social Determinants of Health.

Elsewhere in this issue, Park and colleagues argue that academic health centers (AHCs) must partner with communities to address health disparities and social determinants of health (SDOH). Who is ultimately responsible for addressing them is in question. Countries that have been successful in improving the health of their populations have made these efforts a national priority by, among other things, ensuring universal health care coverage.

Securing a Network for a Research-Intensive, Referral Academic Medical Center: University of Kentucky HealthCare as a Case Study.

Over the last 15 years, UK HealthCare, the clinical enterprise of the University of Kentucky, has undertaken 3 clinical strategic plans to secure its position as a research-intensive, referral academic medical center. The first plan, titled Securing the Traditional Marketplace (2005-2010), focused on building advanced subspecialty programs on campus while pursuing partnerships with providers in UK HealthCare's traditional marketplace, eastern Kentucky. The second plan, Expanding the Footprint (2010-2015), recognized that UK HealthCare needed to cover a population base of 5 to 10 million people to support its subspecialty programs.

Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome in Diabetic Patients: Missing the Mark?

Purpose:  Diabetes mellitus (DM) and carpal tunnel syndrome (CTS) are common pathologies. The diagnosis of CTS can be facilitated by the use of an ultrasound-based wrist-to-forearm ratio (WFR) of the nerve diameter. However, the applicability of WFR in DM-patients is not yet clear.

Let's Get Real About Health Care Reform.

In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets.

Hospital affiliations, co-branding, and consumer impact.

Alliances, affiliations, and partnerships continue to grow as one way for health care organizations to better serve their customers and compete with other organizations and networks. These organizational relationships are often promoted through co-branding joint programs and services. A study of consumers was conducted and shows that these organizational relationships positively affect consumer future behavior and benefit the organizations involved.

Challenges of becoming a regional referral system: the University of Kentucky as a case study.

The U.S. health care system must change because of unsustainable costs and limited access to care.

Commentary: choice--the need for a thorough and open discussion: implications for academic health centers.

The reality is that choice in health care may be limited or substantially curtailed in the future. To imply that the U.S.

Commentary: Institutes versus traditional administrative academic health center structures.

In the Point-Counterpoint section of this issue, Kastor discusses the pros and cons of a new, institute-based administrative structure that was developed at the Cleveland Clinic in 2008, ostensibly to improve the quality and efficiency of patient care. The real issue underlying this organizational transformation is not whether the institute model is better than the traditional model; instead, the issue is whether the traditional academic health center (AHC) structure is viable or whether it must evolve. The traditional academic model, in which the department and chair retain a great deal of autonomy and authority, and in which decision-making processes are legislative in nature, is too tedious and laborious to effectively compete in today's health care market.

Commentary: Health care reform and primary care: training physicians for tomorrow's challenges.

Although Congress recently passed health insurance reform legislation, the real catalyst for change in the health care delivery system, the author's argue, will be changes to the reimbursement model. To rein in increasing costs, the Centers for Medicare and Medicaid aims to move Medicare from the current fee-for-service model to a reimbursement approach that shifts the risk to providers and encourages greater accountability both for the cost and the quality of care. This level of increased accountability can only be achieved by clinical integration among health care providers.

The evolution of a Department of Internal Medicine under an integrated clinical enterprise model: the University of Kentucky experience.

The impact on the Department of Internal Medicine of the emergence of the University of Kentucky Healthcare Enterprise as an integrated clinical model has been enormous. In fiscal year 2004, the department was financially insolvent and on the verge of implementing plans to decrease faculty from 127 to 65. Since that time, the department has changed dramatically with a corresponding improvement in its clinical, academic, and financial activity.

Commentary: Health care reform and its potential impact on academic medical centers.

President Obama's administration has committed to significant changes in the current health care system to address three issues: access, cost, and quality. Leaders at academic medical centers (AMCs) must acknowledge the root cause of the problems within the current system, recognize potential change initiatives, contemplate the changing role that AMCs will play in the health care system of the future, and begin to adapt and respond. The underlying root cause of the problem with our health care system is excessive costs.

Defining the role of University of Kentucky HealthCare in its medical market--how strategic planning creates the intersection of good public policy and good business practices.

In response both to national pressures to reduce costs and improve health care access and outcomes and to local pressures to become a top-20 public research university, the University of Kentucky moved toward an integrated clinical enterprise, UK HealthCare, to create a common vision, shared goals, and an effective decision-making process. The leadership formed the vision and then embarked on a comprehensive and coordinated planning process that addressed financial, clinical, academic, and operational issues. The authors describe in depth the strategic planning process and specifically the definition of UK HealthCare's role in its medical marketplace.

Creating an integrated clinical enterprise at the University of Kentucky: the emergence of UK HealthCare.

If the medical system in the United States is to change, as has been recommended, academic medical centers must, in fact, lead this change process. To prepare for the future, the University of Kentucky decided to move aggressively toward developing an integrated clinical enterprise branded as UK HealthCare, where leadership of the various components of the academic medical center make strategic and financial decisions together to achieve common organizational goals. The authors discuss senior leadership's development of the vision for the enterprise and the governance structure that was established to engage board members and faculty of the institution.

The U.S. health care system is in crisis: implications for academic medical centers and their missions.

The medical care system in the United States is in crisis. Health care costs are escalating and threatening coverage for millions of people. Concerns about the quality of care and patient safety are heightening; patients and payers now publicly share these concerns and want to make providers more accountable.

New, azide-free transformation of epoxides into 1,2-diamino compounds: synthesis of the anti-influenza neuraminidase inhibitor oseltamivir phosphate (Tamiflu).

A new, azide-free transformation of the key precursor epoxide 6 to the influenza neuraminidase inhibitor prodrug oseltamivir phosphate (1, Tamiflu) is described. This sequence represents a new and efficient transformation of an epoxide into a 1,2-diamino compound devoid of potentially toxic and hazardous azide reagents and intermediates and avoids reduction and hydrogenation conditions. Using catalytic MgBr(2).

[Effectiveness of epicondylitis bandages from the biomechanical viewpoint--an experimental study].

Questions: During extension of the elbow joint (test measurement) and extension of the wrist (control measurement), maximal bandage pressure is desired on the extensor group of the forearm, especially of the M. extensor carpl radialis brevis (ECRB). Do the various commercial epicondylitis bandages produce a mechanical effect on the extensor group of the forearm and how do the maximal pressures of these bandages behave in direct comparison? Are the pressures produced clinically relevant?

Methods: Eleven different epicondylitis bandage constructions were examined for their biomechanical effects.

The decade of the nineties at the UCLA Medical Center: responses to dramatic marketplace changes.

The evolution of the health care marketplace in the nineties in Southern California is described, including the dominance of managed care at the decade's end. The marketplace, especially in Los Angeles, is now one of the most complex, competitive, and challenging medical marketplaces in the country. The University of California, Los Angeles (UCLA) Medical Center and the academic health center of which it is a part have had to respond appropriately and vigorously to survive and to position themselves for the future.

The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study.

Background: The hospital admission decision directly influences the magnitude of resource use in patients with community-acquired pneumonia, yet little information exists on how medical practitioners make this decision.

Objectives: To determine which factors medical practitioners consider in making the hospital admission decision and which health care services they believe would allow ambulatory treatment of low-risk hospitalized patients with community-acquired pneumonia.

Methods: Medical practitioners responsible for the hospital admission decision for low-risk patients with community-acquired pneumonia were asked to describe patient characteristics at initial examination that influenced the hospitalization decision, and to identify the health care services that would have allowed initial outpatient treatment of hospitalized patients.

Occupational exposures and diseases among medical inpatients. Prevalence, association, and recognition.

The purpose of this study was to identify the prevalence of occupational exposures, their potential contribution to the development of chronic diseases among medical inpatients, and their recognition by house officers. Occupational histories were obtained from 101 medical inpatients and their charts were reviewed. Sixty-six percent of patients had diseases for which an occupational etiology merited consideration.

The inter-rater reliability and internal consistency of a clinical evaluation exercise.

Objective: To assess the internal consistency and inter-rater reliability of a clinical evaluation exercise (CEX) format that was designed to be easily utilized, but sufficiently detailed, to achieve uniform recording of the observed examination.

Design: A comparison of 128 CEXs conducted for 32 internal medicine interns by full-time faculty. This paper reports alpha coefficients as measures of internal consistency and several measures of inter-rater reliability.

Symptoms and microenvironmental measures in nonproblem buildings.

Symptoms commonly defined as the sick building syndrome were studied in a cross-sectional investigation of 147 office workers in five building areas using a linear-analog self-assessment scale questionnaire to define symptoms at a specific point in time. At the same time, the environment in the breathing zone was characterized by measuring thermal parameters (dry-bulb temperature, relative humidity, air speed, and radiant temperature), volatile organic compounds, respirable suspended particulates, noise and light intensity, and carbon dioxide and carbon monoxide levels. Demographic characteristics of the occupants and building characteristics were recorded.