Lewis J E
Department of Medicine, University of Alabama at Birmingham 35294-0110, USA.
Acad Med. 1995 Jul;70(7):569-77. doi: 10.1097/00001888-199507000-00007.
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)
作者对综合医疗服务体系进行了定义，并指出目前这类体系较少，但处于不同发展阶段的有很多。这样一个体系的规模可以从其服务的患者数量来描述，包括患者的健康状况和医疗服务利用情况、服务区域的地理布局、医生数量以及设施网络的范围和程度。有多种因素会影响一个体系的规模；作者重点关注学术医疗中心在制定体系规模目标时必须考虑的因素。他讨论了：（1）机构为求生存而进行自我架构的方式所产生的影响；（2）技术、创新和医疗成本对这些体系的规模和组织的影响；（3）机构在教育、研究和患者护理方面的特定使命特征所产生的影响。文中给出了与三个可能的机构目标相关的综合体系的实际数据，这三个目标分别是经济可行性、学术可行性和学术领导力。作者解释了学术医疗中心为何不应只试图成为其他综合医疗服务体系的三级或四级护理提供者，但同时强调，各中心要发展自身的体系并非易事，也不便宜。文中还讨论了综合体系的替代结构，比如制药行业正在开发的“疾病管理体系”、“端到端联系”方法，以及各种纳入“专属市场”的想法，如囚犯、大学生和老年社区成员。（摘要截选至250词）
