Integrating clinical and support process design for effective health services.

With increased capitation and managed care competition, health care systems must demonstrate effective health services with predictable costs, timing, transitions, and health outcomes. By involving patients, payers, and multiple providers, a health care system can design integrated clinical and support processes across the continuum for defined populations. The goals are lower costs, increased payer and patient satisfaction, and improved health status. This article shares examples and experiences from four health care systems that teamed with Premier, Inc., to design an integrated services sequence for defined populations.

Improve clinical processes in three meetings.

Many health care organizations have developed methodologies to improve their processes of care. Most have outputs, such as clinical paths and/or algorithms, that require dozens of meetings over many months to design. Morton Plant Health System has taken a "SWAT team" approach and created a multi-hospital, multi-disciplinary team that develops recommendations and process changes after only three meetings of the entire team over two to three months. The organization has been highly successful, with process changes resulting in improve outcomes and savings in charges (1995 compared to 1994) of more than $22 million. What was the evolution of this process, what is the "SWAT" team approach and how does it work, and why has Morton Plant Health System been so successful in its efforts?

IMPACT CARE: a quality assessment tool that works.

IMPACT CARE is the Morton Plant Mease Health Care's internally developed quality measurement tool designed to implement an integrated quality assessment/quality improvement system. IMPACT CARE enables work groups to measure all aspects of performance from a total quality management (TQM) perspective and at the same time meet Joint Commission requirements. The IMPACT CARE format works equally well for the medical staff and for clinical and nonclinical departments throughout the health system. This article relates process improvements that have been made at Morton Plant Mease Health Care since 1992 as a result of using IMPACT CARE.

Physician executives strive for balance in their changing roles.

Many physicians are apprehensive about healthcare reform and what it will mean for them. As physician executives, our job is to help construct systems that cost-effectively deliver high-quality services and achieve positive outcomes in a competitive environment. To this end, we must understand management and all of its ramifications--from finance to organizational dynamics to marketing to systems thinking and information management.

Nephrogenous cyclic AMP levels in primary hyperparathyroidism.

The clinical utility of urinary cyclic adenosine-3',5'-monophosphate (cAMP) determinations has been limited by the overlap between hyperparathyroid and normal patients. We evaluated the potential of the parathyroid hormone (PTH)-dependent, nephrogenous cAMP in the diagnosis of hyperparathyroidism. Twenty-three patients with primary hyperparathyroidism and 19 control subjects had two-hour urine collections and blood sampling at midpoint. Nephrogenous cAMP level was calculated as total urinary cAMP excretion minus the amount filtered. The total urinary cAMP excretion (micromols per gram of creatinine) was higher in hyperparathyroid patients (6.8 +/- .5 SE), but overlapped with values obtained in controls (2.9 +/- .15). The level of nephrogenous cAMP (percent of total) was also higher in hyperparathyroid patients (72.5 +/- 1.8) than controls (26.3 +/- 4.1) and clearly separated the groups. Determination of nephrogenous cAMP levels may be useful in the diagnosis of hyperparathyroidism.