Managing the physics of the economics of integrated health care.

The physics metaphor, as applied to the economics (and financial performance) of the integrated health system, seems appropriate when considered together with the nine principles of management framework provided. The nature of the integrated design enhances leaders' management potential as they consider organizational operations and strategy in the markets ahead. One question begged by this argument for the integrated design is the durability, efficiency and ultimate long-term survivability of the more "traditional" community health care delivery models, which, by design, are fragmented, internally competitive and less capital efficient. They also cannot exploit the leverage of teams, optimal access management or the pursuit of revenues made available in many forms. For those who wish to move from the traditional to the more integrated community health system designs (especially those who have not yet started the journey), the path requires: * Sufficient balance sheet capacity to fund the integration process-especially as the model requires physician practice acquisitions and electronic health record implementations * A well-prepared board13, 14 * A functional, durable and sustainable physician services enterprise design * A redesigned organizational and governance structure * Favorable internal financial incentives alignment design * Effective accountable physician leadership * Awareness that the system is not solely a funding strategy for acquired physicians, rather a fully -.. committed clinical and business model, one in which patient-centered integrated care is the core service (and not acute care hospital-based services) A willingness to create and exploit the implied and inherent potential of an integrated design and unified brand Last, it's important to remember that an integrated health system is a tool that creates a "new potential" (a physics metaphor reference, one last time). The design doesn't operate itself. Application of the management principles presented here are necessary as a complete recipe. Leaders of health systems moving toward integration are cautioned to apply the recipe in full. This article ends with two questions. First, if not an integrated model of health care, what's the alternative? Since it seems clear that many of the existing community-based models are excessively fragmented and inefficient, especially in a reforming U.S. health care marketplace, is there a new model that is superior to the integrated models and, if so, what is it and what are its functional principles? The second question: Is there more than one functional form of integration? This article argues for the most integrated form. Others would argue that clinical integration is sufficient,'s and full integration isn't required. The stability, durability and adaptability of the fully integrated models have, arguably, been tested. The lesser integrated models remain to be proven in an unstable health care marketplace seeking higher levels of economic efficiency.

The effect of a literacy training program on family medicine residents.

BACKGROUND AND OBJECTIVES: Pediatric literacy promotion programs carried out in the primary care setting, such as Reach Out and Read (ROR), have been associated with improved language skills for preschool children. Primary care physicians have frequent contact with young families and may be well situated for a literacy promotion program for both children and adults. We examined whether introducing ROR and an adult literacy intervention improves family medicine residents' literacy knowledge, attitudes, and practices. METHODS: We conducted a single group pretest/posttest evaluation design study of residents in a family medicine residency program serving low-income families. Residents completed self-administered questionnaires assessing literacy knowledge, attitudes, and practice. Then, through educational conferences, precepting, and ROR, residents were trained to assess and counsel patients about literacy. The same questionnaire was readministered 8 months later. RESULTS: All 24 (100%) residents completed both the pre- and post-intervention questionnaires. Literacy knowledge mean scores increased from 74.5% to 83.1%. After the intervention, residents reported a greater sense of comfort in counseling about childhood and adult literacy. After the intervention, a greater proportion of residents reported usually or always asking about literacy milestones (30.2% to 79.2%) and parent-child reading (65.2% to 97.8%) during well-child visits. CONCLUSIONS: A family literacy promotion program improved family medicine residents' self-reported literacy knowledge, attitudes, and practices. Such interventions can be incorporated into the education of family medicine residents with meaningful results.

Principles of child health care financing. American Academy of Pediatrics Committee on Child Health Financing.

Child health care financing must maximize access to quality, comprehensive pediatric and prenatal health care. This policy statement replaces the 1998 policy statement by the same title. Changes reflect recent state and federal legislation that affect child health care financing. The principles outlined in the statement will be used to evaluate the changing structure of child health care financing.

The Pediatrician.

Alcohol consumption by pediatric patients and their parents can have significant impact on the health and development of the children and adolescents. The pediatrician can help prevent or reduce alcohol-induced impairments by providing education and guidance about the responsible use of alcohol and by initiating early intervention if necessary.