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. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."

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. These 2 strategic plans were successful and achieved 4 outcomes: a doubling of annual discharges, a dramatic increase of transfers/external referrals, a significant increase in the case mix index, and impressive growth in subspecialty programs. The third clinical strategic plan, Preparing for Change (2015-2020), has expanded UK HealthCare's gains in the face of rapidly changing reimbursement systems and delivery models. The pillars of this plan are responding to consumerism, strengthening hallmark programs through service lines, "hard wiring" relationships with partnering organizations including establishing the Kentucky Health Collaborative, and building infrastructure to deal with risk-based reimbursement. UK HealthCare is trying to spearhead a rational system of care for Kentucky rather than a system that rations care. Halfway through the third clinical strategic plan, UK HealthCare has seen increased discharges, transfers, and clinical expansion in its hallmark programs, building evidence that well-thought business practices can lead to improved public policy.

Diagnosing and Resolving Conflict Created by Strategic Plans: Where Outreach Strategies and Execution Meet at an Academic Health Center.

The imperative for strategic change at academic health centers has never been stronger. Underpinning the success of strategic change is an effective process to implement a strategy. Healthcare organizations, however, often fail to execute on strategy because they do not activate the requisite capabilities and management processes. The University of Kentucky HealthCare recently defined its 2020 strategic plan to adapt to emerging market conditions. The authors outline the strategic importance of strengthening partnership networks and the initial challenges faced in executing their strategy. The findings are a case study in how one academic health center has approached strategy implementation.

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. Health care legislation and the recognition that health care costs must be curbed have accelerated the change process. How should academic medical centers (AMCs) respond? Teaching hospitals are a heterogeneous group, and the leaders of each must understand their institution's goals and the necessary resources to achieve them. Clinical leaders and staff at one AMC, the University of Kentucky (UK), committed to transforming the AMC into a regional referral center. To achieve this goal, UK leaders integrated the clinical enterprise, focused recruitment on advanced subspecialists, and initiated productive relationships with other providers. Attracting adequate numbers of destination patients with complex illnesses required UK to have a "market space" of five to seven million people. The resources required to effect such progress have been daunting. Relationships with providers and payers have been necessary to forge a network. These relationships have been challenging to establish and manage and have evolved over time. Most AMCs are not-for-profit public good entities that nevertheless exist in an industry driven by competition in quality and cost, and therefore scale and access to capital are paramount. AMC leaders must understand their institutions as both part of an industry and as a public good in order to adapt to the changing health care system. Although the experience of any particular AMC is inherently unique, UK's journey provides a useful case study in establishing institutional goals, outlining a strategy, and identifying required resources.

Evolution of the karyotype and sex chromosome systems in basal clades of araneomorph spiders (Araneae: Araneomorphae).

Concepts of spider karyotype evolution are based mostly on advanced and most diversified clade, the entelegyne lineage of araneomorph spiders. Hence the typical spider karyotype is supposed to consist exclusively of acrocentric chromosomes including the multiple X chromosomes. However, our data show considerable diversity of chromosome morphology and sex chromosome systems in basal clades of araneomorphs. Karyotypes of basal araneomorphs consist of holocentric (superfamily Dysderoidea) or normal chromosomes with localized centromere. In males of basal araneomorphs the prophase of first meiotic division includes a long diffuse stage. Multiple X chromosomes are less common in basal clades. The sex chromosome system of many families includes a Y chromosome or nucleolus organizer region that occurs rarely in the entelegyne spiders. A derived X(1)X(2)Y system with an achiasmatic sex-chromosome pairing during meiosis was found in the families Drymusidae, Hypochilidae, Filistatidae, Sicariidae, and Pholcidae. This suggests a monophyletic origin of the families. In some lineages the X(1)X(2)Y system converted into an X0 system, as found in some pholcids, or into an XY system, which is typical for the family Diguetidae. The remarkable karyotype and sex chromosome system diversity allows us to distinguish four evolutionary lineages of basal araneomorphs and hypothesize about the ancestral karyotype of araneomorphs.