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HISTORY

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HISTORY. Medieval. Medical care an afterthought in jails or alms houses ... Specialized (e.g. Children's, Cancer, Orthopaedics) FUTURE HOSPITAL. Choices ... – PowerPoint PPT presentation

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Title: HISTORY


1
HISTORY
  • Medieval
  • Medical care an afterthought in jails or alms
    houses
  • People inmates not patients
  • Renaissance
  • Institution developed for medical care
  • People inmates, indigent, dependent sick
  • Social pressures and norms dictated activities
  • Medicine offered little

2
HISTORY
  • 18th Mid 19th Century (U.S.A.)
  • Hospitals evolved
  • a) From alms houses socially disadvantaged
  • b) Community responsibility worthy poor
  • Trustees, not doctors, controlled hospitals
  • Education
  • Late 19th Mid 20th Century
  • Drivers anesthesia, antisepsis, microbiology,
    x-ray, laboratories
  • Science comes to medicine professional nursing
    arrives
  • The Youngest Science shifts control to doctors
    and fuels hospitals expansion lt 200 in mid 19th
    Century to gt 6000 by the 1930s
  • Education and research

3
HISTORY
  • Mid 20th Century 21st Century
  • Specialization in medicine drives and is driven
    by the expansion of hospitals
  • WWII creates a sense of the value of science and
    technology
  • Desire for sophisticated hospital services
    fuels insurance which fuels technology
  • Hospitals develop as critical social structures
    in many communities and academic health centers
    develop as the greatest concentrations of
    technology, knowledge and innovation
  • Hospitals the center of health care
    organization

4
HISTORY
  • Drivers of evolution
  • Demography, globalization
  • Innovation in biology genomics proteomics
  • Drug development
  • Innovation in technology CT scan, MRI,
    robotics, fiberoptics, energy sources,
    miniaturization
  • The age of information technology
  • Result
  • Expanded predictive and diagnostic power
  • More precise, less traumatic, more effective
  • Prevention treatment rehabilitation
  • Technology and skills diffuse more rapidly
  • ?place of the hospital in more distributed and
    integrated system of care

5
HOSPITAL ORGANIZATION
  • Location
  • Rural
  • Suburban
  • Urban
  • Academic center
  • Level of Care
  • Primary
  • Secondary
  • Tertiary
  • Tertiary and experimental
  • Acuity of Care
  • Acute Care
  • Rehabilitation
  • Chronic
  • Long term care
  • Content of Care
  • General
  • Specialized (e.g. Childrens, Cancer,
    Orthopaedics)

6
FUTURE HOSPITAL
  • Choices
  • Autonomy vs. integration (cost)
  • Level of care i.e, 2o 3o
  • Content general vs. focus vs. combination

7
FUTURE HOSPITAL
  • Community and Rural
  • Relation to larger hospital or system
  • Access to most advanced skills and technology
  • Facilitated dissemination of technology and
    skills
  • -Quality Assurance
  • Role of information and telecommunications
  • Place of student, Resident, Fellow education
  • Research clinical, care, organization,
    management
  • Staffing - traditional

8
FUTURE HOSPITAL
  • Academic/Urban
  • Concentration of skills and technology
  • Responsibility
  • -Innovation
  • -Dissemination of technology and skills
  • -Quality Assurance
  • Role of information and telecommunications
  • With medical schools, responsible for education
    of students, residents, fellows (direct
    oversight)
  • Research center of translational population
    dependent (genomics-proteomics), organization
    finance
  • Staffing programmatic vs. traditional

9
CONCLUSION
  • Hospitals of the Future
  • Less autonomous - part of broader delivery system
  • Technology - advanced, less traumatic,
    rationalized
  • Skills - distributed to maximize innovation and
    dissemination
  • Education - system or regionally based
  • Research - translational particularly genomics
  • Critical need better, more sophisticated
    information systems
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