The transformation of academic health centers, an integrated perspective of institutional and resource dependence theory.

摘要

The study investigates changes in the research, education, and service missions among academic health centers (AHCs) that may be associated with certain environmental pressures: hospital competition, managed care, and the Balanced Budget Act. An integration of institutional and resource dependence theory is utilized to understand mission changes that may lead to mission shifting and the transformation of AHCs. The study measures the percentage change of mission levels between 1995 and 2002.;The study population is the primary teaching hospital and affiliated medical schools. Research, service, and education missions were measured by NIH funding, Medicare Disproportional Share, and family practice residents respectively.;The research methodology included three stages. Stage one is descriptive statistics. Mean testing is measured in Stage two. Stage three uses multi-variant regressions to identify influences from selected environmental factors.;The descriptive analyses found commonality among AHCs, (e.g., increases of research funding, and decreases of family practice residents and Medicare Disproportional Share), regardless of different organizational characteristics such as medical school orientation, ownership, and location. Mean testing identified no differences among AHCs. Hypothesis testing yielded insignificant relationships from multi-variant analyses, indicating that the components of the integrated model did not explain mission changes.;Given conflicting prior research, these results were not surprising. The interesting finding was AHCs displayed an unexpected level of uniformity in their response to external pressures despite differences in organizational characteristics. These responses may suggest a similar and general pattern of adaptation by these organizations despite their contention that the pressures had ominous implications.;Health care policy (e.g., Medicare) will continue to play a pivotal role concerning the missions of AHCs. Researchers and health care organizations have also been concerned about the impact of other environmental pressures on their existence and future. This study shows that either AHCs are surviving various changes (e.g., reimbursement, legislation and competition) by making common adaptations or these external factors had limited impact.;This study contributed new knowledge regarding the categorization of AHCs, their similarities and differences. These findings can be used as a platform for repeated and new studies concerning multi-mission achievement measures, community based schools and mission shifting.