Even without Congressional consensus, the nation's health care system is undergoing a profound transformation. As Michael J. Halseth, executive director of the U.Va. Medical Center, notes, the primary purchasers of care -- business and government -- are actively searching for "low-cost care, easy-to-access services, and patient satisfaction."

"University health centers such as our own must either help create change or be over whelmed by economic forces beyond our control," adds Dr. Robert W. Cantrell, vice president and provost for Health Sciences.

Accordingly, the Health Sciences Center took decisive steps during the past year to adapt to new marketplace realities, to improve the quality of patient care, and to place health care at U.Va. on a sure financial footing. These efforts produced improvements in price, quality, and service in 1994-95. The U.Va. Medical Center is now one of the five least costly hospitals in the University Hospital Consortium, a national group of academic medical centers. Along with this reduction in costs, the average length of patient stay has decreased from 6.6 days to 6.4 days, and care is being provided in a more efficient and effective manner.

In 1994-95, the Health Sciences Center made progress in a number of areas:

• As part of a comprehensive Value Improvement Program, the Medical Center installed a centralized computer system that simplifies the process of scheduling outpatient appoint ments. The result of these and other efforts is streamlined services, improved productivity, lower costs and enhanced patient satisfaction.
• The reorganized U.Va. Heart Center now offers a seamless flow of care for patients from outpatient clinics or diagnostic areas to their hospital beds and then to rehabilitation and home care. At the same time, the center has restructured its own operations, reducing un necessary medical procedures and management layers and encouraging cross-training of personnel.
• The Health Sciences Center in July inaugurated an emergency medicine residency program to address the shortage of trained emergency physicians nationwide. Presently, only half of the nation's 25,000 emergency room doctors are trained and certified in this specialty.
• The School of Nursing has established a one-year, post-master's nurse practitioner program. Graduates of the program will fill gaps in health care resulting from the shortage of primary care physicians.
• The University's Continuum Home Health Care Program began offering infusion, nursing, therapy, and aide services to patients requiring care at home.

In October, the University announced the appointment of Dr. Don E. Detmer as senior vice president and University Professor, effective January 1, 1996. Dr. Detmer will represent the University on health policy issues at the national level. Much of that work will be accomplished through the Virginia Health Policy Center, which he was instrumental in founding and has co-directed since 1991.

Dr. Cantrell, who has served as interim vice president and provost since January 1995, was named to that permanent position in November. Dr. Cantrell has been on the faculty since 1976. He is a former president of the American Academy of Otolaryngology-Head and Neck Surgery and has held high offices in many other professional organizations. He is the author or coauthor of more than two hundred professional publications. He has served as a consult ant to the U.S. Surgeon General, the National Institutes of Health, and other state and federal agencies. Dr. Cantrell was awarded one of five Presidential Citations from the American Academy of Otolaryngology-Head and Neck Surgery, presented at the 99th annual meeting of the association this fall.

Forging Alliances to Provide Better Care to More People

As the preeminent health care provider in central Virginia, the University has embarked on several enterprises to strengthen its areas of excellence and extend its services to more people. It has also entered into a number of complementary relationships to provide additional services, avoiding the cost of developing these services itself. During 1994-95:

• The Medical Center signed managed care contracts with nearly thirty companies and is actively developing a regional network of care.

   

• The University established HealthCare Partners, a joint venture of the Medical Center and the Health Services Foundation, to expand the University's presence in Central Virginia as a primary-care provider. HealthCare Partners will develop new outpatient clinics and enter into partnerships with existing providers.

   

• The Medical Center entered into a joint venture with Healthsouth, the nation's leading provider of rehabilitation services, and formed a regional network with two of the four hospitals in the state offering rehabilitative care.

   

• The Medical Center joined the Central Virginia Health Network, a partnership of eight Richmond-area hospitals. This arrangement makes the resources of the University available to more residents of the Commonwealth.

Bringing Discoveries from Laboratory to Bedside

The University's reputation as a clinical center has only been enhanced during this last year. In its "1995 Best Hospitals Guide," U.S. News & World Report  ranked the otolaryngology department twelfth, the internal medicine department's divisions of endocrinology fifteenth, gastroenterology, twenty-second, and the Cancer Center twenty-seventh. According to the magazine's editors, "Any institution listed among the top forty medical centers in any specialty should be considered a leading center."

In the Laboratory for Clinical Learning, undergraduate nursing students learn to place and care for intravenous lines.

One reason for our strong showing in these rankings is the University's policy of integrating basic research and clinical practice. This characteristic was highlighted when the Cancer Center moved to its new home in the Medical Center. By bringing together researchers and clinicians, the center's leaders hope to speed the introduction of new cancer-fighting drugs and therapies.

In fact, research currently being conducted in the School of Medicine is making possible promising new treatments for cancer and other diseases. Long-term research by Dr. Joseph Larner offers a way to correct the cellular malfunctioning underlying Type II diabetes, the fourth leading cause of death by disease in the United States, by isolating two key compounds that are reduced or absent in people with Type II diabetes.

Dr. Barry Marshall recently received the American Gastroenterological Association's Distinguished Achievement Award for his work linking bacterial infection to dyspepsia, ulcers, and gastric cancer. He has developed a fourteen-day antibiotic and bismuth therapy to eradicate the bacterium and devised a breath test that confirms its presence in patients within twenty minutes.

Ronald Taylor and his colleagues are doing research with even broader implications. They have invented a modified antibody that may help red blood cells battle disease. Taylor's work could be used to treat a wide variety of diseases, including such autoimmune diseases as arthritis, systemic lupus erythematosus, and myasthenia gravis.

Many of the next generation of vaccines and drug treatments will depend on scientists' ability to strengthen the body's own defenses against infection. The key is to identify the telltale proteins produced by the body's invaders and then develop drugs that target them. Donald F. Hunt, professor of chemistry and pathology, has assembled a unique system for determining protein sequencestandem mass spectrometrythat is up to a thousand times more sensitive than previous methods. Scientists are using this technique to search for other antigens that alert the immune system to viral infections, bacterial infections, and various cancers. Now, with a $750,000 grant from the W. M. Keck Foundation, the University has been able to create a Center for Biomedical Mass Spectrometry to make this crucial tool available to researchers nationally.