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Milbank Q. 1995;73(2):131-60.

Reinventing the American hospital.

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J.L. Kellogg Graduate School of Management, Northwestern University, Evanston, IL 60208-2007, USA.


The American hospital is being reinvented to conform with the forces that are replacing the acute, inpatient-oriented illness model of health care with a disease-prevention, health-promotion, primary-care one. Although hospitals will no longer conduct the "core business" of American health care, they can play a key role by empowering others and facilitating the integration of health services across the continuum of care. New management and governance structures will be required, as will population-based health status needs assessments, new relations with physicians, re-engineering of the clinical processes, organization-wide commitment to improving quality, information systems that link patients and providers, and creation of an overall community care management system. Despite major barriers, there are examples of progress.

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