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Monday, May 09, 2005 | Every day, biomedical discoveries lead to new treatments and technologies that improve health and extend life. Medical progress demands that forward-thinking systems change their design for health care delivery, to ensure that the most advanced care is available to our growing, aging and increasingly diverse population.

That is exactly what the University of California, San Diego Medical Center has done. As a leader both in patient care and medical research, UCSD has conceived a 20-year vision for a new university health system to serve our region.

Faced with the mandate to replace its obsolete Hillcrest hospital, UCSD is seizing the opportunity to transform its Hillcrest and university medical campuses, expanding the services that patients rely on most: outpatient, urgent and emergency care, with increased focus on disease prevention and initiatives that address community health issues.

UCSD’s hospital of the future will be a high-tech center where multi-disciplinary teams of specialists armed with powerful therapeutics and leading edge technologies treat severely ill or injured patients from throughout San Diego and beyond.

This includes the large share of underinsured and uninsured patients who depend on UCSD Medical Center for care. UCSD’s hospital system treats only about 8 percent of all patients in the county, but 36 percent of the county’s indigent patients. Over 43 percent of UCSD’s patients are uninsured or Medi-Cal recipients, with the university absorbing over $42 million in unreimbursed costs for these patients. UCSD has an unwavering commitment to serving this population into the future.

But that is not UCSD’s only role. Like most of the nation’s teaching hospitals, UCSD cares for patients with complicated, often rare diseases – the sickest of the sick- who come from all parts of the county, and from outside of San Diego.

UCSD’s comprehensive system of patient care services supports the respected teaching and clinical research programs of the UCSD School of Medicine, and the Skaggs School of Pharmacy and Pharmaceutical Sciences. This is where the practitioners of the future are trained, and where the promising new treatments and cures of tomorrow are pioneered today – all part of UCSD’s unique mission as the region’s only academic medical center.

UCSD’s model is based on a thorough study of patient care trends locally and nationally. The vast majority of patients today receive their care in an outpatient setting, such as the physician’s office. Even sophisticated surgeries are being performed today without the patient ever being hospitalized. According to the Centers for Disease Control, 63 percent of surgeries were performed as outpatient procedures in 2002, compared with only 16 percent in 1980.

In light of this shift to the outpatient arena, the UCSD Outpatient Center in Hillcrest will be expanded to provide a full range of primary and specialty care services, including outpatient surgery and an imaging center. A new Center for Emergency and Urgent Care Services will provide additional space to relieve overcrowding. For those who do not have a true emergency but who need quick access to a physician, the urgent care center will provide a welcome alternative.

Hillcrest will also become the site for the Center for the Advancement of the Community’s Health. This center will unite UCSD specialists in preventive medicine and public health to collaborate with community partners. The focus will be developing practical interventions to address major health issues affecting large populations, such as obesity, smoking and alcohol and drug abuse.

At the end of this 20-year plan, a new 500-bed hospital on UCSD’s East Campus in La Jolla will combine all of UCSD’s inpatient beds in a modern, patient-focused facility, expanding upon the Thornton Hospital that currently anchors UCSD’s East Campus medical center.

Why consolidate two hospitals into one? To improve care, safety, service and comfort for patients.

Consumer organizations such as the Leapfrog Group for Patient Safety consider the number of times a hospital performs a procedure as a factor in scoring hospital quality. With UCSD’s physician staff split between two relatively small hospitals, this is a standard that UCSD cannot meet.

In addition, UCSD suffers from what the hospital’s CEO Richard Liekweg calls “Noah’s Ark syndrome” – UCSD currently has to buy two of everything in order to equip both hospitals.

By consolidating inpatient beds and dedicating physicians, staff and resources to supporting one state-of-the-art university hospital, UCSD will provide the highest level of care and service to all patients, and eliminate the costly duplication of infrastructure and technology that contributes to soaring costs and inefficiencies.

Elements of this plan have proven successful elsewhere. Twenty years in the future, when the hospital consolidation is complete, the innovative design of UCSD’s Hillcrest Emergency Services Center will position UCSD to continue providing emergency care to the communities it currently services. “Free-standing” emergency rooms are providing excellent care today in a number of states around the country and the model is being discussed in California, in the wake of numerous hospital and emergency room closures around the state. This approach will be further perfected in the coming years, with the application of telemedicine and information technologies allowing for real-time, long-distance consultations, bringing the physician to the patient.

In addition, the concept of a major teaching hospital as the hub of a regional medical complex is exemplified by world-class systems such as the Mayo Clinic and the Texas Medical Center, where centers specializing in every aspect of care, from cancer and heart disease to trauma and transplantation, are concentrated in one central area.

UCSD’s vision for the future is exciting. Updating and replacing old, outdated facilities was the initial challenge. This solution guarantees access to 21st century health care for all of UCSD’s patients.

Elaine Galinson is a trustee of the UCSD Foundation Board and is president of the Galinson Family Foundation.

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