January 2009

Message from Dean Richardson: Our clinical mission and health care reform

As I noted in my last newsletter, against the constant backdrop of bad economic news, it could be easy to lose focus on our missions. The monthly Dean’s newsletter gives me an opportunity, if not to counterbalance the sobering news, at least to help us regain that focus by sharing news and achievements from across the School of Medicine.

Last month, I emphasized the research mission – to read that newsletter, click here – and this time, I’ll emphasize the clinical mission. Emphasizing a single mission may seem unusual because, as we all know, our missions are not independent of each other. In fact, it is the collaboration across healing, teaching, discovery and outreach that makes academic medicine unique and uniquely important. The articles in this newsletter illustrate the outcomes of that collaboration.

Even health care reform – which is at the forefront of the national and state dialogue now, as well as my own thoughts – is not the exclusive domain of the clinical mission. Education and research are critical elements of health care reform too.

One in six Oregonians is without health insurance; many more are underinsured and not able to access timely health care. And now, the number of uninsured is sure to grow alarmingly. Already, in recent months patient requests to OHSU for financial aid to help pay for health care costs have risen dramatically. Thus, the global economic crisis underscores the necessity of reform. In addition to improving access, reform will help us collectively rein in health care costs and, by extension, lower insurance premiums.

There are many faculty members, students and others in the School of Medicine who are actively involved in reform efforts. The School of Medicine adopted a set of "Principles for Health Care Reform" last year. Click here to review those principles. Three aspects of the principles stand out in particular for me and illustrate how health care reform links all of our missions.

1) A focus on supporting “health” in a system of universal access. Every person should have access to a defined set of health care services, and this must include health promotion and prevention. In turn, this means that health care delivery and its financing must reflect a system in which health, not just disease-based intervention, is robustly supported.

2) A recognition that provider education is crucial to reform. Reform efforts must include ways to explicitly fund the education of a provider workforce that can deliver our ideal vision of a health care system; for example, if we are to emphasize team-based health care and medical homes, we must fund appropriately-targeted education.

3) A recognition of the role of discovery in improving health. From evidence-based medicine to less invasive surgery to better understanding the role of nutrition and discovering new cures, research has the potential to improve health and to lower costs. Finding ways to ensure that research is funded must be integral to reform.

We cannot continue to support a system is which so many people have no access to health care; it’s not ethical, it constrains us from fulfilling our missions as we might, and it’s unsustainable. But unless we address the role of education and research in health care reform, we may end up trading one set of problems for another. The time is right for health care reform and for fundamental change. Let’s bang the drum.

Best regards,

Mark Richardson
Dean, OHSU School of Medicine
President and Board Chair, Faculty Practice Plan

A heartbeat closer: OHSU establishes new partnerships with community hospitals

A patient walked into St. John Medical Center in Longview, Washington with chest pain. The physicians there diagnosed the early stages of a severe heart attack and activated a STEMI protocol – a structured protocol for quickly managing patient care for a patient suffering this type of heart attack – which had been previously developed by St. John and OHSU.

The patient was immediately transported to OHSU by Life Flight, where the waiting interventional cardiac team opened the coronary artery with balloon angioplasty and placed a stent to keep the vessel open. Only 88 minutes elapsed from the time the patient walked into St. John until his vessels were opened up by OHSU's cardiac team. Not only did the patient live, he suffered no heart damage.

“That can only happen when two organizations have protocols in place and a seamless system of coverage,” said OHSU's Director of Clinical Outreach, Dr. Mark O'Hollaren.

Some rural areas are not able to support subspecialty care full-time. In response, OHSU is establishing new community clinical collaborations to enhance specialist care. The St. John’s collaboration focuses specifically on cardiac care. In the short-term, the collaboration has formalized and, thus, improved the process by which acute heart attack patients are treated and transferred to OHSU. Over the long-term, OHSU will collaborate to place more cardiologists and services in Longview.

“The partnership came about because St. John has been trying for some time to increase its number of cardiologists. Currently there are two, but there's a need for four,” said St. John's Dr. Noel Santo-Domingo in an article published in the local newspaper. Like many regional medical centers, St. John is struggling to recruit new cardiologists.

As part of a similar collaboration, OHSU will begin providing regular medical and surgical orthopedic coverage in The Dalles in February 2009 with the Mid-Columbia Medical Center (MCMC). An orthopedic faculty member will practice in The Dalles a portion of every week. That physician also will spend one weekend a month in The Dalles providing after-hours call coverage in support of existing orthopedic specialists.

“The current shortage of orthopedic coverage is what motivated us to explore creative, affordable ways to grow our specialty care offerings,” said Duane Francis, President/CEO of MCMC. Later in the year, MCMC and OHSU will jointly bring a cardiologist to the area.

The collaborations were established with the leadership and involvement of Jung Yoo, MD, Chair of the Department of Orthopedics and Joaquin Cigarroa, MD, Associate Professor of Medicine, Associate Chief of Clinical Affairs for the Division of Cardiovascular Medicine and Director of the Cardiac Catheterization Laboratory.

To read local newspaper coverage about The Dalles partnership, click here.

Project Access NOW: OHSU physicians provide free specialty care to uninsured

People without insurance rely on low-cost community safety net clinics for primary care, but when acute or specialty care needs arise, uninsured people face daunting obstacles. As part of Project Access NOW, physicians across the Portland and Vancouver metro area have come together to help partly alleviate this problem.

“Project Access NOW is an example of physicians taking the lead to help solve a socioeconomic problem,” said Mike Bonazzola, MD, Assistant Professor, Department of Medicine and Chief Medical Officer of the Faculty Practice Plan. Dr. Bonazzola is also the volunteer Medical Director for Project Access NOW, providing medical oversight services.

“OHSU physicians have been involved in Project Access NOW, and a precursor volunteer program, for over a decade. The program has enrolled over 500 patients since March of last year. OHSU physicians have provided the care for nearly 100 of those patients,” he said.

“OHSU really has been a tremendous partner in this effort. We are so thankful to Mike for his leadership and the volunteer time that he dedicates as well,” said Linda Nilsen-Solares, Executive Director, Project Access NOW.

Here is how it works. Patients at or below twice the federal poverty level qualify for primary care at a network of safety net clinics across the region. When a specialty need arises, such as a hysterectomy, cancer treatment or neurological condition, the patient is referred to a specialist in the Project Access NOW volunteer network. The physician time is donated and a participating hospital covers non-physician costs, such as lab work, imaging, inpatient and outpatient services.

“OHSU was the first hospital and health system in Oregon to have 100 percent participation,” said Dr. Bonazzola. “Our leadership has encouraged other hospitals and health systems to commit their employed staff as well.” Every OHSU specialty clinician is a Project Access NOW volunteer.

“Access to health care is a problem that isn’t going to go away anytime soon. But if every physician in the Portland metro area contributed at least one case to an uninsured patient, it would help a lot of people, and it would fairly distribute the financial consequences over our entire provider community,” said Dr. Bonazzola.

To learn more about Project Access Now, click here.

OHSU and PSU launch joint MBA degree in health care management

Dean Mark Richardson joined OHSU President Joe Robertson and Portland State University President Wim Wiewel to welcome the 28 students enrolled in the MBA in Health Care Management program.

Speaking at the January 16 ceremonial signing of the Memorandum of Understanding that created the program, Dean Richardson stressed the importance of collaboration between OHSU and PSU, and the contribution that the new graduates will make to reform the way health care is delivered in Oregon.

“The business of health care is complex. We need people like you trained to find better ways to manage our health care system to create what we all want – high quality affordable health care for everyone,” he said.

The MBA degree is collaboration between the Division of Management in the OHSU School of Medicine, and the School of Business Administration at Portland State University. PSU provides the business elements of the curriculum while OHSU provides case studies, speakers and other health care-related components.

Pictured: (above) Presidents Robertson and Wiewel sign the MOU; (below) Dean Richardson (l) and PSU Associate Dean Scott Marshall (r) deliver remarks at the event.

Faculty Spotlight: Jim Reuler, MD

Founder of Wallace Medical Concern expands focus to promote diversity in health care delivery

A member of the School of Medicine faculty for 32 years and the founder of Wallace Medical Concern in 1984, James Reuler, MD, MACP, Professor, Department of Medicine, has focused much of his career on helping patients overcome obstacles to health care, including lack of health insurance. Located in downtown Portland and Gresham, Wallace Medical Concern’s 341 volunteers – many of whom are School of Medicine faculty, staff and students – served over 3,000 uninsured patients last year alone.

Over the last three decades, Dr. Reuler has seen a steady increase in the diversity of the Wallace Medical Concern’s patient population but has not observed a parallel change in the diversity of the volunteer providers. “Over 14 percent of Oregonians now identify as members of an under-represented minority, yet the percentage of under-represented minority students in the MD program has ranged between five and seven percent in the past two years,” he said.

A conversation with School of Medicine Dean Mark Richardson convinced Dr. Reuler that his experiences at Wallace could directly translate into efforts to diversify the applicant pool for places in the MD program. “We have a unique situation at the School of Medicine. Not only are we clinicians, we are educators,” he said. “Clinical practice is one venue where education becomes action, and we are best positioned to increase and widen the paths by which we recruit and educate students to become tomorrow’s health care providers.”

Dr. Reuler has quickly become an accessible and sought-after mentor and advisor to students from under-represented minorities, some of whom connect with him through his clinical activity and end up volunteering at Wallace. Dr. Reuler advises them on applying to medical school, and offers shadowing opportunities during his clinical appointments.

“Working with a Latino student through the YWCA's LearnLinks Mentoring Program for seven years gave me a greater appreciation of the issues facing those whose first language is not English,” he says. “It is also exciting to be collaborating with the Pursuit of Wellness Education program at Portland’s Roosevelt High School.

Dr. Reuler believes that universal access to a quality college education will ultimately have the greatest effect on increasing diversity in the medical profession, but in the meantime, “one-on-one mentoring is certainly an effective alternative. There is great potential in this approach, even though it takes years to create a truly sound collaboration.”

For more information about Wallace Medical Concern, click here.

Discovery Spotlight: David Dorr, MD

Research shows that delivery system may thwart proactive care for seniors

Can a patient-centered care management program utilizing nurse care managers and interdisciplinary teams, supported by electronic tracking and care coordination systems, reduce the rate of deaths and hospitalizations among chronically ill older adults? The answer – based on a three-year study involving more than 3,400 chronically ill seniors led by OHSU researcher David A. Dorr, MD – appears to be “yes.”

The study – described in the December 2008 Journal of the American Geriatrics Society – has implications for how the care of the more than 130 million Americans with chronic illnesses, two thirds of whom are 65 or older, is managed. The article is titled: “The Effect of Technology-Supported, Multidisease Care Management on the Mortality and Hospitalization of Seniors."

“This study underscores the enormous societal costs of a health care infrastructure that does not adequately support the interdisciplinary services and care coordination needed to prevent adverse outcomes for older adults with multiple chronic illnesses,” said Dr. Dorr, Assistant Professor in the Department of Medical Informatics and Clinical Epidemiology.

The study – conducted between 2002 and 2005 at 13 primary care clinics at Intermountain Healthcare, a large not-for-profit integrated health care system in Utah – found that deaths among the 1,144 patients in the “intervention” group receiving optimum care, called Care Management Plus (CMP), were significantly lower in the first and second years than among the 2,288 patients in the control group whose members received the usual care.

In all, 6.5 percent of CMP patients died in the first year of enrollment versus 9.2 percent of control patients; 13.1 percent of CMP patients and 16.6 percent of controls died in the second year. CMP was a particular benefit for patients with diabetes – who constituted 48.7 percent of all patients in the study and had a significantly higher number of comorbidities. Their mortality rate at one year was 6.2 percent versus 10.6 percent for controls; at two years it was 12.9 percent versus 18.2 percent.

Hospitalizations were only slightly lower overall for CMP patients than for controls, but for diabetes patients in the CMP group they were significantly lower – 21.2 percent versus 25.7 percent for controls at one year and 30.5 percent versus 39.2 percent for controls at two years.

“It is clear,” Dorr concluded, “that to provide the kind of high quality and efficient coordination of care tracked in this study across the nation’s health care system will require the redesign of primary care as well as reform of the payment system and reinforcement from policymakers, but it would be an investment in the future health of the chronically ill patient population.”

To read more about the study, click here.

OHSU research generated four startups in FY08

Four companies were formed in fiscal year 2008 dedicated to translating discoveries by OHSU researchers into commercially viable products and services. This brings to 37 the number of OHSU startups incorporated since 2000. The four companies are:

• Cascade LifeSciences, which is advancing technologies licensed from OHSU that could lead to therapeutic stem cell products for a wide array of human diseases. The technologies are based on breakthrough discoveries by Shoukhrat Mitalipov, PhD, and his team at the Oregon National Primate Research Center, who have found novel ways to reprogram primate skin cells into embryonic stem cells. Two methods devised by Dr. Mitalipov – somatic cell nuclear transfer and parthenogenesis – can produce embryonic stem cells genetically matched to individual patients, thereby avoiding the risk of immune rejection. Cascade LifeSciences is a San Diego-based company.

• Flash Sensor Technology, a spinoff from Virogenomics Inc., an earlier OHSU startup, is developing biosensors capable of providing instantaneous point-of-care diagnoses using existing and new disease markers as they are discovered. The technology holds the promise of becoming the platform for the next generation of diagnostic devices. The collaborative research at OHSU by Arthur Vandenbark, PhD, and Rajendra Solanki, PhD, on cell signaling interactions forms the basis of the company’s “lab on a chip” technology. Dr. Vandenbark is a Professor of Neurology and Molecular Microbiology and Immunology. Dr. Solanki, formerly of OHSU, is now at Portland State University. Flash Sensor Technology is based in Tigard, Ore.

• Genefac, Inc. is focusing on development and commercialization of a technology to detect in biologic samples the activity of multiple transcription factors – proteins that read and sequence genetic instructions in DNA. The technology – which was developed in the laboratory of William Mathers, MD, PhD, and Zheng Ye, MD, PhD, of OHSU’s Casey Eye Institute/Department of Opthamology – uses small DNA probes containing a unique binding sequence of DNA called a motif. Genefac plans to market the technology as a test to identify in cancer biopsies the precise molecular profile of a patient’s cancer which could then be used as a guide for appropriate personalized therapy. Genefac is an Oregon-based company.

• Transmed Oncology Inc., an Arizona-based biotechnology company, has optioned two novel cancer therapeutics from OHSU. The first, a synthetic peptide called a bombesin receptor antagonist, is believed to have potential clinical utility in suppressing the growth of malignant cells in a wide variety of cancers, including lung cancer, bone cancer, breast cancer, colon cancer, pancreatic cancer, prostate cancer and melanoma. The second is a small molecule chemotherapeutic which has shown potential as a treatment for prostate cancer. Transmed intends to move this and other potential drug candidates through clinical and regulatory processes as well as to develop and evaluate new cancer drugs.

To read the full announcement, click here.

Committee on Committees seeks nominations

The School’s Committee on Committees will meet in late March to review nominations and propose members for the School of Medicine’s 12 other committees. Participation in a committee is an excellent way to learn more about the workings of the School of Medicine, and to network with colleagues from other disciplines.

Click here to read a Q&A with Susan Hayflick, MD, Professor, Interim Chair Molecular and Medical Genetics, and Chair of the Committee on Committees, about the role of committees in the School’s governance structure, and how you can become involved.

OHSU Knight Cancer Institute leadership team formed

Alan B. Sandler, MD, a nationally renowned lung cancer specialist, is joining the OHSU Knight Cancer Institute as the Chief of the Division of Hematology and Medical Oncology and will be appointed as the DeArmond Chair for Cancer Research. Dr. Sandler is currently the Medical Director of thoracic oncology and the Co-director of the Center for Management Research in Healthcare at Vanderbilt University and the Medical Director of the Vanderbilt-Ingram Comprehensive Cancer Center Affiliate Network. He joins OHSU in March.

David M. Dilts, PhD, MBA, will join the leadership team as Director of Clinical Research. Dr. Dilts has been leading national efforts to streamline clinical trials and his role will be to transform the operations of The Knight such that it is known as the "best in the world" in designing, fostering and managing cancer clinical trials. He joins OHSU in February.

Tom Beer, MD, Director of the OHSU Prostate Cancer Research Program, has been appointed Deputy Director of the OHSU Knight Cancer Institute. In this role, Dr. Beer will assist the Director in carrying out the mission and vision of the institute.

Neil Swanson, MD, is the new Associate Director for Clinical Operations for The Knight; he will also continue in his role as Chair of the Department of Dermatology.

For the full announcement and list of the OHSU Knight Leadership Team: click here.

Faculty Practice Plan Management Committee formed, Web site launched

The Faculty Practice Plan Board (FPP) met in January for the first time. The FPP is the new clinical practice entity resulting from the integration of the OHSU Medical Group into the School of Medicine.

In addition to the Dean (who is President and Chair of the Board of the FPP), the Board is composed of the clinical chairs, two external appointed members, two members elected by the faculty, the FPP Chief Medical Officer and the President of the OHSU Professional Board. The Board’s role is to govern the affairs of the FPP, provide leadership and set strategic goals.

During the meeting, the Board approved the membership of the FPP Management Committee. The committee, which meets weekly, is responsible for day-to-day oversight of the clinical practice. Membership categories are defined by the FPP bylaws.

Jeff Koh, Professor, Anesthesiology & Peri-Operative Medicine and Pediatrics, and Mark Nichols, Professor, Obstetrics and Gynecology, are the two elected faculty members. Stacy Nicholson, Chair, Pediatrics, and David Wilson, Chair, Ophthalmology, are the two members selected from the Board by the Board. The Dean’s appointments (which are drawn from the Board members) were John Saultz, Chair, Family Medicine, and John Hunter, Chair, Surgery.

Other FPP committees are now being formed. If you are interested in serving, please contact Tom Heckler, FPP CEO and Associate Dean for the Clinical Practice.

The FPP charter, Board meeting schedules, committee memberships and contact information are posted on the new FPP ozone Web site:click here. The Web site will expand over time as needed.

Christopher Amling, MD, FACS, appointed Head, Division of Urology

Christopher Amling, MD, FACS, has been recruited as Head of the Division of Urology in the Department of Surgery, effective March 1. Dr. Amling will assume the position long held by John Barry, MD. Dr. Barry has led the OHSU Division of Urology and Renal Transplantation for 29 years. Dr. Barry now will focus on patient care and his work as President of the American Urological Association.

Amling previously served as Professor and Director of the Division of Urology at the University of Alabama at Birmingham, where he held the Anton J. Beuschen endowed chair in urologic surgery and research. Prior to that, he served as Chair of the Department of Urology at the Naval Medical Center in San Diego.

For the full announcement, please click here.

Susan Orloff, MD, FACS, appointed Head, Division of Abdominal Surgery

Susan Orloff, MD FACS, Professor of Surgery, has been appointed Head of the Division of Abdominal Organ Transplant Surgery. Dr. Orloff joined the School of Medicine in 1995 and has been a cornerstone of OHSU’s liver transplant program since then. She developed a successful research program at the VAMC and OHSU, currently holding simultaneous merit review and R01 awards. Her leadership in transplantation and hepatopancreatobiliary surgery is recognized nationally; she serves on the executive committee of the American Hepatopancreatobiliary Association, as well as serving on the transplantation societies.

Martin Fuss, MD, PhD, appointed Vice Chair, Radiation Medicine

Martin Fuss, MD, PhD, was recently appointed Vice Chair of the Department of Radiation Medicine. Dr. Fuss joined the School of Medicine in 2006 and has been instrumental in the introduction of new technologies and services, including the development of the region's largest Stereotactic Body Radiation Therapy program and the region's only Calypso imaging device. Additionally, Dr. Fuss is responsible for the design and opening of a one-of-a-kind treatment vault that incorporates the superior treatment technology of Varian, BrainLab and Philips medical equipment, providing CT services within the treatment vault allowing for the most accurate delivery of radiation therapy.

Welcome new faculty

Azzdine Ammi, PhD, MS, Research Assistant Professor, Medicine
Diaa Bahgat, MD, Instructor, Neurological Surgery
Jennifer Botelho, MPAS, PA-C, Instructor, Medicine
Jian Cheng, PhD, Assistant Professor, Anesthesiology & Peri-Operative Medicine
Carol Chism, MSW, BA, Instructor, Psychiatry
Antony Kim, MD, Associate Professor-Provisional, Medicine
Katharine Leaning, MD, Assistant Professor, Pediatrics
Anna Long, PhD, Assistant Professor, Anesthesiology & Peri-Operative Medicine
Joan Newby, MN, FNP, Instructor, Emergency Medicine
Holly Rosenweig, PhD, Research Assistant Professor, Ophthalmology
Catherine Thompson, PA-C, Instructor, Neurological Surgery
Susan Zaretsky, MSN, FNP, Instructor, Medicine