By Jeff Kraakevik, M.D.

On Friday in the Neuroscience and Behavior Course for second-year medical students, we tried something that we haven’t done before. It’s a pretty interesting teaching model called the “flipped classroom.” Essentially, it takes the traditional method of hearing new content in the day and applying it at night with individual study, and flips that order around.

The outcome is that students learn the material at home the night before the teaching session. Class time is not used for lecture content delivery, but for solidifying that knowledge through applying it.

Here’s what we did. Dr. Claudio Mello, my co-course director, recorded the same lectures he gave last year about the somatosensory system onto his laptop. OHSU provided him with software to record his voice along with the slides on his PowerPoint. He broke the 80-minute lecture up into four 15 to 30-minute segments. The videos were posted on the course website, and the students watched them when it was convenient for them.

The morning of the session, we quizzed students over the material at the beginning of the morning. The quiz was done using a clicker audience response system, so we were able to see the scores in real time. Then, Dr. Mello and I retaught a few points which the students struggled with on the quiz.

This was followed by a team-based learning session (if you don’t know what that, is here’s video from Duke University explaining it) where we used clinical cases in small groups to apply what they learned about the basic neurophysiology and neuroanatomy of the somatosensory system.

All in all, it went better than I expected. I had several students come up to me after we were done and say they really liked it.

One student liked how there was defined and pre-presented content for the team-based learning session, as that allowed more efficient preparation for the session. Another student told me that it was helpful to pause the lecture, and draw out the pathway and structures. There were some technical glitches, but when I polled the audience before the quiz, no one was unable to view the material.

It shows how technology can be integrated pretty easily into the classroom setting. I know I’m not the first to try this method, but I think there aren’t many of medical schools that have tried this yet. I did want to provide a forum to discuss the “flipped classroom.” Have you tried it or something like it either as a learner or an instructor? How did it go for you? If there are students from OHSU that were in the session, how did you think it went? We’ll keep working on making the model work better, but I’m excited to try it again!

***

Jeff Kraakevik, M.D., earned his medical degree from the University of Iowa and his fellowship in Movement Disorders from Oregon Health & Science University. He joined the OHSU movement disorders faculty in 2006 and is currently an Assistant Professor of Neurology. Dr. Kraakevik holds the unique distinction of being a former high school teacher. He has followed this trajectory of educator and currently heads up the development of medical student and resident education for the OHSU department of Neurology and VA Medical Center where he holds a joint appointment. Dr. Kraakevik’s research interests include gait and balance problems of Parkinson’s disease as well as research that explores the best teaching practices for medical education.

You can also follow him on Twitter and at his neurology education blog.

By Tracy Severson, R.D., L.D.

Editor’s note: This is the first in a short series of posts on resolutions. We selected resolutions to feature based on comments left by our Facebook fans in December.

‘Tis the season for making New Year’s resolutions—are you one of the millions of Americans resolving to lose weight or eat better in 2013?

Generic resolutions without a game plan are much more likely to fall by the wayside before the Superbowl (hot wings, anyone?). This year, resolve to set clear, achievable goals to improve your diet and health in 2013.

Need help getting started? Here are the top three nutrition-related improvements I would love to see more people adopt in the coming year.

Resolution #1: Eat breakfast! (and lunch… and dinner…)

Eating within an hour of waking helps kick start your metabolism for the day. Continuing to eat a light snack or meal every three to four waking hours will keep your blood sugar levels stable and prevent you from getting too hungry (which can lead to overeating high-fat, high-sugar foods later in the day).

Resolution #2: Don’t drink your calories

Calories in liquid form—including soda, coffee drinks, juices (yes, even 100 percent fruit juices), energy drinks and sports drinks—aren’t filling, so you don’t eat any less to compensate for them. Instead of sweet drinks, try plain water, herbal tea, or zero-calorie flavored waters to quench your thirst.

For a quick meal, make a fruit smoothie with fresh or frozen fruit blended with skim milk & plain yogurt. You get all of the fiber from the fruit, so it will fill you up!

Resolution #3: Make a plan

Feeling gung-ho about your new healthy diet and tempted to load up on fresh produce, but afraid it will all go bad before you can use it?

Spend a little time at the beginning of the week planning your meals and snacks. Use the meal plan to make a grocery list and stick to it. This way you’ll have all of the needed ingredients but not too much fresh produce or other impulse buys. Now you’re set for healthy meals and snacks all week long!

Here’s to a healthy and happy 2013!

***

Tracy Severson is an outpatient clinical dietitian at OHSU. She earned Bachelor’s degrees in Nutritional Sciences and Sociology from the University of Arizona and completed her training to become a Registered Dietitian (R.D.) at the University Medical Center in Tucson, Arizona. Since becoming an R.D., she has also completed a Certificate of Training in Adult Weight Management.

Tracy moved to Portland from Tucson in 2010, and has worked at OHSU since 2011. She works with the OHSU Surgical Weight Reduction clinic and Cardiac Rehab program, and also provides medical nutrition therapy for General Adult Outpatient Clinics at OHSU.

By Brycie Jones

The next installment in our 2012 year-in-review series features OHSU’s most-read blog posts. These posts received the most unique page views out of all posts on all of our blogs.

Special mention: 2012 Nike Doernbecher Freestyle Collection, Healthy Families

The release of the Nike Doernbecher Freestyle collection is always popular, and it’s easy to see why. Each year, six patients from OHSU Doernbecher Children’s Hospital are selected to work with Nike designers to create six pairs of limited-edition shoes. All proceeds from these shoes benefit our OHSU Doernbecher Children’s Hospital.

This year we were able to share videos and blog posts on each of our patient-designers. Be sure to head over to Healthy Families, our Doernbecher blog, to read about their stories and fantastic shoe designs.

5. How our brains control pain, On The Brain

This post was one of the first to appear on our blog for the OHSU Brain Institute, On The Brain. An excerpt from the post, written by Mary Heinricher, Ph.D. :

Pain is often a warning that something is wrong and that we need to act to avert impending injury or allow ourselves to rest and recuperate. But sometimes pain outlasts an injury, and sometimes we have pain without any obvious injury at all. How can that be?

4. Why I chose Ph.D., part one, StudentSpeak

StudentSpeak, our longest-running blog, features posts by students from our School of Medicine and our School of Nursing. One of those students, David Edwards, wrote about what led him to work for his Ph.D. instead of aiming for a M.D. The whole story is a two-parter. Here’s an excerpt from part one, which lands at No. 4 on our most-read list:

I wasn’t initially interested in graduate school. In college, I started off, like so many students vaguely interested in medicine or healthcare, wanting to be a physician.

I was serious about it, too. I volunteered at hospitals, worked on medical research, served for three years as board member for our local pre-med chapter. I heard countless presentations from physicians about how they got involved in medicine, and I modeled my college trajectory based on their example.

But something was missing—or, as I later discovered, something was never there. There was some veiled hesitation about my wanting to be a physician that I couldn’t put my finger on.

3. Shifting paradigms in medical education, 96,000 Square Miles

Over the past year, Dr. Jeff Kraakevik, an assistant professor of neurology in our School of Medicine, has shared updates on that school’s medical school curriculum transformation process. In this post, he asked readers to imagine what medical school might look like if it wasn’t tied to learning in standardized blocks of time:

What would the first two years of the medical school curriculum look like without set time-frames for students to complete a course on neuroscience look like? What would it look like if students moved on to the next subject or course after demonstrating they have mastered the skills necessary to move forward, and not because the 8-10 week course is done? What would a curriculum look like if there were no walls between the courses?

2. OHSU President Robertson on the Supreme Court’s Affordable Care Act decision, 96,000 Square Miles

This post was one of the very first to appear on our institution-wide blog, 96,000 Square Miles, but it still ranks at No. 2 on our most-read list. Here’s part of the post written by OHSU president Joe Robertson, M.D., M.B.A.:

Today the Supreme Court issued its long-awaited decision on the Affordable Care Act, largely upholding the law. The ruling will require additional analysis but the most vital outcome is that there is now a mechanism in place for achieving universal coverage.

Coverage for all Americans not only improves outcomes for individuals and communities, it’s absolutely vital to address the growing cost of health care. The first and most important of OHSU’s eight essential principles for reform, adopted in early 2009, is universal access to a defined set of health care benefits. Today is an important victory but, of course, the hard work lies ahead, and OHSU and other academic health centers have a vital role to play.

1. Balancing act, Healthy Families

Our most-read blog post in 2012 comes to us from our OHSU Doernbecher Children’s Hospital blog, Healthy Families. One of our residents in pediatrics, Alison Christy, M.D., Ph.D., wrote about how truly difficult it can be to manage the demands of family and residency:

It’s been hard for me to admit how difficult it is to be a resident with two kids. When people ask, I usually tell them it isn’t that bad. My son sleeps eight to 10 hours a night, every night, without fail (don’t hate me – I had the other kind of kid, too). My husband stays home with the kids and his parents drop in for emergency baby-sitting. I really love what I do. I work with smart, friendly, generous, amazing fellow residents. The OHSU residency program has been unbelievably accommodating and helpful. Everyone around me has done everything possible to make this as easy as it can be. I am basically the luckiest working mom you’ve ever met.

All of that is true, but it’s still hard. I finally had to admit it to myself a week ago when my little boy didn’t want to nurse. He wasn’t hungry, and he pushed me away, and it occurred to me that he might prefer a bottle. Why wouldn’t he? He drinks from bottles all day long, every single day. I hate that. What I really want is to be two people at once: one who works all day in the hospital and another who stays at home all day with two kids. I don’t want to be just one thing. I want balance.

By Brycie Jones

Next up in our short 2012 year-in-review series: the year’s most engaging posts on OHSU’s Facebook page.

OHSU has been on Facebook since 2007. At that time, the School of Medicine had OHSU’s only presence on the social network. We now have numerous pages on Facebook that are administered by a wide range of OHSU employees, including a page representing the whole institution. This list counts down the most popular posts — as determined by those who “like” us — from that page.

As the administrator of that page, I’d like to sincerely thank those who’ve been a part of our community on Facebook over the past year. I’ve loved reading your thoughts on our research and passing along your kudos to our deserving staff members.. I hope to see more of you in 2013. Now on to the list!

5. What are you grateful for?

In November, we asked you to fill in this blank: “I am grateful for _______.” Nearly 100 people left comments that ran the gratitude gamut. Several people name-checked OHSU employees, departments or services — thank you — and one commenter left thanks for health and not needing to use OHSU. Family and  job opportunities were also popular choices among our commenters.

4. Congratulations OHSU graduates!

As we bid farewell to another class of newly-trained health care professionals and scientists, we asked our community for what advice they might offer to our new graduates.

Our Facebook community advised our new alumni to wield kindness and compassion in their new professions, and to continue learning. As one commenter wrote: “You are never alone. Ask questions of your peers; pick their brains. Above all, respect your colleagues and your patients.”

3. OHSU earns Magnet status.

In August, we shared good news with our Facebook community: OHSU received prestigious Magnet status, awarded by the American Nurses Credentialing Center. Our community responded by throwing in their own congratulations and notes about their interactions with our nurses.

2. The Dr. Oz Show visits OHSU.

The Dr. Oz Show, in partnership with OHSU, provided 500 free health screenings in July. Many members of our Facebook community browsed, shared or commented on photos from the screening event, which took place on our South Waterfront campus.

1. Phil and Penny Knight give $125 million to fight cardiovascular disease.

The news that Phil & Penny Knight would establish the OHSU Knight Cardiovascular Institute with the largest-ever gift to OHSU was by far the year’s most popular OHSU Facebook story. The post received more than 500 likes and 70 shares. The news also inspired several commenters to leave their own notes of thanks to the Knights, many of whom also included personal stories of their experiences with our cardiovascular programs.

These 2012 posts received the most “engagement” from our Facebook likers, according to the data provided by Facebook’s insights. The score has been slightly adjusted to account for number of people viewing the posts. For the purposes of this list, engagement includes any way in which users interacted with our post, including: likes, shares, comments  and clicks on links associated with the post.

Written by Mark Kemball 

The Mayan Apocalypse may have passed, but the year still has a few days to run. With this in mind, therefore, here aresome informal , unordered Top Nine-and-a-Half Alumni Moments of 2012. (For the Fractional Arithmophobes, we are fully confident that at least half a moment of alumni magic will happen before Dec. 31 to bring the number to ten.)

These are all moments that signaled small victories in long-running projects, celebrated defining moments in our alumni community or just flat out made us happy in 2012.

You Re-united

Our reunion numbers were WAY up this year, thanks to almost 600 alumni and their guests who attended a reunion this year. Once again the School of Dentistry led the way, but it was wonderful to see so many friends from all schools and to catch up with careers, children, grandchildren, travel experiences and so much more.

You H.O.S.T.ed

Our alumni in the School of Medicine stepped up to the Help Our Students Travel (H.O.S.T.) program in a big way, talking with or looking after the fourth year M.D. students who are traveling on residency interviews. So far we’ve recorded 30 matches in 16 states from Alaska to Virginia. Quite apart from the shared information, our HOSTs have helped shave the costs of what is a significant additional expense for our students.

You Logged In

Our annual School of Nursing Puhaty Endowed Lecture, delivered inimitably by Dr. Patricia Benner, had a record physical and online attendance. The OHSU Auditorium wasfull, we saw over 70 logins to the streaming video (hello Chicago and Murfreesboro) and scored almost 100 tweets from Marquam Hill, New York City and places in between.We’re now working on how to replicate this response for events across the whole OHSU alumni community.

You Got Mail

After many years of patient work, @alumni.ohsu.edu email addresses became a reality in 2012 and were given to the graduating class in June. We look forward to providing an @alumni.ohsu.edu address to all alumni in 2013.

You Re-Defined Philanthropy

We continue to be inspired by the many ways in which our alumni contribute. Philanthropy comes in many forms – time, expertise and resources – and we have been honored and humbled time and time again in 2012 by the many ways we have seen it at work. From the dentist who donated not one but two continuing education lectures to the physician who dedicated Friday mornings to rating applicants for the School of Medicine to the nurse who organized and hosted a reception for the Interim Dean of the School of Nursing in central Oregon, we have witnessed countless acts of generosity and support for our missions.

We Grew Our Councils

After a number of years of no formal organization (although plenty of activity) the School of Nursing Alumni Advisory Council was not only re-established but re-energized by our volunteer leaders. Now the real work begins!

We Learned More About Our Home

Fifty-seven percent of our alumni live in Oregon, so it felt especially good to be able to travel to La Grande, Bend, Ashland, Klamath Falls, Coos Bay, Roseburg, Monmouth and Salishan to meet them. Thank you to everyone who hosted and joined us, and a special shout out to the small family of elk that walked us through the Eastern Oregon University campus in the half-light of a frosty March dawn.

We Listened

This has been a year of surveys: communication surveys in the School of Medicine, a “pulse” survey of all our alumni, and planned communications surveys of our School of Dentistry and School of Nursing alumni. Thank you to all who participated: we know completing surveys takes time and the dangling promise of an iPad drawing will only fuel so much perseverance. Your opinions really do help us.

We Awarded

The impact that our various 2012 award recipients have made was nothing short of amazing. We recognized alumni who invented the first home dialysis machine and who created the rehydration protocols that continue to save millions of cholera-sufferers; we thanked outstanding faculty members for their excellence in educating our future alumni; and we honored alumni leaders for the many ways they bring their skills, their leadership and their passions to bear on improving the health of their communities.

You Endowed

This half-moment, not technically complete until early in the new year, celebrates the power of persistence. Twenty years ago a small number of dental alumni got together to play a round of golf to raise money for a project in the School of Dentistry. Year by year others joined them until eventually they booked out an entire golf course for a half day. The result of this decades-long accumulation of drives, chips, putts and divot-replacement is the full endowment of a continuing education lecture, open to the entire dental community and free to OHSU alumni. Could we ask for a better end to the year?

***

Mark Kemball and the alumni relations team are proud to count almost 34,000 dentists, nurses, physicians, researchers, technicians and other health professionals as OHSU alumni. The team strives to keep them all connected with the university, with its students and with each other.

You can also follow Mark on Twitter.

Written by Jackie Wirz, Ph.D.

“I have always imagined that Paradise will be a kind of library” – Jorge Luis Borges

Jorge Luis Borges was an influential Spanish American novelist, perhaps best known for his inventive short stories.  His quotes have sparked literally thousands of essays by hopeful library students, much like the “two paths diverged in the woods” cliché for personal statement essays (see previous blog post here).

Although I admire this quote and agree with it on many levels, my favorite library quote comes from legendary fashion designer Karl Lagerfeld. In addition to being the creative force behind the House of Chanel, he also owns an impressive library and a bookstore. According to Karl, “Books are a hardbound drug with no danger of overdose. I am a happy victim of books.”

OK, perhaps equating books to drugs at a medical campus is not the best course of action, but my major point here is that books have been and continue to be a passion for me.

Is that why I work at a library? The honest answer to that is no. Although our collection of books is extensive and lovely, I hold a burning desire to read only a select few of them. Principles of Physical Biochemistry is a personal favorite, and I’d recommend The Elements of Style to pretty much everybody. Despite my geekiness, I am not remotely interested in reading (or even looking through) the The Color Atlas and Synopsis of Clinical Dermatology  or Dental Caries : the Disease and its Clinical Management.  In short, books are not the reason I work at the library.

Yes, I can practically hear you thinking right now, “Aren’t books the heart of the library?” And for many institutions and libraries across the nation, books do form the cornerstone of a library.

However, the OHSU Library, like many academic research libraries, carries a diverse cross section of information in a variety of shapes and forms: for example, we have an extensive historical collection of medical artifacts, a collection of oral histories, thousands of journals and hundreds of databases.  Some of these items are digital and only a sub-section of them are bound in book format.

The heart of the library could be considered to be the wealth of information in all of its glorious manifestations.

But even here I would disagree. I work at a library because I believe that the heart of the library is contained in the people who work here. Our jobs are not only to ensure that OHSU faculty, students, staff and Oregonians everywhere have access to information; we are also entrusted with facilitating the educational, outreach and research mission of OHSU.

From our amazing Nursing Librarian Loree Hyde to our entire administrative staff, from our brand new Digital Collections Librarian Kyle Banerjee to our long-standing circulation team, each and every individual in the library performs above and beyond the call of duty to help us all find and manage the information we need to succeed as a university. We all have a passion for what we do, and working with these amazing people is what makes this library my home.

Taking it one step further, I also agree with former Harvard President Charles W. Eliot: “The Library is the heart of the University.”

In my opinion, it is the people that make the heart of the library, and these are just some of the same people that make the vibrant heart of  OHSU.

***

Jackie Wirz is an Assistant Professor and the Biomedical Sciences Information Specialist at the Oregon Health & Science University Library. She earned her Ph.D. from Oregon Health & Science University in Biochemistry & Molecular Biology and has a B.S. from Oregon State University in Biochemistry & Biophysics. Her research career has spanned 15 years and has covered diverse topics such as transcriptional regulation, macromolecular structure determination, collagen biophysics and DNA repair. Her professional interests include information, data, and knowledge management, as well as the publishing paradigms of scientists.

Additionally, Jackie is a strong proponent of science outreach and volunteers with a variety of programs designed to promote scientific literacy. Jackie believes in evolution, salted caramel buttercream and Jane Eyre.

Written by Wayne Clark, M.D.

Last October, a 74-year-old woman was brought to the Mercy Medical Center emergency department in Roseburg with stroke symptoms. Mercy Medical’s Brent Crabtree, M.D., called OHSU and requested a telemedicine consultation. Minutes later, an OHSU stroke neurologist was examining the patient using a two-way audio-video robot that had been wheeled to her bedside.

The exam showed the patient had suffered a stroke. Working with Crabtree, OHSU’s Hormozd Borzorgchami, M.D., prescribed t-PA – a clot-busting medication that can minimize brain damage and make a significant difference in how quickly and completely a patient recovers from a stroke. The patient was transferred to OHSU, where interventional neuroradiologists removed the clot using the most up-to-date stroke treatment technology. And because our physician – working in concert with the Mercy Medical Center physician – had already examined the patient and done lab tests, she was taken to stroke treatment as soon as she arrived. She’s made a remarkable recovery.

Such success stories are being repeated throughout Oregon thanks to the OHSU Telemedicine Network. Since adding stroke to the list of telemedicine specialties we offer in spring 2010, OHSU has helped our collaborating hospitals treat more than 200 patients who presented with stroke symptoms – most in rural areas where hospitals cannot afford to have stroke neurologists on staff.

With stroke, time is brain. For example, t-PA must be administered within three hours to be effective.  At the same time, t-PA can cause significant complications for certain patients. It’s critical to bring the right expertise to the patient’s bedside as quickly as possible to make that determination.  OHSU’s tele-stroke team is available 24/7/365. That’s means we can be at the patient’s bedside in five to 10 minutes, helping to make treatment decisions, including the use of t-PA.

The OHSU Telemedicine Network has significantly increased the number of patients who are receiving this life-saving, brain-saving treatment. About 30 percent of patients treated by the OHSU Telemedicine Network have received t-PA. The national average is 2 to 3 percent.

In addition, some 46 percent of the patients examined by way of our tele-stroke network were able to receive care in their home community. Overall, the OHSU Telemedicine Network has spared Oregonians more than $1.5 million in risky, expensive and unnecessary transports.

Stroke is the third leading cause of death in the United States and the leading cause of adult disability.  Telemedicine allows emergency room doctors throughout the region to have a backup – a second opinion – to help reverse this trend. It’s one more way the OHSU Telemedicine Network helps Oregonians receive the right stroke care, in the right place at the right time.

***

Wayne Clark, M.D., is the director of the Oregon Stroke Center at the OHSU Brain Institute. Dr. Clark received his medical degree from Oregon Health & Science University and completed his neurology residency and stroke fellowship at the University of California at San Diego. Dr. Clark`s clinical interest is in the acute treatment of stroke, including the investigation of new potential stroke therapies.

Oregon Health & Science University was named the most admired company in health care in the Portland Business Journal‘s annual survey of more than 1,800 chief executive officers.

OHSU has received the top health care spot in the survey — which recognizes those companies that set “standards in their industries for performance, strategy and innovation” –  for many years running.

Our Doernbecher Children’s Hospital also was recognized in the health care category. They nabbed the no. 3 spot, behind OHSU and Kaiser Permanente.

Written by Roger Chou, M.D.

About 20 percent of patients with HIV infection (equaling about 250,000 persons in the United States) are not aware that they are infected.

This means that their immune systems are slowly breaking down over time and they are a source of infection to others.  A new draft statement by the U.S. Preventive Services Task Force (USPSTF), based on a scientific review performed at the Pacific Northwest Evidence-based Practice Center here at OHSU, recommends that HIV screening be routinely offered to all persons between 15 and 65 years of age.

This is a shift from prior USPSTF recommendations, which focused on screening higher risk persons.  Why the change?

• The HIV test is a simple blood test and is nearly 100 percent accurate—in fact it is one of the most accurate tests we have for any medical condition.

• HIV treatments are very effective, with newer evidence confirming that early antiretroviral treatment, started when the immune system is still quite strong, improves mortality and prevents opportunistic infections.

• We now have good evidence from within the last year that antiretroviral therapy reduces the risk of sexual transmission of HIV by over 90 percent.

• Routine prenatal HIV testing has been a marked success, reducing the number of infected newborns from 1650 to around 200-300 per year.

• Targeting testing to high risk patients misses a lot of cases, and has not reduced the approximately 56,000 new infections that occur annually. Some patients are uncomfortable disclosing their risk factors, and clinicians asking about them.  Some may not be aware that they are at risk. In women, for example, in whom heterosexual contact is the most common risk factor, it is often unclear who is “high risk” since it depends on the number of partners, their specific sexual practices and the risk of their partners—which they might not even be aware of.

• Making HIV testing routine may help remove lingering stigma and barriers to testing. Many states, including Oregon, have already removed requirements for signed informed consent and detailed counseling prior to HIV testing. Under the Affordable Care Act, insurance companies are required to fully cover “A” and “B” recommendations from the USPSTF.

As noted by Hilary Clinton and the United Nations, this is an exciting time since the goal of an AIDS-free generation is finally within sight.

But to achieve this first requires that we identify and treat those currently affected, in order to eliminate the reservoirs of infection that allow HIV to persist.

The draft USPSTF recommendation is currently open for public comment through December 17, 2012.

Editor’s note: Dr. Chou also recently discussed this topic on OPB’s Think Out Loud.

***

Roger Chou, M.D. received his medical degree from Northwestern University Medical School and completed an internal medicine residency at OHSU. He is board certified in internal medicine. Chou’s research interests include development of evidence-based guidelines for health screening and management of pain conditions.

He has led research for the U.S. Preventive Services Task Force, the Drug Effectiveness Review Project, the American Pain Society and the Agency for Healthcare Research and Quality’s Comparative Effectiveness Program. In his free time, he enjoys rock climbing, mountaineering, hiking and photography.

John McConnell, Ph.D., speaks at an event announcing the Silver gift and NIH grant.

By John McConnell, Ph.D.

Figuring out a way to control the growth in health care costs is one of the most critical challenges facing our generation. Health care costs are at the core of the long term debt questions for the federal government and recent budget shortfalls here in our own state. As a health economist, this is both daunting and exciting – and I think OHSU can play a significant role in finding answers.

In response to systemic challenges, the State of Oregon is embarking on a multi-billion dollar experiment that is unlike anything we’ve seen in the history of health care. While there have been a few demonstration projects aimed at cost control, and some recent movement by other states, Oregon has made a bold step toward cost containment.

The state has transitioned its Medicaid program to Coordinated Care Organizations, or CCOs. Oregon has also made an agreement with the Federal government – in exchange for $1.9 billion, Oregon will reduce the rate of healthcare spending by 2 percent. A failure to meet this benchmark without holding quality constant at the same time will mean the loss of hundreds of millions of dollars.

This combination of factors makes Oregon fertile ground for high quality studies. OHSU has a role to play – not just as a provider participating in reform – but as an academic center providing rigorous, independent analysis of what works and what doesn’t. And the truth is, when it comes to knowing what works in the health care system, we are in the dark ages.

The Oregon experience can help us understand how to tackle the important challenge of cost control. There are several elements at play.

First, as noted above, we have a hard target for cost savings, the likes of which we have never seen.

Second, the structure of CCOs includes several innovations of interest. For example, CCOs themselves will be subject to global budgets, which many policy experts believe is the most promising way to move toward cost control.

In addition, CCOs have an explicit focus on the integration of physical, behavioral, and dental health care within a primary care home. Although there is a great deal of experimental evidence that this type of coordinated care should improve care and hold costs down, it has not been rigorously disseminated in the way that Oregon is attempting.

So, we want to know – will it work? If so, when does it work best, and why? If not, where did it go wrong? With new funding from the National Institutes of Health (NIH) and the Silver Foundation, announced this week, OHSU’s Center for Health Systems Effectiveness (CHSE) will provide answers to these questions.

For example, if savings are accomplished, are they accomplished through reductions in inefficient use – unnecessary hospitalizations, as everyone hopes –  or through reductions in payment rates, which is what providers and systems fear.

The influx of funding provides the capacity for OHSU to be at the forefront of the research that will answer critical questions of national importance. At CHSE, we are excited about providing the economic and analytic horsepower to this project, as well as developing partnerships with researchers and stakeholders throughout Oregon to develop and disseminate our findings.

It is my hope and belief that 5 years down the road the world is going to know a lot more about what works in health care and that OHSU will have made major contributions to answering those questions.

***

John McConnell is an associate professor and health economist at Oregon Health & Science University. He also serves as the director of OHSU’s Center for Health Systems Effectiveness.

He received his Ph.D. from Stanford University and spent a year at the University of California at San Francisco before moving to Oregon. His current research includes an analysis of the impacts of Oregon’s 2007 Mental Health & Chemical Dependency “Parity” law and a study of management practices in U.S. hospitals. Dr. McConnell has worked closely with Oregon’s policy-makers and is currently acting as an advisor to the state on reimbursement reform.