January 2014 Newsletter

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Department of Medicine eNewsletter
January 2014
:: Interview
:: Department News
:: Department Events
:: Department Events

"How Genomics is Altering Our Understanding of Cardiomyopathy" by Gerald Dorn


"Quality" by William Annable


"Men and Women of Certain Age" by Gowrishankar Gnanasekaran


"Update on Malaria" by James Kazura
Leardership Council
January 2014
Richard Walsh

B. Arafah

K. Armitage

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

S. Gravenstein

C. Hoppel

T. Hostetter

D. Hricik

N. Meropol

R. Salata

R. Schilz

D. Simon

R. Walsh

J. Wright


Recorded by:
A. Staruch
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department interview
Brook Watts, MD, MS, Chief Quality Officer and Associate Chief of Medicine for Quality and Safety at Louis Stokes Cleveland VA Medical Center, talks about current quality initiatives and their effectiveness, explains how medical record sharing builds trust between patients and physicians, and offers her perspective on female leadership in academic medicine.


How did your professional interest in quality improvement and patient safety originate?

I trained at the University of Michigan and came to Cleveland in 2004 I did an Advanced Quality Fellowship at the Louis Stokes Cleveland VA Medical Center and it included a Master's Degree in Health Policy through Case Western Reserve University. I have always had an interest in problems that we already knew the solutions to, yet were doing nothing about. For example, when I first started, we knew that aspirin was good for patients, yet many people with diabetes or risk of heart disease did not get it. It had always bothered me that we knew the right thing to do, but were not doing it.

What quality improvement projects are you focusing on right now? How do you assess their effectiveness and sustainability?

I am currently working on a new grant on high-intensity patient management. Studies show that there is a small population of patients that account for most of health care costs; specifically, 5 percent of patients account for 50 percent of health care costs and 1 percent accounts for 20 percent of health care costs. Contrary to the common belief, these are not elderly patients, but rather patients with chronic diseases. For example, patients with heart failure whose condition is often worsened by diabetes, high blood pressure and cholesterol, obesity and sleep apnea. In addition, there are patients with substance abuse or psychosocial problems that complicate their ability to deal with the disease.

Recently a high-intensity patient management program has been implemented at the Louis Stokes Cleveland VA Medical Center along with four other sites in the country. We are targeting high-cost patient groups who routinely have a lot of emergency room visits and offer a red carpet program for them instead. We are hiring former military medics to serve as navigators for these patients by driving them to appointments, answering questions about their medications and helping them get their prescriptions filled. By helping patients take better care of their health, we are minimizing the amount of emergency room visits and offsetting the costs of the VA system.

Another project that we are focusing on is an integrative project between cardiology and primary care physicians to increase the quality of care for patients with heart failure. In order to provide coordinated care for patients, we run a series of heart failure boot camps where we train patients and their families to take better care of themselves. For example, we offer an exercise where a patient receives a menu with salt coupons and has to make adjustments to the menu based on daily salt consumption guidelines. We also have exercises teaching patients about weighing themselves, symptom recognition as well as eating and snacking.

Measuring the impact and sustainability of such programs is very important. Before patients leave, we do their skill assessment upon completing the boot camp program. We also have satisfaction surveys where we get feedback directly from our patients. We have received an overwhelmingly positive response on our quality initiatives. Overall, we hope that programs like these can positively impact heart failure readmission rates and improve patient outcomes.

What is the Health Buddies System and how can it assist patients to assess their medical condition? How are you empowering patients to take ownership of their health?

It is a simple electronic monitoring device that can be connected to a phone and has interfaces for diabetes, high blood pressure and heart failure. The device takes a patient through a series of questions; the patient's daily answers are routed to a telehealth nurse who reviews the data and consults the patient. The data also become part of the patient's record. We have built Care Options for Geriatric Patients program centered around this device and instituted a diuretic protocol. In this program, if a telehealth nurse noticed changes, the patient can be seen by a home-based primary care nurse. This monitoring device helps keep patients out of the hospital while reducing cost and improving quality and safety.

Not only are we pushing patients to engage in their own self-management through electronic monitoring devices, but we are also giving them access to their medical records through the VA My HealthyVet Open Notes program. This open policy results in patients being more engaged in their own care and have an increased level of trust for their physicians. At the Louis Stokes Cleveland VA Medical Center, we are also working on improving the quality of information we give to patients by providing them with medication lists and instructions that are patient-centered to ensure patients understand what to do after visiting their physician.

It seems that we are currently going through a cultural shift by making health care more patient-driven. How does patient education influence health care costs?

As physicians, we want to provide the safest and highest quality of care for patients while paying close attention to cost. The prime example of addressing this objective is Choosing Wisely campaign that was developed by the American Board of Internal Medicine (ABIM) in partnership with Consumer Reports. Specialty groups such as the American College of Cardiology, American Gastroenterology Association and others were asked to provide five hings that patients and their doctors should question. For example, the American Academy of Pediatrics suggested questioning the use of antibiotics for treating a virus.

We are trying to raise patient awareness of these issues and eliminate unnecessary costly procedures by facilitating open communication between patients and their doctors. With the support of ABIM, the Better Health Greater Cleveland organization chose five Choosing Wisely topics to educate Clevelanders about through media. This initiative creates an opportunity for patients and physicians to make collaborative decisions together. I believe this also improves patient-doctor communication as we initiate the topic of risk and benefits, which many doctors may be calculating in their heads but not necessarily sharing it with patients.

Your initiatives in quality and safety are highly impactful. As a female faculty leader, do you think there is still a glass ceiling that women in academic medicine are faced with? What are your thoughts on the common challenges women confront in their careers?

Though studies show that the concept is still true, I personally have been very lucky to have mentors who have encouraged my career growth. I believe we all have concerns with the low number of women in high-profile academic positions. It is important to reinforce mentoring of women and support multiple professional paths and trajectories. I think we all see that Dean Pamela Davis, MD, PhD, has made great efforts in encouraging female professionals. In addition, Women Faculty School of Medicine group led by Usha Stiefel, MD, has facilitated mentoring and career development programs for women faculty.

Women career trajectories are affected by childbearing years; I believe a system has to be able to offer support and flexibility. Acknowledging this need for flexibility and growing a reputation of an institution that supports women facilitates recruitment as well as longevity of current female faculty.

department news report
Division of Cardiovascular Medicine

Anne Hamik, MD, PhD, was appointed as an Associate Editor for the Journal of Vascular Medicine.









Daniel Simon, MD, was nominated as Chair of the American College of Cardiology Awards Committee 2014-2015. Dr. Simon was also appointed to the International Editorial Advisory Board for the Journal of Cardiology.







Schedule a clinical appointment with Cardiovascular Medicine physicians






Division of Hematology & Oncology


Matthew Cooney, MD, was awarded a $75,000 catalytic grant from Case/UH CFAR for his project entitled "Evaluation of Human Papilloma Virus-Related Oropharyngeal Carcinomas in Kampala, Uganda."




Clark Distelhorst, MD, published his work in an article entitled "Feedback Regulation Mediated by Bcl-2 and DARPP-32 regulated inositol 1,4,5-Trisphosphate Receptor Phosphorylation and Promotes Cell Survival" in the Proceedings of the National Academy of Sciences.


Schedule a clinical appointment with Hematology & Oncology physicians





Division of Infectious Diseases & HIV Medicine

Eric Arts, PhD, received a $188,000 grant from amfAR, the Foundation for AIDS Research, for his work on an experimental simian immunodeficiency virus vaccine. The vaccine is currently being tested in an animal model and will hopefully be moved to human trials next year.








Michael Lederman, MD, and Benigno Rodrigues, MD, received a $12.7 million grant from the National Institute of Allergy and Infectious Diseases, Part of the National Instututes of Health, for their ongoing research on HIV and AIDS. The funding also supports clinical research efforts at University Hospitals Case Medical Center, the Joint Clinical Research Center in Kampala, Uganda, and the University of Cincinnati. Notably, CWRU/UH AIDS Clinical Trials Unit is one of 37 worldwide that will conduct human studies to advance knowledge of the mechanisms of HIV-related diseases, prevention of HIV acquisition and treatment of HIV/AIDS and its complications.



Schedule a clinical appointment with Infectious Diseases & HIV Medicine physicians





Division of Pulmonary, Critical Care & Sleep Medicine

Robert Schilz, MD, was nominated for the COPD/Asthma Clinical Advisory Group through the Governor's office of Health Transformation.









Kingman Strohl, MD, published his work in the New England Journal of Medicine entitled "Upper-Airway Stimulation for Obstructive Apnea." In his study Dr. Strohl argues that mild electronic stimulation therapy to the upper airway during sleep is effective in reducing obstructive sleep apnea.







department conferences & events

5th Annual Department of Medicine Research Day

When: Friday, May 2

When: 12:00 - 3:30 p.m.

Where: Wolstein Research Building Atrium and Lobby

Abstracts Deadline: Monday, April 14

Click here to register for the event


Team Science Challenge

The purpose of Team Science Challenge is advancing modern medical research. The awards from the Department of Medicine will provide support for developing a major research proposal to a multidisciplinary team.

Application Deadline: March 1, 2014
Submission: Send applications in PDF format to Martha Salata



Grand Rounds

When: Tuesdays, 12:00 - 1:00 p.m.

Where: Kulas Auditorium, Lakeside, 5th Floor


February 4

"Overcoming Barriers to Treat and Prevent Difficult Infections" by Federico Perez, MD

February 11

"Targeting the Epigenome in Heart Failure" by Saptarsi Haldar, MD

February 18

"Approach to Thrombotic Disorders: Is it Time to Change Our Paradigms?" by Lalitha Nayak, MD

February 25

"New Diabetes Medications: Full of Promise or Misplaced Expectations?" by Karen Horowitz, MD



Morbidity and Mortality Conferences

When: Fridays, 12:00 - 1:00 p.m.

Where: Kulas Auditorium, Lakeside, 5th Floor


February 7
A 40-year-old immunosuppressed male presents with headache and hemiparesis.
February 14
Quality/Lessons Learned conference.
February 21
A 56-year-old female presents with chest pain and fatigue requiring urgent surgery.
February 28
A 30-year-old male is treated for Mycobacterium Tuberculosis and develops worsening mental status.

department leadership council minutes

Leadership CouncilDr. Walsh thanked the council members who participated in the two interview days for the Harrington Physician-Scientist Pathway recruitment. Many outstanding candidates have applied and Dr. Armitage will continue to update the council on this selection process. Dr. Salata recommended the following article to council members that he co-authored, "Career Outcomes of the Graduates of the American Board of Internal Medicine Research Pathway, 1995-2007", Academic Medicine, November 2013.

Leadership CouncilDr. Walsh distributed Mr. Zenty's System Overview and Outlook to council members including information on the following: the integration of Parma and EMH Healthcare; HealthSpan; UHAccess; an Accountable Care Organization update; Employee Wellness Offerings; Professional Development Opportunities and the UH Physician Engagement Survey. Dr. Walsh asked Leadership Council members to share this information with their faculty members and staff.

Leadership Council

Dr. Walsh updated the council on the CARTS Analysis project.




Leadership CouncilDr. Walsh announced that hospital leadership has structured the UH community hospitals and outpatient health centers into two regions and has aligned the senior leadership as follows:


· Jeffrey H. Peters, MD, will serve as Chief Operating Officer, effective March 31.

· Eric J. Bieber, MD, President of the UH Accountable Care Organization, has assumed responsibility for the West Region, including University Hospitals Parma Medical Center and University Hospitals Elyria Medical Center and their outpatient health centers; as well as the joint-venture relationships with St. John Medical Center and Southwest General Health Center.

· Richard A. Hanson will be responsible for the East Region, including University Hospitals Ahuja Medical Center, University Hospitals Conneaut Medical Center, University Hospitals Geauga Medical Center and University Hospitals Geneva Medical Center; University Hospitals Bedford Medical Center and University Hospitals Richmond Medical Center, campuses of University Hospitals Regional Hospitals; and the University Hospitals Ambulatory Network. He will also oversee University Hospitals Home Care, the University Hospitals Rehabilitation Hospital joint venture; Outpatient Rehabilitation Services; University Hospitals Senior Services; and the hospital's relationship with HealthSpan.

· Michael R. Anderson, MD, has been promoted to Chief Medical Officer for the System. He will continue to serve as CMO for University Hospitals Case Medical Center.

5Dr. Hostetter reviewed the results of an analysis of Department of Medicine NIH RO1 applications, July - November 2013. This information will appear on the Department of Medicine website.


Leadership CouncilDr. Walsh announced that there will be an external review of the Department of Medicine. Dates for the review will be determined by the School of Medicine and UH Case Medical Center leadership.

Leadership CouncilMr. Creighton distributed guidelines for divisional materials needed for the Department of Medicine external review. The requested data, including a SWOT (strength, weakness, opportunities, threats) analysis from Division Chiefs is due on Monday, January 27. Leadership council members are requested to update and submit their CVs in the approved, standardized format.

Leadership CouncilDr. Armitage gave an update on the Medical Education Building Steering Committee of which he is a member.


Leadership CouncilMr. Creighton presented information on the UH Patient Portal/UH Personal Health Record including: the Patient Portal Time Line; Current Pilot Design and Phase 1; Results and Clinical Data; Phase 2 Results and Recommendations.