How Do You Social? Medical Students Wanted for UCF Study

socialized_medicineBy Andrea Berry and Monica Bailey

About a year ago, the Faculty Development Office at the University of Central Florida (UCF) ventured into the realm of social media to see what opportunities there were for medical education and faculty development. Along with starting a departmental Twitter account (@Comfacdev), the team also conducted a literature review on social media uses in medical education in order to develop a best practices workshop for Faculty. Continue reading

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Health Wonk Review: “Thank God It’s Recess”

Originally posted at Healthcare Lighthouse

By Billy Wynne

Welcome to this “Thank God It’s Recess” edition of Health Wonk Review. With Congress adjourned for the 2014 midterm elections, the wonkophile class has some time to think about the upcoming open enrollment period and broader health system changes. This week we’ve got some insightful gems to get your heads churning for the fall.

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State of Emergency: Overcrowding in the ER [Infographic]

Originally posted on July 15, 2014

By Emily Newhook

In 2010, more than 130 million Americans visited the emergency room. Most of them waited hours to be seen by a medical professional, and even longer to be admitted to the hospital or discharged. But long wait times are symptomatic of a much bigger, systemic problem: emergency room overcrowding has been shown to increase mortality rates, compromise quality of care and strain budgets for patients and providers alike.

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My view: Now is the time to invest in NIH

As the senior vice president of the University of Utah Health Sciences (UUHS), I have the privilege of working with some of the top researchers in the country who have devoted their lives to making discoveries that will change others’ lives for the better. With funding from the National Institutes of Health (NIH), the nation’s primary medical research agency, leading scientists in the United States and our own state of Utah are closing in on discoveries that would save and improve countless lives. A snapshot of discoveries made by researchers at UUHS — including genetic causes for breast, ovarian and colon cancers and preventive and novel treatments for each — speaks volumes about the importance of federal funding for NIH.

This summer, University of Utah researchers identified a previously unknown but crucial component in the process of platelet generation, a discovery that could help ease serious side effects of treatment for multiple myeloma patients. At the same time, the NIH funded University of Utah Molecular Medicine and conducted studies to learn how metabolic stress, inflammation, bleeding and clotting contribute to diseases like diabetes and obesity. Findings like these are revolutionary because they translate into lives saved, enhanced and even lengthened. We are on the right track, but without proper funding for the NIH, our progress could be derailed.

Little attention has been given to the fact that NIH receives nearly 25 percent less in funding than it did in 2003, when adjusted for inflation. The immediate impact of this funding gap is the loss of funding for hundreds of promising proposals for research on cancer, Alzheimer’s and other diseases. Stagnant funding translates into stalled research, something neither Utah nor the rest of the country can afford. And as a leading academic research institution, this can translate to fewer researchers entering the profession. The U.S. has long been the global leader in medical research, but other countries are catching up quickly. If current trends continue, China will outspend the U.S. on medical research by the year 2022.

Utah’s leading research institutions and biotech companies received more than $159 million in research funding from NIH in 2013 alone, and the return on this investment has been significant and measurable. This federal investment not only furthers our scientific endeavors, but it also bolsters our economy. Utah is home to 911 bioscience businesses, and our residents held 23,406 bioscience industry jobs in 2010. From 2010-2013, University of Utah innovation has led to the formation of 75 start-up companies. The University has also issued 265 patents and executed 307 licensing agreements during those years. Without continued investment in NIH, future statistics will not be so bright.

Our lawmakers are at a crossroads when it comes to investing in the health of our country. We are on the cusp of major breakthroughs for diseases that have reached epidemic proportions in the U.S. – cancer, diabetes, heart disease, obesity and Alzheimer’s. If we do not make the investment now in finding cures and treatments, we will pay later. Consider that Alzheimer’s currently costs the U.S. $200 billion a year. Without a breakthrough treatment or cure, that cost will reach $1 trillion by the year 2050. This is a price our country cannot afford.

Now is the time to make up for the past decade of stagnant funding for NIH. As the old adage goes, “You do not have anything if you do not have your health.” Without a healthy funding investment for NIH, nothing else matters.

-Vivian S. Lee, MD, Ph.D, MBA is the senior vice president, University of Utah Health Sciences, CEO, University of Utah Health Care, and Dean, University of Utah School of Medicine.

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Recruit, Reward Clinician–Innovators in Academic Medicine

This post is the first in a series arising from our new partnership with Healthcare: The Journal of Delivery Science Innovation. Learn more about the partnership here.

By Jennifer J. Salopek

???????????????????In their article in the March 2014 issue of Healthcare: The Journal of Care Delivery Innovation, coauthors Andrey Ostrovsky, MD, and Michael Barnett, MD, write that most academic medical centers “have yet to display a commitment to delivery innovation on par with their commitment to basic research,” and that conditions common to AMCs inhibit innovation. In a telephone interview, Ostrovsky invokes the metaphor of the sandbox to expand on these ideas.

“The culture of academic marries fee-for-service with dependence on grant funding, which reinforces high-volume care delivery. Academic medical centers could be sandboxes but are completely underutilized as such. It would be powerful to fuse AMCs with the innovative sandbox principles of startups,” he says.

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Wing of Zock Partners with New Journal to Expand Innovation Coverage

Health Care Journal???????????????????Wing of Zock is joining up with Healthcare: The Journal of Delivery Science and Innovation! Through our exclusive online content partnership, Wing of Zock will highlight the people and passions behind the ideas that make their way into the journal’s pages. It’s great synergy: Healthcare is the only journal that focuses on cutting-edge innovation in care delivery. Wing of Zock is the only blog that focuses on innovation in academic medicine. “With its focus on academic medical center innovation, we are thrilled to work with Wing of Zock to extend the reach of cutting-edge research and thought leadership,” said Sachin Jain, MD, one of the Journal’s founding editors.

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VCU Student-Led Hot Spotting Team Chosen for Interprofessional Collaborative

By Sarah L. Sonies

Patients who frequent emergency rooms, earning miles as hospital “frequent fliers,” have left care teams looking to better understand the social determinants that cause their frequent hospital admissions.

A five-student team from Virginia Commonwealth University (VCU) is one of ten across the nation chosen for a six-month learning collaborative to explore the root causes of repeat visits to the hospital and high health care costs. As part of the learning collaborative, these students will identify super-utilizers, known as “hot spotting,” and work with them to decrease utilization and costs.

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Of Measures and Men

By Ulfat Shaikh, MD

News about the Veterans Affairs (VA) scandal this summer coincided with my being in the midst of reading Daniel Pink’s ‘Drive: The Surprising Truth About What Motivates Us’. Pink’s chapter on unethical behavior seemed uncannily relevant as it described how a carrot-and-stick approach to motivation can encourage cheating, shortcuts and unethical behavior.

The VA reported that patient wait-time data had been falsified in two-thirds of its health care facilities. Organizational leadership failure, an unfocused performance measurement system, a toxic milieu, and unrealistically high goals, that placed undue pressure on staff and promoted unethical practices were cited as key causes.

Several unintended consequences of the VA performance measurement system, mostly related to local implementation methods, were also described back in 2012 by Powell and colleagues.

Performance measurement faces even greater challenges in my own specialty, pediatrics. Pediatric measures tend to be predominantly process measures with sometimes less clear correlations with long-term clinical outcomes and population health. The evidence base for pediatric measures is even less mature than for adult measures, no pun intended.

Performance metrics are essential in tracking outcomes. You can only manage what you measure. And in health care, where demands on scarce resources are increasingly, quality measures are an indisputable way of figuring out which processes need to stay and which can go. Problems begin when performance measures cease to become a means to an end, and become an end unto themselves.

A Robert Wood Johnson Foundation-Urban Institute report advises strategic and parsimonious use of quality measures, recognizing when performance measures are not clinically valid or useful, and recognizing that performance measurement is just one aspect of a learning health care system.

My involvement these days with Central Line-Associated Bloodstream Infection (CLABSI) prevention is demonstrating to me even more strongly the importance of organizational context such as local culture, leadership styles, clinician engagement, and intrinsic motivation in applying quality measures. On hindsight, the training videoon CLABSI measures that my team just finished working on probably needed to include a footnote on the perils and pitfalls of performance measurement. And that CLABSI is in essence a social problem that demands a focus not just on tracking infection rates, but on human behavior within complex and intense environments.

Front line clinicians need to remain accountable for their actions. However, leadership and an organizational culture that enforces rigid top-down measures without attention to providing resources and investing in developing people promotes the systemic infusion of unethical behavior and short cuts.

Measuring Improvement in Health Care from Ulfat Shaikh on Vimeo.
Shaikh-Ulfat Shaikh, MD, MPH, MS is director of health care quality at the University of California Davis School of Medicine. She blogs about health care quality improvement at Pulse.

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