By Lisa Brown
Brian Jack redesigned hospital discharge procedures
The problem first came to Brian Jack’s attention 10 years ago. The School of Medicine professor and chair of family medicine noticed that patients at Boston Medical Center (BMC), like patients at most hospitals, were leaving without a good understanding of how to care for themselves in the short term. Jack started to track the amount of time that nurses and doctors spent with patients before sending them home. The average was five minutes.
“Patients in the hospital are not at the top of their cognitive game,” says Jack, explaining that sick, feverish, or sleep-deprived people are unlikely to comprehend first-time instructions about prescriptions or at-home care procedures.
Jack and his team found that nearly a third of patients experienced a medical setback after going home, and that one in five returned to the hospital within 30 days. That’s when the team started brainstorming solutions and identified 11 areas that must be covered during each discharge—steps like making appointments for follow-up care, identifying and creating a plan for prescriptions, and educating patients about their diagnoses. That list formed the foundation of Project RED (Reengineered Discharge), a practice that has been shown to lower the rate of returns to the hospital in the month after discharge by 30 percent.
It also led, this fall, to Jack earning the Peter F. Drucker Award for Nonprofit Innovation, a respected prize that has been given annually since 1991 to recognize existing programs that meet famous business guru Drucker’s definition of innovation—“change that creates a new dimension of performance.”
This year, 864 nonprofits applied for the award. Boston Medical Center officials nominated Jack’s Project RED, and it won the top prize of $100,000, which he will accept on behalf of BMC at in a November ceremony in Vienna, Austria.
“Project RED is an example of the innovative work we do here to provide safe, effective care to the whole patient,” says Kate Walsh, BMC president and CEO. “I am extremely proud of Dr. Jack, and the Project RED team, and pleased to see them honored with the Drucker Award for this creative approach to decreasing hospital readmissions.”
These days, before leaving BMC, patients are given a personalized package of information, with details about prescriptions and follow-up appointments, exams, or stress tests color-coded on a calendar. The plan, Jack says, reads like a comic book, with big font sizes, multiple colors, and plenty of icons.
Initially, nurses were responsible for going over each part of the plan with patients, but after they found it was too time-consuming, Jack and Timothy Bickmore, a Northeastern University associate professor of computer and information science, designed a computer program with a virtual patient advocate named Louise, who methodically explains the plan to patients at the end of their hospital stay.
Critics might scoff at Louise’s unpolished animation, but, Jack says, the point isn’t to entertain. “Every time she talks to a patient, it’s about their unique tailored information,” he says. “Louise is still four to five years ahead of her time. That really is the future of health care.”
And that future may have lower system-wide costs. A randomized trial performed in 2009 with 749 patients found a 30 percent lower rate of hospital use in the Project RED intervention group compared to those receiving the usual care one month after a patient’s discharge. One readmission or ER visit was prevented for every seven RED participants. According to Jack’s estimates, if readmission rates can be lowered from the current 20 percent to 15 percent over five years, that would save Medicare $17 billion and the private sector another $17 billion.
Project RED developed “at the right place, at the right time” in terms of federal public policy, Jack says. President Barack Obama’s Affordable Care Act, signed into law in 2010, emphasizes efficiency, reducing hospital readmission rates, and increasing the quality of care and patient safety. Federal agencies are now pushing Project RED as an example among the top 10 best practices for reducing cost while maintaining quality, and Jack estimates that at least 500 hospitals have adopted his team’s new discharge procedure so far.
“Many health care institutions are now studying and implementing Dr. Jack’s Project RED strategies,” says Karen Antman, MED dean and Medical Campus provost. “Clearly, reengineering discharge planning to keep patients safe is key to their recovery and to prevent unneeded readmissions.”
While Jack relishes the national attention and awards Project RED has received, he has other things on his mind—like learning how to waltz and finding something to wear to a formal ball in Vienna.
This BU Today story was written by Leslie Friday.
BU’s NEIDL moves closer to full operation
In an action that moves BU’s National Emerging Infectious Diseases Laboratories (NEIDL) closer to full operation, a federal court judge has ruled that a Final Supplementary Risk Assessment prepared by the National Institutes of Health (NIH) adequately analyzes the risks associated with research involving pathogens at BioSafety Level 3 (BSL-3) and BioSafety Level 4 (BSL-4) and that such research can be done safely at the BU Medical Campus site.
That risk assessment, which examined a series of scenarios and potential consequences of procedural failures, including containment system failures and malevolent acts, had been challenged in court by a number of Boston residents and the Conservation Law Foundation. The groups claimed that the risk assessment prepared by the NIH was not adequate and that the NIH decision to approve it was arbitrary and capricious.
In a 76-page opinion, US District Court Chief Judge Patti Saris found that “the NIH provides sufficient scientific support for its ultimate conclusions that the risks to the public are extremely low to not reasonably foreseeable, and the differences between the Boston location and the suburban and rural sites are not significant. In light of the benefits of placing the biolab in an urban area like Boston, which provides opportunity for expert medical research collaboration, and the low risk of harm to the public, NIH’s decision is rational.”
John R. Murphy, NEIDL director ad interim and a School of Medicine professor of medicine and microbiology, says he is pleased that the federal court “went through each and every objection of the plaintiffs in a methodical way and found that they were not warranted.”
“The court is saying that it’s reasonable for the NIH to determine that research using these types of pathogens can be done safely at the NEIDL,” says Murphy. “This is one more step to the opening of the lab.”
Murphy says that one additional judicial hurdle, a similar lawsuit filed in state court, will be heard later this year.
The University has also asked the Boston Public Health Commission for required permits to operate the facility as a BSL-3, and will soon submit documents required for permission to operate as a BSL-4 lab.
Once the lab is open, all research will be subject to at least three systems of supervisions and safeguards. Those include approvals from the Centers for Disease Control, the Institutional Biosafety Committee, and the Boston Public Health Commission.
Construction of the $200 million NEIDL facility was completed in September 2008, but controversy and litigation have kept much of the building’s 192,000 square feet of laboratory space closed. In March, BU researchers moved into the NEIDL, at 620 Albany St., to work on tuberculosis research that has been approved for Biosafety Level 2 (BSL-2) laboratories.
This BU Today story was written by Art Jahnke. He can be reached at email@example.com.
For the tenth year, Boston University Henry M. Goldman School of Dental Medicine (GSDM) volunteers participated in Boston’s Annual Countdown to Kindergarten Citywide Kindergarten Celebration. This year, the celebration took place at the Boston Children’s Museum.
Countdown to Kindergarten Boston is a non-profit collaborative that offers resources and events throughout the year to celebrate and support the transition into kindergarten, a significant educational and developmental milestone for children and their families. The Citywide Celebration is part of Countdown’s Step 2 “Get Ready for School.”
At the event, enthusiastic children and families toured the museum exhibits, climbed aboard real school buses, had last minute school questions answered, received information about health and community resources, and had the opportunity to meet Mayor Thomas Menino and Superintendent of Boston Schools Dr. Carol R. Johnson.
The 29 GSDM volunteers promoted oral health to the children and families, provided dental screenings, and offered hands-on interactive activities. The School’s participation was organized by GSDM chapter members of the American Student Dental Association (ASDA) in collaboration with Community Health Programs. Neelam Shah DMD 14 and Ingy Alhelawe DMD 15, the community outreach co-chairs for ASDA, contributed significantly to organizing GSDM’s participation in the event. Oral Health Promotion Director Kathy Lituri, Director of School-based Programs Dr. Corinna Culler, and Clinical Instructors Ana Keohane and Martin Ugarte-Chavez worked alongside the students.
Kathy Lituri said, “This is by far one of my favorite events. It provides such a great opportunity to interact with young children and their caregivers at a very important juncture in their lives, when they are ready to start school!” She continued, “It’s a perfect time to emphasize the importance of a healthy mouth and how a healthy mouth is so vital to a child’s ability to learn and grow. It is also a favorite event among many GSDM students and often inspires them to consider a post-graduate program in pediatric dentistry.”
Neelam Shah said, “This is my third year attending Countdown to Kindergarten and it’s such a great event! We were able to screen over 120 soon-to-be kindergarteners and their siblings. We love coming back every year to teach them and their parents about maintaining good oral hygiene and making cute tooth necklaces with them.”
Said Ingy Alhelawe, “Countdown to Kindergarten is so much fun. I loved seeing all the kids eager to get their teeth checked. Who knew a sticker can make a child so happy? It’s a great way to teach the children proper dental home care and emphasize the importance of taking care of their teeth. I’m looking forward to next year’s event as well.”
James Lee DMD 14 was there for the sixth year in a row representing BU, having begun as a pre-dental undergraduate, attending then as a Graduate Medical Sciences student, and finally as a GSDM student. Kathy Lituri reports that James’ help and expertise is critical.
Lee said, “Countdown to Kindergarten continues to be my favorite outreach event because it provides an opportunity to serve the larger Boston community outside our treatment center through oral health promotion to pre-kindergarten children and their families.”
The decay-fighting hero Captain Cavity Fighter, played by Andrea Lam DMD 16, made a repeat showing at the event. Making her first public appearance alongside Captain Cavity Fighter was Lieutenant Fluoride, played by Shelly Curtis DMD 16. The duo greeted children with smiles and dental health promoting stickers and also posed for pictures with them.
Thank you to the student volunteers: Ingy Alhelawe DMD 15, Eman Alsagob DPH 16, Ahmed A Alsulaiman DPH 16, Ella Botchevar DMD 14, Julian Camastra DMD 15, Shelby Curtis DMD 16, Zeilig David DMD 14, Ingrao Destinee DMD 15, Jessica Finkielszstein DMD 16, Sammy Gill DMD 14, Marina Gonchar DMD 14, Dr. Rohit Gupte (GSDM post-doc research fellow 2010–13), Delphine Jeong DMD 15, Camestra Julien DMD 15, Courtney Knapik DMD 16, Andrea Lam DMD 16, Dave Lane DMD 16, Lana Le DMD 16, James Lee DMD 14, Brian Leibtog DMD 15, Linda Linsinbigler DMD 15, Matt Mara DMD 16, Mike Mayr DMD 16, Neelam Shah DMD 14, and Kali Stewart DMD 15.
Dean Jeffrey W. Hutter said, “The Annual Countdown to Kindergarten Citywide Kindergarten Celebration is an important event for Boston families and, as such, is also important to the Henry M. Goldman School of Dental Medicine. I am extremely proud of the School’s continuing participation in this citywide event.” He continued, “Thank you to the coordinators and numerous volunteers, including Kathy Lituri and American Student Dental Association members who once again made our participation a success.”
Submitted by GSDM Communications.
Michael J. Fox Foundation sponsored study seeks people without Parkinson’s disease to participate in landmark biomarker study
Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) announced that they will participate as one of 23 clinical sites of the Parkinson’s Progression Markers Initiative’s new arm to study populations who may be at increased risk for developing Parkinson’s disease (PD). The additional arm of the $55 million landmark observational clinical study was added to better understand potential risk factors of the disease. People who volunteer will not have any of the classic motor problems associated with PD. The “pre-motor” arm of PPMI will enroll participants over the age of sixty, who do not have Parkinson’s disease and are living with either a reduced sense of smell, rapid eye movement sleep behavior disorder (RBD) or a mutation in the LRRK2 gene (the single greatest genetic contributor to PD known to date). If one of these risk factors clearly leads to PD, the risk factors could enable earlier detection of PD and open new avenues in the quest for therapies that could slow or stop disease progression.
The initial study was launched in 2010 and is focusing on defining biological markers of PD in order to better diagnose and track PD. Enrollment in the initial study is complete with over six hundred participants. BUSM and BMC have been part of PPMI for three years and are expected to begin enrollment for the new, pre-motor arm of the study immediately.
“Understanding risk factors for Parkinson’s disease could help to identify therapies that may prevent the onset of motor symptoms in future generations of PD patients,” said Samuel Frank, MD, principal investigator. “We are proud to participate in this innovative research and will look to the local community to continue to volunteer for this key study.”
People can easily get involved in this research by being one of 10,000 individuals needed to complete a brief online survey about their sense of smell. People over the age of 60 who do not have Parkinson’s disease are needed to take the survey at https://www.michaeljfox.org/get-involved/smellsurvey-screen.php. Most respondents will be sent a scratch-and-sniff smell test and brief questionnaire in the mail to be completed at home. Some individuals may also be asked to undergo more extensive testing.
“In the third year of PPMI, it is evident that a large-scale biomarker study is not only possible in Parkinson’s disease, but is already yielding scientific insights that could help transform the field of Parkinson’s research,” said Todd Sherer, PhD, CEO of The Michael J. Fox Foundation for Parkinson’s Research. “None of this progress would be possible without the willing volunteers who donate their time and energy to the pursuit of a cure.”
To learn more about this study, visit the website www.ppmi-info.org or call 617-638-7745.
BUMC IT and Information Security is sponsoring several events on the BU Medical Campus Oct. 9 and 11, so mark your calendar. This coincides with Information Security Awareness Week!
Take this opportunity to get sensitive papers out of your office or home and get them properly destroyed. A shredding truck will be on the BU Medical Campus located between BUSM and BUSPH, adjacent to Talbot Green, Oct. 9, 11 a.m.-1 p.m. BUMC IT and Information Security personnel will be available to accept custody of your sensitive paper documents and ensure they are immediately shredded. CDs or old floppy disks will also be accepted and destroyed.
Hard Drive and Computer Disposal
Personnel will also be available to answer questions about computer and IT security, and will accept old computers and hard drives at a table near the Shredding truck on Wednesday, Oct. 9 and in the BUSM lobby Friday, Oct. 11, 11 a.m.-1 p.m.
If you have questions or need more information about this event contact the BUMC IT service desk at 617 638-5914 or email firstname.lastname@example.org
A piano was delivered to the Talbot Green on the BU Medical Campus today as part of “Play Me, I’m Yours,” Street Pianos Boston Festival 2013. Students & faculty are invited to play the multicolored instrument. Tweet your photos to @BUMedicine and use hashtag #streetpianosboston.
The BUMC community is invited to a dedication and reception to celebrate recently restored historical pieces at the School of Medicine and Medical Campus. Recent improvements include the newly created picnic area on Talbot Green, a display of BUSM artifacts and artwork on the first floor of the Instructional Building, and the refurbished marble fountain in front of the School of Medicine.
“We are pleased to recognize the philanthropic support of BUSM faculty, staff, alumni and friends whose generous contributions made these restorations possible,” said BUSM Assistant Dean for Development Lawrence Crimmins. There will be a brief program followed by a reception with light food and beverages.
This event will be held Tuesday, Sept. 24, 4-5 p.m., in the BUSM Instructional Building, Conference Room L-107. RSVP to email@example.com or (617) 638-4570.
Chronic Care Management Program Does Not Result in Increased Abstinence From Alcohol and Other Drug Dependence According to BUSM’s Saitz
Persons with alcohol and other drug dependence who received chronic care management including relapse prevention counseling and medical, addiction and psychiatric treatment were no more abstinent than those who received usual primary care, according to a study in the September 18 issue of JAMA.
Chronic care management (CCM) is a way of delivering care that has been shown to be effective for chronic medical and mental health conditions. “Chronic care management is multidisciplinary patient-centered proactive care, a way to organize services that provides coordination and expertise, and has been effective for depression, medical illnesses, and tobacco dependence (a substance use disorder),” the authors write. Trials of integrated medical and addiction care suggest that CCM may be effective for treating addiction, particularly since care elements long known to be effective for addiction overlap with CCM approaches.
Richard Saitz, MD, MPH, of Boston University Schools of Medicine and Public Health and Boston Medical Center, and colleagues conducted a study to examine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care. Participants (n = 563) were recruited between September 2006 to September 2008 from a freestanding residential detoxification unit, and from referrals to an urban teaching hospital and from advertisements; 95 percent completed 12-month follow-up. Participants were randomized to receive CCM (n=282) or no CCM (n=281).
The chronic care management group received longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (to specialty addiction treatment mutual help). The primary care group received a timely appointment and a list of addiction treatment resources including a telephone number to arrange counseling.
The researchers found no difference in abstinence from stimulants, opioids, and heavy drinking between the CCM intervention and control group (44 percent vs. 42 percent, respectively, at 12 months). In a subgroup of patients with alcohol dependence, there were fewer alcohol problems among those who received the intervention.
The authors did not detect differences in secondary outcomes of addiction severity, health-related quality of life, or drug problems.
The authors write that current health care reforms in the United States include a focus on CCM in patient-centered medical homes to reduce chronic disease burden and to reduce costs (both of which are among the highest for those with addiction), in part because numerous studies have found such benefits for medical and mental health conditions. “Even though CCM is effective for a number of chronic conditions, it may be premature to assume that CCM will be the solution to improve the quality of care for and reduce costs of patients with addiction,” the authors write. Further research is warranted to determine whether more intensive or longer-duration CCM, or CCM designed differently, might do so.”
sustainability@BU is holding a festival on Wednesday, Sept. 18, 11 a.m.-2 p.m. on Talbot Green for BUMC students, faculty and staff. Receive a free travel mug in exchange for pledging to participate in BU’s sustainability effort Join the Challenge, a campus-wide campaign in which school and college teams compete for points by performing one sustainable action each month.
Learn about other sustainable products and environmentally friendly service providers including Office Depot’s Greener Office, and TranSComm, the hub for alternative transportation information for Medical Campus commuters.
“We want to educate the BUMC community about the sustainability opportunities available,” says University sustainability director Dennis Carlberg. “People are thinking about what they can do to get involved, and this is a chance to do it, hopefully on a beautiful day.”
The Accreditation Review Commission on Education for the Physician Assistant Inc., had approved the BU School of Medicine Physician Assistant Program for provisional accreditation. Provisional accreditation is granted to programs that have not yet enrolled students but have demonstrated preparedness to initiate a program in accordance with accreditation Standards.
The Physician Assistant profession, which began in 1965 at Duke University, was developed to address the primary care shortage in rural and underserved areas. Physician assistants practice medicine with physician supervision. The profession now includes medical providers in a variety of health-care delivery settings and in virtually all medical and surgical specialties. According to the US Bureau of Labor Statistics, it is among the fastest growing profession with an expected increase in PA positions of 30% during this decade. There are nearly 84,000 physician assistants practicing in the United States and the average salary is 92,460.
Capitalizing on these statistics the Boston University School of Medicine Physician Assistant Program will educate physician assistants in a novel interprofessional education and practice model. In this first year up to 28 highly qualified candidates will be admitted to the program; in the following years it will comprise a class of 36 students. The 28-month (seven semesters) program, housed in the BUSM Division of Graduate Medical Sciences, includes 12 months of traditional lectures and seminar sessions in medical sciences and pathophysiology, while the second 16 months provides clinical education in hospitals and clinics, and two months dedicated to the thesis proposal. Graduates will receive a Master of Science degree.
The application deadline is Oct. 1, 2013. Applications to the program are submitted through the Centralized Application Service for Physician Assistants.
For more information, visit the PA program website.