April 2014 Newsletter

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Department of Medicine eNewsletter
April 2014
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
Leadership Council
April 2014

Richard Walsh


B. Arafah

K. Armitage

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

S. Gravenstein

D. Hricik

M. Jain

N. Meropol

R. Salata

R. Schilz

R. Walsh


Recorded by:
A. Staruch
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department interview
Rajesh Chandra, MD, Division Chief of General Internal Medicine and Geriatrics, projects the future of hospitalist medicine, offers his perspective on public reporting and discusses the division's approaches to ensuring seamless communication and cost-effective health care.



In your opinion, how will the position of a hospitalist change over the next few years?


Hospital medicine is still a very young field; it originated in 1995, and has traditionally been focused on acute inpatient care. Early on it witnessed some pushback from primary care physicians due to the lack of continuity of care and communication issues. However, over the course of the past 20 years, the specialty has matured and physicians have been able to get around that obstacle.


The future of hospital medicine lies in providing a new continuum of care. A lot of hospitalists feel that patients who have had complicated hospital stays need relatively quick follow-ups, perhaps within a week of discharge. The reality is that patients may not be seen by their primary care physicians for several weeks. To partly address this issue, some hospitalist programs around the country have set up post-discharge clinics to follow up on high-risk discharges. In order to deliver great care, hospitalists have to understand that care transitions are as important as the care they provide during a patient's stay. We have to get out of the mindset that we are just acute care physicians providing episodic care in the hospital. Once we provide this continuity model, we will realize that, in essence, we are offering better care to our patients.


How is the Division of General Internal Medicine positioning itself to answer this growing demand?


The academic model of health care has a reasonably robust system that bridges the communication gap between a primary care physician and a hospitalist. One of the biggest initiatives we have implemented is the EMR discharge summary. We are training our residents to get the summary done on the day of a patient's discharge; this gives a primary care provider who works within the system the ability to view it right away. Primary care physicians who are not part of the system receive discharge summaries via fax. This new automated system is a much-awaited change that allows patient information to be transferred in a timely and seamless fashion.


In addition, we are concentrating on enhancing the patient care experience: we want to develop a model of care that involves personal engagement and generates a sense amongst patients that they are genuinely being taken care of. Right now when we round, we see a patient for five to ten minutes and though this traditional "batch rounding" model saves time, it is not always effective in providing quality health care. By spending more time at bedside, sitting down and engaging patients, explaining their illnesses through pictures, drawings or even showing them their X-rays, we will build trusting relationships with our patients. Ensuring that critical and time-sensitive tasks are carried out right away (for example, calling consults right away instead of doing so by the end of rounds) also helps improve our efficiency and overall care of patients.


Finally, we are working on improving cost control. Patients can get 100-150 lab tests done over two to three days of stay in the hospital with the majority of tests being nonessential for their diagnosis and health care. We need to break away from old habits of reflex testing and show patients we are truly vested in providing cost-effective care to them.


What can we do in internal medicine residency training to help further embrace this new culture?

I believe public reporting will greatly impact physicians' behavior. Every trainee has to understand that the quality of their work and the cost of their care will now be publicly reported. If an individual is looking for a primary care physician, he or she will choose a high value physician who is not only good at medicine but is also economical. Trainees have to realize that in the new era of medicine, they will be under public scrutiny the moment they step into practice. So as part of their residency training, a lot of it will have to be about changing their attitudes toward clinical learning. It is no longer about the science behind health care, but also about delivering health care effectively.


With most trainees still applying for other medical specialty fellowships, what is the future of hospital medicine as a professional career choice? Do you believe this trend will change any time soon?


The need for hospitalists as part of our country's physician workforce is still quite strong and will only continue to grow. Hospital medicine is the fastest growing specialty in the history of American health care. Currently there are 40,000 hospitalists in the U.S. and estimates suggest that in order to meet our inpatient care needs, we require about 50,000 hospitalists. To serve as a hospitalist, you need to be trained in internal medicine, and with most residency training occurring in the inpatient setting, most graduating residents are technically ready to do hospital medicine (though some hospitalist thought leaders don't necessarily believe that). Data shows that on average around 7 percent of graduating residents become hospitalists. The problem is that a significant portion of that 7 percent temporarily stays in the field, eventually moving on to other specialty careers.


At the national level, the Society of Hospital Medicine through its Physician in Training Committee has been specifically working on strategies to project hospital medicine as an attractive and viable career choice. I serve on that committee and we are currently targeting residents, medical students and even high school students to increase awareness about hospital medicine and cultivate career interest in this specialty. By showing multiple career paths a hospitalist can take, including physician administration, clinical research, medical education, quality and patient safety, and health policy, I think hospital medicine can be a satisfying career choice for many.


How do you feel the residents' clinic will evolve as a training site, particularly with regard to developing the new generation of primary care providers over the next few years?


At the residents clinic (DMC), we are currently conducting a pilot for a patient-centered medical home. In this setting, residents work with medical assistants in a team based model to ensure the continuity of health care for patients in the ambulatory setting. This model delivers higher satisfaction among providers and patients as well as better clinical outcomes when compared to a traditional clinic.


Currently our residents mostly train in the inpatient setting, and it's challenging to get them interested in primary care. Our hope is that by developing a more coordinated and efficient ambulatory care site in the form of a medical home, we may be able to generate more interest in this field. But that is not the only challenge. Some trainees, who originally may even have some interest in the specialty, lose it because there is just not enough financial incentive to pursue a career in this field. Until there is a change in the philosophy of compensating procedural specialties at a higher level compared to specialties such as primary care, we should not expect any major change in the number of trainees pursuing primary care careers. This also means that the burden we face as a society in providing primary care to our patients will only continue to grow. The value of primary care, chronic disease management and coordination of care has to be appreciated and compensated appropriately. I think when that happens, we may be able to revitalize the primary care workforce in the U.S.

The department news report
Richard Walsh, MD, was presented with the Distinguished Medical Alumnus Award from the University of North Carolina at Chapel Hill. This honor is bestowed upon those alumni who have significantly enhanced the reputation and prestige of the School of Medicine through their lifelong careers of service and accomplishment. This award celebrates Dr. Walsh's exceptional achievements as a clinician, scholar, educator, investigator and leader in cardiovascular disease research.




Division of Cardiovascular Medicine

Daniel Simon, MD,
and his team have paved the way for future treatments targeting the so-called heart attack gene, myeloid related protein-14 (MRP-14). In their recent article published in the Journal of Clinical Investigation and entitled "Platelet-Derived S100 Family Member Myeloid-Related Protein-14 Regulates Thrombosis" the researchers argue that MRP-14 generates dangerous clots that could trigger heart attack or stroke. The recent finding suggests the possibility of developing safer anti-thrombotic agents.

Albert Waldo, MD, received an honorary PhD from the University of Puerto Rico School of Medicine.









Schedule a clinical appointment with Cardiovascular Medicine physicians





Division of Gastroenterology & Liver Disease

Fabio Cominelli, MD Fabio Cominelli, MD, PhD,
was appointed Chair of the Gastrointestinal Mucosal Pathobiology Study Section 2014-2016.

In addition, under the mentorship of Dr. Cominelli, medical student Ashley Trotter received the 2014 American Gastroenterological Association Student Abstract Prize. The award will be presented during Digestive Disease Week in Chicago, Illinois.




Linda Cummings, MD, received one of three 2014 American College of Gastroenterology Junior Faculty Development grants. The $225,000 grant is awarded for

Dr. Cummings' project entitled "Medication and Perioperative Effects on Esophageal Cancer Outcomes."







Under the mentorship of Jeffry Katz, MD, gastroenterology fellow Prachi Biyani, MD, was awarded a $10,000 clinical pilot grant from the American College of Gastroenterology to research the effects of fecal transplantation in patient with pouchitis following surgery for ulcerative colitis.






Schedule a clinical appointment with Gastroenterology & Liver Disease physicians





Division of Hematology & Oncology


Afshin Dowlati, MD, received a CTSC Core Utilization Pilot Program award for his proposal entitled "Construction of a Small-Cell Lung Cancer Tissue Microarray." This award will lay the groundwork for identification of new biomarkers and therapeutic targets in this deadly disease.






Jennifer Eads, MD,
received Career Development award from the Case Gastrointestinal Cancer Specialized Program of Research Excellence (GI SPORE). Dr. Eads will be working on the project entitled "DNA Repair as Therapeutic Targets in GI Cancers."
Stephen Fink, MD, also received Career Development award from the Case Gastrointestinal Cancer Specialized Program of Research Excellence (GI SPORE). Dr. Fink will pursue his studies on the project entitled "CCSP1 as a Colon Cancer Prognostic Marker and Therapeutic Target."


Hillard Lazarus, MD
, was appointed Editor-in-Chief of Bone Marrow Transplantation Journal. This position recognizes Dr. Lazarus' scientific contributions as well as outstanding expertise in medical communication.







Schedule a clinical appointment with Hematology & Oncology physicians





Division of Infectious Diseases & HIV Medicine


Case Western Reserve University, in collaboration with Clinical Research Management, a full-service clinical research organization, attained one of five highly competitive awards from the U.S. Department of Health and Human Services and the Biomedical Advanced Research and Development Authority (BARDA) to design and conduct clinical research studies needed to develop medical countermeasures - drugs, vaccines and diagnostic tests - that help protect health against bioterrorism, pandemic influenza and other public health emergencies. Robert Salata, MD, will serve as the university PI for this $110 million grant. The activities of the seven-year project are closely tied to the National Institutes of Health (NIH).


Schedule a clinical appointment with Infectious Diseases & HIV Medicine physicians




Division of Nephrology & Hypertension

The Division of Nephrology & Hypertension and University Hospitals Transplant Institute received renewed funding for the next phase of NIAID's Clinical Trials in Organ Transplantation. The new grant will provide funding for seven years with direct costs of approximately $1.5 million directed to University Hospitals Case Medical Center. Donald Hricik, MD, will serve as local PI and Clinical Protocol Chair for the consortium that includes nine transplant centers in the United States and Canada; Joshua Augustine, MD, will serve as the local sub-PI. The funded study will explore the effects of anti-TNF on innate and alloimmunity in kidney transplant recipients at high risk for delayed graft function and rejection. The renewed grant marks 17 consecutive years of NIH funding for the CTOT initiative at University Hospitals Case Medical Center.

Schedule a clinical appointment with Nephrology & Hypertention physicians


department conferences & events

Bronson's Day

Date: Thursday, May 8

Time: 10:00 a.m. - 5:00 p.m.




Spring Dinner 2014

Spring Dinner celebrates the high level of education and training in the Department of Medicine. We will be honoring our graduating class of 2014 and presenting annual awards to fellows, post-docs and faculty for exemplary work.

Date: Thursday, May 22

Time: 6:00 - 9:30 p.m.

Location: Thwing Ballroom

RSVP Deadline: May 12

Click here to RSVP to the event


Click here to nominate recipients for the Department of Medicine Awards 2014



Grand Rounds

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

Where: Kulas Auditorium, Lakeside, 5th Floor


May 6

"Preservation of Beta-Cells in Type 2 Diabetes: Is It Possible?" by Faramarz Ismail-Beigi, MD

May 13

"Breast Cancer Screening" by Megan McNamara, MD

Panel Discussion by Donna Plecha, MD, Lyndsay Harris, MD


May 20

"Infectious Retinitis" by Carlos Subauste, MD


May 27

"Immune Surrogates of Cardiovascular Disease" by David Zidar, MD


May 29

"TBD" by Julie Gerberding, MD



Morbidity and Mortality Conferences

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

Where: Kulas Auditorium, Lakeside, 5th Floor


May 9
A 29-year-old male with neck pain is diagnosed with a rare and aggressive neoplasm.

May 23
A 33-year-old male with hypercalcemia and lymphadenopathy is diagnosed with granulomatous disorder.

May 30
A 61-year-old female presenting with fever, is prescribed zosyn and sustains significant hepatic injury.



Research Day 2014
The 5th Annual Research Day brought together fellows, residents, post-doctoral and medical students showcasing their latest research. The number of posters presented was the highest yet in the history of the event. The Department of Medicine is proud of the high caliber of research projects our trainees presented.

department leadership council minutes

Leadership Council
Dr. Walsh updated the council members on the Clinical Chair searches. Dr. Warren Selman has been asked to head the Search Committee for the Chair of Surgery and the Search Committee has been charged. A Search Committee for the Chair of Family Medicine will begin meeting in the near future.


Leadership Council

Dr. Walsh updated the council on the search for the position of Director of the Respiratory Health Institute and Division Chief of Pulmonary, Critical Care and Sleep Medicine. Three outstanding finalist candidates have been identified.


Leadership Council

Dr. Walsh distributed data on UHMG revenue including: MTD Charges, MTD Charge Budget, MTD Variance and Percentage of Charges by department for March 2014. Mr. Creighton distributed the data on UHMG revenue, by Department of Medicine divisions, for April 2014.


Leadership Council
Dr. Walsh reviewed information on the impact of UHPS HealthSpan.



Dr. Walsh gave an overview of the UH Personal Health Record/MyUHCare. This project is currently in the "Go Live" stage with patient record activation.



Leadership Council

Dr. Walsh announced the dates for the External Review of the Department of Medicine, June 16 - 18. He asked the council members to be available during these dates for any meetings requested through the Dean's office.



Leadership Council

Mr. Creighton presented an update on the Patient Health Record (PHR) activation process.



Leadership Council

Mr. Creighton distributed a document, "University Hospitals Department of Medicine and University Hospitals Customer Access Center, Guiding Principles for UHAccess Agreement". The agreement is to support timely, exceptional service for Department of Medicine patients and patients' families during their appointment scheduling and insurance verification interactions with both the department and with UH Customer Access Center personnel.


Leadership Council

Mr. Creighton reviewed the UHMG Statement of Operations for the Department of Medicine, and for each division, for the first quarter, January - March 2014.