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March 7, 2014

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Message from Paul Ramsey

Paul G. Ramsey

Seattle Business Magazine honors UW Medicine for healthcare leadership

Dear Colleagues:

This year’s Seattle Business Magazine’s Leaders in Health Care Awards announcement opens with the following statement:

“The 2014 Leaders in Health Care Awards offer evidence of the enormous impact of UW Medicine. The entity that owns or operates the University of Washington Medical Center, Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Neighborhood Clinics, UW Physicians, the UW School of Medicine and Airlift Northwest affects the lives of thousands of people every day.

It’s hardly surprising that 10 of the 25 honorees this year are affiliated in some way with UW Medicine.”

Johnese Spisso, UW Medicine chief health system officer and vice president for medical affairs, was named Outstanding Health Care Executive. She shares the award with Joyce Jackson, president and CEO of Northwest Kidney Centers. Among her many accomplishments, Johnese was cited for leading the transformation of UW Medicine into an accountable care organization, where care is integrated across the entire system to control costs and improve patient outcomes. Her work and dedication are superb—congratulations and thank you, Johnese!

Congratulations as well to Joyce Jackson. Among her many accomplishments, Joyce was instrumental in the creation of the Kidney Research Institute, a collaboration with UW Medicine. Joyce and the Northwest Kidney Foundation are vital partners to UW Medicine.

J. Randall Curtis, professor of medicine in the Division of Pulmonary & Critical Care Medicine and director of the UW Medicine Palliative Care Center of Excellence, received the Outstanding Health Care Practitioner Award. Randy’s dedication and advocacy for the seriously ill are widely known; we are fortunate to have him as a leader at UW Medicine.

Seattle Business Magazine's cover features Johnese Spisso.
Seattle Business Awards

William Catterall, professor and chair of the Department of Pharmacology, was named the winner for the category of Achievement in Medical Research. Bill’s accomplishments in achieving research advances are legendary. His landmark research has led to the development of drugs and treatments for arrhythmia, epilepsy and many other diseases.

Paul Yager, professor of bioengineering and former chair of that department, was the winner for Achievement in Medical Devices. Among Paul’s many contributions, his current work to develop a disposable paper that can help diagnose malaria or other pathogens from a blood sample was noted. Paul is an outstanding member of our community whose work has broad impact.

Fred Appelbaum, executive vice president and deputy director of FHCRC and executive director, president of the Seattle Cancer Care Alliance (SCCA) and professor of medicine in the Division of Medical Oncology, received the Lifetime Achievement Award. Fred’s contributions to the development of autologous bone marrow transplantation and treatments for leukemia are sufficient reason for this award. However, Fred has also been instrumental in developing and leading the SCCA.

Also honored with Silver Awards were Julie Gralow, professor of medicine in the Division of Medical Oncology and director of breast medical oncology at SCCA, for Individual Achievement in Community Outreach. Beti Thompson, of the School of Public Health and Center for Community Health Promotion at FHCRC, received the top award in that category. For Achievement in Community Outreach by an organization, the WWAMI Program received a Silver Award. For Outstanding Global Health Organization, the Department of Global Health received a Silver Award; the winner in that category was the Grand Challenges in Global Health program in the Bill & Melinda Gates Foundation.

Congratulations to all of the awardees of this year’s Leaders in Health Care Award! More information about the awards and recipients is available online.

It is a privilege to work with each of the individuals and programs recognized, as well as the thousands of other UW Medicine community members dedicated to our mission of improving the health of the public.


PGRamsey Signature2


Paul G. Ramsey, M.D.
CEO, UW Medicine
Executive Vice President for Medical Affairs and
Dean of the School of Medicine,
University of Washington



High-resolution CT scans can identify deadly lung disease

Ganesh Raghu

People who have suspected idiopathic pulmonary fibrosis (IPF) without typical patterns on high-resolution computed tomography (HRCT) scans could be spared the substantial risks of lung biopsy and be given a confident diagnosis of IPF based on clinical and radiological findings alone, according to new research published in The Lancet Respiratory Medicine.

“Surgical lung biopsy is associated with substantial risks and many patients are too elderly, sick, and/or have comorbid conditions to tolerate the invasive procedure,” explains lead researcher Ganesh Raghu, UW professor of medicine and laboratory medicine and director of the UW Center for Interstitial Lung Disease.

“A confident diagnosis of IPF is needed to ensure that patients are well informed of the poor prognosis associated with IPF, are treated with the most appropriate therapies, consider participation in clinical trials of new therapies, and to identify those most suitable for lung transplantation.”

Studies suggest IPF is becoming more common. In the United States, about 50,000 new cases are diagnosed each year and as many as 40,000 Americans die from IPF each year—the same number as die of breast cancer.

IPF causes progressive scarring of lung tissue, which eventually prevents the lungs from being able to supply the body with adequate oxygen. IPF has no cure and most people live only three to five years after diagnosis. Appropriate treatment is complicated by the fact that a definitive diagnosis often requires a lung biopsy.

HRCT scans of the lungs can identify the typical “honeycombing pattern” of lung scarring and damage to the air sacs known as usual interstitial pneumonia (UIP) in people with IPF. In a patient with progressive breathlessness who has no significant environmental exposures attributable to pulmonary fibrosis, or evidence of collagen vascular diseases, the UIP pattern on HRCT is characteristic of IPF. When patients suspected of having IPF do not have the definitive UIP pattern on HRCT images, international guidelines recommend a surgical lung biopsy to make a confident diagnosis of IPF.

In this retrospective study of 315 patients aged 40 years and older with little or no (5% or less) honeycombing on high resolution CT, 79 (94%) of 84 patients who had a high-resolution pattern of possible UIP diagnosed by an expert radiologist and pathologist had histopathological UIP confirmed after analysis of lung biopsy samples.

According to Raghu, “Our findings suggest that when a team of multidisciplinary experts in interstitial lung disease at a regional center (that includes a chest radiologist and a pulmonologist) work together to interpret possible UIP pattern on high-resolution CT in a patient suspected to have IPF, surgical lung biopsy might not be necessary to reach a diagnosis of IPF.”

Raghu concludes by cautioning, “Since the patients enrolled in our study were a highly selected cohort of patients suspected to have IPF and referred to regional sites for consideration of participation in a clinical trial, the findings from our study must not be extrapolated for all patients demonstrating the possible UIP pattern on HRCT images interpreted by general pulmonologists and radiologists in the community.”

Read the abstract of the paper in The Lancet.

Sleep duration can heighten risk for depression

Nathaniel Watson
Nathaniel Watson

A genetic study of adult twins and a community-based study of adolescents both report novel links between sleep duration and depression. The studies were published in the Feb. 1 issue in the journal Sleep, according to a news release from the American Academy of Sleep Medicine.

A University of Washington study of 1,788 adult twins is the first to demonstrate a gene by environment interaction between self-reported habitual sleep duration and depressive symptoms.

Results suggest that sleep durations outside the normal range increase the genetic risk for depressive symptoms. Among twins with a normal sleep duration of seven to 8.9 hours per night, the total heritability of depressive symptoms was 27 percent. However, the genetic influence on depressive symptoms increased to 53 percent among twins with a short sleep duration of five hours per night and 49 percent among those who reported sleeping 10 hours per night.

"We were surprised that the heritability of depressive symptoms in twins with very short sleep was nearly twice the heritability in twins sleeping normal amounts of time,” said principal investigator Nathaniel Watson, UW associate professor of neurology and co-director of the UW Medicine Sleep Center.

“Both short and excessively long sleep durations appear to activate genes related to depressive symptoms,” Watson added.

Optimizing sleep might help maximize the effectiveness of psychotherapy and other treatments for depression, he suggested.

Read more online.


Clinical Care 

UW Medicine entering into Accountable Care Organization contracts

David Dugdale

(The following message is from David (DC) Dugdale, medical director of Care Management and Population Health for UW Medicine.)

UW Medicine is currently entering into contracts to serve as an Accountable Care Organization (ACO) in 2015. An ACO is a collaboration by healthcare organizations (hospitals, clinics and health professionals) with health care payers in which financial and quality expectations are established to care for specific patient populations. ACOs have been created as a method of delivering healthcare to help the U.S. medical system accomplish the “Triple Aim” of healthcare reform to:

    •  Improve the experience of care for individual patients by maximizing quality
    •  Improve the health of the population served
    •  Reduce per capita costs of healthcare

In essence, this means that we are held “accountable” for the patient-friendliness of our care delivery, for the quality of the care, and for the cost and cost effectiveness of that care. An ACO-modeled arrangement defines groups of patients for which the healthcare organization is accountable. If the cost of patients’ care is reduced, the ACO can receive some of the savings, but only if specified quality measures are also achieved. Thus, these are commonly called “shared savings” programs.

ACOs are a natural successor to simpler “pay for performance” programs that began about 10 years ago but will require greater care transformation. Programs with similar objectives are already in existence, such as “total cost of care” contracts. Success with these contracts will be easier if we adopt ACO principles for all patients. It is important to emphasize that this “ACO work” will support our UW Medicine mission of improving the health of the public.

Eastside Specialty Center expands, changes venue

Eugene Yang
Eugene Yang

UW Medicine’s relocated and expanded Eastside Specialty Center, 3100 Northup Way in Bellevue, has undergone a transformation to improve patients' experience and to offer more services.

The new 33,000 square-foot facility, which opened Monday, Feb. 24, brings together more than 40 specialists, doubling the providers at the former location. Cardiology, gastroenterology, sports medicine, vascular surgery, occupational therapy and other services have been expanded; new areas of specialization include audiology, dermatology, endoscopy/colonoscopy, neurology, and urology, as well as allergy, ENT (ears, nose, and throat), and urgent care.

The new space includes an on-site pharmacy, infusion services and free parking.

“Our new location allows us to better serve Eastside families,” said Eugene Yang, UW clinical associate professor of medicine in the Division of Cardiology and medical director of the Center. “We want to give people access to the advanced care they would typically have to go into Seattle to find.”

Patients can access on-site MRI, ultra-low dose CT, and 4D (3D in real-time) ultrasound. A new, online communication system will allow for speedy return of image interpretation reports, and all images will be read by two radiologists.

The new space gives patients more control over their care experience. Exam check-in stations will be located throughout the lobby, where patients can independently sign in for their appointment and go directly to their exam room. Separate hallways for providers and patients minimize patient disruption.

Patients will have access to advances in care through ongoing clinical trials conducted by UW Medicine physicians at the new space, the UW Medical Center—which operates the Eastside Specialty Center—and other UW Medicine facilities. The Center will also host community events and educational programs for local providers, Yang said.

“Patients here have access to all UW Medicine services,” Yang said. “If a service isn’t offered at our Eastside location, we’ll be able to quickly and easily connect patients to care opportunities elsewhere within the UW Medicine system. For the first time on the Eastside, we’re able to unify expert care, education opportunities, and clinical research.”

The Eastside Specialty Center will hold an open house for the general public from 1-3 p.m., Saturday, May 17.

Read the full story.


Education and Training 

Leo Morales appointed UW School of Medicine’s chief diversity officer

Leo S. Morales
Leo Morales

Leo S. Morales, UW affiliate professor in public health, has accepted the position of chief diversity officer at the UW School of Medicine, effective June 1. He succeeds David Acosta, who left the UW last year to become the associate vice chancellor of diversity and inclusion at UC Davis Health System.

Morales has been an affiliate associate professor in public health at the UW since 2009, when Group Health Research Institute recruited him as an associate investigator and he started practicing intemal medicine at Group Health Cooperative. At Group Health and the UW, Morales has been a leading researcher, establishing a successful and well-funded program of research. His special interests are in patient-centered outcomes and the role that cultural factors play in health and healthcare. He has developed successful outreach programs in Group Health and throughout Washington state, particularly involving Latino and other underrepresented communities.

Morales received his medical and master's in public health degrees (in health sciences) from the UW in 1990 and completed his doctoral degree in policy studies at the RAND Graduate School in Santa Monica, Calif. in 2000. He completed residency training in primary care internal medicine at the University of California, San Francisco/San Francisco General Hospital in 1993 and served as a fellow in the University of California, Los Angeles /NIH National Research Service Award Primary Care Fellowship Program from 1995 to 1998. Following completion of fellowship, Morales served as assistant professor at UCLA in general internal medicine from 1998 to 2004, when he was promoted to associate professor.

Morales's research has focused on health disparities, patient-reported outcomes, and minority health. His research has been supported by peer-reviewed funding from the National Institutes of Health and he also received the Harold Amos Minority Medical Faculty Development Program Career Award from the Robert Wood Johnson Foundation in 2001. Morales's research has led to several awards including election to the American Association of Clinical Investigators in 2007.

Online course in healthcare disparities launches on MedEd Portal

Janice Sabin, UW research assistant professor of biomedical informatics and medical education, is an author on a new online course about disparities in healthcare developed by Talaria Inc., a Seattle-based research and development company. The course, available live on MedEd Portal, is targeted to healthcare providers and health professions faculty. The lead author is Eileen Van Schaik, senior research scientist at Talaria Inc. and UW clinical assistant professor of biobehavioral nursing and health systems. 

The Healthcare Disparities course is designed to increase awareness about racial and ethnic disparities across the spectrum of healthcare services and examine the use of patient-centered communication skills to minimize these disparities.

Healthcare Disparities includes peer-reviewed research, interactive case studies, and multimedia case studies in three modules covering:

    •  The evidence for the occurrence and causes of healthcare disparities
    •  How unconscious bias may conflict with consciously held egalitarian values
    •  The use of patient-centered communication to reduce disparities in the patient-provider relationship

The full course was evaluated using a randomized-controlled trial with a national sample of 130 physicians and resident physicians. It appears to have global effects on physicians’ knowledge of disparities, attitudes toward unconscious bias, and satisfaction with virtual patient encounters.

Sabin, whose research in the Department of Biomedical Informatics and Medical Education aims to reduce healthcare disparities among minority populations by improving the patient-provider relationship, collaborated with colleagues at Talaria Inc. to develop this course with funding from the National Center on Minority Health and Health Disparities at the National Institutes of Health.

The course is available at no charge on the MedEdPORTAL and will soon be available for CME at Virtual Lecture Hall for a small fee.

Learn more about the course at the MedEd Portal. Citation: Van Schaik E, Howson A, Sabin J. Healthcare Disparities. MedEdPORTAL; 2014.

Listening sessions scheduled for proposed medical school curriculum structure

Curriculum Graphic small

The UW School of Medicine Curriculum Renewal Steering Committee will hold a series of listening sessions about the proposed new medical school curriculum structure during the month of March. A narrative and schematics that summarize the proposed structure, based on the work of five committees, will be released on Friday, March 7, after an initial discussion at the Medical School Executive Committee meeting that day. Look for the documents on the Curriculum Renewal website.

Sessions will provide an opportunity for School of Medicine community members—faculty, staff, students and trainees—to discuss and voice thoughts, questions and reactions to the proposed structure. The Steering Committee wants to hear from you to identify strengths, challenges, potential improvements. The next stage of curriculum renewal—course and clerkship content development—is slated to begin after additional discussion of the proposed structure at the UW Medicine Leadership Retreat in early April.

The listening session schedule is detailed below.

    •  Tuesday, March 11: 4:30-5:30PM at Harborview, R&T 117/121
    •  Friday, March 14: 12:00-1:00PM at UW Health Sciences, T-625
    •  Monday, March 17: 12:00-1:00PM at UW Health Sciences, D-209 (videostreamed) [UW NetId required]
    •  Tuesday, March 18: 8:00-9:00AM at UW Health Sciences, D-209 (videostreamed) [UW NetID required]
    •  Thursday, March 27: 12:00-1:00PM at UW Health Sciences, D-209
    •  Friday, March 28: 12:00-1:00PM at UW Health Sciences, T-733
    •  Monday, March 31 8:00-9:00AM at Harborview, R&T 109/113

In addition, Ellen Cosgrove, vice dean for academic affairs, will give Medicine Grand Rounds on Thursday, March 13, 8:00-9:00 a.m. in Health Sciences Room T625. The title of her talk is: Continuous Curriculum Improvement: The UW Path to Renewal.

Contact Sarah Shirley at sarahs23@uw.edu with questions.

WWAMI Regional News

WWAMI hosts the Rural Medical Educators Conference

Second-year TRUST student Ryan Mulligan talks with Wyoming WWAMI clinical coordinator Larry Kirven.
Ryan Mulligan

By Doug Nadvornick
WSU Medical Sciences Communications

“So what are the attractions for you to a rural medical practice and what are the barriers?”

The question was asked by one of the attendees at the recent Rural Medical Educators Conference hosted by WWAMI on the Washington State University campus in Spokane. The question was directed at a panel of four medical students, all in the UWSOM’s Targeted Rural Underserved Track program (TRUST), and one TRUST graduate, now a family medicine resident working in Billings, Mont.

“For me the attraction is the variety in my day. I get to do more hands-on procedures than my peers in a big university hospital,” said third-year student Kial Anderson, now a WRITE (WWAMI Rural Integrated Training Experience) student in Newport, Washington, about 40 miles north of Spokane. “The barriers? I worry about our partners and their ability to find jobs in the same towns where we practice.”

“I like the broad scope of practice and the way you can shape that,” said Ryan Mulligan, a second-year student whose TRUST assignment is also in Newport. “My concern is with high turnover rates. I don’t want to be the only doctor in town or on call all the time. I want to be in a place where I have professional support.”

That exchange came during a two-day meeting of doctors and administrators representing medical schools and rural training programs in about 20 states. The attendees learned about TRUST, WRITE and RUOP (Rural/Underserved Opportunities Program). They also heard about the nation’s oldest Rural Training Track (RTT) residency program in Colville, about 60 miles northwest of Spokane.

“For me the greatest joy of working in Colville is the patient population,” said second-year resident Paul Gloe, an Alaska WWAMI graduate. “I like that I get to care for everyone in the community.”

Mo Campbell, a first-year resident who came to the Colville RTT from Minnesota, says she chose the Washington residency because it matches her mission and vision as a doctor.

“I like that RTTs foster autonomy and independence,” Campbell said.

This year, she’s based at Spokane’s Family Medicine Residency. She’ll spend the next two years full-time in Colville; she already has a favorable impression.

“You’re treated as a colleague, not as a resident,” she said. “We’re included and actively engaged in conversations that are beyond patients, about the community and financial issues.”

Colville’s Mount Carmel Hospital now hosts one second-year and one third-year resident on site. Angela Ball, the RTT coordinator, hopes to expand the program to two residents per year, but says there are still issues to be worked out.


Upcoming Events

The following events may be of interest to the UW Medicine community: 

Science in Medicine WWAMI Lecture, March 12

Rethinking the Role of Glutamate Transport in the Brain, noon to 1 p.m., Wednesday, March 12, Foege Auditorium, Genome Sciences Building. Michael Kavanaugh, director of the Center for Structural and Functional Neuroscience, University of Montana, will speak. Kavanaugh studies neurotransmitter transporters in the brain, how they function and how they impact synaptic transmission. He will discuss his recent work on glutamate transporter modulation of excitatory synaptic transmission and plasticity in the brain. Lectures are open to all faculty, staff and students. No registration is required. Visit the Science in Medicine website or email somevent@uw.edu for more information.

2014 UW Presidential Entrepreneurial Faculty Fellows Lecture, March 13

Translating Discovery from Lab to Marketplace: A Researcher’s Guide to a Different Culture, 3:30 p.m., Thursday, March 13, Walker-Ames Room, Kane Hall. David Linker, associate professor of medicine in the Division of Cardiology and attending cardiologist at UW Medical Center, will give the lecture. Linker invented the Stealth Ambulatory Monitor, an innovative, non-invasive technology that is used to screen for one of the most common forms of irregular heartbeat atrial fibrillation. Presented by the C4C, the UW Center for Commercialization. Register online. Contact Clare LaFond at clarela@uw.edu or 206.543.0905 for more information.

26th Annual Robert F. Rushmer Lecture, March 21

The (Radically) Changing Landscape in Biomedical Technology Innovation, 4:30 to 5:30 p.m., Friday, March 21, William H. Foege Auditorium (South Foege Bldg. Room 0S60), UW campus. The Rushmer lecture will be given by Paul G. Yock, the Mikati Foundation Professor of Biomedical Engineering and Professor of Medical Sciences at Stanford University. As more affordable medical technologies from abroad enter the U.S. market, the U.S. will be forced to place a new emphasis on developing more cost-effective products. Yock will discuss the implications for training the next generation of medical technology innovators. Contact Shirley Nollette at 206.685.2002 or nolletts@uw.edu for more information.

The Brotman and Ragen Awards: Nominations due March 28

UW Medicine created two awards in 2008 to acknowledge exceptional volunteer leadership and to commemorate the end of its last fundraising campaign: the Brotman Leadership Award and the Ragen Volunteer Service Award. The awards are named after UW Medicine advocates Jeffrey H. Brotman and Brooks G. Ragen. The Brotman Leadership Award recognizes visionary leadership, while the Ragen Award recognizes outstanding service from volunteers, faculty and staff. Nominations are sought for the 2014 awards. Nominations are due Friday, March 28. If you have questions, please contact Lynn Hogan, chief advancement officer at UW Medicine, at 206.543.6865 or lhogan@uw.edu. (Please note that current UW Medicine Board members are not eligible to receive these awards.)

11th Annual Western Regional International Health Conference, April 4-6

Uncensored: Gender, Sexuality & Social Movements in Global Health, April 4-6, 2014, University of Washington, Seattle. Conference will cover social and political movements, diverse sexualities and sexual health, gender-based violence, reproductive rights, global discrimination against LGBTQ community, income inequality, and universal access to healthcare. Keynote speaker will be Stella Nyanzi, Ph.D., of the Makerere Institute of Social Research at Makerere University in Kampala, Uganda. Her research covers the politicization of sexuality in contemporary Uganda. The conference is sponsored by the UW, the WRIHC, UW chapter of GlobeMed and the UW Department of Global Health. Register here. For more information, visit the Western Regional International Health Conference website or contact info@wrihc.org.

Paws-on Science recruiting researchers for April 4-6 Husky Weekend event

Paws-on Science: Husky Weekend at the Pacific Science Center is recruiting researchers to take part in its annual community outreach event, April 4-6. Paws-on Science, a partnership between the UW and Pacific Science Center, introduces families and the community to innovative research underway at the UW in a fun and accessible way. During the past four years, more than 1,100 UW scientists have shared their work through hands-on activities with nearly 47,000 adults and children. For more information, contact McCayla Butler at mcbutler@uw.edu or 206.543.1867.

Continuing Medical Education 

Visit Continuing Medical Education for information on upcoming classes.


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