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June 22, 2012
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UW AIMS Center receives national funding to integrate mental health and primary care
I am pleased to announce that the Centers for Medicare and Medicaid Services (CMS) has awarded nearly $18 million to a national collaboration of partner organizations that includes UW Medicine. The three-year agreement, part of a $1 billion CMS Health Care Innovation Challenge, will fund implementation of an evidence-based collaborative care management model for patients with depression plus diabetes and/or cardiovascular disease in primary care in seven states.
Jürgen Unützer (photo, below), UW professor and vice chair in the Department of Psychiatry & Behavioral Sciences and director of the Division of Integrated Care and Public Health, leads the AIMS (Advancing Integrated Mental Health Solutions) Center that will participate in the collaboration. Dr. Unützer is principal investigator for the UW portion of the project. Other investigators include Wayne Katon, UW professor and vice chair of the Department of Psychiatry & Behavioral Sciences, and Paul Ciechanowski, UW associate professor of psychiatry and behavioral sciences.
This is a vitally important area for achieving the national healthcare goals of reducing costs, improving quality of care for individuals and meeting the healthcare needs of populations. Integrated mental health is designed to improve the health and mental health of populations through patient-centered, integrated mental health services. A large number of studies have shown that such programs are more effective and more cost-effective than usual care for common mental disorders such as depression and anxiety.
The newly funded program focuses on patients with depression plus one of two common diseases. About one-third of Medicare patients have diabetes and another one-third have coronary artery disease. Depression combined with one of these diseases substantially increases mortality and healthcare costs in this population.
A model developed at UW Medicine by Dr. Katon and his research team and tested with patients with depression and comorbid conditions will be used in the collaborative project nationally. In addition, the participating organizations will use a web-based care management tracking system developed at and licensed by UW to support program implementation. The AIMS Center at UW will help design the program and train the participating organizations in the model, provide technical assistance for implementation across nine healthcare organizations in seven states and assist in program evaluation. The lead center for the project is the Institute for Clinical Systems Improvement in Minnesota. Community Health Plan of Washington will also participate.
The AIMS Center has been a major driver in moving integrated mental health services forward. The center focuses on improving the care for individuals with common mental disorders who are treated in such settings as primary care clinics, specialty medical care programs, community mental health centers, home healthcare programs and other community-based settings. Over the past 10 years, the center has trained more than 5,000 clinicians in evidence-based collaborative care models.
Please join me in congratulating Drs. Unützer, Katon and Ciechanowski and their entire team for this award and for the outstanding work they perform in advancing evidence-based collaborative care management for patients with depression and other common mental health problems.
Paul G. Ramsey, M.D.
Patients ages 13 to 24 who are given opioids for pain are more than twice as likely to become addicted if they have mental health disorder, according to a study by Laura Richardson, UW associate professor of pediatrics in the Division of General Pediatrics, and a team of investigators at the Seattle Children’s Research Institute and the UW.
The study, “Mental Health Disorders and Long-term Opioid Use among Adolescents and Young Adults with Chronic Pain,” was published in the June 2012 Journal of Adolescent Health.
The study, “Mental Health Disorders and Long-term Opioid Use among Adolescents and Young Adults with Chronic Pain,” was published in the June 2012 Journal of Adolescent Health.
Richardson’s team examined the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults. They found that those with mental health disorders were not only more likely to be prescribed opioids for chronic pain but also 2.4 times more likely to become long-term opioid users than those without a mental health disorder.
The study contains data from January 2001 to June 2008, and tracked opioid usage patterns of 62,560 adolescent and young adults from the West, Midwest and Southwest regions of the United States. Long-term opioid use is defined as using opioids for more than 90 days within a six-month period with no gap of usage over 30 days. Chronic pain complaints included back pain, neck pain, headache and arthritis or joint pain.
“There are a number of reasons why adolescents and young adults with mental health issues are more likely to become long-term users of opioids,” said Richardson. “Depression and anxiety might increase pain symptoms and lead to longer treatment. Physicians may see depressed patients as being more distressed and may be willing to treat pain symptoms over a longer period of time.”
While there may be a role for opioids in treating some patients, Richardson offers tips to help reduce risk of long-term opioid use in a video.
Web-based tool helps parents improve kids' asthma treatment
The study, led by Dimitri Christakis, UW professor of pediatrics and member of the Seattle Children’s Research Institute, was published in Academic Pediatrics.
His research team found that the most significant benefits to the web-based approach were the intervention's interactivity and scalability. These made it convenient and easy for parents to use. Scalability is the ability of computer hardware or software to continue to function well when it is changed to meet a user’s needs.
The website, called “My Child’s Asthma,” was developed to increase positive beliefs about asthma management, optimize care by increasing provider-prescribed controllers for children with persistent asthma, and promote compliance among children.
“My Child’s Asthma” gathered information from 600 parents enrolled in the study and applied algorithms to determine asthma severity, home care practices and parental expectations related to their administration of asthma medication on a daily basis. The website also provided feedback to parents on their child’s asthma symptoms at each successive visit and allowed participants to set goals for themselves.
“The vast majority of families enrolled in our study liked using ‘My Child’s Asthma,’ and wanted to continue using it,” said Christakis. “Sustainability is always an issue. But there are numerous benefits from this type of website for the child who has fewer asthma attacks and, subsequently, less hospital and emergency room visits.”Read more on the Seattle Children's website.
New Financial Conflicts of Interest training available online
UW Medical Center is one of 15 clinical centers in the United States and the first in the Pacific Northwest to be certified to use a new medical device, the NovoTTF-100A, to treat adult patients with recurrent glioblastoma (GBM), a deadly and common form of brain tumor.
Maciej Mrugala, UW associate professor of medicine in the Department of Neurology and Neurological Surgery and a member of Fred Hutchinson Cancer Research Institute, was instrumental in bringing the new therapy to Seattle and obtaining the UW’s certification as a Clinical Center of Excellence by the device’s manufacturer, Novocure. The device is available in the United States for use by centers whose clinical staff has been trained in the use of the system.
Novocure, a commercial oncology company that develops novel therapy for solid tumors, has launched a portable, non-invasive medical device that uses a low-intensity electric field to inhibit cancer-cell growth within the tumor. The NovoTTF-100A system has been approved by the U.S. Food and Drug Administration as a therapy for adults with recurrent GBM. The therapy has been found to be clinically effective and produces a better quality of life and fewer side effects than chemotherapy. The device is available in the U.S. for use by centers whose clinical staff has been trained in the use of the system.
“As we continue to expand the number of clinical centers where NovoTTF therapy is provided, including some of the most prestigious cancer centers in the world, our hope is that more patients can be helped with this effective treatment option which does not have the debilitating side effects seen with traditional chemotherapy,” said Gabe Leung, chair of global commercialization at Novocure.Read more about the new Centers of Excellence on the Novocure website.
The Puget Sound region is home to a large population of military service members, veterans, and retirees, many of whom suffer from chronic pain from injuries sustained during military service.
The Interdisciplinary Pain Center at Madigan Army Medical Center has received the Business Examiner Media Group of Tacoma’s Community Health Care Champions Military Services Award for its efforts to improve the quality of pain care for patients.
The Center, a collaborative project of the Puget Sound Pain Management Council, was created under the guidance of Alex Cahana, UW professor of anesthesiology and pain medicine and chief of the Division of Pain Medicine, and Major General Richard Thomas, Commanding General of Western Regional Medical Command. Cahana and Thomas accepted the award at a ceremony at the Tacoma Museum of Glass June 13.
The Interdisciplinary Pain Management Center at Madigan Army Medical Center includes professionals from primary care, anesthesia pain medicine, clinical pharmacy, health psychology, substance misuse counseling, nurse case management, physical therapy and occupational therapy. The center also includes specialists in complementary and alternative medicine, including chiropractic, acupuncture, medical massage and yoga. Input from Puget Sound Pain Council members was critical to the successful establishment of the Madigan Interdisciplinary Pain Management Center. The UW Pain Medicine faculty provided valuable advice on establishing systematic measurement of patient-centered outcomes.
The Puget Sound Pain Management Council was created in July 2011 to bring together institutions that advance higher quality pain medicine in the Puget Sound area. Members of the council include the Western Regional Medical Command, Madigan Army Medical Center, the UW School of Medicine, Bastyr University, the VA Puget Sound Healthcare System, and the Puget Sound Multi-Service Market Office. Members share knowledge and education opportunities, and identify best practices for clinical pain care and clinical outcome. The council’s goal is to achieve excellence in patient-centered pain management resulting in better pain relief, improved patient function, and greater patient well-being.
The Patient Safety Innovations Program (PSIP) promotes collaboration between clinicians and researchers to explore solutions to patient safety and quality of care challenges. The UW Medicine Quality and Safety Executive Committee will award $50,000 in pilot funding and operational and academic support to clinicians and researchers with innovative one-year projects. Applications are due by Monday, July 9, at 5 p.m. PDT.
Thomas Montine, the Alvord Professor of Neuropathology, has been appointed chair of the UW Department of Pathology, effective June 16. Montine had been interim chair since December 2010 and succeeds the late Nelson Fausto, who died earlier this year.
Montine is a neuropathologist with research interests in the structural and molecular bases of cognitive impairment in Alzheimer’s and Parkinson’s diseases. He is working to define key pathogenic steps and thereby identify new potential therapeutic targets through a combination of epidemiology-related neuropathology, biomarkers for clinical trials, and experimental studies. Montine is the director of the Pacific Northwest Udall Center and is associate director of the Alzheimer's Disease Research Center at the UW.
Lynne Robins, UW professor of biomedical informatics and medical education, received the 2011 UW Medicine Award for Excellence in Mentoring.
Robins is director of the UW Teaching Scholars Program and holds adjunct appointments in the UW departments of Anesthesiology and Pain Medicine, Family Medicine, and Pediatric Dentistry. She has played a significant role in mentoring faculty and students in curriculum development, interprofessional collaboration and competence, patient safety and patient-physician communication.
Nomination letters describe Robins as doing “an outstanding job of mentoring others in a quiet but meaningful way.”
Erika Goldstein said Robins is “frequently sought out as an advisor and mentor for students and faculty who are interested in scholarship in medical education. She takes these individuals under her wing, works with them, and advocates for them. She directs them to additional faculty and resources as needed, while maintaining a close relationship and supporting their progress.”
Robins holds a doctoral degree in anthropology from the University of Michigan, where she completed her thesis on physician-patient communication. Prior to joining the UW faculty in 2000, she was director of curriculum evaluation at the University of Michigan Medical School.
John Ensinck, UW professor emeritus of medicine in the Division of Metabolism, Endocrinology and Nutrition, died Sunday, May 20, of complications of Parkinson's disease. He was 81.
Born in Montreal, Canada, Ensinck received his undergraduate and medical degrees from McGill University and completed fellowships at Rockefeller University and the UW.
Ensinck joined the School of Medicine faculty in 1961 as an instructor and became professor of medicine in 1973. He was program director of the UW General Clinical Research Center, the predecessor of today’s Institute for Translational Health Sciences, for 25 years before retiring in 1996. Ensinck was instrumental in establishing policies for including and protecting human subjects in research and teaching. He chaired the first Health Sciences Biomedical Review Committee.
A prolific investigator, Ensinck studied calcium metabolism, insulin and glucagon activity, and other areas related to diabetes. He cared for patients at UW Medical Center, Harborview Medical Center, as well as the VA.
Ensinck was a member of the American Society for Clinical Investigation and a fellow of the American Association for the Advancement of Science, and the American College of Physicians.
Jane Shelby (photo,left) has been appointed first-year assistant dean and director of WWAMI medical education at the University of Alaska, Anchorage, effective July 1.
Shelby will be responsible for the coordination, oversight and faculty leadership of UW Medicine’s WWAMI medical education program at the University of Alaska, Anchorage. She will work closely with the School of Medicine Office of Academic Affairs and Regional Affairs on issues related to: admissions, curriculum, development of pre-med educational and information programs, student affairs and identification of state work force needs.
Most recently, Shelby was the executive director for health sciences at Montana State University in Bozeman where she worked with WWAMI students and chaired the WWAMI Montana medical information and decision-making course. Shelby received her doctoral, master’s and bachelor’s degrees from the University of Utah. Shelby is the creator and director of the rural Native American Community Service Learning Project and founder and director of three community service programs for Navajo children and families.
Yong “Ki” Shin (photo, right) has been appointed assistant clinical dean of WWAMI Western Washington, effective July 1. Shin is the first Western Washington assistant dean. As Western Washington assistant dean, he will join the UW School of Medicine Office of Regional Affairs and assistant clinical deans in central/eastern Washington, Wyoming, Alaska, Montana and Idaho.
Shin will work closely with the School of Medicine’s Academic Affairs, Graduate Medical Education, and clinical departments to ensure the implementation and management of the clinical medical education programs in Western Washington. He will be a liaison between hospitals in Western Washington, the state hospital association and county medical societies, residency programs and the School of Medicine to represent the needs and opportunities for medical education in Western Washington.
A WWAMI graduate, Shin has been in a private general internal medicine practice in the rural community of Montesano, Wash., in Grays Harbor County. He graduated from the UW School of Medicine and completed his residency in primary care internal medicine in the Seattle-Boise track and spent one year as chief resident at the Boise VA Medical Center in Boise, Idaho. He has taught medical students in the Rural/Underserved Opportunity (RUOP) program since 1998. He has been the internal medicine site coordinator for third-year medical students since 2001.
More than 300 guests filled the Metropolitan Ballroom of the Sheraton Seattle Hotel June 3rd to celebrate the 40th anniversary of the UW School of Medicine’s WWAMI program—the University of Washington’s medical education training partnership with the states of Washington, Wyoming, Alaska, Montana and Idaho. Derived from the first letter of the names of each of the five partner states, WWAMI is an innovative regional program with a core objective that has remained steady over four decades: to train a physician workforce and other healthcare professionals from and for the five-state region that WWAMI serves.
The Seattle celebration was the culmination of numerous WWAMI anniversary events across the participating states throughout the past year, each bringing together former and current WWAMI leaders, educators, legislators, students, alumni and supporters to celebrate the program’s early pioneering efforts and focused mission, and to hear where WWAMI is headed next.
A strong theme among speakers was the partnership and collaboration that has characterized WWAMI from the beginning. Former Washington State Governor Dan Evans (photo, above), governor when WWAMI began in the early 1970s, spoke about the enduring value of WWAMI. He described how many individuals, groups, hospitals, universities and government leaders have collaborated over the past four decades to advance regional excellence in medical education and meet physician workforce needs in rural and underserved areas. The important end result after 40 years, Evans said in his address, is that thousands of patients throughout the million square miles of WWAMI states have better access to medical care, first-rate care, and better health.
Other speakers included Suzanne Allen, vice dean for regional affairs at the UW School of Medicine; George Novan, associate director of the WWAMI Spokane Medical Education Program at Washington State University; Mark Jutila, interim head of the Department of Microbiology and WWAMI course director for immunology at Montana State University; Patrice Burgess, a WWAMI preceptor and family medicine physician in Boise, Idaho and a WWAMI graduate; and Paul Ramsey, CEO of UW Medicine and dean of the UW School of Medicine.
In his remarks, Ramsey discussed the vision and leadership of the WWAMI pioneers who established the foundation for the most cost-effective, high-quality medical education program in the nation. He characterized the pioneers and subsequent leaders of the program as having vision, talent, drive, optimism, partnership, selflessness and courage to be innovative and try new approaches to improve medical education. He asked a large number of individuals in the audience to stand to be acknowledged, some of whom had traveled from across the nation for the event.
Nationally and internationally renowned as a high-quality, cost-effective program that prepares physicians to serve their communities, WWAMI was first established in 1971 as a partnership between the UW School of Medicine and the University of Alaska Fairbanks (later at Anchorage). Montana and Idaho joined the program in 1972 and Wyoming in 1996. WWAMI Spokane, the newest first-year university training site, started in 2008.
The Wyoming WWAMI Program salutes Kathleen Hannifan for her outstanding efforts as preceptor for first-year medical students in Laramie. Hannifan, a 2006 graduate of the WWAMI Program, completed her residency in pediatrics at Seattle Children’s. Upon joining the Laramie Physicians for Women and Children in 2009, she immediately began serving as a preceptor for first-year medical students.
Hannifan shared her thoughts about the importance of the first-year preceptorship program.
“It is important to get students in the clinic as soon as possible,” Hannifan says. “Because of the amount of basic science information in the first year, students can lose sight of their long-term goals in medicine. The preceptorship program allows students to maintain their enthusiasm for medicine. It also allows students to form clinical insights at the beginning of their medical training and balance these clinical observations with basic science topics.”
The first-year preceptor experience allows students to receive clinical training from experienced physicians in treating actual patients. Hannifan has mentored three first-year WWAMI students in the Wyoming preceptorship program. The students appreciate her caring nature, willingness to teach, and expertise in pediatrics. Her WWAMI students repeatedly comment on her willingness to set aside time to teach them clinical information during the course of seeing patients.
Hannifan recalls that her first-year preceptorship experience was an important part of her medical education. Her first-year preceptor was Brian Horst, a pediatrician in Laramie. Her time with Horst reinforced her interest in pediatrics. She and Horst now share a practice at the Laramie Physicians for Women and Children.
“Being a first-year preceptor is exciting because everything is new for first-year students. Even the most routine procedures are interesting for a first-year medical student. This helps to keep our jobs exciting. Students ask great questions which force you to stay on your toes and keep up with the literature.”
The following events may be of interest to the UW Medicine community:
Special Pathology Seminar, June 27
Non-invasive Whole Genome Sequencing of a Human Fetus, 4:30 p.m., Wednesday, June 27, UW Genome Sciences Building, Foege Auditorium. Jay Shendure, UW associate professor of genomes sciences, will present new work that demonstrates the feasibility of obtaining whole genome sequence information on a human fetus by sequencing DNA from maternal blood that contains circulating fetal DNA as well as maternal DNA. A new approach to sequence analysis allowed fetal DNA to be distinguished from maternal and paternal genomes, as well as the identification of new mutations in the fetus. The study opens new avenues for prenatal detection of mutations using a noninvasive procedure. Contact Steve Berard at firstname.lastname@example.org or 206.685.0564 for more information.
2012 - 2013 Teaching Scholars Program applications due June 30
The 2012-2013 Teaching Scholars Program is a 10-month professional development program for health sciences faculty who want to improve their teaching and academic leadership skills. The program runs from Sept. 18, 2012 to June 18, 2013 and includes a one-day teambuilding session on Sept. 25. Applications are due by June 30, 2012. For application requirements, visit the Teaching Scholars Program website and press the "Register Now" button. Contact Teaching Scholars Program Co-directors Lynne Robins at email@example.com or Jan Carline at firstname.lastname@example.org for more information.
Survival Skills for the Research Years, July 9 - 10
Everything You Need to Know to Thrive in Academics! The annual UW Department of Medicine Workshop on Survival Skills for the Research Years, July 9 – 10, UW Medicine South Lake Union, 850 Republican St., Seattle. The two-day workshop covers skills necessary for academic success, such as grant writing, scientific writing, oral presentation and job negotiations. The course will be led by Lynn Schnapp (Pulmonary and Critical Care Medicine) and Thomas Hawn (Allergy & Infectious Disease). This free workshop is designed for research fellows and is open to fellows and junior faculty from all departments. Please visit the workshop website to register and to see a detailed course agenda.
Continuing Medical Education
Visit Continuing Medical Education for more information on upcoming classes.
Exceptional alumni — and an exceptional education
In June, the UW Medicine Alumni Association celebrated five UW School of Medicine alumni. Every year, the School of Medicine recognizes several alumni for their contributions and achievements at the annual alumni reunion. Learn more about this year’s recipients — John Kendall, Jr., M.D. ’56 (the world-renowned endocrinologist who received the Distinguished Alumni Award); Melissa Smith, M.D. ’87, Res. ’91 (the recipient of the Humanitarian Award, who has dedicated her career to underserved populations); Samuel Tarica, M.D. ’52, Res. ’55, and David Wolter, M.D. ’52, Res. ’58 (who received the Alumni Service Award for decades of service to the alumni association); and Bradley Bernstein, Ph.D. ’97, M.D. ’99 (the genomic investigator who was given the Alumni Early Achievement Award) — on Vimeo.
*Due to the July 4th holiday, Online News will not be published July 6th. The next issue will be published Friday, July 13th.