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Oct. 16 issue of UW Medicine Insight
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A $30 million grant will help clinical practices throughout WWAMI
Thanks to a new $30 million award, UW Medicine has the opportunity to improve the health of nearly 2 million people across our five-state WWAMI region. The award, titled the Transforming Clinical Practice Initiative, was made to UW Medicine at the end of September by the U.S. Department of Health and Human Services.
UW Medicine will receive up to $5.5 million for the first year and then up to $30.2 million over a four-year span to assist clinicians in Washington, Wyoming, Alaska, Montana and Idaho. The initiative’s goals are to improve quality of care, increase patients’ access to information and spend healthcare dollars more wisely.
The award permits UW Medicine to build on our significant progress in recent years to transform clinical practices — work that already has a solid foundation through our well-developed accountable care infrastructure.
As a Practice Transformation Network, UW Medicine will support nearly 7,000 clinicians to expand their quality-improvement capacity, learn from one another and achieve common goals of improved care, better health and reduced cost. The network will train primary- and specialty-care health professionals using a mix of web-based and on-site coaching. It will use rapid-cycle performance surveillance and benchmarking of quality metrics, telemedicine, support for coordinated care and data and information sharing across practices.
The network will also use programs to drive performance improvements, including patient-reported outcomes where appropriate, hospital readmissions, unnecessary testing and procedures and healthcare costs.
This is one of the best opportunities we have had in many years to use our collective expertise and commitment to improve clinical care for our entire WWAMI region. Hundreds of our faculty and staff will be involved in deploying the initiative. Please join me in congratulating and thanking David Flum, professor of surgery, DC Dugdale, professor of medicine, and Allison Devlin, program director for the Surgical Outcomes Research Center, all of whom coordinated the application and are leading this remarkable initiative. For more details, see article in HSNewsBeat, "UW Medicine among 39 systems in U.S. to plan to transform care."
Paul G. Ramsey, M.D.
Researchers at UW Medicine and Seattle Children’s Research Institute have pioneered a gene editing technique in T cells that can kill and resist HIV. The technique could have implications for cancer and other diseases. David Rawlings, UW professor of pediatrics and chief of the UW Division of Pediatric Immunology, and Andrew Scharenberg, UW professor of pediatrics, are researchers at the Center for Immunity and Immunotherapy at Seattle Children’s Research Institute; they published their findings in Science Translational Medicine. Using HIV as a model for this new gene editing technique, they found that T cells could be engineered to resist HIV infection and simultaneously kill HIV-infected T cells or B cell tumors.
Hans-Peter Kiem, UW professor of medicine (oncology) who uses similar techniques at the Fred Hutchinson Cancer Research Center but wasn’t involved in the study, called it “quite a significant advance in the field.” For more on the story, see article on KPLU-FM 88.5 (NPR) website. Also coverage in On the Pulse, Seattle Children’s blog.
Andrew Hoofnagle, UW associate professor of laboratory medicine, and collaborating labs at other institutions have developed and are testing more than 10 new assays in clinical studies of Vitamin D deficiency.
Some population studies had shown that blacks were much more likely than whites to have had lab readings suggesting a Vitamin D deficiency. The findings were puzzling because the low levels did not carry the same risk of bone fractures or heart attacks in blacks that they did in whites. This discrepancy might stem from not having the right test marker for Vitamin D status, or it could be that genetic variations in the marker skewed test results. For more on the story, see article in HSNewsBeat.
UW Medicine researchers are helping to create the largest resource to date on how individuals and populations vary genetically from each other; their findings were reported in two papers, both included in the Sept. 30 issue of Nature. Evan Eichler, UW professor of genome sciences, and his laboratory team were among the leaders of one of the reports.
The 1000 Genomes Project Consortium has collected information on genetic differences from the DNA maps of more than 2,500 people, representing 26 population groups from around the globe. African populations show the greatest genetic diversity. This was not unexpected, because humans originated in Africa. Later, ancestors of Asians, Europeans and Native Americans moved away and settled other parts of the world. For more on the study, see article in HSNewsBeat.
More research stories:
Richard Ellenbogen and Stanley Herring, co-medical directors of the UW Medicine Sports Concussion Program at Harborview Medical Center, held a news conference to provide context to the recent high school football injuries, including one death. Such circumstances are devastating, but rare, they said, mentioning the nationwide movement to increase awareness of safer protocols for injury-prevention in prep team sports. “The tragic irony is that sports are probably safer,” Herring said. For more on the story, see article in The Seattle Times and coverage on KOMO-TV ABC 4 and Radio 100, KCPQ-TV Fox 13 and Northwest Cable News.
There are an estimated 2.8 million breast cancer survivors in the United States, a testament to the more than 25-year decline in mortality, according to the American Cancer Society. Still, 231,000 women alone will be diagnosed with the disease this year and about 40,000 will die. Julie Gralow, UW professor of medicine (oncology), talked to The Huffington Post about five breakthroughs in breast cancer that patients should know about. They include 1) a new drug that could stop a type of incurable cancer, 2) genetic tumor testing, 3) less aggressive chemotherapy, 4) benefit of bone strengthening medications and 5) the promise of immunotherapy. For more on the story, see article in The Huffington Post. (October is Breast Cancer Awareness Month.)
KING-TV profiles Andre Kajlich, who found a passion for hand cycling after losing both his legs 10 years ago. Kajlich, 24 at the time, was struck by an oncoming train in Prague. After two months in intensive care, he was flown to Harborview Medical Center and Douglas Smith, an orthopedic trauma surgeon at Harborview, closed his wounds and reconnected his tissues, muscles and ligaments. Kajlich lost one of his legs above the knee and the other at the hip joint. He will be competing Nov. 13 in a 24-hour, 400-mile race to set a world record. In June, he hopes to hand cycle across America in 12 days for another world record. For more on the inspiring story, see KING-TV NBC 5.
Related clinical stories:
UW physician in Spokane describes experience with Immersion:
This perspective of the 2015 UW School of Medicine curriculum was written by Matt Hollon, UW clinical associate professor of medicine located in Spokane. Dr. Hollon divides his time between leading the faculty group that teaches clinical skills to UW School of Medicine students during their first two years of medical school in Spokane and supervising internal medicine residents at Providence Sacred Heart Hospital in Spokane, as well as seeing his own patients.
I had the privilege of helping to design and implement “Immersion” locally with my colleague Dr. Janelle Clauser, who chairs the UW School of Medicine clinical skills course in Spokane for students in their first two years.
Immersion is a two-week, eight-hours-per-day “boot-camp” in core clinical skills for incoming medical students that includes learning to interview patients, performing the physical exam and recording the complete medical database. With participation from our entire local UW School of Medicine core faculty, we taught Immersion to the 40 students who started medical school in Spokane on August 24. Incoming medical students at each of the five other WWAMI sites experienced Immersion with unique twists (i.e., in Wyoming, students were immersed in clinical medicine as part of wilderness medicine training). Ours included a full day of team-building and leadership training at nearby Twin Lakes, Idaho.
It was an amazing experience. Helping an entire class of thoughtful, intelligent, engaged, committed students take their first steps in their lifes’ work was as rewarding an experience as I have had in almost two decades in medical education. In contrast to the traditional approach of medical school that begins with students cutting into cadavers and memorizing biochemical pathways, these students had the chance to anchor the work and challenges of medical school that lay ahead to an infinitely more robust initial experience of doctoring.
While they will still have to learn gross anatomy and biochemistry early in their education, we gave them the opportunity to see the real purpose of medical school upfront rather than occasional clinical experiences gained slowly over their first years. The students responded with astounding enthusiasm and appreciation that was deeply touching – not only was I moved, but I was also left thinking to myself, “I can’t believe we haven’t been teaching medical school like this before now.”
Sharing the core aspects of doctoring and our love of the daily work of medicine from the very start of training is not just rewarding — I suspect it will have long-term implications. Data on student burnout in traditional medical education is disheartening. More than half of all third-year medical students report being burned-out.  Educators have shown that in the traditional curriculum, students’ empathy declines throughout medical school. 
Like all physicians, I certainly know that our doctoring work will always be difficult; that even for practicing providers well into their careers, the nature of the work can lead to burnout; and that there is no panacea to prevent the emotional exhaustion, depersonalization, and loss of satisfaction at the core of burnout. However, I have realized that, with Immersion and ongoing robust, meaningful, and frequent clinical experiences for medical students early in their training, we may have hit on something important – strongly connecting students to a sense of purpose from the beginning. This, in turn, may help to cultivate deep enthusiasm for the work and long-term resiliency against burnout.
More education stories:
In Montana, 10 entering 2015 Montana WWAMI students spent four days on the Blackfoot Indian reservation in Browning as part of their immersion experience. All the students are scholars in the Targeted Rural Underserved Track or TRUST. The trip allowed them to learn about health disparities on the reservation and programs to address these disparities; it also allowed them to learn about the culture of the Blackfoot people.
Students participated in preparing and serving a meal at the Browning Homeless Shelter and then heard about the history of the Indian Health Service and about Native medicine. They also took part in a discussion on the problem of opiate addiction in mothers and newborns on the Blackfoot reservation. Tribal elder Joe McKay led an engaging discussion on the history of the Blackfoot people. A tour through the Museum of the Plains Indians and the Blackfoot Heritage & Art Gallery provided visual and textual highlights to the local cultural experience and the opportunity to see native artists at work. On the last evening, they took part in a lively traditional hand game competition.
“The Browning trip allowed me to see what difference rural physicians can make in their communities and how desperately they are needed,” said first-year medical student Rebekah Huckeby. Kyler Kingston, another first-year student noted how the environment can have a strong influence health: “It was impactful to see how significantly, both positively and negatively, a person’s life and health can be influenced by their community,” he said. And first-year student Justinn Marshall said: “I was greatly impacted by the first-hand exposure to medicine in an underserved area, and it strengthened my desire to practice in a similar area.”
The entering class of medical students in the WWAMI program at Montana State University consists of 30 medical students this year. The other 20 students also spent time on reservations as part of their immersion experience: 10 students visited the Confederated Salish and Kootenai Reservation in Polson, Mont., and 10 traveled to Hardin, Mont., home of the Crow Reservation.
Randall Kyes, UW research professor in the Department of Psychology, adjunct research professor in global health, core scientist in the UW Primate Center, and director of the UW Center for Global Field Study, has spent 25 years of field training on Tinjil Island, Indonesia, and has been taking students there for 20 years. The month-long program focuses on conservation biology and global health, and is open to anyone interested in field research. Tinjil Island is home to more than 1,500 long-tailed macaque monkeys, as well as monitor lizards and many other tropical fauna and flora. For more on the story, see the article in the College of Arts & Sciences Perspectives newsletter.
Mary-Claire King, the American Cancer Society professor in the UW departments of medicine and genome sciences, tells a personal story of overcoming heartbreak on The Moth Radio Hour..
The Moth is an acclaimed not-for-profit organization dedicated to the art and craft of storytelling. Since its launch in 1997, The Moth has presented thousands of stories, told live and without notes, to standing-room-only crowds worldwide. Although the story of Dr. King aired in January, when it was recently posted on Facebook, it received the most likes of any story for the past two weeks. To hear her story, listen to The Moth.
Both Harborview Medical Center and the University of Washington Medical Center made the Becker's Hospital Review of the 50 greenest hospitals in the United States. According to Becker's, “This list features hospitals whose sustainability policies and practices (and in some cases, construction) have demonstrated a commitment to environmental responsibility. To develop the list, the Becker's Hospital Review team conducted research and analyzed sustainability information from sources such as Practice Greenhealth, Healthier Hospitals Initiative, the U.S. Green Building Council's Leadership in Energy and Environmental Design program and the Environmental Protection Agency, among others. For more on the ranking, see Becker Hospital Review.
Chronic pain affects over 100 million Americans and costs up to $635 billion in medical treatment and lost productivity each year. Recognizing the need to change this, the National Institutes of Health Pain Consortium have selected 11 centers to develop pain curricula, including the UW John Loeser Center of Excellence in Pain Education. The UW center was first selected in 2012 as a center of pain excellence and this award of $914,350 represents a continuation of funding for this work.
Housed jointly in the schools of medicine and nursing, the John Loeser Center of Excellence in Pain Education is co-led by David Tauben, Ardith Doorenbos, Debra Gordon and John Loeser. More than 30 core faculty are involved in the center representing all the UW health science schools: Dentistry, medicine, nursing, pharmacy, public health and social work.
The U.S. Department of Justice awarded nearly $500,000 in federal grant money for a program to reduce gun violence in Seattle. The grant, under the Project Safe Neighborhood program, supports the Puget Sound Regional Crime Gun Task Force, which is focused on increasing the ability of law enforcement to trace shell casings and firearms used in crimes and thus identify shooters and take them off the streets. The grant will also pay part of the costs for a special assistant U.S. attorney to prosecute gun crimes and provides funding to the Harborview Injury Prevention & Research Center to work with gunshot victims through an innovative hospital-based intervention and structured outreach program to prevent future firearm-related crime.
Approximately $100,000 will be set aside for academic study and review of the funded programs to determine the level of effectiveness of the grant-supported strategies. The Department of Justice funding would complement the Seattle Mayor's request for funding to prevent gun violence as part of the city budget.
“Our communal sense of safety has been shaken by recent national and local episodes of gun violence,” said UW Medicine’s Monica Vavilala, director of the Harborview Injury Prevention & Research Center. “Most firearm violence is preventable and the grant funding will allow us to address key causes of gun violence and lay the groundwork for developing programs that work to reduce firearm-related injuries.”