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U-M Hospitals and Health Centers recognized among top U.S. hospitals

UMHHC awarded for lower mortality rates, fewer complications and reduced readmission rates

The U-M Hospitals and Health Centers have been named one of the top 100 hospitals and among the top 15 major teaching hospitals in the country.

Truven Health Analytics released its 100 Top Hospitals list this week based on independent and objective research measuring hospital and health system performance. Organizations do not apply or pay for this honor.

The Truven Health study found that the top hospitals have roughly a half-day shorter patient length of stay, 4 percent fewer complications, and 5.9 percent lower risk-adjusted mortality rates. The winners also performed better than peer-group hospitals on 30-day readmissions for heart failure, heart attack and other conditions.

To conduct the study, Truven Health researchers evaluated 3,000 short-term, acute care, non-federal hospitals. They analyzed Medicare cost reports, Medicare Provider Analysis and Review data, core measures and patient satisfaction data–all publicly available from the Centers for Medicare and Medicaid Services Hospital Compare website.

Based on this year’s results, if all Medicare inpatients received the same level of care as those treated in the award-winning facilities:

• Nearly 126,500 additional lives could be saved
• $1.8 billion in inpatient costs could be saved
• Nearly 109,000 additional patients could be complication-free
• The average patient stay would decrease by half a day
• Episode of illness expense would be 2 percent lower than the peer average

If the same standards were applied to all inpatients, the impact would be even greater.

The Truven Health 100 Top Hospitals study incorporates public data; proprietary, risk-adjusted and peer-reviewed methodologies; and key performance metrics to arrive at an objective balanced scorecard measuring current performance and long-term improvement. Truven Health evaluates performance in 11 areas: mortality; medical complications; patient safety; average patient stay; expenses; profitability; patient satisfaction; adherence to clinical standards of care; post-discharge mortality and readmission rates for acute myocardial infarction (heart attack), heart failure, pneumonia; and new for this year, Medicare Spend per Beneficiary (Medicare Spend). The study has been conducted annually since 1993.

For more information and to see a complete list of winners, visit http://100tophospitals.com/studies-winners/100-top-hospitals

Time to “just say no” to behavior-calming drugs for Alzheimer patients? Experts say yes

Doctors write millions of prescriptions a year for drugs to calm the behavior of people with Alzheimer’s disease and other types of dementia. But non-drug approaches actually work better, and carry far fewer risks, experts conclude in a new report.

In fact, non-drug approaches should be the first choice for treating dementia patients’ common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions, say the researchers in a paper just published by the British Medical Journal.

The best evidence among non-drug approaches is for those that focus on training caregivers—whether they are spouses, adult children or staff in nursing homes and assisted living facilities—to make behavioral and environmental interventions.

The researchers, from the University of Michigan Medical School and Johns Hopkins University, reviewed two decades’ worth of research to reach their conclusions about drugs like antipsychotics and antidepressants, and non-drug approaches that help caregivers address behavioral issues in dementia patients.

They lay out their findings along with a framework that doctors and caregivers can use to make the most of what’s already known. Called DICE for Describe, Investigate, Evaluate, and Create, the framework tailors approaches to each person with dementia, and as symptoms change.

“The evidence for non-pharmaceutical approaches to the behavior problems often seen in dementia is better than the evidence for antipsychotics, and far better than for other classes of medication,” says first author Helen C. Kales, M.D., head of the U-M Program for Positive Aging at the University of Michigan Health System and investigator at the VA Center for Clinical Management Research. “The issue and the challenge is that our health care system has not incentivized training in alternatives to drug use, and there is little to no reimbursement for caregiver-based methods.”

Coincidentally, a new U.S. Government Accountability Office report published the same day as the BMJ paper addresses the issue of overuse of antipsychotic medication for the behavior problems often seen in dementia.  It finds that one-third of older adults with dementia who had long-term nursing home stays in 2012 were prescribed an antipsychotic medication — and that about 14 percent of those outside nursing homes were prescribed an antipsychotic that same year.

The GAO calls on the federal government to work to reduce use of these drugs further than it’s already doing, by addressing use in dementia patients outside nursing homes.

Kales, however, cautions that penalizing doctors for prescribing antipsychotic drugs to these patients could backfire, if caregiver-based non-drug approaches aren’t encouraged.

She and her colleagues from Johns Hopkins, Laura N. Gitlin PhD and Constantine Lyketsos MD, note in their paper that “there needs to be a shift of resources from paying for psychoactive drugs and emergency room and hospital stays to adopting a more proactive approach.”

But they also write, “drugs still have their place, especially for the management of acute situations where the safety of the person with dementia or family caregiver may be at risk.” For instance, antidepressants make sense for dementia patients with severe depression, and antipsychotic drugs should be used when patients have psychosis or aggression that could lead them to harm themselves or others. But these uses should be closely monitored and ended as soon as possible.

The authors lay out five non-pharmacologic categories to start with based on their review of the medical evidence. These approaches have been shown to help reduce behavior issues:

  • Providing education for the caregiver
  • Enhancing effective communication between the caregiver and the person with dementia
  • Creating meaningful activities for the person with dementia
  • Simplifying tasks and establishing structured routines
  • Ensuring safety and simplifying and enhancing the environment around the patient, whether in the home or the nursing/assisted living setting

They also note that many “hidden” medical issues in dementia patients – such as urinary tract infection and other infections, constipation, dehydration and pain – can lead to behavioral issues, as can drug interactions. So physicians should look to assess and address these wherever possible.

Kales, Gitlin and Lyketsos are working with the U-M Center for Health Communications Research to launch a National Institute of Nursing Research-sponsored clinical trial this spring that will test the DICE approach through a computer based tool for caregivers called the WeCareAdvisor. The tool will help families identify tips and resources in a single computer interface to address behavioral symptoms.  The tips are designed to prevent or mitigate possible triggers for common behavioral symptoms such as pacing, repetitive questioning, restlessness, or shadowing. .

For instance, de-cluttering the environment, using music or simple activities that help to engage a person with dementia, or using a calm voice instead of being confrontational, could help greatly to reduce behavioral symptoms, Kales says. And making sure that caregivers get breaks from their responsibilities and take care of themselves, especially in the home, can help them avoid burnout and taking their frustration out on patients.

“Behavior-based strategies may take longer than prescriptions,” acknowledges Kales, a member of the U-M Institute for Healthcare Policy and Innovation. “But if you teach people the principles behind DICE, the approach becomes more natural and part of one’s routine. It can be very empowering for caregivers or nursing home staff.”

More research on both new drug options and the best ways to assess and address behavioral symptoms is needed, the authors conclude. But in the meantime, the evidence to date comes down in favor of non-drug approaches in most cases.

The components of the DICE approach are:

  • D: Describe – Asking the caregiver, and the person with dementia if possible, to describe the “who, what, when and where” of situations where problem behaviors occur and the physical and social context for them. Caregivers could take notes about the situations that led to behavior issues, to share with health professionals during visits.
  • I: Investigate – Having the health provider look into all the aspects of the person’s health, dementia symptoms, current medications and sleep habits, that might be combining with physical, social and caregiver-related factors to produce the behavior.
  • C: Create – Working together, the patient’s caregiver and health providers develop a plan to prevent and respond to behavioral issues in the person with dementia, including everything from enhancing the patient’s activities and environment, to educating and supporting the caregiver.
  • E: Evaluate – Giving the provider responsibility for assessing how well the plan is being followed and how it’s working, or what might need to be changed.

“I Can’t Imagine a Better Place to Be.” Dr. Marschall Runge speaks on starting his new job as EVPMA

We in the U-M Health System welcome Marschall Runge, M.D., Ph.D., as the new executive vice president for medical affairs. Today is his first day.

Please watch the video below to hear Dr. Runge’s early thoughts on being EVPMA.

Later this week, check back here for other videotaped interviews with Dr. Runge where he shares his ideas on leadership and challenges in the healthcare industry.

Read more about Dr. Runge here: http://evpma.med.umich.edu/about-us/index.html

Be the Change with Your Input: Take the Employee Engagement Survey in March

From March 9 – 27, you will be able to share your honest and confidential feedback through our Employee Engagement Survey.
EMPLOYEES_REVISION

Take the survey to tell our leaders what works in your area and what needs to be improved. Your opinions and suggestions will lead to lasting improvements where you work every day and for our entire health system.

You will receive a global message March 9 when our survey launches. More information is available on the Employee Engagement website and the Frequently Asked Questions page.

Don’t miss this opportunity to share your thoughts and inspire positive change in our health system.

Survey Details:
The survey can be accessed from a computer on the UMHS network or mobile device with AirWatch and VPN access. To take the survey, you will need your:

  1. Work Area Code: Your supervisor will tell you the code to use so your responses are linked to your unit. See a complete list of codes here.
  2. Password: The 10-digit password consists of your 8-digit Employee ID number, plus your two-digit date of birth. (For example, if you were born on June 4 and your employee ID number is 12345678, your password will be 1234567804.)  By requiring a survey password, we are ensuring that only eligible UMHS employees can take the survey.

Who takes the survey?
Hospitals, Health Centers and Medical School staff who began working at UMHS before Feb.16, 2015 should take the survey. Dual-appointment employees will be able to take the survey as long as one of their appointments is at UMHS. Any temporary employee will also be able to complete the survey. Volunteers and individuals who are working temporarily through a vendor (e.g. Manpower) are not eligible to complete the survey. Faculty and House Officers take a different survey at a different time.

Be the change with your survey input!

AMA president-elect to speak at UMHS next week

Steven J. Stack, M.D., the president-elect of the American Medical Association, will visit UMHS next week, and give two lectures on Wednesday, March 4.

At 11:45 a.m. in the MCHC Auditorium in UH South, he will speak on “The Road Ahead: Emergency Medicine’s Role in a Post-Reform Delivery System” as part of the Department of Emergency Medicine Grand Rounds series. CME credit will be offered.

Later that day, he will speak at the Ann Arbor City Club on Washtenaw Ave., in a talk sponsored by the Washtenaw County Medical Society that is open to the general public. He will be introduced by Bradley Uren, M.D., a faculty member in Emergency Medicine and member of the society’s executive council.

For details on this event, including information on the social hour and dinner available before the 7 p.m. talk, visit http://umhealth.me/stackAMA

In both talks, Dr. Stack will offer a physician’s perspective on the seismic changes transforming health care today, from payer and hospital consolidation to new delivery models to the impact of the Affordable Care Act. Amid widespread change in terms of who receives health care, how it is paid, and how it is delivered, new opportunities exist for physicians and hospitals to collaborate. Dr. Stack will examine the shifting industry and regulatory landscape, the impact of digital health on the practice environment, and the AMA’s ongoing effort to improve the health of the nation through its three-pronged strategic plan.

Dr. Stack currently practices in Lexington and surrounding central Kentucky, and has served as medical director of multiple emergency departments. He is the first emergency medicine board-certified physician to serve on the AMA’s Board of Trustees, and was elected president-elect in June 2014. He will take office as president this June.

He has special expertise in health information technology (IT) and was chair of the AMA’s Health Information Technology Advisory Group from 2007 to 2013. He has also served on multiple federal advisory groups for the Office of the National Coordinator for Health Information Technology. He is currently the secretary of eHealth Initiative, a non-profit association committed to improving health care through the advancement of health IT.

MiChart Support Office now open for providers

MiChart Training is now offering a new program for clinical MiChart users.

This program allows MiChart Providers to place a request for additional MiChart training/support. Based on requests, trainers will be made available either at the support office or on site in clinical areas to assist.

Learn to:

  • Create specialized and comprehensive SmartPhrases for quicker completion of documentation.
  • Create filters in Chart Review to find information more efficiently.
  • Create orders “favorites” to speed up order entry.
  • Utilize letter templates to maintain communication with external providers and patients.
  • Run reports to better monitor special patient populations.

The office is now open for walk-in support and by appointment.

  • Location & Hours:
    • UH South (Old Mott) F5510B from 8 a.m. – 5 p.m., Monday-Friday
      • Take elevator 9 to the 5th floor
  • MiChart Providers can:
    • Visit the MiChart training office on a walk-in basis to obtain support.
    • Schedule appointments for assistance at the support office.
    • Schedule appointments for assistance at their clinical site, either group or 1-on-1.

Additionally, if you have previously completed MiChart training for your role and have already been using the system, consider enrolling in a Provider Efficiency Course. These courses are designed to help enhance understanding and proficiency with MiChart functionality.

Please refer to the following tip sheet for a list of efficiency courses available: Efficiency Training Catalog.

Nominate faculty for 2015 Dean’s Awards Program

Every year, the Medical School honors the achievements of some of its top faculty through the Dean’s Awards Program. Now in its 15th year, the program recognizes faculty who demonstrate exceptional accomplishments in the areas of teaching, research, clinical care, innovation and community service.

The Dean’s Office currently is accepting nominations of faculty members for excellence in seven categories. The 2015 winners will be honored in the fall during the annual Faculty and Staff Awards Dinner.

The deadline for nominations for the following faculty awards is May 1, 2015:

Education Award

The Lifetime Achievement Award in Medical Education — This award honors a lifetime of achievement in all types of education in which our faculty are engaged: undergraduate medical education, graduate medical education, doctoral and postdoctoral education in research, and continuing medical education.

Research Awards

The Basic Science Research Award — The award recognizes a scientist or group of scientists with outstanding contributions to the basic biomedical research of the Medical School.

The Clinical and Health Services Research Award — Nominations will be accepted for faculty in any rank on any track who are making outstanding contributions in the areas of clinical and translational research and health services research.

The Distinguished Faculty Lectureship Award in Biomedical Research — Ideal candidates demonstrate extraordinary national and international contributions as a research leader with pivotal discoveries that have wide-ranging impact for the advancement of scientific knowledge.

Clinical Award

The Outstanding Clinician Award — The award, often given to more than one faculty member, recognizes exemplary performance of a practicing clinician and can include those with outstanding service as medical program or ambulatory care unit directors, developers of clinical care management programs or new care models, as well as innovations in institutional quality improvement initiatives. Nominees for this award are considered for the Lifetime Achievement Award in Clinical Care.

Innovation Award

A new category for 2015, the Innovation and Commercialization Award recognizes a faculty member or group of faculty members who have developed a new research method, technology or innovative service that will radically improve or transform patient health.

Service Award

The Community Service Award — Candidates for this award make outstanding contributions to the community — locally, nationally or globally.

Faculty and staff are encouraged to nominate a deserving colleague for one of these awards.

Dr. Theodore Lawrence named director of University of Michigan Comprehensive Cancer Center

Theodore S. Lawrence, M.D., Ph.D., has been named the director of the University of Michigan Comprehensive Cancer Center.

The appointment was approved Thursday by the University of Michigan Board of Regents.

Lawrence succeeds Max S. Wicha, M.D., who founded the Cancer Center 27 years ago.

“This is a tremendous program with talented and dedicated faculty and staff, a terrific research infrastructure and superb core facilities,” says Lawrence, who will assume the title of Max S. Wicha, M.D., Distinguished Professor of Oncology. He is also chair of radiation oncology.

Lawrence cites the Cancer Center’s strength in precision medicine, drug discovery and health policy research as well as opportunities to deepen clinical and translational research efforts.

The center’s “comprehensive” status is designated by the National Cancer Institute and reflects participation in cancer basic, clinical and population sciences research, with strong interactions among those areas. A center must also provide public information, education and outreach programs. U-M is one of two comprehensive cancer centers in Michigan and one of 41 across the country.

“Michigan has been the epicenter of many global advances in cancer research and care. As patients, families and the scientific community look to us for the next breakthroughs, we are fortunate to have the expertise of an established leader of Dr. Lawrence’s caliber to guide the Cancer Center into a very promising future,” says James O. Woolliscroft, M.D., dean of the U-M Medical School and Lyle C. Roll Professor of Medicine.

In addition to continuing to advance the Cancer Center’s research excellence, Lawrence plans to grow the center’s statewide presence as part of an effort to bring cancer care closer to home.

“The vast majority of cancer care can be done in the community with strong partnerships. We want to create more of those partnerships to allow more patients in our state to receive the right care in the right place,” Lawrence says.

Lawrence’s laboratory interests are focused on chemotherapeutic and molecularly targeted radiosensitizers. His clinical research combines these laboratory studies with conformal radiation guided by metabolic and functional imaging to treat patients with pancreatic and other gastrointestinal cancers. Lawrence expects to continue patient care and research activities as Cancer Center director. He will continue to serve as chair of radiation oncology as well.

In addition, Lawrence has served in leadership positions in many of the most prestigious oncology societies, including the American Society of Radiation Oncology, the American Society of Clinical Oncology, the Radiation Oncology Institute, the Society of Chairs of Radiation Oncology, and both the Board of Scientific Councilors and the Board of Scientific Advisors of the National Cancer Institute. He is a member of the Institute of Medicine of the National Academy of Sciences. He has received the ASTRO Gold Medal, the highest award conferred by the society, an ASCO Statesman Award, and the 2014 Outstanding Investigator Award from the Radiological Society of North America.

Lawrence joined the faculty of the University of Michigan in 1987, following a fellowship in medical oncology and a residency in radiation oncology at the National Cancer Institute. He received his research degree in cell biology from the Rockefeller University in New York, followed by his medical degree from Cornell University and an internal medicine residency at Stanford University.

Medical School to host June 3 faculty town hall on curriculum transformation

The town hall will be 5:30-7:30 p.m. in Dow Auditorium of the Towsley Center for Continuing Medical Education. Medical School leadership, including Senior Associate Dean for Education and Global Initiatives Joseph C. Kolars, M.D., and Associate Dean for Medical Student Education Rajesh S. Mangrulkar, M.D., will give a one-hour presentation from 5:30-6:30 p.m. Attendees are invited to stay afterwards for a reception in the Towsley lobby.

Since 2013, hundreds of faculty, staff and students have worked countless hours to create a new curricular model aimed at developing physician leaders to answer society’s call for improved systems of health care. The new model will include a scientific and clinical foundation, advanced professional development, applied leadership education, and a mentored learning community.

UMMS faculty are encouraged to attend the town hall, ask questions, and become familiar with all aspects of the new curriculum ahead of an all-faculty vote on the proposed changes. The vote will take place (online) from June 10-24, 2015.

To learn more about the new curriculum, and the ongoing strategic planning process, visit: http://curriculum.med.umich.edu.