As my fellowship is winding down and my summer comes to an end, I can't help but think back on what I have accomplished (or failed to). I started out enthusiastically insisting that I could make an impact with the 2 1/2 months I had to work with. This enthusiasm has slowly waned from existence as roadblocks in the form of IRB approvals, HIPAA regulations and financing issues slowed my project to a crawl. But this is the reality of trying to change the world. Nothing is ever an easy fix, and if it was it probably isn't worth fixing. It became clear to me that my summer was just the tip of the iceberg for this project, and that many more months/summers/years would be necessary to achieve the results I am looking for.
With this realization, I began to understand that it wasn't me who was necessarily making an impact, and I wasn't going to change the world in 2 months. But instead I soon discovered that a more important event was occurring: the impact was being made on me. I may not have accomplished much this summer on paper, but I am now a firm believer in working towards improving health care. One of my new favorite quotes is from the revered Atul Gawande: "New laboratory science is not the key to saving lives. The infant science of improving performance-of implementing our existing know-how--is"
How true this is. So much of NIH's money has been invested into the basic sciences that historically there has been little interest in changing the current practice of medicine. Not to undermine the importance of basic scientific research, there have been many life-saving discoveries that have been essential to current medical practices. However, much of this research never makes it to the patient - and is forever stuck in the purgatory of research known as translation. Furthermore, if we continue to focus on discovering new techniques and technologies, the cost of medicine will only continue to sky rocket. Anywho - I digress but my point is: focusing on changing our current system of practicing medicine has the potential to make an immediate and significant difference both in the general health of the population and in reducing the cost of health care.
The stories behind each patient I have seen with Dr. Fangman has encouraged me to continue working towards improving care for disadvantaged populations. The disparities in care are truly staggering and almost left untold in medical school! That's not to say there aren't those in the medical community who are talking on this subject. In fact, each physician/NP/PhD/community worker involved with public health I have spoken to are some of the most devoted and inspirational people I have ever met. I recently sat down with Dr. Meurer, the Director of the new Urban and Community Health Program at MCW, and we ended talking for 2 hours about the projects we were involved in and bouncing ideas off one another. It's events like this that has encouraged me to continue working on this project throughout my medical school tenure.
Alrighty, so hopefully you made all the way through my ranting and raving. What does the future hold for this project? We are currently in the process of meeting with key individuals involved with the Wisconsin Health Information Exchange program and the IRB board and have a proposal in the making to finally make this project a reality. The proposal does not have the same objectives as our original due to HIPAA regulations, but still has the potential to provide valuable information regarding ARCW patient's visits to Emergency Departments.
I will continue working on this project as school starts up again, so stay tuned!
Monday, August 10, 2009
Friday, June 26, 2009
6/26 Update
So it appear as though things are starting to pick up around here!
This week I've been working more on the WHIE project.
What is the WHIE? Excellent question!!
The Wisconsin Health Information Exchange project is an electronic health program that enables Milwaukee area EDs to share health information on ER patients.
We are currently working with the WHIE directors to get ARCW onto the program so that we may access and share patient information with the ERs in the Milwaukee area. Any time one of our patients visits an ER they should make a visit to the ARCW clinic within 72 hours. Unfortunately, we have difficulty accurately following ER visits and thus have very few follow up appointments with these patients.
In order to quantify the importance of capturing more ER visits by ARCW patients, we are looking at all the documented ER visits in the ARCW system for a certain time period. Once we have access to the WHIE system, we can find out exactly how many ER visits were missed by the current ARCW system for documenting ER visits which usually rely on phone calls made by the patient or ER to our staff.
So that means I get to look through months of ARCW patient information trying to find evidence of ER visits!
I've also joined up with another study which is utilizing a prediction model for virologic failure created by MGH staff. We are adapting their model to fit our patient population and medical record system at ARCW. Ideally, we will be able to reliably predict which patients are at risk for virologic failure and act accordingly.
So that's my brief update, more to come!
-Chad
This week I've been working more on the WHIE project.
What is the WHIE? Excellent question!!
The Wisconsin Health Information Exchange project is an electronic health program that enables Milwaukee area EDs to share health information on ER patients.
We are currently working with the WHIE directors to get ARCW onto the program so that we may access and share patient information with the ERs in the Milwaukee area. Any time one of our patients visits an ER they should make a visit to the ARCW clinic within 72 hours. Unfortunately, we have difficulty accurately following ER visits and thus have very few follow up appointments with these patients.
In order to quantify the importance of capturing more ER visits by ARCW patients, we are looking at all the documented ER visits in the ARCW system for a certain time period. Once we have access to the WHIE system, we can find out exactly how many ER visits were missed by the current ARCW system for documenting ER visits which usually rely on phone calls made by the patient or ER to our staff.
So that means I get to look through months of ARCW patient information trying to find evidence of ER visits!
I've also joined up with another study which is utilizing a prediction model for virologic failure created by MGH staff. We are adapting their model to fit our patient population and medical record system at ARCW. Ideally, we will be able to reliably predict which patients are at risk for virologic failure and act accordingly.
So that's my brief update, more to come!
-Chad
Monday, June 15, 2009
First Impressions
So I've finally started my summer research project as of last week!
While I haven't made significant progress in changing society saving lives or fixing our health care system, I have spent a lot of time reading research literature. I spent the majority of my time at my little desk and ARCW extensively reviewing the literature on HIV and ERs. It may not sound exciting, but I have learned a lot of interesting things about HIV testing in ERs and health care utilization by HIV patients. Don't worry, I won't bore you with the details. :)
The really interesting experiences have come from my shadowing experiences with Dr. Fangman. Last week Dr. Fangman allowed me to shadow him during this clinic hours here at ARCW. The patients we saw were truly astounding! Not because they had some incredible disease I've never heard of. Instead, the social histories and lives that these HIV patients face everyday is so radically different from my own experiences that it has drastically changed my perspective of these patients. So many of these people have faced violence, drugs, alcohol and death that it amazes me that they even show up for their routine HIV visits. Most of the patients can't drive or don't have cars, so they have to rely on public transportation or the good will of others to get to work, a grocery store or to an HIV clinic like ARCW. It is quickly becoming apparent that there exists several barriers to proper care for these individuals.
So what happens when they stop showing up for routine HIV care?
When an HIV patient stops adhering to their medications, their health will deteriorate rather quickly resulting in increased visits to the ER with AIDS related illnesses or opportunistic infections. Currently, ERs rarely screen their patients for HIV even when a patient presents with AIDS related symptoms or high risk factors like STD's. Even fewer refer HIV patients to aftercare clinics like ARCW. We hope to develop a system in which we can monitor ARCW patients who present to an ER in hope that we can reconnect with these individuals to improve their quality of life. We also are aiming to increase HIV testing in ERs to catch more HIV patients before they progress to AIDS.
There's a lot of work ahead of us with this project. There's only so much I can aim to achieve this summer with such goals. It's ambitious I know, but that's why I wanted to be a part of it.
-Chad
While I haven't made significant progress in changing society saving lives or fixing our health care system, I have spent a lot of time reading research literature. I spent the majority of my time at my little desk and ARCW extensively reviewing the literature on HIV and ERs. It may not sound exciting, but I have learned a lot of interesting things about HIV testing in ERs and health care utilization by HIV patients. Don't worry, I won't bore you with the details. :)
The really interesting experiences have come from my shadowing experiences with Dr. Fangman. Last week Dr. Fangman allowed me to shadow him during this clinic hours here at ARCW. The patients we saw were truly astounding! Not because they had some incredible disease I've never heard of. Instead, the social histories and lives that these HIV patients face everyday is so radically different from my own experiences that it has drastically changed my perspective of these patients. So many of these people have faced violence, drugs, alcohol and death that it amazes me that they even show up for their routine HIV visits. Most of the patients can't drive or don't have cars, so they have to rely on public transportation or the good will of others to get to work, a grocery store or to an HIV clinic like ARCW. It is quickly becoming apparent that there exists several barriers to proper care for these individuals.
So what happens when they stop showing up for routine HIV care?
When an HIV patient stops adhering to their medications, their health will deteriorate rather quickly resulting in increased visits to the ER with AIDS related illnesses or opportunistic infections. Currently, ERs rarely screen their patients for HIV even when a patient presents with AIDS related symptoms or high risk factors like STD's. Even fewer refer HIV patients to aftercare clinics like ARCW. We hope to develop a system in which we can monitor ARCW patients who present to an ER in hope that we can reconnect with these individuals to improve their quality of life. We also are aiming to increase HIV testing in ERs to catch more HIV patients before they progress to AIDS.
There's a lot of work ahead of us with this project. There's only so much I can aim to achieve this summer with such goals. It's ambitious I know, but that's why I wanted to be a part of it.
-Chad
Introductions
The last 7 days kicked off my first week in the WMS Fellowship working with Dr. Fangman!
For those who aren't familiar with my project this summer, I'll give you a quick introduction. Currently, there are approximately 1 million people in the US living with HIV/AIDS and 40,000 new diagnosis anually. In order to reduce the incidence of HIV infection in Milwaukee and to improve the quality of life for HIV patients, Dr. Fangman and I are initiating a program to help us identify, screen and increase the follow up care of HIV patients presenting in Emergency Departments.
Why focus on ER's?
A lot of our patients are either difficult to reach or prefer to hide their HIV status due to the stigma surrounding the disease. Therefore, the ER gives us a unique opportunity to reconnect with these individuals and link them to aftercare programs like the AIDS Resource Center of Wisconsin where I am currently working the Dr. Fangman who is the medical director of this location. Furthermore, the ER provides us with another opportunity to screen patients for HIV based on the presence of certain risk factors.
So this all sounds great, but how realistic are these goals? ERs are already overcrowded, overburdened, and overstressed. To get the ER staff to test for HIV and refer them to aftercare is asking them to increase their work load. So right now we are planning on developing a survey to assess what barriers are currently preventing ERs from screening HIV patients.
So that's the plan, stay tuned for updates!
-Chad
For those who aren't familiar with my project this summer, I'll give you a quick introduction. Currently, there are approximately 1 million people in the US living with HIV/AIDS and 40,000 new diagnosis anually. In order to reduce the incidence of HIV infection in Milwaukee and to improve the quality of life for HIV patients, Dr. Fangman and I are initiating a program to help us identify, screen and increase the follow up care of HIV patients presenting in Emergency Departments.
Why focus on ER's?
A lot of our patients are either difficult to reach or prefer to hide their HIV status due to the stigma surrounding the disease. Therefore, the ER gives us a unique opportunity to reconnect with these individuals and link them to aftercare programs like the AIDS Resource Center of Wisconsin where I am currently working the Dr. Fangman who is the medical director of this location. Furthermore, the ER provides us with another opportunity to screen patients for HIV based on the presence of certain risk factors.
So this all sounds great, but how realistic are these goals? ERs are already overcrowded, overburdened, and overstressed. To get the ER staff to test for HIV and refer them to aftercare is asking them to increase their work load. So right now we are planning on developing a survey to assess what barriers are currently preventing ERs from screening HIV patients.
So that's the plan, stay tuned for updates!
-Chad
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