Clinical
CLINICAL: General Medicine, Geriatrics and Palliative Care
General Medicine
The General Medicine section, led by Mohan Nadkarni, focuses on the care of adults age 18 and over. Its emphasis is on preventive care and fostering long-term relationships between patients and physicians. Led by Ira Helenius, University Medical Associates (UMA) conducted over 32,000 patient visits in FY 2013 while serving as the continuity practice for all DOM medical residents. UMA, the division’s primary care practice located at UVA Hospital, has 19 dedicated internists and recently completed a successful transition from a traditional-model “residents’ clinic” to a “firm” system in which residents are given more autonomy in how the clinic is run. UMA maintains some of the highest quality indictors in the state, while continually striving to expand services. These currently include pharmacy, podiatry, and anti-coagulation for management of patients who are on oral anticoagulant therapy.
A concept that has taken root over the last decade and is transforming how primary care is delivered in the United States is that of the “primary care medical home” (PCMH). Over the last several years, the UMA clinic has been working to restructure its practice along PCMH lines. In 2012 it sought and received the designation of “Patient-Centered Medical Home” from the National Committee for Quality Assurance, the first clinical area at UVA to be so designated. The division is currently working to reshape its other practices along these same lines.
The division’s other major Charlottesville-based clinical practice, University Physicians Charlottesville (UPC) located in the Fontaine Research Park, conducted almost 11,500 visits in the past year. Led by Ken Ballew, the UPC group continues to expand its ambulatory internal medicine presence in the community. The University Physicians Orange (UPO) practice serves a largely rural population north of Charlottesville. It welcomed Lien Dame as its new medical director and conducted nearly 16,500 patient visits during FY 2013. To support the expansion of services in this region, UPO carried out a successful search for two new clinicians, who join the practice in FY 2014.
Highlight: Programs-Activities-Initiatives
“Accountable Care Organizations” (ACOs) are groups of doctors, hospitals, and other healthcare entities that form voluntary networks in order to provide coordinated care for Medicare patients, with the goal of reducing costs and eliminating unnecessary spending. The incentive: through the Medicare Shared Savings Program, ACOs can qualify for higher payments if they meet certain quality and cost benchmarks. In 2012-13, the UVA Health System established an ACO task force to prepare for transition to this new model of care; Margaret Plews-Ogan and Mohan Nadkarni were appointed to serve on the ACO Clinical Operations Committee.
Hospital Medicine
Directed by George Hoke and now in its eighth year of operation, the Hospital Medicine service admits and manages medically complex patients at both UVA Hospital and the Transitional Care Hospital at Northridge, while also providing a significant share of in-hospital training for residents and medical students. Hospitalists offer general medicine consults to the surgical services and provide direct patient care on the hospital’s general medicine wards. The Hospitalist program maintains outstanding quality statistics, including a demonstrated reduction of mortality rates as compared to other clinical services. Hospitalist physicians staff the Surgical Pre-Operative Assessment Service, and direct or co-direct task forces on sepsis, glycemic control, and inpatient redesign, as well as numerous other hospital quality committees.
Geriatrics
The University Health System, in collaboration with Riverside Health System and Jefferson Board for Aging (JABA), will open a new facility for geriatric care under the direction of new faculty member and Geriatric section head Mark Newbrough. The flagship program, Blue Ridge PACE, will allow for significant expansion of services to the aging population within a 25-mile radius of Charlottesville. Medicaid’s “PACE” designation (“Program of All-Inclusive Care for the Elderly”) indicates an organization that provides comprehensive, coordinated, interdisciplinary services for Medicaid and Medicare enrollees.
The Geriatrics section has two well-established outpatient clinics: Colonnades Medical Associates (Diane Snustad, medical director) and University Physicians at JABA (Laurie Archbald-Pannone, medical director); together, they conducted over 5,000 patient visits in the past year. The division’s geriatricians also serve as medical directors at area nursing homes. During FY 2013, the division launched a geriatric “house calls” program; staffed by Ruby Ford, this program will undergo further refinement and expansion in the coming year. The division also recently spearheaded a CMS Innovations grant to improve outcomes for patients with Alzheimer’s disease, focusing on education and support for caregivers at home.
Palliative Care
Palliative care is an interdisciplinary approach to treating patients who have illnesses no longer responsive to curative treatment. The goal is to achieve the highest possible quality of life through aggressive pain and symptom management together with psychosocial and spiritual support to lessen suffering for both patients and their families.
The Palliative Care service, led by Leslie Blackhall, is one of the oldest and most comprehensive in the country. Demand exceeded capacity in FY 2013, with the section’s three full-time faculty conducting nearly 3,000 outpatient visits at the Emily Couric Cancer Center and providing another 2,000 inpatient consults. During 2012-2013 the division launched a mentored program for non-palliative faculty wanting to become board certified in palliative care via the experiential pathway. Three General Medicine faculty members – John Schorling, Robert Powers and Evelyn Bargmann – completed this program and were board certified in palliative medicine. To address the increasing demand for palliative care services, the division has recently hired two full-time nurse practitioners to expand clinical capacity and launched a national search for three new faculty members to join the program in 2014.
Quality & Patient Safety
The Division’s Quality and Patient Safety initiative, led by John Voss and Tammy Schlag, launched a quarterly morbidity and mortality conference with a particular focus on transitions in care. Schlag, Voss, and UMA medical director Ira Helenius have been involved in developing and adopting PCMH clinical care guidelines for diabetes, hypertension and hyperlipidemia. In addition, UMA has pioneered the development of “smart phrases” and team care to improve performance on retinal screening and diabetic foot care as well as on pneumococcal and flu vaccine rates. Supported by grants from UVA’s Academy of Distinguished Educators and Graduate Medical Education, division faculty members are also developing a patient safety curriculum that involves residents in a “hands-on” approach to improving safety and reducing errors.