The assistant secretary for planning and evaluation of the U.S. Department of Health and Human Services recently released the report called for in the Expanding Capacity for Health Outcomes (ECHO) Act of 2016. The 220-page report was requested as a part of Public Law 114-270 to inform the U.S. Congress on the growing interest, rapid adoption and current status of ECHO and ECHO-like models of telehealth.
‘Virtual care delivery models have demonstrated their ability to deliver on quadruple-aim outcomes.’ – John F. “Fred” Thomas, PhD
With the healthcare marketplace continually evolving in terms of technological innovation, payment models, delivery of care and rural-based workforce development, Colorado, along with the rest of the nation, continues to look for innovative ways to address these challenges. Of the 165 affiliated ECHO hubs in 35 states and 24 countries, nine case studies were highlighted in the report to illustrate the diversity and breadth of the programs. ECHO Colorado’s statewide effort was one of the highlighted programs due to its unique and innovative adaptation of the model.
“Virtual care delivery models have demonstrated their ability to deliver on quadruple-aim outcomes – increasing access, lowering the costs of care, all while improving patient satisfaction and reducing provider burden. This report highlights what we already knew, the need to focus on developing programs that build the evidence of effectiveness in effecting both provider and patient-level health outcomes,” said John F. “Fred” Thomas, PhD, executive director of ECHO Colorado.
ECHO Colorado is a statewide effort with a community-based board of directors and ties to both the University of Colorado Anschutz Medical Campus and the State of Colorado. For more information about ECHO Colorado visit echocolorado.org.
In the past year, she’s surveyed neighborhoods in Puerto Rico to study the aftermath of Hurricane Maria; made daily treks to the Syria-Lebanon border to examine the role of environmental change on women’s health; walked through sugar cane fields in Central America where heat stress may be a culprit behind workers’ increasing rates of kidney disease; and attended numerous conferences and board meetings across the nation.
“The work is so incredible,” she said. “There is so much opportunity for physicians to be involved in this topic.”
Sorensen is the inaugural fellow in the Living Closer Foundation Fellowship in Climate and Health Science Policy, a collaborative post-graduate training program offered through CU Anschutz, National Institutes of Environmental Health Sciences (NIEHS), Centers for Disease Control (CDC) and the Medical Society Consortium of Climate and Health.
“We’re getting indications that other major universities are super-excited about what we’ve done here,” Lemery said. “Going forward, we’re looking at doing the fellowship as a consortium. We could potentially send our fellow to Harvard to work on public health and human rights projects and vice versa. That would be the goal – to start to pool and share resources.”
Lemery said the threat to human health from climate change — natural disasters such as heat waves, wildfire, hurricanes and rising oceans as well as increases in vector-borne disease and air-quality degradation — is clearly borne out by science. However, physicians have been largely absent from the dialogue, and consequently, from the policy decisions that drive meaningful change.
Healthcare providers, as the professionals dealing with illness and injury on the front lines, are uniquely positioned to say, “this is a significant problem; something must be done,” Lemery said.
“Climate change is a force multiplier – it will worsen health in many different ways and we have a chance to mitigate it. It’s not too late; we’re not doomed,” he said. “Just like we tell our patients: ‘Stop smoking now, while you’re in their 20s, because I can tell you what this looks like in your 60s.’ Climate change is the same thing.”
Lemery said the aftermath of Hurricane Maria, a category 5 hurricane that slammed Puerto Rico in September 2017, illustrates the need to study correlations between climate change and health. The death toll was initially reported as 64 by local authorities, but subsequent studies, including the one Sorensen took part in, revealed the statistical mean mortality from the storm to be approximately 4,600.
“If you can’t explain the damage of extreme weather on a vulnerable population, how are you going to understand the true impact of these threats?” Lemery said. “Like any science, you need data. Data fuels decisions and policy makers.”
In the past year, Sorensen has been on the forefront of offering – from a physicians’ viewpoint — hard science to the policy makers. Sorensen and Lemery were among the authors of the latest National Climate Assessment, which summarizes the impacts of climate change on the United States, both currently and into the future.
The CU fellowship has given Sorensen, who chairs the Education Committee for the Medical Climate Society for Climate Health, a seat at the table at some of the most important discussions taking place on the topic.
The proposal to create the climate and health science fellowship at CU Anschutz included these data points:
Between 2000-2009, heat waves contributed an estimated $5 billion in direct healthcare costs in the United States.
The Zika epidemic in the Americas, which may have been facilitated by permissive climatic conditions that increased mosquito vector abundance, led to $1.1 billion in costs.
“As physicians, we bring a unique perspective because we take care of patients on the front line. We understand human physiology,” she said. “Public health experts understand the epidemiology and the statistics around disease, while we’re the experts on human health.
“So, when all these people team up, you gain an incredible perspective,” Sorensen added. “I think physicians are so vital to solving these problems.”
Environmental health = human health
Sorensen received her bachelor’s degree in environmental ecology from CU Boulder. She went on earn a doctor of medicine degree, leading to meeting Lemery during her residency in emergency medicine at Denver Health. They shared a strong interest in the intersection of environment and health, and a “light bulb went off.” To Sorensen it was obvious: the health of the environment is essential to all organisms on the planet which rely upon it.
In another project, Sorensen and researcher James Crooks at National Jewish Hospital are examining how wildfire and smoke exposure correlate with patients requiring ICU care. Because ICU beds are limited, predictive analytics would help hospitals adjust resources accordingly to meet higher demands. “We have the potential to predict a couple days out in places near wildfires that will see surges of people needing ICU care,” she said.
Potential sub-specialty: climate medicine
She hopes to continue working as a practicing physician, while also actively studying the interplay of climate and human health. In the near future, Sorensen predicts, climate medicine will become a popular sub-specialty in schools of medicine.
“You’d be amazed how many emails Jay and I get from interested students all around the country every week,” she said. “I’m currently working with a student at Johns Hopkins University who has come to us at the University of Colorado because we’re the people doing this. We need to keep creating opportunities to involve students in whatever we’re doing.”
Just this month, the Department of Emergency Medicine in the CU School of Medicine launched a new elective for fourth-year medical students – Climate Change & Human Health. The two-week course has about 20 students, several of whom are coming from out of state. The class is being collaboratively taught by over 15 faculty members from CU Anschutz and CU Boulder.
“There is so much interest in this topic from this next generation of physicians,” Sorensen said. “People are wanting to come here to figure out what we’re doing, because it’s very unique. For fourth-year medical students, there just aren’t opportunities to study climate change and medicine.”
Added Lemery, “In terms of education on climate and health, we’re it. There’s so much work to be done.”
Each year, U.S. News compiles listings of medical schools in these two general categories based on surveys and data reviews of accredited medical schools in the United States. The magazine then assigns rankings to schools using its own criteria to assess the information, which includes peer assessments provided by professionals at other medical schools.
This year, the magazine considered 152 medical schools and 33 schools of osteopathic medicine. Of those 185 institutions, 120 responded and provided the data that U.S. News needed to calculate its rankings.
On last year’s U.S. News listing, the CU School of Medicine was No. 9 for primary care and No. 32 for research.
“The University of Colorado Anschutz Medical Campus is among the best academic medical centers in the country because of the excellent work of our faculty, staff, students, and partners,” said CU School of Medicine Dean John J. Reilly, Jr., MD. “We are continually striving to fulfill the needs of our students, patients, and community by investing in programs, facilities, and people that make our School even stronger.”
The magazine also provides rankings of specific specialties based on ratings provided by medical school deans and senior faculty from surveyed schools. University of Colorado School of Medicine programs that were ranked in the top 10 among were:
Family Medicine No. 7
Pediatrics No. 6
The School of Medicine’s Physician Assistant Program ranked No. 7 on the magazine’s separate listing of Best Graduate Schools Health Specialties Programs.
Colorado SPH moves up eight places
The Colorado School of Public Health (ColoradoSPH) is ranked No. 23 in the nation, along with nine others, out of 177 Master of public health programs accredited by the Council on Education for Public Health (CEPH), according to the U.S. News rankings.
ColoradoSPH moved up eight places from No. 31 out of 50 schools that were last ranked based on the results of peer assessment surveys sent to deans, other administrators and faculty of accredited public health degree programs or schools. The last time U.S. News ranked schools and programs of public health was in 2014; the public health rankings occur every five years.
The school, which celebrated its 10th anniversary in 2018, is now ranked in the top 25 of all schools in the country offering the Master in Public Health (MPH), and accomplished this within its first decade.
“I am delighted by this new ranking,” said ColoradoSPH Dean Jonathan Samet, MD, MS. “We will continue to move up as we develop new programs and advance our research.”
Guest contributors: Mark Couch, CU School of Medicine; and Tonya Ewers, Colorado School of Public Health
“The findings mark the first time a genetic variant has been associated with birth control,” said the study’s lead author Aaron Lazorwitz, MD, assistant professor of Obstetrics and Gynecology at the University of Colorado School of Medicine.
The study was published today in the journal Obstetrics & Gynecology.
Contraceptives are not 100 percent effective but the reasons they fail have never been fully explained.
Women are usually blamed for not using the medication properly. But Lazorwitz and his colleagues suspected that there may be other reasons at work. They looked at 350 healthy women with a median age of 22.5 years old and a contraceptive implant in place for between 12 and 36 months.
The researchers found that 5 percent of women tested had a gene called CYP3A7*1C that is usually active in fetuses and then switched off before birth. But some women with this gene continue to make the CYP3A7 enzyme into adulthood.
“That enzyme breaks down the hormones in birth control and may put women at a higher risk of pregnancy while using contraceptives, especially lower dose methods,” Lazorwitz said.
The variant could be found during genetic screening.
“When a woman says she got pregnant while on birth control the assumption was always that it was somehow her fault,” Lazorwitz said. “But these findings show that we should listen to our patients and consider if there is something in their genes that caused this.”
The findings point to how pharmacogenomics, a relatively new field which analyzes how genes affect a person’s response to drugs, has the potential to dramatically alter the field of women’s health.
“Especially in light of the social, financial, and emotional consequences of contraceptive failure and the breadth of indications for steroid hormones throughout a woman’s life-span,” the study said.
Lazorwitz said the study may help spur the development of more precise medical tools that can help tailor treatment to individual patients.
“As more genetic data becomes available, clinicians may need to consider adding genetic predisposition to increased steroid hormone metabolism in their differential diagnosis for unintended pregnancies in women reporting perfect adherence to hormonal contraceptive methods,” he said.
The study co-authors include: Christina L. Aquilante, PharmD; Kris Oreschak, BS; Jeanelle Sheeder, PhD; Maryam Guiahi, MD, MSc; Stephanie Teal, MD, MPH.
From pregnancy to parenting, it is common that many soon-to-be and new parents and have many questions along the way.
To help answer these questions, the CU Health Plan is now offering Ovia Health to CU Health Plan members.
What is Ovia?
Ovia Health offers a suite of mobile applications to help families throughout each stage of family planning with education on fertility, pregnancy and parenting, as well as specific information about the maternity benefits available through the University of Colorado.
Distinct apps meet diverse needs
Ovia Fertility: Women can learn more about their health and fertility with cycle tracking, expert research and tips and instant data feedback. Use this app to predict periods and ovulation, track symptoms and mood and get pregnant faster.
Ovia Pregnancy: Get answers to pregnancy questions with articles, health and wellness tips. Use this app to track the growth of your baby, research effects of foods and medications, learn about your symptoms and have an overall healthier pregnancy.
Ovia Parenting: Ovia Parenting supports families with expert parenting articles, daily tips and guidance based on your child’s age and the ability to share updates with friends and family. Use this app to identify and understand developmental milestones, track progress and have an easier transition to life with a new family member.
In the lead up to International Women’s Day on March 8, the CU Anschutz communications team engaged students, faculty and staff on campus in the global event, asking them to pay tribute to their personal female heroes by placing the names of women who inspire them on a #IWD2019 posterboard as a small way of saying thank you.
As the board became populated, the diversity in people’s heroes quickly became apparent. Tributes ranged from Joan Jett, to fellow colleagues, to civic leaders and Supreme Court Justices, to scientific leaders and visionaries such as Marie Curie and Rosalind Franklin. And of course: moms, grandmothers, aunts, sisters, cousins.
Watch a short time-lapse of our heroes project below.
And on this Friday, take a short moment to let someone important to you know the impact they have made on your life. We promise it will make both of your days.
On her bedroom wall, Jean Kutner, MD, MPH/MSPH, chief medical officer at the University of Colorado Hospital, associate dean for medical affairs and professor of medicine, has a framed sheet of first edition stamps featuring Elizabeth Blackwell, MD, one of the first female physicians and one of Kutner’s childhood heroes. “I remember writing book reports on her,” Kutner said. “Did I know that I was going to pursue a career having something to do with healthcare? Yeah, most likely. But this? This? Who knew?”
Kutner recently gave the keynote address, titled “Navigating Your Career”, at the inaugural Women in Leadership Power Breakfast to an audience of over 200 predominantly early career women at the CU Anschutz Medical Campus. A world-renowned expert in palliative care and geriatric medicine, Kutner said, “My entire research career has been devoted to improving quality of life for people with serious illness and their families.” Kutner joked about the job security: “Also, there will never be a shortage of older people.”
Recognize the difference between a crafted narrative and reality
“I could tell you a backward story how everything in my life pointed me to where I’m at now, and that’s absolutely the story I tell when I’m applying for a job. But reality is much messier,” Kutner began. After a bachelor’s degree from Stanford followed by medical school and an internal medicine residency at the University of California San Francisco, followed by primary care research fellowship and geriatric fellowship at the University of Colorado, Kutner joined the faculty in the CU School of Medicine in 1997.
At the beginning of her career, Kutner envisioned a traditional research path, with 20 percent clinical and 90 percent research effort as a palliative care investigator. Kutner’s journey first veered in the direction of leadership in 2002 after being recruited to acting division head of General Internal Medicine, followed by a permanent position in that role in 2005. She said, “I stepped into a division head position as a brand-new associate professor. Was that the right time to make that move? Did I know where that highway was going? No, but here we are.”
In 2014, Kutner chose to embark on a new challenge: the University of Colorado Hospital was seeking its first-ever chief medical officer. Though it was unfamiliar territory, Kutner said, “Sometimes you take a leap of faith and say yes, even though you’re not sure what you’re leaping into.” She continued, “But it helped to ask myself, what gets me out of bed in the morning?” Kutner saw the CMO role as a way to help effect change and influence patient care, while continuing her passion for mentoring the next wave of palliative care researchers in her academic role.
For those embarking on their own career journey, Kutner said, “It’s OK not to know where you are going, but it’s important to know who you are and what your passions and strengths are.” She added, “Listen to your heart. Pay attention when it doesn’t feel right. If you come home and say that was a really good day, ask yourself what happened that made it so good.”
Cultivate mentors and sponsors (and know the difference!)
Kutner credited her many mentors with her passion for research but was careful to point out that mentorship is only half of the equation. “Mentorship provided me with support and guidance for my career, but sponsorship provided opportunities — actually putting me in a room where I could demonstrate my leadership and gain more experience,” Kutner said. Relative to finding strong mentors in a new environment, Kutner referenced the children’s book, “Are You My Mother?” “Start talking to people, tell them your interests, see if there is a resonance there. Ask who else you should be meeting with,” she advised.
ABOUT THE SERIES
The Women in Leadership series grew out of a final project developed by Jan Gascoigne, PhD, assistant vice chancellor of Student Services, and Karen Aarestad, assistant vice chancellor of Advancement, during a fellowship in the Academic Management Institute for Women Leaders in Higher Education. They planned the series along with Janet Corral, PhD, associate professor of educational informatics in the CU School of Medicine, and received funding support from the CU Anschutz Staff Council, CU Anschutz Student Affairs and CU Anschutz Human Resources.
Kutner advocated for a practice she calls career walkabouts, where she seeks out senior faculty to ask, “What advice do you have looking back? Tell me about decisions you made in your career.” She continued, “When you go talk to people about their lives, and you’re not asking for resources, or space, or parking, or a raise, people are really generous with their time. It was helpful to understand how they made decisions along the way.”
It’s all life
Asked by an attendee about work-life balance, Kutner replied that the language around the conversation is wrong. “It’s life. It’s all life. Work is part of it. Family is part of it.” She added that it’s up to us to define the umbrella of life, and it’s different for everyone. “Just because I’m sending emails at 11:30 at night doesn’t mean I expect you to respond at 11:30,” she clarified.
How does Kutner find enough hours in the day? “Give yourself permission that the list is not done. Set rules and be explicit when you need to work and when you need to be present at home — don’t pretend that you can do both,” she said. She recommended taking regular breaks, such as exercise or meditation, to reflect on your passions and integrity. Kutner herself goes backpacking every year for the last two weeks of August. “Even my patients know I’m unavailable at that time.”
When the unique pressures of academia accumulate, Kutner said, “One thing that we can do for each other is to talk about the rejections. I remember when my first fellowship paper was rejected, and I was devastated. Now if a paper gets rejected, it’s a bummer to revise it but I know I’ll just send it somewhere else.” She added, “As academics, no one told us that we are embarking on a life of failure. And we need to talk about that.”
The art of graceful self-promotion
“As women, we tend to think that people will automatically recognize our amazing achievements and give us promotions accordingly,” Kutner said. “It’s not our nature to self-promote; it’s a learned skill.” Hence, she advised the audience to get comfortable telling their professional network about achievements, such as papers published or awards received. “People can’t advocate for you if they don’t know what you’ve done.”
Four and a half years into the CMO position, when she asks herself how things are going, Kutner laughingly referenced the Talking Heads song “Once in a Lifetime”:
“And you may ask yourself/ Am I right?/ Am I wrong?/ And you may say to yourself/ ‘My God! What have I done?’”
Kutner said, “I’m currently in my fourth year as CMO, and not a week goes by where I don’t say, oh my God, can I do this job? But I’m doing it. Every day, I’m doing it.” She added that she continues to learn something new every day. “How cool is that?”
The Women in Leadership Power Breakfast is a quarterly offering from the CU Anschutz Medical Campus. The next event, featuring CU School of Dental Medicine Dean Denise Kassebaum, will take place on April 16.
Guest contributor: Shawna Matthews, a postdoc at CU Anschutz
“The overall goal remains steadfast, ambitious and far-reaching: to provide the finest medical care in the world, to push the science behind that care to new horizons, and to train those who will deliver it in the future,” said CU Anschutz Chancellor Donald Elliman.
This work is fueled by philanthropy, and the annual Benefactor Recognition Dinner highlighted the progress made possible by our community of support. More than 475 people attended the 2019 event in the Seawell Ballroom at the Denver Center for the Performing Arts on Feb. 28.
CU Anschutz Chancellor Don Elliman, center, introduces special honorees Ted Harms, left, and Christian Anschutz, right, from The Anschutz Foundation at the dinner.
This year’s gathering highlighted two special honorees: The Anschutz Foundation and The Marcus Foundation. Hosts for the evening included Chancellor Elliman and UCHealth President and CEO Elizabeth Concordia, with special guests CU President Bruce Benson and CU First Lady Marcy Benson.
The event started with a video demonstrating the rapid growth of the CU Anschutz Medical Campus and the power of philanthropy for advancing its forward trajectory.
“Back in the late 1990s, a group of leaders at CU, facing considerable opposition, had the imagination to look at 230 acres of dirt and decrepit buildings and envision a thriving healthcare campus,” said Elliman. “All this has been made possible with your support in the 20 years since. Our task is now to imagine the course for the next 20 years.”
Marcus Ruzek, left, of The Marcus Foundation and Spencer Milo of the Marcus Institute for Brain Health step to the podium as special honorees at the annual Benefactor Recognition Dinner.
The Benefactor Recognition Dinner demonstrated the power of philanthropy and the unique characteristics of an academic medial campus that together add up to more than the sum of its parts. “When I first visited the Anschutz Medical Campus several years ago, I was amazed at what this campus offers,” said Concordia. “Beautiful, state-of-the-art buildings, nationally recognized education and research programs, excellent health care – and most importantly, exceptional people.”
CU President Bruce Benson and CU First Lady Marcy Benson receive a custom saddle embossed with the CU Anschutz Medical Campus logo.
In honor of President Benson’s final year at CU, Chancellor Elliman presented the Bensons with a custom saddle dually embossed with their family’s brand and the CU Anschutz Medical Campus logo.
“We hope you share our excitement about how far we’ve come and where our momentum will take us next,” said Elliman. “You helped us write the recent chapters of our history together, and you will be essential to the next one.”
Guest contributor: Devin Lynn, Office of Advancement
Stroke is the No. 5 cause of death and the leading cause of disability in the United States. On average, someone in the United States has a stroke every 40 seconds. A stroke occurs when your blood flow is stopped to a portion of your brain. With the recent death of actor Luke Perry you may be wondering what you should know about stroke and how to react if a loved one is experiencing one.
What is a stroke?
The most common type of stroke is called an ischemic stroke. This happens when a blood clot blocks an artery that brings blood to the brain. When blood cannot get to the brain, the brain tissue dies and it cannot regrow or be fixed. This often means people who have had a stroke will have residual weakness or other long-term deficits from the stroke.
The other kind of stroke is called a hemorrhagic stroke. It is caused by a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue.
Who can have a stroke?
Don’t think that stroke only impacts older people. “Anyone from a newborn infant to an elderly person can have a stroke. It is more common for older adults to have a stroke, but at UCHealth and Children’s Hospital Colorado, we see many young adults and children who have strokes.” says Megan M. Barry, DO, in the CU Department of Neurology.
How can you prevent a stroke?
Strokes can occur at any time even in otherwise healthy adults. However, there are risk factors that increase your risk of suffering a stroke.
“The most common risk factors for stroke are similar to those that we think of in heart disease: high blood pressure, high cholesterol, obesity, diabetes and smoking,” says Sharon Poisson, MD, associate professor and co-director of stroke services, CU Department of Neurology.
You can help control these risk factors by seeing your primary care doctor on a regular basis. Having a doctor look for these risk factors and control them can prevent many strokes.
What to do if you suspect someone is having a stroke?
The most important thing to remember if you think someone is having a stroke is to act FAST.
Face – Ask the person to smile. Is one or both sides of the face drooping or numb? Is their smile uneven or lopsided?
Arms – Ask the person to raise both arms. Does one arm drift downward? Is there weakness or numbness on one side?
Speech – Ask the person to repeat a simple sentence. Does the person have slurred or garbled speech? Is he/she hard to understand or speaking words that don’t make any sense together?
Time – Call 911 for immediate medical attention or get the person to the hospital immediately if you notice one or more of these signs.
The time factor cannot be overemphasized when it comes to stroke.”We have treatments that can help to stop a stroke in its tracks, but we have a short period of time to be able to use them, so the sooner the person can be seen in an emergency room, the better their chances of a good recovery,” says Poisson.
UCHealth University of Colorado Hospital is a Comprehensive Stroke Center, meaning our campus can provide the highest level of stroke care to the most complicated patients. In addition, our collaboration with Children’s Hospital Colorado means we have expertise throughout the continuum of lifespan from young infants and children all the way to older adults.
We’re also using the latest technology and treatments to improve patients lives when the worst happens. The UCHealth Mobile Stroke Treatment Unit is one of only a handful of such units in the United States and is revolutionary in Colorado and beyond. It allows on-board diagnosis and critical blood clot-busting medications to be administered to stroke patients en route to the hospital.
When Marc Moss, MD, vice chair of clinical research for the Department of Medicine at the University of Colorado School of Medicine (SOM), delivers presentations about the growing epidemic of physician burnout he shows a clip from the “M*A*S*H” TV show. In the “Heal Thyself” episode, the Army hospital hosts a top-notch replacement surgeon who ends up breaking down amid the unabated stream of wounded soldiers. The strain builds until the surgeon finally crumples to the floor, rubbing his hands together and saying to no in particular, “The blood won’t come off.”
Likewise, the real-world working environments for critical care professionals — stress-filled, with high rates of morbidity and mortality — can cause severe psychological distress. “We see a lot of tragedy in the ICU, and no one ever taught us to deal with this,” Moss said. “It’s all pretty similar to what occurred in a war setting. … The wellness of healthcare professionals is the next big issue in health care.”
A first for university
Enhancing wellness and preventing burnout among healthcare professionals, especially critical care providers, is a strong area of interest for Moss, who is also the Roger S. Mitchell professor of medicine in the Division of Pulmonary Sciences and Critical Care Medicine. Last summer, he applied for a cooperative agreement from the National Endowment for the Arts (NEA), which recently awarded $150,000 to CU to create a Creative Arts Therapy (CAT) program for critical care professionals. With additional matching funds from the Department of Medicine and the Division of Pulmonary Sciences and Critical Care Medicine, the full amount of the award is $375,000.
The long-term goal is to create a hub of creative outlets that help professionals better cope with the stressful aspects of their work.
Alarming burnout rates
The National Academy of Medicine recently recognized that “The people we rely on to keep us healthy may not be healthy themselves.” The un-wellness trends in the profession are alarming:
Over half of doctors feel their families have suffered from their choice of becoming a physician.
A 2014 national survey found that 54 percent of U.S. physicians reported at least one symptom of burnout.
Physicians have double the suicide rate of the general population.
Growing rates of depression and substance abuse.
Burnout in the health care field, which is seeing a workforce shortage amid increasing clerical burdens and pressure to reduce costs, is “really common and has devastating consequences,” Moss said. “It affects patient care, providers’ health and has economic implications.”
Other factors causing stress among health care professionals include:
Less autonomy at work (more focus on documentation, and increased shift work);
Patients are sicker (more chronic diseases and critical illnesses);
Increased patient/family expectations; and
Decreased patient trust (in 1966, 73 percent of Americans had great confidence in the medical profession; in 2012, the rate declined to 34 percent).
Research shows that health care professionals with burnout syndrome (BOS) are more likely to leave the profession, resulting in turnover that drives up health care costs, reduces quality of care, and diminishes staff morale. Through the arts interventions, the CU research group hopes to:
Reverse the trend of BOS and other forms of psychological distress in critical care providers;
Improve patient care by addressing the well-being of health care providers; and
Reduce costs by reversing the high rates of turnover.
In the next two years, CU will design four CAT programs for 150 critical care providers and test their feasibility, acceptability and effectiveness. The Division of Pulmonary Sciences and Critical Care Medicine has a strong history of studying this issue; CU’s critical care research group is one of only two U.S. groups that are funded by the National Institutes of Health to study burnout syndrome in health care providers.
In the NEA initiative, the CU research group is one of four grant awardees in the third cohort. There are two previous cohorts of four awards each, for a total of 12 awards.
Partnering with nonprofits
For the writing CAT, Moss’s group will partner with the Lighthouse Writers Workshop, which engages with many different populations, including cancer patients and at-risk youths, to use creative writing as an outlet as an emotional and relaxational outlet. For the visual arts, music and dance/movement CAT, CU will partner with the Ponzio Creative Arts Therapy Program which serves children and adolescents at the Pediatric Mental Health Institute of Children’s Hospital Colorado.
A fifth area of therapy, horticultural activity in conjunction with the Denver Botanic Gardens, is also being considered.
A major aspect of the problem, Moss said, is the stigma associated with admitting to the difficulty of maintaining personal wellness as a healthcare professional. “We’re supposed to be tough enough to do this kind of work without suffering from mental stress,” he said. Studies have shown that health care professionals are reluctant to share these problems because they’re worried about how it reflects on their medical center or may impact career advancement. “If anything, these symptoms of burnout appear in the most ideal of employees,” Moss said. “They occur in people you’d want to have as your doctor or nurse. There is a stigma; it needs to change.”
Programs to replicate nationally
While the research project hopes to demonstrate how these creative outlets can reduce burnout and restore joy to health care providers in the Denver area, the goal is to reach a broad population of professionals, Moss said. Emerging best practices could be replicated to health care workers, who work in both critical and non-critical positions, nationwide.
“The goal will be to develop these programs and disseminate them across the country,” he said.