INSIDE 2 BEYOND FILLING PRESCRIPTIONS Recently accredited community pharmacy residency program helps patients manage their meds.

3 COMICs APPROACH International graphic arts meeting showcases the power of cartoon medical narratives. 4 SPEEDY LIFESAVING TRANSPORT Rapid responders team expedites emergency support in the Johns Hopkins Outpatient Center. 6 AGING GRACEFULLY Johns Hopkins Bayview Medical Center’s PACE offers medical and social support to the elderly. DA publication for the Johns Hopkinso Medicine family mVolume 65 • Numbere 7 • September 2014 GARTH GLAZER Sharing a Vision of Health Johns Hopkins is training physicians to motivate their patients to change unhealthy behaviors.

t’s something physicians see too often: A patient is The process can also uncover undiagnosed depression hospitalized for acute symptoms of alcoholic pancre- and anxiety. “Evidence shows that if those underlying atitis—her third admission for the same reason. Al- conditions are not treated, there is less chance of success- though it’s possible to alleviate her pain and nausea, fully addressing an addiction,” says Christmas, who also the underlying reason for her illness—her alcohol directs the primary care track at the school of medicine. Iabuse—remains. She says Behavioral Medicine on the Ward, a yearlong “Physicians’ way of treating the behavioral part has been program launched last year at Hopkins Bayview, is help- TAPPING INNOVATIVE SOLUTIONS to say, ‘You really should stop drinking,’” says Colleen ing residents learn techniques to assist patients in adopt- AND TECHNOLOGY Christmas, director of the Internal Medicine Residency ing healthier lifestyles. Program at Johns Hopkins Bayview Medical Center. “As Although behavior interventions have always been a Insight is a new section that spotlights you can imagine, our success rate with that intervention doctor’s job, doing them effectively is more important how digital technologies are transforming not just communications, but also Johns hasn’t been very high.” than ever, says Roy Ziegelstein, the school of medicine’s Hopkins Medicine’s interactions with Unhealthy behaviors exacerbate many of the most com- vice dean for education. patients, colleagues, our communities and mon chronic diseases affecting adults today, including “Many of the illnesses affecting people in the U.S. relate the world. Here, you’ll find articles that obesity, diabetes, arthritis and addictions. For that reason, to health behaviors such as overeating or the use of drugs, showcase innovative developments by our says Robert Shochet, an assistant professor of medicine, cigarettes and alcohol,” he says. Meanwhile, the benefits of staff members along with insight into tapping one of the most important things a physician can do is healthy routines, such as regular exercise, are also becoming cutting-edge solutions to improve outcomes, partner with patients to create a shared vision of what their more apparent. Health care reform’s emphasis on disease efficiencies and access to information. health could be, then help them take the necessary steps to prevention and patient-centeredness is subtly changing the get there. “Doctors don’t change patients; patients change relationship between doctors and patients. Tell us what you think of Insight. themselves. But they need allies, and health professionals “Clinicians traditionally have taken the role of fixing the Complete the survey: can offer vital guidance and ongoing support.” patient’s health problems. Now, we are expanding that to hopkinsmedicine.org/insight/survey . Johns Hopkins begins training medical students to be be consultants to patients as they take a more active role in such allies as soon as they enter medical school. In the their care,” says Stephen Wegener, an associate professor in course Obesity, Nutrition and Behavior Change, for in- the Department of Physical Medicine and Rehabilitation. stance, first-year students learn about motivational inter- “Serving as consultants to patients requires us to use addi- viewing, a technique based on the premise that everyone tional skills to engage them and help them develop positive has a reason to adopt healthier habits, even if it is deeply health behaviors.” Read more about the strategic buried. Through such interviews, clinicians help patients Behavioral Medicine on the Ward begins with a two- priority for education online at identify how their behavior conflicts with a core value, week rotation in which residents hone their abilities in hopkinsmedicine.org/strategic_plan such as the desire to be a good parent or to maintain a motivational interviewing. Rachel Kruzan, a Hopkins stable relationship. Bayview internal medicine resident, says she is inspired by (continued on page 5)

Published by Johns Hopkins Medicine Marketing and Communications PATIENT SAFETY EDUCATION Putting Safety First Rx for a Successful Paul B. Rothman, M.D. Dean of the Medical Faculty CEO, Johns Hopkins Medicine Pharmacy Career ifteen years ago, the Insti- Two years strong, Johns Hopkins Home Care tute of Medi- Group’s community pharmacy residency program cine published its famous earns accreditation and fills a growing need. Freport called To Err Is Human, which blamed medical errors for s a clinical pharmacy coordinator for the Johns Hopkins nearly 98,000 deaths in Outpatient Center Pharmacy, Lubna Kousa processes pre- this country each year. scriptions for international patients. But she also meets face to Seeing that stark figure face with them to develop medication calendars and a plan to in print was a wake-up safely manage their medications by understanding side effects call for an industry not Aand drug interactions. known for transparency Kousa, who works exclusively with Johns Hopkins Medicine Interna- around outcomes. It tional patients, is one of the first graduates of the Johns Hopkins Outpatient prompted some criti- cally important work at Pharmacy’s Community Pharmacy Residency Program. It recently received Johns Hopkins Medicine and elsewhere around the country. accreditation from the American Society of Health-System Pharmacists Since then, the Armstrong Institute for Patient Safety and Quality (ASHSP). Established in 2012, it is the only such program in Maryland. and others across the organization have made headway in improving Demand for outpatient pharmacy services patient safety. The Johns Hopkins Hospital is one of the few academic When she noticed a is expected to rise as the nation’s population medical centers to be recognized as a top performer in quality by the ages and people live longer with chronic Joint Commission. We are approaching 100 percent compliance on growing need among diseases, says Amy Nathanson, clinical core safety measures. We lead the country in research to reduce cen- Middle Eastern patients manager for the Johns Hopkins Outpatient tral line-associated bloodstream infections. We have new safety dash- to better understand Pharmacy. boards to show our teams how they are performing in real time. In a ASHSP accreditation is the nationally handful of divisions, we even have appointed a chief quality officer—a their medication recognized standard for high-quality post- new position for us. The goal: to apply the same level of quantitative regimens, the Arabic- rigor we require in finance to the realm of quality. speaking pharmacist graduate training. To achieve accreditation, the outpatient pharmacy demonstrated that That said, there is still work to do. In July, a group of clinicians, crafted a pilot program nurses and others from around Johns Hopkins Medicine gathered at it could provide diverse and high-caliber an off-site retreat to brainstorm additional ideas for enhancing clinical to educate them. patient care services, while the residency excellence. In a session called “Success Stories,” Elizabeth Wick, a program was evaluated for the quality of its colorectal surgeon at The Johns Hopkins Hospital, gave an inspiring instruction and research opportunities. presentation about an initiative she is leading to improve postsurgical Trainees complete rotations in areas such as pharmacy administration, recovery. She examined colorectal surgery practices across our five pharmacy practice, informatics, medication safety and medication manage- adult hospitals and saw far too much variation. Taking outcomes into ment for patients living with such chronic diseases as HIV, hepatitis C and account, she devised a single “best” care plan for before, during and asthma. after surgery. It is too early to say with certainty whether her efforts Thus far, the program has accepted two residents each year. In addition to will curb complications, but the data so far are promising. I hope to see more and more of you take this kind of creative ini- practicing at The Johns Hopkins Hospital’s Arcade and Monument Street tiative. And I’m not the only one soliciting this kind of thinking. More pharmacy locations, residents spend time working throughout Johns Hop- often, outside groups are asking for concrete evidence of continued kins Health System outpatient pharmacies and clinics. These include Johns advances in safety and quality. Under Maryland’s new hospital-payment Hopkins Bayview Medical Center, Howard County General Hospital and system, we must show measurable improvements in quality measures Johns Hopkins Community Physicians Green Spring Station. such as readmissions and hospital-acquired infections. Similarly, U.S. Kousa and Ashley Pham, who works at the Monument Street pharmacy, News & World Report has changed the formula it uses to rank hospitals, are the first residents to have landed permanent positions as community shifting weight from reputation to a handful of patient safety indica- pharmacists with Johns Hopkins Home Care Group, which oversees the tors. outpatient pharmacies. Last year’s community resident graduates, Jonathan Johns Hopkins Medicine is committed to providing the safest care Grant and Lauren Lakdawala, also stayed with the Johns Hopkins Outpa- possible. Our goal is to partner with patients and their loved ones to eliminate preventable harm, continuously improve patient outcomes tient Pharmacy. and experience, and eliminate waste in health care. To do this, science As a resident, Kousa learned to run an outpatient pharmacy, participate in must guide the way. There are many ways to measure quality and many research projects and coordinate medication therapy management through agencies engaged in this complex undertaking. The medical profession Medicare and other providers. When she noticed a growing need among is still sorting out which methods are most valid and most viable. It is Middle Eastern patients to better understand their medication regimens, the an important conversation, one we should be leading nationally. After Arabic-speaking pharmacist crafted a pilot program to educate them. That all, our peers trust us. It’s why they consistently tell U.S. News they effort proved so successful that she developed a full-time service for interna- would feel comfortable sending us their most complex cases. tional patients. Unfortunately, as medical complexity rises and boundaries get Kousa credits the residency with inspiring her approach. “Thanks to this pushed, opportunities for error also abound. And there is very little program, I have the chance to empower patients every day.” room for error when human lives are at stake. So I thank you for the —Judy F. Minkove tremendous care and focus you put not only into healing our patients but also protecting them from harm.

To read more insights from Dean Rothman, visit hopkinsmedicine.org/leading_the_change .

“Our goal is to partner with patients and their loved ones to eliminate preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care.” Ghazi Shubayli of Saudi Arabia, who received a lung and pancreas transplant at The Johns Hopkins Hospital, was Lubna Kousa’s first patient—and the inspiration behind the pilot international pharmacy program. Shubayli went from being hospitalized monthly because of medication mix-ups to leading an active life.

2 • DOME • SEPTEMBER 2014 .

INTEGRATION MyChart Patient Activation Rates

40,000 30, 65 23, 7 All in the Family 20,000 00,404 How to enroll children in MyChart: 00,000 A resource guide to the proxy access process. 80.000 74,409 60.000 To date, more than 130,000 patients across Johns Hopkins Medicine 47, 42 have activated their MyChart account. That’s an impressive start but 40.000 still short of Meaningful Use standards for using electronic health re- Number of Patients 20.000 6,438 cord systems and avoiding financial penalties. All the more reason for care teams to help parents and guardians ob- 0 tain proxy access to children’s MyChart medical records. It’s important April–June July–Sept Oct–Dec Jan–Mar April–June July-Sept to remember that gaining access to Epic’s secure patient portal is not a 20 3 20 4 “one size fits all” process. The procedure—and degree of access—differs Dates according to a child’s legal status, age and cognitive capacities. —Stephanie Shapiro

For more information on MyChart: For an overview of the MyChart proxy access process, see the links below for helpful tips, instructions and authorization forms: n Visit hopkinsmedicine.org/epic . 1. General tips on MyChart proxy access 3. Pediatrics tip sheet on proxy access n Click on “Frequently http://tinyurl.com/lhs5buq http://tinyurl.com/l8tf2s3 Asked Questions.” n Click on “MyChart FAQs.” 2. MyChart proxy access Lunch and Learn broadcast 4. HIPAA request forms for MyChart proxy access http://tinyurl.com/mel7xkm http://tinyurl.com/ksj45wu A JHED login is required.

PEOPLE PATIENT- AND FAMILY-CENTERED CARE

Rethink Your Drink: Comics Relief The Healthy An international conference on comics and medicine considers the Beverage Initiative humanizing power of graphic novels.

tarting later this month, n Jane’s Story, a wise little owl explains to a The Johns Hopkins Hos- child how she will receive chemotherapy for Spital is introducing an a tumor in her eye. This small comic book, initiative to increase the offerings created by Lydia Gregg, a medical illustrator of healthy beverages and decrease and instructor with joint appointments in the availability of sugar-sweet- Ithe Department of Radiology and Radiological ened drinks. It’s part of the insti- Sciences and the Department of Art as Applied tution’s five-year plan to “actively to Medicine, isn’t meant to be funny—even if it’s support a healthy workforce.” filled with cartoons. Increasingly, such graphic novels are designed to Under the new program, all bev- explore social issues and serious medical matters erages will be classified by color, in a way that makes them more comprehensible to based on the density of calories the general public. per ounce and the volume of This summer, 235 people flocked to Johns Hop- each beverage container: kins’ East Baltimore campus to attend the fifth annual international Comics and Medicine con- Green: water, unsweetened tea/ ference. The three-day event, held in the school coffee, skim/2 of medicine’s Preclinical Teaching Building, was percent milk, diet beverages chaired and organized by Gregg in collaboration with Corinne Sandone, director of the graduate Yellow: low-calorie fruit drinks program in medical and biological illustrations, and sports drinks, 100 percent and Gary Lees, director of the Department of Art fruit/vegetable juice as Applied to Medicine. The theme of this year’s conference was “From Red: fruit drinks, soda, sports Private Lives to Public Health.” Roughly 80 drinks, coffee drinks, whole milk speakers from throughout the country and over- seas highlighted how personal health narratives By October, meetings and and such issues as barriers to health care and the events at the hospital will only stigma of illness are portrayed in comics. provide beverages in the health- Speakers included Jeff Day, a medical and ier categories. Also, you will no- biological illustration student who delighted the tice changes in the availability, audience by doodling clever drawings as he spoke size and pricing of certain bev- about creating a cartoon guide on how to avoid erages in the cafeteria and retail harm while exploring nature. Medical student In Jane’s Story, written and drawn locations in the hospital. Lena Caron described her research into the en- by Lydia Gregg, Jane asks Otus during popularity of the 66-year-old Rex Morgan the Owl to explain how a tumor These changes are already in M.D. comic strip. Although tackling serious sub- in her eye will be treated. effect at Johns Hopkins Health- jects such as domestic violence and drug abuse, Care and Johns Hopkins Home the strip owes its continuing success, Caron said, to an observa- “I think the speakers did a wonderful job showing how the Care Group and will be imple- tion by the late Nicholas Dallis, the strip’s creator: “Messages comics medium is powerful at capturing multiple perspec- mented across other Johns Hop- don’t keep people reading—a good story does.” tives—from the patient, doctor, student, family member, etc.,” kins Medicine organizations. Gregg says her goal in organizing the conference was to pro- says Adela Wu, a second-year medical student. mote comics’ remarkable ability to convey “difficult-to-describe —Neil A. Grauer scenarios, events and emotions.”

DOME • SEPTEMBER 2014 • 3 PATIENT- AND FAMILY-CENTERED CARE

The Johns Hopkins Outpatient Center’s rapid response team and the Lifeline critical care transport team perform frequent code simulations to sharpen their ability to respond to a wide variety of emergencies. A Lifesaving Shortcut Rapid responders team with critical care transport workers to speed up emergency support in the Johns Hopkins Outpatient Center.

ast winter, Johns Hopkins physician Swift and coordinated, the two-stage re- an anesthesiologist, pharmacist and security Dwight Wooster had just stepped sponse was “lifesaving,” says Wooster, an officer—stabilizes the patient. Then, Lifeline into a crowded elevator in the Johns internist and pulmonologist, who recently takes over to care for and transport the patient Hopkins Outpatient Center when returned to his clinical practice and teach- to the Emergency Department. “That way, our he collapsed in cardiac arrest. One ing duties in the school of medicine’s inter- team is able to stay in the building to care for Lhospital worker immediately called a Code nal medicine clinics. Receiving care during other assigned patients in the Outpatient Cen- Blue to the Department of Emergency Medi- transport by ambulance to the Emergency ter, minimizing interruptions in routine care,” cine’s Lifeline Critical Care Transport Team’s Department is the safest option on a campus Kubiak says. dispatch center, while another began chest with untold twists and turns, he says. “This is Since the ambulatory emergency response compressions on the pulseless Wooster. a city within a city, the way I look at it. In an tactic debuted more than two years ago, In fewer than five minutes, the Outpatient emergency, you have to find the path of least code calls from the Outpatient Center have Center’s rapid response team members took resistance.” doubled, from an average of six calls a month control of Wooster’s care. They pulled him As the Sheikh Zayed Tower and The Char- to 14. The increase could reflect higher patient halfway out of the elevator for better access lotte R. Bloomberg Children’s Center neared volume at the Outpatient Center as well as and began resuscitation and intubation. Mo- completion several years ago, Julie Kubiak, more patients who are very sick, Kubiak says. ments later, the Lifeline emergency transport assistant director of nursing for ambulatory The calls come from clinics, outpatient sur- team arrived and worked with the first re- care, realized that the new adult and pediatric gery, Express Testing and the Outpatient Cen- sponders to stabilize Wooster before rushing emergency departments were a lengthy walk ter lobby. Most concern patients and visitors him by ambulance three long blocks away to away, posing a patient safety risk in an emer- who experience shortness of breath, chest pain, The Johns Hopkins Hospital’s Emergency De- gency. Kubiak collaborated with the Lifeline a fall or loss of consciousness. partment. Critical Care Transport Team—the critical Using frequent code simulations, post-re- care transport service for patients en route to sponse debriefings, cross-disciplinary collabo- or within The Johns Hopkins Hospital—to ration and data analysis, the combined teams Receiving care during transport create an alternative system that would take continue to sharpen their ability to respond to by ambulance to the Emergency patients to the Emergency Department from a wide variety of emergencies, Newton says. Department is the safest option on a outside, instead of through the halls, under- Their duties will soon expand. Members of the campus with untold twists and turns. ground corridor and elevators. hybrid response team are now preparing to Kubiak and Scott Newton, assistant director provide overnight coverage to the Sleep Disor- —DWIGHT WOOSTER of nursing for Lifeline, mapped out the two- ders Center, located in the Outpatient Center. stage emergency response plan used to trans- —Stephanie Shapiro port Wooster. First, the Outpatient Center’s rapid response team—a physician, two nurses,

4 • DOME • SEPTEMBER 2014 EDUCATION

Sharing a Vision of Health (continued from page 1)

how quickly clinicians trained in at the Johns Hopkins Center this approach can help patients. Her for Behavior and Health, Vital colleague Jason Liebowitz, for ex- Score is modeled after the ample, was able to assist a man hos- Apgar score used to assess new- pitalized for a heart attack who was borns at one and five minutes also diagnosed with diabetes. Hail- after birth. Using a numerical ing from a large Italian family, the scale of one to 10, Vital Score patient resisted giving up the pasta measures the health of patients and bread he loved until Liebowitz based on their answers to ques- helped him realize that he wanted tions about exercise, smoking, to stay healthy enough to keep his sleep, diet and drinking. physically demanding shipyard job. Kruzan says that merely Between his discharge and first receiving a health rating will follow-up appointment, the patient drive patients to try to improve followed a low-carb diet and shed it. “No matter what they score, Jason Liebowitz and Rachel Kruzan talk to a patient several pounds. Most important, he whether it’s a four or seven, they about her progress. kept his blood sugar under control. ask me about gyms and diet Residents taking the course and tell me they want to score also use Vital Score, a tool to help higher when they come back,” she “Sometimes we physicians and change unhealthy behaviors. Invent- says. residents hold ourselves to a different Foundations of ed by Hilary Hatch, an instructor To illustrate how difficult it is to standard—we say we’re busy, we’re change behavior, the program re- doing important work,” Liebowitz Motivational Interviewing quires residents to initiate their own says. “But janitors and bus drivers, • Showing compassion and seeking “Doctors don’t change self-improvement regimens. For two they work hard and do important to understand patients’ priorities, patients; patients change weeks, they wear a Fitbit biometric work, too, and also have family thoughts and feelings. bracelet to establish baseline readings responsibilities. Everyone faces the themselves. But they • Evoking patients’ own motivations for need allies, and health of their activity levels, sleep patterns same challenges. With the right change. One patient may quit smoking professionals can offer and more. Then they set a goal, like motivation, we can all change our because his father died of cancer; vital guidance and ongoing losing 5 pounds or increasing their health behaviors in a positive way.” another, because her partner resents sleep to at least seven hours per —Christina DuVernay the secondhand smoke. support.” night, for the following month. When Liebowitz chose to walk at For a list of courses focused on com- • Accepting that patients have a right to Robert Shochet, assistant make their own decisions. least 10,000 steps per day, he also municating effectively with patients, professor of medicine learned how much he has in com- visit www.hopkinsmedicine.org/ mon with his patients. dome .

The SOURCE for a Life of Service The Student Outreach Resource Center allows medical students to take their learning out into the world.

lthough Cody Cichowitz has participat- ed in a number of service projects over the years, he was unprepared for the re- wards of working with an organization that helps refugee families navigate the AU.S. health care maze. “These families remind me why I want to study medicine and have helped me under- stand how medical professionals can serve patients and those in need,” says the second-year medical student. The Refugee Health Pathway is one of many com- munity outreach projects available to medical students through the auspices of the Student Outreach Re- source Center, or SOURCE. Directed by Mindi Levin, SOURCE is a joint community service and service learning center for the school of medicine, the school of nursing and the Bloomberg School of Public Health. It supports dozens of service-based student groups, Through two service projects, M.D./Ph.D. student such as the Refugee Health Pathway, and partners with Melissa Liu and medical student Cody Cichowitz help patients in East Baltimore gain access to care. more than 100 nonprofits in Baltimore. Every year, some 200 medical school students take part in com- munity outreach projects through SOURCE, which will celebrate its 10th anniversary in 2015. The Refugee Health Pathway pairs a small team of is preparing him to practice 21st century medicine, 335 people were screened, with 126 referred to Wilmer. medical students with a refugee family referred by the Cichowitz says. “If I get stumped, one of my teammates Fifth-year M.D./Ph.D. student Melissa Liu, who now International Rescue Committee at the Baltimore Re- will know what to ask or what to say.” directs Student Sight Savers, says she is drawn to oph- settlement Center. The families come from all over the Student Sight Savers is another organization that thalmology because of the widespread need for access to world—Sudan, Nepal, Iraq, Eritrea. “We do home visits brings medical students into the community. Started in vision care. Community service work also makes what and help them come up with questions to ask the doc- 2011 by former medical student Thomas Johnson, now she studies less abstract. “It allows medical students to tor,” says Cichowitz. The students also connect the fam- an intern, it performs eye screenings at local communi- reach out to East Baltimore residents in a very power- ilies to community resources, such as medical clinics ty events under the supervision of faculty ophthalmolo- ful way,” she says. “With Sight Savers, I’m putting my and food banks, and advise them about the nutritional gists. Those with potential medical issues, such as glau- learning to work.” value of American food. coma or diabetic retinopathy, are referred to the Wilmer —Christina DuVernay Working in teams and witnessing the social and Eye Institute, where they receive free care if they do not cultural factors that affect the health of these families have health insurance. As of March 2014, Johnson says,

DOME • SEPTEMBER 2014 • 5 PATIENT- AND FAMILY-CENTERED CARE

From left, Hedy Johnson, Lillian Phillips and Carolyn Sawyer enjoy medical and social support from the Johns Hopkins ElderPlus program. A Comfortable Old Age PACE finds solutions to the challenges of aging in place.

he day center of Johns Hopkins’ The focus is less on treating ailments and more on Studies of PACE show that people in the pro- ElderPlus program is bustling: On improving quality of life. gram, who must be old and sick enough to qual- one side of the large room, men “This is a very important approach for people ify for nursing home care, remain in their com- and women in chairs lift their arms who are older adults,” says Laura Gitlin, director munities, have fewer hospital visits and are more in unison during a seated exercise of the Center for Innovative Care in Aging, based likely to die at home, as they wish, instead of in a Tclass. On the other side, people greet each other in the nursing school with representatives from hospital or nursing home, says Matthew McNab- as they arrive, some in wheelchairs, others push- the schools of medicine, public health, business ney, medical director for PACE and associate pro- ing walkers or leaning on canes. and engineering. fessor of geriatric medicine, who authored some of Lillian Phillips, 83, chats with her friends “The health system is bent on managing disease the research, which he conducted with colleagues Hedy Johnson and Carolyn Sawyer. Phillips, who but ignores the consequences to disease—often from the National PACE Association. comes to the center twice a week, lives alone in more problematic than the disease itself, such as Though PACE has 103 locations nationwide, the three-story East Baltimore row house where functional difficulties, preparing meals or bath- the Johns Hopkins center is the only one in she raised 11 sons and daughters. Two years ago, ing,” she says. Maryland, which allows, by state law, just 150 when her children became concerned about her The freedom to purchase what’s needed for participants. McNabney believes demand exists ability to live by herself, she joined a waiting list PACE participants without worrying about bill- for a second center in Baltimore or elsewhere in for PACE (Program of All-Inclusive Care for the ing for each procedure and piece of equipment is Maryland. Elderly) based at Johns Hopkins Bayview Medical central to the success of the national program. It Meanwhile, the current participants seem Center. In August 2013, she got in. came to Johns Hopkins, where it is known as El- pleased with the care they are receiving. “I wouldn’t want to be in a nursing home,” says derPlus, in 1996. Funded by Medicare and Med- Sawyer, 72, lives in East Baltimore with her Phillips, who has diabetes. “I like where I am.” icaid, PACE uses a “capitated” payment system, 86-year-old husband, David. She has diabetes and In addition to the day center, PACE provides providing a lump sum per participant per month. chronic obstructive pulmonary disease, which medical care, counseling, transportation and even That means a participant with troubled breath- requires her to breathe through oxygen tubes. She services such as cooking or laundry, if needed. ing might receive an air conditioner not normally enrolled in PACE because it “provides so many An occupa- covered by Medicare or Medicaid, says Jack services,” she says. PACE caregivers came to her tional therapist Rund, director of operations for Johns Hopkins home, told her to pull up her allergen-trapping “ I wouldn’t want to be in a nursing inspects the ElderPlus. “What’s their greatest need?” he asks. carpet and installed grab bars in her bathroom. home. I like where I am.” home of every “What’s going to keep them safely at home? She attends a PACE-organized support group —Lillian Phllips PACE partici- What’s going to ease the burden of the caregiver?” called Puffers for people with oxygen tanks. She pant, suggest- To ensure that those questions are answered, participates in PACE activities and gets help from ing health and each PACE participant is the subject of a team PACE staff when her dentures bother her. safety improvements. “Everything you need is meeting twice a year that involves about 15 peo- Johnson, 82, has been in PACE since she was right here,” Phillips says. ple, including nurses, social workers, occupational diagnosed six years ago with transverse myeli- Older people with chronic ailments, like Phil- therapists, a doctor, a day center staffer, a medical tis, a spine condition that causes her to lose her lips, are too often voracious and inefficient con- device coordinator and a dietitian. balance. Through PACE, she goes on trips to sumers of health care, particularly if they lack Every Thursday at 8:15 a.m., the team gathers the theater and museums, and she comes to the consistent care and instead seek treatment in in a Hopkins Bayview conference room to discuss PACE center four days a week. “You don’t sit in a emergency rooms, geriatricians say. PACE is part one person at a time, including that individual in corner,” she says. “They keep you from feeling like of a movement, increasingly urgent as the popula- the conversation when possible. Thanks to such you can’t do anything.” tion ages, that combines medical and nonmedical sessions, one woman who “furniture surfs” be- “People make you feel so welcome,” says Phil- interventions in creative ways. cause she doesn’t want to take her walker on the lips, who clearly enjoys her time with Sawyer and Key to this strategy is visiting people at home stairs will now get a second walker to keep on the Johnson. “When you’re eating together, people to solve problems as basic as empty fridges, inac- top floor of her home. Another will begin receiv- have a tendency to talk more.” tivity, exhausted caregivers and trip-hazard rugs. ing Meals on Wheels. —Karen Nitkin

6 • DOME • SEPTEMBER 2014 BIOMEDICAL DISCOVERY A Possible Missing Link to Understanding Type 2 Diabetes

orking with mice and human blood and liver samples, Johns HopkinsW Children’s Center investi- gators have identified a previously unsuspected liver hormone as a criti- cal player in the development of type 2 diabetes, a condition that affects nearly 26 million people in the United States and is a leading cause of heart disease and stroke, as well as kidney, nerve and eye damage. The study shows that the hormone kisspeptin 1, or K1—up until now known for its regulation of puberty and fertility—also slows down the production of insulin, the sugar- regulating hormone secreted by the pancreas, and in doing so fuels the development of type 2 diabetes. The findings, published in the jour- nal Cell Metabolism, provide what researchers consider a missing link in understanding the origins of type 2 diabetes. Two hormones, glucagon and insulin, must work in synchrony to maintain healthy sugar levels in the Endocrinologist Mehboob Hussain’s studies bloodstream. Secreted when sugar lev- revealed that the hormone kisspeptin 1 A Comfortable Old Age (K1) suppresses pancreatic cells’ function, els drop, glucagon causes the liver to causing reduced insulin secretion. release its strategic reserves of glucose PACE finds solutions to the challenges of aging in place. into the bloodstream. Insulin acts as an antidote to glucagon and helps the body lower blood sugar by transporting insulin output until they stop making endocrinologist and metabolism expert at theory, cure diabetes, instead of simply it out of the bloodstream and into organs insulin altogether. the Children’s Center. mitigating its symptoms. and tissues as fuel. In type 2 diabetes, The new findings, however, show that The identification of K1 as a key The Johns Hopkins team says it has pancreatic cells secrete too little or no the pancreatic cells don’t just get tired; their player in diabetes offers a possible new already identified a hormonelike sub- insulin at all, leading to a dangerous function is directly suppressed by K1. treatment target that could lead to the stance that blocks the K1 receptor in the buildup of sugar in the blood. “Our findings suggest that glucagon development of drugs that restore the pancreatic cells of mice. The investigators The prevailing wisdom has been issues the command, but K1 carries out function of the insulin-secreting cells. will next study whether this receptor- that exposure to chronically elevated the orders, and in doing so, it appears to Currently, diabetes therapy is based on blocker can restore the function of glucagon and blood sugar levels takes be the very cause of the declining insulin injecting synthetic insulin to maintain human pancreatic cells. a gradual toll on the pancreas, and its secretion seen in type 2 diabetes,” says blood sugar levels. However, restoring —Ekaterina Pesheva overworked beta cells slowly decrease lead investigator Mehboob Hussain, an natural insulin production could, in

BRIEFCASE

Advancing Military level. Zaminsky Gynecologic Cancer and Veterans and Adam Hart- Awareness Symposium Research man won the faculty awards; Each year, nearly 88,000 women SAVE THE DATE Zachary Kaminsky spends Denver Lough, in the United States are diag- much of his time identify- Aleah Roberts, nosed with a gynecologic cancer, Nov. 1, 2014: A Woman’s ing biological markers Ben Hung, according to the American Can- Journey turns 20: Don’t miss for suicidal behavior in Devin Miller and cer Society. To mark Gynecologic the premier conference on military service mem- Sujith Sajja each Oncology Awareness Month, the women’s health. Details: bers—studies he hopes received $10,000 Johns Hopkins Kelly Gynecologic http://tinyurl.com/kpc5f9k. will one day prove trans- grants. Judges Oncology Service will offer a sym- formative in preventing included mem- posium at the Baltimore Marriott veterans’ suicides. His bers of the JH- Waterfront on Sept. 27 regard- research recently got MVHI steering ing state-of-the-art treatment a boost from the Johns committee and updates and cancer survivorship Hopkins Military & Vet- leaders from for women with ovarian, fallopian erans Health Institute the Department tube, primary peritoneal and improving cancer survivorship and (JHMVHI). Kaminsky, an of Defense. Relevance of the pro- uterine cancers. Featuring physicians the role of “unsung hero” caregivers. assistant professor in the Depart- posed research to service members, and researchers from Johns Hopkins, There will also be ment of Psychiatry and Behavioral veterans and their families was a key Massachusetts General Hospital and a nutrition and wellness program. Sciences, is one of seven researchers factor in the competitive process. other nationally recognized cancer The symposium is co-sponsored to receive inaugural grants from the Johns Hopkins Medicine provides care centers, the symposium runs from 8 by the Greater Baltimore Medical JHMVHI’s research program. The for roughly 42,000 veterans and their a.m. to 4 p.m. and is free to cancer Center. For details and registration, group bestowed five grants of up to families, under a DOD contract with survivors and their families. Topics call 410-955-8240 or visit the Founda- $10,000 to students, residents and fel- Johns Hopkins HealthCare. To learn include the latest clinical trials and tion for Women’s Cancer website at lows, and two grants of up to $25,000 more about the institute, visit http:// novel treatments for gynecologic foundationforwomenscancer.org. to faculty at the assistant professor wp.jh.edu/jhmvhi/. cancers, sexual health, menopause,

DOME • SEPTEMBER 2014 • 7 who / what Picture THIS

Bloomberg oncology and pediatrics and will Professorships collaborate closely with George Dover, M.D., professor and Patricia Janak, Ph.D., has been director of the Johns Hopkins appointed to a Bloomberg Dis- Children’s Center, to manage tinguished Professorship, joining its multifaceted clinical and re- a group of world-class scholars search centers. formed earlier this year to anchor collaborative, interdisciplinary Jonathan Lewin, programs across the university. M.D., senior vice Janak, most recently a professor president of integrat- of neurology at the University of ed healthcare deliv- California, San Francisco, will ery, professor and di- hold joint appointments in the rector of the Depart- Department of Neuroscience in ment of Radiology the school of medicine and in and Radiological Science, and the Department of Psychological radiologist-in-chief at The Johns and Brain Sciences in the Krieger Hopkins Hospital, has been School of Arts and Sciences. Also elected president of the Associa- appointed a Bloomberg Distin- tion of University Radiologists. guished Professor is Kathleen Frank Lin, M.D., Sutcliffe, Ph.D. , formerly a pro- Ph.D., associate pro- fessor of business administration, fessor of otolaryn- management and organizations at gology–head and the University of Michigan. Sut- neck surgery, geron- cliffe will hold joint appointments tology, mental in the Carey Business School and health and epidemi- NEW MOTHERS OF INVENTION: If you can get anything from chips to live bait in a vending the school of medicine, where ology, has received the Hearing machine, why not storage bottles, breast pads, nipple cream and nursing pump accessories? When Meg Stoltzfus, a program manager with the Office of Work, Life and Engagement, asked she will be part of the Armstrong Loss Association of America’s Institute for Patient Safety and herself that question, a great idea was born. Last month, Stoltzfus oversaw the installation of a 2014 James B. Snow, Jr., M.D. vending machine stocked with pumping necessities in a nursing mothers’ room in the hospital’s Quality and will participate in the Award in recognition of his com- Nelson/Harvey Building. The vending machine, believed to be the first of its kind, is part of Individualized Health Initiative. mitment to research on hearing Johns Hopkins’ Breastfeeding Support Program and sells items at a discount to employees. In this photo, Melanie Cragway, a clinical customer service coordinator in the neurosciences Healthnetwork loss and how it affects people as they age. critical care unit, makes a purchase from the new vending machine. Foundation Awards Jeffrey Palmer, Paul Auwaerter, M.D., professor M.D., professor and of medicine and clinical direc- director of the De- JOHNS HOPKINS tor of the Division of Infectious of Psychiatry at Johns Hopkins VIP List celebrating young pro- partment of Physical Bayview, has received The Johns COMMUNITY PHYSICIANS fessionals under the age of 40. Diseases, and Michael Polydef- Medicine and Reha- kis, M.D., associate professor of Hopkins University’s Alumni Melissa Helicke, Akbar has been with Johns Hop- bilitation, has been Association 2014 Excellence in neurology and director of the M.B.A., former assis- kins Medicine International since named an Honorary Teaching Award. Cutaneous Nerve Laboratory, are tant dean at Johns 2008, managing projects in the International Member of the Middle East and North Africa. two of 10 physicians nationwide Japanese Association of Rehabili- Laura Hanyok, M.D., assistant Hopkins Bayview, as to receive $10,000 service excel- tation Medicine. Palmer, who professor of medicine, has been well as administrator lence research awards from the also is physiatrist-in-chief at The selected out of a national pool of of the Department of Healthnetwork Foundation. Johns Hopkins Hospital and di- 91 medical and nursing educa- Medicine there, has Follow Johns Hopkins Medicine rector of the Oral Functional tors to be one of six Macy Fac- become vice president of practice EAST BALTIMORE and Swallowing Laboratory, gave ulty Scholars for 2014. Funded operations for Johns Hopkins f Facebook: Ahmet Baschat, M.D., B.Ch., the keynote address at the associ- by the Josiah Macy Jr. Founda- Community Physicians. facebook.com/JohnsHopkinsMedicine an internationally recognized ation’s annual meeting in June. tion, the $100,000 annual grant t Twitter: authority on the screening, for each of the next two years SIBLEY MEMORIAL twitter.com/HopkinsMedicine David Valle, M.D., HOSPITAL prevention and management of will enable Hanyok to spend at YouTube: Ph.D., professor and least half of her time pursuing a yt placental dysfunction and fetal director of the McK- Sibley’s Get With the Guide- youtube.com/user/ growth restriction, has been ap- mentored educational innovation lines-Stroke program received JohnsHopkinsMedicine usick-Nathans Insti- project and to engage in other pointed professor and director tute of Genetic The American Heart Association/ of the Johns Hopkins Center for opportunities to enhance her ca- American Stroke Association Medicine, has re- reer as an educator. Fetal Therapy. ceived the American Gold Plus Quality Achievement Jessica Bienstock, M.D., Society of Human Genetics’ Vic- HOWARD COUNT Y Award for implementing specific M.P.H., professor and director tor A. McKusick Leadership GENERAL HOSPITAL quality improvement measures for of the Department of Gynecol- Award for his achievements in treating stroke patients. ogy and Obstetrics’ residency fostering and enriching the de- Heart Care Honors Joanne Miller, M.S.N., R.N., Dome program, has been chosen to rep- velopment of human genetics a veteran of more than 20 years resent the school of medicine in disciplines. The American Heart Associa- Published 10 times a year for members of tion has given its Lifeline Bronze with progressive nursing leader- the Johns Hopkins Medicine family by the 2014 Executive Leadership in ship experience, has been named Marketing and Communications. Academic Medicine Program. Marketing and Communications Receiving Quality Achievement Award to Howard County Gen- vice president for patient care ser- The Johns Hopkins School of Medicine Joseph Cofrancesco, M.D., The Health Information Re- eral Hospital for implementing vices and chief nursing officer. The Johns Hopkins Hospital source Center has bestowed Johns Hopkins Bayview Medical Center M.P.H., director of the Johns specific association-recom- The marketing team has received Howard County General Hospital Web Health Awards on all eight Johns Hopkins HealthCare Hopkins Institute for Excellence mended quality improvement a Silver Award from the Aster Johns Hopkins Home Care Group in Education, has been named the videos the Marketing and Com- measures for the treatment of munications team submitted to Awards, a medical marketing pro- Johns Hopkins Community Physicians inaugural Johns Hopkins Insti- patients who suffer severe heart gram sponsored by Creative Im- Sibley Memorial Hospital tute for Excellence in Education its competition for the highest- attacks called ST-segment eleva- Suburban Hospital Healthcare System quality digital health resources ages Inc., in the poster/display se- All Children’s Hospital Professor of Medicine. Appointed tion myocardial infarctions. ries category for the hand hygiene director of the institute in 2009, for consumers and health pro- Editor fessionals. For more info, visit The Maryland Institute for campaign material that was post- Linell Smith he has developed it into a national ed on the inside of the elevators leader in academic medicine. http://www.healthawards.com/ Emergency Medicine Services Contributing Writers wha/news.html. Systems has granted a five-year in the main hospital and the Re- Christina DuVernay, Neil A. Grauer, naissance Building. Judy F. Minkove, Karen Nitkin, David Hackam, M.D., Ph.D., re-designation as a Cardiac In- Ekaterina Pesheva, Stephanie Shapiro recognized worldwide for his JOHNS HOPKINS terventional Center to Howard SUBURBAN HOSPITAL Copy Editors groundbreaking studies of intes- BAYVIEW MEDICAL County General for meeting the Abbey Becker tinal inflammation and injury CENTER state’s highest standards in the Jason Cole has become the Judy F. Minkove in infants, has been named the care of patients who have been hospital’s first senior director of Designer Margaret Chisolm, M.D., asso- Robert Garrett Professor of Pedi- transported to the hospital by information systems. Previously Dave Dilworth ciate professor of psychiatry and atric Surgery and chief of pedi- emergency medical services after information technology director Photographer behavioral sciences and director atric surgery at Johns Hopkins. suffering an ST-segment eleva- for Johns Hopkins Community Keith Weller of education for the Department He also holds professorships in tions myocardial infarction. Physicians, where he oversaw its Dalal Haldeman, Ph.D., M.B.A. conversion to Epic, Cole will man- Senior Vice President, Johns Hopkins Medicine age the daily operations of the Marketing and Communications hospital’s information systems, Pain Management Symposium: Taking Pain Seriously Send letters, news and story ideas to: focusing on service delivery and Editor, Dome The Johns Hopkins Hospital Pain Task this topic at a symposium on Monday, improved customer service. Johns Hopkins Medicine Force is on a mission to make sure Sept. 29, from 8 a.m. to 1 p.m. in Marketing and Communications JOHNS HOPKINS 901 S. Bond St., Suite 550 that frontline staff members across the Sheikh Zayed Tower, room Baltimore, MD 21231 2117. MEDICINE Phone: 410-955-2902 the system always treat the subject Learn which procedures safety Email: [email protected] of pain seriously. Join nurses, doc- data show are a major source of patient INTERNATIONAL tors, pharmacists, social workers and complaints and about the latest findings Read Dome online at Awais Akbar, M.B.A., a senior hopkinsmedicine.org/news/publications/ representatives from the service excel- on ways to manage pain without medi- associate project manager special- dome lence team who report to the hospital’s cation. To register, contact Eileen Kasda izing in developing and building © 2014 The Johns Hopkins University and Patient Safety Committee to discuss at 410-502-3903 or [email protected]. strategic partnerships, has been The Johns Hopkins Health System Corporation. named to The Daily Record’s 2014

8 • DOME • SEPTEMBER 2014