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