|Spring 2012||Volume 27, Number 2||Findings Magazine|
Territory to State
Where Research and Policy Meet:
An unprecedented new program brings researchers from UM together with Lansing policymakers.
“Researchers across UM are engaged in significant work that can and should inform policy,” says CHRT director Marianne Udow-Phillips, an SPH alumna (M.H.S.A. ’78) and adjunct professor. “Similarly, policymakers can help faculty understand how the policy process works so that research can be better targeted to have a meaningful impact.” The first ten CHRT fellows began meeting in February in day-long sessions led by health policy leaders and subject-matter experts. Fellows are paired to produce policy-relevant work on health issues of mutual interest.
The SPH Preventive Medicine Residency:
The transition from clinician to public health physician can be “astounding,” says Matthew Boulton, director of the school’s Preventive Medicine Residency (PMR) program. Boulton should know—he went through the process himself years ago and says “it’s a radical departure from the standard clinical training trajectory. A lot of our residents are mid-career clinicians, and they want to have an impact at the population level. That was true for me.”
Founded in 1969, the SPH PMR has trained over 80 physicians for careers in clinical preventive medicine and public health. More than half of the program’s graduates in the past decade now hold leadership positions in Michigan. Last year, the program received the largest federal grant award—$2.25 million—of any preventive medicine residency nationwide. In compliance with the award, all SPH residents now spend three-month rotations in federally funded community health centers in Detroit, Jackson, or Lansing, where they provide direct clinical services to poor and underserved populations. Below, 2 PMR residents tell why they went into preventive medicine.
Anand Pathak: A Physician-Scientist: A second-year resident (at left in photo above) with a joint M.D./Ph.D. from the University of Cincinnati, Anand Pathak wants to learn how biology, socioeconomic status, and medical treatment contribute to racial disparities in cancer outcomes. He has completed research projects with the Michigan Department of Community Health and the Karmanos Cancer Institute in Detroit: "As a physician-scientist, I thought that doing a preventive medicine residency focusing on cancer epidemiology would marry my interests in science and epidemiology, all serving the public good, because cancer epidemiology can be very important in cancer prevention and control. I think there’s great synergy in combining clinical medicine, epidemiology, and basic science. It’s more efficient, and it can be more accurate, because when you’re dealing with population-level data, the number of samples is so large that you can generate really good, and theoretically sound, hypotheses. Obviously the ultimate goal is to apply this science to benefit the individual as well as public health in general."
Drew Heyding: A Doctor for the Community:
As a palliative-care physician in New York City’s Harlem Hospital Center (at right in photo above), and a graduate of Columbia University Medical Center, Drew Heyding got plenty of experience focusing “on the family in front of me.” He also learned firsthand why prevention is so vital a part of health care: "With palliative care, you’re at one end of the life spectrum, and it makes you wonder what kind of impact you could have on a person’s life if you could move back in time and play a different role. For example, if you’re trying to help a 50-year-old man who comes into the hospital with stage 4 lung cancer because he was a smoker and had poor medical follow-up, as a palliative-care person I can do what I’m trained to do, but there’s some part of you that wants to be able to step back and say, ‘This is an injustice.’ It’s the same with the patient you see the next day, a 40-year-old undocumented immigrant from South America who has liver cancer from hepatitis, and who can’t get a transplant because Medicaid will pay for the transplant but not the drugs, so no hospital will do the transplant.
Primary Care in Michigan: A Model for the Nation?
A novel approach to primary care is lowering costs, improving quality, and transforming the patient experience. What if primary care weren’t organized around a single physician, but rather around a team of health care professionals who took a systematic, team-based approach to patient care? What if systems were put in place to help manage patients with chronic disease, so that they lowered their chances of being hospitalized?
That’s the idea behind the Patient-Centered Medical Home (PCMH), a new approach to primary care that’s transforming health care systems around the country, including the UM Health System (UMHS), which introduced the approach in 2006. Since then, UMHS has seen a twofold increase in colorectal cancer-screening rates, a rise in immunization rates for pneumonia among elders, substantial improvement in diabetes management, and a “complete turnaround” in lead-screening rates for at-risk children, says SPH alumnus Lee Green, MPH '88, professor of family medicine at the UM Medical School with a joint SPH appointment, who is contributing to a statewide PCMH demonstration directed by fellow physician and SPH alumna Jean Malouin, MPH '02. Michigan is one of eight sites nationwide for the demonstration project, which is funded by the U.S. Centers for Medicare and Medicaid Services.
Green and Malouin say Michigan—with its diverse population, decentralized health-care system, high chronic-disease burden, and steep economic challenges—is an ideal place to test the new approach. A key partner in the project is Blue Cross Blue Shield of Michigan, where SPH alumnus David Share, MD, MPH ‘81, vice president of value partnerships, and colleagues have invested heavily in efforts by physicians’ organizations and practices to transform primary care in Michigan, guided by the PCMH model. “The scale of our transformative efforts in Michigan vastly exceeds similar efforts elsewhere,” says Share, “and our successes are inspiring many outside of Michigan.”
New Tools for Local Health Departments
As state and local health departments across the United States move toward a national voluntary accreditation process, Michigan—with significant help from the SPH Office of Public Health Practice—is leading the way. Last year, the practice office convened a day-long training session, or “Crosswalk,” in Lansing, aimed at providing a better understanding of national accreditation standards and how these overlap with Michigan standards—and by extension with state and local standards across the country. More info about the Crosswalk (PDF), including training talks and a document detailing similarities between Michigan’s accreditation standards and those of the Public Health Accreditation Board; also offers tools on quality assurance, community health assessment, and health planning.
Elsewhere in the State
The topics range from dental mercury to nursing homes and pertussis, but these SPH studies have one thing in common: they’re made in—and in many cases for—Michigan:
> Although mercury dental amalgam remains the profession’s most common restorative material, a three-year study by SPH researchers Nil Basu and Al Franzblau, in collaboration with the Michigan Dental Association, reveals no evidence that occupational mercury exposure causes nerve damage in dental professionals.
Joining the Union:
The State Lab
During a visit to the Michigan Department of Community Health’s laboratories in January, SPH Dean Martin Philbert met with laboratory staff and exchanged information on a range of topics, from mass spectrometry to TB genotyping, fish analysis, and infectious disease control. Over lunch, Philbert and state laboratory director Frances Downes and members of her staff discussed the future of the state’s public health workforce, and how SPH can help the lab meet its staffing needs in the coming decades.
The two institutions have a shared past: Michigan’s first-ever state laboratory opened on the UM campus in 1889, where it was known as the Hygienic Laboratory. Its director, Victor Clarence Vaughan, also taught sanitation, hygiene, and bacteriology, and his courses were the foundation of all subsequent public health education at UM. In 1907, the State Board of Health established a new public health laboratory in Lansing, where it has remained ever since.