A 10-Year Vision for Neuroscience by University of Cincinnati Foundation

A 10-YEAR VISION FOR NEUROSCIENCE

“I think the way you get to be the best is by starting with the people, because it’s the talent that gets you there. Recruit and retain talented people; I think that’s one of the most important ingredients to getting to be the best.” JOSEPH P. BRODERICK, MD Director, UC Gardner Neuroscience Institute

OUR INSTITUTE LEADERS AND CARE TEAMS ARE COMMITTED TO BEING THE BEST The leadership team at the University of Cincinnati Gardner Neuroscience Institute has constructed a 10-year vision that will grow our areas of excellence in research, care and education. With your partnership, we will continue to lead the way—forging pathways to potential cures, growing our outreach and influence and constantly improving patient care—as one of the best neuroscience institutes in the nation. This vision outlines our priority areas for philanthropic investments, including: Recruitment and retention of the most sought-after talent. Research focused on precision medicine and lifelong brain health. The power of big data to enhance patient care outcomes. Technology and services to connect patients to the right treatment at the right time, particularly for mental health care. Excellence in education and staffing, building career pipelines to keep up with the growing needs of neurological and neurosurgical care.

We are honored to present our vision for your thoughtful consideration. With philanthropic investments from our grateful patients, community and business leaders, we will drive new discoveries and deliver personalized care across our institute, serving as a model for other academic medical centers.

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RESEARCH Growing and retaining top talent At the UC Gardner Neuroscience Institute, our faculty leaders bring an evidence-based focus to everything we do. To attract rising-star researchers and expand our quests for discovery, we must evolve our resources to maintain the fast pace required for continual health care innovation.

Endowed chairs for clinical leadership and research faculty Historically, endowed chairs were a want-to-have, today it is a need-to-have in order for UC to be competitive with other nationally ranked academic medical centers. Chairs are essential to our ability to recruit and retain top talent among a competitive field of other neuroscience institutes. Establishing new chairs builds permanency and sustainability in our areas of excellence: Clinical leadership to advance the subspecialty care areas of: • Stroke

• Epilepsy

• Mood Disorder

• Traumatic Brain Injury

• Anxiety

• Imaging

• Neurodegenerative Disease

• Patient Outcomes

• Parkinson’s & Alzheimer’s

• Population Health

Neuroscience research chairs expand clinical trials and basic neuroscience research, to enable the discovery of new medications and treatments, and protect time for physician-scientists to balance patient care with research and teaching. An endowed research chair allows us to recruit new thought leaders or retain vital faculty and ensures continuity of important research efforts at the university. Paired with our advanced facilities and research operations, endowed chairs will attract nationally and globally recognized faculty to the UC Gardner Neuroscience Institute. This accelerates the research and development of new treatments, all to directly benefit more patients.

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Expanding research for improved outcomes MRI research technology MRI scans are now a key component of clinical research trials at the neuroscience institute— including in Parkinson’s disease, stroke, epilepsy, memory and mood disorders. Neuroimaging research allows a physician or researcher to evaluate a patient’s baseline or see how they respond to new medications or therapies. To support our robust research efforts, the institute is in need of a dedicated research scanner. An MRI focused entirely on research, with staff trained in neuroinformatics and the latest imaging techniques, will broaden our discovery efforts across all specialty areas. The outpatient facility (that opened in 2019) was built to accommodate an additional MRI with researcher staffing space. For example, the Cincinnati Cohort Biomarker Project, led by Alberto Espay, MD, involves a comprehensive collection of health data. It requires many MRI scans per year for its more than 800 study participants. With the evolution of personalized medicine our team now takes multiple images throughout a patient’s care journey to evaluate in real time how they are responding to medicine or therapies.

Research endowment fund Neuroscience is the most prolific research area throughout the academic health center and the entire university. Creating a substantial research endowment will encourage further cross-disciplinary projects across departments and centers and can spark “high-risk/high-reward” ideas that are less likely to find support through conventional grant funding. Pilot grants are the mustard seeds of research. Their results lead to much larger grants from the National Institutes of Health and other external foundations. For example, $925,000 in pilot grant funding from 2014 to 2020 resulted in $16,236,369 in monies from the government and external foundations—a 16 to 1 return on investment. A research endowment fund is critical to progress and will allow investigators to pursue more novel, long-term and untested research projects, giving them the security to take the risks that will yield breakthrough discoveries right here in Cincinnati.

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Research focused on precision medicine and lifelong brain health New approaches to precision medicine are advancing our knowledge of age-related diseases, specifically in the areas of Alzheimer’s and Parkinson’s disease:

Alzheimer’s disease Under the leadership of Rhonna Shatz, DO, Bob and Sandy Heimann Endowed Chair in Research and Education in Alzheimer’s Disease, the UC Memory Disorders Center is pioneering new approaches to neurodegenerative diseases by focusing on brain health at all stages of life. Historically, patients have not had access to a comprehensive clinical diagnosis. Our center is unique—using a framework of cognitive assessments (like sleep and gait monitoring) in combination with the collection of biomarkers. This full picture gives patients and their families confidence to develop an individualized care plan. Established research shows that more than 40 to 60% of Alzheimer’s disease and other dementia conditions can be prevented with attention to lifestyle, sleep and vascular risk factors beginning as early as childhood. Our memory care team is partnering with primary care providers to standardize tracking data points in electronic medical records such as blood pressure, cholesterol, sleep and exercise. Using this data, our team can intervene when a patient displays a deviation in cognition. With early intervention and a preventative approach, we can make lifelong brain health a reality. A significant multi-year investment to expand our research tools and recruit new faculty will drive personalized medicine in collaboration with our patients. This growth and expansion of our research and care approaches to Alzheimer’s and other memory disorders would position us for designation as an Alzheimer’s Disease Research Center (ADRC). The investment and resulting recognition and impact from an ADRC are similar to achieving National Cancer Institute designation—a best-inclass status—and are a key metric in rankings.

Parkinson’s disease Led by Alberto Espay, MD, research endowed chair of the James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, the Cincinnati Cohort Biomarker Program (CCBP) is tackling the diseases of brain aging from an ambitious new mindset, one that drops old definitions and lets the data guide and redefine a personalized medicine approach, beginning with Parkinson’s and Alzheimer’s. Thanks to support from the Gardner Family Foundation, the CCBP study is the first of its kind— working to match a patient’s biology to treatments already available to slow or stop their disease. Dr. Espay and his team have already gathered health data points from thousands of patients, including genome sequencing and neuroimaging, in order to deploy principles of precision medicine in patients with Parkinson’s and other neurological diseases. This is similar to the evolution of cancer care and treatments, where physicians can now identify 20 different types of breast cancer and individualized treatment plans, as opposed to a single “cancer” diagnosis and treatment. Dr. Espay believes neuroscientists will soon be able to definitively diagnose, treat and cure a patient with Parkinson’s disease based on their unique biological markers. In a Buenos Aires-Cincinnati collaboration, over a period of four years, the CCBP has uncovered the genetic causes of approximately 30% of 341 enrolled patients.

CLINICAL CARE Grow our patient data infrastructure, strengthen services for our centers of excellence, creating a national destination for care The power of Big Data: Improving patient outcomes To offer truly world-class care for our patients, we need to rely on not just the expertise of one doctor, but leverage the expertise of every single doctor in our institute and beyond. We must continue to scale our approaches to personalized treatment for our patients, understanding that care is unique to each individual. With the vast amount of health data now available, a physician has millions of data points at their fingertips. The flow of new information never stops as biomedical knowledge from new research doubles every 73 days. However, the time lag from putting new knowledge into practice currently takes more than a decade. The UC Gardner Neuroscience Institute is building an integrated network of research, clinical data and quality improvement processes that will rapidly deliver new learnings to the bedside, vastly improving patient care and quality and longevity of life. This network will connect all of our centers of excellence, and eventually connect us to peer neuroscience institutes like the top-ranked Weill Institute at UC San Francisco. These connectors multiply the expertise of our institute, identifying new approaches and treatments that will improve patient outcomes not only in our region, but worldwide.

Adopting a Big Data approach to care Before

After

• Average 17 years from evidence to practice.

• Less than 3 years to apply new evidence to patient care.

• Lacks patient input and learned experience.

• Patient-driven research and resources.

• Disparities in practice, decision-making.

• Aligned use of best practices, efficient and accessible evidence.

• Measures process with outcomes.

• Real-time patient outcomes that matter.

Leveraging Big Data This approach to care will measure real-world outcomes from our patients and make immediate and continuous improvements to the system as a result. Our leaders have already demonstrated how an integrated, data-driven approach can optimize patient outcomes for brain and mental health care. For example, UC’s epilepsy team has focused on controlling seizures and reducing patient barriers to medication. By partnering with patients to identify common issues, 30% of epilepsy patients were found to have at least one barrier to medication—including access or cost, forgetting to take the medication, or not taking it due to side effects. With patients contributing data in between visits, through wearable apps, surveys and/ or seizure diaries, it drives both quality improvement and research. The care teams can view all of this in a digital dashboard to look for patterns and make immediate adjustments to a patient’s treatment plan.

“Getting to the truth of a patient’s problem and how best to cure it, requires data scientists, analysts and biostatisticians—people and tools that aren’t normally part of the healthcare model. And I think this is where philanthropy and the generosity of our community and patients can make a big impact.” JOSEPH CHENG, MD Associate Director for UC Gardner Neuroscience Institute Frank H. Mayfield Endowed Chair & Professor of Neurosurgery

Technology and services As our patient outcomes continue to excel, new technology and comprehensive services in support of the whole person will evolve across the institute. Our current priorities include: • New neurosurgical technology, like the O-armTM, a 2D/3D imaging system that can reduce the risk of complications and shorten recovery time for a variety of spinal and cranial surgical procedures. • Software to improve the patient journey, upgrading our ability to seamlessly communicate with patients. • Brain health longevity program to offer in-depth neurological assessments for signature world-class preventative care. • Integrative medicine and survivorship clinics offered by the Osher Center for Integrative Health at UC, providing complementary therapies like wellness classes for nutrition, mindfulness and exercise.

Tackling the mental health care crisis The COVID-19 pandemic revealed a new pandemic of its own: the overwhelming need to better support mental health care. Over half of adults with a mental illness do not receive proper treatment. More than 28 million individuals in the United States don’t have access to care with Ohio as one of the most challenging states for patients to access care.

Rapid access services A current gap in our psychiatric services is a walk-in clinic that can provide short-term psychiatric services to immediately connect patients to the level of care they need. UC Health receives nearly 500 referrals a week of new patients urgently seeking mental health care treatment—however, with our care teams working at full capacity, we can only reach about 6% of these patients in need. A Rapid Access Care model would staff an expanded team comprised of psychiatrists, nurse practitioners, social workers and care coordinators to assess, stabilize and guide patients to necessary and appropriate treatment. A triage model of care would match patients to the right services and resources they need, to prevent more urgent and possibly life-threatening situations. Adding this level of care would increase access by 50% for those patients seeking psychiatric services.

“We’re establishing innovative care models to keep up with the growing demand for mental health care. Rapid access services would help us reach populations who desperately need to be seen, to prevent progression of illness.” MELISSA DELBELLO, MD, MS Dr. Stanley and Mickey Kaplan Professor Chair of Psychiatry and Behavioral Neuroscience

Neuromodulation center The growing demand for innovative therapies for mood disorders has created a lengthy waitlist for therapies like transcranial magnetic stimulation (TMS) and ketamine nasal spray. These therapies are provided by staff in our clinic for patient observation and safety. As one of only a few sites in the U.S. providing ketamine treatment, we are also leading the way in research to understand its effectiveness in treating depression and suicidality.

Prevention and early intervention care for mood and anxiety disorders Care services that introduce prevention strategies and early interventions for adolescents and young adults will improve long-term mental health outcomes. Currently, two in three youth diagnosed with depression and/or anxiety are unable to access the care they need. Early identification of risk and resilience factors plays a vital role in diagnosing and managing depression and anxiety disorders while facilitating access to appropriate care. Types of care may include nutrition assessments, like checking levels of Omega-3s and prescribing natural supplements, or practicing mindfulness meditation, both of which are proven to be effective without the adverse side effects of some medications. The addition of junior researchers in subspecialty areas of mood and anxiety disorders will allow us to explore untested yet promising approaches that will continue to advance personalized care, maximizing treatment effectiveness and reducing illness severity.

“I’m determined to discover the most effective treatments for patients battling anxiety and depression. This often entails trying multiple treatments before finding the right one. But what if we could begin with a treatment tailored to an individual’s unique characteristics and genes, increasing the chances of success from the start? Our research at UC is moving us closer to this goal and toward personalized medicine.” JEFFREY R. STRAWN, MD Professor and Director of the Anxiety Disorders Research Center at the University of Cincinnati A 10-Year Vision for Neuroscience | 15

EDUCATION Building excellence in care, training, specialized staffing In the hospital setting, talented nurses, resident physicians and support staff, often spend more time with patients and families than the attending physicians. These expert care teams provide compassionate, research-driven care to the bedside—and are a key component to becoming the neuroscience institute by which all others are measured.

Nursing endowment and expansion of programs The demand for neuroscience nurses is high, due in part to an aging patient population and a growing rate of neurologic conditions, paired with a national nursing shortage. This high demand is also due to the extensive and ongoing requirements for continual, progressive education and skills training that nurses need to provide care in the neurological specialty and stay abreast of evolving advances and technologies. An endowment fund will build opportunities for nurses to train, advance and contribute to the science of neurological care, further positioning our institute as a national leader in treating complex neurological problems. Investments in nursing education within UC and area schools will grow the pipeline of passionate, skilled nurses, as well as help talent retention. Additional investments will enhance our ability to support nurses with patient mobility and ambulation, technology improvements and continuing education.

Fellowship positions One-year post-graduate training programs provide the opportunity to advance in a subspecialty area of neurological care. Fellowship positions will include MDs but also extend to opportunities for physician assistants and nurse practitioners who wish to pursue specialized training. Fellows will work in outpatient, inpatient and ICU settings across all subspecialty areas of clinical neurology and neurosurgery.

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Education and training programs The UC Gardner Neuroscience Institute is a magnet of talent, attracting out-of-state high school graduates and potential graduate students to Ohio with the promise of a world-class education, mentors in research and industry, and access to leading laboratory and clinical facilities. We plan expansion and support of the following areas: • Simulation lab space and training support Several of the top programs in the country use simulation-based training: realistic clinical environments that blend learning with virtual and hands-on experiences through a model of team-based patient care. At UC, leadership from across the academic health center and UC Health have articulated a high-level vision and operational model for a simulation center that will teach not only basic procedures but also complex neurological care skills. • Diversity programming and recruitment efforts The UC College of Medicine is committed to building a more diverse physician workforce that accurately reflects the patient community we treat. Our mission is to recruit and retain talented students, residents and faculty from all ethnic, racial and gender groups into our outstanding medical center and support them in pursuing neuroscience specialties. • Continuing medical education Training programs will provide continuing medical education in our areas of excellence. New programming will offer primary care physicians opportunities to enhance learning in often requested specialties like headache management.

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FACILITIES As our institute grows, so does the need for additional spaces to provide patient care and expand clinical research Neuroscience Intensive Care Unit (Neuro-ICU) At the UC Medical Center, the Neuro-ICU is where thousands of lives are saved each year with our advanced teams providing round-the-clock care. Thanks to an investment from the James J. and Joan A. Gardner Family Foundation, UC Health is renovating this space with an improved focus on patient and family care. With this, we are seeking $2.75 million in matching gifts to transform our Neuro-ICU into a modern, healing environment for patients and families that reflects the unsurpassed level of neurological care we provide. Highlights of the renovation include: • Upgrading 22 patient rooms that provide round-the-clock care for critically ill neurological and neurosurgical patients. • Installing a circadian lighting system to promote natural sleep patterns and stave off depression, resulting in better patient outcomes up to a year after their stay. • Designing nurse workstations with a direct line of sight into patient rooms. • Transforming the lobby and waiting areas, including a patient education area and two new conference rooms for family consultations. • Creating comfortable accommodations with showering/ changing facilities so that families can stay close to their loved ones. We are positioned to lead the charge in defining a new standard of excellence in neurological intensive care.

Looking ahead, proposed areas for expansion of our footprint include:

West Chester Hospital: Dedicated neuro unit The neurological and neurosurgical specialties have a unique opportunity to customize and expand space at West Chester Hospital to accommodate growing demand from our region’s northern communities. Currently, our neurologists and neurosurgeons can see and treat patients, but are limited in the specialized space for more acutely ill patients who require intensive care. West Chester Hospital is in the planning stages for an additional new neurology wing with the expansion options for a floor of up to 36 new inpatient beds. There is an option to build out 20 dedicated neuro beds and shell 16 more beds for future phases of expansion.

Clifton outpatient building expansion When first conceived, the four-story UC Gardner Neuroscience Institute outpatient building (UC Health Clifton Campus) was designed to support up to eight floors, to allow for anticipated expansion. These floors would accommodate our growth of patient volumes, as well as our clinical research operations and expand opportunities for community partnerships with our researchers and clinicians.

MEASURES OF SUCCESS Philanthropic support will speed our time to impact in the areas of research, patient care and training the next generation. We will track and measure our success in these areas through improved scores and metrics in:

Research Our research portfolio will grow and be measured by: the number of publications in top level journals, faculty presentations at conferences, and scores/rankings from the National Institutes of Health and Blue Ridge Rankings. Additionally, we will track membership growth in premier research networks such as StrokeNET, Mood Disorders, and the Alzheimer’s Disease Research Centers (ADRCs).

Clinical Investments into personalized medicine and clinical advancements will be measured by: improving patient outcomes (relevant to a patient’s quality of life including symptoms, functionality, and physical, mental and social health), impacting key hospital metrics like decreasing mortality and readmissions rates, and improving patient safety and satisfaction. These will additionally support our reputation rankings in mass media outlets like U.S. News and World Report.

Education Being a destination for complex neurological care also means being a destination for the best and brightest talent—from students pursuing our residency and specialty fellowship programs to new clinicians and researchers. As demand increases for limited spots (for example, hundreds of fellowship applicants for 10 openings), so will competitiveness and the strength of applicants, along with the quality of care and research across the institute. Professional physician networks like Doximity and professional organizations like Association of American Medical Colleges will help us measure this.

THANK YOU We’re grateful for your thoughtful consideration of a leadership gift to our 10-year Vision for Neuroscience, that will drive us to becoming a top five institute impacting care and cures for patients worldwide.

CONTACT Emma Laverty Assistant Vice President for Development University of Cincinnati Foundation Emma.Laverty@foundation.uc.edu (610) 331-9046 Jonathan Agree Vice President for Development, Academic Medicine University of Cincinnati Foundation Jonathan.Agree@foundation.uc.edu (610) 533-3014

The University of Cincinnati Foundation | PO Box 19970 | Cincinnati, OH 45219-0970

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