WINTER 2018
ACADEMIC ENTERPRISE
Advancing research, health care and education in Texas and beyond
Five years of extraordinary people working wonders
T
his past fall marked my fifth year at The University of Texas Medical Branch (UTMB) in Galveston. When I joined UTMB in 2012, I was excited about the possibilities ahead like just about everyone I met. In my very core, I knew it would be an honor to work alongside the institution’s diverse collection of administrative and support personnel, internationally renowned scientists, awardwinning teachers, master clinicians, as well as the thousands of inspiring young men and women attending our schools. And, I had heard the stories about how UTMB’s community came together, lifting each other up during the aftermath of 2008’s devastating Hurricane Ike. I met many of the people, from senior leaders and managers to frontline staff members, who had pulled on their rubber boots and UTMB leadership members celebrated at the 2017 Vizient Clinical Connections waded in to help the institution and the communities we Summit held September 14 in Denver. From left: Dr. Danny O. Jacobs, Adam Spieker, Cheryl A. Sadro, Dr. Gulshan Sharma, Deborah McGrew, Donna serve recover. That kind of dedication and resilience is Sollenberger, Ann O’Connell, Dr. David Marshall and Dr. David L. Callender. special. Nevertheless, there are many areas where we can continue Because of the hard work, determination and heart of our to improve. We still have work to do! But, further progress is members, and with our President’s leadership, we have been within our reach and can be measured in “real time.” I am able to work wonders to advance our research and education incredibly proud to be part of the great things happening at programs and improve the lives of those we serve even in the UTMB every day. This special fifth issue of our magazine is a face of recent challenges such as Hurricane Harvey (more tribute to UTMB’s outstanding people, who make extraordinary on Page 8). In fact, we can point to many accolades or other progress possible. evidence of our efforts to get better every day. So, whether you are an employee, trainee, alumnus, friend, For example, in Fiscal Year 17 alone, UTMB earned a family member, advocate, supporter or simply an interested national quality award for patient care, welcomed more party, thank-you for all that you do, have done or will do for students than ever before, received an additional $7 million in our institution and its people. research dollars and earned recognition as a best place to work in our region. Since I have been blessed to be part of this great organization, we have built two new hospitals, broken ground on a new Health Education Center, created new and innovative Danny O. Jacobs, MD, MPH, FACS educational programs for our trainees, and established several Executive Vice President, Provost and internal and external partnerships that strengthen our ability to Dean of the School of Medicine serve communities across the region and around the world. Thomas N. & Gleaves T. James Distinguished Chair
WINTER 2018 David L. Callender, MD, MBA, FACS President
Danny O. Jacobs, MD, MPH, FACS Executive Vice President and Provost, Dean of the School of Medicine
Cheryl A. Sadro, CPA, MSM Executive Vice President, Chief Business and Finance Officer
Donna K. Sollenberger, MA Executive Vice President and CEO, UTMB Health System
David W. Niesel, PhD Senior Vice President and Dean, Graduate School of Biomedical Sciences, Chief Research Officer
Vicki S. Freeman, PhD, MASCP, MLS (ASCP)CM SC, FACB Interim Dean, School of Health Professions
Deborah J. Jones, RN, MSN, PhD Senior Vice President and Dean, School of Nursing
MAGAZINE CONTRIBUTORS Editor
Alexis Loyd Writers
KirstiAnn Clifford Connie Holubar, MS, MBA Mary Feldhusen Stephen Hadley Shelley Smith, MEd Tammie Taylor, MLA Photographer
Mark Kinonen
2 8 10 14 16 18 19 20 21 22 24 32
Highlights: Training for the Future, Pursuing Innovation, Caring for Patients Harvey Can’t Dampen the UTMB Spirit Scenes From the Storm A Formula for Success In Sync and On Target Research News: Infectious Diseases Students Practice Skills at Disaster Day Simulation Building the Future Learn Together, Work as a Team Making an Impact: Innovations in Mind UTMB Earns Five Stars Working Wonders Across the Globe
Designer
Robert Cortez ©Copyright 2017 The University of Texas Medical Branch at Galveston. Member, Texas Medical Center® For more information regarding supporting UTMB, visit https://InnovationsInMind.utmb.edu.
ON THE COVER: The five-year special issue includes a cornucopia of successes across UTMB’s education, research and patient care mission areas including the new Jennie Sealy and League City Campus hospitals and various accreditations and awards. Read more highlights on Pages 2–7.
training
for
the
future
UTMB is training the health care workforce of the future. UTMB is a leader in student diversity
Total enrollment in the schools of Medicine, Nursing, Health Professions and Biomedical Sciences
Increased by 36% since 2009
3,302
From 2000–2016, the School of Medicine ranked*: •
1st nationally in the number of Hispanic graduates; 4th nationally in 2016
•
4th nationally in the number of African-American graduates; 1st nationally in 2016
•
2nd nationally in total underrepresented minority graduates; 1st nationally in 2016
2,430
2009
2017
The School of Nursing earned several accolades including: •
Among U.S. News and World Report's Top 20 of Best Online Graduate Programs
•
No. 2 spot on the 50 Best Value Bachelor's of Nursing 2017 list on BestColleges.com
•
•
2 2
No. 5 ranking for best online nursing graduate programs across the nation on GraduatePrograms. com in 2017 No. 1 ranking on OnlineCollegePlan.com's 2017 Top 25 Online Masters Programs for Nursing Degrees
UTMB ACADEMIC ENTERPRISE
The School of Health Professions established new and innovative programs: •
The Department of Nutrition and Metabolism's Master of Science and Dietetic Internship
•
The Clinical Laboratory Sciences and Occupational Therapy doctorate degree programs
*Source: 2016 Integrated Postsecondary Education Data System (IPEDS) from the National Center for Education Statistics (excludes medical schools at historically black universities and in Puerto Rico)
Educational Accreditations Highlights: Recognized for Excellence Michael Laposata, MD, PhD, was listed as No. 3 overall (and No. 1 in America) on the Pathologist’s 2015 Power List of the 100 most influential laboratory medicine professionals. Sharron Forest, DNP, APRN, NNP-BC, received the 2017-2018 American Association of Colleges of Nursing Novice Faculty Teaching Award. Karen Wagner, MD, PhD, began serving her two-year term as president of the American Academy of Child and Adolescent Psychiatry in the fall 2017. Carolyn A. Phillips, PhD, RN, received a 2016 Excellence in Nursing Award from the Good Samaritan Foundation. Dr. Phillips won a Gold Medal in Nursing Education. Thomas Blackwell, MD, FACP, received the 2015 Parker J. Palmer Courage to Lead Award from the Accreditation Council for Graduate Medical Education. Courtney Townsend Jr., MD, was the 97th president of the American College of Surgeons (2016–2017), the largest organization of surgeons in the world. The Association of American Medical Colleges awarded Bernard Karnath, MD, FACP, with the 2014 Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Award.
The Academic Enterprise is pleased to welcome... Deborah J. Jones, RN, MSN, PhD, as Senior Vice President and Dean for our School of Nursing. Dr. Jones is known for her outstanding leadership, innovation and excellence in education, and commitment to research. She has taught in all nursing programs from the baccalaureate to the doctoral levels, as well as been instrumental in program development and schoolwide strategic planning. Janet H. Southerland, DDS, MPH, PhD, as Vice President of Interprofessional Education, Institutional Effectiveness and the Health Education Center. Dr. Southerland has spent more than 25 years in academia in roles including dean, division chief and senior chief executive officer. She is an experienced leader, researcher and educator.
• The Southern Association of Colleges and Schools Commission on Colleges, 2008–2018 • Accreditation Council for Education in Nutrition and Dietetics, 2017–2024 • The Council on Education for Public Health, 2015–2022 • The Accreditation Council for Occupational Therapy Education, 2015–2022 • The Commission on Accreditation in Physical Therapy Education, 2015–2025 • Council on Accreditation for Respiratory Care, 2016–2026 • Liasion Committee on Medical Education, 2015–2022 • The Accreditation Council for Graduate Medical Education, 2013–2022 • The Commmission on Collegiate Nursing Education, 2014–2024 • National Accrediting Agency for Clinical Laboratory Sciences, 2017–2027 AE
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pursuing
i n n ovat i o n
UTMB's scientists are engaged in cutting-edge research. $131,998,593
UTMB's research funding has increased more than 20 percent in the last five years.
$124,631,214 $119,295,167 $118,942,401 $109,513,252
FY2013
$132 million $7.4 million or 5.9%
Awarded in research funding in FY2017
Increase in overall funding awarded to UTMB from FY2016–FY2017
FY2014
FY2015
FY2016
FY2017
$22.5 million
Increase in UTMB research funding from FY2013–FY2017
$89.3 million
Invested by UTMB in support of research from FY2013–FY2017
4 4
UTMB ACADEMIC ENTERPRISE
Research Highlights
•
•
•
The Centers for Disease Control and Prevention awarded UTMB $10 million to establish the Western Gulf Center of Excellence for VectorBorne Diseases. The Sealy Center for Vaccine Development was named a World Health Organization Collaborating Center for Vaccine Research, Evaluation and Training on Emerging Infectious Diseases. UTMB is only the second university in the Western Hemisphere and seventh in the world to receive this designation from the World Health Organization. UTMB received a $22 million Clinical and Translational Science Award (CTSA) from the National Center for Advancing Translational Sciences. The CTSA supports research teams from diverse disciplines working together to translate discoveries and innovations into clinical practices that improve health.
•
UTMB’s Sealy Center on Aging was re-designated a World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Center in Aging and Health. UTMB is one of only three collaborating centers in the United States that are focused on aging.
•
UTMB and Nature Publishing Group launched a new open access journal, npj Vaccines, in 2016. Alan D. Barrett, PhD, serves as editor-inchief. This journal is a high-impact publication that focuses on identifying and reporting significant scientific advances in vaccine research and development and is free for everyone. Pei-Yong Shi, PhD, and David Walker, MD, are associate editors.
•
The UTMB Claude D. Pepper Older Americans Independence Center received $3.4 million from the National Institute on Aging to continue its mission to improve physical function and independence in older adults.
•
UTMB named one of only nine hospitals in the country selected by the U.S. Department of Health and Human Services to be a regional treatment center for patients with Ebola or other highly infectious diseases. AE
Grants Central™ was created to help faculty members maximize research funding potential (Read more on Page 14) There are 210 active U.S. patents protecting UTMB inventions to date Intellectual property licenses produced $13.3 million in revenue for UTMB in 2016 and 2017, adding to a total of $19.6 million since 2013 David Niesel, PhD, selected as Chief Research Officer to oversee universitywide, research-related activities and develop a comprehensive strategic plan for research and administration 5 faculty members currently ranked in NIH Top 50 in their respective disciplines School of Health Professions ranked in the Top 15 in NIH funding
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caring
for
pat i en ts
UTMB strives to provide the best care to every patient, every time. UTMB Health volumes increased steadily from 2013 to 2017 to meet expanding patient needs:
•
UTMB's Pulmonary Rehabilitation program was certified by the American Association of Cardiovascular and Pulmonary Rehabilitation in 2017, recognizing a commitment to improving quality of life by enhancing standards of care. AACVPR-certified programs are considered leaders in cardiovascular and pulmonary rehabilitation because they offer the most advanced practices available.
•
Recertified as a Level I Trauma Center by the Committee on Trauma of the American College of Surgeons in 2017, honoring dedication to providing optimal care for injured patients.
•
Received the American Heart Association and American Stroke Association’s highest recognition, the Gold Quality Achievement Award for the third year in a row in 2017 for continuing to achieve resuscitation standards set under the AHA’s Get with the Guidelines® program.
•
Earned The Joint Commission’s (TJC) Gold Seal of Approval for Advanced Certification in Chronic Obstructive Pulmonary Disease program in 2017 by demonstrating continuous compliance with national standards for health care quality and safety in disease-specific care.
•
The Joint Commission re-designated the Primary Stroke Center in 2017.
Discharges up 27% Deliveries up 19% Emergency Department: Trauma up 5% Non-trauma up 100% Surgery: Inpatient up 33% Outpatient up 40% Clinic visits: Cath Total up 23% Total MRI up 43% Total CT up 75%
Physician productivity has increased by double digits since 2012
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UTMB ACADEMIC ENTERPRISE
•
MakerNurse and UTMB unveiled the MakerHealth Space at UTMB in 2015, the first of its kind in the nation for health care providers. The space provides nurses and other clinical staff with tools, resources and expertise to test out their ideas for improving health care.
•
The American Burn Association and the American College of Surgeons Committee on Trauma re-verified UTMB’s Blocker Burn Unit for its commitment to providing quality burn care to its patients. The unit has the highest survival rate of patients with major burn injury — greater than 80% — of all hospitals in the U.S.
•
The National Committee for Quality Assurance recognized five UTMB primary care clinics with Level Three Patient-Centered Medical Home certification — its highest level of achievement — in 2015.
•
Recognized as a Level 3 Epilepsy Monitoring Center by the National Association of Epilepsy Centers in 2014 in validation of its commitment to improving the lives of patients with epilepsy.
•
One of only four hospitals in Texas to receive the Center of Excellence in Minimally Invasive Gynecology designation in 2013, signifying the highest level of laparoscopic gynecological expertise, from the AAGL — the world’s premier professional society dedicated to minimally invasive surgery in gynecology.
UTMB rated a top place to work UTMB'S HEALTH SYSTEM was awarded a 2017 Top Workplaces honor by The Houston Chronicle in November 2017. Approximately 5,025 Health System employees, physicians and mid-level providers were invited to participate in the survey to determine the top workplaces; 2,595 responses were received, representing a 52 percent participation rate. The survey, conducted by WorkplaceDynamics, LLC (now known as Energage), asked employees to rate their organization in areas such as potential for advancement, work schedule flexibility, pay, benefits and leadership. The survey was focused on the health care category for UTMB. UTMB was ranked as one of only 30 large employers in the Greater Houston area on the list. A total of 150 organizations were included in the overall study, including small, medium and large employers. AE
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Harvey can't dampen the
UTMB Spirit T
he start of the 2017–2018 academic year was a memorable one for UTMB. Just days after welcoming new students from all schools to campus at fall orientation, leaders in UTMB’s Academic Enterprise had the safety of students, as well as faculty and staff members in mind when they cancelled classes as Hurricane Harvey closed in on the Texas Gulf Coast. Classes were halted on Friday, August 25; the hurricane made its first landfall between Port Aransas and Port O’Connor that night. The storm slowly moved north along the Texas coast, flooding a large swath of Southeast Texas over the next few days. Student support groups were held throughout the time UTMB was on emergency status, and the Student Government Association turned its focus to helping community members by setting up the UTMB SGA Hurricane Harvey Relief Fund. University staff members ensured that classroom and testing spaces were ready for the students’ return on September 5. Academic leaders also took action to preserve UTMB’s research mission. The institution’s research community collaborated with Business Operations and Facilities staff members to identify buildings that would lose air-handling capabilities in a power outage. Working closely with departments located in the at-risk facilities, the university ordered and distributed dry ice to
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UTMB ACADEMIC ENTERPRISE
NASA Goddard MODIS Rapid Response Team
preserve freezers. And, buildings were monitored throughout the emergency period to quickly identify and address any issues. UTMB’s Animal Resource Center (ARC) team took action to safeguard against any potential damage. Veterinary technician Erika Main spent the night on campus to provide any necessary clinical care and husbandry support.
Riding out the storm at UTMB's Galveston campus Harvey would be Erika Main’s third big storm experience in the Houston area. She lived here during Tropical Storm Allison in 2001 and was a student in Galveston when Hurricane Ike hit in 2008. She knows first-hand the havoc a storm can wreak on a region. Before Harvey rolled in, Main heard several of the meteorologists saying that it could create massive flooding like Allison, during which the area sustained more than $5 billion in damages. “The ARC was keeping an eye on the storm and decided to trigger part of our hurricane plan Thursday evening,” Main says. On Friday, all hands were on deck to evacuate the department’s animal population. All large animals were moved to safe housing in central Texas, and 2,800 cages of rodents and supplies relocated to elevated facilities on the Galveston Campus. “I was so proud of our department for moving so many animals and supplies within about 12 hours. It was a huge logistical feat.” Main was scheduled to work the weekend, so she decided to prepare for the possibility that she would not be able to get home during the storm. She packed her car with supplies and called her parents in Tomball to evacuate her two cats, Freddy and Smudge, who her mom affectionately calls “my grandcats.” Her previous experience with storms of this magnitude made Main inclined to over-prepare, she says, so by Friday af-
ternoon she had decided to ride out the storm on campus. By Friday evening, the power was out at her home. Early Saturday morning, Main arrived at UTMB and performed her routine animal checks, then began documenting the evacuation in the animal’s medical records. Several members of the ARC team offered her a place to stay but, concerned with the flooding risk, Main set up camp in the vet tech office, which she likened to “glamping” because she had air conditioning, internet access and cellphone service, but ate canned goods and slept on a cot. By Sunday morning, she realized the gravity of the situation on the mainland.
“There is something to be said about the Texan spirit: We may get kicked down, but we get right back up. And, we help others get back up, too." “Most of our husbandry team for that weekend couldn’t make it in since they all lived inland, so it was up to the ‘islanders’ to take care of the animals,” Main says. She and a colleague split up the work: Her colleague checked on the rodents and Main cared for the larger animals, including feeding them and cleaning their enclosures. “I already had so much respect for our husbandry staff,” she says. “But,
it’s really true when they say you don’t know the entirety of someone’s job until you have walked in their shoes.” In addition to Main, a small group of facility supervisors, husbandry technicians and veterinarians remained on-site every day to care for the animals and stand by in case clinical care was needed. “Many of these individuals went above and beyond their prescribed duties to cover animal care over the weekend and during the peak of the storm in Galveston,” said Doug Brining, DVM, ARC director and attending veterinarian. Main says that Harvey taught her that, even when it seems like overkill, being prepared is key. It was also a reminder to take nothing for granted, she says. One of her cats escaped her parents’ home and did not return. “I lost one of my beloved cats that I will likely never see again. I know that seems small and insignificant to most people but, as a veterinary technician, our pets really are our children.” Main empathizes with everyone across the region affected by the storm, particularly those with property damage or loved ones lost. “There is something to be said about the Texan spirit: We may get kicked down, but we get right back up. And, we help others get back up, too,” says Main. As a result of efforts before and during the storm, the university’s research enterprise had an essentially smooth return to normal operations on September 1. “This event let us test our emergency preparedness plan and lessons learned from Hurricane Ike,” said Toni D’Agostino, associate vice president for research administration. “And, because of everyone’s hard work, we passed the test.” AE
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scenes
from
UTMB took in patients from other hospitals in the region, including several babies flown in from a Beaumont hospital. Below: UT System Chancellor William McRaven took time to tour the NICU on his Sept. 1 visit to the Galveston Campus.
the
storm 27 trillion Gallons of rain fell on Texas and Louisiana in six days
51.88
Inches of rain fell over a week, the most ever recorded on the U.S. mainland from a tropical cyclone
350 to 375 Patients seen daily at UTMB clinics and hospitals during Harvey
2,800
Calls UTMB's Access Center responded to each day during the storm
128 Babies were born on UTMB's three campuses during the week it was under emergency operations
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UTMB ACADEMIC ENTERPRISE
T
he storm raging outside didn’t matter. On UTMB’s campuses, mothers still had to have their babies. In the approximately one week that UTMB was under emergency operations, 99 babies were born on the Galveston Campus, 19 at the League City Campus and another 10 at the Angleton Danbury Campus. UTMB also took in patients from other area hospitals, including several babies flown in from Beaumont. And, patient calls to the UTMB Access Center never stopped. Patients wanted to know if their upcoming appointment would be rescheduled, if they could get medication refilled, if elective surgeries were being canceled and when clinics would reopen. Access Center employees worked tirelessly to reassure callers and help patients find the answers they needed. As the effects of Harvey wore on during the final week of August, employees of the Access Center—which was relocated from the Clear Lake Center building to the League City Campus and into a makeshift call center on the Galveston Campus—took thousands of calls. In fact, call volumes were higher than normal, with the Access Center responding to more than 2,800 calls a day during the storm.
Patient Latasha Vernon gave birth to her twin newborns on UTMB's Galveston Campus.
Emma Beard, a patient access specialist, answered calls throughout the storm at the League City Campus.
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scenes
from
Dr. Doug Tyler, chair of Surgery (pictured right) did not hesitate when UTMB's League City Campus needed a surgeon on Aug. 27. He took this photo (and the one below) on his cellphone on his way to the hospital. Jeremy Brynes, associate vice president of business development for UTMB's Health System and administrator for the League City Campus (right) was on hand to help.
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UTMB ACADEMIC ENTERPRISE
the
storm
Above: A Black Hawk helicopter delivered 500 pounds of critical blood products, including a rare type of blood for a patient with sickle cell disease, to UTMB's Angleton Danbury Campus on Aug. 29. RIght: A UTMB police officer meets with one of the military personnel who delivered the shipment.
Below and right: UTMB senior communications specialist KirstiAnn Clifford captured images from around Houston after the storm hit.
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a
formul a
UTMB’s Grants Central helps researchers earn funding with targeted grant proposals
S
cientists across the country breathed a collective sigh of relief this September when Congress rejected proposed deep cuts to science programs and increased the National Institutes of Health’s budget by $1.1 billion (or approximately 3 percent) to $35.2 billion for Fiscal Year 2018. But, challenges persist for researchers under pressure to find funding for their vital work in today’s hypercompetitive environment. That’s why when UTMB research leaders convened to create a strategic plan for 2020, a top priority was developing a resource to support faculty members throughout the grant proposal process. In January 2016, the Office of Research Advancement, or “Grants Central,” opened its doors. Since then, Grant Central’s leader (and only staff member at first) Craig Cassidy, MHA, has helped garner funding for more than half of the grant proposals that have come across his desk. When Cassidy joined UTMB, he had one main goal in mind: to facilitate faculty members spending less time agonizing over grant proposals and more time saving lives through their research. With a background that includes working with Congress to advance legislation protecting federal research funding, coordinating research teams and garnering more than $80 million in research funding through his grant writing, Cassidy’s unique perspective helps him understand one of the scientific community’s
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UTMB ACADEMIC ENTERPRISE
for
success
most burning questions: How do you translate a great idea into an effective grant proposal? Grants Central creates a total support pipeline so that scientists have a clear path to follow as they work to turn their innovative ideas into funded research. Cassidy emphasizes quality over quantity: “I would rather help write one good grant in three months than three bad grants that will never get funded.” Ideally, Cassidy says, he’s able to work with faculty members on their proposals from inception, though that’s not always possible. “Chalk talks,” where faculty members present an idea to colleagues for feedback, are a first step in the process. These informal presentations help researchers shape their projects and allow Cassidy to see the passion that propels the concept. “If it excites them, we can excite reviewers,” says Cassidy. Grants Central also offers editing, strategic planning, identification of funding opportunities and training
on topics relevant to UTMB’s research community. For Fiscal Year 2016, NIH reported a 19 percent success rate (the percentage of reviewed grant applications that receive funding), which is the highest it’s been since 2010 (20.6%). “Fifty percent of applications never get reviewed, so the first thing you can do is cut any number NIH gives you in half,” says Cassidy. He adds that NIH’s success rate excludes resubmissions, meaning that a scientist may spend significant time revising an application and submitting it again, sometimes multiple times, but NIH does not consider those resubmissions in its success rate. So, while NIH’s official reported success rate is 19 percent, Cassidy says, to the investigator it feels more like 8 percent. Since January 2016, Cassidy has helped submit 37 grants, with 17 receiving funding, five pending review and 15 declined. That translates to a 53 percent success rate, with $41,280,409 received.
Craig Cassidy keeps his eye on upcoming deadlines on a wipe board with Grant Central's ever-growing list of Principal Investigators and their grant proposals.
The Word from NIH... Giulio Taglialatela, PhD, professor and vice chair of research for UTMB’s Department of Neurology and director of the Mitchell Center for Neurodegenerative Diseases, recently collaborated with Grants Central to apply for funding that supports 14 undergraduates while they spend 10–12 weeks conducting research as part of the Summer Research Experiences in Neurological Dysfunction program. “Without Craig’s support, that grant never would have left UTMB,” Dr. Taglialatela says. According to Dr. Taglialatela, a large part of Cassidy’s value is his ability to help researchers answer the big questions that come up when a scientist is creating a grant proposal. What is the best program for this submission? How should I approach the program officers? Should I propose a multi-investigator project instead? “This is where Craig’s help becomes gold. Literally,” Dr. Taglialatela says. “What he’s capturing is the process.” Ricardo Rajsbaum, PhD, who joined UTMB as assistant professor of Microbiology and Immunology in 2014, submitted his first three grant proposals in the past two years, two of which have already received funding. Dr. Rajsbaum first began working with Grants Central because, “I wanted as many people as possible to read my grants.” For Dr. Rajsbaum, Cassidy offered editorial guidance on his introduction page and valuable insight into reviewers’ perspectives when he was preparing a grant for resubmission. It’s also helpful to have a resource that stays upto-date on NIH requirements, he says. Kimberly Moore, program manager for medicine services, says that after
more than two decades at UTMB, she is excited to see the difference that Grants Central is making. Moore worked with one junior faculty member whose grant earned a nonfundable score upon first review. But, after working with Craig, the grant’s score was almost perfect, Moore says. One NIH reviewer noted that the scientist’s resubmitted proposal was thoughtful and well-written. The reviewer wrote: “…This was a breath of fresh air to read.” Moore encourages more faculty members, especially seasoned scientists who might be stuck in a routine, to consider engaging Craig’s expertise. Sometimes when a faculty member is struggling to translate their great idea into a great (and fundable) proposal,
“This is where Craig’s help becomes gold. Literally." Moore might say, “Let’s think out of the box. Let’s let Craig look at it and see what he thinks.” Grants Central has quickly become an in-demand resource for UTMB faculty members. The office added two staff members in October 2017. Cassidy — who was working on 15 grants for submission that same month — says the help comes just in time. Excited to expand the office to reach even more faculty members, he jokes, “I will be thrilled after I sleep sometime in November.” AE
UTMB'S GRANTS CENTRAL is one solution to the time constraints facing today's scientists. The National Institutes of Health (NIH) is also working to address this issue. “A number of recent studies demonstrated that while NIH support is essential to ensure the productivity of an investigator, there is a point of ‘diminishing returns’ if an investigator becomes overextended. Quality science and fiscal stewardship require time and effort, and it stands to reason that a person can be stretched too thin,” NIH director Francis Collins, MD, PhD, said in a budget hearing in May 2017. NIH, the largest public funder of biomedical research worldwide, invests in more than 300,000 researchers at over 2,500 institutions in the U.S. and around the globe. NIH is working to enable more early- and mid-career scientists to receive funding, as well as to reduce administrative burdens on scientists. “Virtually none of the substantial gains in reducing human suffering and extending longevity over the last century would have happened without basic science,” Dr. Collins also said in May. “NIH’s emphasis on fostering innovation to understand fundamental biological processes has led to no fewer than 149 Nobel Prizes to our grantees, and is leading year by year to new and more effective ways to treat complex medical conditions.” The 21st Century Cures Act, which passed in 2015, aims to increase the amount of funds awarded for biomedical research, including high-risk, high-reward research, as well as research conducted by early stage investigators; and reduce administrative burdens on NIH-funded researchers among other priorities. WINTER 2018
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in
sync
and
on
ta r g e t
UTMB researchers collaborate to create solutions for key local, state and national health care concerns
W
hile UTMB researchers have pioneered lifesaving discoveries throughout the institution's 126-year history, they are being recognized more than ever for achievements from engineering the world's first Zika virus infectious clone to growing the first human lungs in a laboratory. UTMB’s numbers are reflecting this success: Total research funding increased by nearly $7.4 million from FY2016 to FY2017. Research dollars peaked at $131,998,593 in FY2017; the total was $124,631,214 in FY2016. This nearly $132 million encompasses more than $92 million from the National Institutes of Health (NIH), as well as $8.2 million from the Department of Defense. UTMB receives additional awards from NASA, the Agency for Healthcare Research and Quality, the Health Resources & Services Administration and other federal agencies, as well as local and private organizations. The research community more than doubled dollars awarded from the National Science Foundation (NSF), totaling $1,043,727 million in FY17 versus $408,204 in FY16. According to the NSF’s latest data, UTMB ranks in the top 15 percent for total federal funding and total research and development investment. UTMB ranks 93rd out of 1,005 institutions across the nation in funding and 112 out of 905 in R&D expenditures. UTMB’s School of Medicine moved up in rankings for NIH funding in 2016, according to the Blue Ridge Institute for Medical Research. The School
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UTMB ACADEMIC ENTERPRISE
of Medicine ranked 51st out of 139 institutions across the country, bringing in $73,330,206. The School of Health Professions remains in the Top 15 out of approximately 70 national counterparts. Strategic planning and sustained hard work across UTMB is enabling scientists to do more innovative research to improve lives. Throughout the past few years, a multidisciplinary group from UTMB’s research enterprise has been collaborating with leadership to create and implement strategic initiatives designed to enhance the institution’s position as a leader in research. As part of this effort, David Niesel, PhD, senior vice president and dean of the Graduate School of Biomedical Sciences was appointed chief research officer in 2015. Recent success can be credited to the dedication, talent and motivation of faculty and staff members, as well as targeted planning, says Dr. Niesel. “We have really focused our energies to pursue our areas of real strength and the faculty are working to achieve a significant national impact.” Dr. Niesel, who has served at UTMB for more than three decades, says that it's an exciting time to be part of the institution. “We've connected our research and clinical strengths for the first time ever,” says Dr. Niesel. As outlined in UTMB's Research Strategic Plan, the instiution has homed in on areas of focus including Infectious Diseases and Neurodysfunction. And, UTMB’s research strengths currently align with state and national priorities. Take UTMB’s Mitchell Center for Neurodegenerative Diseases, for in-
stance, which is led by Giulio Taglialata, PhD, vice chair of research in Neurology. Scientists are engaged in groundbreaking work on Alzheimer’s and other neurodegenerative disorders. This science is in sync with the UT System Brain Health Quantum Leap, established by Chancellor William McRaven in November 2015 as part of his vision. “The UT System will launch an effort akin to the Manhattan Project to understand, prevent, treat and cure the diseases of the brain,” McRaven said in his November 2015 address to the Board of Regents. On the national scale, former President Barack Obama launched the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative in 2013, a large-scale effort to advance neuroscience research and improve treatment for a variety of brain disorders such as Alzheimer’s disease, schizophrenia, autism, epilepsy, and traumatic brain injury. In 2017 alone, BRAIN Initiative funding totaled $260 million. This is just one example of UTMB scientists’ coordinated efforts. UTMB is participating as a key national consortium member to begin unraveling the science behind exercise. The insitution is also home to thought leaders in areas including aging, burns, infectious diseases and women’s health research. UTMB’s researchers also now are connecting across disciplines in a way they haven’t previously, Dr. Niesel says. “When you put scientists from different disciplines together, that’s the sweet spot. Now, you are able to answer questions you couldn't answer before.” AE
Grants Spotlight A MULTIMILLION DOLLAR GRANT could help researchers develop a novel therapy for women recovering from hip fractures. UTMB is part of a consortium of seven universities that received $15.6 million from the National Institute on Aging to study testosterone therapy and exercise in post-menopausal women recovering from hip fracture. Elena Volpi, MD, PhD, director of UTMB’s Sealy Center on Aging, is UTMB’s principal investigator. The project will evaluate the benefits of short-term testosterone therapy combined with supervised exercise during the recovery process. “Hip fracture is a major contributor to loss of independence in older women. With this study, we hope to find a novel therapeutic approach to accelerate recovery of physical function and independence in these patients,” Dr. Volpi says. More than 260,000 hip fractures occur annually in the U.S. Many of those experiencing a fracture also incur significant functional decline. The other participating institutions are Washington University, Harvard University, University of Maryland, Johns Hopkins University, University of Colorado Denver, and University of Connecticut. AE
Initiative supported by a multidisciplinary Initiative supported team of accomplished by a multidisciplinary clinical trialists team of accomplished clinical trialists
We help UTMB investigators begin and refine their clinical trials. We assist researchers at any career level, and we can provide feedback on We at help UTMB beginOur andareas refineof their clinical trials. We trials any stageinvestigators of development. expertise include: assist researchers at any career level, and we can provide feedback on Creating & Managing trials at any stage of development. Our areasCompleting of expertise Regulatory include: Clinical Trials Creating & Managing • Designing rigorous studies Clinical Trials • Developing biostatistics, • Designing rigorous studies epidemiology, and research • Developing biostatistics, design protocols epidemiology, and research • Utilizing biomedical informatics design protocols • Forming recruitment plans Utilizing biomedical • •Conducting multisiteinformatics trials • •Adhering research ethics Forming to recruitment plans • •Integrating special populations Conducting multisite trials • •Engaging Adheringcommunities to research ethics • •Communicating results Integrating special populations • Engaging communities Building Strong Translational • Communicating results Research Skills & Teams • Training mentoring the Buildingand Strong Translational clinical trials workforce Research Skills & Teams • Identifying collaborators • Training and mentoring the • Enhancing grant applications clinical trials workforce • Identifying collaborators • Enhancing grant applications
Requirements Completing Regulatory • Creating consent forms Requirements • Navigating the IRB • • Creating consent forms Applying for INDs and IDEs • • Navigating theinIRB Registering Clinical Trials.gov • Applying for INDs and IDEs • Registering in ClinicalUT Trials.gov Utilizing NCATS, System, & ITS Resources • Utilizing NCATS’sNCATS, Trial Innovation Network UT System, • UT System’s Clinical Trials Express & ITS Resources ITS’s Clinical ResearchNetwork Center • • NCATS’s Trial Innovation
• UT System’s Clinical Trials Express • ITS’s Clinical Research Center
Institute for Translational Sciences
Liz Ruiz (409) 772-1920 ebruiz@utmb.edu Institute for Translational Sciences
Dr. Elena Volpi
Liz Ruiz (409) 772-1920 ebruiz@utmb.edu
SUMMER WINTER 2018 2017
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Research News: Infectious Diseases
F.A. Murphy/ UTMB
UTMB researchers gained new insight into how the Ebola virus uses the body’s natural defenses to speed the rate of infection and unleash its lethal disease, according to a report in mBIO. Ebola virus disease is severe in part because the virus causes the immune system to malfunction. T-cells, white blood cells that seek and destroy virus-infected cells, are particularly vulnerable to the virus. “In this study, we demonstrated the central role of a T-cell protein called Tim-1 in the development of Ebola virus disease,” says senior author Alexander Bukreyev, PhD, a virologist in UTMB’s Departments of Pathology and Microbiology and Immunology. “Mice that were genetically engineered without Tim-1 became less ill when infected with Ebola virus and only one died, whereas all of the unmodified mice succumbed.” The study was conducted in collaboration with the University of Washington and The National Institute of Allergy and Infectious Diseases.
Lassa is an Arenavirus (above): CDC
A team of scientists led by UTMB has successfully protected nonhuman primates against one of the most deadly viruses in the world, Lassa fever, eight days after they became infected. The findings are available in Nature Medicine. The virus, for which there are no approved vaccines or treatments, infects hundreds of thousands of people every year and is estimated to kill approximately 34 percent of those infected, according to the Centers for Disease Control and Prevention. Also, military and science experts say that the virus could be used as a biological terror weapon.“In this study, we tested a combination of three monoclonal antibodies by giving them to nonhuman primates beginning up to eight days following exposure to a lethal amount of Lassa virus,” says UTMB’s Thomas Geisbert, PhD, a professor in the Department of Microbiology and Immunology. “We found that the treatments were well-tolerated and provided 100 percent protection from Lassa fever. Without treatment, the animals show evidence of the virus in their bodies by day four after exposure.”
For the first time, a collaborative team led by UTMB has shown that a potential Zika vaccine quickly can protect fetuses against infection as well as protect males against testicular infection and injury. It also prevents a lowered sperm count after one vaccination. “Besides quickly mounting a protective immune response, this live-attenuated vaccine exhibited an excellent safety profile in both mouse and non-human primate models. Taken together, the results suggest that this vaccine merits further development in humans," says UTMB’s Pei-Yong Shi, PhD, senior author and professor for the Department of Biochemistry and Molecular Biology. AE CDC/ Cynthia Goldsmith
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Students Practice Skills at Disaster Day Simulation
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TMB’s Interprofessional Scholars Program hosted its first Disaster Day, a student-led, large-scale simulation aimed at preparing and educating students on responding to a crisis. School of Nursing students Casey Schneider, Sophia Hashemi and Madison Lankford collaborated with other schools at UTMB to gather about 200 students and faculty volunteers for the Nov. 4 simulation. The goal of Disaster Day was to foster interprofessional teamwork and provide an opportunity to practice skills learned in the classroom and apply them in a simulation of a potentially catastrophic event, says Shelley Smith, MEd, UTMB director of Interprofessional Education and Practice. In this instance, the simulation was a hydrofluoric acid release caused by the landfall of a tropical storm. Third- and fourth-year medical and nursing students teamed up as volunteer first responders who “treated” patients affected by the acid release. The patients were student volunteers from all four UTMB schools. During the simulation, there were four waves of patients with a variety of diagnoses, such as mental illness, burns, abrasions, a woman in labor and more. As students worked together to treat the patients, faculty members provided instruction and assistance. Afterward, responders discussed lessons learned during the simulation and faculty members provided feedback. “During this simulation, students learned about interprofessional communication, the triage system and how to effectively organize their team and prioritize to provide effective health care in the event of an emergency,” Smith says. AE
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building
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y the close of FY18, UTMB’s Academic Enterprise will have invested $175 million in education, research and patient care facilities over five years. Library renovations, relocation of the student health center, building out the surgical simulation laboratory, upgrades to information systems infrastructure and the remodeling of various offices and laboratories are all part of a concerted effort to ensure that UTMB is equipped to compete with top academic institutions across the globe. When Danny O. Jacobs, MD, MPH, FACS, joined UTMB as executive vice president, provost and dean of the School of Medicine in late 2012, he partnered with institutional leadership to create a unified and centralized process to make it easier to invest for the future while taking into account the entire longevity of equipment and other resources. “We aim to attract and retain the best people to work at our institution,” says Dr. Jacobs.“To do that, we need to ensure we have the tools they need to do their jobs to the best of their ability.” For a world-class research institution such as UTMB, expanding research space and adding state-of-the-art facilities was a key priority. Central to this objective is the expansion of one research building, which will provide critically needed animal research facilities, as well as reserve more than 20,000 of the 93,000 square feet for emerging research needs. The expanded facility will feature modern technology capacities and emergency power, as well as connect to other nearby research buildings to
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foster collaboration among researchers in different areas and enable the secure and private transfer of research assets. This will ensure access to needed supplies to provide continued operation during emergencies. Nearly 40 percent, or $50 million, of UTMB’s research enterprise requires animal protocols. Maintaining stateof-the-art animal research facilities is essential to UTMB’s ability to improve health by advancing biomedical science. This project will help UTMB secure new grant funding, as well as ensure continued accreditation from the Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC). In 2019, UTMB will open the doors to its brand-new Health Education Center (HEC), another major investment project. The center will feature 160,000 square feet of education space designed to prepare trainees to work in teams. “The Health Education Center is the first academic building on campus that brings all four schools together in one building, so supporting collaboration was a priority for the project design team,” says Bob Brown, AIA, LEED AP, program director for facilities planning. In addition to providing shared teaching spaces and simulation areas, Brown says, thoughtful architecture can foster collaboration and creativity between students, faculty and staff by designing space into the building that supports spontaneous interaction. “Through the middle of the building will be a large, bright and open stairway that is connected to a variety of alcoves, flexible gathering spaces and meeting rooms on three floors to provide a
learn work pleasing, vertical circulation alternative to elevators and opportunity for the accidental collisions that can produce spontaneous and creative conversations,” Brown says. The HEC will feature a standardized patient and simulation center for students in all health science disciplines, as well as classroom space, conference rooms, educational offices and administrative space to accommodate the planned growth of UTMB’s educational programs for the next 15 years. Texas, along with the rest of the country, is experiencing critical shortages in the number of physicians, nurses and other health professionals needed to care for its diverse, growing and aging population. According to a report released by the Association of American Medical Colleges in March 2017, the U.S. will face a shortage of between 40,800 and 104,900 physicians by 2030. The U.S. Bureau of Labor Statistics projects a need for 1.1 million new registered nurses by 2022 to avoid a nursing shortage. Other health professions face similar shortages. UTMB has set targeted enrollment increases over the next eight years in all four of its schools and the HEC will help accomodate planned increases in student enrollment. UTMB strives to prepare more top biomedical researchers and health care professions as part of its mission to improve health in Texas and beyond. Choosing to invest in key projects enables the institution to meet the needs of the communities it serves as well as helps ensure continued success meeting the challenges of today’s health care environment. AE
together as
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PREPARING STUDENTS for clinical rotations provided an ideal opportunity for interprofessional practice at the Clinical Skills Experience held recently in UTMB's Interprofessional Nursing Simulation Center. Nursing students served as instructors and coaches for medical students gaining skills for basic procedures and learning to manage high-acuity situations. “It is a natural fit to bring these two professions together to learn with each other,” said Rachel Kilgore, PhD, RN, director of the Interprofessional Nursing Simulation Center and coordinator of the event. “We provided a low-risk environment so that these professions could practice together in preparation to work in teams in the real world.” The course is required for medical students preparing for clinical rotations in their third and fourth years. “Students learn basic procedures such as peripheral intravenous catheter insertion, venous blood draw, nasogastric tube insertion, urethral catheterization, hand hygiene and Point of Care Testing,” says Bill Boudreaux, EdD, RN, medical educator for the School of Medicine Nursing students in their final semester at UTMB enrolled in the Clinical Capstone course volunteered to help the medical students with their clinical skills. According to course director Rebeka Watson Campbell, PhD, RN, CNE, the nursing students were well-versed in the procedures and able to put their skills into action as they collaborated in small groups. They demonstrated the procedure and provided coaching while medical students practiced on simulated patients. “The saying is true: 'Learn one, do one, teach one,'” says Dr. Watson Campbell. “The students learn the most when they teach others.” According to Dr. Watson Campbell, the key to interprofessional activities is to make the event interactive, meaningful and realistic, she says. Faculty members from the School of Nursing provided instruction and oversight for skills clinicals and simulations. Students in both schools gained mutual respect as their knowledge of each other’s roles and understanding of professional contributions to health care increased. The clinical lab experience is an example of activities that will be incorporated in UTMB's new Quality Enhancement Plan IPE²Practice, designed to enrich the interprofessional culture at UTMB. AE
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Our Innovations in Mind initiative envisions a dynamic future for health care. We invite you to join us. The Innovations in Mind initiative will provide important support to: Construct a Health Education Center where aspiring health care professionals can train in settings that mimic the practical realities of patient care Broaden research into disorders like Alzheimer's and Parkinson's, exploring the frontiers of neuroscience to give hope to millions around the world Establish faculty endowments to recruit and retain some of science and medicine's finest minds Expand our scholarship offerings, helping educate tomorrow's health care pioneers
At the end of the initiative in November 2016, contributions and pledges totaled:
2011–2016
The Working Wonders initiative was the largest effort for private support in UTMB's history.
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$450.9 million
$200 million
$34 million
for the new Jennie Sealy Hospital including $170 million from The Sealy & Smith Foundation, the single largest philanthropic commitment ever made to a Texas health institution
invested in programs advancing vaccine development, women’s health, neurodegenerative diseases, traumatic brain injury, infectious disease research and more
$28.4 million
to establish 37 new faculty endowments
$26 million
13,000
benefactors supported the initiative
400
to create 79 new student scholarships
dedicated volunteers made the initiative possible
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exas is facing a profound shortage of health care professionals. In response, UTMB has broadened its enrollment by 40 percent over the past decade. With a student body that has grown beyond the limits of our existing infrastructure, the Health Education Center is a vital next step in the future of Texas health care. Your gift to the Health Education Center is an investment in our state’s oldest academic health center. But it’s something even more: an investment in the communities near and far, all of whom depend on our graduates for care across the lifespan—an investment in better health for a growing state. Visit https:// InnovationsInMind.edu for more information about how you can help make the center possible or use the provided envelope to contribute today. AE
UTMB's new Health Education Center (top) will feature elements designed to encourage interprofessional collaboration, such as larger classrooms, a simulation center and a bright, open stairway connected to a variety of alcoves and meeting spaces (above) that will provide an opportunity for "accidental collisions that can produce spontaneous and creative conversations."
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utmb
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TMB earned five stars, ranking among the top 12 academic health centers nationally for quality and safety, according to the latest Vizient Quality and Accountability Study, conducted annually since 2005. UTMB also won a 2017 Vizient Bernard A. Birnbaum, MD, Quality Leadership Award, which recognizes superior quality and safety performance in patient-centeredness, effectiveness, mortality, safety, efficiency and equity. A leadership team from UTMB was on hand to receive the award on September 14 during the 2017 Vizient Clinical Connections Summit held in Denver. Only 12 out of 107 participating academic health centers received the prestigious award. UTMB ranked ninth overall, rising from No. 76 in 2016. “It is an honor to see UTMB listed among other top academic medical centers across the nation striving to provide top quality care to all patients,” says UTMB president David L. Callender, MD, MBA, FACS. An organization-wide effort enabled such significant improvement in one year. This work began in earnest in June 2016 after University of Texas System Chancellor William H. McRaven announced a “bold and sweeping path forward” for the entire UT System. His vision for the future challenged UTMB, along with other UT organizations, to achieve a national reputation for delivering the finest health care possi-
five
ble. The goal was to improve quality performance to rank among the top 20 academic medical centers (AMCs) in the nation. UTMB’s journey to the top required a multifaceted approach that was based on a simple premise, coined “Best Care”: Always deliver the right care, at the right time, in the right way, for the right person, with the best possible results for every patient, every time. Led by Gulshan Sharma, MD, MPH, professor of internal medicine, vice president, chief medical and clinical innovation officer, UTMB focused on improving accuracy of clinical documentation and processes of care, as well as ensuring patients experienced a safe and timely discharge, avoiding potentially preventable patient readmissions within 30 days of discharge, and improving patient safety — while providing patient-centered, equitable care. “We implemented an initiative, Best Care, to be the best in 2016, and I am proud to say this award shows all of our hard work is paying off,” says Donna K. Sollenberger, executive vice president and chief executive officer, UTMB Health System. “We thank our dedicated faculty, nurses and staff for their daily efforts that are allowing UTMB Health to achieve the highest levels of excellence.” Quarter by quarter, individuals in every role of the organization maintained a steadfast focus on how they
sta r s
THE ACADEMIC HEALTH CENTER WINNERS FOR 2017 ARE:
1
Mayo Clinic – Rochester
2
NYU Langone Health
3
Froedtert & the Medical College of Wisconsin – Froedtert Hospital
4
Rush University Medical Center
5
Penn State Health Milton S. Hershey Medical Center
6
University of Utah Health
7
UC Health University of Colorado Hospital
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Lehigh Valley Health Network
9
University of Texas Medical Branch at Galveston
10
The University of Kansas Hospital
11
Nebraska Medicine
12
Oregon Health & Science University Hospital
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personally contributed to Best Care. And, quarter by quarter, UTMB saw its performance steadily improve. Best Care involves every member of UTMB, from patient care providers to staff members in information services and human resources. For instance, human resources and nursing service colleagues partnered to increase patient mobility and improve employee safety by ordering equipment such as patient lifts and standing aids. “These devices are a win-win for patients and employees,” says Odette Comeau, DNP, adult critical care clinical nurse specialist. “There’s plenty of literature out there to support the improved outcomes of patients who mobilize sooner. That includes things like shorter ICU and hospital stays and increased muscle strength. Along with that, employee safety is increased— when assistive devices are used, fewer staff are needed to mobilize patients, and those that are assisting are now freer from back injuries and other injuries.” Cheryl Sadro, CPA, MSM, executive vice president and chief business and finance officer says,“Our goal is always
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to enhance UTMB’s service excellence through focus on our people, our facilities, our technology systems, our financial sustainability and our future growth.” Danny O. Jacobs, MD, MPH, FACS, executive vice president, provost and dean of the School of Medicine believes that implementing Best Care is one’s professional duty as a member of an academic health center. “Everything we do in the Academic Enterprise is ultimately about the patient—directly, as part of patient services, or indirectly, through scientific discoveries to improve the human condition or training future providers,” Dr. Jacobs says. “We have world-class expertise and we’ve developed strong partnerships across the insitution in an effort to improve the lives of those we serve.” Internal medicine chair Randall Urban, MD, helped lead an innovative project focused on better managing frequently admitted patients. Under the new patient management approach, doctors are split into three teams that each provide care to the same patients whenever they come to the hospital.
“Previously, a frequently admitted patient would see physicians from any of the three teams and they could get lost in the system,” says Dr. Urban. “Now, when the patient is admitted to the hospital, the same team cares for them each time and the doctors get to know that patient very well. This has been a really big change for us and a better way to provide continuity of care.” Other efforts included the Department of Obstetrics and Gynecology’s work to improve documentation. Gary Hankins, MD, OB/GYN chair, and George Saade, MD, chief of Obstetrics and Maternal Fetal Medicine, established a real-time documentation review process for potentially preventable complications, implemented Epic optimizations and trained faculty members to reduce documented OB complications dramatically in a year’s time. Vizient, Inc. is the largest member-driven health care performance company in the U.S. and has conducted the study annually since 2005. In previous years, the Vizient Excellence Awards were known as the University HealthSystem Consortium Awards. AE
BEST CARE IS... Safe: Avoiding injuries to patients from the care that is intended to help them. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse). Efficient: Avoiding waste, in particular waste of equipment, supplies, ideas and energy. Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status. Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
UTMB’s Health System received an A grade from the Leapfrog Group for its accomplishments in reducing errors, infections and accidents that can harm patients. The Leapfrog Hospital Safety Grade assigns ratings to hospitals “based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents and infections,” according to its website. Leapfrog is a nonprofit organization founded in 2000 with the goal of providing information that helps the public make better decisions about their health care. UTMB’s A grade is the latest kudo for the health care system. In September, UTMB was honored with the 2017 Vizient Bernard A. Birnbaum, MD, Quality Leadership Award. UTMB was one of 12 academic health centers in America, and the only one in Texas, to earn the recognition and receive a five-star rating (more on Page 25). “Alone, each of these recognitions is a tremendous accomplishment,” says Donna Sollenberger, MA, executive vice president and chief executive officer, Health System. “Together, they signify the progress that we are making to provide the best care to every patient, every time. The recognitions are the result of our faculty physicians, house staff, nurses, other care providers and those in support functions working together to meet the highest standards of patient safety. ”
UTMB was recognized in 2017 for meeting the highest standards of nursing for the second consecutive time since 2012, earning Magnet Program status. The American Nurses Credentialing Center’s Magnet Recognition Program distinguishes health care organizations that meet rigorous standards for nursing excellence based on quality indicators and standards of nursing practice. This credential is the highest honor for professional nursing practice. UTMB is one of 468 U.S. health care organizations out of more than 6,300 to achieve Magnet recogntion. Hospitals applying for recognition must provide an environment that empowers nurses, values their contributions and supports nursing leadership. According to the ANCC, Magnet health care facilities consistently deliver better patient outcomes than non-Magnet facilities and report higher nurse retention, recruitment and job satisfaction rates. “I am so proud of the health care team at UTMB. Our dedicated nurses, physicians, caregivers and hospital staff collaborate every day to provide the highest level of quality and experience to those we serve,” says David Marshall, JD, DNP, RN, UTMB’s chief nursing and patient care services officer. AE
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According to the 2017 Vizient Quality and Accountability Study, UTMB is ranked No. 12 in patient-centeredness among the 107 academic health centers that participated in the survey. A growing body of evidence suggests a link between patient experience and quality and safety of health care. That’s why UTMB focuses on enhancing every patient’s experience through effective communication, shared decision-making and sensitivity to the patient’s unique needs. In 2001, the Institute of Medicine — now The National Academy of Medicine — released "Crossing the Quality Chasm: A New Health System for the 21st Century," which defined patient-centered care as “respectful of and responsive to individual patient preferences, needs, and values” and emphasized that patient values should guide all clinical decisions. UTMB uses the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), a national, standardized, publicly reported survey of patients’ perspectives on hospital care, to monitor quality of service and benchmark its performance locally, regionally and nationally. Patient satisfaction encompasses how patients felt about communication during their hospital stay, responsiveness of hospital staff, how well their pain was controlled, whether they understood medications and discharge information, and cleanliness and quietness of the hospital environment, as well as their overall experience and likelihood they would recommend the hospital. UTMB implemented a variety of strategies beginning in 2013 to increase patient-centeredness including:
UTMB is No. 7 out of 107
• Enlisting patient and family advisors: More than 10 advisors provide insight into quality and safety, inpatient and outpatient operations and services, hospital modernization projects, wayfinding and more.
UTMB is No. 27 out of 107
• Commit to Sit: UTMB placed chairs in patient rooms so providers can sit comfortably and talk with patients and families at eye level, increasing engagement and time spent with the patient. UTMB's nurses implemented a similar initiative: Connect with each patient in 56 seconds through meaningful introductions, reviewing scheduled procedures and ensuring the entire care team understands what matters most to each patient.
N RA
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UTMB
Safety: 26.25%
No.
overall
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academi centers ac nati
Efficiency: 5.5%
Patient Centeredness: 5.5%
UTMB is No. 12 out of 107
• Unit-based clinical leadership teams: Originally developed by the University of Pennsylvania Health System, clinical leadership teams are led by a physician and nurse director who develop unit-specific initiatives to improve quality of care and patient safety. Teams regularly review patient satisfaction data and patient comments and are able to resolve any issues at the unit level. UTMB now ranks in the 90th percentile nationwide, with an overall increase in patient satisfaction of nearly 30 percentile points in the Press Ganey HCAHPS database.
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Breakdown of Vizient Qu Rankings for Acade
ansformation UTMB improved its mortality ranking in the 2017 Vizient Quality and Accountability Study by 39 slots, moving from No. 94 to No. 55 among 107 academic health centers nationally.
s No. 1 of 107
uity: 5%
ranked
Mortality: 26.25%
o. 9
UTMB is No. 55 out of 107
Medical coders translate information in patients' medical records into data used for quality and physician report cards, reimbursement, and public health research. After implementing the Best Care initiative, UTMB discovered that clinical documentation was not reflecting the severity and complexity of patients’ illnesses, making it difficult for coders to select options that accurately depicted mortality risk. Mortality rate is measured using a ratio that compares the total number of patients who passed away with the number of patients expected to pass away. UTMB implemented a mortality review process to determine within 48 hours whether each death was a predictable event with an inevitable outcome or if there was opportunity to improve the outcome. Clinical documentation specialists were also assigned to each inpatient unit to conduct routine rounds with physicians. And, systems analysts optimized workflow in the electronic medical record (EMR) system.
out of
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UTMB improved its effectiveness ranking in the 2017 Vizient Quality and Accountability Study from No. 47 to No. 14 out of 107 participating academic health centers.
ic health cross the ion Effectiveness: 21%
UTMB is No. 14 out of 107
u a l i t y a n d A c c o u n ta b i l i t y m i c H e a lt h C e n t e r s
In 2013, UTMB established an initiative to reduce preventable 30-day readmissions. Modeled after the Society of Hospital Medicine's Project BOOST, short for Better Outcomes by Optimizing Safe Transitions, UTMB aimed to identify patients' risk for issues after discharge. Although not all readmissions are preventable, UTMB analyzes root causes for all readmissions. Risk factors include taking multiple medications, psychological illnesses, limited health literacy, poor social support and having a primary diagnosis such as cancer, stroke, diabetes or heart failure. The care team can mitigate risk possibilities while the patient is still in their care if identified early. Last year, UTMB launched progression of care rounds on all inpatient units. The patient’s primary nurse, care managers and social workers, as well as utilization review nurses collaborate with patient care facilitators and physical/occupational therapists, clinical pharmacists, nutritionists, respiratory technicians and speech therapists. The group meets several times weekly to discuss the plan of care. One “point person” provides feedback to the primary physician. Nurse Rachel Witte, on the CT Surgery/Vascular Surgery Unit in Jennie Sealy Hospital, believes the rounds have been highly effective. “It has been extremely beneficial,” she says. “It does take a little extra time, but it really helps us think about how to care for the patient, not only while they are here [in the unit], but after they leave the hospital.” AE
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focused on quality
F
rom the introduction of the Affordable Care Act in 2010 to its implementation and recent efforts to revise or replace the law, one thing is certain: The U.S. health care system is complex and expensive. According to a recent study by the Commonwealth Fund, the high cost of care in the U.S. — about twice per capita than that of the rest of the developed world — is largely due to poor quality of care and inefficiency. Our nation ranks last among 11 industrialized countries for health quality, efficiency, access to care, equity of care and healthy lives. Not all health care spending is bad. We go to doctors and hospitals more often, we are more likely to receive certain procedures (such as heart surgery), we continue to innovate and provide new treatment options to people with serious acute and chronic illnesses, and we lead the world in health care research and certain treatments, such as for breast and colorectal cancers.
Americans are greater consumers of medical technology, including diagnostic imaging. We consume more drugs, and they cost more. Herein lies opportunity for improvement: According to the High Value Practice Academic Alliance, unnecessary tests, procedures and treatments increase patients’ financial burden without adding value. The Kaiser Family Foundation has estimated that nationally, 20 percent or more of total health care expenditures is due to various forms of waste, including overtreatment, failures of care coordination and care delivery, administrative complexity and pricing failures. An estimated $3.6 trillion could be saved over the next decade — that’s 10 percent of projected health care expenditures — by reducing waste. UTMB provides comprehensive care for patients in the region with routine health care needs as well as complex and rare conditions. It is also considered an “essential hospital,” meaning the
organization is dedicated to providing high-quality care for all, including uninsured, underinsured and other vulnerable patients. “Statewide, many patients have limited access to routine primary health care. This means that when these individuals arrive in our hospital for care, they are already very sick, sometimes with more than one serious condition,” says Donna Sollenberger, MA, the health system's executive vice president and CEO. “UTMB must be highly efficient and effective in the care we deliver to produce exceptional patient outcomes while providing care at an affordable cost.” Danny O. Jacobs, MD, MPH, FACS, executive vice president, provost and dean of the School of Medicine says, “The Academic Enterprise is an enthusiastic, willing and able partner in this effort.” Creating value for patients and payors alike is UTMB's next phase of focused efforts. The organization aims to reduce unnecessary testing, procedures and treatments; improve resource management; and continue to manage patient medications and precription protocols; as well as continue ensuring the best quality supplies are purchased at the lowest possible cost, an initiative that saved the organization $7.2 million last year alone. Promoting evidence-based medicine, disease prevention and chronic disease management, and eliminating waste are all largely aimed at improving quality of care. UTMB has made great strides in quality and safety and will continue its Best Care initiative in 2018, with the goal of remaining a five-star hospital. AE
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hen Irene Slovak, who was an otherwise healthy 74-year-old woman, began experiencing stomach pain and fatigue, she knew something wasn’t right. Although she didn’t have a primary care physician, she lived near the UTMB Multispecialty Care Clinic in League City, so she called and made the first available appointment with a nurse practitioner. Suspecting the patient was suffering from acid reflux or an ulcer, the nurse practitioner ordered some tests and noticed Irene’s liver enzymes were unusually high. The nurse practitioner immediately called the radiology department in Galveston to set up an appointment for Mrs. Slovak to receive an ultrasound the following day. During the ultrasound, the technician noticed something that she didn’t recognize. She called the manager in to review the ultrasound, who recognized the severity of the situation and called Dr. Jason Ross, senior radiology resident, to review the case. Dr. Ross suspected cancer: “I saw what was going on and it concerned me. As a radiologist, I generally want bad news to come from someone who the patient knows. I don’t want to scare the patient. It’s better to have the primary care physician, the one who the patient has a relationship with, deliver news. They can do it better than I can.” While reviewing the patient’s records, Dr. Ross noticed that Mrs. Slovak did not have a primary care physician and the nurse practitioner from her original appointment was out of town, so he reached out to the clinic's internal medicine physician for help. After assessing the situation over the phone, the physician asked Dr. Ross if he would be willing to talk to Mrs. Slovak.
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Dr. Ross explains, “It’s not something in my wheelhouse — not something I do every day — but she was a patient under my care. I was going to try to help, even if I was a little uncomfortable.” He continues, “For her peace of mind and continuity of care, I needed a CT scan to be performed that same day. As a radiologist, I don’t have a follow-up clinic, and the person who told her about the ultrasound needed to be the same person who told her about the CT results.” Dr. Ross worked with the internal medicine physician to schedule the CT scan, talked to Mrs. Slovak’s insurance provider and then returned to explain to her what they suspected was the cause of her symptoms. Mrs. Slovak shared her experience that day, “I just had a feeling that there was something going on. I didn’t rule out cancer or think about cancer necessarily, but I was very grateful that I was going to get an answer that day.” After the CT scan results were in, Dr. Ross met with Mrs. Slovak and her husband and confirmed the mass was pancreatic cancer. By Monday, Mrs. Slo-
vak delivered the news to her children and was admitted to the hospital. She could finally receive something to ease the pain. When asked if she would have preferred to hear her diagnosis from a primary care doctor, Mrs. Slovak said, “Oh, no. Dr. Ross saw the results firsthand. No other doctor knew as much about me as he knew, at the time. He did it very well. If it wasn’t for him, everything else would have been delayed and I would still be miserable.” Dr. Ross shared the lessons he learned from this experience and what he hopes will help other specialists who may someday find themselves in a similar situation: “I sometimes feel like I didn’t do enough and I wish that I could do more. But what I hope other radiologists or specialists who don’t typically have direct relationships with patients will learn from this is, if a patient doesn’t have someone else, even if we’re uncomfortable, we can make a difference.” For Irene Slovak and her husband, it was their radiologist and his dedication to compassionate and exceptional care who changed everything. AE
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Scientists from UTMB and Houston Methodist Research Institute (HMRI) collaborated on a project designed to grow lungs in space. The project, supported by the Center for the Advancement of Science in Space, NASA and HMRI, is the third of four collaborations active at HMRI’s Center for Space Nanomedicine. Drs. Joan Nichols andJoaquin Cortiella have successfully grown lungs in their Galveston lab, but now they will see if astronauts can do the same in zero gravity. The researchers prepared bioreactor pouches that include lung progenitor and stem cells and pieces of lung scaffolding that were sent up to the Space Station in August 2017.
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The Sealy Center for Vaccine Development (SCVD), in conjunction with the World Health Organization (WHO) headquarters, sponsors an internship program that supports up to three graduate students who spend three months in Geneva, Switzerland. The career development opportunity provides first-hand experience of global health planning and policy. Three UTMB graduate students were selected for 2016: Samantha Nava (Microbiology & Immunology), Daniele Swetnam (Microbiology & Immunology) and Benjamin Satterfield (MD/PhD program, Microbiology & Immunology).
In August 2017, UTMB's Dr. Vicki Freeman and Michael Brown from San Jacinto College traveled to Kisumu, Kenya, to mentor biomedical equipment technicians at Jaramogi Oginga Odinga Teaching and Referral Hospital and Regional Blood Transfusion Center as part of a partnership with Kenya National Public Health Laboratory Services (NPHLS) through the American International Health Alliance. In January, 2018, Dr. Freeman will provide Doctorate in Clinical Laboratory Sciences students an opportunity to provide laboratory consultation and training to clinical officers and physicians at Maua Methodist Hospital, a regional medical center in Maua, Kenya. Since 2005, Dr. Freeman has traveled to Maua to help laboratorians assess and update laboratory quality systems. She is interim dean of the School of Health Professions, as well as professor and chair of the Department of Clinical Laboratory Sciences.
Dr. Marlene Salas-Provance, associate dean for student affairs in the School of Health Professions, travels around the world with Rotaplast International, a nonprofit that provides free reconstructive surgery and treatment to those with cleft lip and palate. In 2016, she went to Lima, Peru, on a two-week mission, where she worked with an interdisciplinary team to educate, evaluate and perform surgeries on children and adults with orofacial clefts. These birth defects occur when a baby’s lip or mouth does not form properly during pregnancy and can result in feeding and speaking problems. Cleft lip and palate occurs in approximately one of every 500 births in Peru. 32
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In August 2017, a team of Occupational Therapy and Physical Therapy students, faculty members and spouses spent a week in Chichicastenango, Guatemala, providing care in the Center for Physical Motor Assistance (CAF), a rural physical therapy clinic and local school for children with disabilities. Jennifer Hoines, a UTMB PT graduate, established CAF in 2005 with ASELSI, a nonprofit. Under the guidance of the licensed therapists, the UTMB students saw a variety of children, as well as women with pelvic pain and adults with musculoskeletal injuries. The CAF clinic is now run by a Guatemalan-trained physical therapist and local assistants. Jennifer visits regularly and assists with promoting the needs of the clinic as well as helping to arrange for visits from groups such as UTMB. Many UTMB PT students have received clinical training through rotations at the CAF clinic.
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Dr. Harold Pine and his UTMB medical mission team trekked to the village of Deusa in Nepal in April 2017, handing out 40 pounds of toothbrushes, providing medications, and offering free head and neck cancer screenings, skin evaluations and other medical care. They were joined by a UTMB medical student, surgical intensive care unit nurse and faculty members representing otolaryngology, pediatrics, urology, dermatology, radiology and plastic surgery. In addition to medical care, the team also built an entire computer classroom for the village school, donating 20 brand new fully loaded Dell computers with software. The medical mission was followed by the physically demanding hike to Everest Base Camp, which stands at more than 17,500 feet.
Dr. Dennis Bente, an associate professor in the Department of Microbiology & Immunology, took students and postdocs who work with him on Crimean-Congo hemorrhagic fever (CCHF) research to Turkey to learn about ticks and changes in their ecology, which may account for a decline in cases in recent years. According to Dr. Bente, Turkey has been the epicenter of CCHF cases since 2002. The disease, transmitted to people from ticks and livestock, is very severe with a case fatality rate of up to 40 percent. Dr. Bente’s team had the opportunity to train with their Turkish collaborators in field work, including tick collection. UTMB is home to the Galvestion National Laboratory, a BSL-4 laboratory where highly infectious diseases can be safely studied.
Dr. Caley Satterfield offered a Field Epidemiology Course in August 2017. This two-week training experience in Peru focused on simulated disease outbreak investigation and response. Students learned about rapid response teams, logistics for field activities, cases and controls tracing, vector and reservoir trapping, handling, dissection, and specimen collection. The course demonstrates that teamwork and field epidemiology are not only enjoyable, but can make a difference in people's lives. The course is available to students in all four schools at UTMB, residents, physician fellows and postdoctoral fellows. AE WINTER 2018
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NON-PROFIT ORGANIZATION U.S. Postage PAID North Houston, TX PERMIT NO. 27600 The University of Texas Medical Branch Office of the Provost 301 University Blvd. Galveston, Texas 77555
Brant Cain, a UTMB Correctional Managed Care practice manager at the East Texas Treatment Facility in Henderson, 40 miles southeast of Tyler, is no stranger to the trauma of a natural disaster. Just last year, his lake house in East Texas flooded during extreme weather. So when he watched the news showing people in danger during Harvey, he jumped into action, taking his boat first to The Woodlands, then to the Katy and Port Arthur areas. Carrying six people at a time in his boat, Cain helped first responders rescue more than 200 people from their homes over a four-day period. See Page 8 for more on Hurricane Harvey.