As health care comes under greater scrutiny by policymakers, this is a pivotal moment for the United States and those who are involved in medical and nursing care, research, and education. As an academic medical center, the University of Virginia Health System has a responsibility not simply to deliver care but to help invent the future of care.
Night Scene at Matsuchiyama, Sanya Canal
from the series One Hundred Views of Edo, 1857
Utagawa Hiroshige, 1797–1858
Museum purchase with funds from the
E. Rhodes and Leona B. Carpenter
Foundation and the Robert Cross
Bequest Fund, 2004.24
University of Virginia Art Museum
The U.Va. Health System does more than introduce the latest innovations in medical and nursing care in its hospitals and clinics. Researchers find ways to make new treatments more effective and more widely available. They work with others to translate recent insights gained in the laboratory into better therapies and cures. And in classrooms, faculty and instructors are determined to devise better ways to prepare students to practice medicine and nursing well into the twenty-first century.
Through innovation in care, discovery, and education, the Health System is doing its part to ensure that, despite the many challenges, the next fifty years of medical progress are successful, with the ultimate goal of providing the best health care for all who need it.
Delivering Next — Generation Care
The U.Va. Medical Center is creating an environment of care to meet future patient needs. Currently, the Medical Center is at full capacity several days a week. In response, a $500 million expansion is under way, which will modernize facilities and allow the Health System to make better use of space. The Emily Couric Clinical Cancer Center, now under construction, will improve the integration of services to patients and their families by offering the latest therapies and comprehensive cancer care all under one roof. Planning is also progressing for the Barry and Bill Battle Building at U.Va. Children’s Hospital, which will bring together outpatient services for pediatric patients. A long-term acute care hospital next to the Northridge clinic will provide service to patients who require long-term care while freeing space for shorter-term acute patients at the Medical Center. The Medical Center also broke ground on a six-story, seventy-two-bed, glass-fronted addition above the University Hospital lobby. In addition, efforts to update the environment of the University’s health care facilities are reflected in the refurbishment of all inpatient care areas and expansions, including two new operating rooms, where new technology is being added. The addition of new equipment and technology requires many changes and reinforcements to infrastructure. The goal of these projects is not simply to enlarge the Medical Center but to create an environment that reinforces staff efforts to provide the best possible care to patients and their families.
The Health System is also introducing an electronic medical record (EMR) system. Medical records have been divided between paper and electronic files housed in several locations and systems. A centralized EMR system will allow providers across locations and specialties instant access to the same records. The benefit for patients: fewer forms to fill out, a more comprehensive record of their health and medical treatments, and a greater ability to participate in their own care. For staff: timely, accurate information at their fingertips and the ability to share information quickly.
Reaching Out to New Partners
Jason Franasiak (Medicine ’09) completed a rotation at Primeros Pasos, a clinic in Quetzaltenango (Xela), Guatemala, during his final year of medical school. Working side by side with Guatemalan medical students helped Dr. Franasiak improve his Spanish language skills while serving the residents of the Palajunoj Valley, a rural valley in western Guatemala with high rates of communicable diseases, malnutrition, and untreated chronic diseases.
The Health System has also embarked on initiatives to ensure that comprehensive health care is more readily available to those who need it. The most efficient approach is to strengthen partnerships with local institutions in other regions of Virginia. This year, the Medical Center began a three-year, $40 million investment in Culpeper Regional Hospital, which equates to a 49 percent investment in the hospital. This funding will expand the emergency room and inpatient capacity, integrate clinical services so U.Va.’s Culpeper patients can receive care closer to home, and ultimately link radiology, laboratories, and medical records electronically.
Outreach efforts have been expanded to offer free health care in the underserved region of southwest Virginia. Specialty teams in neurology, pulmonary medicine, neurodevelopment, orthopedics, endocrinology, cardiology, and genetics regularly travel to the region to conduct clinics for adults and children. Nursing faculty and students regularly assist in providing primary and specialized care in the region. Each October, a volunteer team of doctors, nurses, medical and nursing students, social workers, pharmacists, and other Health System staff provides medical care to the Remote Area Medical (RAM) Clinic in Grundy, s health care comes under greater scrutiny by policymakers, this is a pivotal moment for the United States and those who are involved in medical and nursing care, research, and education. As an academic medical center, the University of Virginia Health System has a responsibility not simply to deliver care but to help invent the future of care.
The Health System is the key health care provider to the RAM Clinic at Wise, providing vision, hearing, and medical care on a first-come, first-served basis to people who are uninsured, underinsured, unemployed, or cannot afford to pay. Typically, more than 500 people are in line at the start of each day. This year, the Health System received the Virginia Hospital and Healthcare Associationís first Community Benefit Award for its role in the RAM Clinic. The clinic is a collaborative initiative organized and coordinated by the Health Wagon, a mobile health provider in Clinchco. The Lions Club, the Virginia Dental Association, and the Lenowisco Health District are also major partners in the event.
In December 2008, U.Va.ís Office of Telemedicine teamed up with U.Va.ís Cancer Center and Department of Radiology, the Health Wagon, and the Virginia Department of Healthís Every Womanís Life program to offer free mammography screenings to women in rural Virginia. To provide faster mammography results, the Office of Telemedicine equipped the mobile digital mammography van with a new computer server. The server allows X-ray technologists and mammographers to transmit the digital images to Health System radiologists, who can then get screening results back to patients promptly. The team effort gives state-supported follow-up care to uninsured patients who need it.
The Health System can embark on these outreach efforts because of the quality of the services already offered to Medical Center patients. The Medical Center has attained Magnet Recognition for nursing excellence from the American Nurses Credentialing Center. The designation reflects nurse satisfaction, quality improvement, nursing research, and an organization-wide commitment to patient care.
Service to patients is a priority throughout the Health System, as indicated by national rankings. According to figures gathered by the American College of Cardiology and the American Heart Association, heart attack treatment times at the Health System are in the top 3 percent nationally. The latest U.S. News & World Report review of America’s Best Hospitals ranked the Health System in three specialties. In addition, the Medical Center is one of only fifteen major teaching hospitals to be ranked among the nation’s best, according to the Thomson Reuters 100 Top Hospitals: National Benchmarks study. The Health System has also assembled an outstanding group of physicians. Forty-seven physicians from the Health System were included in the 2009 edition of America’s Top Doctors.
Olympic National Park, Washington
This photograph of the Sea Stacks at Hole-in-the-Wall Beach on the Olympic Peninsula was taken by Dr. John Voss, director of education and associate professor of medicine at the School of Medicine. The photo, taken at dusk on August 17, 2005, was featured in the summer 2009 issue of Hospital Drive, an online journal produced by the School of Medicine.
Health System physicians also lead national professional organizations. For example, Dr. John Dent, associate professor of medicine, is president of the American College of Cardiology; Dr. Irving Kron, the S. Hurt Watts Professor of Surgery, is president-elect of the American Association of Thoracic Surgery; and Dr. Karen Rheuban, professor of pediatrics, associate dean for continuing medical education, and medical director of the Office of Telemedicine, is president of the American Telemedicine Society. U.Va. medical faculty publish in high-impact scientific journals, such as Cell, Nature, Science, Journal of the American Medical Association, New England Journal of Medicine, and Proceedings of the National Academy of Sciences. Nursing faculty are well represented in leading journals, such as the Journal of the American Academy of Nurse Practitioners, Public Health Nursing, Advances in Nursing Science, and Cancer Nursing.
As scientists begin to understand the fundamental mechanisms that sustain life, gaining insights that will dramatically affect medical care in coming years, researchers at the U.Va. Health System play an important part.
Japanese Fairy Tales (illustration)
Lafcadio Hearn, printed in color by
hand from Japanese wood blocks
Tokyo, T. Hasegawa or
Yosaku Nishimiya, 1898–1942
Clifton Waller Barrett Library of
Albert and Shirley Small
Special Collections Library
University of Virginia Library
Fraydoon Rastinejad, professor of pharmacology and biochemistry and molecular genetics and director of U.Va.’s Center for Molecular Design, has launched a study of the body’s system of self-regulation. In this system, hormones turn genes on and off by docking with hormone receptors. In the case of diseases and conditions such as diabetes, breast cancer, osteoporosis, and high cholesterol, these interactions go awry — and scientists believe that controlling these hormone receptors represents an important step in managing these diseases more effectively. Mr. Rastinejad set the stage for this development by describing the structure of these receptors for the first time.
Research led by Boris Kovatchev, associate professor of psychiatry and neurobehavioral sciences and systems and information engineering in the School of Medicine, may change the lives of patients suffering from type 1 diabetes. Mr. Kovatchev’s team conducted a pilot clinical study of an artificial pancreas, a computerized system that uses an individually "prescribed" control algorithm to regulate blood glucose levels. Diabetes patients in the study achieved excellent overnight control of glucose levels and a five-fold reduction of hypoglycemia, a condition produced by lower than normal blood sugar levels that can result in coma, seizures, and even death.
In many areas, Health System researchers are the most eminent in their fields and lead major research efforts. This year, the Bill & Melinda Gates Foundation made a $30 million multi-institution grant to the Foundation for the National Institutes of Health to fund a five-year study of the relationship between malnutrition and intestinal disorders in children and lifelong physical and emotional problems. The study will be led by Dr. Richard L. Guerrant (Medicine ’68), the Thomas Harrison Hunter Professor of International Medicine and director of U.Va.’s Center for Global Health; and Dr. William A. Petri, Jr. (Graduate Arts and Sciences ’80, Medicine ’82), the Wade Hampton Frost Professor of Epidemiology and chief of the Division of Infectious Diseases and International Health. This year, Dr. Guerrant won the Walter Reed Medal from the American Society of Tropical Medicine and Hygiene.
U.Va. researchers are also developing and testing treatments and diagnostics for disease. Dr. Jason Sheehan (Engineering ’92, Graduate Arts and Sciences ’97, Medicine ’98), associate professor of neurological surgery, radiation oncology, and neuroscience, has found that combining two emerging medical technologies, noninvasive focused ultrasound and controlled-release nanoparticles, is more effective in treating one of the most devastating forms of brain cancer, glioblastoma multiforme, than traditional drugs. He received the 2009 Young Investigator Award from the American Association of Neurological Surgeons.
In the School of Nursing, professor Randy Jones (Nursing ’00, ’02, Graduate Arts and Sciences ’05) is principal investigator for a $305,963 grant focused on decision making in patients with advanced prostate cancer. The study is funded by the National Institutes of Health National Cancer Institute and the U.Va. Cancer Center. Another nursing professor, Marianne Baernholdt, received a $238,707 NIH grant to lead an NIH National Institute of Nursing Research study on the impact of the nursing working environment on rural quality of care and clinical outcomes.
Other federally funded clinical research projects this year include a $1.3 million grant from the National Institute on Drug Abuse to test a smoking cessation application that can be used on handheld computers during routine office visits. In related studies, two nursing research teams are using $1.2 million in grants from the Virginia Tobacco Settlement Foundation to investigate new methods for preventing teen smoking. Health System researchers have also received a grant from the National Cancer Institute to develop new imaging agents for early detection of pancreatic cancer. Currently there is no screening like mammography or colonoscopy that can diagnose this deadly form of cancer.
Over the last decade, the University has developed many models to translate insights from basic research into clinical interventions. This year, the Ivy Foundation created the Biomedical Innovation Fund to promote translation research at U.Va. The fund is supporting a number of projects, including a new tool to diagnose early Alzheimer’s disease and techniques to promote red blood cell formation in patients undergoing cancer therapy. An important characteristic of all these projects is that they pair basic researchers with clinicians. The hope is that this collaboration will increase the likelihood that the research project will produce a direct clinical impact.
This year, the School of Medicine also opened the Carter-Harrison Research Building, adding 102,000 square feet of new space, enough to house nearly 240 scientists and lab personnel.
Educating Students for Twenty-first-Century Practice
Both the School of Nursing and the School of Medicine are highly selective and highly ranked. According to U.S. News & World Report, the School of Medicine is 24th among research universities and 29th among primary care programs. U.S. News ranks the School of Nursing among the country’s top 5 percent, tied at nineteenth among 448 schools. Two of the school’s graduate programs are ranked in the top ten: psychiatric/mental health and clinical nurse specialist.
Revamping the curriculum to better meet patient needs is an ongoing project at both schools. The School of Nursing developed the first doctor of nursing practice program in the Commonwealth, awarding its first degree to Amy Boitnott this year. Instead of writing a dissertation, a DNP candidate uses evidence-based research to develop interventions that may improve clinical practice. The School of Medicine is leading an effort to advance a new curriculum that is more learner-centered, content-integrated, and clinical performance-oriented. This new vision for medical education will be supported by the new Claude Moore Medical Education Building, currently under construction. In addition, a nineteen-member task force representing both the Schools of Medicine and Nursing is developing an Interprofessonal Education curriculum for medical and nursing students.