Illinois Medicine

PATIENT- CENTERED in health care, with a focus on comparing clinical effectiveness. The Chicago consortium is one of 11 A P OUT OF CONTEXT ATIENTS OFTEN RECEIVE INAPPROPRIATE CARE when their doctors don't account for their individual circumstances, according to a joint study by the College of Medicine and the VA Center for Management of Complex Chronic Care, published in the July 20 issue of Annals of Internal Medicine. "Physicians did quite well at following guidelines or standard approaches to care, but not so well at figuring out when those approaches were inappropriate because of a particular patient's situation or life context," says Saul Weiner, MD, associate professor of medicine and pediatrics at the University of Illinois at Chicago and staff physician at the Jesse Brown VA Medical Center. Actors trained to simulate real patients made 400 visits to a wide variety of physician practices in Chicago and Milwaukee, including several VA sites. The actors fol- lowed scripts with "red flags" of significant biomedical and/ or contextual issues. For example, an actor playing a man concerned about worsening asthma mentioned both a biomedical red flag (coughing at night) and a contextual red flag (losing his job) that suggested acid reflux and loss of health insurance, respectively. The study examined whether the physician picked up on the red flags. Only 22 percent of physicians provided error-free care during a contextually complicated case, 28 percent during a biomedically complicated case and 9 percent during an designated by the Department of Health & Human Services' Agency for Healthcare Research and Quality to participate in the DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. The centers will compete amongst them- selves for agency projects. UIC is represented in the consortium Physicians often fail to account for patients' complex situations, but training can help encounter that combined contextual and biomedical is- sues. "We believe that reflects the way in which physicians are educated," says Weiner, lead author of the study, funded by the VA. "The lesson here is that there has to be a dramatic change in the way we train physicians." Indeed, a separate study by College of Medicine re- searchers published in the Sept. 15 issue of JAMA reports that doctors can be taught to listen better. Fourth-year UIC medical students were divided into a group that attended four short workshops training them to recognize and respond to contextual clues, and a control group that did not attend the workshops. Students from the two groups each saw four standardized patients—ac- tors who are trained to portray patients the same way every time. In the control group, students correctly treated the contextually complicated patients about 25 percent of the time. In the group that attended the training, students cor- rectly identified and appropriately treated the contextually complicated patient two-thirds of the time. "Our workshop was not only effective at improv- ing students' abilities to individualize care, but it focused specifically on that ability without affecting their other abilities as a doctor," says Alan Schwartz, PhD, associate professor of medical education and pediatrics at UIC and first author of the study, who also served as a co-author to the previous study. by its colleges of Pharmacy, Medicine and Nursing, the School of Public Health as well as the UIC Center for Pharmacoeco- nomic Research, the Institute for Health Research and Policy and the Center for Clinical and Translational Sciences. The Chicago consortium's other primary members are the University of Chicago, Northwestern University, Blue Cross Blue Shield and the U.S. Department of Veterans Affairs Center for Management of Complex Chronic Care, as well as the VA's Pharmacy Benefits Management Group. Glen Schumock, PharmD, MBA, professor and director of UIC's Center for Pharmacoeconomic Research, will lead the consortium. Simon Pickard, UIC associate professor of pharmacy administration, and David Meltzer, associate professor of medicine at the University of Chicago, will be deputy principal investigators. The Agency for Healthcare Research and Quality launched the DEcIDE centers to help the federal government evaluate the Medicare Part D drug benefit, as man- dated in the legislation that created Part D, the Medicare Prescription Drug Improve- ment and Modernization Act of 2003. The Chicago DEcIDE Center has completed five projects since its incep- tion, including one that researched the effectiveness of drug therapies for chronic obstructive pulmonary disease, and an- other that developed a protocol to identify which drugs most need study of their off-label use. That led to a list of 14 priority candidates. OUTCOMES UIC leads Chicago consortium to study health services effectiveness FEDERAL AGENCY has tapped the University of Illinois at Chicago to coordinate a consortium of Chicago institu- tions that will support research on patient-centered outcomes I L L INOI S MEDICINE | 9

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