(continued on page 5)

It’s something physicians see too often: A patient is hospitalized for acute symptoms of alcoholic pancre-atitis—her third admission for the same reason. Al-though it’s possible to alleviate her pain and nausea, the underlying reason for her illness—her alcohol

abuse—remains.“Physicians’ way of treating the behavioral part has been

to say, ‘You really should stop drinking,’” says Colleen Christmas, director of the Internal Medicine Residency Program at Johns Hopkins Bayview Medical Center. “As you can imagine, our success rate with that intervention hasn’t been very high.”

Unhealthy behaviors exacerbate many of the most com-mon chronic diseases affecting adults today, including obesity, diabetes, arthritis and addictions. For that reason, says Robert Shochet, an assistant professor of medicine, one of the most important things a physician can do is partner with patients to create a shared vision of what their health could be, then help them take the necessary steps to get there. “Doctors don’t change patients; patients change themselves. But they need allies, and health professionals can offer vital guidance and ongoing support.”

Johns Hopkins begins training medical students to be such allies as soon as they enter medical school. In the course Obesity, Nutrition and Behavior Change, for in-stance, first-year students learn about motivational inter-viewing, a technique based on the premise that everyone has a reason to adopt healthier habits, even if it is deeply buried. Through such interviews, clinicians help patients identify how their behavior conflicts with a core value, such as the desire to be a good parent or to maintain a stable relationship.

The process can also uncover undiagnosed depression and anxiety. “Evidence shows that if those underlying conditions are not treated, there is less chance of success-fully addressing an addiction,” says Christmas, who also directs the primary care track at the school of medicine. She says Behavioral Medicine on the Ward, a yearlong program launched last year at Hopkins Bayview, is help-ing residents learn techniques to assist patients in adopt-ing healthier lifestyles.

Although behavior interventions have always been a doctor’s job, doing them effectively is more important than ever, says Roy Ziegelstein, the school of medicine’s vice dean for education.

“Many of the illnesses affecting people in the U.S. relate to health behaviors such as overeating or the use of drugs, cigarettes and alcohol,” he says. Meanwhile, the benefits of healthy routines, such as regular exercise, are also becoming more apparent. Health care reform’s emphasis on disease prevention and patient-centeredness is subtly changing the relationship between doctors and patients.

“Clinicians traditionally have taken the role of fixing the patient’s health problems. Now, we are expanding that to be consultants to patients as they take a more active role in their care,” says Stephen Wegener, an associate professor in the Department of Physical Medicine and Rehabilitation. “Serving as consultants to patients requires us to use addi-tional skills to engage them and help them develop positive health behaviors.”

Behavioral Medicine on the Ward begins with a two-week rotation in which residents hone their abilities in motivational interviewing. Rachel Kruzan, a Hopkins Bayview internal medicine resident, says she is inspired by

Sharing a Vision of Health Johns Hopkins is training physicians to motivate their patients to change unhealthy behaviors.

Read more about the strategic priority for education online at

hopkinsmedicine.org/strategic_plan

GA

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A publication for the Johns Hopkins Medicine family Volume 65 • Number 7 • September 2014

INSIDE2 BEYOND FILLING PRESCRIPTIONS

Recently accredited community pharmacy residency program helps patients manage their meds.

3 COMICS APPROACHInternational graphic arts meeting showcases the power of cartoon medical narratives.

4 SPEEDY LIFESAVING TRANSPORTRapid responders team expedites emergency support in the Johns Hopkins Outpatient Center.

6 AGING GRACEFULLYJohns Hopkins Bayview Medical Center’s PACE offers medical and social support to the elderly.

Dome

Published by Johns Hopkins Medicine Marketing and Communications

TAPPING INNOVATIVE SOLUTIONS AND TECHNOLOGY Insight is a new section that spotlights how digital technologies are transforming not just communications, but also Johns Hopkins Medicine’s interactions with patients, colleagues, our communities and the world. Here, you’ll find articles that showcase innovative developments by our staff members along with insight into tapping cutting-edge solutions to improve outcomes, efficiencies and access to information.

Tell us what you think of Insight. Complete the survey: hopkinsmedicine.org/insight/survey .

Fifteen years ago, the Insti-tute of Medi-cine published its famous

report called To Err Is Human, which blamed medical errors for nearly 98,000 deaths in this country each year. Seeing that stark figure in print was a wake-up call for an industry not known for transparency around outcomes. It prompted some criti-cally important work at Johns Hopkins Medicine and elsewhere around the country.

Since then, the Armstrong Institute for Patient Safety and Quality and others across the organization have made headway in improving patient safety. The Johns Hopkins Hospital is one of the few academic medical centers to be recognized as a top performer in quality by the Joint Commission. We are approaching 100 percent compliance on core safety measures. We lead the country in research to reduce cen-tral line-associated bloodstream infections. We have new safety dash-boards to show our teams how they are performing in real time. In a handful of divisions, we even have appointed a chief quality officer—a new position for us. The goal: to apply the same level of quantitative rigor we require in finance to the realm of quality.

That said, there is still work to do. In July, a group of clinicians, nurses and others from around Johns Hopkins Medicine gathered at an off-site retreat to brainstorm additional ideas for enhancing clinical excellence. In a session called “Success Stories,” Elizabeth Wick, a colorectal surgeon at The Johns Hopkins Hospital, gave an inspiring presentation about an initiative she is leading to improve postsurgical recovery. She examined colorectal surgery practices across our five adult hospitals and saw far too much variation. Taking outcomes into account, she devised a single “best” care plan for before, during and after surgery. It is too early to say with certainty whether her efforts will curb complications, but the data so far are promising.

I hope to see more and more of you take this kind of creative ini-tiative. And I’m not the only one soliciting this kind of thinking. More often, outside groups are asking for concrete evidence of continued advances in safety and quality. Under Maryland’s new hospital-payment system, we must show measurable improvements in quality measures such as readmissions and hospital-acquired infections. Similarly, U.S. News & World Report has changed the formula it uses to rank hospitals, shifting weight from reputation to a handful of patient safety indica-tors.

Johns Hopkins Medicine is committed to providing the safest care possible. Our goal is to partner with patients and their loved ones to eliminate preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. To do this, science must guide the way. There are many ways to measure quality and many agencies engaged in this complex undertaking. The medical profession is still sorting out which methods are most valid and most viable. It is an important conversation, one we should be leading nationally. After all, our peers trust us. It’s why they consistently tell U.S. News they would feel comfortable sending us their most complex cases.

Unfortunately, as medical complexity rises and boundaries get pushed, opportunities for error also abound. And there is very little room for error when human lives are at stake. So I thank you for the tremendous care and focus you put not only into healing our patients but also protecting them from harm.

To read more insights from Dean Rothman, visit hopkinsmedicine.org/leading_the_change .

PATIENT SAFETY

Putting Safety FirstPAUL B. ROTHMAN, M.D.DEAN OF THE MEDICAL FACULTYCEO, JOHNS HOPkINS MEDICINE

Ghazi Shubayli of Saudi Arabia, who received a lung and pancreas transplant at The Johns Hopkins Hospital, was Lubna Kousa’s first patient—and the inspiration behind the pilot international pharmacy program. Shubayli went from being hospitalized monthly because of medication mix-ups to leading an active life.

“ OUR GOAL IS TO PARTNER WITH PATIENTS AND THEIR LOVED ONES TO ELIMINATE PREVENTABLE HARM, CONTINUOUSLY IMPROVE PATIENT OUTCOMES AND ExPERIENCE, AND ELIMINATE WASTE IN HEALTH CARE.”

Rx for a Successful Pharmacy CareerTwo years strong, Johns Hopkins Home Care Group’s community pharmacy residency program earns accreditation and fills a growing need.

As a clinical pharmacy coordinator for the Johns Hopkins Outpatient Center Pharmacy, Lubna Kousa processes pre-scriptions for international patients. But she also meets face to face with them to develop medication calendars and a plan to safely manage their medications by understanding side effects

and drug interactions. Kousa, who works exclusively with Johns Hopkins Medicine Interna-

tional patients, is one of the first graduates of the Johns Hopkins Outpatient Pharmacy’s Community Pharmacy Residency Program. It recently received accreditation from the American Society of Health-System Pharmacists (ASHSP). Established in 2012, it is the only such program in Maryland.

Demand for outpatient pharmacy services is expected to rise as the nation’s population ages and people live longer with chronic diseases, says Amy Nathanson, clinical manager for the Johns Hopkins Outpatient Pharmacy.

ASHSP accreditation is the nationally recognized standard for high-quality post-graduate training. To achieve accreditation, the outpatient pharmacy demonstrated that it could provide diverse and high-caliber patient care services, while the residency program was evaluated for the quality of its

instruction and research opportunities.Trainees complete rotations in areas such as pharmacy administration,

pharmacy practice, informatics, medication safety and medication manage-ment for patients living with such chronic diseases as HIV, hepatitis C and asthma.

Thus far, the program has accepted two residents each year. In addition to practicing at The Johns Hopkins Hospital’s Arcade and Monument Street pharmacy locations, residents spend time working throughout Johns Hop-kins Health System outpatient pharmacies and clinics. These include Johns Hopkins Bayview Medical Center, Howard County General Hospital and Johns Hopkins Community Physicians Green Spring Station.

Kousa and Ashley Pham, who works at the Monument Street pharmacy, are the first residents to have landed permanent positions as community pharmacists with Johns Hopkins Home Care Group, which oversees the outpatient pharmacies. Last year’s community resident graduates, Jonathan Grant and Lauren Lakdawala, also stayed with the Johns Hopkins Outpa-tient Pharmacy.

As a resident, Kousa learned to run an outpatient pharmacy, participate in research projects and coordinate medication therapy management through Medicare and other providers. When she noticed a growing need among Middle Eastern patients to better understand their medication regimens, the Arabic-speaking pharmacist crafted a pilot program to educate them. That effort proved so successful that she developed a full-time service for interna-tional patients.

Kousa credits the residency with inspiring her approach. “Thanks to this program, I have the chance to empower patients every day.”

—Judy F. Minkove

When she noticed a growing need among Middle Eastern patients to better understand their medication regimens, the Arabic-speaking pharmacist crafted a pilot program to educate them.

EDUCATION

2 • D O M E • S E P T E M B E R 2 0 1 4

.

All in the Family

For an overview of the MyChart proxy access process, see the links below for helpful tips, instructions and authorization forms:

1. General tips on MyChart proxy access http://tinyurl.com/lhs5buq

2. MyChart proxy access Lunch and Learn broadcast

http://tinyurl.com/mel7xkm

3. Pediatrics tip sheet on proxy access http://tinyurl.com/l8tf2s3

4. HIPAA request forms for MyChart proxy access

http://tinyurl.com/ksj45wu

Starting later this month, The Johns Hopkins Hos-pital is introducing an

initiative to increase the offerings of healthy beverages and decrease the availability of sugar-sweet-ened drinks. It’s part of the insti-tution’s five-year plan to “actively support a healthy workforce.”

Under the new program, all bev-erages will be classified by color, based on the density of calories per ounce and the volume of each beverage container: Green: water, unsweetened tea/coffee, skim/2 percent milk, diet beverages

Yellow: low-calorie fruit drinks and sports drinks, 100 percent fruit/vegetable juice

Red: fruit drinks, soda, sports drinks, coffee drinks, whole milk

By October, meetings and events at the hospital will only provide beverages in the health-ier categories. Also, you will no-tice changes in the availability, size and pricing of certain bev-erages in the cafeteria and retail locations in the hospital.

These changes are already in effect at Johns Hopkins Health-Care and Johns Hopkins Home Care Group and will be imple-mented across other Johns Hop-kins Medicine organizations.

INTEGRATION

How to enroll children in MyChart: A resource guide to the proxy access process.

To date, more than 130,000 patients across Johns Hopkins Medicine have activated their MyChart account. That’s an impressive start but still short of Meaningful Use standards for using electronic health re-cord systems and avoiding financial penalties.

All the more reason for care teams to help parents and guardians ob-tain proxy access to children’s MyChart medical records. It’s important to remember that gaining access to Epic’s secure patient portal is not a “one size fits all” process. The procedure—and degree of access—differs according to a child’s legal status, age and cognitive capacities.

—Stephanie Shapiro

For more information on MyChart:n Visit hopkinsmedicine.org/epic .

n C lick on “Frequently Asked Questions.”

n Click on “MyChart FAQs.”

A JHED login is required.

In Jane’s Story, a wise little owl explains to a child how she will receive chemotherapy for a tumor in her eye. This small comic book, created by Lydia Gregg, a medical illustrator and instructor with joint appointments in

the Department of Radiology and Radiological Sciences and the Department of Art as Applied to Medicine, isn’t meant to be funny—even if it’s filled with cartoons.

Increasingly, such graphic novels are designed to explore social issues and serious medical matters in a way that makes them more comprehensible to the general public.

This summer, 235 people flocked to Johns Hop-kins’ East Baltimore campus to attend the fifth annual international Comics and Medicine con-ference. The three-day event, held in the school of medicine’s Preclinical Teaching Building, was chaired and organized by Gregg in collaboration with Corinne Sandone, director of the graduate program in medical and biological illustrations, and Gary Lees, director of the Department of Art as Applied to Medicine.

The theme of this year’s conference was “From Private Lives to Public Health.” Roughly 80 speakers from throughout the country and over-seas highlighted how personal health narratives and such issues as barriers to health care and the stigma of illness are portrayed in comics.

Speakers included Jeff Day, a medical and biological illustration student who delighted the audience by doodling clever drawings as he spoke about creating a cartoon guide on how to avoid harm while exploring nature. Medical student Lena Caron described her research into the en-during popularity of the 66-year-old Rex Morgan M.D. comic strip. Although tackling serious sub-jects such as domestic violence and drug abuse, the strip owes its continuing success, Caron said, to an observa-tion by the late Nicholas Dallis, the strip’s creator: “Messages don’t keep people reading—a good story does.”

Gregg says her goal in organizing the conference was to pro-mote comics’ remarkable ability to convey “difficult-to-describe scenarios, events and emotions.”

“I think the speakers did a wonderful job showing how the comics medium is powerful at capturing multiple perspec-tives—from the patient, doctor, student, family member, etc.,” says Adela Wu, a second-year medical student.

—Neil A. Grauer

Comics ReliefAn international conference on comics and medicine considers the humanizing power of graphic novels.

PEOPLE

RethinkYour Drink: The HealthyBeverage Initiative

PATIENT- AND FAMILY-CENTERED CARE

In Jane’s Story, written and drawn by Lydia Gregg, Jane asks Otus the Owl to explain how a tumor in her eye will be treated.

D O M E • S E P T E M B E R 2 0 1 4 • 3

0

20.000

40.000

60.000

80.000

100,000

120,000

140,000

July-SeptApril–JuneJan–MarOct–DecJuly–SeptApril–June

Dates

Num

ber

of P

atie

nts

16,438

123,117

74,409

100,404

47,142

MyChart Patient Activation Rates

130,165

2013 2014

Last winter, Johns Hopkins physician Dwight Wooster had just stepped into a crowded elevator in the Johns Hopkins Outpatient Center when he collapsed in cardiac arrest. One

hospital worker immediately called a Code Blue to the Department of Emergency Medi-cine’s Lifeline Critical Care Transport Team’s dispatch center, while another began chest compressions on the pulseless Wooster.

In fewer than five minutes, the Outpatient Center’s rapid response team members took control of Wooster’s care. They pulled him halfway out of the elevator for better access and began resuscitation and intubation. Mo-ments later, the Lifeline emergency transport team arrived and worked with the first re-sponders to stabilize Wooster before rushing him by ambulance three long blocks away to The Johns Hopkins Hospital’s Emergency De-partment.

Swift and coordinated, the two-stage re-sponse was “lifesaving,” says Wooster, an internist and pulmonologist, who recently returned to his clinical practice and teach-ing duties in the school of medicine’s inter-nal medicine clinics. Receiving care during transport by ambulance to the Emergency Department is the safest option on a campus with untold twists and turns, he says. “This is a city within a city, the way I look at it. In an emergency, you have to find the path of least resistance.”

As the Sheikh Zayed Tower and The Char-lotte R. Bloomberg Children’s Center neared completion several years ago, Julie Kubiak, assistant director of nursing for ambulatory care, realized that the new adult and pediatric emergency departments were a lengthy walk away, posing a patient safety risk in an emer-gency. Kubiak collaborated with the Lifeline Critical Care Transport Team—the critical care transport service for patients en route to or within The Johns Hopkins Hospital—to create an alternative system that would take patients to the Emergency Department from outside, instead of through the halls, under-ground corridor and elevators.

Kubiak and Scott Newton, assistant director of nursing for Lifeline, mapped out the two-stage emergency response plan used to trans-port Wooster. First, the Outpatient Center’s rapid response team—a physician, two nurses,

an anesthesiologist, pharmacist and security officer—stabilizes the patient. Then, Lifeline takes over to care for and transport the patient to the Emergency Department. “That way, our team is able to stay in the building to care for other assigned patients in the Outpatient Cen-ter, minimizing interruptions in routine care,” Kubiak says.

Since the ambulatory emergency response tactic debuted more than two years ago, code calls from the Outpatient Center have doubled, from an average of six calls a month to 14. The increase could reflect higher patient volume at the Outpatient Center as well as more patients who are very sick, Kubiak says.

The calls come from clinics, outpatient sur-gery, Express Testing and the Outpatient Cen-ter lobby. Most concern patients and visitors who experience shortness of breath, chest pain, a fall or loss of consciousness.

Using frequent code simulations, post-re-sponse debriefings, cross-disciplinary collabo-ration and data analysis, the combined teams continue to sharpen their ability to respond to a wide variety of emergencies, Newton says. Their duties will soon expand. Members of the hybrid response team are now preparing to provide overnight coverage to the Sleep Disor-ders Center, located in the Outpatient Center.

—Stephanie Shapiro

A Lifesaving ShortcutRapid responders team with critical care transport workers to speed up emergency support in the Johns Hopkins Outpatient Center.

Receiving care during transport by ambulance to the Emergency Department is the safest option on a campus with untold twists and turns.

—DWIGHT WOOSTER

The Johns Hopkins Outpatient Center’s rapid response team and the Lifeline critical care transport team perform frequent code simulations to sharpen their ability to respond to a wide variety of emergencies.

4 • D O M E • S E P T E M B E R 2 0 1 4

PATIENT- AND FAMILY-CENTERED CARE

how quickly clinicians trained in this approach can help patients. Her colleague Jason Liebowitz, for ex-ample, was able to assist a man hos-pitalized for a heart attack who was also diagnosed with diabetes. Hail-ing from a large Italian family, the patient resisted giving up the pasta and bread he loved until Liebowitz helped him realize that he wanted to stay healthy enough to keep his physically demanding shipyard job. Between his discharge and first follow-up appointment, the patient followed a low-carb diet and shed several pounds. Most important, he kept his blood sugar under control.

Residents taking the course also use Vital Score, a tool to help change unhealthy behaviors. Invent-ed by Hilary Hatch, an instructor

at the Johns Hopkins Center for Behavior and Health, Vital Score is modeled after the Apgar score used to assess new-borns at one and five minutes after birth. Using a numerical scale of one to 10, Vital Score measures the health of patients based on their answers to ques-tions about exercise, smoking, sleep, diet and drinking.

Kruzan says that merely receiving a health rating will drive patients to try to improve it. “No matter what they score, whether it’s a four or seven, they ask me about gyms and diet and tell me they want to score higher when they come back,” she says.

To illustrate how difficult it is to change behavior, the program re-quires residents to initiate their own self-improvement regimens. For two weeks, they wear a Fitbit biometric bracelet to establish baseline readings of their activity levels, sleep patterns and more. Then they set a goal, like losing 5 pounds or increasing their sleep to at least seven hours per night, for the following month.

When Liebowitz chose to walk at least 10,000 steps per day, he also learned how much he has in com-mon with his patients.

“Sometimes we physicians and residents hold ourselves to a different standard—we say we’re busy, we’re doing important work,” Liebowitz says. “But janitors and bus drivers, they work hard and do important work, too, and also have family responsibilities. Everyone faces the same challenges. With the right motivation, we can all change our health behaviors in a positive way.”

—Christina DuVernay

For a list of courses focused on com-municating effectively with patients, visit www.hopkinsmedicine.org/dome .

Although Cody Cichowitz has participat-ed in a number of service projects over the years, he was unprepared for the re-wards of working with an organization that helps refugee families navigate the

U.S. health care maze. “These families remind me why I want to study medicine and have helped me under-stand how medical professionals can serve patients and those in need,” says the second-year medical student.

The Refugee Health Pathway is one of many com-munity outreach projects available to medical students through the auspices of the Student Outreach Re-source Center, or SOURCE. Directed by Mindi Levin, SOURCE is a joint community service and service learning center for the school of medicine, the school of nursing and the Bloomberg School of Public Health. It supports dozens of service-based student groups, such as the Refugee Health Pathway, and partners with more than 100 nonprofits in Baltimore. Every year, some 200 medical school students take part in com-munity outreach projects through SOURCE, which will celebrate its 10th anniversary in 2015.

The Refugee Health Pathway pairs a small team of medical students with a refugee family referred by the International Rescue Committee at the Baltimore Re-settlement Center. The families come from all over the world—Sudan, Nepal, Iraq, Eritrea. “We do home visits and help them come up with questions to ask the doc-tor,” says Cichowitz. The students also connect the fam-ilies to community resources, such as medical clinics and food banks, and advise them about the nutritional value of American food.

Working in teams and witnessing the social and cultural factors that affect the health of these families

is preparing him to practice 21st century medicine, Cichowitz says. “If I get stumped, one of my teammates will know what to ask or what to say.”

Student Sight Savers is another organization that brings medical students into the community. Started in 2011 by former medical student Thomas Johnson, now an intern, it performs eye screenings at local communi-ty events under the supervision of faculty ophthalmolo-gists. Those with potential medical issues, such as glau-coma or diabetic retinopathy, are referred to the Wilmer Eye Institute, where they receive free care if they do not have health insurance. As of March 2014, Johnson says,

335 people were screened, with 126 referred to Wilmer.Fifth-year M.D./Ph.D. student Melissa Liu, who now

directs Student Sight Savers, says she is drawn to oph-thalmology because of the widespread need for access to vision care. Community service work also makes what she studies less abstract. “It allows medical students to reach out to East Baltimore residents in a very power-ful way,” she says. “With Sight Savers, I’m putting my learning to work.”

—Christina DuVernay

“ Doctors don’t change patients; patients change themselves. But they need allies, and health professionals can offer vital guidance and ongoing support.”

ROBERT SHOCHET, ASSISTANT PROFESSOR OF MEDICINE

Sharing a Vision of Health(continued from page 1)

D O M E • S E P T E M B E R 2 0 1 4 • 5

EDUCATION

The SOURCE for a Life of ServiceThe Student Outreach Resource Center allows medical students to take their learning out into the world.

Through two service projects, M.D./Ph.D. student Melissa Liu and medical student Cody Cichowitz help patients in East Baltimore gain access to care.

Jason Liebowitz and Rachel Kruzan talk to a patient about her progress.

Foundations of Motivational Interviewing• Showingcompassionandseeking

to understand patients’ priorities, thoughts and feelings.

• Evokingpatients’ownmotivationsforchange. One patient may quit smoking because his father died of cancer; another, because her partner resents the secondhand smoke.

• Acceptingthatpatientshavearighttomake their own decisions.

PATIENT- AND FAMILY-CENTERED CARE

The day center of Johns Hopkins’ ElderPlus program is bustling: On one side of the large room, men and women in chairs lift their arms in unison during a seated exercise

class. On the other side, people greet each other as they arrive, some in wheelchairs, others push-ing walkers or leaning on canes.

Lillian Phillips, 83, chats with her friends Hedy Johnson and Carolyn Sawyer. Phillips, who comes to the center twice a week, lives alone in the three-story East Baltimore row house where she raised 11 sons and daughters. Two years ago, when her children became concerned about her ability to live by herself, she joined a waiting list for PACE (Program of All-Inclusive Care for the Elderly) based at Johns Hopkins Bayview Medical Center. In August 2013, she got in.

“I wouldn’t want to be in a nursing home,” says Phillips, who has diabetes. “I like where I am.”

In addition to the day center, PACE provides medical care, counseling, transportation and even services such as cooking or laundry, if needed.

An occupa-tional therapist inspects the home of every PACE partici-pant, suggest-ing health and

safety improvements. “Everything you need is right here,” Phillips says.

Older people with chronic ailments, like Phil-lips, are too often voracious and inefficient con-sumers of health care, particularly if they lack consistent care and instead seek treatment in emergency rooms, geriatricians say. PACE is part of a movement, increasingly urgent as the popula-tion ages, that combines medical and nonmedical interventions in creative ways.

Key to this strategy is visiting people at home to solve problems as basic as empty fridges, inac-tivity, exhausted caregivers and trip-hazard rugs.

The focus is less on treating ailments and more on improving quality of life.

“This is a very important approach for people who are older adults,” says Laura Gitlin, director of the Center for Innovative Care in Aging, based in the nursing school with representatives from the schools of medicine, public health, business and engineering.

“The health system is bent on managing disease but ignores the consequences to disease—often more problematic than the disease itself, such as functional difficulties, preparing meals or bath-ing,” she says.

The freedom to purchase what’s needed for PACE participants without worrying about bill-ing for each procedure and piece of equipment is central to the success of the national program. It came to Johns Hopkins, where it is known as El-derPlus, in 1996. Funded by Medicare and Med-icaid, PACE uses a “capitated” payment system, providing a lump sum per participant per month.

That means a participant with troubled breath-ing might receive an air conditioner not normally covered by Medicare or Medicaid, says Jack Rund, director of operations for Johns Hopkins ElderPlus. “What’s their greatest need?” he asks. “What’s going to keep them safely at home? What’s going to ease the burden of the caregiver?”

To ensure that those questions are answered, each PACE participant is the subject of a team meeting twice a year that involves about 15 peo-ple, including nurses, social workers, occupational therapists, a doctor, a day center staffer, a medical device coordinator and a dietitian.

Every Thursday at 8:15 a.m., the team gathers in a Hopkins Bayview conference room to discuss one person at a time, including that individual in the conversation when possible. Thanks to such sessions, one woman who “furniture surfs” be-cause she doesn’t want to take her walker on the stairs will now get a second walker to keep on the top floor of her home. Another will begin receiv-ing Meals on Wheels.

Studies of PACE show that people in the pro-gram, who must be old and sick enough to qual-ify for nursing home care, remain in their com-munities, have fewer hospital visits and are more likely to die at home, as they wish, instead of in a hospital or nursing home, says Matthew McNab-ney, medical director for PACE and associate pro-fessor of geriatric medicine, who authored some of the research, which he conducted with colleagues from the National PACE Association.

Though PACE has 103 locations nationwide, the Johns Hopkins center is the only one in Maryland, which allows, by state law, just 150 participants. McNabney believes demand exists for a second center in Baltimore or elsewhere in Maryland.

Meanwhile, the current participants seem pleased with the care they are receiving.

Sawyer, 72, lives in East Baltimore with her 86-year-old husband, David. She has diabetes and chronic obstructive pulmonary disease, which requires her to breathe through oxygen tubes. She enrolled in PACE because it “provides so many services,” she says. PACE caregivers came to her home, told her to pull up her allergen-trapping carpet and installed grab bars in her bathroom. She attends a PACE-organized support group called Puffers for people with oxygen tanks. She participates in PACE activities and gets help from PACE staff when her dentures bother her.

Johnson, 82, has been in PACE since she was diagnosed six years ago with transverse myeli-tis, a spine condition that causes her to lose her balance. Through PACE, she goes on trips to the theater and museums, and she comes to the PACE center four days a week. “You don’t sit in a corner,” she says. “They keep you from feeling like you can’t do anything.”

“People make you feel so welcome,” says Phil-lips, who clearly enjoys her time with Sawyer and Johnson. “When you’re eating together, people have a tendency to talk more.”

—Karen Nitkin

A Comfortable Old AgePACE finds solutions to the challenges of aging in place.

“ I wouldn’t want to be in a nursing home. I like where I am.”

—LILLIAN PHLLIPS

From left, Hedy Johnson, Lillian Phillips and Carolyn Sawyer enjoy medical and social support from the Johns Hopkins ElderPlus program.

6 • D O M E • S E P T E M B E R 2 0 1 4

A Comfortable Old AgePACE finds solutions to the challenges of aging in place.

Working with mice and human blood and liver samples, Johns

Hopkins Children’s Center investi-gators have identified a previously unsuspected liver hormone as a criti-cal player in the development of type 2 diabetes, a condition that affects nearly 26 million people in the United States and is a leading cause of heart disease and stroke, as well as kidney, nerve and eye damage.

The study shows that the hormone kisspeptin 1, or K1—up until now known for its regulation of puberty and fertility—also slows down the production of insulin, the sugar-regulating hormone secreted by the pancreas, and in doing so fuels the development of type 2 diabetes.

The findings, published in the jour-nal Cell Metabolism, provide what researchers consider a missing link in understanding the origins of type 2 diabetes. Two hormones, glucagon and insulin, must work in synchrony to maintain healthy sugar levels in the bloodstream. Secreted when sugar lev-els drop, glucagon causes the liver to release its strategic reserves of glucose into the bloodstream. Insulin acts as an antidote to glucagon and helps the body lower blood sugar by transporting it out of the bloodstream and into organs and tissues as fuel. In type 2 diabetes, pancreatic cells secrete too little or no insulin at all, leading to a dangerous buildup of sugar in the blood.

The prevailing wisdom has been that exposure to chronically elevated glucagon and blood sugar levels takes a gradual toll on the pancreas, and its overworked beta cells slowly decrease

insulin output until they stop making insulin altogether.

The new findings, however, show that the pancreatic cells don’t just get tired; their function is directly suppressed by K1.

“Our findings suggest that glucagon issues the command, but K1 carries out the orders, and in doing so, it appears to be the very cause of the declining insulin secretion seen in type 2 diabetes,” says lead investigator Mehboob Hussain, an

endocrinologist and metabolism expert at the Children’s Center.

The identification of K1 as a key player in diabetes offers a possible new treatment target that could lead to the development of drugs that restore the function of the insulin-secreting cells. Currently, diabetes therapy is based on injecting synthetic insulin to maintain blood sugar levels. However, restoring natural insulin production could, in

theory, cure diabetes, instead of simply mitigating its symptoms.

The Johns Hopkins team says it has already identified a hormonelike sub-stance that blocks the K1 receptor in the pancreatic cells of mice. The investigators will next study whether this receptor-blocker can restore the function of human pancreatic cells.

—Ekaterina Pesheva

Advancing Military and Veterans Research Zachary Kaminsky spends much of his time identify-ing biological markers for suicidal behavior in military service mem-bers—studies he hopes will one day prove trans-formative in preventing veterans’ suicides. His research recently got a boost from the Johns Hopkins Military & Vet-erans Health Institute (JHMVHI). Kaminsky, an assistant professor in the Depart-ment of Psychiatry and Behavioral Sciences, is one of seven researchers to receive inaugural grants from the JHMVHI’s research program. The group bestowed five grants of up to $10,000 to students, residents and fel-lows, and two grants of up to $25,000 to faculty at the assistant professor

level. Zaminsky and Adam Hart-man won the faculty awards; Denver Lough, Aleah Roberts, Ben Hung, Devin Miller and Sujith Sajja each received $10,000 grants. Judges included mem-bers of the JH-MVHI steering committee and leaders from the Department

of Defense. Relevance of the pro-posed research to service members, veterans and their families was a key factor in the competitive process. Johns Hopkins Medicine provides care for roughly 42,000 veterans and their families, under a DOD contract with Johns Hopkins HealthCare. To learn more about the institute, visit http://wp.jh.edu/jhmvhi/.

Gynecologic Cancer Awareness SymposiumEach year, nearly 88,000 women in the United States are diag-nosed with a gynecologic cancer, according to the American Can-cer Society. To mark Gynecologic Oncology Awareness Month, the Johns Hopkins Kelly Gynecologic Oncology Service will offer a sym-posium at the Baltimore Marriott Waterfront on Sept. 27 regard-ing state-of-the-art treatment updates and cancer survivorship for women with ovarian, fallopian tube, primary peritoneal and uterine cancers. Featuring physicians and researchers from Johns Hopkins, Massachusetts General Hospital and other nationally recognized cancer centers, the symposium runs from 8 a.m. to 4 p.m. and is free to cancer survivors and their families. Topics include the latest clinical trials and novel treatments for gynecologic cancers, sexual health, menopause,

improving cancer survivorship and the role of “unsung hero” caregivers. There will also be a nutrition and wellness program. The symposium is co-sponsored by the Greater Baltimore Medical Center. For details and registration, call 410-955-8240 or visit the Founda-tion for Women’s Cancer website at foundationforwomenscancer.org.

BIOMEDICAL DISCOVERY

BRIEFCASE

SAVE THE DATE

Nov. 1, 2014: A Woman’s Journey turns 20: Don’t miss the premier conference on women’s health. Details: http://tinyurl.com/kpc5f9k.

A Possible Missing Link to Understanding Type 2 Diabetes

Endocrinologist Mehboob Hussain’s studies revealed that the hormone kisspeptin 1 (K1) suppresses pancreatic cells’ function, causing reduced insulin secretion.

D O M E • S E P T E M B E R 2 0 1 4 • 7

Bloomberg Professorships

Patricia Janak, Ph.D., has been appointed to a Bloomberg Dis-tinguished Professorship, joining a group of world-class scholars formed earlier this year to anchor collaborative, interdisciplinary programs across the university. Janak, most recently a professor of neurology at the University of California, San Francisco, will hold joint appointments in the Department of Neuroscience in the school of medicine and in the Department of Psychological and Brain Sciences in the Krieger School of Arts and Sciences. Also appointed a Bloomberg Distin-guished Professor is Kathleen Sutcliffe, Ph.D., formerly a pro-fessor of business administration, management and organizations at the University of Michigan. Sut-cliffe will hold joint appointments in the Carey Business School and the school of medicine, where she will be part of the Armstrong Institute for Patient Safety and Quality and will participate in the Individualized Health Initiative.

Healthnetwork Foundation Awards

Paul Auwaerter, M.D., professor of medicine and clinical direc-tor of the Division of Infectious Diseases, and Michael Polydef-kis, M.D., associate professor of neurology and director of the Cutaneous Nerve Laboratory, are two of 10 physicians nationwide to receive $10,000 service excel-lence research awards from the Healthnetwork Foundation.

EAST BALTIMORE

Ahmet Baschat, M.D., B.Ch., an internationally recognized authority on the screening, prevention and management of placental dysfunction and fetal growth restriction, has been ap-pointed professor and director of the Johns Hopkins Center for Fetal Therapy.

Jessica Bienstock, M.D., M.P.H., professor and director of the Department of Gynecol-ogy and Obstetrics’ residency program, has been chosen to rep-resent the school of medicine in the 2014 Executive Leadership in Academic Medicine Program.

Joseph Cofrancesco, M.D., M.P.H., director of the Johns Hopkins Institute for Excellence in Education, has been named the inaugural Johns Hopkins Insti-tute for Excellence in Education Professor of Medicine. Appointed director of the institute in 2009, he has developed it into a national leader in academic medicine.

David Hackam, M.D., Ph.D., recognized worldwide for his groundbreaking studies of intes-tinal inflammation and injury in infants, has been named the Robert Garrett Professor of Pedi-atric Surgery and chief of pedi-atric surgery at Johns Hopkins. He also holds professorships in

oncology and pediatrics and will collaborate closely with George Dover, M.D., professor and director of the Johns Hopkins Children’s Center, to manage its multifaceted clinical and re-search centers.

Jonathan Lewin, M.D., senior vice president of integrat-ed healthcare deliv-ery, professor and di-rector of the Depart-ment of Radiology

and Radiological Science, and radiologist-in-chief at The Johns Hopkins Hospital, has been elected president of the Associa-tion of University Radiologists.

Frank Lin, M.D., Ph.D., associate pro-fessor of otolaryn-gology–head and neck surgery, geron-tology, mental health and epidemi-

ology, has received the Hearing Loss Association of America’s 2014 James B. Snow, Jr., M.D. Award in recognition of his com-mitment to research on hearing loss and how it affects people as they age.

Jeffrey Palmer, M.D., professor and director of the De-partment of Physical Medicine and Reha-bilitation, has been named an Honorary

International Member of the Japanese Association of Rehabili-tation Medicine. Palmer, who also is physiatrist-in-chief at The Johns Hopkins Hospital and di-rector of the Oral Functional and Swallowing Laboratory, gave the keynote address at the associ-ation’s annual meeting in June.

David Valle, M.D., Ph.D., professor and director of the McK-usick-Nathans Insti-tute of Genetic Medicine, has re-ceived the American

Society of Human Genetics’ Vic-tor A. McKusick Leadership Award for his achievements in fostering and enriching the de-velopment of human genetics disciplines.

Marketing and Communications

The Health Information Re-source Center has bestowed Web Health Awards on all eight videos the Marketing and Com-munications team submitted to its competition for the highest-quality digital health resources for consumers and health pro-fessionals. For more info, visit http://www.healthawards.com/wha/news.html.

JOHNS HOPKINS BAY VIEW MEDICAL CENTER

Margaret Chisolm, M.D., asso-ciate professor of psychiatry and behavioral sciences and director of education for the Department

of Psychiatry at Johns Hopkins Bayview, has received The Johns Hopkins University’s Alumni Association 2014 Excellence in Teaching Award.

Laura Hanyok, M.D., assistant professor of medicine, has been selected out of a national pool of 91 medical and nursing educa-tors to be one of six Macy Fac-ulty Scholars for 2014. Funded by the Josiah Macy Jr. Founda-tion, the $100,000 annual grant for each of the next two years will enable Hanyok to spend at least half of her time pursuing a mentored educational innovation project and to engage in other opportunities to enhance her ca-reer as an educator.

HOWARD COUNTY GENER AL HOSPITAL

Heart Care Honors

The American Heart Associa-tion has given its Lifeline Bronze Receiving Quality Achievement Award to Howard County Gen-eral Hospital for implementing specific association-recom-mended quality improvement measures for the treatment of patients who suffer severe heart attacks called ST-segment eleva-tion myocardial infarctions.

The Maryland Institute for Emergency Medicine Services Systems has granted a five-year re-designation as a Cardiac In-terventional Center to Howard County General for meeting the state’s highest standards in the care of patients who have been transported to the hospital by emergency medical services after suffering an ST-segment eleva-tions myocardial infarction.

JOHNS HOPKINS COMMUNITY PHYSICIANS

Melissa Helicke, M.B.A., former assis-tant dean at Johns Hopkins Bayview, as well as administrator of the Department of Medicine there, has

become vice president of practice operations for Johns Hopkins Community Physicians.

SIBLEY MEMORIAL HOSPITAL

Sibley’s Get With the Guide-lines-Stroke program received The American Heart Association/American Stroke Association Gold Plus Quality Achievement Award for implementing specific quality improvement measures for treating stroke patients.

Joanne Miller, M.S.N., R.N., a veteran of more than 20 years with progressive nursing leader-ship experience, has been named vice president for patient care ser-vices and chief nursing officer.

The marketing team has received a Silver Award from the Aster Awards, a medical marketing pro-gram sponsored by Creative Im-ages Inc., in the poster/display se-ries category for the hand hygiene campaign material that was post-ed on the inside of the elevators in the main hospital and the Re-naissance Building.

SUBURBAN HOSPITAL

Jason Cole has become the hospital’s first senior director of information systems. Previously information technology director for Johns Hopkins Community Physicians, where he oversaw its conversion to Epic, Cole will man-age the daily operations of the hospital’s information systems, focusing on service delivery and improved customer service.

JOHNS HOPKINS MEDICINE INTERNATIONAL

Awais Akbar, M.B.A., a senior associate project manager special-izing in developing and building strategic partnerships, has been named to The Daily Record’s 2014

VIP List celebrating young pro-fessionals under the age of 40. Akbar has been with Johns Hop-kins Medicine International since 2008, managing projects in the Middle East and North Africa.

whO / whAT

DomePublished 10 times a year for members of the Johns Hopkins Medicine family by Marketing and Communications.

The Johns Hopkins School of MedicineThe Johns Hopkins HospitalJohns Hopkins Bayview Medical CenterHoward County General HospitalJohns Hopkins HealthCareJohns Hopkins Home Care GroupJohns Hopkins Community PhysiciansSibley Memorial HospitalSuburban Hospital Healthcare SystemAll Children’s Hospital

EditorLinell Smith

Contributing Writers Christina DuVernay, Neil A. Grauer, Judy F. Minkove, Karen Nitkin, Ekaterina Pesheva, Stephanie Shapiro

Copy EditorsAbbey BeckerJudy F. Minkove

DesignerDave Dilworth

Photographer Keith Weller

Dalal Haldeman, Ph.D., M.B.A.Senior Vice President, Johns Hopkins MedicineMarketing and Communications

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NEW MOTHERS OF INVENTION: If you can get anything from chips to live bait in a vending machine, why not storage bottles, breast pads, nipple cream and nursing pump accessories? When Meg Stoltzfus, a program manager with the Office of Work, Life and Engagement, asked herself that question, a great idea was born. Last month, Stoltzfus oversaw the installation of a vending machine stocked with pumping necessities in a nursing mothers’ room in the hospital’s Nelson/Harvey Building. The vending machine, believed to be the first of its kind, is part of Johns Hopkins’ Breastfeeding Support Program and sells items at a discount to employees. In this photo, Melanie Cragway, a clinical customer service coordinator in the neurosciences critical care unit, makes a purchase from the new vending machine.

PICTURE ThIS

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Pain Management Symposium: Taking Pain Seriously

The Johns Hopkins Hospital Pain Task Force is on a mission to make sure that frontline staff members across the system always treat the subject of pain seriously. Join nurses, doc-tors, pharmacists, social workers and representatives from the service excel-lence team who report to the hospital’s Patient Safety Committee to discuss

this topic at a symposium on Monday, Sept. 29, from 8 a.m. to 1 p.m. in the Sheikh Zayed Tower, room 2117. Learn which procedures safety data show are a major source of patient complaints and about the latest findings on ways to manage pain without medi-cation. To register, contact Eileen Kasda at 410-502-3903 or ekasda1@jhmi.edu.