Personalized Health Care:  The Foundation of Rational Health Reform <ul><li>Ralph Snyderman, MD </li></ul><ul><li>Chancell...
Science and Medicine ©2009 RALPH SNYDERMAN 1900s Germ Theory Chemistry Physiology Pathology Physics Find It Fix It Underst...
Concepts of Disease ©2009 RALPH SNYDERMAN Reductionism: Single factor Causative  Factor Disease
Contemporary Practice of Medicine <ul><li>Disease-oriented </li></ul><ul><li>Find it, fix it </li></ul><ul><li>Reactive </...
Science and Medicine ©2009 RALPH SNYDERMAN 1900s Germ Theory Chemistry Physiology Pathology Physics 2000s Genomics Proteom...
Concepts of Disease ©2009 RALPH SNYDERMAN Emergence: Multiple factors Reductionism: Single factor Baseline  Risk Environme...
©2009 RALPH SNYDERMAN Time Cost 1/reversibility Disease Burden Typical Current Intervention Earliest Clinical Detection Ea...
<ul><li>Health risk analysis </li></ul><ul><li>Pathogenesis tracking  </li></ul><ul><li>Molecular diagnosis </li></ul><ul>...
Predictive Model Development ©2009 RALPH SNYDERMAN CLINICAL DATA  COHORT OTHER PROTEOMIC GENETIC CLINICAL PREDICTIVE MODEL...
Paradigm Shift to Personalization ©2009 RALPH SNYDERMAN Traditional Medical  Evaluation and Record Chief Complaint History...
©2009 RALPH SNYDERMAN Personalized Health Plan PATIENT’S EVALUATION Medical “work up” -- including relevant predictive fac...
Fragmented Health Care ©2009 RALPH SNYDERMAN PRIMARY  CARE SPECIALTY CARE HOSPITAL CARE ER CARE URGENT CARE SELF CARE
©2009 RALPH SNYDERMAN Model for Personalized Health Approach PATIENT PHYSICIAN PERSONAL HEALTH PLAN Health Risk Assessment...
Personal Health Plan Coordinates Care   ©2009 RALPH SNYDERMAN PRIMARY  CARE SPECIALTY CARE HOSPITAL CARE ER CARE URGENT CA...
Clinical Decision Support at the Point of Care ©2009 RALPH SNYDERMAN EHR Clinical Risk Predictors Clinical Decision Suppor...
Example:  A point-of-care predictive test for  prevention of febrile neutropenia (FN) ©2009 RALPH SNYDERMAN
<ul><li>Universal access </li></ul><ul><li>Health education and personal empowerment </li></ul><ul><li>Personalized preven...
©2009 RALPH SNYDERMAN “ There is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage th...
©2009 RALPH SNYDERMAN “ Is is not the strongest of the species that survives, but rather the one most responsive to change...
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Personalized Health Care: The Foundation of Rational Health Reform

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Dr. Ralph Snyderman presented, "Personalized Health Care: The Foundation of Rational Health Reform" to the attendees of the 2009 Personalized Health Care National Conference.

Ralph Snyderman, MD, is chancellor emeritus of Duke University and the founder and chairman of Proventys, Inc. From 1989 to 2004, he served as chancellor for Health Affairs and dean of the School of Medicine at Duke. During his tenure, he led Duke’s medical center to a position of international prominence in academic medicine.

We thank Dr. Snyderman for sharing this presentation with the world.

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  • 10/01/09 Studies by Caggiano et al. (Cancer 2005) and Weiss et al. (Proc Am Soc Clin Oncol 2003) have estimated the national incidence of hospitalizations for FN at ~60,000 which gives an incidence of disease of ~0.78%. In the sentinel work by Boggs et al. (Cancer 1960), 44% of cancer patients with fever were found to have an infection. In a review of 7 hospital discharge databases with ~12M patients (all types of tumors), Caggiano et al. (Cancer 2005) found that the overall mortality rate in hospitalized neutropenic patients was 6.8%. Also found that the LOS was 10.1 +/- 11.2 days Mean cost for hospitalization from FN was $14,900 +/- $23,600
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  • Personalized Health Care: The Foundation of Rational Health Reform

    1. 1. Personalized Health Care: The Foundation of Rational Health Reform <ul><li>Ralph Snyderman, MD </li></ul><ul><li>Chancellor Emeritus, Duke University </li></ul><ul><li>James B. Duke Professor of Medicine </li></ul><ul><li>Personalized Health Care National Conference </li></ul><ul><li>Ohio State University Medical Center </li></ul><ul><li>October 1 , 2009 </li></ul>©2009 RALPH SNYDERMAN
    2. 2. Science and Medicine ©2009 RALPH SNYDERMAN 1900s Germ Theory Chemistry Physiology Pathology Physics Find It Fix It Understanding Disease
    3. 3. Concepts of Disease ©2009 RALPH SNYDERMAN Reductionism: Single factor Causative Factor Disease
    4. 4. Contemporary Practice of Medicine <ul><li>Disease-oriented </li></ul><ul><li>Find it, fix it </li></ul><ul><li>Reactive </li></ul><ul><li>Sporadic </li></ul><ul><li>Physician-directed </li></ul><ul><li>Very expensive </li></ul>©2009 RALPH SNYDERMAN
    5. 5. Science and Medicine ©2009 RALPH SNYDERMAN 1900s Germ Theory Chemistry Physiology Pathology Physics 2000s Genomics Proteomics Metabolomics Systems Biology Informatics Micro/Nano Processing Find It Fix It Predict It Personalize It Understanding Disease Understanding Health, Disease and Complexity
    6. 6. Concepts of Disease ©2009 RALPH SNYDERMAN Emergence: Multiple factors Reductionism: Single factor Baseline Risk Environmental Factors Preclinical Progression Disease Initiation Disease Progression Irreversible Damage Causative Factor Enhance Health and Well-Being Disease
    7. 7. ©2009 RALPH SNYDERMAN Time Cost 1/reversibility Disease Burden Typical Current Intervention Earliest Clinical Detection Earliest Molecular Detection Baseline Risk Initiating Events Stable Genomics Dynamic Tracking Therapeutic Decision Support Personalized, Predictive, Prevention Prevention Early Intervention End of Life Care Disease Management Personal Health Plan
    8. 8. <ul><li>Health risk analysis </li></ul><ul><li>Pathogenesis tracking </li></ul><ul><li>Molecular diagnosis </li></ul><ul><li>Clinical event prediction </li></ul><ul><li>Therapeutic potential analysis </li></ul>©2009 RALPH SNYDERMAN New Clinical Tools
    9. 9. Predictive Model Development ©2009 RALPH SNYDERMAN CLINICAL DATA COHORT OTHER PROTEOMIC GENETIC CLINICAL PREDICTIVE MODELER ADDITIONAL DATA; NEW BIOMARKERS STATISTICAL VALIDATION y = f (x 1 , x 2 ,…x n ) OUT OF SAMPLE POPULATIONS DATA PREDICTION MODELS BASELINE RISK DISEASE PROGRESSION EVENT PREDICTION DECISION SUPPORT PATIENT PHYSICIAN PATIENT’S DATA PREDICTIVE MODEL CLINICAL EVENT
    10. 10. Paradigm Shift to Personalization ©2009 RALPH SNYDERMAN Traditional Medical Evaluation and Record Chief Complaint History of Illness Past Medical History Family History Social History Physical Exam Diagnostic Tests Assessment and Plan Personalized Health Plan Health Risk Assessment Current Health Status Tracking Wellness and Pathogenesis Clinical Event Prediction Wellness Plans Therapeutic Plans
    11. 11. ©2009 RALPH SNYDERMAN Personalized Health Plan PATIENT’S EVALUATION Medical “work up” -- including relevant predictive factors and biomarkers PATIENT’S OUTCOME Tracking Data Clinical Event Data Patient’s Digital Data Base Risk Models Library PERSONALIZED HEALTH PLAN Current Health Status Health Risk Assessment Health Risk Tracking Disease Event Prediction Health and Wellness Plans Therapeutic Plans
    12. 12. Fragmented Health Care ©2009 RALPH SNYDERMAN PRIMARY CARE SPECIALTY CARE HOSPITAL CARE ER CARE URGENT CARE SELF CARE
    13. 13. ©2009 RALPH SNYDERMAN Model for Personalized Health Approach PATIENT PHYSICIAN PERSONAL HEALTH PLAN Health Risk Assessment Current Status Health Tracking Health and Wellness Plan Health Enhancement Resources Navigator Health Care Provider Team And Resources Integrated Delivery System
    14. 14. Personal Health Plan Coordinates Care ©2009 RALPH SNYDERMAN PRIMARY CARE SPECIALTY CARE HOSPITAL CARE ER CARE URGENT CARE SELF CARE Health Navigator Personal Health Plan
    15. 15. Clinical Decision Support at the Point of Care ©2009 RALPH SNYDERMAN EHR Clinical Risk Predictors Clinical Decision Support Diagnostics Selectors Therapeutic Predictors Payer Adjudication PDx Server Clinical Research New Model Validation Biocausality Engine
    16. 16. Example: A point-of-care predictive test for prevention of febrile neutropenia (FN) ©2009 RALPH SNYDERMAN
    17. 17. <ul><li>Universal access </li></ul><ul><li>Health education and personal empowerment </li></ul><ul><li>Personalized prevention and strategic health planning </li></ul><ul><li>Biomedical research and regulatory reform </li></ul><ul><li>Delivery systems integration </li></ul><ul><li>Reimbursement reform </li></ul>©2009 RALPH SNYDERMAN Key Factors in Health Care Reform
    18. 18. ©2009 RALPH SNYDERMAN “ There is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. The initiator has the enmity of all who profit from the old institution and merely lukewarm defenders in those who would gain the new ones.” Niccolo Machiavelli
    19. 19. ©2009 RALPH SNYDERMAN “ Is is not the strongest of the species that survives, but rather the one most responsive to change.” Charles Darvin

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