These awards and achievements are the result of having every employee in the Medical Center focused on the shared goal of creating and developing what we call P4 Medicine.The four “Ps” stand for:PredictivePreventivePersonalized and ParticipatoryP4 Medicine will result in health care that predicts and prevents illness, focuses on health and wellness, and considers the consumer as the central figure in care. It will create a future for health care that is more precise, cost-effective and higher quality.Today, I would like to share with you some examples of how Ohio State is leading the country in each of the areas of P4 Medicine, and some of the lives we have changed in the process.
Ohio State has taken a leading role in the development of P4 Medicine by establishing innovativerelationships with national organizations.Coriell Personalized Medicine CollaborativeOhio State’s Medical Center has partnered with the Coriell Institute for Medical Research, home of the world’s leading biobank resource for human cells and DNA, on the Coriell Personalized Medicine Collaborative (CPMC). The CPMC is a long-term research study designed to determine the value of using a patient’s genome information in their health management and clinical decision-making. Volunteer study participants submit a small saliva sample for genome analysis, answer online health questionnaires, and in return, receive personal risk assessments.P4 Medicine Institute The Institute for Systems Biology, an internationally known research organization located in Seattle, has invitedThe Ohio State University Medical Center as a founding member of the P4 Medicine Institute. The Institute is the country’s only non-profit research organization dedicated to accelerating the emergence and adoption of health care that is predictive, preventive, personalized and participatory (P4 Medicine) and its impact on our society.The Medical Center will serve as the clinical demonstration site for the Institute’s pilot projects.Personalized Medicine CoalitionThe Medical Center was also the first major public academic medical center to join the Personalized Medicine Coalition – a Washington, D.C.-based independent, non-profit group that works to advance the understanding and adoption of personalized medicine. Dr. Clay Marsh is a member of the board of directors of the Personalized Medicine Coalition, which gives Ohio State a national voice in the movement toward P4 Medicine.
We are also incorporating elements of P4 Medicine into our College of Medicine curriculum.The College of Medicine is in the process of developing a new curriculum that prepares students for careers in P4 medicine, including increased focus on predictive medicine, including genetics and bioinformatics increased focus of preventive health care, particularly in career paths such as family medicine greater diversity of academic paths, allowing students to personalize their education use of mobile technology in the medical curriculum. Our medical students are using the iPod touch to view surgical and medical videos and condense classroom material and lectures. These mobile, Internet-connected devices also encourage patient participation, giving our students and doctors immediate access to a wealth of information, allowing them to answer patient questions right at the bedside.The expansion of the Medical Center’s Clinical Skills Education and Assessment Center is also under way, which will provide additional opportunities for students to perfect their skills with emerging technologies by using state-of-the-art patient and surgical simulations. Being able to practice on these high-tech simulations helps prevent complications in the OR.Ohio State has also received the prestigious Howard Hughes Training Grant, to develop a new graduate training program in clinical and translational research.This is Catherine Lucey. She is the vice dean for Education and the vice chair of Education in the Department of Internal Medicine. I have also recently appointed her as interim dean of College of Medicine. Dr. Lucey has played a central role in the structuring of the College of Medicine curriculum as well as the overall advancement of the educational mission of the Medical Center.
P4 Medicine May 2011
“It is not the fittest of the species that survives, it is the most adaptable to change”Charles Darwin<br />
What is the Compelling Opportunity in Medicine?<br />
Healthcare: The Need for Transformation<br />Total health care spending was $2.5 trillion in 2009, representing ~17.6% of the GDP, likely to reach $4 trillion by 2016<br />75-90% were spent on managing and treating chronic illnesses that are preventable and effectively managed<br />IOM reports that up to 98,000 preventable deaths occur per year and the research to practice gap is 17 years.<br />The U.S. healthcare ranked by the WHO 37/191 countries in performance.<br />Drugs prescribed for patients are effective in fewer than 60% of treated patients but costs of development is skyrocketed.<br />
Formula for Change<br />D x V x F> R<br />D = Dissatisfaction with how things are now <br />V = Vision of what is possible <br />F = Initial, concrete steps that can be taken towards the vision.<br />If the product of these three factors is greater than R = Resistance, then change is possible. <br />Because of the multiplication of D, V and F, if any one is absent or low, then the product will be low and therefore not capable of overcoming the resistance.<br />
Disruptive Innovation to Transform Health Care <br />Create precision medicine (personalized care)<br />Push care from more specialized to less specialized providers using rules-based approaches<br />Decentralize medical care (push to community)<br />Integrate medical information<br />Incentivize health from integrated organizations that will benefit from health of its members (like Ohio State)<br />
What Do Health, Disease and Nature Share in Common?<br />
25<br />P4 Medicine in Medical Curriculum<br />Curriculum restructure prepares future doctors to practice P4 Medicine<br />Greater focus on predictive medicine and preventive health care<br />Use of mobile devices like iPod touch at the bedside promotes participatory medicine<br />P4 Scholars program<br />Catherine Lucey, MD<br />
P4 Medicine: Disease to WellnessHow Do We Define Wellness?<br />
Personalized Health Care <br />www.elecamino.dnadirect.com<br />
Two Main Pilot Projects: Wellness and Care Coordination in Chronic Disease<br />wellness.ucsd.edu/WhatisWellness.shtml<br />kardiol.com/?tag=heart-failure<br />
Wellness<br />Optional special and/or virtual clinics that meet individual needs<br />Molecular Diagnostics Genetic Counseling<br /><ul><li>Biomarker and Genetic risk factor awareness and education</li></ul>Longitudinal PHA/Biomarker data leads to Care Team review and recommendations<br /><ul><li>Behavioral risk factor awareness and mitigation strategies; happiness, optimism</li></ul>Behavioral Health <br /><ul><li>Sleep medicine and circadian rhythm analysis
Assist individuals for best rest to promote health</li></ul>Sleep Medicine & Circadian Rhythm<br />Your Strategic Plan For Health<br />Nutrition<br /><ul><li>Evidence-based recommendations
Nutrition and diet changes that meet each person’s unique needs</li></ul>Exercise & performance<br /><ul><li>Exercise and physical performance routines designed for individual needs</li></li></ul><li>http://www.nytimes.com/imagepages/2011/04/11/magazine/mag-17Sugar-t_CA2.html?ref=magazine<br />
Principles of Transforming Health Care <br />Reduce variability and deliver evidence-based medicine (Personalize)<br />Stratify patients to create smaller, precise groups (Predict, Prevent, Personalize)<br />Analyze data to create knowledge (Predict, Prevent, Personalize)<br />Activate patients (Participation)<br />
Reduce Variability to Decrease Cost and Increase Quality <br />
Participatory Medicine <br />ama-assn.org <br />
The Power of Networks<br />> 500 M users<br />50% on line at any one time<br />Avg. user 130 friends<br />700 B minutes a month<br />177 M tweets/day<br />572K new accts/day <br />jeichert.wordpress.com <br />
You Tube is the 2nd Most Used Search Engine on the Internet<br />
1 in 75 People in the World Play Farmville <br />www.slideshare.net/avantgame/born-to-play-games-a-talk-by-jane-mcgonigal-about-human-destiny-circa-2020-ad<br />
Networks, Participation, the Power of Games and Crowdsourcing <br />