Sutter Family Practice Residency Program
Awarded $447,000 Grant for Innovative Physician Training
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Sutter Medical Center of Santa Rosa's Family Practice Residency Program has been awarded a federal grant of nearly $447,000 over the next three years to continue an innovative physician training program in chronic disease management at its Family Practice Clinic across from the hospital on Chanate Road. The program, directed by longtime family practice physician Sean Gaskie, MD, is focused on training physicians to teach diabetes management skills to their patients. But the program's implications for physicians, patients and the health care system at large go far beyond the specifics of diabetes management, Gaskie says. That is perhaps one reason why the current grant represents a renewal of a previous $514,000 federal investment that helped launch the program for the years 2000-2003.
The source of the grants is a federal "Title VII" program operated by the Health Resource and Service Administration (HRSA). Title VII funds are earmarked to improve residency training in primary care, particularly among medically underserved populations. The current grant picks up where the other left off, funding a variety of faculty positions and support programs beginning in July 2003 and running through June 2006.
The program originated with diabetes management both because diabetes is approaching near-epidemic proportions among all age groups in America, and because there is widespread medical consensus on the best treatment protocols known to result in better patient outcomes, Gaskie says.
"There are two fundamental differences in our program that turn traditional residency training and the larger medical world on its head," says Gaskie. "Currently, residency training and the medical system is set up on an acute care rather than a disease management model. Right along with that, it places the doctor in the center as the one who 'fixes' problems by dispensing treatments, advice, and prescriptions."
"In contrast, our program puts patients and their families at the center. Our goal is to make people more capable and confident in dealing with their health problems. There’s really no other choice if we ever hope to fix a health care system that everyone knows is broken."
The new approach dramatically changes the role and the behavior of physicians, Gaskie says, requiring them to function more as a motivational and information resource rather than an emotionally distant clinician. To that end, the residency program incorporates a significant amount of training in behavioral change-not only with respect to patients, but for the physicians themselves.
"It's terrifying for physicians to give over true control to patients, and it takes very specific skills to do so," Gaskie says. "So our program includes behavioral experts who work with our residents on these emotionally complex issues. But we have learned that it's the patient who runs the show. Their health is 99 percent influenced by what they do every day throughout the year, not by what goes on in the one or two total hours they annually spend in their doctor's office. The key for physicians is to spend that time wisely by giving patients the tools they need to manage their own health. Our program refers to the physician's role now as being 'the guide on the side rather than the sage on the stage.'"
Gaskie notes, however, that far from allowing physicians to reduce their responsibility for patient care, the disease management model intensifies it, because it requires their much deeper knowledge of the day-to-day life and health profile of their patients while ensuring the provision of literally dozens of proven medical interventions.
"It's not just about getting a diabetic's blood sugar under control," he says. "You have to look at the whole constellation of factors that might be contributing to diabetic problems, and you have to follow each one of them. The doctor, nurse, and even receptionist are all involved in this process-it's very much a team effort throughout the office. In a disease management model, you have to know details about the patient's exercise program, their blood pressure, whether they had a flu shot, when they last visited their ophthalmologist, their podiatrist, and a number of other factors. These need to be charted in a simple, easy-to-use format."
Accurate, comprehensive record-keeping is thus another key facet of the program, Gaskie says. "How many times have you sat in a paper gown while your doctor flipped through pages and pages of your chart, trying to connect the dots of your health history? Our program has developed a one-page chart that notes all the key data we need to put an office visit or a phone call to the best possible use. Our goal is for the physician to know everything that will be covered before the patient's visit, so there is no time wasted leafing through inches-thick charts."
The program's success through the first grant cycle has been well documented, says Gaskie, by a series of assessments focusing on key indicators of successful diabetes management. These include measuring the diabetic population's control of blood sugar, lipids, and blood pressure and such factors as the percentage of patients who regularly exercise and make annual visits for vision, foot and dental exams. Those data are then compared to both national norms and figures for Family Practice Center patients not in the diabetes management program.
The program's figures indicate dramatic improvement - from an average of 17 percent of patients meeting these care criteria in October 2001 to 54 percent in September, 2002. The national average is 37 percent.
"Our program is too new to show long-term results, but research clearly shows that diabetes patients who follow these key protocols live longer, healthier lives," Gaskie says. "So we know we're on the right track with this program, and the lessons we're learning should transfer right over to other chronic conditions, from heart disease to high blood pressure to depression. The old approach to care is driving everyone crazy. In our little corner of the world here, we're redesigning it in a fundamental way-around the needs and abilities of patients."
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