From near-worst to first?
Have you ever taken a moment to read our vision statement? It says, “IU School of Medicine will lead the transformation of health care through quality, innovation and education and make Indiana one of the nation’s healthiest states.”
It might seem easy to dismiss that last part as wishful thinking, considering the state’s track record. We all know the disheartening statistics:
- Indiana is 41st in the nation in overall health, according to the 2018 America’s Health Rankings report.
- We are ranked 42nd when it comes to mental health, according to Mental Health in America 2019.
- Approximately one baby dies in Indiana every 14 hours—amounting to 600 infant deaths a year—making the state’s infant mortality rate one of the worst in the country.
- We consistently have one of the 10 worst death rates from cancer in the United States, the CDC reports.
These data are a powerful reminder of why we must act with urgency to improve the health of those who call our state home. And it is not enough to aspire to be in the middle of the pack. As Indiana’s medical school, we have an obligation to Hoosiers to set ambitious goals—and to strive to meet them.
That is why we have made the very first priority of our strategic plan to “Improve the health of Indiana’s citizens.” Specifically, we have set goals to improve Indiana’s Mental Health in America overall ranking, reduce infant and maternal mortality, improve cancer prevention and detection rates, and decrease cancer mortality rates.
A significant amount of work and planning are underway with our health care partners to make progress toward those goals, and I want to take this opportunity to share a few examples with you. More broadly, I want to challenge every member of the school community—faculty, staff, students and residents—to think about how you can contribute to the state’s health.
I want to hear from you.
Share your ideas about how we can continue to strategically improve the health of Indiana’s citizens.
Improving access to mental health services
Our Department of Psychiatry has launched multiple programs aimed at improving the mental health of Indiana citizens, and I want to highlight just one. Recognizing that the overwhelming number of patients with mental health conditions will be treated in primary care settings, the CHOICE program embeds psychiatrists and psychologists in three large primary care clinics in Marion County and will be expanding to a fourth clinic this year.
At these clinics, a patient with depression, anxiety or any mental health concern can be introduced on the spot to the psychiatrist or psychologist, without the inconvenience or possible stigma associated with a separate appointment. Alternatively, the primary care physician can easily consult with the behavioral health colleagues on topics ranging from diagnosis to medication or therapy treatments.
In a pilot study, patients who were referred to CHOICE experienced a more robust reduction in depression than a control group of patients with behavioral health conditions who did not participate. Notably, both emergency department visits and inpatient stays increased in the control group but decreased or remained stable among those who participated in CHOICE. While these findings have not yet been published, they provide compelling evidence that this model of integrated care can be effective in Indiana, and we are partnering with IU Health to expand it.
Diagnosing autism earlier
Research tells us that early diagnosis and intervention can significantly improve the quality of life of children with autism and their families. Despite that, the average age of diagnosis for children in Indiana is over 5 years old—well above the Healthy People 2020 goal of 36 months old. The Department of Pediatrics is leading the development of solutions.
Beginning in 2012, the department created an innovative network of 14 Early Evaluation Hubs across the state stretching from South Bend to Evansville. In 2018, community-based providers at these hubs evaluated more than 900 children. Notably, children seen in the hubs are receiving their diagnoses of autism and/or developmental delay before age 3.
The goal is to continue to expand this hub model and to further develop a navigation system for families to access evidence-based interventions in a timely manner after their child’s diagnosis.
Combatting infant mortality
Infant mortality is a complex problem, and IU School of Medicine is partnering with our communities to address an array of contributing factors—from safe sleep to spacing between pregnancies. For example, preterm birth is a significant risk factor for infant mortality, and mothers who have already had one preterm baby are more likely to have another premature delivery. The use of 17 Alpha-Hydroxyprogesterone can decrease that risk by 30 to 40 percent, but many barriers prevent universal adoption.
Our faculty members are collaborating with the Indiana Perinatal Quality Improvement Collaborative to implement quality improvement processes to eliminate hurdles such as those related to prior authorization, and they have developed a data collection tool to understand how many women begin but don’t complete weekly injections, and why. The goal is to identify barriers and to develop systems to maximize the number of eligible women who receive the treatment.
Hard and necessary work
We know the work of improving the health of Hoosiers is hard and will take time. These are just a few examples of the impact we can have when we bring to bear our expertise and work in partnership with colleagues across Indiana, state officials, and community organizations.
As a public medical school, one of the primary reasons we exist is to help meet the health care needs of our state. Put simply, this must be a priority, and bringing about changes requires all of us. Thank you for your contributions.
Jay L. Hess, MD, PhD, MHSA
Executive Vice President for University Clinical Affairs
Dean of the School of Medicine