I am privileged to write on behalf of the faculty, students, and staff at Saint Louis University School of Medicine (SLUSOM) to provide an update on the activities in the oldest school of medicine west of the Mississippi River. Using our historic accomplishments as a foundation, our faculty, students, and staff have been busy transforming our school. Since my arrival in January 2017, we have engaged in a disciplined process called Transformative Excellence in Academic Medicine or TEAM. Through this process we seek to establish a culture of excellence and accountability that will lead to quality and growth in everything we do. Our aspirational goals include setting the standard for delivery of high-value care in an academic setting, becoming a desired destination for faculty, students, and staff who are empowered to make change, and achieving leading financial results that permit reinvestment in our mission. To provide focus to our TEAM initiatives we are concentrating our work in six areas: (1) delivery of high-value care, (2) patient access, (3) research and education, (4) integration of our missions, (5) supportive infrastructure, and (6) strategic direction. As we move forward with project TEAM, we are contemplating carefully the dynamic healthcare landscape and anticipating a future of medicine in which clinical care delivery, team-based research programs, and inter-professional education look vastly different than they do today. In the following paragraphs, I will share highlights of the good work our faculty, students, and staff are performing in the clinical, research, and education missions.
Our clinical mission is dominated by our continual improvement in the delivery of high-value care. In our practice, SLUCare, a dedicated unit, led by Ali Kosydor and Beth Page, seeks first to improve patient access because without access we cannot deliver high-quality care. As a result of their efforts and many others we have experienced six (6) percent year-over-year growth in arrived patients. Importantly, the quality of care delivered has improved markedly, and our rate of improvement with some outcome measures, such as smoking counseling and cessation, is the greatest in the nation (Figure 1). In addition, our quality team is working hand-in-hand with our population health team to address patients with uncontrolled diabetes mellitus. In one example, they worked diligently with a patient in their home to decrease the hemoglobin A1C from 16% to less than 6% and sustain this improvement over nine months through diet control and exercise. This example of meeting patients where they live exemplifies the personalized, quality care our teams are providing.
Figure 1.
SLUCare quality data demonstrating year-over-year marked improvement in outcome measures.
Our partners in the delivery of clinical care, SSM-STL, are likewise working assiduously to offer high-value care at our three academic hospitals: Saint Louis University Hospital, Cardinal Glennon Childrens’ Hospital, and St. Mary’s Hospital. Furthermore, leaders across Saint Louis University and SSM are working to develop an integrated delivery network across the St. Louis region so our patients receive the correct care, at the appropriate time, and in a convenient location. Collectively, we seek to put the patient first in our decision-making processes. As part of this decision-making process, a $550 million investment in facilities is being made by SSM on Grand Avenue (Figure 2). We are excited about the new facilities, which are rapidly becoming a reality as steel girders are now visible above the ground. The new 316-bed hospital will offer state-of-the-art facilities for our patients and is uniquely designed to accommodate teaching rounds for faculty, students, residents, and staff. In addition, the adjacent ambulatory care center will offer patients quick and convenient access to our physicians and staff. These two healthcare facilities will be the nucleus of greater community investment in midtown St. Louis, where a billion dollars of construction will reshape the community. This opportunity for redevelopment of midtown St. Louis is led by the 353-redevelopment project that the city of St. Louis granted to Saint Louis University. Clearly, the next several years will be highlighted by construction of facilities that will improve the health of our community.
Figure 2.
Rendering of the new SSM-Saint Louis University Hospital and ambulatory care center, which are under construction and set to open in September 2020.
We are proud of the clinical care we deliver, but we seek to enhance that care by offering research opportunities for the patients. As I write this article, we are in the midst of one of the worst flu seasons in recent history. With a vaccine that was 36% or less effective, we have plenty of opportunity to improve preventive vaccines and our Saint Louis University Vaccine Center is poised to improve the flu vaccine. The Vaccine Center, led by Dr. Dan Hoft, is one of nine federally-funded vaccine centers and a research treasure for our School. Importantly, the Vaccine Center will soon add an important resource to conduct human clinical trials as we are completing construction of a human vaccine trial unit. This physical space will allow the conduct of clinical trials that seek to improve the effectiveness of a universal flu vaccine, a top priority for the National Institutes of Allergy and Infectious Diseases. Our Vaccine Center and the human clinical trials unit will make major contributions to achieving a more effective universal flu vaccine.
When we think about recent major contributions to eradication of disease, the Saint Louis University Liver Center played an integral role in curing hepatitis C. Through basic science research and clinical trials led by Drs. Bruce Bacon, Adrian Di Bisceglie, and team, hepatitis C has essentially been cured pharmacologically. This team of investigators, however, has pivoted their focus to non-alcoholic steatohepatitis (NASH) or fatty liver disease. We are currently adding liver scientists to our team and seek to make major contributions to alleviating the effects of NASH.
Nationally, treatment of sepsis is a major focus of the Center for Medicare and Medicaid Services because of the high mortality and morbidity coupled with the excessive cost of treatment. At SLUSOM, we are fortunate to have excellent scientists who are uncovering the basic mechanisms by which sepsis creates its deleterious effects. Drs. David Ford and Jane McHowat have recently published high-impact research papers in the Journal of Clinical Investigation and Journal of Lipid Research detailing their work on the role of 2-chlorofatty acids as potential biomarkers in sepsis (Figure 3). Their efforts to engage multiple investigators at SLUSOM and across the country will lead to the creation of an integrated team of scientists that will have a major impact on the care of septic patients.
Figure 3.
SlU faculty members, Drs. David Ford, PhD, and Jane McHowat, PhD, collaborate on a project examining the role of lipids in sepsis. The work has led to several high-impact publications.
Sadly, the opioid epidemic and crisis has crippled many patients and families in the United States and our region, in particular. The federal government has recently recognized this crisis and will increase funding for many programs that will address addiction from a variety of viewpoints. SLUSOM is also playing a role in this nationwide approach by developing non-narcotic pharmacologic alternatives to treat chronic pain. Dr. Daniela Salvemini is well-funded and has published extensively in this field and identified several non-narcotic compounds that can alleviate pain in experimental models. Because of the national crisis, we seek to increase our presence in this tragic crisis and to incorporate our basic science efforts into a comprehensive program that will examine and treat opioid abuse.
Finally, I would like to address developments in our educational programs. In February 2017, we received the unwelcome news from the Liaison Committee on Medical Education (LCME) that our accreditation status would be “accredited with probation.” This designation mandated notification to our students and potential students and caused a great deal of anxiety among our faculty, students, staff and alumni. I am proud to say, however, that we quickly assembled a steering committee and two working groups to address the citations. Our faculty, students, and staff diligently got to work assessing our citations, developing a gap analysis, and writing an action plan, which was approved by the LCME. Though the initial news of probation was upsetting, the dedicated work of many individuals, working in teams, has been a galvanizing effort across SLUSOM. We look forward to our June 2018 site survey visit to demonstrate the numerous advances in our medical education program. Throughout this process, we sought not only to rectify our deficiencies but to create changes that would make us a leading medical education program. As we continue to remodel our medical education program, we will seek to become a leading medical school.
Our SLUSOM sponsored graduate medical education program (GME) was reviewed in January of 2018 and received a status of continued accreditation, the highest status designated. We are delighted that our GME programs are in good standing, but here too, we will strive for continuous improvement. Our residents and fellows work hard to deliver the highest-quality care, and we will work relentlessly to offer the best training programs available.
In conclusion, SLUSOM is undergoing transformative change to deliver high-quality care that is research inspired and follows our Jesuit tradition of treating the entire patient. Through clear definition and adherence to our mission and values, we will make valuable contributions to the care of the people of St. Louis and across Missouri. We welcome your engagement in our journey to transform healthcare.
Biography
Kevin E. Behrns, MD, MSMA member since 2017, is Vice President for Medical Affairs, and Dean, Saint Louis University School of Medicine, St. Louis, Mo.
Contact: kevin.behrns@health.slu.edu
