Research News

Health care reform at the “grass-roots” level

Health care reform will likely remain a hot-button issue through the 2012 election.

But while the pros and cons of last year’s health reform legislation are debated in Congress and on the campaign trail, considerable efforts are underway at the grassroots level to redesign the way health care is delivered in this country.

The goals are ambitious: to improve health care quality, outcomes and efficiency, to avoid mistakes and minimize the side effects of treatment, to prevent disease and disability, and to raise the overall health of the population – while cutting costs dramatically.

It can be done, the experts say, by applying recent advances in genomics and informatics, through continued investment in basic research, and through new approaches to health care such as “personalized medicine.”

Vanderbilt University is one of the pioneers in this grass-roots effort.

Last August, for example, the Vanderbilt-Ingram Cancer Center launched a “personalized cancer medicine initiative,” one of the first routine tumor genotyping programs in the country.

Tumors removed from patients with lung cancer and melanoma are screened for genetic variations, and then matched with cancer drugs that target those specific variations.

The goal is to choose the drugs most likely to stop tumors in their tracks. Eventually the program will be expanded to include other cancers. Read a story about a lung cancer patient who is benefiting from this new approach to treatment.

Another genome-based program, PREDICT, aims to improve the effectiveness of drug therapy while avoiding the side effects.

“The most common adverse drug effect is … it just doesn’t work,” says Dan Masys, chair of Biomedical Informatics and a strategic architect of Vanderbilt’s personalized medicine initiative. Americans spend billions of dollars each year on prescription medication. Cutting out useless and harmful medication “could pay for a big chunk of health reform,” he says.

Last September, Vanderbilt began testing every patient undergoing cardiac catheterization for a genetic variation that can affect their response to the anti-coagulant drug Plavix. The goal is to identify “non-responders” early, and prescribe an alternative drug that will work better for them.

PREDICT is part of a larger effort at Vanderbilt that is testing the value of routinely embedding genetic information in patients’ electronic medical records. Read a story about the first patient at Vanderbilt to benefit from the PREDICT program.

[rquote]Vanderbilt’s approach to personalized medicine is as much about reforming systems of care as it is about applying the latest technology and knowledge.[/rquote]

Last fall, for example, Vanderbilt’s first “diagnostic management team” was launched to provide expert guidance to physicians who are caring for patients with clotting or bleeding problems. The goal is to improve the speed and accuracy of diagnoses, avoid unnecessary and costly tests, reduce complication rates and increase the likelihood that treatments will be successful.

“To begin to deliver on the promise of personalized medicine, we need systems fit to the individual,” says Bill Stead, Vanderbilt University Medical Center’s Chief Strategy and Information Officer, “a combination of people, process and technology that does what we want to do every time and … (gets) the result we want every time.”