External research funding tops $570 million
|Bali Pulendran (seated) and colleagues received a $15 million NIH renewal grant to improve immune responses to vaccines.
Emory researchers garnered external research awards totaling $572,409,537 in fiscal year 2014-2015, a 9.69% increase over last year. This marks the first year in the institution's history that this total has exceeded $550 million.
The research total for health sciences was $537.1 million, an 11% increase over last year's total of $482.9 million. The FY 2015 total represents nearly 94% of the overall university total.
The new health sciences total breaks down as follows:
• Medicine, $362,975,409
• Public Health, $90,008,751
• Yerkes, $66,597,038
• Nursing, $14,273,888
• Executive VP, Health Affairs, $3,199,789
"Even though the NIH budget has remained flat, our researchers have held their own in NIH funding while managing to attract new support from other government and non-government sources," says David Stephens, WHSC VP for research and chair of the medical school's Department of Medicine. "These numbers are truly heartening and impressive."
NIH awards over the past year include $15 million over five years to renew a "systems vaccinology" grant, $18.7 million over seven years designating Emory as one of four TB Research Units, $9 million over five years to renew Emory's Fragile X Syndrome Research Center, $8.9 million over five years to study effects of reactive oxygen species and inflammation on blood vessel function and dysfunction, $3.6 million over five years to study effects of maternal stress on infants, $3.5 million over five years to develop software tools to help cancer researchers gain new insight from imaging data, and $2.5 million over five years to study links between infectious disease transmission and agricultural practices.
Grants from other government agencies include $10.8 million over three years from the Defense Advanced Research Projects Agency to study the immune systems of Ebola survivors, $12 million over five years from the US Department of Health and Human Services/CDC for Emory to lead a National Ebola Training and Education Center, $7.4 million over five years from CDC to implement a global health security program, and $1.5 million over three years from NASA to study contributors to radiation carcinogenesis.
Grants from private organizations include $73 million from the Gates Foundation to create a new global child health network and $1.8 million over four years from the Cystic Fibrosis Foundation to expand CF research in Atlanta. Read more.
Medicare hospital ratings: How Emory compares
Earlier this year, Medicare began using a five-star system, like those used for restaurants and hotels, to rate hospitals on its Medicare.gov hospital-compare site to help consumers better understand the site's data. The ratings are based on responses to surveys sent randomly via third-party vendor to a subset of hospital patients across the country.
Not unexpectedly, Emory fared well in the Medicare ratings. In data posted July 16 (information is updated quarterly), Emory University Hospital (EUH), Emory Johns Creek Hospital, and Emory Saint Joseph's Hospital (ESJH) all received four stars (the highest rating in Georgia), and Emory University Hospital Midtown (EUHM) received three. Only one other local hospital (Northside) received four stars.
But what do these ratings actually mean to patients, and how do they compare with various hospital rankings conducted by other entities? Recent US News rankings, for example, included EUH (one), ESJH (four), and EUHM (five) all in the top 10 for Atlanta, as did a new ranking out this month from Market Strategies International: EUH (one), ESJH (two), and EUHM (four).
In truth, such numbers are just one of many factors influencing where patients seek care, with some measures more objective or comprehensive than others. In assessing the relevance of the Medicare ratings in particular, one should be aware that the metrics encompass two years of data at a time, says Redge Hanna, corporate director of service performance for Emory Healthcare and an adjunct faculty member in Rollins School of Public Health (health policy). "Each time 'new' information is posted, it could pertain to a patient who was here as long as two years ago."
Where the Medicare data has its greatest significance, he says, is in determining a hospital's reimbursement for services provided to Medicare patients.
"Each day, approximately $50 to $70 out of our daily reimbursement rate is deducted from our Medicare payment for each patient. We have the opportunity to earn these dollars back if, over two years, we are consistently better than others in the nation or we improve statistically over our past reports in the following domains: RN communication, MD communication, clean/quiet, responsive, meds explained, pain management, discharge, and hospital overall rating."
The requirement to report hospital patient survey data to Medicare began in 2010 as part of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, itself an initiative of the Agency for Healthcare Research and Quality (AHRQ). The goal of the CAHPS program was twofold, says Hanna: (1) to develop standardized patient questionnaires that can be used to compare results across sponsors over time and (2) to generate tools and resources that sponsors can use to produce understandable and usable comparative information for both consumers and providers.
Starting in 2010, hospitals were incentivized financially just to participate in the program, i.e., to report their survey results. Once AHRQ and Center for Medicare & Medicaid Services (CMS) had "normalized" the results from one hospital to another—adjusting them to account for differences among institutions—hospitals began to be graded and reimbursed based on the results themselves.
The CAHPS measures are not just for hospital patient care, Hanna says: "To maintain almost $9 million in clinic reimbursements, we are required starting this month to select our official CAHPS vendor for our physician group practices to administer CG [clinician and group] CAHPS surveys."
Over time, even more patient care areas will be affected, he adds. For example, "in January 2016, we will start voluntary CAHPS data collection to report results for ambulatory or same-day surgeries. After AHRQ and CMS report and normalize these data, we anticipate these areas will be reimbursed based on survey results as well."
Center brings "all hands on deck" to address antibiotic resistance
|Infectious disease researcher David Weiss directs the new center.
Emory is launching an Antibiotic Resistance Center as a means of identifying and consolidating expertise on an issue of increasing urgency and concern.
Antibiotic resistance is so challenging that it must be addressed by an "all hands on deck" approach, says infectious disease researcher David Weiss, who directs the center. "While we're not at the point where doctors treating the average bacterial infection have no options, that is the case in a growing number of instances."
A comprehensive approach means that microbiologists will probe mechanisms of resistance, chemists will search for new antibiotics, and microbiologists and pathologists will refine methods for detecting dangerous bacteria.
At the same time, clinicians and public health experts will consider how to nudge physicians into better antibiotic stewardship, how to organize expanded surveillance, and how to better organize health care programs and systems to avoid infections in the first place.
Accordingly, the center's faculty represent a wide range of expertise: ethnobotany structural biology, carbohydrate biochemistry, epidemiology, pharmacology, microbiology, pathology, cardiology, infectious disease, global health, pediatrics, and physics, among others. The center takes advantage of research and clinical strengths in immunology and infectious disease as well as already-existing leadership in antibiotic resistance. (See Carlos del Rio, who leads the Gonococcal Isolate Surveillance Program Emory Regional Laboratory, for example, or Monica Farley, who tracks antibiotic-resistant bacteria regionally as leader of the Georgia Emerging Infections Program.)
Weiss sees the center's role as facilitating interactions. "We are trying to unite experts from diverse disciplines, especially researchers and clinicians," he says, adding that the center plans to engage in targeted "matchmaking" in an effort to jump-start preparation of interdisciplinary grant proposals in promising areas.
"We want to be open to the unexpected," says Weiss. As an example, he cites a collaboration between his laboratory and pathologist Eileen Burd, director of clinical microbiology at Emory University Hospital. Together, Burd and Weiss's lab identified a strain of Enterobacter that is "heteroresistant" to the last-resort antibiotic colistin, meaning that a stealthy subpopulation is resistant.
"We are now demonstrating the relevance of these resistant subpopulations during infection, an area that we would not even be investigating without this interdisciplinary collaboration," he says.
Finally, center faculty also are playing an important role in training others who will work in antibiotic resistance—for example, PhD students in the Antimicrobial Resistance and Therapeutic Discovery Training Program, led by William Shafer, and physicians in the Infectious Diseases Fellowship Training Program—Quinn Eastman
Meeting the need for physician assistants
Physician assistants (PAs) are more in demand than ever, says PA program director Maha Lund, DHSc, PA-C. "Our students don't graduate until December, and already employers are asking to meet them. It speaks to the need out there."
Emory's PA program, one of 200 in the country, recently ranked third in U.S. News & World Report's 2016 "America's Best Graduate Schools" guide.
The demand for advanced practice providers like PAs and nurse practitioners has skyrocketed in the past decade. An estimated 4,000 PAs in Georgia and more than 100,000 in the US are currently board certified to practice medicine as part of a physician-directed team.
PAs are certified to diagnose and treat common diseases and can provide preventive health services and patient education. They also can order and interpret tests and write prescriptions and can perform "at least 80% of the responsibilities of a physician," says Lund.
Applicants to Emory's program are growing substantially, says Lund. More than 1,500 applicants (average age, 28) applied for 54 spots in the current Emory PA class (the 28-month program accepts 54 students each year.) But applicants for the class beginning in 2016 already total 2,200, and the portal is open till October 1. This represents a 50% increase, she says, while applications nationally have increased just 25%.
And the growth is not just in quantity but quality as well. While applicants are required to have a minimum of 2,000 health care hours before entering the program, the class that just started in August has more than 7,000 hours of such experience, says Lund.
When students finish their training, they have a wide range of options. Currently, about one-third of PAs work in primary care, with the rest in specialty medicine. As to locations, 38% practice in hospital settings, another 38% work in physician practices, and the rest are in community health centers, freestanding surgical facilities, nursing homes, school- or college-based sites, industrial settings, and correctional institutions.
"A physician with a PA can get so much more done and see so many more patients," says Lund. "PAs are an important part of the solution to current and projected clinician shortages.”
Lund, whose clinical background is in hospital medicine, joined Emory in July 2014 from the Massachusetts College of Pharmacy and Health Sciences in Boston, where she was program director of the Department of PA Studies. She is a distinguished fellow of the American Academy of PAs and has been recognized by the National Honor Society for Allied Health Professionals.
Emory's PA program has a direct link to the beginnings of the profession—the late Eugene Stead, known as founder of the field, was an Emory undergraduate and medical school alumnus, an Emory faculty member, chair of the department of medicine, and dean of the medical school before moving to Duke in 1947. The Emory PA program was founded by Stead's colleague, renowned cardiologist J. Willis Hurst, in 1967.
Like other PA programs around the country, Emory’s observes PA week from Oct 6-12. Lund says the PA program will celebrate with service to underserved patient populations, information sessions about the profession, and a campus blood drive.—Mary Loftus