Publications

Members and colleagues of the Center have published a number of articles on prospective and Personalized Health Care. Following is a list of some of the seminal works representing our views on personalized care in medicine today.

In Reply to Goetz

^{Snyderman, Ralph. “In Reply to Goetz [Letter to the Editor].” Academic Medicine 95, no. 7 (July 2020): 972-73.}

Value of Personalized Medicine

^{Snyderman, Ralph, Caroline Meade, and Connor Drake. “Value of Personalized Medicine.” Jama 315, no. 6 (February 9, 2016): 613.}

Health Care Reform in the United States

^{Meade, Caroline, Connor Drake, and Ralph Snyderman. “Health Care Reform in the United States.” Jama 316, no. 18 (November 8, 2016): 1923-24. https://doi.org/10.1001/jama.2016.15237.}

An evaluation of mHealth adoption and health self-management in emerging adulthood

Abstract

This study offers a description of factors that predict the adoption of mobile health technologies (mHealth) and their application for health self-management in emerging adults. Primary data collection occurred at three diverse postsecondary educational institutions (N= 1,329). The analysis used a logistic regression to identify predictors of mHealth adoption. Descriptive analyses are presented on health self-management applications and perceived ease of use and effectiveness. Use of mHealth was high in respondents (58.5%). Factors associated with increased likelihood of mHealth adoption included being female, overweight or obese, having a chronic condition, eating the recommended amount of daily fruit, and engaging in regular moderate exercise. Low household income was associated with being less likely to use mHealth. The most common self-management application for mHealth was for tracking physical activity. Findings related to ease of use and effectiveness ratings by applications may provide insight into designing more effective mHealth tools in this population.

^{Drake, C., Cannady, M., Howley, K., Shea, C., & Snyderman, R. (2019). An evaluation of mHealth adoption and health self-management in emerging adulthoood. In AMIA Annual Symposium Proceedings (Vol. 2019, p. 1021). American Medical Informatics Association.}

Assessing and Addressing Social Needs in Primary Care

Key Takeaways

1. Assessing and addressing social and non-medical drivers of health requires an upfront investment in clinic infrastructure, workforce development, and collaborative community partnerships.

2. Implementing a protocol to assess and address patient social needs requires a multidisciplinary team-based approach. Our experience highlights the important role of social workers and behavioral health professionals in clinical settings.

3. A patient-centered model for responding to SDOH risk factors in routine outpatient clinical encounters must include a participatory shared decision-making process to develop a tailored non-medical care plan.

4. Capturing and disseminating SDOH data can be leveraged to identify gaps in community resources and inform population health management strategies and investments.

^{Drake, C., & Eisenson, H. (2019). Assessing and Addressing Social Needs in Primary Care. NEJM Catalyst, 5(6).}

Compassion and Health Care: A Discussion with the Dalai Lama

Abstract

The calling to be a physician has historically been driven by compassion—that is, the desire to relieve the suffering of others. However, the current health care delivery system in the United States has increasingly limited the ability of physicians to express compassion as they are afforded little time for meaningful interaction with their patients. One of the authors (R.S.) draws on his current focus on developing personalized, proactive, and patient-driven models of care to argue that patient engagement plays a critical role in achieving favorable outcomes. Believing that compassion is key for establishing the physician–patient relationship needed to foster patient engagement, R.S. sought the advice of one of the world’s most recognized thought leaders on this topic, His Holiness the 14th Dalai Lama. This Invited Commentary describes the meeting between the two authors, the Dalai Lama’s thoughts about compassion, and his challenge to bring attention to the importance of compassion in medical education, practice, and research.

Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus

Abstract

OBJECTIVES:
This study describes the feasibility of implementing personalized health planning (PHP) within shared medical appointments (SMAs) for patients with type 2 diabetes mellitus. The PHP-SMA approach was designed to synergize the benefits of SMAs with those of PHP, enabling greater patient engagement focused on meeting individualized therapeutic goals in a group setting.

METHODS:
Patients were assigned randomly to a PHP-SMA or a standard eight-session SMA series. Standard SMAs included an interactive educational curriculum delivered in group medical encounters. The PHP-SMA included the addition of a patient self-assessment, health risk assessment, shared patient-provider goal setting, creation of a personal health plan, and follow-up on clinical progress. Clinical and patient-reported outcomes and qualitative data from focus groups with patients, providers, and administrative staff were used for evaluation. Qualitative data explored facilitators and barriers to implementation of the PHP-SMA. The Consolidated Framework for Implementation Research was used to provide insight into implementation factors.

RESULTS:
PHP was successfully integrated into SMAs in a primary care setting. Patients in the PHP-SMA (n = 12) were more likely to attend ≥5 sessions than patients assigned to the standard SMA (n = 7; 58% PHP, 28.5% control). Qualitative data evaluation described the advantages and barriers to PHP, the team-based approach to care, and patient participation. The PHP-SMA group experienced reductions in hemoglobin A1c, low-density lipoprotein, blood pressure, and body mass index, as well as successful attainment of health goals.

CONCLUSIONS:
The PHP-SMA is a proactive and participatory approach to chronic care delivery that synergizes the benefits of PHP within SMAs. This study describes the components of this intervention; collects evidence on feasibility, acceptability, and clinical outcomes; and identifies implementation barriers and facilitators. The PHP-SMA warrants further evaluation as an approach to improve health outcomes in patients with common chronic conditions.

^{Drake, C., Meade, C., Hull S., Price, A., Snyderman, R. Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus. South Med J. 2018 Nov;111(11):674-682.}

To Adopt Precision Medicine, Redesign Clinical Care

Overview

A vision for the implementation of personalized health care, from Duke University, that abandons the “find-it-and-fix-it” model of care.

“Lofty goals for personalized and precision medicine (PPM), reflected in the 2015 Precision Medicine Initiative, are out of reach until the health care delivery system is designed for health promotion, comprehensive disease prevention, and efficient adoption of PPM capabilities. Toward that end, we believe in a personalized health care approach that abandons the reactive find-it-and-fix-it model of care and more effectively addresses the complex chronic diseases that now account for about 80% of health care expenses.”

Snyderman R, Meade C, Drake C. To Adopt Precision Medicine, Redesign Clinical Care. NEJM Catalyst. 2016, December 28. http://catalyst.nejm.org/adopt-precision-medicine-personalized-health/

Personalized Health Planning in Primary Care Settings