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.
Assessing and addressing social and non-medical drivers of health requires an upfront investment in clinic infrastructure, workforce development, and collaborative community partnerships.
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.
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.
Capturing and disseminating SDOH data can be leveraged to identify gaps in community resources and inform population health management strategies and investments.
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
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.
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.
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.
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.
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/
Simmons, L., Drake, C., Gaudet, T., and Snyderman, R. “Personalized Health Planning in Primary Care Settings.” Federal Practitioner. 2016; January, 27-34.
President Obama’s Precision Medicine Initiative has refocused national attention on the ability of genomics and other emerging technologies to provide a better understanding of the relationship between genetics, environment, lifestyles, and the development of disease1. This initiative was heralded as a “bold new research effort to revolutionize how to improve health and treat disease” (2). Yet, in 2000 the sequencing of the human genome was also anticipated to lead to new ways to personalize medicine and to prevent, diagnose, and cure disease. While there have been major advances in diagnosing and treating disease, the goals for personalized medicine to improve health and prevent disease have not yet been achieved (3-5). Despite the benefits of more targeted disease treatments, the real promise of personalized/precision medicine lies in its ability to prevent disease and improve health as, in addition to the human cost, our nation spends almost 80% of its unaffordable health care expenses on treating complex, chronic diseases which are preventable. Research in precision medicine will certainly provide new capabilities to improve health and minimize disease, but to actually do so, the approach to the practice of medicine must change so it is prepared to use them.
Snyderman, R., Drake, C.D. “Personalized Healthcare: Unlocking the Potential of Genomic and Precision Medicine.” Journal of Precision Medicine. 2015; October-November, 38-41.
While the full promise of genomic medicine may be many years in the future, personalized health care (PHC) can begin solving health care needs now and provide a framework for the adoption of genomic technologies as they are validated. PHC is a strategic approach to medicine that is individualized, predictive, preventive, and involves intense patient engagement. There is great need for more effective models of care as nearly half of Medicare patients age 65 and older have three or more preventable chronic conditions and account for 89% of Medicare’s growing expenditures. With its focus on reactive care, the current health care system is not designed to effectively prevent disease nor manage patients with multiple chronic conditions. PHC may be a solution for improving care for this population and therefore has been adopted as the delivery platform along with a new personalized health plan tool for 230 multi-morbid, homebound Medicare recipients in Durham, North Carolina who have been high utilizers of health care resources. PHC integrates available personalized health technologies, standards of care, and personalized health planning to serve as a model for rational health care delivery. Importantly, the PHC mode of care will serve as a market for emerging predictive and personalized technologies to foster genomic medicine.
Snyderman, R., Simmons, L., Burnette, R. “Personalized Health Care as a Pathway for the Adoption of Genomic Medicine.” Journal of Personalized Medicine. 2012; 2, 232-240.
Personalized medicine is more than genomic medicine: confusion over terminology impedes progress towards personalized healthcare
Over the last decade, scientific discovery and technological advances have created great anticipation for capabilities to tailor individual medical decisions and provide personalized healthcare. Despite some advances, adoption has been sporadic and there remains a lack of consensus about what personalized healthcare actually means. This confusion has often resulted from the mistake of equating personalized medicine with genomic medicine, and thereby, attributing it as yet unfulfilled expectations of genomic medicine to the broader application of personalized medicine. The lack of a clear understanding of personalized medicine has limited its adoption within clinical delivery models. It is thus essential to reach a consensus regarding what personalized healthcare and its components mean. We propose that personalized healthcare is an approach to care that utilizes personalized medicine tools to deliver patient-centered, predictive care within the context of coordinated service delivery, and it is poised to improve healthcare delivery today.
Snyderman, R., Simmons, L., Dinan, M., Robinson, T. “Personalized medicine is more than genomic medicine: confusion over terminology impedes progress towards personalized healthcare.” Future Medicine. 2012; 9(1), 85-91.
The practice of medicine stands at the threshold of a transformation from its current focus on the treatment of disease events to an emphasis on enhancing health, preventing disease and personalizing care to meet each individual’s specific health needs. Personalized Health Care is a new and strategic approach that is driven by personalized health planning empowered by personalized medicine tools, which are facilitated by advances in science and technology. These tools improve the capability to predict health risks, to determine and quantify the dynamics of disease development, and to target therapeutic approaches to the needs of the individual. Personalized Health Care can be implemented today using currently available technologies and know-how and thereby provide a market for the rational introduction of new personalized medicine tools. The need for early adoption of Personalized Health Care stems from the necessity to reduce the egregious and wasteful burden of preventable chronic diseases, which is not effectively addressed by our current approach to care.
Snyderman, R. “Personalized health care: From theory to practice.” Biotechnology Journal. 2012, 7:973-979.
Commentary: Personalized Health Planning and the Patient Protection and Affordable Care Act: An Opportunity for Academic Medicine to Lead Health Care Reform
The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery–such as patient-centered medical homes, accountable care organizations, and disease management programs–in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient’s specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients’ health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application.
Dinan, M., Simmons, L., Snyderman R,. “Commentary: Personalized Health Planning and the Patient Protection and Affordable Care Act: An Opportunity for Academic Medicine to Lead Health Care Reform,” Academic Medicine. Vol. 85, No. 11, 1665-1668, Nov 2010.
Snyderman, R., Dinan, M. “Improving Health by Taking it Personally.” The Journal of the American Medical Association. 2010; 303 (4): 365-366.
Snyderman, R., “Creating Meaningful Health Care Reform.” The Journal for Clinical Investigation. 119:2855 (2009).
The authors contend that the crisis facing the U.S. health care system is in large part a consequence of that system’s disease-oriented, reactive, and sporadic approach to care, and they suggest that a prospective approach to health care, which emphasizes personalized medicine and strategic health planning, would be a more rational way to prevent disease and maximize health. During recent years, personalized, predictive, preventive, and participatory medicine–that is, prospective care–has been receiving increasing attention as a solution to the U.S. health care crisis. Advocacy has been mainly from industry, government, large employers, and private insurers. However, academic medicine, as a whole, has not played a leading role in this movement. The authors believe that academic medicine has the opportunity and responsibility to play a far greater role in the conception and development of better models to deliver health care. In doing so, it could lead the transformation of today’s dysfunctional system of medical care to that of a prospective approach that emphasizes personalization, prediction, prevention, and patient participation. Absent contributing to improving how care is delivered, academic medicine‘s leadership in our nation’s health will be bypassed.
Snyderman, R., Yoediono, Z. “Prospective Health and the Role of Academic Medicine: Lead, Follow or Get Out of the Way.” Academic Medicine. Vol. 83, No 8 707-714, Aug 2008.
Proposal for a New Health Record to Support Personalized, Predictive, Preventative, and Participatory Medicine
Yoediono, Z., Snyderman, R. “Proposal for a New Health Record to Support Personalized, Predictive, Preventative, and Participatory Medicine.” Future Medicine Ltd. 5(1), 47-54, Jan 2008.
Emerging scientific technologies provide rich sources of predictive biomarkers, which could transform health care. Identification of causal biomarkers will enable the development of tools to quantify risk and anticipate disease. Accurate health risk analysis is rapidly becoming feasible, so health care can become rational, preventive and personalized.
Snyderman, R., Langheier, J. “Prospective health care: The Second Transformation of Medicine.” Genome Biology. 2006, 7:104. 27 March 2006.
Snyderman, R. “AAP Presidential Address: The AAP and the Transformation of Medicine.” The Journal of Clinical Investigation. 114: 1169-1173, 2004.
Langheier, J.M., Snyderman, R. “Prospective Medicine: The Role for Genomics in Personalized Health Planning.” Pharmacogenomics 5(1), 1-8, 2004.
The introduction of science into the practice of medicine in the early 20th century was a transforming event for the profession. Now, breakthroughs in science and know how make it possible to transform care once again and to fix the broken U.S. health care system. To realize this potential, new models of prospective health care must be created and validated. Prospective health care would determine the risk for individuals to develop specific diseases, detect the disease’s earliest onset, and prevent or intervene early enough to provide maximum benefit. Each individual would have a personalized health plan to accomplish this. Current knowledge is already sufficient to implement this approach, but there are no effective practice models, delivery systems, and appropriate reimbursement mechanisms. The authors describe the mechanisms of managing care prospectively, describe the components of a personalized health plan, and show how prospective care could relate to a community or group of covered individuals. They conclude by stressing that all interested parties, including academic health centers, insurers, and payers, will need to work together to develop innovative applications of new technologies and appropriate delivery models. At their own institution, pilot programs to foster prospective health care have already begun, and another initiative to develop models to use genomic medicine is also underway. Bipartisan political support will also be needed to help achieve rational reimbursement between providers and payers, so that prospective care can fulfill its promise of being the best cost-effective model to improve the nation’s health.
Snyderman, R., Williams, R.S. “Prospective Medicine: The Next Health Care Transformation.” Academic Medicine. 78:11, 1079-1084, November 2003.
Williams, R.S., Willard, H.F., Snyderman, R. “Personalized Health Planning.” Science Magazine, 300:549, 2003.