Volume 24 • No. 3 • March 2000
DeMerger to be official April 1
Dean search expected to give VP more time for clinical leadership
Home Care services to operate separately
Former associate dean Steward dies
Probably few groups at the Medical Center are tackling the issues of increasingly limited time for patient contact and education as explicitly as the pilot Stanford Health Partners Program - an effort of Stanford Medical Group, Stanford Family Practice and the groups' chronic disease patients.
This month Fact File talks with Halsted Holman, co-chief of the dividisons of Family and community medicine and immunology and rheumatology and founder of Health Partners; Joseph Hopkins, medical director for health plans and a physician at Stanford Family Practice Group (SFPG); Paul M. Ford, assistant professor of medicine and lead physician at Stanford Medical Group (SMG); and Margaret Wellington, Health Partners program coordinator and a registered nurse with a public health academic background.
1. The Partners Program was launched after focus groups of chronically ill primary care patients disclosed that patients wanted quality time with their primary care physicians in a venue where they could find support and knowledge from fellow patients. This could be found in guided self-care that could be offered in groups.
2. Health Partners is currently available to patients served by the Stanford Medical Group and Stanford Family Practice. It is based on models developed in Stanford's Chronic Disease Self-Management Program for arthritis patients, at Kaiser Permanente Medical Group in Denver for chronically ill patients and at Dartmouth Medical School. The Stanford program is funded by grants from the Aetna Foundation and the Robert Wood Johnson Foundation with an initial $20,000 seed grant from the former Stanford Health Services.
3.
Health Partners currently includes two components,
with a third component scheduled to begin this year:
a.
Group Visits consist of about 20 people who meet two hours monthly
as a group with their joint primary care physicians. The agenda is set by
the patients. The group may have an educational presentation or may decide
to discuss shared experiences on a specific topic. Sufficient time is built
in to allow one-on-one contact with the physician to discuss or complete routine
patient care issues, such as prescription refills or a brief discussion about
symptoms.
b. Living Well with Chronic Disease Workshops serve 15 to 20 chronically ill patients, caregivers and/or family members. Each workshop meets for two hours per week for six weeks under the direction of trained lay leaders, who often face their own chronic illnesses. The workshops, held in a centrally located conference room, are designed to teach patients how to manage such common symptoms of chronic conditions as fatigue, pain, medication effects and frustration. Participants are taught lifestyle skills, such as how to communicate more effectively with family, friends and physicians or how to start or enhance a personal exercise or relaxation program. Virtual discussions among the group via e-mail are also being planned.
c. A Web-based program to improve communication is expected to be developed before the end of the year. This will allow patients to reach their physicians more easily and allow physicians to elicit information from patients.
4. Chronic conditions typically represented in current groups include hypertension, diabetes, arthritis, congestive heart failure, chronic obstructive pulmonary disease, stroke, and transplantation survivors.
5. Group visit workshops are currently being hosted by Joseph Hopkins, Paul Ford, and most recently, by John J. Jernick of Stanford primary care practices. The program is expected to be expanded to include other SFPG or SMG physicians this year. The model is designed to be easily replicable and available to other physician groups and practices that may wish to become involved with their own patients.
6. Paul M. Ford received a master of science (biometrics) degree in 1985 from the University of Colorado School of Medicine, where three years later he received his MD degree. After finishing his internal medicine residency at Stanford in 1991, Ford joined the Stanford Medical Group. He was named to the regular faculty in general internal medicine in 1994. An active clinician and teacher with a busy practice, Ford has a special interest in sports medicine, serving as a core physician and internal medicine consultant in the Stanford Sports Medicine Program, team physician for the Stanford crew, wrestling and men's water polo teams, and as a member of the editorial board of the Clinical Journal of Sports Medicine.
7. Halsted R. Holman, the Guggenhime Professor of Medicine, received his MD from Yale University in 1949 after completing the first of two early-career fellowships in biochemistry. He came to Stanford in 1960 from the Rockefeller Institute of New York, where he spent five years as a researcher, junior faculty member and practicing physician. At Stanford, Holman served from 1960 to 1971 as chair of medicine before turning to full-time teaching, research and clinical care. For 20 years, starting in 1977, Holman was program director of the Stanford Multi-Purpose Arthritis Center. He currently serves as co-chief of the Division of Family and Community Medicine since 1987 and as co-chief of the Division of Immunology and Rheumatology since 1997. He is the recipient of numerous awards and has served on many national committees and editorial boards, including the Blue Ribbon Committee on New Therapies of the American College of Rheumatology.
8. Joseph R. Hopkins switched from veterinary school at the University of Illinois to medical school at Stanford, where he received his MD degree in 1973. He completed his residency in family medicine at the University of Rochester and Highland Hospital, Rochester, N.Y., in 1976. After teaching in a UCLA-affiliated family medicine resident program at UCLA-Antelope Valley Hospital Medical Center, Hopkins came to Palo Alto in 1977 as medical director of the Midpeninsula Health Service. This was an early model of health delivery based on critical analysis of diagnostic and therapeutic decisions, including guided self-care. In 1986 he was appointed executive director of the Midpeninsula Health Service and remained leader of the group after it was acquired by Stanford in 1989. After a succession of leadership positions, Hopkins was appointed medical director for health plans at Stanford and medical director of Stanford Home Care. Since 1997, Hopkins has served as medical director of the Stanford-Coastside Medical Clinic.
9. Margaret Wellington received her RN degree from New Rochelle Hospital Medical Center in New York in 1976. She is currently completing work on a master's degree in public health at San Jose State University. For nearly 25 years, Wellington has worked in a variety of research, supervisory and clinical nursing positions. Much of Wellington's career has focused on chronically ill patients, primarily in the area of hemodialysis. In 1990 and 1991, she served as assistant program manager in the hemodialysis outpatient unit at El Camino Hospital, Mountain View. In 1997 Wellington worked as a case manager at Pinnacle Disease Management Inc., San Mateo.
10.
The
Stanford Health Partners program office is located at 1000 Welch Road. The
coordinator, Margaret Wellington, can be contacted at (650) 724-3359. The
Web site, which includes a schedule of programs, is www.stanford.edu/group/LivingWell/.
