Our nation ’s health system is widely recognized to be the best in the world for treating complex, acute illnesses. As a nation, we are also known to lag many economically developed nations in meeting overall population health needs.
The same is true in Arkansas. Our system mirrors the national problems, but is also complicated by our rural nature, large numbers of underserved patients, and the number of people with a lower socio-economic and educational status. We are near the bottom of the nation in many health categories, including the number of children living in poverty and infant mortality.
Within Arkansas, health outcomes vary widely by region and demographic segments. Factors such as rural versus urban or suburban residence impact access to health care. Insurance status, economic status, educational level, ethnicity, personal habits (obesity, tobacco use and exercise) – all affect health outcomes.
The triple aim of efforts to reform our nation’s health system is to raise quality and safety throughout the system, improve the patient’s experience by becoming more patient and family centered, and improve efficiency and reduce cost. The goals, quite simply, are better health, better health care and lower cost.
With the mapping of the human genome about six years ago, we entered a biomedical era with great promise to understanding the molecular mechanism underlying our most important chronic diseases. Many different molecular pathways can lead to cancers, cardiovascular disease, psychiatric illnesses and other diseases.
The term of art we use to describe this field is “personalized medicine.” We at UAMS have been developing the infrastructure for the kind of team science necessary to unravel the mechanisms of disease and to translate findings into actual improvements in our approaches to health and disease.
As we are making advances on the scientific front, we also are wrestling with the fact that the burden of illness is not distributed evenly throughout society. Some populations experience higher infant mortality, shorter life expectancy and worse outcomes from chronic diseases than others. These disparities are intertwined with social issues, such as geography, health insurance, education, economic status and ethnicity.
The complexity and interconnectedness of these issues demand that the medical, social and educational sectors work collaboratively to make measurable progress without sacrificing those aspects of our system that make it great.
Enabled by communication technology and partnerships with the Arkansas Department of Health, other state agencies and community leaders, UAMS is developing the strategies to do just this.
We have embraced the foundation of a reformed system, which is comprehensive patient centered medical homes staffed with teams that can engage patients and families in preventive services, promote and reward healthy behaviors, and support the management of chronic diseases, while bringing newer personalized, precise, molecular diagnostics and therapeutics to the care of patients rapidly and effectively.
UAMS is working on a health information backbone that supports best practice, provides up-to-date clinical information and enables clinicians and patients to be notified when preventive services are due, such as monitoring blood pressures, checking blood glucose and getting vaccinations. We are using distance technology to connect patients and primary care practices to specialist services when needed.
There’s much more work to be done. We as a society need to continue addressing issues of improving the health system to achieve better health outcomes, while changing the structure of payment. We must give our health professionals the tools needed to be successful for all of our sakes.
–Dan Rahn, M.D.