Health care costs and access have been particularly problematic in the past for vulnerable populations such as the poor, the elderly, children, racial and ethnic minorities, and the mentally ill. Patients in these groups face substantial non-financial barriers to care because of limited education, transportation resources, cultural barriers, and social circumstances which may promote risky behavior. The focus of this emphasis area is to examine strategies for meeting the needs of these populations in an era of resource competition.
Faculty in the Department of Health Services include experts in quality of health care (James LoGerfo and Rita Altamore), ambulatory care organization and management (Mary Richardson), long term care (Susan Hedrick), and health promotion for underserved populations (William Beery). The Department includes several health economists (Douglas Conrad, Thomas Wickizer, Allen Cheadle, Nicole Urban, Carolyn Watts Madden) with a wide range of interests in health financing, organization, and c ost-effectiveness. There is also a strong group of health behavior experts with backgrounds in psychology and sociology: Donald Patrick, Susan Curry, Hendrika Meischke, and Beti Thompson.
Carolyn Madden and Aaron Katz head the Health Policy Analysis Program, which has evaluated Medicaid demonstrations, programs to support rural hospitals, and the Basic Health Plan, a pilot state initiative to increase access to insurance for low-income working populations. The WAMI rural health research center, headed by Gary Hart and Roger Rosenblatt (both Family Medicine), is engaged in policy-oriented research concerning rural hospitals, perinatal care, rural health manpower, and the quality and outcomes of care. The University of British Columbia's Center for Health Services and Policy Research, headed by Morris Barer (Economics), has provided past Clinical Scholars with province-wide data for comparison with Washington State.
Jim LoGerfo, a nationally recognized expert on assessing quality of care and the interactions of quality, access, and cost, is principal investigator on the Pew/Rockefeller Health of the Public program at the UW, working with Harold Goldberg (Medicine, UCSF Clinical Scholar alumnus). This program has introduced curriculum changes in teaching population-based medicine, and has created a managed-care consortium to study and improve the cost-effectiveness of hypertension therapy. Jim also sits on the JCAHO advisory committee to provide direction on JCAHO's Agenda For Change. Through the Health of the Public Program, Jim has led a statewide effort to analyze obstetrical care and to develop indicators of quality of obstetrical care for a ll hospitals statewide.
Several UW faculty are involved in national and state-level guideline development efforts, intended to improve quality of care, reduce costs, and reduce variability in care. For example, Al Berg (Family Medicine and UWCSP alumnus) is a member of the U.S. Preventive Health Services Task Force, updating a widely used guide to clinical preventive services. Rick Deyo was on the AHCPR-sponsored guidelines panel for low back pain. Gary Franklin has been instrumental in developing and evaluating clinical guidelines for the state's Workers' Compensation agency. Rick Deyo, Jim LoGerfo, and Harold Goldberg are involved in a Washington State Medical Association initiative to foster development of a statewide outcomes database, serving both on the steering committee and as heads of key task forces.
Al Jonsen is a nationally recognized leader in the recent evolution of medical ethics, serves as Chairman of the Department of Medical History and Ethics (part of the Medical School), and is a member of the UWCSP core faculty. His de partment includes ethicists with major interests both in clinical ethics and in the ethics of resource allocation at a societal level. He has worked with the Department of Health Services to create an "ethics track" within the M.P.H. curriculum. Other key members of this department who have worked with Clinical Scholars include Nancy Jecker in Clinical Ethics and James Whorton in Medical History.
A VA Center for Medical Ethics was recently initiated by Robert Pearlman, a UWCSP alumnus. This center draws together experts at the Puget Sound VA Medical Center, Portland VA, and the University of Washington for purposes of evaluating clinical ethical problems and for developing system-wide policies.
Basic advances in molecular biology pose growing ethical problems in medical genetics and genetic interventions. Funding of an endowed chair and Department of Molecular Biotechnology brought Lee Hood to the UW to head research on the human genome. Part of his program draws together the interests of other medical geneticists such as Arno Motulsky and Gil Omenn and Al Jonsen's expertise to heighten interest and investigation in this complex ethical arena.
Local programs have created unusual strength in studying and improving health care for Native Americans, Southeast Asian refugees, Hispanics, and African Americans. For example, the Minority Affairs Program in the Medical School Dean's Office has received funding from the Indian Health Service for a Native American Center of Excellence, intended to match health research expertise with tribal needs, encourage Native American student research involvement, and improve the curriculum in minority health. Dale Walker (Psychiatry) is leading a three-generation study of drinking problems in Native Americans. Other Native American health initiatives include surveys of health status among Native Americans in King County (David Grossman, Pedia trics), and of mental health among school children in the nearby Colville Tribe (Michael Storck, Psychiatry).
Southeast Asian refugees comprise a substantial proportion of the patient population at the Harborview Refugee Clinic, now led by Carey Jackson, a UWCSP alumnus. This clinic provides culturally sensitive clinical services and a research program concerning health information needs and traditional healing practices. A more general program in cross-cultural health care is funded by the Kellogg Foundation and led by Robert Putsch (Medicine), providing cross-cultural training for providers and interpreters, and encouraging ethnic minorities to enter health professions.
Washington State is home to substantial numbers of Central American refugees and Mexican-American farm workers. Communities in Eastern Washington have many migrant and seasonal farm workers, whose needs are met in large part by a network known as the SeaMar Community Health Clinics, directed by Case Kolff, another UWCSP alumnus. Cross-cultural work with any of these populations is facilitated by medical anthropologists such as Lorna Rhodes (Department of Anthropology and a member of the CSP core faculty) and Noel Chrisman (Nursing).
The very young and the very old comprise vulnerable populations for which extensive local resources are also available. There is a strong, multi-disciplinary Maternal and Child Health Program based in the School of Public Health, directed by UWCSP alumus Fred Connell. Resources in injury prevention have been discussed above. The Washington State Department of Parent-Child Health Services is headed by Maxine Hayes, who is also Clinical Assistant Professor of Health Services. Hayes has provided seminars for the CSP and served on individual Scholar advisory committees, opening access both to her own expertise and her department's programs.
The Division of Geriatrics, headed by Itamar Abrass, has an extensive research program related to multiple aspects of aging. Robert Pearlman is particularly involved with ethical issues in end-of-life decision making. David Buchner ( Health Services and Geriatrics) is studying prevention of falls in the elderly and geriatric assessment units. Long-term care is also a central focus of the VA's Health Services Research Program. Susan Hedrick has studied adult day health care, home hea lth care, and geriatric assessment units intended to obviate the need for nursing home care. Eric Larson, Medical Director of the University Hospital, continues an active research program on dementia in the elderly, work that has involved several Clinical Scholars.
Back to UWCSP home page
Last modified: 1/6/97