Providing superior healthcare to the people of Iowa and our global community is an important part of our mission. We want to be—and we are—the place people turn to when they are desperate for help for their health problems. There is so much more to providing the best clinical care than just seeing patients. And so many exciting things to do.
There is outreach to the community. There is organizing, scheduling, and forecasting. There is a need for vision and capitalizing on new opportunities, whether it is connecting disciplines for better precision and coordination or it is integrating new technologies for better diagnoses or treatments.
This week, I asked some of our department’s clinical leaders to highlight the work they and their colleagues do, some of the recent successes, and some shining goals on the road ahead. I hope you will learn as much as I have about just how broad a reach our department has. I also hope you will share the gratitude I have to them for this information and for the great work they continue to lead.
Ferhaan Ahmad, MD, PhD, Director of the Cardiovascular Genetics Program
The Cardiovascular Genetics Program brings together basic scientists and clinicians who are focused on heritable cardiovascular disorders. I lead a multidisciplinary team of genetic cardiologists, electrophysiologists, interventional cardiologists, sleep medicine physicians, psychiatrists, surgeons, nurse practitioners, genetic counselors, and nurses who care for patients and families in a network of individual clinics focused on each of these disorders. As the only Center of Excellence in Iowa recognized by the Hypertrophic Cardiomyopathy Association, we are currently caring for several hundred patients with hypertrophic cardiomyopathy. As an example of bench-to-bedside translation, my laboratory contributed to the preclinical development of the first-in-class myosin inhibitor, mavacamten, in a genetically engineered pig model of hypertrophic cardiomyopathy. We participated in clinical trials of mavacamten in patients, leading to its approval by the FDA in 2022 as the first drug specifically developed for hypertrophic cardiomyopathy. Subsequently, we were the first group in Iowa to prescribe mavacamten. In the coming year, we will continue to develop novel pharmacological and gene therapy strategies for the treatment of cardiomyopathies in mouse and pig models, and to translate our findings by testing them in human clinical trials.
A. Benjamin Appenheimer, MD, Associate Clinical Director of Infectious Diseases
In a broad sense, my role is focused on (along with the division director) overseeing the clinical aspects of our division. My general tasks include monitoring the volume and RVU productivity of each of our inpatient clinical services, working with the division administrator to align clinical assignments with RVU targets, putting together the schedule, working with Med Specialty Clinic leadership to address any issues that come up in the clinic, and helping address any gaps in clinic coverage (due to illness, etc).
In my role, I continually monitor the service-to-education balance of our teaching services and adjust our clinical structure as needed. Over the past several years, we have added a new consult service (working directly with the non-teaching hospitalist services), added a new weekend service, and instituted a jeopardy coverage system for our faculty.
Over the last year, we have designed a new service that will better align our busy teaching service with our faculty members’ clinical expectations. I helped lead a faculty retreat in December to discuss various options and we are now implementing this new service starting in July. For this coming year, the main task will be to see how effective this new service is in achieving its goals.
Muhammad Furqan, MD, Director of HCCC Clinical Research Services
In addition to serving as the Medical Director of the Holden Comprehensive Cancer Center’s (HCCC) Clinical Research Services (CRS), I also co-lead the thoracic multidisciplinary oncology group (MOG). As the director of CRS, I oversee a team of 85 research professionals supporting more than 240 cancer-related clinical trials, including 137 active studies. During the last academic year, we developed and implemented a system to fairly distribute CRS resources across all the cancer types, based on patients’ volume and catchment area needs. We have worked hard to enhance the quality of research-related activities by revising all the standard operating procedures and by further strengthening the quality assurance program.
The CRS team is leading the implementation of the financial module to improve the efficiency of research billing within the institutional clinical trials monitoring system, Oncore. In addition, clinical trial budgets are now determined by third-party professionals to allow more effective and smooth contract negotiation across all the stakeholders. Our goals for next year are to further enhance the HCCC investigator-initiated clinical trials and early phase programs, improve and fast-track coordinators’ training, initiate a state-wide cancer trials navigation program, and provide more support toward trials investigating novel anti-cancer approaches including cellular therapies, bispecific antibodies, including T cell engagers, intra-tumoral agents, etc.
Lauren Graham, MD, MPH, Director of the Post-COVID Clinic
Our primary role in the post-COVID clinic is to provide support for patients and primary care clinicians around the state (and beyond) who are grappling with the challenges of managing post-COVID conditions, including “long-COVID.” In the last year we have seen 430 patients for evaluation of post-COVID conditions. Patients have travelled from 53 counties in Iowa, 9 states and Puerto Rico for evaluation. Our services focus on diagnosis, evaluation, and connecting patients with resources locally and at UIHC that help them through this challenging process. The clinic also works closely with our research coordinators to connect patients interested in opportunities for post-COVID research studies and improved understanding of this new and challenging condition.
Furthermore, we are working to educate primary care providers around the state regarding our experiences and findings with long-COVID through education at family practice programs around the state, through our Visiting Professor Program, nursing conferences, and a variety of media outlets. In the next year, we hope to continue our clinical endeavors as well as ongoing education of the medical community. We hope to distribute a “white paper” on long-COVID tips for primary care providers, detailing helpful tips we have found in the workup and management of long-COVID patients as we know the need for more services across the state is great.
Douglas Hornick, MD, Director of Pulmonary Patient Care Programs
For as long as I have been here (three division directors), our division has maintained a horizontal administrative model. Responsibility and drive for building new and enhancing existing clinical programs arises naturally within this culture. My role is to facilitate where possible, but generally stay out the way.
An example of a successful new program would be the one to evaluate and select emphysema patients appropriate for placement of endobronchial valve(s), a novel bronchoscopic intervention to reduce dyspnea. Dr. Kim Baker-El Abiad with the help of Sara Kraus, ARNP, initiated this program and Dr. Baker-El Abiad recently reported she had successfully placed valve(s) in the 20th patient, culled from more than 125 patient evaluations. Referrals continue to grow at a rate that will soon require adjustments to sustain.
For examples of sustaining and continually enhancing clinical programs, the lung transplant program under the direction of Dr. Julia Klesney-Tait assisted by Dr. Tahuanty Peña, as well as the multidisciplinary lung cancer program managed by Drs. Tom Gross, Rolando Sanchez, Kim Baker-El Abiad and Charles Rappaport, both come to mind. These programs are consistently exceptional with better than national average outcomes. The clinical director can stand aside along with the division director, pitch in occasionally, but mostly admire the ingenuity, progress, and added-value these programs bring.
Julia Klesney-Tait, MD, PhD, Director of Thoracic Transplant
My role is to assure that the mission and goals of the thoracic transplant service lines are accomplished. This involves assuring excellence in clinical practice and patient care for the thoracic transplant group through our robust quality programs and advocating for transplant resources when we need them. I work with the physician leaders in Cardiothoracic Surgery and Internal Medicine to implement programmatic changes in clinical care, find EPIC efficiencies for our groups, and optimize care of these highly complex patients. Transplant is a highly regulated specialty, so I also spend a great deal of time making sure we are compliant with regulations set by the Centers for Medicare & Medicaid Services (CMS) and the United Network for Organ Sharing (UNOS).
Amie Ogunsakin, MD, Clinical Director of Endocrinology
As the clinical director, I plan, supervise, and oversee clinical services and programs throughout the division. In the last year, we have improved outpatient access. By working with our clinical providers and scheduling team, we have decreased endocrine clinic wait-times for patients, post-hospitalization from a maximum of 3 months to less than a month in most cases.
We are also in collaboration with the Division of Nuclear Medicine in the Radiology Department on a project that will streamline the process of referrals, diagnosis, and treatment of patients requiring radioiodine therapy. This new process is on track to be implemented next fiscal year. We will continue to work on expansion of our inpatient and outpatient clinical services.
Bilal Rahim, MD, Assistant Director, Iowa Oncology Network
The aim is to grow our oncology influence throughout the state through a variety of pathways, including provider service agreements for oncology services that include hiring community based UIHC oncology physicians, outreach, and medical oncology directorships among others. We are also strengthening our existing infrastructure for community oncology care with our Quad Cities location and entertaining possible outreach models with local communities closer to that location. I have only been in his role since October 2022, but one highlight has been working with the Abben Cancer Center in Spencer, IA. We have successfully executed provider service agreements to help hire a UIHC medical oncologist embedded in their clinic. In addition, I am currently serving as their medical oncology director in a remote role in order to help strengthen our relationship. Hopefully, this will lead to additional opportunities of engagement with oncology services at the main campus and for other non-oncology services. I am currently working on clarifying a process for their oral oncolytic medications.
Otherwise, my role for the network has been to help plan our vision along with Division Director Dr. Mohammed Milhem and to identify and reach out to potential community oncology clinics that may benefit from our services. Our goal for the upcoming academic year is to expand our provider service agreement and outreach portfolio to include additional medical oncology directorships and embedding more UIHC oncology physicians in the community. By increasing community engagement/connections we hope to solidify and improve our reputation as a world-class institution for oncology and to help improve access to clinical trials and other services that are less common in the community setting. In addition to provider service agreements and outreach we would also like, over time, to create additional UIHC oncology clinics in key areas of need throughout the state, similar to our Quad Cities model.
Grerk Sutamtewagul, MD, Director of Leukemia Clinical Research and Leukemia MOG
I started to lead the leukemia team in December 2020, with the role divided into 2 different parts: 1) leukemia clinical trials and 2) inpatient malignant hematology service.
Within the role involving the leukemia clinical trials, I serve as the Director of Leukemia Clinical Research and Leader of the Leukemia Multidisciplinary Oncology Group (Leukemia MOG). Primary responsibilities include overseeing and growing the leukemia/myelodysplastic syndrome (MDS) clinical research platform, including industry-sponsored, cooperative group, and investigator-initiated clinical trials, and communicating with referring physicians to promote our clinical services and research program in leukemia. I also lead the discussion in the weekly leukemia tumor board.
In 2022, our Leukemia MOG reached the third highest accrual for interventional cancer clinical trials (37 patients), and the highest accrual per number of new patients (32.5% of new patients enrolled to clinical trial) across the MOGs. In 2022, we opened 3 more clinical trials, all industry-sponsored.
We still have multiple areas of need for clinical trials, especially in relapsed and refractory acute myeloid leukemia (AML) and high-risk MDS, as the outcomes in these groups of patients remain poor. We already have an AML clinical trial pending activation and 7 more clinical trials in the process within the MOG, from both industry-sponsored and the cooperative group. This year, in collaboration with the Cancer Center Clinical Trial Office, we are developing a new platform to streamline and monitor the process of clinical trial acquisition, activation, and patient enrollment, all in one place.
Inpatient malignant hematology service is an inpatient primary service that takes care of patients with hematologic malignancies. The majority of the patients are those diagnosed with AML and high-grade lymphomas. As the Medical Director of Inpatient Malignant Hematology Service, I oversee the attending schedule, serve as liaison with nursing, hospitalist, other hospital services, and supervise the advanced practice providers (APPs) assigned to this service. We have developed many of the standard operating procedures (SOPs) within the service and continue to identify more areas that need SOP. In 2023, we expect to accommodate medical students and internal medicine residents who are interested in hematologic malignancy to rotate in our service.