UTHEALTH NEUROSCIENCES OUTCOMES REPORT 2019
UTHEALTH NEUROSCIENCES OUTCOMES REPORT 2019
Dear Esteemed Colleagues,As physicians, seeing our patients do well is the main joy of our profession. As a team, we hold each other accountable for thecare we deliver. As we look back together on a decade of growth at UTHealth Neurosciences and UT Physicians Neurology weremain committed to raising the bar with first-rate clinical programs in all areas of neuroscience.Table of Contents26810Neuroscience at Its BestAt a GlanceHistory of FirstsFeatures— Walmart Partners with UTHealth Neurosciencesto Provide High-quality Spine Care toAssociates in the Southeast Region— Landmark UTHealth Study Shows thatIntracranial Evaluation with SEEG Is Saferand Produces Better Outcomes than SDE— Leveling Care Across Multiple HospitalsThrough Telemedicine— UTHealth Neurosciences Extends SubspecialtyCare Across the City22 Accolades26 Scope of Services— Brain Tumor— Cerebrovascular— Children’s Neuroscience— Epilepsy— Memory Disorders and Dementia— Movement Disorders andNeurodegenerative Diseases— Multiple Sclerosis— Neuromuscular Disorders— Neurotrauma and Neuroscience Critical Care— Pain Management— Spine Disorders90 Research & Innovation100 Selected Publications126 Patient Stories136 Staff DirectoryWe’re proud to join a handful of select facilities in Walmart’s elite Centers of Excellence network providing the highest qualityspine surgery to the company’s associates. We will provide spine coverage for all Walmart associates in the southeastern UnitedStates, coordinating the entire experience for the patient from transportation from the airport through follow-up. Based on thesuccess of the Walmart COE, we have expanded our spine program to other employers including HEB, McKesson Corporation,Lowe’s and Jet Blue.Our group now has more than 130 subspecialty providers in clinics located in suburbs throughout Houston, allowing us tocoordinate the care of patients from all areas of Houston. In addition, the UTHealth Telemedicine Program has extendedcomprehensive neurological and neurosurgical care to 23 facilities in the southern half of Texas, providing 24/7 consultationsfor partner hospitals to ensure prompt diagnosis and help avoid unnecessary transfers to Houston.Congratulations to our faculty who have received major recognitions, including neurosurgeon Arthur L. Day, MD, who receivedthe prestigious Distinguished Service Award, the highest honor given by the Society of Neurological Surgeons, and ClaudioSoto, PhD, who received a Michael J. Fox Foundation grant to develop a noninvasive biochemical test for early diagnosisof Parkinson’s disease.We’re proud of our entire team of neuroscience providers, who do their best daily and consistently ask how to do things better.Please feel free to contact us directly if you would like more information about our services, research and programs.With best wishes,Dong H. Kim, MDLouise McCulloughPROFESSOR AND CHAIRNancy, Clive and Pierce Runnells DistinguishedChair in NeuroscienceVivian L. Smith Department of NeurosurgeryMcGovern Medical School at UTHealthPROFESSOR AND CHAIRRoy M. and Phyllis Gough HuffingtonDistinguished ChairDepartment of NeurologyMcGovern Medical School at UTHealthDIRECTORMischer Neuroscience Institute at MemorialHermann-Texas Medical CenterCO-DIRECTORMischer Neuroscience Institute at MemorialHermann-Texas Medical Center713.500.6170713.500.70651
Neuroscienceat Its Best2The providers at UTHealth Neurosciences have aacross the region, creating a citywide networkcenter where physicians treat more aneurysms andreputation for innovation, high-quality outcomes andof neurologists, neurosurgeons, neurointerventionalists,arteriovenous malformations than any other center in thethe best possible healthcare experiences, which drawsneuro-oncologists, interventional pain managementregion, an established pediatric neurosurgery program inpatients from around the world. Together with UTspecialists and advanced practitioners – and reducedcollaboration with Children’s Memorial Hermann Hospital andPhysicians Neurology, the group’s clinicians, researchersreferral wait times by building a new structure forThe University of Texas MD Anderson Cancer Center,and educators are nationally recognized for leading-the practice of neurology in the community. Thesean unmatched spinal neurosurgery and reconstructiveedge medicine and consistently ranked by qualityproviders analyze quality data and track outcomesperipheral nerve surgery program and a Brain Tumor Center,benchmarking organizations as leaders in clinicalas a group using the same standards employed bywhere physicians diagnose and treat hundreds of newquality and patient safety. Their insights, technologicaltheir counterparts at UTHealth Neurosciences at thetumor patients each year. Physicians are also innovators ininnovations and success at applying research findings atTexas Medical Center. This helps them continuallythe treatment of multiple sclerosis, movement disorders,the bedside are transforming the field of neuroscience.modify clinical practice and ensure exceptionalneurocognitive disorders, memory disorders and dementia,patient experiences.neuromuscular diseases, chronic pain and traumaticPart of McGovern Medical School at UTHealth, the groupbrain injury.is Houston’s undisputed leader in neuroscience care andThis comprehensive, integrated approach led to thethe foremost neuroscience provider in the southern halfcreation of the Southwest’s leading epilepsy program,Through its telemedicine and neurocritical care programs, theof Texas. The group has extended its continuum of carea highly ranked neurotrauma program, a cerebrovasculargroup offers patients in outlying communities access to stroke,3
NEUROSCIENCE AT ITS BESTneurology, and critical care expertise, as wellas opportunities to participate in clinical trials.Twenty-three facilities in Texas are now linkedthrough remote presence robotic technology.In addition, UTHealth physicians are reachinglarger numbers of people and engaging themin a powerful way through patient accessportals on the group’s website.Through the Innovation and Quality (IQ)Program, the group’s leaders are organizingdata to improve physician and serviceperformance, fostering innovative ways tomeasure quality and track long-term outcomes,and increasing infrastructure support to enablefaculty at McGovern Medical School to conductmore clinical trials and patient-centeredresearch. The results of these novel treatmentsare quickly transitioned to clinical practice.These efforts have led to a strong 12-yearimprovement in quality outcomes. During thattime, our physicians have reported mortalityrates well below the national expectedbenchmark and have seen a greater than 50percent reduction in length of stay, despite theincreased acuity of the patients they treat.45
Patient Volumes in ClinicAt a GlancePhysician TeamStaff Physicians100Clinical Residents and Fellows 85Medical Students on Rotation339Research Fellows 40Advanced Practice Providers 32Clinic VisitsThe Patient Experience140,000120,000100,000The impact of patient-centered care on clinical outcomes and patient satisfaction is well documented in medical literature.As institutions across the country struggle to improve outcomes and satisfaction while reducing costs, Mischer Neuroscience80,000Institute is achieving both goals. The close cooperation of UTHealth physicians and an innovative administrative structure60,000that gives nurses more time to coordinate patient care has led to an upward trend in patient satisfaction over the last 10years. Data gathered by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey shows40,000Inpatient FacilitiesTotal Neuro Beds160Neuro ICU Beds 38Neuro IMU Beds 15Neuro Acute Care Beds 61Stroke Unit Beds 12Neurorehabilitation Beds 12Dedicated Operating Rooms 9EMU Beds – Pediatric & Adult 13consistent improvement in domains considered critical to a high level of patient satisfaction.20,0000%FY16FY17FY18HCAHPS Overall AssessmentFY19Surveys Received FY08-19Total Survey Respondents Per Year:FY08 - 237Neurology Market Share FY1830%680%Percent Market Share70%FY12 - 795FY13 - 671FY14 - 792FY15 - 887FY16 - 893FY17 - 808FY18 - 661FY19 - 66267%62%74% 76%70% 68%81%82% 81%82%80%74%75%73%70%73%76% 77%79%84% 85%84% 82%80%50%40%15%30%20%10%0%FY11 - 83060%20%10%0%5%Rate Hospital% respondents choosing 9 or 10MemorialHermannHCAHoustonMethodistCHISt. Luke’sHarrisHealthWould Recommend% respondents choosing “definitely yes”TCHHCAHPS Domain of CareSurveys Received FY08-19Neurosurgery Market Share FY18Respondents choosing “always” or 17FY18FY19100%91% 90% 90% 90%89% 90%90%30%Percent Market ShareSpecialty Equipment includes: Leksell Gamma Knife Perfexion Varian Trilogy Linear Accelerator Siemens Artis zee (intra-operative angiography suite) Robotic SEEG (ROSA) RP-7TM Remote Presence System 3D C-Arm Philips Healthcare endovascular temperaturemodulation system Simultaneous electroencephalographyand polysomnography Continuous EEG monitoring Magnetoencephalography imaging(Magnes Elekta Neuromag TRIUX) MRI capable of advanced spectroscopicand diffusion tensor imaging with tractotomy Portable CT machine Nihon Kohden EEG 1200 machine withNeuroWorkbench data management software Viking Nicolet EMG machines (2 freestanding)& Viking NicVue EMG Machine (1) portable Phillips CX50 sonography machine (4) LivaNova VNS therapy devices Allergan Botox injection amplifier Medtronic DBS programmer – Samsung tabletFY10 - 60990%25%ResearchResearch Projects in ProgressMore than 200Grants AwardedOver 50 million(Neurology and Neurosurgery)FY09 - 436100%80%85%87%84% 84%79% 79% 81%76%79% 79%78%74%83% 83%84%82%80%78%81% 82% 81%74%69%68% 67%65% 65%68% 68%73%72% 72%72%71% 70%70%68%70% 70%66%67%61% 61%60%20%76%74%73%70%84%76%76%61%58%62% 62% 63%68%69%63%58%56%72%68%67%65%62% 61%62%56% 56%55% 55%69% 70%64%57%64%57%61% 62% 62% 61%58%52% nMemorialHermannHoustonMethodistHCACHISt. Luke’sHarrisHealthSource: Texas Hospital Association Patient Data System (FY2016 Q3 - FY2018 Q2) provided by Truven, formerly ThomsonReuters. Texas Hospital Inpatient Discharge Public Use Data File (FY2016 Q3 - FY2018 Q2) provided by Texas Departmentof State Health Services, Center for Health Statistics; FY2016 Q3 - FY2018 Q2 discharges estimated by using historicaldata by hospital. Excludes Normal Newborns and SNF and any hospital not reporting to THA or Truven. Expanded GreaterHouston consists of 12 counties: Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, SanJacinto, Waller, Walker and anagementHospitalEnvironmentCommunication:New MedicationsTCHSource: Press Ganey, national hospital survey vendor, for all surveys received from patients discharged from 7 Jones, EMU, 5 Jones,NIMU, Stroke, Spine added as of FY14, NVICU added as of FY16. HCAHPS scores have not been adjusted to account for a survey modeadministration change.Responsivenessof StaffCareTransitions7
A History of Firsts The first center to discover a genetic mutationlinked to intracranial aneurysms. The first stroke program in Texas and the only onein the region to meet The Joint Commission’srigorous standards for the highly covetedComprehensive Stroke Center certification. Site of the first single-center clinical trial forrecurrent medulloblastoma, ependymoma andatypical teratoid-rhabdoid tumors using the directinfusion of chemotherapy into the fourth ventricle;the first trial of infusion of 5-AZA into the fourthventricle or resection cavity in children withrecurrent posterior fossa ependymoma; andthe first trial of combination intraventricularchemotherapy (methotrexate and etoposide)infusions into the fourth ventricle or resectioncavity in children with recurrent posterior fossabrain tumors. The first neurosurgery center in the region to offerall advanced modalities of treatment for complexlesions: expert microsurgery, interventionalneuroradiology/endovascular surgery and GammaKnife radiosurgery.8 The North American leader in studies of primaryprogressive multiple sclerosis and the most activecenter in Texas for organized clinical trials of newtherapies for MS. The first facility in Houston and one of the first inthe United States to test the clot-dissolving drug tPAfor acute stroke. The first stroke center in Houston and one of thefirst dedicated stroke programs in the world. One of the first centers in the nation to offer MRguided laser interstitial thermal therapy (MRgLITT)using the Visualase system for the treatment ofwell-delineated focal epilepsies. The first center in the region to use the NeuroPace RNS System, a new FDA-approved techniquefor responsive neurostimulation to treat adults withmedication-resistant epilepsy. Mischer Neuroscience Institute brought the firstclinical magnetoencephalography (MEG) sensor toHouston and has updated the technology to theElekta Neuromag TRIUX. The first hospital in the south-central United Statesand one of only a few in the country offering intraarterial chemotherapy for retinoblastoma, the mostmodern treatment for the disease. The Institute houses one of only a few adult andpediatric inpatient Epilepsy Monitoring Unitsin the country with the unique capability ofsimultaneously performing electroencephalographyand polysomnography. The first in Texas to use robotic stereoencephalography (SEEG) for 3-D mappingof epileptic seizures. The first in the region to inject human centralnervous system stem cells into the spines of spinalcord injury patients. The first in Houston to offer amyloid imaging, adiagnostic tool that enables physicians to diagnoseAlzheimer’s disease.9
FEATUREWalmart Partners with UTHealthNeurosciences to Provide High-Quality SpineCare to Associates in the Southeast RegionIn an expansion of its elite Centers of Excellence network, more than whether the surgeon did a good job in the ORWalmart has added UTHealth Neurosciences and Mischer equally important are preoperative and postoperativeNeuroscience Institute at Memorialcare that set the patient up for recoveryHermann-Texas Medical Center to itsand return to function. We providelist of facilities offering the highestquality spine surgery to the company’sassociates. The group will provide spinecoverage for all Walmart associates inthe southeastern United States, whichmeans that when a Walmart associaterequires spine surgery, UTHealthNeurosciences coordinates the entire“The care we providethrough this program istruly end-to-end. We takefull responsibility andaccountability for every stepof the care delivery process,just as it should be andjust as we do with all of ourpatients.”– Dong Kim, MDpatient experience. Coordination beginswith transport from the airport andincludes constant communication and joint decisionmaking throughout the process, which is organized by adesignated clinical navigator.Houston to preoperative evaluation,surgical or therapeutic intervention andpostoperative care. Our focus is alwayson the patient.”Candidate centers undergo a thoroughevaluation process, and fewer than 5percent initially identified meet all thequality requirements for consideration.The process includes an extensivereview of the system’s quality, outcomes and patientsatisfaction data. Hospitals must provide detailed clinicalprotocols, surgical patient selection criteria, clinicalJust a handful of select facilities are part of Walmart’sregistry participation, information on multidisciplinaryexisting Centers of Excellence program for spineshared decision-making as well as institutional andsurgeries, including Mayo Clinic hospitals in Arizona,physician performance metrics – length of stay, return toMinnesota and Florida; Virginia Mason Medical Center insurgery, infection rates and procedure-specific outcomes.Seattle and Geisinger Medical Center in Danville, Pa.This approach to patient care, developed by Dong Kim,“By selecting a small number of facilities that meet thecriteria important to Walmart – quality care, exceptionalservice, a track record of appropriate patient selectionfor surgery versus conservative therapy – the company10a seamless transition from arrival inhas found that outcomes are better and overall costs areMD, director of Mischer Neuroscience Institute andprofessor and chair of the Vivian L. Smith Department ofNeurosurgery at McGovern Medical School at UTHealth,and Spielman, easily matched the philosophy andapproach of a Walmart Center of Excellence.lower, even when travel and hotel costs are included,”The spine surgeries are performed by neurosurgeonssays Amanda Spielman, senior vice president and chiefDaniel H. Kim, MD, FACS, FAANS; Arthur Day, MD; Johnoperating officer of neurosciences at McGovern MedicalQuinn, MD; and Albert Fenoy, MD. Pain management isSchool at UTHealth. “For spine patients, it’s about mucha critical part of the spine program, and neurosurgeons11Photo courtesy of Memorial Hermann-Texas Medical Center
FEATUREBehind the Scenes: Why Walmart Chose UTHealth NeurosciencesPhysicians for the Spine Center of Excellencework closely with interventional pain managementdate. They carefully detailed her upcoming itinerary.specialists Ashley Amsbaugh, MD, and Nadya M.She would fly down on Sunday, come to the clinic onDhanani, MD, for patients who may benefit fromMonday to meet her surgical team, have the proceduremore conservative treatment. The program is basedon Tuesday, spend that night at the hospital, then spendat the UTHealth Neurosciences Spine Center, locatedWednesday and Thursday in a nearby hotel suite within the Texas Medical Center.her daughter – all of which would be prearranged for her“The care we provide through this program is truly end-Friday, and she would be home by Saturday.Patients in need of spine care have many optionsto-end. We take full responsibility and accountabilityfor treatment. Depending on the evaluation, thefor every step of the care delivery process, just as it“We were picked up at the airport in a shiny new Lincolnneurosurgeon may recommend injections for painshould be and just as we do with all of our patients.Town Car. Every step of the way, we were treated likemanagement or therapy. If surgery is indicated,But this is obviously different from the typical fee-for-VIPs. I’ve never experienced anything like it before,”the highest quality spine care is available throughservice model. This is the future of health care, andLuscomb says. “On Monday for our clinic visit, we were inour providers.we’re excited to be at the forefront of the transitionan exam room within five minutes of our arrival. Dr. Kimas the industry moves in this direction,” Dr. Dong Kimspent time with me, walking me through what all he was“Our team of clinicians determines the best plan ofsays. “It’s a win-win-win for all parties involved, andgoing to do, quickly putting my mind at ease.”care for each patient,” says Rahil Tai, MD, director ofespecially for the patients.”clinical quality review for UTHealth Neurosciences.“When Walmart invited us to present a proposal, weprovided our clinical quality data and volumes, and theguidelines and protocols we have in place to ensureevidence-based patient care. Our data showed ourare unnecessary. The service is 100 percent paid bystrong performance, which led to the program beingWalmart, with no out-of-pocket expenses for employees.named as the only Center of Excellence in Texas.”“Our model focuses on providing the highest qualityAccording to Walmart, the percentage of patients whocare, allowing us to avoid unnecessary costs andhave surgery is lower for those who are evaluatedunnecessary readmissions,” Dr. Tai says. “Whenat Centers of Excellence than in local markets. Thepatients get high-quality spine care, they recover andcompany selects its COEs based on whether they foster
innovations and success at applying research findings at the bedside are transforming the field of neuroscience. Part of McGovern Medical School at UTHealth, the group is Houston’s undisputed leader in neuroscience care and the foremost neuroscience provider in the southern half of Texas. The group has extended its continuum of care Neuroscience
Ethics Program, McGovern Center for Humanities and Ethics, UTHealth Medical School, Houston, Texas. Dr. Walji is an assistant professor, Department of Diagnostic Sciences, UTHealth School of Dentistry, Houston, Texas. Dr. Spike is a professor and director, Campus-Wide Ethics Program, McG
The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences . Health Insurance Certification Guide Log-In to myUTH: https://my.uth.tmc.edu/ . and you have BCBS (Blue Cross Blue Shield), call BCBS 866-882-2034 to obtain your Benefits ID#, and request that a new card be mailed to you. .
UTHealth Resource Scheduler, Astra Schedule migration to Astra Cloud training introduces schedulers to the new layout and some new features. Training will cover Event Process and Solicitation Process for experienced schedulers. Training demonstrations will show the correct way to schedule events in Astra Cloud.
Eric Thomas, MD, Director, UTHealth-Memorial Hermann Center for Healthcare Quality and Safety and Associate Dean for Healthcare Quality McGovern Medical School and Co-Director, CS&E Program 9:00am Keynote Speaker: "Transforming Academic Medical Centers into Learning Health Systems: Strategie s and
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Nicholas M. Barbaro, MD Malva Clinic for the Neurosciences UT Health Austin Kenneth F. Casey, MD Chief of Neurosurgery Oakwood Southshore Hospital Steven D. Chang, MD Stanford University School of Medicine Neurosciences Professor Gary D. Klasser, DMD Associate Professor, Diagnostic Sciences LSUHSC School of Dentistry Michael Lim, MD
nerveux central en neurosciences cognitives et comportementales, à travers la définition de normes de contraintes sur des modèles computationnels et expéri-mentaux. THOMAS BIENVENU Chercheur en neurosciences au Neurocentre François Magendie à Bordeaux et psychiatrie à l’hôpital Charles Perrens. Il est un des coordonnateurs du double
Brain anatomy, physiology, Stroke & Neurological Assessment Stephanie Drysdale. Stephanie Drysdale. Functions of the Brain FRONTAL PARIETAL OCCIPITAL Personality/Behaviour Planning Decision making Concentration Voluntary motor functions Primary motor cortex (precentral gyrus) Comprehension and language Sensory functions (pain, heat and other sensations .
