High-risk African Americans with multiple risk factors for cardiovascular disease: challenges in prevention, diagnosis, and treatment.

Coronary heart disease (CHD) is the second leading cause of death in the United States. Despite previous downward trends, which have not persisted, CHD mortality remains higher in African Americans than in Whites. Among African American and White adolescents and adults are trends of increased physical inactivity, smoking, and obesity. Approximately 47 million Americans have metabolic syndrome, a constellation of obesity, hypertension, dyslipidemia, and insulin resistance leading to diabetes. Despite a lower prevalence of metabolic syndrome, African Americans are more insulin resistant than Whites at similar degrees of adiposity, have higher blood pressures, and among women, have more obesity. Since African Americans tend to be diagnosed later and have more risk factors, which confers greater than additive risks, we propose the term "African American multiple-risk patient (AAMRP)." The AAMRP poses clinical and public health challenges for healthcare providers. We provide clinical and public health strategies for early detection and aggressive management of AAMRP.

Views of new internal medicine faculty of their preparedness and competence in physician-patient communication.

BACKGROUND: We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. METHODS: Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. RESULTS: Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average +/- SD, 9.4 +/- 1.0 vs 7.7 +/- 1.2, P < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. CONCLUSION: Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.

An in-house learning laboratory for patient-centered innovation.

Profound economic and social forces are challenging healthcare organizations to deliver higher quality care that is more patient-centered and evidence-based. We describe a novel way in which organizations can respond to the challenge of patient-centered, evidence-based innovation--an in-house learning laboratory for healthcare delivery services and processes. Mayo Clinic's SPARC Innovation Program, initiated in 2002 and fully operational in 2005, facilitates the generation of new ideas, tests prototypes, and disseminates the knowledge required for systemic, repeatable organizational innovation. Results from the innovation program suggest that healthcare organizations can successfully develop and realize value from such learning laboratories.

The application of design principles to innovate clinical care delivery.

Clinical research centers that support hypothesis-driven investigation have long been a feature of academic medical centers but facilities in which clinical care delivery can be systematically assessed and evaluated have heretofore been nonexistent. The Institute of Medicine report "Crossing the Quality Chasm" identified six core attributes of an ideal care delivery system that in turn relied heavily on system redesign. Although manufacturing and service industries have leveraged modern design principles in new product development, healthcare has lagged behind. In this article, we describe a methodology utilized by our facility to study the clinical care delivery system that incorporates modern design principles.