Internal Medicine

We are studying how different models of inpatient care delivery impact patient outcomes and resource utilization. In addition, we are evaluating the implementation of disease-specific interventions such as heart failure management strategies on patient outcomes. From these studies we will better understand predictors for hospitalization, readmission and mortality. As a community-based academic center, not only can we develop creative solutions to improve care, but also evaluate those interventions and share our results with others.

A multi-center study sponsored by the National Institutes of Health and the National Heart Lung and Blood Institute is being conducted through the Endocrine Section of Internal Medicine. This study is compares two treatments for coronary artery disease in patients with diabetes. Another Phase III multicenter study, sponsored by competitive research funds from a pharmaceutical company, compares the efficacy of two different drugs in changing coronary atheroma volume in subjects with type II diabetes. Both of these studies represent cooperative research efforts between sections in the Internal Medicine Department and Saint Joseph Mercy Health System’s Michigan Heart & Vascular Institute.

For the better part of the last decade, I have become increasingly involved in clinical efforts directed at improved patient care, most notably in the anticoagulation discipline. Not only have these efforts benefited orthopedic patients, but also cardiology patients, general surgery and medicine patients. Our work allowed us to create national and international linkages to help us problem solve. We participated in multi-center clinical trials including Thrive V, DUT Free Registry, and Innovate. My research interests in the future will continue to focus on the areas of anticoagulation and critical care. We plan to continue contributing to our critical care database, IMPACT, and become increasingly involved with the KEYSTONE ICU research to improve quality and safety in the ICU. A few areas of interest for future research include studies of appropriate anticoagulation treatment using heparins and warfarin in different patients, exploration of the impact of oral thrombin inhibitors, should anticoagulation therapies in certain neoplasms be dictated by vascular pathologic findings, and to determine changes in coagulation markers during sleep that may portend more serious cardiovascular outcomes.

The Gastroenterology Section of the Department of Internal Medicine is uniquely positioned to conduct leading-edge research in a real world setting. Our diverse patient base allows our group to study a number of different disease entities while providing our patients with state-of-the-art care. Our research interests include colon cancer screening, hepatitis C, gastroesophageal reflux (GERD) and drug-induced liver disease.

Two of our notable current projects include a study on drug-induced liver injury, and a large scale analysis of the care of hepatitis C patients.

The drug-induced liver injury studies are part of a National Research Network assessing medications and their effects on the liver. Drug-induced liver disease can cause serious medical problems and is the main reason for medication being removed from the market. This study will also assess the potential impactof alternative and complementary medicines on the liver.

The hepatitis C research includes studies on the severity of hepatitis C in community-based patients, and efficacy versus effectiveness of treatment.

The research work with hepatitis C will continue with:

• An intervention in multiple primary care practices attempting to optimize the identification and management of patients with the disease
• An assessment of the real world practice of physicians, the true effectiveness of treatment and rates of patient identification
• Interventions to optimize the care of this growing group of patients

This compelling research has the potential to change the perception of hepatitis C among physicians and policy makers, as well as bring lifestyle change and treatment to the large proportion of unidentified patients.