Honora Englander, M.D., is associate professor of medicine, OHSU School of Medicine.

August 21, 2015

What’s been the most interesting development in your area in the last two years?

Health care transformation efforts – largely driven by the Affordable Care Act – have shifted the focus of the health care delivery system toward providing high value care across a population. Efforts are underway to drive integration across settings and disciplines, and there is growing recognition of the need to integrate behavioral and physical health. The delivery system is starting to shift its focus from generating volume to producing value. And health reform is driving increased interest and ability to provide care to previously disenfranchised populations. While we have a long way to go, there is more support in the community for our most medically and socially vulnerable adults.

What projects are you currently working on and are there opportunities for fellow faculty to participate?

Currently I am leading addiction improvements for hospitalized adults at OHSU called IMPACT (the Improving Addiction Care Team). In a recent needs assessment of 200 hospitalized adults we found that hospitalization is a reachable moment to initiate and coordinate addiction care. Many patients want to cut back or quit, and they are interested in medications such as naltrexone for alcohol use and methadone or suboxone for opioid use disorders. To address these needs, IMPACT includes an inpatient addiction consult service comprised of a physician, social work counselor and peer recovery mentors. Patients have difficulty accessing care after hospitalization and wait times are often long. Thus, IMPACT includes ‘in-reach’ from community addiction partners who will perform assessments during hospitalization and facilitate accelerated pathways to outpatient addiction care. Finally, because many patients with addiction stay in hospital for weeks because they are socially – not medically – vulnerable, we are working with OHSU OPAT (infectious disease), CODA (a specialty addiction agency) and Coram infusion pharmacy to develop an innovative model of combined medical and addiction care. In this new model, patients will be able to leave the hospital sooner and safer, and receive IV antibiotics in a residential addiction care setting.

Addiction is a disease of the brain that has strong social and genetic determinants. Faculty can participate by partnering with our team, supporting a culture of trauma-informed care, and practicing safe opioid prescribing. In addition, it would be interesting to hear from faculty across basic science, clinical, education and public health arenas to see how OHSU can come together to understand and improve addiction care.

What is the most important aspect of support that OHSU provides to you currently and how would you like this or other support to grow in the future?

In 2009, OHSU’s leadership team took a risk and sponsored development of C-TRAIN, the Care Transitions Innovation, a hospital-to-home transitional care program that I co-developed with Devan Kansagara, M.D.*, and many, many others. This support included funding our first transitional care nurse, pharmacy team, paying for medical homes in the community for uninsured adults who wouldn’t otherwise have access to care, and providing 30 days of medications using a low-cost value-based formulary that we created. This investment allowed us to develop C-TRAIN, which has served over 1,000 patients regionally, been implemented in three area hospitals, and expanded to include any insurance – not just uninsured and publicly-insured adults. C-TRAIN also served as a platform for system-wide improvements. We have improved and grown through the tremendous support from leadership and clinical staff across Social Work, Care Management, Pharmacy, and in- and outpatient physicians. The addiction reforms that we are developing emerged from our C-TRAIN experience.

OHSU has created a Clinical Integration Department that will provide infrastructure to support innovative, integrated approaches to care across the clinical enterprise. I hope that OHSU continues a strong commitment to health equity and the care of disadvantaged populations across clinical, educational and research missions.

*Particulars

• Dr. Kansagara is associate professor of medicine, OHSU School of Medicine and a VA Portland Health Care System physician

About Three Questions
This Q&A series features OHSU School of Medicine faculty members talking about their work with the goal of getting to know them and different areas across the school. View more