Dr. Aanand NaikOver the past several weeks, we’ve been introducing the John A. Hartford Foundation’s new funding areas and we’ve been highlighting examples of people and projects that exemplify the work we want to support under each strategy. Last week, Wally Patawaran discussed our Tools and Measures program area, which will support the improvement and advancement of quality measurement and information technology that can drive improvements in clinical practice and patient outcomes.
Today, we are sharing an interview with Dr. Aanand Naik, a geriatrician and a health services investigator at the DeBakey VA Medical Center in Houston and associate professor of medicine at Baylor College of Medicine. Dr. Naik was a Hartford Health Outcomes Research Scholar and affiliated with our Center of Excellence in Geriatric Medicine at Baylor.
He is passionate about patient engagement (his Twitter handle is @EmpoweringPts) and argues against the notion that health care quality can only be judged by expert clinicians (see his blog post Patient-Centeredness Is the Intuitive Grasping of Health Care Quality on the Prepared Patient Blog). He reminds us that quality measurement needs to be rooted in the patient’s own goals and preferences, particularly when dealing with multiple chronic conditions.
Dr. Naik also has an interest in health information technology and you can see him discuss the potential of electronic health records in this video from the Agency for Healthcare Research and Quality.
http://www.youtube.com/watch?v=I_mQ0WdKh84
In the following interview, Hartford Foundation senior program officer Rachael Watman talks with Dr. Naik about his background, interdisciplinary work, and views on the Hartford Foundation’s new strategies.
Can you tell us about what got you interested in working with older adults and how the Hartford Foundation has influenced your development as a leader in the field of aging?
Like a lot of people who are interested in aging, it definitely came from influences growing up and being around my grandparents and my great-grandmother—who really helped raise me. I saw not so much all their ailments, but really the positive things about their lives, what was important to them, and how getting older could be a great and wonderful thing. Being in a multigenerational family was definitely a very positive initial influence.
Then as a medical student and resident, I saw more of the negative side of taking care of older adults, in the sense of just how the system is designed—or not designed—to address their needs.
Patients come in with multiple chronic conditions and impairments and often, as a physician, you’re trained to tackle one problem at a time and provide all the evidence, medications, diagnostics, and therapeutics for each individual condition. For a lot of the older patients that I would take care of, they had four, five, or six of these conditions. So simply doing all the appropriate things for all these multiple conditions actually caused more harm than good. This is not just from a cost perspective, but from the perspective of their health and their quality of life. That really got me very interested in trying to tackle this problem.
The Hartford Foundation has been supporting me in this work from the very beginning. As soon as I became a faculty member, I was able to successfully get a Hartford Foundation Geriatrics Health Outcomes Research Scholar Award, and that was important from a career perspective in terms of validation that you are an investigator who can go out and get external funding.
Since that time, program officers at the Foundation have given me advice and support, connected me with more senior geriatricians working in this area, provided mentoring, and built a community of scholars with other physicians and other types of clinicians supported by the Hartford Foundation. There’s not so many people like us at each of our individual locations throughout the country, but the Hartford Foundation provides a community and that’s very important.
Tell us about your work to improve the health of older adults. Does this include work with an interdisciplinary team?
A lot of the work I’ve done is certainly with an interdisciplinary team in terms of clinicians. I’ve worked with one of the Practice Change Fellows, Ciona Regev, a social worker, and we developed a clinic to help assess older adults who were having trouble making decisions and being able to live safely and independently. Through that experience, which was a fully multidisciplinary team of doctors, nurses, social work, occupational therapy, and physical therapy, we designed a program where we conduct a very comprehensive assessment of this question: Can you make and execute decisions for safe and independent living?
And then more broadly, I like to think of my work as looking at the micro level in terms of an encounter between a patient, the patient’s caregiver, and then one or more clinicians. How do you involve patients and caregivers in certain situations to become part of the team and to understand how the decisions at hand impact their life, impact their goals, impact their roles and relationships.
What we’ve learned quickly is that it’s not a matter of just giving information. Education is not alone the answer. Many times patients don’t know what to do with that information, can’t put it into the right context that’s useful for them in their life. So when it comes to the scientific questions surrounding what do you discuss with a patient, how do you discuss it, what’s the context of presenting it, how do you give options in ways that are actually meaningful to that patient, there are two ultimate goals.
The first is to improve their health outcomes. I think that’s probably the highest and most important and often the most objective. In addition to that is improving the overall quality of the health care they receive and improving quality in the sense that the patient says, “Yes, I actually got better care.” So they can intuitively say, “That was good quality. This choice helped me to achieve the things that I think are important to me in the way that those choices were given, and the outcomes that I received from them were personally meaningful to me. I think that was better than another way that it was delivered.”
That’s the end goal of the work, and really how to do that is not so simple and easy.
So given the strategic shift in the direction of the Hartford Foundation to support leaders like you to make change in the practice environment, what do you think Hartford can offer to others going forward?
My feeling is that this shift is really important. It’s very consistent with where I think my work and many other geriatricians’ work is evolving and I embrace this change toward the practice environment very much.
While I am an academic, and getting grants and publishing papers will always be important, I want to see that the work I’m doing has an immediate impact. Even more than that—and I think most scientists would say the same—when I decide to take on a study, or do a clinical trial, or test an intervention, I don’t want to test it in a “black box” or in a test tube. It needs to be tested in the practice environment because that’s the only way we know whether it’s worthwhile, whether it’s effective, whether it’s worth the costs that go into it.
The skill sets that are needed to do this are sometimes not what’s taught in our research training program, but it is something that the Hartford Foundation has been supporting. Some of that includes messaging and how to communicate your ideas in effective ways. Some of it is training in how to think about return on investment or how to develop a budget for a sustainable project that persists over time. How do you think about that? How do you interact with potential funders or people who’d be willing to support such an intervention? These are really different questions, and I think it’s something that people like me and other investigators would really need and would benefit from.