"We cannot accept that our health care system is too hard to change. Rather, change can only occur when we dare to be an active participant in our health, whether patient, parent, or physician. It is daring to ask for a roadmap to health. It is daring to question the norm and say it is unacceptable. It is time to turn the page in this great country where we have the means and technologies to right the system." — Steven D. Freedman, MD PhD
The Passport to TRUST Program was developed by Steven D. Freedman MD, PhD and Mark Aronson, MD, both Professors of Medicine at Harvard Medical School and senior physicians at Beth Israel Deaconess Medical Center in Boston. Drs. Freedman and Aronson have focused on a critical but neglected area in health care reform – the patient-physician encounter. By making the patient and their family informed partners in their care, they believe this transparency and TRUST will lead to improved outcomes and decreased harm.
The TRUST team developed and piloted an electronic communication tool, (called the Passport to TRUST program), where the potential causes of a patient’s symptoms are described to the patient and their family, any tests or treatments justified as to how this will change management, the timelines and follow up mapped out, and their questions or concerns addressed. Following the successful pilot, they are about to initiate a larger controlled study at Harvard and other institutions to measure the effect on quality, patient satisfaction, expected cost savings and scalability. They will also be studying the incorporation of this model into training of medical students and residents at Harvard Medical School. Since physicians control 91% of costs, this structuring of the doctor-patient interaction is likely to have profound effects on improving quality while decreasing costs. This includes improving health literacy and improving compliance with medications and treatment regimens, especially as ‘personalized medicine’, genomics, and as new technologies emerge.
An important element of any health reform program is the ability to bring together the different stakeholders and demonstrate sustained improvements in health outcomes. Drs. Freedman and Aronson are looking to develop partnerships with insurers, PMBs and other key partners to develop effective models and robust outcome measures (e.g., increased prescription compliance, testing linked to action, decreased hospitalizations) that can be tested in different settings.
Steven D. Freedman, MD PhD
Steven D. Freedman M.D., Ph.D. is Director of the Pancreas Center at Beth Israel Deaconess Medical Center. He is also Chief of the Division of Translational Research, Director of Clinical Research, and Professor of Medicine at Harvard Medical School, Boston, Massachusetts. He plays a leadership role in clinical translational research both at Beth Israel Deaconess Medical School and throughout Harvard University. The latter includes his recent role as Associate Dean for Clinical and Translational Research at Harvard Medical School and co-director of the NIH funded Harvard Clinical and Translational Science Center (Harvard Catalyst: http//catalyst.harvard.edu).
Dr. Freedman received his Ph.D. from Yale University School of Medicine in 1981 followed by the M.D. degree at the University of Connecticut in 1986. He completed his residency and fellowship in Gastroenterology at Beth Israel Hospital and has remained on faculty since 1991. Dr. Freedman’s expertise is in exocrine pancreatic disease with a particular focus on pancreatitis and cystic fibrosis in both adults and children. He is an internationally recognized leader in these areas with an extensive research program that encompasses both basic science as well as clinical trials of new therapies for pancreatitis and cystic fibrosis. Dr. Freedman’s group has also identified the site representing visceral pain within the cerebral cortex and are testing a novel interventional therapy. In addition, his group has identified an association between cystic fibrosis gene mutations and the development of chronic pancreatitis and Primary Sclerosing Cholangitis. As a result, his group is currently testing new therapies for both of these diseases. Lastly, his collaborative work with Dr. Camilia Martin in the Dept. of Neonatology at BIDMC has led to new insights into how fatty acids and nutrition may predispose preterm infants to chronic lung disease and infection.
Dr. Freedman has also developed a major focus on health care delivery reform that addresses structuring the doctor-patient encounter to build informed partnerships leading to sustained improvements in health outcomes.
Mark Aronson, MD
Dr. Mark Aronson is a Professor of Medicine at Harvard Medical School, Vice Chair for Quality in the Department of Medicine, and Associate Chief of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center (BIDMC). A primary care internist serving a large panel of patients, including many distinguished Boston physicians, Dr. Aronson also founded the BIDMC Hospital Medicine program that now cares for the majority of general medicine admissions to the Hospital.
Dr. Aronson is the founding director of the Stoneman Center for Quality Improvement at BIDMC. Focusing on improving patient safety and quality of care, the Center has created imaginative and effective interventions in both clinical and educational programs within the Medical Center. The Stoneman Center created the first comprehensive training program in quality improvement and patient safety for medical residents in the country. Its work has informed similar efforts nationwide.
He is Editor in Chief of the Adult Medicine and Primary Care Section of Up-to-Date in Medicine, an electronic text that has become the most widely used medical textbook in the world. An expert on guideline development, Dr. Aronson served for five years on the American College of Physician’s Clinical Efficacy and Assessment Subcommittee.
Author of numerous scholarly articles and editor of 4 books, Dr Aronson’s research has focused on making evidence-based medical care more cost effective and on improving medical safety and quality for both hospitalized and ambulatory patients.
Named among the Best Doctors in Boston and in the USA on several occasions, Dr. Aronson is a Master of the American College of Physicians and in 2007 received the Career Achievement in Medical Education award from the Society of General Internal Medicine, its highest award for medical education.
Camilia R. Martin, MD MS
Camilia R. Martin M.D., M.S. is an Assistant Professor of Pediatrics at Harvard Medical School, and the Associate Director of the Neonatal Intensive Care Unit and Director for Cross-Disciplinary Research Partnerships in the Division of Translational Research at Beth Israel Deaconess Medical Center, Boston, MA.
Dr. Martin received her M.D. from Cornell University School of Medicine in 1992 and completed her internship and residency at Children’s Memorial Hospital/Northwestern School of Medicine in 1995 where she also served as Chief Pediatric Resident in 1996. Dr. Martin completed her fellowship in Perinatal-Neonatal Medicine at the Harvard Combined Program in Neonatology in 1999. During her fellowship training, she completed a Masters in Epidemiology at Harvard School of Public Health in 1998.
Dr. Martin’s research interests are focused on neonatal nutrition and its impact on health and disease in the preterm infant. She has participated in multi-site clinical trials serving as the Principal Investigator at BIDMC resulting in publications evaluating growth and long-term neurodevelopmental outcomes in the extremely preterm infant. In 2009, Dr. Martin received a Faculty Fellowship Award from the Program for Faculty Development and Diversity from Harvard Catalyst/Harvard Medical School facilitating her transition from general epidemiology to translational research. Her current research activities are in fat digestion and fatty acid metabolism, postnatal intestinal adaptation, development of local and systemic immune defenses, and regulation of the inflammatory response.
Dr. Martin is working with the TRUST Team to develop the electronic application tools that will enable improved patient-physician communication leading to improved health outcomes and health cost savings. Additionally, Dr. Martin, in her role as a neonatologist, brings her expertise and that of the Department of Neonatology at Beth Israel Deaconess Medical Center in providing coordinated, multidisciplinary patient care with the focus on making families informed partners in the care of their critically ill children. This type of model has partially formed the basis of the Passport to TRUST initiative.