Probing Cells, Mannequins And Dollars

A Full-Circle Research Approach
by Stevie Sigan
Photography by David Vernon

The University of Illinois College of Medicine at Peoria has a long tradition of cutting-edge research. New centers, collaborations and hires reflect its mission to both improve health using scientific advances from the laboratory and to tackle structural deficiencies in the healthcare system.

“The end goal is a healthier population,” explains Dr. Sara Rusch, UICOMP’s regional dean, “whether it’s being better able to cure disease or prevent disease—that’s the goal of all the research we do.”

She describes the school’s research approach as a spectrum. At one end are the basic sciences and accompanying lab work, publications and discoveries; at the other, systems design and the strategic measure of healthcare outcomes; and in between is interactive learning. “When we talk about research and development,” she says, “it’s equally important that you focus on the first and last parts of that spectrum.”

The Scientific Approach to Better Health
UICOMP is a hotbed for research these days. Dominating the news in recent months, the $13-million Cancer Research Center held its first public open house on March 29th, placing Dr. Jasti Rao and his patented discovery of a new anti-cancer treatment at center stage in the new digs. With modern lab space for various NIH, DOD and otherwise funded projects, the newly opened facility will aid Rao and his growing team of specialized researchers in their quest to prevent and cure cancer.

“As you stand here, you can see this beautiful new lab space,” says Rusch, guiding a tour of the new building like a realtor showcasing a multi-million-dollar home. But in lieu of expensive décor and furniture, this home boasts tissue cultures—cancer lines and umbilical stem cell donations stored in freezers at -212 degrees Celsius—and something Rusch calls “Jurassic Park-like”—polymerase chain reaction technology capable of replicating tiny bits of DNA to study changes over time.

Like any tasteful home, the Center shows off art in its front hall: con-focal microscopes capture single cancer cells in layers, displayed on canvases by the front door; as well as the latest technology: the lab has a high-speed centrifuge capable of spinning so fast it’s outfitted with titanium blades that won’t fly apart as it divides cells into their component parts, moving “about 4,000 times as fast as a washing machine,” Rusch jokes.

Large posters explaining complex research to the layperson hang on the walls of the new laboratory bay. “This is what’s different about a cancer cell—why it’s cancerous,” Rusch explains. “It can stick to places other cells don’t, it grows…it can move, and then it can spread from a normal tissue, where it lives, to another spot.” Simply put, UICOMP researchers are approaching the disease from every angle—attempting to thwart the very characteristics that make cancer cells cancer cells.

With the second floor largely filled, UICOMP is actively recruiting new investigators for the first floor. “This is really a chance for us to recruit new faculty, and at the same time...help some of the new clinicians that need space for their own areas of expertise,” explains Rao. Some of the new space, for example, houses the pediatric and surgery departments. “We now have the flexibility to provide more space to different departments who want to do research,” he says. “It helps with collaboration.”

The real goal, Rusch explains, is to “focus energy…[and] get enough people working in similar areas to cross-fertilize each other with ideas, share equipment and other infrastructure costs.” Along with the cancer work, she cites ongoing studies in metals toxicity, fetal alcohol syndrome, stroke and stem cells as examples of this cross-fertilization potential in the related areas of neuroscience, cancer and biology. “By putting our basic scientists and neurosurgeons together, you’re able to look at things and get ideas that you might not otherwise,” she says.

Interactive Learning and Simulation
Another approach centers on the Jump Trading Simulation and Education Center being constructed on the OSF Saint Francis Medical Center campus and slated to open next spring. A collaborative effort between the college and the hospital, the center will utilize simulation—using mannequins, patient “actors” and computer technology—to teach more interactively, and in a more realistic setting. The goal is to train medical professionals to become more effective care providers.

“Instead of learning on a patient, you would learn on a model, on a piece of technology, or with a standardized patient, or patient actor,” Rusch explains. Simulation exercises could involve practicing putting a central line into a plastic model, or working as a team to resuscitate a mannequin on an operating table, in order to improve communication among nurses, respiratory therapists, residents and doctors.

“We have one scenario called ‘telling bad news,’ where a physician tries to resuscitate someone, fails, and then has to go tell the ‘family members,’” Rusch explains. “The ‘family members’ are actors because in the real-life setting, you want them to do it well the first time… You can’t really stop them partway through…’”

Rusch believes the simulation center will improve communications research, educational approach and medical device implementation. “Before you invent something, you don’t want to try it first in a real person, you want to try it in a mannequin or dummy,” she says. “Or if you’re going to create a device, you want to see how real people use it in what feels like a real setting. Jump Trading should be able to do those things.”

Outcomes Research: Measuring Accountability
At the opposite end of the spectrum, last summer UICOMP announced the hire of Dr. Carl Asche to lead its new Center for Health Outcomes Research (CHOR), conducting multidisciplinary, collaborative research to analyze the outcomes of healthcare practices, interventions and medical education. Using the community as its laboratory, CHOR will work with a variety of regional partners to determine solutions for improving the quality of healthcare in central Illinois.

“We’re looking at healthcare practices from every angle,” explains Dr. Asche. “This is an amazing community for healthcare. If we can improve the care a patient receives and save the doctor or nurse time in providing that care, then they will be able to better serve more patients at a higher level. If that saves money along the way, then everyone wins.”

A self-proclaimed “health economics geek,” Asche’s background is uniquely suited to his new position. He says dabbling in “nearly every” therapeutic area has been a virtue in a career spanning positions in government and the pharmaceutical industry, as well as a seven-year stint teaching and conducting research in pharmaceutical therapy at the University of Utah. He was lured to Peoria last year, citing the city’s history of testing products like penicillin, as well as demographics reflective of “typical America” as major boons for health outcomes research.

“The city has a stable population that tends to be strongly connected to its families and the community,” he says. “The clinicians that practice here are really good and they tend to take the extra steps…to ensure an effective healthcare system for their patients. And you have a stable population of providers—people who come here and train here tend to stay here. It’s an excellent opportunity to engage in research to make improvements to healthcare quality in the region.”

To illustrate these layered goals, one of CHOR’s first projects is a “no-show” economic analysis in collaboration with OSF HealthCare to determine which patients are cancelling or not going to their medical appointments. With an average rescheduling rate of nine percent—and with some clinics at 50 percent—this issue represents a major gap in efficiency. “Many doctors are booked 150 percent of their time because they anticipate cancellations,” he says. “Doctors and nurses could…put their skills to better use at a higher level instead of waiting for patients who don’t show up.”

Using factors like age, gender, socio-economic status and the distance from home to appointment, Asche and his team are attempting to create a predictive model. “If you can begin to predict the type of person who might miss an appointment, then you can…devise ways to improve their…access to healthcare. It could be as simple as [the lack of a] bus line to get them from their home to the hospital. That could lead to a community needs assessment in Peoria, looking at disparities in access.”

In another project, Asche is working with geriatric clinics on a medication reconciliation study, looking at patients who take a long list of drugs—upwards of 20 prescriptions at a time—and the effectiveness of potential drug interactions and medical reporting. “We are trying to understand what medications they’re taking and why. The problem is there are a lot of adverse effects when taking drugs,” he says. “It’s not uncommon for people to share medications and to not [take it properly]… It’s really difficult because what people…report to the doctor is dramatically different from what they’re really taking.”

Complex studies like these require extensive planning, time and money. In the geriatric study, for example, Asche’s team must go into subjects’ homes to physically look through their cabinets, examine labels and pill boxes, and record patient accounts. The outcome of such thorough research, Drs. Rusch and Asche hope, will be a greater ability to measure and monitor the results of making and administering changes to the system. “We know that we need to reform healthcare,” explains Rusch. “[But] we don’t really know very well what will work to make it better—or if there will be unintended consequences.”

“What we’re doing is developing a model that will save the system so much money,” Asche explains. “If Peoria’s really seen as an effective and efficient healthcare setting…[with] all the collaboration among the hospitals, doctors and other groups who share my goal…to get better, to do the right thing and improve healthcare for all…then that mission will gravitate. If we can show in Peoria what we can save, then replicate that a thousand times over [across the country]—we will save billions.”

Piece by Piece
UICOMP’s approach to research is not unlike putting together a puzzle—a picture of improved health. But with all the complexity of cancer research, new models of education and the task of bridging inefficient gaps in the system, placing pieces can be quite slow-coming. Whether that piece is a frozen DNA sample thawing out from -212 degrees, a published medical actor script, or the confession of someone who doesn’t take his prescriptions as required, one piece leads to another…

“If you think of the whole thing at once, it looks a little overwhelming,” Rusch admits. “But if you worry about just putting two pieces together at a time, eventually it happens.

“While I’d love to have us be the ones to put the final piece in to fill the puzzle…you have to be excited about the day-to-day discoveries and the little pieces, with the belief that someday those little pieces will be put together to form the whole picture.” iBi

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