DRAFT AGENDA (updated 2/12/2016)

A Lown Institute Annual Conference is unlike any other conference in medicine. People leave a Lown Conference not just better informed but inspired – not just better connected, but engaged with their peers, ready to make real change in health care.

New this year is the Research Day on April 15. We want to add to our understanding of “right care” with scientific papers and posters that up until now have been practically non-existent, but sorely needed to enhance medical education and quality improvements.

The conference will focus on concrete ways participants can advance right care in their clinical communities – to restore the relationship between patients and clinicians and end the culture of overuse, misuse, and underuse in medicine. The conference will also highlight a vision for the future and the role grassroots organizing and movement building must play in creating change.

Who should attend? Clinicians, patient advocates, patients, trainees, students, and policymakers

Friday, April 15, 2016Time Session Name

7:30 – 8:30 am Registration and breakfast

8:30 – 8:45 am Welcome

8:45 – 9:15 am Keynote: The Evidence for Overuse

Rita Redberg, MD, Chief Editor, JAMA Internal Medicine; Professor and Director, Women's Cardiovascular Services, University of California, San Francisco

9:15 - 10 am Abstract Slam Session A (descriptions pending)

10 – 10:15 am Break

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10:15 – 11:15 am

Oral Abstracts: Drivers of Overuse

11:15 – 12:00 pm

Panel Discussion: Drivers of Overuse

12 - 12:15 pm Break

12:15 – 1:00 pm Abstract Slam Session B (descriptions pending)

1 – 2:30 pm Lunch and Poster Session

2:30 – 3:30 pm Oral Abstracts: Interventions to Reduce Overuse

3:30 – 4:15 pm Panel Discussion: Interventions to Reduce Overuse

4:15 – 4:30 pm Break

4:30 – 5 pm Keynote: The Evidence Ecosystem – A Model for Producing Valid Evidence and Getting it to the BedsideGordon Guyatt, MD, Distinguished Professor, Department of Clinical Epidemiology & Biostatistics, McMaster University

5 – 5:15 pm Awards and Closing

6:30 - 8:30 pm Cocktail ReceptionMeet the speakers and fellow conference attendees.

Saturday, April 16, 2016

Time Session Name

8 – 9 am Breakfast

9 – 9:15 am Welcome and IntroductionsVikas Saini, MD, President, Lown InstituteShannon Brownlee, MSc, Senior Vice

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President, Lown Institute

9:15– 9:45 am Keynote: What are the Barriers to a Right Care System?

Joanne Lynn, MD, Director, Center for Elder Care and Advanced Illness, Altarum Institute

9:45 – 10:30 am Panel Discussion: What are the Real Harms of a Culture of Over-testing and Overtreatment? Perspectives from Patients, Clinicians and CommunitiesThis panel discussion and Q&A will explore the ways in which overuse results in harm to patients, clinicians, and our communities.

Moderator:Shannon Brownlee, MSc, Senior Vice President, Lown Institute

Panelists:Kim Witczak, Drug Safety Advocate; Co-Founder, Woodymatters

Nneka O. Sederstrom, PhD, MPH, FCCP,Director, Center for Ethics, Spiritual Care Department, MedStar Washington Hospital CenterLauren Taylor, Doctoral Student, Health Policy and Management, Harvard Business School

10:30 - 10:45 am Break

10:45 – 11:30 pm

Keynote: Moving Toward Right CareJeff Brenner, MD, Founder and Executive Director, Camden Coalition of Health care Providers

11:30 – 12:15 pm

Panel Discussion: Bright Spots in the Health Care Landscape that Imagine a Better SystemThis panel offers a set of ground-

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breaking, on-the-ground initiatives in primary care, medical education, advanced illness care, hospital restructuring and community organizing, which are reducing overuse and underuse and advancing the right care.Moderator:Cheryl Sullivan, MSES, CEO, American Academy of Nursing

Panelists: Thomas Cornwell, MD, Chair and Chief Medical Officer, The Home Centered Care Institute

Lauran Hardin, MSN, RN, CNL,Director, Complex Care Program, Mercy Health Saint Mary'sDaniel Wheeler, MD, Chief Resident, UCSF School of Medicine; Lown Institute RightCare Young Innovator Grantee – Think Twice, Stick OnceKathleen Grimm, MD, Co-Chair of the Community Health Worker Network of Buffalo, NY; Director of Palliative Medicine, Erie County Medical Center

12:15 – 1:15 pm Lunch

1:15 – 1:45 pm KeynoteJohn P.A. Ioannidis, MD, Professor, Stanford University; Director, Stanford Prevention Research Center

2 – 3:15 pm Workshop Session #1 (descriptions below)

3:15 – 3:45 pm Break

3:45 – 5 pm Workshop Session #2 (descriptions below)

5 – 6 pm Networking Hour

Sunday, April 17, 2016Time Session Name

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8 – 9 am Breakfast

9 – 10:30 am Symposium: A Vision of a Better System: Barriers and OpportunitiesSpeakers:

Vikas Saini, MD, President, Lown InstitutePhillip Thompson, PhD, Associate Professor, Head, Housing, Community & Economic Development, MITRyan Meili, MD, Vice-chair, Canadian Doctors for Medicare; Executive Director, Upstream; Physician, University of Saskatchewan College of Medicine

Mona Hanna-Attisha, MD (invited)Director, Pediatric Residency Program, Hurley Medical Center, Flint, MI

10:30 – 10:45 am Break

10:45 – 11:15 am Keynote: A Movement for Transforming Health CareEliseo Medina, Former International Secretary-Treasurer, SEIU

11:15 – 11:45 am Overview: RightCare Action Week and RightCare Alliance Councils

11:45 – 12 pm Closing:Shannon Brownlee, MSc, Senior Vice President, Lown Institute

12 – 1 pm Grab and Go Boxed Lunch

1 – 4 pm Right Care Alliance Councils’ Working Sessions: Each council will convene working group sessions to shape their agenda for the year. Councils include: Advanced Illness, Cardiology, Emergency Medicine, General Surgery, Health Care Education, Nursing, Orthopedics, Pediatrics, Primary Care, Psychiatry, Public Engagement, and Science &

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Evidence.

Social MediaWe’re building a movement to transform health care, and it’s crucial we amplify the messages and ideas coming out of this conference. It’s up to all of us to be the messengers. We encourage all attendees to be vocal and active on social media during the conference, and please include the hashtag #Lown2016

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Saturday, April 16, 2016 Workshops

Saturday afternoon is built around a series of in-depth workshops that tackle the most important challenges facing practicing clinicians, medical educators, and policymakers in government and medicine.

First Workshop 2-3:15 pm Second Workshop 3:45-5 pmRight Care in Psychiatry and Behavioral Health

Primary Care’s Role in Supporting Patients and Managing their Care

Right Care Rounds: Conducting A High-Value Educational Conference

Baby Boomers for Balanced Health Care: Holding Community Conversations on Medical Overuse

Making Wise Choices in Treatment of Back Pain and Enhanced Access to Urgent Orthopedic Care

Engaging in Difficult Conversations

Providers for Responsible Ordering (PRO): Organizing to Promote Right Care

Techniques to Quickly Connect to Patients and Their Caregivers

The Nuts and Bolts of Patient and Family Partnerships in Co-Designing Ambulatory Care

Combating Heart Disease Fear Mongering in Clinics and Communities

Opportunities for RNs to Influence Decisions to Provide Right Care

Medical Misinformation vs. Reliable and Clinically Useful Evidence for Truly Informed Consent and Improved Outcomes

Overtreatment and Deceptive Drug and Device Promotion in the Context of Health Care Corruption

Right Care Educator Networking Session

Your Voice, Your Values (title TBD) Toward the Right Care In Surgery: Harvesting the Low-Lying Fruit

Organizing (title TBD)

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Descriptions

First Workshop 2-3:15 pm

Right Care in Psychiatry and Behavioral Health

A case vignette will serve as a springboard to a wide-ranging discussion among panel members who will explore several dilemmas with the diagnoses and treatments of common behavioral disorders. Panelists will speak from their perspectives as a family member, seasoned public advocate, and expert in psychiatry and family medicine. They will explore the consequences of under- and over- diagnoses and over- and under-treatments of various psychiatric illnesses, including ADHD, depression and bipolar disorders. They will also address how addictive disorders complicate diagnoses and treatment of psychiatric conditions. Avenues for improving mental health care and ways that family members can facilitate recovery and resilience will be suggested. Brief questions, comments, and lively interactions are encouraged.

Presenters:

Macaran A. Baird, MD, MS, Professor and Department Head, University of Minnesota Department of Family Medicine and Community Health

Wesley Boyd, MD, Psychiatrist, Cambridge Health Alliance Leigh Jennings, MD, Staff Psychiatrist, Methodist Hospital System, San

Antonio, TX Bruce H. Price, MD, Chief, Department of Neurology, McLean

Hospital/Harvard Medical School

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This workshop was developed by the Behavioral Health Council of the Right Care Alliance.

Right Care Rounds: Conducting A High-Value Educational Conference

Training students and residents to recognize and avoid unnecessary care increases value of care, although current mechanisms for this training are limited. Right Care Rounds promotes a new paradigm: Doing “as much as possible for the patient and as little as possible to the patient.” This educational initiative transforms the familiar case presentation format to facilitate an evidence-based discussion with the goal of promoting appropriate patient care.  It is structured to address the whole patient and the entire continuum of care and provides a unique opportunity to reflect on patient preferences, social or cultural contexts and systems-level dysfunction that is often “business as usual.” It also explores the many drivers of overuse and underuse that may get in the way of appropriate medical care. This workshop will give interested clinicians the tools they need to implement Right Care Rounds at their home institutions.

Presenters:

Brandon Combs, MD, FACP, Assistant Professor, University of Colorado School of Medicine

Edward Murphy, MD, Instructor, University of Colorado School of Medicine Darlene Tad-Y, MD, Assistant Professor, University of Colorado School of

Medicine

Making Wise Choices in Treatment of Back Pain and Enhanced Access to Urgent Orthopedic Care

This session addresses two important topics in orthopedics.

Back pain accounts for a large portion of annual health care expenditure. In an increasingly market-driven world, new treatments crowd an already packed roster of therapeutic choices. How are physicians to make choices that best benefit their patients while remaining cost-effective? This part of the program will outline a sensible approach to treating back pain with evidenced-based treatments in an appropriate timeframe.

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A community orthopedic clinic implemented a process to improve access to urgent care that has led to high rates of patient satisfaction, prompt access to specialty care, and price transparency. Insurance coverage remains an obstacle to the spread of this type of care. This part of the program will discuss this process of care, along with the role of medical insurance and urgent specialty care outside of the Emergency Department.

Presenters:

Steven Ballinger, MD, Orthopedic Surgeon, Samaritan Health Services Thomas Grogan, MD, Pediatric Orthopedic Surgeon, Pacific Coast Sports

Medicine

Providers for Responsible Ordering (PRO): Organizing to Promote Right Care

This workshop presents a method of sparking culture change within an academic campus or institution. The mission of Providers for Responsible Ordering (PRO) is "to provide all of the care that patients need, and none that they do not." PRO convenes providers who are concerned about the harms associated with overtreatment and under-treatment. The workshop will begin with a series of case studies illustrating how the first PRO chapter was able to identify and correct errors of overtreatment on the Johns Hopkins Bayview Medical Center campus. Q&A will follow, and interested attendees will be able to receive information about how to start a PRO chapter on their own campuses.

Presenters:

Anthony Accurso, MD, Faculty Director, Bayview PRO Sara Naylor, MD, Faculty Director, University of California Los Angeles PRO Sonali Palchaudhuri, MD, Resident Director, Bayview PRO Christopher Pertrilli, MD, Faculty Director, University of Michigan Medical

School PRO

The Nuts and Bolts of Patient and Family Partnership in Co-Designing Ambulatory Care

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In recent years, achieving effective patient and family partnership in care has become the holy grail of nearly every influential health care advocacy organization in the United States. But what does true patient and family partnership in ambulatory care mean, and why is it important? In this session, attendees will learn how patient and family partnership is not only the right thing to do, but also can also improve outcomes including health status and practice efficiency. Actual examples will be shared from ambulatory practices that effectively partnered with patients and families to co-design care and highlight the specific tools and strategies they used to achieve success. All participants will have access to a co-designing care toolbox for use in their practices and home institutions.

Presenters:

Cynthia (Daisy) Smith, MD, FACP, Director, Clinical Program Development, Senior Physician Educator, American College of Physicians

Others TBD

Opportunities for RNs to Influence Decisions to Provide Right Care

How do we RNs identify and utilize the opportunities to influence the choice for “Right Care”? Establishing a rapport with patients and their family network in a short period of time is crucial, but it is also what is done daily. RNs interact with others on the care team regularly with varying effectiveness. What are the techniques that are most effective in influencing the decisions that affect patients? In this workshop, attendees will hear a patient story and then collectively analyze the gap(s) in the patient’s access to the Right Care. They will also hear different perspectives of the care team to better understand where care potentially went wrong and what can make the care more effective. At the end of the workshop, attendees will produce a Top 5 list of needed improvements so that right care can be realized.

Presenters:

Kathy Day, RN Selwyn Rogers, MD, Vice President, Chief Medical Officer for the Health

System, University of Texas Medical Branch; Assistant Dean, Clinical Affairs, School of Medicine

Steve Rooney, Moderator/Facilitator

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Mary Fran Tracy PhD, RN, CCNS, FAAN, Critical Care Clinical Nurse SpecialistAdjunct Clinical Professor, University of Minnesota

Overtreatment and Deceptive Drug and Device Promotion in the Context of Health Care Corruption

Our health care system does not meet the needs of patients or providers, partly due to overtreatment and other decision-making that does not put patients’ needs and values first. Pharmaceutical, biotechnology, and device companies may promote their wares by affecting, and sometimes distorting and manipulating almost every source of medical information that physicians and patients rely on. Furthermore, these actions may occur in a context in which dishonesty and outright corruption are prevalent, enabled by a culture of silence and impunity. This interactive workshop will describe covert promotional techniques used to undermine rational prescribing, discuss the larger context of dishonesty, corruption, and impunity, and start a conversation about possible solutions.

Presenters:

Adriane Fugh-Berman, MD, Associate Professor, Department of Pharmacology and Physiology, Department of Family Medicine, Georgetown University Medical Center; Director, PharmedOut

Roy Poses, MD, Clinical Associate Professor of Medicine, Alpert Medical School, Brown University; President, Foundation for Integrity and Responsibility in Medicine

Second Workshop 3:45-5 pm

Primary Care’s Role in Supporting Patients and Managing their Care

What is primary care’s role within a system that promotes Right Care? How can health professionals design care not only to deliver better care, but also to control the cost of care of the people served? This workshop will examine the following issues in the context of a panel discussion: Building trust with patients; designing a model of care that promotes access, patient self-management and self-efficacy, while reducing waste; social determinants; and payment strategies that incentivize Quadruple Aim.

Presenters:

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Wayne Altman, MD, FAAFP, Family Medicine Clerkship Director; Director of Medical Student Education; Foundations of Patient Care Course Director; Professor of Family Medicine, Tufts University School of Medicine

Alan Glaseroff, MD, Co-Director, Stanford Coordinated Care Alan Roth, DO, Chair, Department of Family Medicine, Jamaica Hospital

Medical Center

This workshop was developed by the Primary Care Council of the Right Care Alliance.

Baby Boomers for Balanced Health Care: Holding Community Conversations on Medical Overuse

Baby Boomers for Balanced Health Care is a citizen group generating community conversations to challenge the cultural idea that more health care equals better health. Partnering with the Lown Institute and Consumer Reports, the group will distribute a process for small and large forum conversations to engage community members in promoting cultural change around medical overuse. This presentation will include a description of the process, a video example, a robust discussion, and a few ways to take this public engagement method to home clinics and communities.

Presenters:

William J. Doherty, PhD, Professor, University of Minnesota Bill Adams, Citizen Member, Baby Boomers for Balanced Health Care

This workshop was developed by the Community Engagement Council of the Right Care Alliance.

Engaging in Difficult Conversations

This workshop will provide participants with tools for having difficult conversations in short periods of time that meet the patient’s agenda, but also value patient safety and stewardship of limited resources.

Presenters:

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Auguste H. Fortin VI, MD, MPH, Associate Professor of Medicine, Yale University

Michael Wilkes, MD, MPH, PhD, Professor, Internal Medicine, University of California, Davis

This workshop was developed by the Health Care Education Council of the Right Care Alliance.

Techniques to Quickly Connect to Patients and Their Caregivers

With limited time for each appointment and the knowledge that communication is critical to helping patients and their families cope with their diagnoses and treatments, how can providers maximize every minute? In the pediatric world, clear communication requires understanding a family's perspective and accounting for its economic circumstances, cultural views, and health literacy. In this workshop, learn easy-to-implement successful tips that doctors use to connect with patients, engage their loved ones, and ensure that decisions meet patient expectations.

Presenters:

Jose L. Gonzalez, MD, JD, MSEd, Vice President, Clinical Affairs/Medical Director, Cook Children’s Health Plan/Center for Children’s Health

Daniel Nicklas, MD, FAAP, Assistant Professor, Department of Pediatrics, Children’s Hospital Colorado

Randi Redmond Oster, MBA, President, Well Path Press Ricardo Quiñonez, MD, FAAP, FHM, Associate Professor of Pediatrics,

Baylor College of Medicine; Chief, Division of Pediatric Hospital Medicine, Children’s Hospital of San Antonio

Alan R. Schroeder, MD, Chief, Pediatric Inpatient Services, Santa Clara Valley Medical Center

This workshop was developed by the Pediatric Council of the Right Care Alliance.

Combating Heart Disease Fear Mongering in Clinics and Communities

Heart disease is our nation’s number one killer. Cardiovascular awareness and screening programs harness fear to promote early detection of heart disease. The

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Go Red for Women campaign is one such example. Vascular screenings offered at community centers is another. But atherosclerosis, the disease underlying most cases of heart disease, responds best to basic lifestyle measures, not expensive health care therapeutics. In this workshop, attendees learn from a case-based format, highlighting how these campaigns foster over-diagnosis and overtreatment. Worse, these initiatives distract patients and doctors from what is really important for heart health—lifestyle change. Learn more about steps clinicians and community members can take to fight the culture of overuse in cardiology.

Presenters:

John Mandrola, MD, Cardiac Electrophysiologist, Baptist Health; Columnist, theHeart.org|Medscape Cardiology; Blogger, Dr. John M

Stephen Martin, MD, Family Medicine Physician, UMass Memorial and Boston Medical Center

This workshop was developed by the Cardiology Council of the Right Care Alliance.

Medical Misinformation vs. Reliable and Clinically Useful Evidence for Truly Informed Consent and Improved Outcomes

Knowing the reliability of medical evidence is required for making informed clinical decisions. There is a high likelihood of distorted study results when evidence is of low quality. However, most health care professionals are unaware that much medical science is not reliable or clinically useful. There currently exists a “medical misinformation mess” —a hidden and little known crisis affecting every patient. The basic skills for evaluating the quality of medical science are much easier to acquire and apply than most people think. This workshop is designed to enable attendees to recognize the size and importance of this crisis through compelling cases, as well as to learn about the common threats to validity in medical literature. Critical appraisal tools will help attendees assess medical evidence for reliability and clinical usefulness.

Presenters:

John Ioannidis, MD, Professor, Stanford University; Director, Stanford Prevention Research Center

Sheri Strite, Co-Founder, Managing Director and Principal, Delfini Group, LLC

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Michael Stuart, MD, Co-founder, President and Medical Director, Delfini Group; Clinical Assistant Professor, University of Washington School of Medicine

Toward the Right Care In Surgery: Harvesting the Low-Lying Fruit

This session will consist of subject matter experts in several essential specialty areas of surgery and perioperative care. Each will outline three areas of improvement in health care delivery that are within grasp and have a large impact on quality relative to the efforts required to transform the processes.

Presenters:

Zara Cooper, MD, MSci, FACS  Palliative Care Tracks for Preoperative and Emergency Room Patients  "Let us Begin at the Beginning"

Angela Bader, MD, MPH  Standardizing Preoperative Protocols Mallory Williams, MD, MPH, FACS  Maintaining Quality in Surgery and our

Faith: "Resisting Efforts to Raise the Dead, Walk on Water, and Divide the Sea"

Please check back often for updates; several workshops will be added over the next weeks.

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