VP&S-Bassett Partnership Strengthens Clinical Care and Training
People living in rural areas are generally at higher risk of disease and death than people living in urban areas. These differences in risk are known as rural health disparities and are caused in part by less access to health care because of fewer providers, environmental exposures, and higher rates of smoking, obesity, and high blood pressure.
Addressing the issue of access to improve the health of rural populations is one of the strengths of the relationship between VP&S and Bassett Healthcare Network in Cooperstown, New York.
The network’s anchor facility, Bassett Medical Center, was founded 100 years ago to honor Mary Imogene Bassett, a physician and trailblazing medical administrator who devoted herself to caring for the people of Cooperstown. Bassett’s commitment to education and the partnership with Columbia, which includes the unique Columbia-Bassett program, clinical clerkships for medical students, and residency opportunities, are strong elements of the medical center’s culture.
“Bassett has an extraordinary legacy of medical education, research, and an interest in supporting clinical care in rural parts of our country. It’s a natural partner for VP&S in how we push forward to train the best doctors who thrive on excellence in patient care,” says Katrina Armstrong, MD, dean of VP&S.
The impact of the training experience is profound. First-year VP&S student Sidney Saint-Hilaire has wanted to be a psychiatrist since childhood. Saint-Hilaire had already begun his VP&S application when a description of Columbia’s unique partnership with Bassett caught his eye.
“Bassett is relationship focused,” says Saint-Hilaire. “For me, it’s an answer not only for that personal connection, but also that ability to have multilevel thinking and nurturing of a doctor who has an interest in systems change and also an interest in the person.”
Monica Lypson, MD, vice dean for education at VP&S, sees the Columbia-Bassett program and other opportunities for medical students as vital training grounds for VP&S students. “Bassett is a great place for our learners to understand and experience what patients throughout the United States experience,” says Lypson. “Doctors in training at Bassett learn about the unique challenges of receiving—and providing—rural health care, preparing them for practice in places across the country.”
The Columbia-Bassett program combines science-based coursework in Manhattan with clinical education at Bassett. All students study a longitudinal integrated curriculum and follow a panel of patients for a full year, across specialties. Through SLIM (Systems, Leadership, Integration, and Management) modules, students dig into the tools and principles of process improvement. A third track, known as LEC (Life Experiences Curriculum), prepares students to recognize and respond to the roots of emotional trauma underlying physical illness in people who might offer only subtle hints of emotional struggle.
“There is a great need for this kind of training,” says Henry Weil, MD, professor of clinical medicine at VP&S, who serves as senior associate dean for the Columbia-Bassett program and chief academic officer and chief clinical officer for the Bassett Healthcare Network. “Outcomes for people who live in rural areas are almost uniformly worse than those of people who live in non-rural areas, cutting across outcomes in terms of opioid use disorder, heart disease, lung disease, a broad assortment of common illnesses. There aren’t enough training programs of any kind in rural areas to supply the kind of workforce that’s needed.”
Cardiovascular care is one specialty area that has been nurtured in the past 10 years and was built on a program created in 1997 by Allan Schwartz, MD, chief of Columbia’s cardiology division, and Craig Smith, MD, chair of Columbia’s Department of Surgery. Their HeartSource health care consulting and management service develops cardiovascular clinical care programs and supports quality improvement. In the 25 years since HeartSource was created, the service has worked with more than 20 health systems from Miami to Shanghai to develop new surgical and interventional programs; help institutions recruit staff and establish or refine pathways of care; and regularly review patient outcomes to promote quality improvement. The partnership with Bassett Healthcare Network began in 2012.
“We’re trying to extend what we have at VP&S, which is one of the best quaternary care centers in the country, and make it as available as possible,” says Schwartz, the Harold Ames Hatch Professor of Medicine and Seymour Milstein Professor of Cardiology (in Medicine) and chief of the Seymour, Paul and Gloria Milstein Division of Cardiology at VP&S. “Through HeartSource, we provide 24/7 ability to physicians to get in touch with us in real time to deal with complex and urgent medical problems.” When necessary, VP&S cardiologists accept referrals for transplants and other high-risk surgeries.
To support its pledge to provide round-the-clock clinical consultations, the HeartSource team developed digital infrastructure to expedite long-distance review of heart ultrasounds, angiograms, and other diagnostic technology. This summer, the Columbia-Bassett partnership leveraged those efforts to begin offering Bassett patients telehealth consultations with VP&S cardiologists.
“We have a nurse in an exam room with a patient and a stethoscope and the VP&S cardiologist on a computer monitor interacting and listening and doing an evaluation, seeing them as a remote physician,” explains Michael Holmes, MD, chief of cardiology at Bassett Healthcare Network. “Our primary goal is increased access for patients in this community where there’s limited access to local cardiologists. As we move forward, there will be opportunities for people who have expertise in subspecialities to be available for patients without them having to travel.” The telehealth consults are currently available two days a week. Holmes envisions expanding the program to the equivalent of having a full-time remote VP&S cardiologist on his team.
Armstrong sees the cardiology partnership as a critical training ground as VP&S leadership and medical students alike grapple with how to address barriers to health care access for patients nationwide. “As a medical center, this is an extraordinary opportunity for us to partner to elevate the quality of care in places that do not have easy access to advanced specialty treatments and diagnostics," says Armstrong. "With the expansion of virtual and telehealth through what we’ve learned during the pandemic, it’s an exciting opportunity for us to think about how to lead innovation for clinical care, particularly in rural settings.”
In addition to witnessing the effect of geography or other structural access issues that affect rural patients, students gain vital insights into the distinctions among patient populations, says Lypson. “Each community is individual and to understand that community you have to live there and talk to the people who live there. It’s eye-opening.”
As a person of Caribbean descent, Sidney Saint-Hilaire envisions one day working with Black and Brown communities. In Cooperstown, he saw an opportunity to hone the techniques that will help him earn each patient’s trust. “There are so many modalities that affect people’s interactions with medical environments and so many people in upstate New York deal with aspects of scarcity,” he says. “It’s important as a physician to recognize what it really means to practice medicine and meet patients where they are, advocating at a social and political level. That’s just as valuable in an upstate rural community as in an urban center.”