Department of Family Medicine

Mary Jo Welker, MD, Chair

The Department of Family Medicine provides quality health care based on a family practice model, teaching and modeling family medicine principles and values, pursuing cutting-edge research and scholarship, and providing service through personal, professional and political efforts. The Department fosters, facilitates and reports collaborative, interdisciplinary research directed toward optimizing peoples’ health. Central to these efforts is the Ohio State Primary Care Research Institute, a collaboration including faculty from the Division of General Internal Medicine and the Division of Ambulatory Pediatrics plus numerous other departments at Ohio State. Family Medicine’s collective laboratory is the 24-site Ohio State Primary Care Practice-Based Research Network, which includes all of Franklin County and serves some 107,000 patients. Numbers and funding amounts of research projects are increasing annually.

Ongoing Research Programs

Academic Administrative Units in Primary Care: This three-year, federally funded grant project supports the Ohio State Primary Care Research Institute in expanding research in cancer, diabetes, genetics and cardiopulmonary conditions.
Patient-Centered Communication During Chemotherapy: Funded by the National Institutes of Health, this two-year project will develop a patient-centered communication intervention for breast cancer patients undergoing chemotherapy treatment, examine patient reactions to the intervention and evaluate its effects on pain, depression and fatigue symptoms.
Teaching to the CORE: Using Core Competencies Without Losing Core Values: This three-year, federally funded grant project will enhance medical school curriculum at Ohio State, focusing on core competencies identified by the Accreditation Council for Graduate Medical Education and creating a medical school environment allowing students to retain the values of altruism and service values drawing students to primary care.
Cognitive Behavioral Therapy Techniques and Lifestyle Changes: Reducing Systolic Blood Pressure – This study tests the hypothesis that patients can be taught to implement Lifestyle Behavioral Changes (LBCs - restricting dietary sodium, engaging in aerobic physical activities and moderating alcohol intake) augmented by Cognitive Behavioral Therapy-Techniques (CBT-T) in the time frame of a routine primary care office visit.

Research Accomplishments of 2006

Tom Best, MD, PhD, joined the Department in 2005-06 with four funded projects: Biomechanical Effects of Eccentric Exertions in the Workplace, a three-year project funded for $387,000 by the National Institute for Occupational Safety and Health; Modeling of Muscle Strains and Prediction of Injury Risk Factors, a two-year study funded for $100,000 by the AIRCAST Foundation; Effects of a Previous Strain Injury on Hamstring Muscle Mechanics During Springtime: Implications for Preventing Re-Injury, a six-month project funded for $125,000 by NFL Charities; and The Use of Botulinum A Toxin to Reduce Muscle Contracture and to Promote Myogenesis in a Rabbit Distraction Osteogenesis Model, a two-year project funded for $100,000 by the Orthopaedic Research and Education Foundation. Best focuses on the pathophysiology of muscle-tendon injuries. Through federal and industrial support, he has assembled a team of post-docs, graduate students and medical students who use animal models to examine the biomechanics and pathophysiology of injury and repair, with interest in the role of leukocytes. They use immunological and molecular techniques to dissect the role of NF-KB and other transcription factors in the repair of stretch-injured skeletal muscle. Best has collaborated with other scientists at Ohio State to understand more about the role of exercise in cancer-induced cachexia. They are using an animal model to explore optimal methods of attenuating muscle wasting.
Pat Fahey, MD, along with Mary Jo Welker, MD, Tom Blincoe, Donna Cruz-Huffmaster and Chris Welker, investigated downstream revenue that the Ohio State University Primary Care Network (OSU PCN) generates for The Ohio State University Medical Center (OSUMC). They assessed total billings and collections in fiscal 2003-04 from five revenue streams at OSUMC from the OSU PCN. These streams – hospital billings, tests and procedures from network and specialty attending physicians, and specialist physician billings – were compared with billings and collections from the OSU PCN. The researchers used a novel weighting system to capture the concept that not all admissions or referrals of OSU PCN patients were ordered by OSU PCN physicians. Total downstream net revenue of nearly $115 million was more than six times the net revenue to the network. A downstream direct contribution margin of $52 million was 6.3 times the network loss. The researchers concluded that a primary care network can generate significant financial support for an academic medical center. Their manuscript, “Analysis of Downstream Revenue to an Academic Medical Center from a Primary Care Network,” was published in the August 2006 issue of Academic Medicine.
Larry Gabel, PhD, with support from Pat Fahey, MD, Linda Stone, MD, and others from outside the Department, completed two funded projects investigating “telehealth”: Telehealth: A Unique Solution for Health Needs of the Columbus Empowerment Zone was a three-year project funded for $108,000 by the Columbus Compact Corporation; and Ohio Telemedicine, Education, and Linkage Program (Ohio TeleHelp): A Proof-of- Concept Study, a one-year project funded for $150,000 by the Ohio Board of Regents.

These projects suggested that medical outcomes via telemedicine are the same or better than outcomes of similar face-to-face medical services, and that concomitant costs of service are the same or less. A university-commercial partnership was established to create and maintain a statewide broadband network to link facilities interested in participating in a proof-of-concept study. Each facility was configured with at least a video-teleconference unit connected to all others through wired or wireless means. Networked facilities included: four nursing homes (two in Columbus, one in Cleveland and one in Waverly); a non-profit community mental health center, a non-profit community primary healthcare center, and a non-profit community refugee center, all in Columbus; a non-profit county health department in Portsmouth; a university-based hospital in Columbus; and two university-based emergency departments in Columbus and Chillicothe. A pilot study of this network revealed satisfaction by consulting physicians at the Distant Site (university hospital) and staff and patients at the Originating Sites (nursing homes). Especially apparent were savings in time, travel and staff resources that are normally part of person-to-person healthcare delivery. A later analysis suggested that using telemedicine could save Medicaid about $98.5 million annually. But Ohio Medicaid does not reimburse for care provided via telemedicine, and nor does Medicare in metropolitan areas, so there is reason to consider changing restrictive regulations.