Latest / Becker’s Healthcare - Clinical Leadership Podcast / Advancing Memory Care and Neurology at AdventHealth Carrollwood with Dr. Douglas A. Ross

Transcript

Advancing Memory Care and Neurology at AdventHealth Carrollwood with Dr. Douglas A. Ross · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  The most important health care decisions don't happen
• 0:05
  in isolation.
• 0:06
  They happen when leaders come together.
• 0:08
  Becker's sixteenth annual meeting brings together more than
• 0:11
  3,500
• 0:12
  hospital and health system executives this April in
• 0:15
  Chicago.
• 0:16
  With 800 speakers from Ascension,
• 0:18
  Cleveland Clinic, CommonSpirit and more, the conversations get
• 0:22
  real. Leaders will share how their scenario planning
• 0:24
  for policy shifts, breaking through value based care
• 0:27
  barriers, and building clinical teams that translate new
• 0:30
  ideas into real world care.
• 0:32
  Join top decision makers in the room April
• 0:35
  13 through the sixteenth.
• 0:37
  For the agenda and event details, visit beckers
• 0:40
  hospital review dot com and click on the
• 0:42
  events tab in the upper right.
• 0:45
  This is Laura Dierda with the Becker's Healthcare
• 0:47
  podcast.
• 0:48
  I'm thrilled today to be joined by doctor
• 0:50
  Douglas Ross, chief medical officer at AdventHealth Carolwood.
• 0:53
  Doctor Ross, it's a pleasure to have you
• 0:54
  on the podcast today. Thanks so much,
• 0:57
  Laura. Great to be here. Honored to be
• 0:59
  here. Absolutely fantastic. Well, I'm excited for our
• 1:03
  conversation because we're gonna be talking a lot
• 1:05
  about,
• 1:06
  age related neurological and cognitive conditions, some of
• 1:09
  the challenges related to that, as well as,
• 1:11
  you know, how clinicians and organizations can really
• 1:13
  support those who are going through those challenges.
• 1:16
  But before we dive in, can you tell
• 1:17
  us a little bit more about yourself and
• 1:19
  AdventHealth Carol Wood?
• 1:21
  Yeah. Sure. I'm an ENT by background, and
• 1:24
  I'm the
• 1:26
  hospital leader here focused on operationalizing
• 1:28
  care models
• 1:30
  so that,
• 1:31
  clinicians can do the highest
• 1:33
  value work while the system lowers barriers for
• 1:35
  patients and families.
• 1:37
  I've been in,
• 1:39
  administration now. I started,
• 1:41
  in administration around 2008.
• 1:44
  And so I've been in, health care administration
• 1:47
  for a long time and particularly
• 1:49
  in guiding and leading
• 1:51
  and helping doctors,
• 1:53
  as,
• 1:54
  the evolution, and that's a kind word to
• 1:57
  say, of medicine
• 1:59
  has been occurring. But,
• 2:01
  so,
• 2:02
  I've had a lot of battle scars, but,
• 2:04
  really enjoyed the role.
• 2:07
  AdventHealth began as a mission driven health system,
• 2:09
  so just talking about us. And we've grown
• 2:12
  into a larger integrated network that emphasizes whole
• 2:15
  person care.
• 2:16
  Clinical excellence wrapped with spiritual and social supports.
• 2:21
  That philosophy shapes how we approach aging. It's
• 2:24
  not only about medical diagnosis,
• 2:26
  but it's about independence,
• 2:28
  dignity, and quality of life.
• 2:31
  So Atherton Health Carrowood is our Tampa area
• 2:33
  acute care campus that functions as a community
• 2:36
  hub for neurology and aging services.
• 2:39
  We provide inpatient acute care, stroke services, outpatient
• 2:43
  neurology, and memory care access for families who
• 2:45
  want expert care close to home.
• 2:48
  And importantly for us, and for the community,
• 2:51
  Carrollwood is connected
• 2:53
  into the AdventHealth's
• 2:54
  broader neuroscience
• 2:55
  institute
• 2:56
  and the systems memory and aging programs, and
• 2:59
  we have a few.
• 3:01
  The so that connection lets us offer sophisticated
• 3:04
  diagnostic and specialty input,
• 3:07
  when patients need it.
• 3:09
  And that keeps, that and we also
• 3:12
  keep the care as local and, patient centered
• 3:15
  as possible.
• 3:16
  On a practical level, that means we focus
• 3:18
  on three things at Carrollwood, timely access,
• 3:21
  interdisciplinary
• 3:22
  coordination,
• 3:23
  and care navigation.
• 3:25
  Timely access, we want seniors to be seen
• 3:27
  quickly. We really, like, really want our entire
• 3:29
  population who comes, spends time with us, not
• 3:32
  to waste their time. So we wanted them
• 3:34
  seen quickly,
• 3:36
  when their concerns arise or you know, and
• 3:39
  provide
• 3:39
  interdisciplinary
• 3:41
  core coordination,
• 3:42
  which is
• 3:43
  really for the senior,
• 3:45
  long term cognitive conditions are complex and rarely
• 3:49
  managed by a single specialist. So
• 3:51
  we combine primary care, neurology,
• 3:54
  geriatrics,
• 3:55
  pharmacy, rehab, and social work into team based
• 3:58
  pathways.
• 3:59
  In care navigation,
• 4:01
  we help families understand next steps, whether that's
• 4:04
  home services, therapy,
• 4:06
  or clinical trial.
• 4:08
  That blend of, community access plus system
• 4:12
  expertise is how we make the care both
• 4:15
  capable and compassionate.
• 4:18
  So we're really, you know, we really are
• 4:20
  focusing
• 4:22
  systematically
• 4:23
  and using both our local and
• 4:25
  system resources in dealing with these challenges of
• 4:29
  this aging population.
• 4:31
  That's helpful to understand and, you know, really
• 4:34
  critical, especially when you think about the aging
• 4:36
  population. I know there's a growing number of
• 4:38
  people that are are entering into that space
• 4:40
  and a huge demand for, those types of
• 4:43
  services. So,
• 4:44
  with that steady growth of age related neurological
• 4:47
  and cognitive conditions, where are some of the
• 4:49
  health systems like yours feeling the greatest pressures,
• 4:51
  and how is that changing care delivery models?
• 4:55
  It's a good question.
• 4:57
  Let me start with the, pressures. Three big
• 5:00
  forces really we see are converging. The first
• 5:02
  is, demographics. The population 65 and older is
• 5:06
  growing rapidly.
• 5:07
  More older adults means higher prevalence of dementia,
• 5:10
  Parkinson's disease,
• 5:12
  stroke
• 5:13
  survivors, living with cog cognitive deficits, and,
• 5:16
  multimorbidity.
• 5:18
  That increases volume
• 5:20
  across clinics, EDs, and, post acute services. So
• 5:24
  that really puts a strain.
• 5:26
  Second is the workforce and diagnostic bottlenecks.
• 5:30
  There simply aren't enough neurologists and geriatric specialists
• 5:34
  in many communities,
• 5:36
  really pretty much in most communities factually.
• 5:39
  And that creates long wait times and pushes
• 5:41
  a lot of responsibility back onto our primary
• 5:44
  care docs,
• 5:45
  which is the right clinical quarterback, but needs
• 5:48
  better tools and team support
• 5:51
  in order to do the right
• 5:53
  by the patient.
• 5:55
  Third, the social side, there's caregiver stress, fragmented
• 5:59
  transitions from hospital home and constraints and skilled
• 6:02
  nursing and home care capacity. And these upstream
• 6:05
  social gaps translate into preventable readmissions,
• 6:09
  crises, and poor quality of life, not just
• 6:12
  for the patient, but for the caregiver as
• 6:14
  well.
• 6:15
  So how are systems responding, you ask? Well,
• 6:19
  the pattern I'm seeing and what we're building
• 6:21
  at AdventHealth is a movement
• 6:23
  from episodic specialist,
• 6:25
  centric care
• 6:27
  to longitudinal
• 6:29
  team based and community anchored models.
• 6:32
  What does that mean, really? So
• 6:34
  number one, we're we're creating interdisciplinary
• 6:37
  memory clinics and 65 plus primary care pathways
• 6:41
  that embed social work, pharmacists, and care navigators.
• 6:45
  That's a one stop approach, reduces fragmentation,
• 6:49
  and speeds decision making for families. Really
• 6:52
  a great model. I've I've I've witnessed it
• 6:55
  myself. It's it's phenomenal.
• 6:57
  We're also scaling telehealth and home based care
• 7:00
  to reach patients who can't easily travel.
• 7:03
  Teleneurology
• 7:04
  visits, virtual caregiver coaching,
• 7:07
  and remote monitoring reduces unnecessary ED visits and
• 7:11
  keeps patients safer at home.
• 7:15
  And, in terms of that, we're also in
• 7:18
  trying to increase our,
• 7:20
  the number of neurologists. So for example, at
• 7:23
  our sister hospital in Tampa,
• 7:25
  we're starting a neurology residency hopefully by 2027
• 7:29
  because we recognize the need for further neurologists,
• 7:32
  in our community.
• 7:34
  We're investing, in data driven triage too. EHR
• 7:38
  flags,
• 7:39
  we use, EPIC, but, you know, a lot
• 7:42
  of the EHRs have these flags.
• 7:44
  Brief digital cognitive screens in primary care,
• 7:48
  and where helpful blood
• 7:49
  biomarkers or a functional texting, which we'll talk
• 7:52
  about in a little bit, I think, to
• 7:53
  prioritize
• 7:54
  who needs specialty input.
• 7:56
  And we're strengthening caregiver support because caregiver well-being,
• 8:00
  like I said before, is a clinical outcome
• 8:02
  in itself.
• 8:04
  So we do coaching, respite resources,
• 8:07
  and navigators
• 8:09
  to, lower the caregiver strain and reduce crises.
• 8:12
  The goal really isn't to replace specialists,
• 8:15
  but it's to use specialists more effectively by
• 8:18
  reserving their time for patients
• 8:21
  who truly need advanced diagnostics
• 8:23
  or interventions
• 8:25
  while ensuring everyone else is, receiving the right
• 8:28
  support and follow-up. And,
• 8:30
  you know, much like our behavioral health crisis
• 8:33
  in in the country, a lot of the
• 8:35
  burden has fallen on the primary care doctors
• 8:37
  as we all know. And
• 8:39
  and that's really
• 8:40
  becoming
• 8:41
  more true with our seniors and dementia
• 8:45
  and other,
• 8:46
  cognitive abnormalities.
• 8:49
  That makes a lot of sense and, you
• 8:50
  know, it's such a helpful overview in how
• 8:53
  everything, the landscape is changing and has been
• 8:55
  evolving. I think it's, fascinating to hear about
• 8:58
  all of those different factors that, you know,
• 9:00
  are are really,
• 9:02
  converging together in order to, bring about change
• 9:05
  in the care delivery models, not only, you
• 9:06
  know, just the population shifts in caregiver, but
• 9:09
  also thinking about the technology that's available and
• 9:12
  how you can use that. So I know
• 9:14
  that many organizations still rely heavily on cognitive
• 9:17
  testing and structural imaging.
• 9:19
  What are some of the limitations that are
• 9:21
  becoming more apparent there, and how does the
• 9:23
  functional brain assessment add value to some of
• 9:25
  the clinical decision making that you're doing as
• 9:27
  well?
• 9:28
  Yeah. Well, I think, all the tests are
• 9:31
  are are useful in some regard. You know,
• 9:33
  traditional tools,
• 9:35
  short cognitive screens and, structural MRIs, they're indispensable,
• 9:39
  but they have their limits. And
• 9:42
  cognitive schemes like, MMSE
• 9:44
  or MOCAs
• 9:46
  are practical.
• 9:47
  They're fast,
• 9:48
  but they're just snapshots.
• 9:50
  And they can be influenced by education,
• 9:52
  language, mood, or culture, and they often capture
• 9:55
  change only after the disease has progressed. And
• 9:58
  structural imaging, standard MRI or CT scan,
• 10:02
  is terrific,
• 10:03
  for ruling out tumors, large strokes, or hydrocephalus,
• 10:08
  or gross atrophy of the brain. But,
• 10:11
  yet in early neurodegenerative
• 10:14
  diseases, the MRI can look deceptively normal.
• 10:17
  So,
• 10:18
  by the time a problem shows on these
• 10:20
  measures,
• 10:21
  biological disease has often been present for years.
• 10:25
  So that's where functional and, molecular assessments add
• 10:28
  real clinical value. And there are three practical
• 10:31
  areas of advantage and things we can use
• 10:35
  today.
• 10:35
  So in, for earlier pathophysiologic
• 10:38
  insight, the PET imaging and,
• 10:41
  emerging plasma biomarkers can detect, Alzheimer related pathology
• 10:46
  before substantial cognitive decline,
• 10:50
  which is phenomenal
• 10:52
  because that's usually when we catch it, when
• 10:54
  you see the cognitive decline.
• 10:57
  But that means that you can identify biological
• 10:59
  targets
• 11:00
  when an intervention still has a chance to
• 11:02
  alter trajectory.
• 11:04
  And really for families, that timing is everything.
• 11:08
  Then there's a mechanistic clarity,
• 11:11
  functional tools like FDG PET scan or tau
• 11:14
  amyloid PET scans or advanced MRI analytics,
• 11:18
  and even EEG based network measures
• 11:21
  help distinguish
• 11:23
  ideologies
• 11:23
  like Alzheimer's versus vascular cognitive impairment versus frontal
• 11:28
  temporal syndromes
• 11:29
  where treatment and prognosis
• 11:31
  differ.
• 11:32
  That clarity avoids guesswork
• 11:34
  and speeds the right plan of care.
• 11:37
  And third, practical triage and monitoring. So blood
• 11:40
  based biomarkers are becoming a scalable screening,
• 11:43
  step.
• 11:44
  Quantitative EEG and advanced functional
• 11:47
  MRIs can support monitoring over time without repeated
• 11:51
  invasive tests.
• 11:52
  For health systems, those are tools to triage
• 11:55
  who needs expensive scans
• 11:57
  and who can be managed conservatively with risk
• 12:00
  reduction and supportive care.
• 12:02
  So clinically, adding functional assessment changes
• 12:06
  lets us, counsel families more accurately about prognosis
• 12:10
  and
• 12:11
  decides whether disease modifying therapies are appropriate.
• 12:14
  Or enroll patients
• 12:16
  in trials selectively.
• 12:18
  Or personalized non drug interventions,
• 12:21
  everything from targeted cognitive rehabilitation
• 12:25
  to fall prevention programs.
• 12:28
  That's fascinating to hear, and I think so
• 12:30
  helpful to understand some of the different technologies
• 12:34
  and,
• 12:35
  opportunities available for for testing because I think,
• 12:38
  you know, having the most sophisticated,
• 12:40
  you know, technologies and processes out there, really
• 12:43
  makes a big difference in the treatment and
• 12:45
  trying to get early and those kinds of
• 12:46
  things.
• 12:48
  How do you see the field evolving in
• 12:49
  the next year or two?
• 12:51
  Well, it's an exciting field, right now. I'm,
• 12:55
  I'm very optimistic. And as I said before,
• 12:57
  the earlier you can
• 12:59
  make a diagnosis with this,
• 13:01
  the better. So, I mean, as this biomarkers
• 13:04
  become
• 13:06
  cheaper to do and more accessible to that
• 13:09
  could be used as a primary,
• 13:11
  care.
• 13:13
  You know, that'll be so so biomarkers will
• 13:16
  move into routine workflows,
• 13:18
  Blood tests for amyloid and, phosphorylated
• 13:21
  tau
• 13:22
  are already increasingly reliable and much easier to
• 13:25
  deploy than the PET or the or CSF
• 13:27
  testing.
• 13:28
  And that really does mean primary care can
• 13:31
  play a larger screening role and refer the
• 13:33
  right patients faster.
• 13:35
  Second, the disease modifying therapies are changing expectations.
• 13:39
  With therapies that target underlying pathology now available,
• 13:43
  health systems, must create processes to confirm pathology
• 13:47
  and deliver therapy safely.
• 13:49
  Infusion pathways, monitoring protocols, and shared decision frameworks.
• 13:54
  And I know when we are building our
• 13:56
  new, medical office buildings across the state and
• 13:59
  across our multistate,
• 14:01
  we are building infusion centers into those,
• 14:05
  clinics or into those, office buildings
• 14:09
  with the I idea not just for cancer,
• 14:11
  but for infusion of, these kind of,
• 14:14
  therapies for,
• 14:16
  Alzheimer's, much bigger population.
• 14:19
  Thirdly,
• 14:20
  digital and AI tools will support early detection.
• 14:23
  Voice and speech analyses,
• 14:25
  passive monitoring, and machine learning models that integrate
• 14:29
  EHR data will help flag at risk patients
• 14:32
  who need evaluation.
• 14:34
  For example,
• 14:36
  Parkinson disease now can be diagnosed using AI
• 14:39
  and voice and speech analysis,
• 14:41
  which is fascinating.
• 14:44
  And that expands detection beyond the small subset
• 14:47
  that comes to special attention.
• 14:49
  Fourthly,
• 14:50
  care delivery will shift upstream to prevention and
• 14:53
  function. You know, life style interventions, vascular risk
• 14:56
  control, and cognitive training are being adopted in
• 15:00
  community programs,
• 15:01
  and they offer the potential to delay progression.
• 15:05
  We haven't really found a cure yet, but
• 15:07
  we have found things that can delay progression,
• 15:09
  which is
• 15:11
  the best we have so far.
• 15:13
  And health systems that integrate prevention with diagnostics
• 15:16
  and specialty care will have the highest impact
• 15:19
  really.
• 15:20
  And finally, equity will be the implementation
• 15:23
  challenge. You know? We must ensure the new
• 15:25
  tests and therapies don't become available only to
• 15:28
  patients who live near tertiary centers. That's why
• 15:32
  hub and spoke models,
• 15:33
  telehealth and targeted outreach
• 15:36
  are essential. And,
• 15:38
  at AdventHealth, we practice this a significant amount
• 15:40
  of hub and spoke,
• 15:42
  opportunities for patients so that they can take
• 15:44
  advantage of tertiary care
• 15:47
  even entering
• 15:48
  into one of our
• 15:50
  primary care offices.
• 15:53
  Got it. That makes a lot of sense,
• 15:54
  and it's really fascinating to think about how
• 15:56
  you're able to go upstream there more and
• 15:58
  really rework, the way you're connecting with the
• 16:01
  community and the programs that are available,
• 16:03
  so they're more convenient to the patients, especially
• 16:05
  with the technology we have evolved evolved to
• 16:08
  include digital and more.
• 16:10
  I I'm curious.
• 16:12
  Where do you see some of the biggest
• 16:13
  opportunities for AdventHealth to continue growing in the
• 16:16
  age related medicine field?
• 16:18
  Well, for AdventHealth, the opportunity is clear. You
• 16:21
  know? Scale integrated community anchored programs that connect
• 16:25
  primary care, memory clinics, home services, and specialty
• 16:28
  hubs.
• 16:29
  And at
• 16:31
  Carrollwood, specifically,
• 16:32
  our role is to be a local access
• 16:34
  point, a place where families get time
• 16:46
  you
• 16:49
  you know, the embedding of biomarker screenings and
• 16:51
  streamlined triage in primary care,
• 16:54
  expanding the home,
• 16:56
  and teleneurology
• 16:58
  so frail seniors aren't forced to travel, and
• 17:01
  investing in care navigators and care giver programs
• 17:04
  really at the local level because that's really
• 17:07
  where you're gonna touch the patients and their
• 17:09
  families.
• 17:10
  And then, of course, we're running, through our
• 17:13
  larger
• 17:14
  research arm, pragmatic trials and registries, so they
• 17:18
  have patients have access to these therapies even
• 17:21
  just coming to Carrollwood.
• 17:23
  And then for population health outreach, we use
• 17:26
  our EHR,
• 17:28
  data to target once it becomes more
• 17:31
  defined, you know, how we can do prevention
• 17:34
  and close gaps.
• 17:36
  So, really, these the all these moves really
• 17:39
  align with our mission
• 17:40
  at AdventHealth for better health outcomes, you know,
• 17:43
  supported caregivers
• 17:44
  and
• 17:45
  care that treats the whole person, which is
• 17:48
  what we believe in.
• 17:50
  I love that. Doctor Ross, thank you so
• 17:52
  much for joining us on the podcast today.
• 17:53
  This has been such a fascinating conversation, and
• 17:56
  I look forward to connecting with you again
• 17:57
  soon.
• 17:58
  I appreciate it, Laura. Thanks for having me
• 18:00
  on. I I'm, you know, it's a it's
• 18:02
  an interesting topic, a mix of science and
• 18:05
  social, I think, really. You know? We have
• 18:07
  to we're dealing with, Alzheimer's. I think most
• 18:11
  of us have all been touched by patients
• 18:14
  with Alzheimer's, whether they're relatives or close friends,
• 18:18
  and family.
• 18:19
  So we understand the import of really being
• 18:22
  able to diagnose early,
• 18:25
  start interventions,
• 18:27
  support the caregivers. It's all very critical, and,
• 18:30
  I appreciate the opportunity to talk about it.
• 18:32
  Thank you.