Latest / Becker’s Healthcare 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 Podcast

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