A joint effort by National Jewish Health and Icahn School of Medicine at Mount Sinai, The Respiratory Institute will provide comprehensive care to patients in New York City while furthering national respiratory research, beginning October 1st, 2014.

By Phyllis Hanlon

Image: Dennis S. Charney, MD, (left) President of Academic Affairs for the Mt. Sinai Health System and Michael Salem, MD, (right) President and CEO of National Jewish Health, sign an agreement creating The Respiratory Institute in December of 2013. The institute will open its doors October 1, 2014.

This fall, patients with a range of respiratory illnesses in the northeastern United States will have access to “local” comprehensive care when the Icahn School of Medicine at Mount Sinai, in collaboration with National Jewish Health (NJH), opens The Respiratory Institute in New York City.

The Mount Sinai Health System in New York, known for its outstanding research program, has the largest training program across the country with 2,000 residents/fellows, and is one of the largest nonprofit, multisite health systems in the nation. The 115-year old, nonprofit National Jewish Health, located in Denver, is the leading hospital globally for respiratory, cardiac, immune, and related diseases.

According to Charles A. Powell, MD, CEO of the Mount Sinai-National Jewish Health Respiratory Institute, chief of the division of pulmonary critical care and sleep medicine, and endowed professor at Mount Sinai, the partnership with NJH is a natural fit. “[National Jewish] has a well-deserved reputation for a patient-centered seamless program,” he said. “And Mount Sinai has strong medical school resources and experience in lung cancer, sarcoidosis, genomics, and personal medicine. The Institute will maximize the partnership.”

Providing Comprehensive Patient Care

Powell indicated that in April 2012 the two entities began conversations regarding a possible collaboration. “We both saw this as a unique opportunity to combine the strength of two institutions and deliver a structure and process of respiratory care services in the New York metropolitan area in a fashion that was likely to be more successful,” he said. “It will allow us to change the model of care from the typical private practice and deliver better outcomes.”

This collaboration will enable Mount Sinai to establish a productive relationship with a world-class leader in respiratory disease that the hospital did not previously have, according to Powell. “We will share clinical and research ideas with our colleagues from Denver. National Jewish Health has implemented some terrific patient-centered care practices, so we will have access to a wider range of research and training that will benefit our research facility, our school, trainees, and fellows. It will allow us to more expeditiously deliver a model of care,” he emphasized.

More important, Powell pointed out that this joint effort would result in better patient outcomes, since the Institute will capture key patient metrics. “Typically, an independent physician practice doesn’t have patient level data or process metrics. At the Institute, we have spent time on developing a large set of patient-centered outcomes for all patients with respiratory disease,” he noted. “We can track by location and provider as well as track hospital readmissions and mortality rates.” Additionally, the data will include information on length of stay and utilization of resources.

The Respiratory Institute will be located in a new outpatient space in a new building and will include a number of related specialties, such as programs for asthma, pulmonary disease, otolaryngology (ENT), allergy, gastroenterology, and pediatrics. The variety of specialties will deliver more efficient, comprehensive care. For instance, adults or children with a clear indication of asthma complicated by reflux, sinusitis, or allergies can schedule concurrent visits, thus optimizing their care.

The Institute will offer similar programs for chronic obstructive pulmonary disease (COPD) complicated by interstitial disease as well as other comorbidities, such as COPD and heart disease. A cardiologist will be part of the program, according to Powell. “We will be able to do full on-site pulmonary function testing and the results will be readily available for review. I’ve long aspired to do this, but it was not possible until we developed this new model in the new space,” he said, “This multidisciplinary practice will improve the quality of care, outcomes, and efficiency.”

Benefits for All

In an effort to develop a system that would deliver optimal care, personnel from Mount Sinai visited National Jewish Health in Colorado prior to the collaboration. After observing the programs and processes there, Mount Sinai revamped its current staffing configuration to create an exemplary continuum of care model. Once the Institute is fully operational, staff will comprise two schedulers, registered nurses, nurse practitioners, a practice manager, patient ambassador, and two medical assistants per room.

While both institutions envision several benefits from the collaboration, the biggest winners will be patients. The multidisciplinary approach will help solve “diagnostic mysteries for challenging cases,” according to Powell, while straightforward cases will continue to receive consistent, effective care.

Additionally, patients will have an enhanced clinical experience since the model aims to eliminate the typical frustrations encountered with any healthcare system. “We’re focused on addressing interaction that should be much more pleasant. Patients will feel comfortable through every phase. We will help them from diagnosis to hospital, to rehab and to home,” Powell said. Mount Sinai and National Jewish jointly developed care pathways for guiding diagnosis and treatment of all diseases.

Enhanced Research

Already steeped in intense research efforts, both institutions will ramp up clinical investigations as part of the Institute’s work: basic, translational, and clinical research will take place at both sites. Powell pointed out that the union of two well-regarded research facilities would generate studies that produce more effective treatment options and better patient outcomes.

To reach that goal, the Institute has been in the process of recruiting physician scientists and program leads and has already developed an innovative program in asthma, COPD, interstitial lung disease, and lung cancer research. Patients will play an integral role in the research, as they will have an opportunity to participate in a range of clinical and registry trials, according to Powell. He said, “Each program lead will spend time learning from each other as we share patients. We will also share clinical cases and conferences and research projects. Our mutual learning has extended beyond respiratory and now reaches into radiology.”

Fulfilling a Mission

Richard J. Martin, MD, professor and chair of the Department of Medicine at National Jewish Health, explained that the Respiratory Institute expects that blending the expertise of two renowned health systems will create inroads into personalized medicine, which he said is the direction medicine is going. He reported that physician scientists would explore several research areas, including the interaction between genetics and the environment.

“This is very important for disease progression,” he said. For example, asthma, while not a disease but a syndrome, does not always respond to standardized treatment. “You have to phenotype the individual to better direct treatment. Genes, no matter whether suppressed or expressed, interact with disease progression,” Martin explained. “Patients come from all over the world and have already had the usual workup. We have to think outside the box to figure out exactly what is happening to improve the disease process.”

In addition to new research areas, extensive funding, and multiple ongoing protocols, the Institute will have a “bio-bank” and invite patients to participate, according to Martin. “We will collect specimens from the patients and freeze them for later use. In 5 years, there may be new techniques and we can use the samples.”

When the Institute begins formal operations, Martin will be on-site for a month to help direct patient care and conduct research. “I’ll help develop the clinical aspect, but won’t see patients directly,” he said, explaining that if another practitioner assumed patient care in his absence, it would interrupt the continuity of care.

In a supervisory role, Martin will oversee research with basic, translational, and clinical science programs and grant submissions. He will also teach medical students, residents, and fellows. “At the Respiratory Institute, there will be pulmonary fellows who’ve met their residency requirements and want to specialize in respiratory or allergy medicine,” he reported. “Some fellows may elect to go to Denver, but there will still be interaction between the two institutions.”

National Jewish Health expects to fulfill its mission of improving health through the creation of the Respiratory Institute. “We will help deliver the best care to patients in the northeast corridor of the United States,” Martin reported. Not only do many New Yorkers utilize its respiratory care services, but others in the entire Northeast would also like to travel to Denver but can’t, due to severe disease or financial constraints. “A respiratory institute in New York City would help deliver healthcare to these individuals,” he said.

Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, president for academic affairs, Mount Sinai Health System, and professor, Departments of Psychiatry, Neuroscience, and Pharmacology & Systems Therapeutics, cited a “synergism” between these two top-notch health institutions. “NJH is focused on respiratory disease and is one of the best in the world. A lot of their patients travel to Denver and they wanted to have a site in New York to provide local care,” he said. “And Mount Sinai is a world class medical center with a strong research program. We wanted to build something special in New York City. Having a model of care available to patients in the local New York area was a strong motivating factor.”

Charney added that Mount Sinai already has a very strong base of patients with pulmonary disease, which illustrates the need for a specialized program focused on respiratory issues. “Mount Sinai has more than 40% of all discharges in Manhattan,” he noted. Mount Sinai currently operates the World Trade Center Health Program, which provides all respiratory care for workers, volunteers, and responders to the terror attacks of 9/11.

“Our job as one of the top medical schools is to be at the cutting edge of treatment. By combining with NJH, we can achieve the goal of effectively treating respiratory disease. It’s a win-win situation,” said Charney.

The Respiratory Institute plans to open its doors to patients on October 1, 2014.


Phyllis Hanlon is a contributing writer to RT. For more information contact [email protected].