Frequent visitors to Duke University Hospital, as well as patients who make extended stays, often deal with a variety of complex health care problems, including end-of-life issues, chronic pain, lacking the ability to pay, and homelessness. In this week’s Faculty Spotlight Joanna Kipnes, MD, talks about creating tailored health care plans for these patients--and why these patients choose to come to Duke.
How long have you been at Duke? How long have you been at the division?
I started Duke and the division at the end of 2009, so I’m about to celebrate my five year anniversary here.
What are your responsibilities within the division? What does a typical day look like for you?
Really there is no typical day for me. I spend 50 percent of my time as a clinician and 50 percent on other projects.
My clinical days are pretty typical. I spend much of my clinical time working on the teaching service, taking care of admitted general medical patients with residents, interns, and medical students. I also spend some of my clinical time on a hospitalist-only service, where I take care of patients independently.
My non-clinical days are spent on a variety of projects, but there are two main ones that I’m working on. The first is that I’m in charge of the inpatient familiar faces program which was started at Duke University Hospital by Dr. Noppon Setji, MD, and is now expanding to include Duke Regional Hospital and Duke Raleigh Hospital. For this program we work on individualized complex care plans for high utilizers of the inpatient health system.
This is a complex group of patients who cope with many different issues. Some have end-stage diseases, many of them have issues with chronic pain, or mental health issues. Many of them are also living with difficult social and financial situations outside of the hospital.
A multidisciplinary team comes together to work on individualized care plans for patients. These plans are meant to coordinate complex care, make their inpatient care more consistent from the time of admission until discharge, and help to organize better, more coordinated outpatient services to reduce the need for inpatient hospitalization.
What’s the second project that you’re working on?
My second major non-clinical project is outlier management. I work with people from hospital administration, nursing leaders, and other physicians to review patients who have been admitted to the general medical services for more than seven days. We try to understand the reasons that patients are spending a long time in hospital, and if there are barriers to being discharged we try to help patients overcome those barriers.
What sort of barriers to discharge do you see most often?
There are a lot of barriers such as a significant medical illness, lack of funding, mental illness, homelessness, poor social support, geographical distance from Duke, drug abuse, and more...the list goes on. We also see a large number of patients who are immigrants with undocumented status.
Many patients come here for state-of-the-art care and because they know Duke cares about them. We try to help them move smoothly out of the inpatient environment. I work with a multidisciplinary group of case managers, nursing leadership, and senior physician leadership to try to help these patients successfully transition to the outpatient realm.
What do you like to do when you’re not at the division?
I like to hang out with my husband and three children--two seven year-old girls and a two-and-a-half-year-old son. I also enjoy running, watching movies, and routing for the Philadelphia Eagles.