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In Full Bloom: Mischer Neuroscience Institute Approaches Maturity

In Full BloomGrowth continues to be a focus for the Mischer Neuroscience Institute. Through a longstanding commitment to providing quality care to patients, the Institute has become the largest and most comprehensive neuroscience provider in the region. Targeted recruitment of expert faculty, dedication to quality initiatives, expansion of the Institute’s critical care services across the city and innovative research have made this growth possible. 

The Institute was established in 2006 with a gift from Houston businessman and philanthropist Walt Mischer and his family. The following year, neurosurgeon Dong Kim, M.D., was recruited from Harvard to lead the new Institute, which had a combined neurosurgery and neurology market share of 12 percent in the nation’s fourth largest city. Today, thanks to a visionary growth strategy supported by a solid clinical infrastructure, the Institute’s market share has more than doubled to 28 percent.

The growth in market share has come in part through the addition of new clinical and academic programs, the recruitment of more than 80 nationally recognized faculty, and the creation of Mischer Neuroscience Associates (MNA) as the Institute’s arm in the community. Today, Mischer Neuroscience Institute comprises a comprehensive team of neuroscience physicians, including neurosurgeons, neurologists, critical care physicians, neuro-oncologists, radiation oncologists and pain management physicians, with a large clinical practice stretching across the city.

As director of MNA’s West Market Division, which includes clinics in Memorial City, Katy and Cypress, neurosurgeon Paul Boone, M.D., oversees a collaborative, multidisciplinary team. “We’ve put together a collegial group of neuroscience providers that allows us to offer our patients great continuity of care at a level of quality previously available only in the Texas Medical Center,” he says. “In the process we reduced patient wait times for neurology – a longstanding problem. The lines of communication we’ve established between the two specialties allow neurologists to fast-track patients who need neurosurgical care. By working back and forth between neurology and neurosurgery, we’re providing comprehensive neuroscience care in a much more streamlined fashion.”

Community practices tend to be inundated with the work involved with scheduling patients, filing insurance forms, reviewing test results and following up, and important aspects of care like tracking quality, safety and performance improvement are not always top of mind. “Physicians in the community run busy practices and don’t always have time to focus on quality metrics as much as they would like,” Dr. Boone says. “We all believe we’re providing superior care, but if we rely on our own self-assessments, there may be surprises when we see the actual data collected by government agencies and others who make it available on the Internet.”

MNA set a goal of applying the same standards used at the Mischer Neuroscience Institute to their suburban neighborhood practices. “Today we’re tracking mortality, surgical site infections, length of stay, patient satisfaction and other data as a group, and using it to modify our clinical practice to ensure that we deliver best-practices care,” says neurosurgeon Geoffrey Zubay, M.D., FACS, who heads MNA’s North Market Division with practices in northeast Houston and The Woodlands. “We sit down in quarterly meetings to address any issues that need resolution. By proactively looking at our own data and continuously improving our practice, we stay ahead of the curve.”

Dr. Zubay is pleased to bring high-quality care to even more patients through the expansion of the North Market. At the end of 2015, MNA-The Woodlands broke ground on a neuroscience center that will put neurologists, neurosurgeons and supporting subspecialties under the same roof. The 25,000-square-foot facility is expected to open in 2017.

“We’re becoming the critical care institution for our community, caring for people with more acute neurological conditions,” Dr. Zubay says. “In response to population growth in The Woodlands, we expect to expand our services very quickly.”

MNA’s critical care plans for the future include the addition of neurocritical care specialists across the city. The team recently recruited three neurointensivists – Wamda O. Ahmed, M.D., Robert J. Brown, M.D., and Jeremy T. Ragland, M.D., who are rotating through the Neurointensive Care Units at Memorial Hermann Memorial City, Memorial Hermann Greater Heights Hospital and Memorial Hermann Southwest Hospital, as well as at the Mischer Neuroscience Institute.

“Our ultimate goal is to provide fulltime neurocritical care coverage at these locations by replicating what we’ve accomplished at the Mischer Neuroscience Institute,” says Kiwon Lee, M.D., FACP, FAHA, FCCM, director of neurocritical care at the Institute, vice chair for critical care in the Vivian L. Smith Department of Neurosurgery, vice chair for clinical affairs in the department of Neurology and an associate professor of neurology and neurosurgery at UTHealth Medical School. “Numerous studies have shown that patients have better outcomes when they receive care in a dedicated neurocritical care unit staffed by specially trained physicians and nurses. The system-wide expansion of neurological emergency and critical care services will facilitate triage and transfer to the appropriate hospital within the network, which will also lead to better outcomes.”

Focus on Discovery

With the citywide infrastructure in place, Dr. Dong Kim has turned more of his focus to the discovery of new knowledge that will change the face of patient care. “We’re thinking much bigger about our future than ever before, especially in terms of research,” says Amanda Spielman, senior vice president for neuroscience at Memorial Hermann Health System.

Clinical research is crucial to optimizing care and providing patients with state-of-the-art treatment options. Under Dr. Kim’s leadership, physicians affiliated with the Mischer Neuroscience Institute are melding research and clinical practice. Patients are evaluated, and those who meet qualifying criteria are invited to participate in innovative research studies. In addition, neuroscience patients are offered the opportunity to participate in research by consenting to allow their tissue samples to be banked in the Institute’s Neuroscience Research Repository (NRR) for current and future research.

“We’ve found it to be incredibly beneficial to have patients collaborate with us in our research endeavors through programs like the NRR, which improves the care of future patients as well as their own,” Dr. Kim says. “And we continue this collaboration through the Innovation and Quality (IQ) Program, where researchers are testing novel treatments in clinical trials and transitioning the results of that research to clinical practice. As the IQ Program expands, we will design even more trials to help neuroscience patients reach their desired functional potential.”

Through two new research centers created in 2015 – the Will Erwin Headache Research Center and the National Center for Testing Treatments in Chronic Spinal Cord Injury and Traumatic Brain Injury – leadership at the Institute has committed to investment in discovery in two areas that affect Americans profoundly. Recruiting physicians who spend 75 percent of their time focused on research is a new direction for the Mischer Neuroscience Institute.

“We are constantly asking questions and modifying our tools to create new research infrastructures,” Dr. Kim says. “We can now track a range of outcomes across various subsets of our patient population. We’re creating a rich data source that includes long-term outcomes and enables us to identify the best interventions for a particular condition. We can tie that data to decisions about future research, enabling us to positively impact patient outcomes throughout the timeline of patient care.”