Personalized Health Care: The Foundation of Rational Health Reform

1. �2009 RALPH SNYDERMAN 1 Personalized Health Care: The Foundation of Rational Health Reform Ralph Snyderman, MD Chancellor Emeritus, Duke University Chairman, Proventys, Inc. National Summit on Personalized Health Care Deer Valley, Utah October 4 � 6 , 2009

2. �2009 RALPH SNYDERMAN 2 Contemporary Practice of Medicine Disease-oriented Find it, fix it Reactive Sporadic Physician-directed Very expensive

3. �2009 RALPH SNYDERMAN 3 Science and Medicine

4. �2009 RALPH SNYDERMAN 4 Concepts of Disease

6. �2009 RALPH SNYDERMAN 6 Paradigm Shift to Personalization

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8. �2009 RALPH SNYDERMAN 8 Health risk analysis Pathogenesis tracking Molecular diagnosis Clinical event prediction Therapeutic potential analysis

9. �2009 RALPH SNYDERMAN 9 Predictive Model Development

10. �2009 RALPH SNYDERMAN 10 Fragmented Health Care

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12. �2009 RALPH SNYDERMAN 12 Personal Health Plan Coordinates Care

13. �2009 RALPH SNYDERMAN 13 Clinical Decision Support at the Point of Care

14. �2009 RALPH SNYDERMAN 14 Example: A point-of-care predictive test for prevention of febrile neutropenia (FN) Studies by Caggiano et al. (Cancer 2005) and Weiss et al. (Proc Am Soc Clin Oncol 2003) have estimated the national incidence of hospitalizations for FN at ~60,000 which gives an incidence of disease of ~0.78%. In the sentinel work by Boggs et al. (Cancer 1960), 44% of cancer patients with fever were found to have an infection. In a review of 7 hospital discharge databases with ~12M patients (all types of tumors), Caggiano et al. (Cancer 2005) found that the overall mortality rate in hospitalized neutropenic patients was 6.8%. Also found that the LOS was 10.1 +/- 11.2 days Mean cost for hospitalization from FN was $14,900 +/- $23,600Studies by Caggiano et al. (Cancer 2005) and Weiss et al. (Proc Am Soc Clin Oncol 2003) have estimated the national incidence of hospitalizations for FN at ~60,000 which gives an incidence of disease of ~0.78%. In the sentinel work by Boggs et al. (Cancer 1960), 44% of cancer patients with fever were found to have an infection. In a review of 7 hospital discharge databases with ~12M patients (all types of tumors), Caggiano et al. (Cancer 2005) found that the overall mortality rate in hospitalized neutropenic patients was 6.8%. Also found that the LOS was 10.1 +/- 11.2 days Mean cost for hospitalization from FN was $14,900 +/- $23,600

15. �2009 RALPH SNYDERMAN 15 Universal access Health education and personal empowerment Personalized prevention and strategic health planning Biomedical research and regulatory reform Delivery systems integration Reimbursement reform

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