fleischer institute for diabetes and metabolism

Baseline participant characteristics overall and by race-ethnicity. He is also a professor of medicine and of molecular pharmacology and the Judy R. and Alfred A. Rosenberg Professorial Chair in Diabetes Research at Einstein. 718-430-8557 (Fax), Montefiore Medical Center Moses Division Endocrinologist Noah Bloomgarden, M.D., tends to a patient at the new Fleischer Institute. In addition, DMEs/pharmacies trained our administrative staff on best practices to improve the likelihood of authorization. These practice transformations occurred from January 2019 to December 2021 and are detailed in chronological order below: In response to patient needs that aligned with leadership strategic plans, the diabetes center started a specialty clinic to focus on type 1 diabetes. The example set by his fatherKermit Bloomgarden, a noted Broadway produceralso inspired him. In total, 1,357 adults with type 1 diabetes were included. With sustained improvements in CGM prescribing as has been shown in our study, there is potential for clinical outcomes to improve over time with increased CGM use, reducing the risk of diabetes-related long-term complications in our underserved populations. Dr. Fleischers lifelong commitment to social justice and the Bronx population made an enormous impact on our community which has one of the highest rates of diabetes in the country, with one in three adults living with the disease. 04, and Joshua D. Nosanchuk, M.D. P values of <0.05 were considered statistically significant. Join us as we continue this important work. Recently diagnosed? A specialized program (link to SEAD program) provides dedicated care for young adults living with type 1 diabetes. Thus, this study was designed as the first critical step to ultimately improving equity in type 1 diabetes outcomes, by focusing on a root cause of inequity, namely, provider prescribing behaviors. Prescriptions then recovered to pre-pandemic rates and were again reduced to 12% at the onset of the second surge in SeptemberOctober 2020 (Fig. To improve equity in real-world diabetes care and extend diabetes technology to underserved adult populations with type 1 diabetes, our diabetes practice underwent several transformations to target health care system factors that may inadvertently enable inequitable CGM prescribing behaviors. Despite having limited resources and caring for a diverse population, the majority of whom are underserved with complex social and psychological needs, our practice transformations resulted in a fourfold increase in CGM prescription rates over 3 years. We sought to address the root causes of inequities beyond managing or adjusting care for social determinants and socioeconomic status, to focus on barriers at the health care system and provider levels that have historically gone unnoticed. Funding. By supporting the Fleischer Institute for Diabetes and Metabolism with philanthropy, you help address one of the most significant epidemics of the 21ST century, and continue Dr. Norman Fleischer's legacy of making a world of difference to a world in need. 1621 Eastchester Road Bronx, NY 10461 Phone: 718-405-8040 Fax: 718-405-8050 Directions from GoogleMap. Comprehensive Diabetes Care The Fleischer Institute clinical program (insert link to patient care) encompasses advanced diabetes care at several sites in the Bronx, including the flagship center at 1180 Morris Park Ave., and a newly opened site in Elmsford (link). The National Cancer Institute grant is for five years, Investigators have received millions of dollars to fund research in predementia and Alzheimers, breast cancer, chemotherapy, and more, Roger W. 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Our efforts at including multilevel stakeholder input provide an example of how to improve the likelihood of success and sustainability of health care delivery changes. Message From the Alumni Association President: Janina Galler, M.D. Similarly, there was a 13% improvement in pediatric insulin pump use among 12- to 26-year-olds after instituting provider pump education, integration of informed decision-making tools, and insurance approval workflows (20). Home - DRIF Furthermore, we recently conducted in-depth user-centered design workshops to elicit perspectives from a variety of diabetes health care providers who co-created interventions to increase technology use in underserved populations with type 1 diabetes (16). Norman was an inspirational figure, the grandfather of everything we do here in endocrinology. In addressing this critical issue, our adult diabetes practices, which service a large cohort of underserved adults with type 1 diabetes in New York, underwent several non-grant-funded clinic transformations over a period of 3 years to reshape the way we prescribe and offer diabetes technology. News & Announcements | Einstein-Mount Sinai Diabetes Research Center Norman Fleischer NYC Regional Diabetes Symposium & Rifkin LectureshipMay 3, 2019 From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations targeted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. The Fleischer Institute provides personalized and multidisciplinary care for weight management (link), which includes support for nutrition, exercise and positive lifestyle changes, medications and referral for bariatric surgery. Stephanie Leung - Director.. - Montefiore Health System | ZoomInfo He dedicated his life to building one of the first and largest diabetes centers in the country and a world-renowned Endocrine Division and training program. Continuous glucose monitoring today makes that effort even more achievable., Over the decades, Dr. Bloomgarden honed his clinical skills, learning how to keep diabetes complications to a minimum. Dr. Fleischers lifelong commitment to social justice and the Bronx population made an enormous impact on our community which has one of the highest rates of diabetes in the country, with one in three adults living with the disease. In total, we included 1,357 adults with type 1 diabetes in the analysis (mean SD age 38 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). Moreover, most studies evaluating or targeting CGM inequity are focused on pediatric care systems (19,20), which differ significantly from adult care systems where there are less resources, less specialized staff, less funding, and shorter visit times. We hypothesized that metabolic acidosis would be highly prevalent and associated with worse allograft function in pediatric KTRs.Pediatric KTRs at Montefiore Medical Center from 2010 to 2018 were included. Jennifer Gonzalez BSN, RN, CCRN - Staff Registered Nurse - LinkedIn Mechanistic/Mammalian target of rapamycin (mTOR) orchestrates cellular homeostasis by controlling cell growth, proliferation, metabolism, and survival by integrating various growth factors, nutrients and amino acids. In January 2019, before practice transformations were initiated, 100 type 1 diabetes visits were conducted per month by four diabetologist physicians, three nurse practitioners, and eight endocrine fellows (n = 15). 2022 Albert Einstein College of Medicine |, Fleischer Institute for Diabetes and Metabolism, Master of Science in Clinical Research Methods (M.S. Practice transformations and CGM prescriptions in adult type 1 diabetes cohort from January 2019 to December 2021 (n = 1, 357). He was active during the Hollywood blacklists, when so many people in entertainment lost their livelihoods, Dr. Bloomgarden says. Philanthropic support of the Fleischer Institute can help address one of the most significant health challenges of the 21st century and continue Dr. Norman Fleischers legacy of making a world of difference to a world in need. Thanks to Dr. Bloomgarden and other donors, the Fleischer Institute is increasingly able to meet the needs of people with diabetes. Norman Fleischer The newly established Fleischer Institute for Diabetes and Metabolism (Fleischer Institute) at Montefiore Einstein will serve as a major hub for discovery by conducting cutting edge basic, clinical, and translational research, and offering unique and innovative programs for the care of diabetes and metabolic disorders. We gave didactic lectures on the emerging literature from our group and others to highlight technology inequity and barriers to CGM use, underscoring the role of provider bias and practice system issues. SEAD offers a range of services to educate you on your condition and get you acclimated to managing your diabetes on your own. 2). To examine the effect of our practice transformations, we retrospectively reviewed monthly aggregate data from the electronic medical record (EMR) and measured CGM prescription rates from January 2019, when the transformations began, to December 2021. Our study demonstrates the potential of targeting health care structural barriers to change provider prescribing behaviors, which is one of the most proximal steps in CGM use. Metabolic Flexibility of Mitochondria Plays a Key Role in Balancing One way were honoring his legacy is to create a place where patients can get truly comprehensive care.. Comprehensive Family Care Center. Bronx, NY 10461. Named after Dr. Norman Fleischer in honor of his pioneering research and contributions to the field of diabetes, the Fleischer Institute builds on the strong foundation he established during his 46-year career at Einstein. One way were honoring his legacy is to create a place where patients can get truly comprehensive care, Dr. Crandall adds. CGM prescriptions included those for Dexcom G4/G5/G6, FreeStyle Libre 1/2, and Guardian. ). Fleischer Institute for Diabetes and Metabolism1180 Morris Park AvenueBronx, NY 10461Phone: 1-866-MED-TALK (633-8255)Fax: 718-239-6912, MosesCampus: Greene Medical Arts Pavilion3400 Bainbridge Avenue, Second FloorBronx, NY 10467Phone: 1-866-MED-TALK (866-633-8255), Moses Campus: Diabetes Education, Greene Medical Arts Pavilion 3400 Bainbridge Avenue, Second FloorBronx, NY 10467Phone: 718-920-7247, MosesCampus: Diabetes Teaching Clinic3444 Kossuth Avenue, Room 460Bronx, NY 10467Phone: 718-920-5101, Clinical Diabetes Center - New York City - Montefiore Medical Center, Montefiore Locations: Information and Directions, Obtain a Price Estimate for Your Services, Commitment to Quality Care and Patient Safety, Partnership with Albert Einstein College of Medicine, Allied & Other Health Professionals Training, Community and Population Health Dashboards, Supporting Emerging Adults with Diabetes (SEAD) Program, Diabetes, Hormones & Metabolism (Endocrinology), Notice of Privacy Practices Health Information, Privacy Policy Web and Mobile Applications, Nisha Suda, MD, Masters in Health Administration, Obtain a price estimate for your services. Our multidisciplinary team includes endocrinologists, diabetes educators, advanced practice clinicians (nurse practitioners and physician assistants), nutritionists and specialists in behavioral medicine. 1300 Morris Park Avenue New study says diabetes could be the defining disease of the century - MSN Mirroring the demographics of the Bronx, the racial-ethnic breakdown of MMC patients is 56% Hispanic, 30% Black, and 10% White, with the majority covered by public insurance (>75% Medicaid or dual-eligible Medicaid/Medicare) (21,22). Pediatric Fatty Liver Disease An Education in Aging Lab Chat with Johanna Daily, M.D., M.S. This integration of medicine and technology drives the vision behind the DRI strategy, a comprehensive, multidisciplinary approach to cure diabetes. None of the work described in the interventions was grant funded. Fleischer Institute for Diabetes and Metabolism 1180 Morris Park Avenue Bronx, NY 10461 Phone: 1-866-MED-TALK (633-8255) Fax: 718-239-6912. Participants were excluded if they had not been seen in the endocrine practice for >1 year, if they had ICD-10 codes associated with steroid-induced diabetes, maturity-onset diabetes of the young, or gestational diabetes mellitus, or if they had a ratio of type 1 diabetes to nontype 1 diabetes or type 2 diabetes ICD-10 codes of <50% in the EMR. In this issue of Diabetes, Wende et al. The Fleischer Institute for Diabetes and Metabolism at Montefiore Einstein serves as the home for cutting-edge research (basic, translational, clinical) and clinical care for patients with diabetes, obesity and related conditions. Named after Dr. Norman Fleischer in honor of his pioneering research and contributions to the field of diabetes, the Fleischer Institute builds on the strong foundation he established during his 46-year career at Einstein. For race-ethnicity groups, we collected data on patients of Hispanic, Black, and White race-ethnicity. His philanthropy inspired both my wife [Jane, a clinical psychologist in private practice and director of the child/adolescent/parent psychotherapy training program at the Westchester Center for the Study of Psychoanalysis and Psychotherapy and adjunct faculty member at the Ferkauf Graduate School of Psychology] and me to do charitable work. The Fleischer Institute clinical program (insert link to patient care) encompasses advanced diabetes care at several sites in the Bronx, including the flagship center at 1180 Morris Park Ave., and a newly opened site in Elmsford (link). Due to limitations of EMR data, we were unable to collect data on real-time CGM use; thus, our prescription rates may overestimate actual CGM use. Md Jessica Fleischer, MD, Endocrinology, Diabetes & Metabolism - WebMD Author Contributions. Importantly, these changes were not grant funded and, hence, were carried out through repurposing existing resources and leveraging outside support to enable and sustain these transformations over time. Currently, gaps remain in the field regarding whether modifying clinic structures and care processes will promote equity in CGM prescribing among providers. Moving from pediatric care to an adult diabetes provider? Previously, Stephanie was a Psychologist Care Manager at Wyckoff Heights Medical Center and also held positions at VA Connecticut . SEADs one-on-one counseling helps patients with diabetes meet their target blood- glucose levels and avoid serious complications and hospitalizations, according to SEAD director Shivani Agarwal, M.D., assistant professor of medicine at Einstein and director of the Young Adult Diabetes Clinic at Montefiore. The Fleischer Institute for Diabetes and Metabolism at Montefiore Einstein serves as the home for cutting-edge research (basic, translational, clinical) and clinical care for patients with diabetes, obesity and related conditions. Agarwal is the associate director of the Fleischer Institute of Diabetes and Metabolism at the Albert Einstein College of Medicine and Montefiore Medical Center. Building upon our Bronx roots our mission is to improve the health of the people and communities we serve. The strategy builds upon decades of cure . Fleischer Institute for Diabetes and Metabolism at Montefiore Health System based in Bronx, New York. 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It helped give patients more control over their disease, which we could reinforce with education and counseling. As a result of our interventions, CGM prescriptions for adults with type 1 diabetes increased dramatically and, more importantly, were equivalent across Hispanic and Black populations when compared with Whites. This article contains supplementary material online at https://doi.org/10.2337/figshare.20382990. Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053). pasquale.mone@unicampania.it. At this proximal stage in the CGM process, provider bias has been shown to affect whether patients are informed of technology options and are ultimately prescribed technology (8,9,16,30). Washington, DC Another limitation of our study is that certain practice transformations were not uniformly disseminated to all of our clinic sites, due to staff shortages and limited resources. "The idea is to create an overarching institute that will encompass existing efforts at Montefiore in the field of diabetes, and bring our many specialists together in one location," says Dr. Crandall. Our interventions were designed to address gaps in the field, specifically, whether clinical transformations targeting equity can result in similar gains in CGM access across racial-ethnic groups and whether preliminary successes in pediatric clinics can be achieved in adult clinics. They understand the power of multidisciplinary diabetes care. (Learn more about Yaron Tomer, M.D., professor and chair of medicine and the Anita and Jack Saltz Chair in Diabetes Research at Einstein and Montefiore, in Confronting the Covid 19 Crisis and Type 1: The Other Diabetes.), New diabetes institute builds on a legacy of research and interdisciplinary care. In the larger scheme, reducing disparities in technology-prescribing patterns could positively impact sustainable access to technology, diabetes self-management, and quality of life, and eventually improve long-term outcomes in underserved populations with type 1 diabetes. Our Transitions Clinic provides unique, tailored, compassionate care and services to young adults to support transition to adult care. Fleischer Institute for Diabetes and Metabolism (FIDAM) Message from the Former Dean Message from the Chair of Medicine The Issue at a Glance Highlights Enzymologist Extraordinaire: Vern Schramm, Ph.D. Q&A With the New Dean: Gordon Tomaselli, M.D. Diabetes Care 2022;45:22312237, https://doi.org/10.2337/figshare.20382990, https://www.health.ny.gov/statistics/community/minority/county/bronx.htm, https://www.census.gov/quickfacts/fact/table/bronxcountynewyork/PST045221, https://www.health.ny.gov/health_care/medicaid/redesign/2018/2018-cgm_diabetes_mgmt.htm, https://newyork.fhsc.com/downloads/providers/NYRx_PDSP_fact_sheet.pdf, https://www.health.ny.gov/health_care/medicaid/program/update/2001/nov2001.htm#::text=Insulin, https://www.diabetesjournals.org/journals/pages/license, Copyright American Diabetes Association. Results of linear regression revealed that the rate of continued CGM prescriptions significantly increased from 15 to 69% in the overall cohort from January 2019 to December 2021 (P < 0.001) (Fig. 1) and from 12% to 44% in Black, 15% to 48% in Hispanic, and 20% to 30% in White patients (Fig. The Institute is located on the Einstein Campus at 1180 Morris Park Avenue and led by Jill Crandall, MD, Chief, Endocrinology, and Director, Fleisher Institute. The Fleischer Institute for Diabetes and Metabolism will host leaders, scientists, physicians, nurses, and staff working together to respond to the diabetes and obesity epidemic through research, clinical programs, education, community outreach, and population health approaches. Above, David K. Bloomgarden, M.D., with his wife, Jane Bloomgarden, Ph.D., right, and Eva Fleischer, LCSW, who was at the institutes opening to honor her late husband; at top, healthcare staff at work at the new center. Beginning in the 1970s, Dr. Fleischer built a robust Endocrine division at Einstein, having trained nearly 85 fellows; the division currently has 30 full-time faculty, as well as many trainees. Priyanka Mathias, Lakshmi Priyanka Mahali, Shivani Agarwal; Targeting Technology in Underserved Adults With Type 1 Diabetes: Effect of Diabetes Practice Transformations on Improving Equity in CGM Prescribing Behaviors. Dr. Bloomgarden is quick to share credit for this accomplishment with his late father-in-law, Albert Willner, M.D., an orthopedist and philanthropist. Future studies will examine the impact of CGM prescriptions on actual use and the impact on longitudinal changes in HbA1C levels, hospitalizations, and psychosocial parameters. The Fleischer Institute for Diabetes & Metabolism Diabetes Care 1 October 2022; 45 (10): 22312237. We need to make sure that our research findings inform our clinical care, and vice versa, says Jeffrey Pessin, Ph.D. He taught me to be more socially conscious, and Ive put that energy into my philanthropic work for Montefiore and Einstein.. The majority of participants were publicly insured (74%, n = 1,004). Fathoming the Role of mTOR in Diabetes Mellitus and its - PubMed Endocrinology, Diabetes & Metabolism, Geriatric Medicine . Leroy B. Fleischer, MD | Main Line Health https://doi.org/10.2337/dc22-0555. The newly established Fleischer Institute for Diabetes and Metabolism (Fleischer Institute) at Montefiore Einstein will serve as a major hub for discovery by conducting cutting edge basic, clinical, and translational research, and offering unique and innovative programs for the care of diabetes and metabolic disorders. Interventions such as bias training and increasing provider awareness have not traditionally been effective at reducing inequity in prescriptions. While such clinical interventions are laudable, it is unclear whether all race-ethnicities benefitted equally from these initiatives, especially in the earlier studies, and whether these largely pediatric clinic interventions could apply to adult care paradigms. Functional role of gut microbiota and PCSK9 in the pathogenesis of Analyzing rates and interventions year by year, in 2019, when the specialty type 1 diabetes clinic, social needs coordinator, nurse training, and device trials began, there was a dramatic increase in continued CGM prescriptions, from 15% to 41% overall (Fig. Future initiatives will focus on modifying our data entry and collection methods to accurately capture patient use of CGM, to evaluate whether increased prescriptions translated to increased use. The Diabetes Research Institute houses teams of scientists, engineers, and clinicians with the expertise required to tackle diabetes from many angles. Designed to be the most comprehensive diabetes center in our service area, the new Fleischer Institute for Diabetes and Metabolism is now open. Likewise, new CGM prescriptions increased from 22% to 31%, overall (P = 0.01). Nevertheless, despite ease of use and established benefit of CGM, universal uptake remains limited. Close collaborationsbetween researchers in diabetes and obesity, between the lab and the clinic, and between generous partnershave been and will continue to be a priority. -sitosterol (SIT), the most abundant bioactive component of vegetable oil and other plants, is a highly potent antidiabetic drug. Join us as we continue the work of a brilliant clinician, researcher, leader, and above all, a kind, generous family member, friend, colleague, and mentor. Targeting upstream links in the chain of inequity should have great potential for reducing downstream health inequity across generations. ). To remain responsive to gaps identified, we specifically focused our interventions on improving equity for underserved populations, offloading burdens for health care providers, and implementing changes that are feasible and sustainable. The newly established Fleischer Institute for Diabetes and Metabolism (Fleischer Institute) at Montefiore Einstein will serve as a major hub for discovery by conducting cutting edge basic, clinical, and translational research, and offering unique and innovative programs for the care of diabetes and metabolic disorders. National expert in the development, payment and regulatory oversight of value-based care. Helping patients with diabetes live long and healthy lives is difficult, he says, but its doable with attentive care, collaboration, and attention to detail., As Dr. Bloomgardens practice grew, so did his frustration that many other diabetes patients were receiving less-than-optimal care. Theres more awareness than there used to be of the mental health problems associated with diabetes, but psychological support is rare, says Jeffrey Gonzalez, Ph.D., professor of medicine and of epidemiology & population health at Einstein. Epub 2021 May 20.PMID: 34031592. Improving CGM prescriptions is a critical first step in eventually promoting CGM use. The program teaches patients how to take ownership of their health, which is key to long . In addition, all interventions were developed with input from diabetes providers and, most importantly, based on feedback from our patient advisors, which likely enhanced sustainability and acceptability. Experience in driving Intelligent business decisions within context of operations and current and expected . S.A. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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