Robert C. Hendel, MD: Tulane in Public Health

Understanding the absolute value of healthcare practices—from in-patient tests to diet education—is a critical point of Tulane University’s message to patients. It’s also much-highlighted facet of their work in their community and beyond.

In an interview with MD Magazine®, Robert C. Hendel, MD, chair of Cardiovascular Medicine at Tulane, explained the critical public health education offered by the institution to its local New Orleans patients, as well as the global spread of their ‘appropriate use’ criteria education.

MD Mag: What sort of public health outreach efforts are Tulane involved with?

Hendel: Tulane is very focused in on education to the population of New Orleans. We need to get the word out about healthcare and how to obtain it, and also some basic rules and basic ideas.

Nutrition is really a problem here. The food of New Orleans is fabulous, but unfortunately it is not heart-healthy. it contains a lot of fat and also a lot of sodium, and both of these are sort of the enemies of cardiovascular disease. So we want to promote care, we want to promote education, and we want to provide services.

And one of the things that we've seen, especially with heart failure—and again this is nothing new—but unless a patient after hospital discharge is seen by a provider shortly afterwards, then perhaps compliance with either diet or medications is lacking. And that results in readmissions and further concerns—and actual harm to the patient, because they're just simply not being cared for in the proper way.

What is the scale of the concept of ‘appropriate use’ in healthcare?

So the concept of appropriate use and the development appropriate use criteria has been a national initiative. This is something that we're really not only actually taking nationally, but actually we've had opportunities to help create appropriate use criteria in other countries.

I was recently in Malaysia, where they've created their own set of appropriate use criteria, because they like us have restrictive resources and can't offer this. And I also want to highlight it's not just about resource utilization and money. It's also about exposing patients to unnecessary procedures or test, and therefore exposing them to harm without real benefit.

And I think when we do those sort of teeter-totter evaluation of risks and benefits, that's what the appropriate use criteria are trying to guide us towards—which is there has to be overwhelming benefits in order to do a test or a procedure as related to the risk.

So even something as relatively benign as doing a stress test, there are risks involved. And if you're not going to use the information to help guide care, why are we doing it?