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Fund created to study, advance new proximal health concept

April 29, 2021

Lisa Hacker, speech language pathologist, uses play to test speech skills with a toddler as the girl's mother looks on.
Lisa Hacker, speech language pathologist, uses play to test speech skills with a toddler as the girl's mother looks on. (file photo)

By Amy Geiszler-Jones

For more than 20 years, Paul N. Uhlig, M.D., associate professor in the KU School of Medicine-Wichita Department of Pediatrics, and a small group of colleagues from across the U.S. have been working to understand the conditions that allow exceptional health care to flourish among patients and providers.Dr. Paul Uhlig profile photo

With a generous gift from Derry Larson, a Wichita accounting firm CEO, a fund with Dr. Uhlig as its namesake will begin studying and promoting the concept of proximal health. It's a concept that builds on Dr. Uhlig's longtime work on improving the quality of health care, combined with factors - known as determinants of health - that affect health and well-being, and the idea that health and health care aren't commodities to be delivered but resources that are co-created as people work and learn together.

Eventually the work done through the Paul N. Uhlig, MD, Proximal Health Innovation and Research Fund could lead to an institute that will further research and develop policies to promote proximal health models, say officials at KU School of Medicine-Wichita.

The Cerebral Palsy/Medically Complex Clinic, run by KU Wichita Pediatrics, was recently chosen as the first recipient of a grant from the fund to jointly plan, study and implement the proximal health ideas.

When it comes to social determinants of health, "we do a good job in recognizing them but we don't do an optimal job at looking at how they can be used to benefit patients, providers and care itself. This lens of proximal health definitely challenges us to do that more effectively," said Brian Pate, M.D., chair of the Department of Pediatrics at KU School of Medicine-Wichita.

What is proximal health?

Determinants of health can be classified as proximal or distal, with proximal determinants being factors that are closest to a person, such as being part of a community or having access to clean water and air. Distal determinants are those farther away from people yet still important, such as social policies.

The term proximal also means closer to the heart. Understanding and taking into consideration what has meaning for people, Dr. Uhlig contends, is important for patients and health care professionals alike. Plus, matters of the heart are important to Dr. Uhlig, who is a well-known adult cardiovascular surgeon.

As a fourth-generation Kansas physician, Dr. Uhlig also likes to ponder how medical education and the practice of medicine have changed since his great-grandfather was a rural doctor in Andale, Kansas. His grandfather was one of the first internists in Wichita, while his father was a pediatrician.

"The values they lived are the same ones that we need today. Those values have not changed and never will. Yet there are so many unsolved challenges in health care today - traditional approaches to care they lived and passed along to us, as much as we honor and revere them, are no longer working. We've outgrown them. What's driven me for the past 20 years or so, is "how can we do even better?", Dr. Uhlig said.

He believes answers can be found in new approaches that view health and care from the perspective of the environments that surround us.

Jan Arnold, physical therapist, examines a baby with the mother’s help"Proximal health honors the strengths and expertise of patients and families, their networks of connections and relationships with others. It seeks to build and strengthen care environments that honor and sustain the compassion that draws individuals into the medical field, environments that lift us all up and make us better. It is an approach that elevates everyone involved," Dr. Uhlig said. "Proximal health is a way of working together that honors the human spirit.

"It turns out that the same conditions that keep people healthy and thriving in ordinary life are exactly the same conditions that allow health care teams to achieve exceptional care outcomes. The list is short but powerful - being safe physically; feeling safe psychologically; knowing that you belong and are valued; feeling seen, felt, heard and appreciated for who you are and what you do; and being able to contribute in ways that make a difference," Dr. Uhlig said. "These fundamental human experiences relate directly to health and healing. Proximal health asks us to consider an idea that culture itself - the environments that surround us, thoughtfully structured and carefully nurtured - can be among our most important and effective instruments of care."

"Proximal health challenges us to go beyond a model that says, ‘you're a patient - my job is to diagnose you and offer treatment.' It asks us to stand beside the patient and look together at the social and relational environments that surround us, whether in health care or in the community. It invites us to work together to strengthen those environments as shared therapeutic interventions," Dr. Pate said.

A reputation for quality improvement

Dr. Uhlig has built a reputation for improving health care, and that's one of the reasons Dr. Pate, the pediatrics chair, finds him a valuable resource for not just the pediatrics department but also other areas of KU School of Medicine.

"Paul is an innovator and creative thinker and he's been working in the field of juxtaposition between the quality of health care and the relationships between providers, health care teams and patients. He's been working in a lot of areas that come together that make the focus of proximal health," Dr. Pate said.

In 2002, while on the faculty of Dartmouth Medical School, Dr. Uhlig and the cardiac surgery team he led at Concord Hospital in New Hampshire received the John M. Eisenberg Patient Safety Award from the National Quality Forum and the Joint Commission. To get better outcomes, he and the team changed how they interacted with patients, like making rounds together and asking patient's family members to join them as they visited a patient's bedside and using less medical jargon. It was the start of Dr. Uhlig's recognition that better outcomes can be achieved by deeper connections among patients and providers.

He's also received international recognition for research concerning patient safety, teamwork and health care culture, including a 2007-2008 King James IV Professorship of the Royal College of Surgeons of Edinburgh, Scotland.

Dr. Uhlig's reputation has impressed Larson, the founder of Larson & Co. PA in Wichita, who gave the gift to start the proximal health fund.

The pair first met when Larson helped Dr. Uhlig and others establish a nonprofit that became Project Access, which coordinates access to donated care by physicians for uninsured, low-income patients in Sedgwick County.

"He's a doctor who is ahead of his time on doing things for the medical community and health care," Larson said.

Above, right: Profile photo of Dr. Paul Uhlig

Above, left: Jan Arnold, physical therapist, examines a baby with the mother's help.

* Photos for this story were taken prior to the COVID-19 pandemic.

KU School of Medicine-Wichita
Last modified: May 03, 2021
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KU School of Medicine–Wichita
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1010 N. Kansas
Wichita, KS, 67214

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