Networking Venture Benefits Both

WASHINGTON--Community hospitals gain immensely in enhanced patientcare when they form partnerships with universities, Allen S. Lichter,MD, said at the annual national meeting of the Association ofCommunity Cancer Centers (ACCC). The benefits of such a jointventure, however, flow both ways, said Dr. Lichter, chairman ofthe Department of Radiation Oncology, University of Michigan.

Currently, his department provides radiation oncology servicesfor the Veterans Administration hospital in Ann Arbor, ProvidenceHospital in Southfield, and Foote Hospital in Jackson.

The University of Michigan has recently agreed also to a jointventure in radiation oncology at Michigan Capital Medical Centerin Lansing, which includes the participation of Michigan StateUniversity, and another at Botsford Hospital in Farmington Hills.

"All of our sites have multicollimated machines and performconformal radiation therapy," Dr. Lichter said. "Theycan do everything we can, except stereo-tactic radiotherapy."

The hospitals are all within about an hour's drive of Ann Arbor,and Dr. Lichter regards such proximity as vital to supplying thefacilities with state-of-the art radiotherapy services. This includesthe services of on-site radiation oncolo-gists, who remain anintegral part of his department.

"All of the physicians are full-time faculty at the university,"Dr. Lichter said. "They rotate back to the university atleast one day a week so that they can stay involved in our program.We try to make sure that we are practicing the same type of radiationoncology at all sites."

In addition, the physicians get together for journal clubs, guestspeakers, and educational sessions." We do weekly chart roundsat each of our satellites. All of this helps produce an extraordinaryuniformity in patient care," Dr. Lichter said.

The physicists and dosimetrists at the allied hospitals are alsoemployees of the University of Michigan. "A small practicewith a single dosimetrist has a problem when that dosimetristgets sick, goes on vacation, or resigns." Dr. Lichter commented."We have 10 or more dosime-trists who can move around asneeded. This is true for physics support, and also for big projects,such as calibrating the machines."

As residents rotate through Michigan's allied hospitals, theyobtain something many of their counterparts elsewhere do not--experiencein a community-based practice--and that makes them more savvyin making the choice between an academic or community career,Dr. Lichter said.

Unified Database Benefits Research

The Michigan department heavily taps the patient population atits satellite centers for its research projects. "This university-communityinteraction helps our research," Dr. Lichter said. "Wehave a unified patient database, so instead of a 1,000-patient-a-yearpractice, we are a 2,500-patient-a-year practice."

When a Michigan team did a dose-escalation trial in lung cancer,"about two thirds of the cases in the study came from oursatellites," he said.

His program plans several efforts that should cut costs withinthe various university-community hospitals, including packagingsome equipment aboard trucks and driving it from site to site,and forming a consortium to maintain accelerators and other equipment.

The radiation oncology department will soon take some treatmentplanning on-line. "The cases will all be in cyber-space,"Dr. Lichter explained. "There will be no need for a dosimetristto be at a facility to plan a case."

3D Treatment Planning

Once this approach proves itself within the Michigan alliances,he expects to offer a service through which his department willdo computerized 3D treatment planning for other radiation oncologists.

Dr. Lichter said that his department's ventures have led to otheragreements for the University of Michigan. These include jointventures in emergency medicine and cardiology at Foote Hospitalin Jackson and in medical oncology at Providence Hospital in Southfield.

"I'm enthusiastic about university-community interactions,"he said. "I think they are the way to go; they help bothsides of the equation."