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Remarkable Collaboration: Johns Hopkins Medicine and the AHN Women’s Institute

In January 2020, Allegheny Health Network announced an expanded collaboration with Johns Hopkins Medicine, with a specialized focus on maternal-fetal medicine and gynecologic care, in addition to COPD and lung transplantation. The announcement created one of the largest coordinated collaborative women’s gynecologic and obstetrical health programs in the U.S. For AHN patients, it meant streamlined access to hundreds of additional clinical trials, as well as second opinions and specialized treatments for rare and complex conditions.

Against the backdrop of an ongoing pandemic, significant strides have been made in innovation, clinical collaboration and research for the AHN Women’s Institute, and leading clinicians and researchers from the two organizations have come together on a consistent basis to secure NIH funding, propose clinical trials and treat highly complex cases.

I spoke with Marcia Klein-Patel, MD, PhD, and chair of AHN Women’s Institute, to get her thoughts on the first year of this remarkable collaboration, and the opportunities to continue advancing research and patient care.

Coordinated care for the most complex cases

Dr. Marcia Klein-Patel, chair of the AHN Women’s Institute

Dr. Marcia Klein-Patel, chair of the AHN Women’s Institute

Nikki Buccina: From an AHN patient perspective, what has the collaboration with Johns Hopkins Medicine added or improved?

Dr. Marcia Klein-Patel: What’s important to emphasize when we discuss the patient benefit is that the average patient, on a day-to-day basis, will likely not have to leverage this partnership for care. However, for those who are going through the most complex OB/GYN conditions, we now have a coordinated care model with one of the most progressive and established women’s and fetal therapy programs in the country. So one benefit is reassurance that, with this relationship, there isn’t anything you could need that we don’t have access to.

Nikki Buccina: Can you expand on the fetal therapy program specifically?

Dr. Marcia Klein-Patel: The Johns Hopkins Center for Fetal Therapy is a national leader in the field, treating a large number of rare, complex cases from across the country. They have an expert team of fetal surgeons who specialize in the diagnosis and treatment of a range of fetal conditions — including congenital diaphragmatic hernia, spina bifida and complicated twin pregnancies — using the most advanced fetal intervention procedures.

Nikki Buccina: If you need those services, what would the patient experience be like?

Dr. Marcia Klein-Patel: We’ve designed the patient experience to be as seamless and eased as possible. In these scenarios, we recognize that it can be very stressful for patients, their families and loved ones, so we try to do as much as we can on the back end to alleviate some of that.

With something like the complex maternal-fetal medicine cases, the Johns Hopkins Center for Fetal Therapy is in Baltimore, so there is travel involved, but the care is completely integrated. The relationship is managed by a dedicated AHN nurse navigator in conjunction with the woman’s primary maternal-fetal physician or perinatologist. We truly operate as one team, as we would with any AHN patient, but now we add an even wider and deeper breadth of experience through our colleagues at Johns Hopkins.

When a patient arrives at the Johns Hopkins facility, the maternal-fetal medicine care team there will be fully updated on the case and ready to perform the necessary procedure. The trips are typically short — a few days at most — and then the care picks right back up at the patient’s respective AHN facility. So, even though there’s travel, the care feels the same, the clinicians are talking with each other all the time, and you have an integrated team and experience that, frankly, most patients just don’t have access to.

Embracing clinical collaboration

Nikki Buccina: What about from the clinician point of view? How has the relationship progressed in its first year?

Dr. Marcia Klein-Patel: I think from a clinician’s perspective, we’ve seen an amazing level of collaboration on joint tumor boards, research initiatives, virtual conferences and grand rounds.

Take our tumor board clinical meetings. A tumor board is an opportunity for a physician to present unique patient cases that don’t perfectly align with standard treatment protocols. The presentation now takes place with our fellow Johns Hopkins physicians, and the audience spans gynecology, oncology, radiation oncology, pathology, medical oncology, and radiology.

Following the presentation of the patient’s case, an in-depth discussion takes place that references other cases that may have common elements. A huge advantage of this partnership is that the patient volume and case load has essentially doubled from a reference perspective — there are more opportunities to draw from what’s been done in the past and ultimately design the best course of treatment as jointly prescribed by AHN and Johns Hopkins providers.

Nikki Buccina: Let’s transition to research, as this partnership has formed one of the country’s largest clinical research collaborations. How has that been going?

Dr. Marcia Klein-Patel: One of the first tasks we accomplished after forming the partnership was to establish and gain approval of highly competitive and, frankly, tremendously excellent, research projects across areas including OB/GYN, maternal-fetal medicine, oncology, urogynecology and patient safety.

Each research project has principal investigators at both sites. It’s a true peer-to-peer collaboration, and Johns Hopkins has been really gracious in recognizing our excellence. Sometimes in a collaboration with the “big houses,” it’s more about them initiating every idea and then saying, “hey, do you want to be on our study?” With this collaboration, I’m proud that we’ve initiated projects. Johns Hopkins has been very generous — their approach is that a good idea is a good idea and it’s not less of a good idea just because it didn’t originate at one of the nation’s big research institutions.

Nikki Buccina: Can you talk more about one or two of those “good ideas”?

Dr. Marcia Klein-Patel: One of the research projects is focused on how we can best treat women with endometrial cancer who have not yet completed childbearing. Normally the treatment would be to remove the uterus. But if you have not yet completed childbearing, the question becomes: What can we do to promote your ability to have children and keep you safe? In this specific research project, we’re focusing on answering that question with comprehensive lifestyle changes.

Another one that would be novel in the maternal-fetal medicine field looks at improving placental function through aspirin therapy. This is a way to potentially treat intrauterine growth restriction, a condition where the baby is smaller than it should be during development in the womb.

Nikki Buccina: What developments or milestones do you see for this collaboration in the near future?

Dr. Marcia Klein-Patel: In the future, an important milestone will be to consistently and jointly submit NIH proposals, receive approvals, and earn national recognition for that work as a collaborative effort between our teams.

Look, all of this outstanding work from the first year has taken place with the backdrop of the coronavirus pandemic. It’s interesting to think about how quickly we were able to pivot to continue to grow our relationship a little differently than what we originally planned.

However, it would be remiss to not point out an area where COVID may have hurt us. There’s a lot of relationship building and ideation that occurs best when you’re having the after-hours conversation — the meeting “after the meeting.” Some of the best ideas come from going to the same conference, sitting next to someone, and then picking up the conversation later to ask “what if?” So, there’s nothing specific I can point to that we’ve lost out on because of COVID, but I do think even more innovation will come more quickly when we can have those casual conversations again and build those personal relationships.

Part of what I’m excited about with this collaboration is that it’s so complementary. At AHN, we have a lot of focus on pathway development and clinical care paths. When you combine the research expertise of Johns Hopkins with our expertise in care pathways, each area helps to inform and advance the other and you really create something tremendous.

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