What do patients really need?

As family physicians in East Brady, the 20-something, New York–born Blocks learned what their rural patients needed… by listening to their patients. “We were trained to be doctors by people in the community,” Bruce Block says. When Marian Block was named Pennsylvania Family Physician of the Year in 2001, she thanked the people of East Brady. “They taught me how to be a family doctor. They showed me the way.” 

“Living among our patients, we saw them outside the office, not in their paper gowns but in their lives,” Bruce remembers. “You would see that grandmother limping up the street with her grandchild in tow. And all of a sudden you cared a lot more about her knee pain.

“We realized that health happens in between doctors’ visits. That became our mantra.”   

Led by the needs of their rural patients, the Blocks got federal grants to create a five-practice rural health system, owned and directed by a regional community board, and to build the area’s first housing for the elderly. They and their colleagues trained nurse practitioners to support the local school system, the new medical practices, and senior citizens.

But the Blocks wanted not only to care for patients but also to teach family medicine — then a new specialty combining the biological, clinical, and behavioral sciences for people of every age. So the couple’s lives took a new turn when they moved to Pittsburgh in 1981. Marian became the first family physician to be employed full time by the University of Pittsburgh as chief of the Division of Family Medicine. She and her colleague Jack Coulehan authored The Medical Interview, teaching physicians how to listen to their patients. It is now in its fifth edition. She also became the first full-time chair of the Department of Family Medicine at West Penn Hospital and its first medical director for quality.  

Meanwhile, Bruce Block began his history-making association with Shadyside Hospital as medical director of the Family Health Center and faculty of the Family Medicine Residency. 

“I was able to make some significant changes in the patterns of care,” he says in a masterpiece of understatement. 

The doctor and his Commodore

First, working with staff to clarify roles and responsibilities, they tripled the number of patient visits to the Family Health Center. Next, to find out what these thousands of people needed to improve their health, Dr. Block used his Commodore personal computer in 1984 to design one of the first electronic patient record systems — and to make the Family Health Center the first site in America to use this system for primary care.

Why?

“Outstanding health care depends on physicians having complete and up-to-date information about each patient,” Dr. Block says. “It’s like listening carefully to your patients. The more information you have, the better care you can offer. And that data over the years enabled us to begin to see where there were problems in patterns of care and to develop solutions in a scientific way.”

Just one example of this improvement? A better
way to care for patients who had abnormal Pap tests,
a screening for cervical cancer. To get the information he needed, Dr. Block combed through the pathology department’s handwritten records, entered them in his computer — and discovered that only 44 percent of Family Health Center patients had any documented follow-up after their abnormal tests. With these data, the center’s staff was able to create new tracking and follow-up systems not only for Pap tests but also for overdue immunizations and other important screenings.

“After about 18 months, we were able to repeat the Pap study and show that we had doubled the follow-up,” Dr. Block remembers. “We did a similar study about what happens to kids who have abnormal lead levels.

“So, by having these data, we were able not only to generate nice ideas, which everybody has, but actually figure out how to make change happen.” 

The computer system that Dr. Block introduced remained in use at the Family Health Center for 18 years, until UPMC’s first electronic health record launched in 2003 — with the support of Dr. Block’s experience. He was honored in 2005 with Pennsylvania’s Quality Innovator Award.

“A great ripple effect” 

Acting on his mantra that “health happens between doctor visits,” Dr. Block partnered with the Centers for Healthy Hearts and Souls to take diabetes care and education, smoking cessation, nutrition, and exercise programs into Black churches. These programs enabled him to give people timely feedback about their own health behaviors, drive self-care changes, and track results. At the end of the first year of the community-based diabetes support groups, 85 percent of the participants were doing some kind of regular exercise and showed significant improvements in their health. 

The Blocks again partnered in the 1990s, when Marian was one of three principal investigators in a landmark study of depression. Discovering that depression is as common in family practice as high blood pressure, the Family Health Center instituted universal depression screening and follow-up. “The potential for effective mental health care remains great,” he believes. (Please see story on substance use disorders on page 38.)

Residents at the Family Health Center started Pittsburgh’s first AIDS support group. The center also provided transportation vouchers for pregnant individuals and parents of children needing immunizations, blood pressure cuffs for people living with high blood pressure, and reminder systems for people with lapsed care.

When Dr. Block realized that many family medicine residents had little or no understanding of their patients’ day-to-day lives and challenges, he built a clinical rotation where every resident would visit five agencies in the community and learn about truly
comprehensive care. Faculty at the Residency built on this idea, adding a Global Health Rotation where residents now travel to Honduras to care for people
in a remote mountain village clinic. 

“The residents were incredibly enthusiastic,” he says. “Many of them said, ‘This is why I went into family medicine, but I hadn’t seen any of this until I went out into the community.’” 

Shadyside graduates often stayed in the local community. They went to work with David Hall at the East Liberty Family Health Care Center or with Dan Lapp at his East End Community Health Center. Or they set up their own practices, like Yvette Broadnax, who practices in Penn Hills and is now president of the medical staff. 

Many others went to work in underserved areas throughout the U.S. Among them is the recently elected governor of Hawaii, Dr. Josh Green. After completing his residency here, he joined the National Health Service Corps in 2000, aiming to improve health care resources in Hawaii’s rural areas. He has said that this experience inspired him to begin his political career and to bring a voice to underserved communities while continuing to practice as a family physician.

“There was a great ripple effect, which was very rewarding,” Dr. Block says about these former residents.

Widening the audience

Dr. Block’s passion for putting assessment data into the hands of providers and patients continued to inform his goals when he became chief medical informatics and learning officer at the Jewish Healthcare Foundation’s Pittsburgh Regional Health Initiative (PRHI). In that role, he spread and taught the use of electronic health records statewide. (For more on this work, please visit “Honoring Dr. Bruce Block” at www.jhf.org.)

Retiring from the Jewish Healthcare Foundation in 2021, he continues to share a lifetime of innovation in health care quality improvement with students at CMU’s Heinz College Master of Medical Management program. 

“It’s been very satisfying to be able to take these experiences and to be a mentor for people from all over the country,” he comments. 

The Shadyside Hospital Foundation as a partner

“I want to emphasize our longtime partnership with the Shadyside Hospital Foundation,” states Dr. Block. “We would get the data, identify serious problems with care, and the Shadyside Hospital Foundation helped us get funding. There are ripples and waves of the Foundation’s investment in the work we’ve all done. And that’s what motivated Marian and me to create this fund at the Foundation to support ongoing innovation in family medicine. Our hope is that many more people will help it grow with their own gifts. This is the kind of medicine people need.” 

You are invited to help take innovation in family medicine to new generations at the Shadyside Family Health Center with your gift to the Shadyside Hospital Foundation. Visit shadysidehospitalfoundation.org to donate online or contact Louise Brown, executive director, at brownlr@upmc.com or 412-623-6600.