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IMAG INEInnovations in Care

It’s not uncommon when meeting a new person, to ask what they do, what’s their occupation. The answers are often very interesting, but even more interesting might be to ask “why.” Why do we do what we do? What is our purpose? What drives us?

At Dartmouth-Hitchcock, our “why” is clear. We are here to improve the lives of the people and communities we serve, for generations to come. Delivering health and health care, educating future physicians and performing research is what we do. But it’s the why that is most important. Our physicians and staff are passionate about serving our patients and families, and it shows in the work we do every day.

In the following pages, you’ll get a glimpse of some of that work. These stories illustrate how we are creating a sustainable health system with a core focus on patients and families first. Our goals as a leading academic health system are to improve the health of our population, to provide value — only the highest quality care that well informed patients want and need, at a reasonable price — and to do so transparently, in payment models that reward quality and value, not the number of patients we see or procedures we do.

Thank you for your trust and your support. We’re privileged to serve you.

Dr. James N. WeinsteinCEO and President

EditorsAnne ClemensVictoria McCandless

Design Erin Higgins David Jenne

Photography Mark Washburn

Writers Steve BjerklieTim DeanJennifer DurginE. Senteio

Published by Dartmouth-Hitchcock Communications and MarketingOne Medical Center DriveLebanon, NH 03765dartmouth-hitchcock.orgAll contents © 2014.

in this issue

02 ONE LIFE A patient Experience: Bonnie Mercier

08 Q&A WITH Dr. James N. Weinstein

11 FOREFRONTDiscoveries at D-H

28 FROM THE BOARDList of Trustees and Officers, and thank you letter

29 DONORSLists and Profiles

features

04 TELEMEDICINEThe Road Less Traveled: Telemedicine Brings Health Care Home

14 TRANSITION OF CAREMoms: The First Line of Treatment for Neonatal Abstinence Syndrome

18 PRIMARY CARE Primary Care at the Leading Edge: A conversation with Don Caruso, MD, MPH

20 CANCER RESEARCHNanotechnology: The New Frontier in Cancer Research

24 PATIENT OUTCOMESTargeting Sepsis: Teamwork Drives Exceptional Care

imagine innovation

A PATIENT EXPERIENCEONE LIFE:

For a number of years, Bonnie Mercier suffered from episodes of pain down the

side of her right leg. Initially diagnosed as sciatica — a common type of pain affecting the sciatic nerve, which extends from the lower back down through each leg — the condition got worse over time.

“It got to the point in the spring of 2012 where I couldn’t walk more than a few yards without stopping because the pain was so excruciating,” she recalls. “It almost ruined the Disney cruise that my husband and I took our granddaughter on for her 16th birthday. It took me forever to walk around the ship. They had to keep waiting up for me, and we had to sit down and take little rests.”

Even after many other treatment options failed — including acupuncture, chiropractic care, massage therapy, physical therapy and pain injections — Mercier resisted having an operation. “My mother had back surgery years ago and it pretty much paralyzed her, so I was very leery about it,” she says. “Finally, I couldn’t take it anymore. I said to my doctor, ‘Send me to someone who can help me.’”

That someone was William Abdu, MD, at Dart-mouth-Hitchcock’s Spine Center. Mercier had a proce-dure called a “laminectomy and fusion” with Abdu in December of 2012. “I had a disc out of place that was pressing on the spinal nerves,” she says. “Basically, he removed the material that was pinching the nerves. Then he used some rods and screws and a bone graft from my hip to put my disc back in place and make it stable again. As soon as I woke up from the procedure, I had immedi-ate relief. The pain was gone.”

Mercier is back to the active lifestyle that she enjoys. “I walk every day and I’m able to do everything I want without limitations,” she says.

“My husband and I love Dr. Abdu,” adds Mercier. “He was compassionate and very thorough. He spent a lot of time with us, explaining all the ins and outs of the procedure and the recovery process. That made such a difference. I couldn’t be more pleased with how things turned out. I feel 10 years younger.”

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THE MILES TRAVELED

H O M ET E L E M E D I C I N E B R I N G SH E A LT H C A R E H O M E

LIKE MOST GRANDFATHERS,

4The Dartmouth-Hitchcock Center for Telehealth offers life-saving and support care across the miles.

RONALDO “RON” PELCHAT loves to play with his four grandchil-dren. So as 5-year-old Lilianna (Lili) pedaled her tricycle around the drive-way of his Lancaster, NH, home on a June afternoon, Pelchat raced after her.

Even though the 57-year-old ran two Boston marathons and climbed Mount Washington several times, he did not race Lili on foot. Instead, Pelchat chased her in a motorized wheelchair that he operates with a head array, a halo-like device connected to his wheelchair that he controls by moving his head. The ravages of amyotrophic lateral sclerosis (ALS, known as Lou Gehrig’s disease) have left him with muscle function only in his face, neck and shoulders, and confine the now-re-tired high school social studies teacher to a wheelchair or hospital bed.

Additionally, the tracheostomy he un-derwent in December 2013 has meant full-time ventilation and a feeding tube. It’s also robbed him of his voice. A Dy-naVox Vmax+ speech-generating device is Pelchat’s primary way of communi-

Pelchat races down the driveway with his granddaughter Lili.

Jeffrey Cohen, MD

cating. To speak, he moves his head and a dot on his glasses selects letters or prepared phrases for him on the screen, allowing him to type sentences that are spoken by the DynaVox.

Anita Pelchat, his wife of 30 years, calls the tracheostomy a “life-saving choice” since her husband was losing his ability to breathe on his own and would have died without the proce-dure. But the trachestomy tube has made more difficult the long drive to Dartmouth-Hitchcock Medical Center (DHMC) for appointments with Pel-chat’s neurologist, Jeffrey Cohen, MD.

“We need to travel with someone who monitors the trach now,” Anita explained. “And the roads are bumpy, especially in the winter, so it jostles him all over the place. It’s a couple of hours driving there, a couple of hours at the appointment, a couple of hours to drive home and then right to bed. And toileting and eating are not easy on the road. It’s an exhausting day.”

PELCHAT HAS BEEN Dr. Jeffery Cohen’s patient since his ALS diagnosis in August 2009, but had not seen him since July 2013 due to the challenging drive, however, in May and July of 2014, he had appointments with Cohen via a telemedicine consult, connecting Cohen at DHMC in Lebanon, NH, to Pelchat at Weeks Medical Center in Lancaster, NH, less than a mile from his home. The Dartmouth-Hitchcock Center for Telehealth had equipped Weeks with telemedicine carts in February 2014, thanks to a three-year rural health care grant provided by the United States Department of Agriculture.

These carts enable D-H rheumatolo-gists, dermatologists and psychiatrists to conduct real-time video consults with Weeks Medical Center’s patients. Now the Neurology department at Dartmouth-Hitchcock utilizes them for Pelchat and for a TeleStroke program that launches at Weeks this fall.

“With the difficulty of long-distance travel, telehealth consults made perfect sense both physically and financially,” Pelchat said. “For people in rural areas,

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or those with severe travel difficulties, it’s an efficient and advantageous way to gain and maintain access to special-ized care.”

“These telemedicine appointments have been really helpful,” Cohen said. “It’s great to be able to interact with Ron. This is not an acute medical situa-tion. It’s more of a support situation as we help him through this stage of the disease. But it’s very helpful to see him, talk to him, and answer any questions that he and Anita have.”

Anita Pelchat is thrilled that tele-medicine gives her husband access to Cohen again, minus the challenging

drive. “The whole telemedicine piece allows us to have a complete ALS clinic team without having to travel more than a quarter mile. The pulmonologist goes to Weeks and everyone else — the speech pathologist, the occupational therapist, the physical therapist — they all come to our house. So the only piece we were missing was Dr. Cohen.”

“We’ve created our own clinic team,” her husband added. “It sounds daunting but it can be done, especially with the help of your local home health care agency. For us, Dr. Cohen completed the link.” Pelchat paused, grinned and then re-sumed selecting letters. “Can we call Dr. Cohen the missing link? Ha, ha, ha!”

CLEARLY, PELCHAT HAS not lost his sense of humor despite this difficult disease. “He has a good outlook on things,” Anita con-firmed. As Pelchat posted on his Facebook page in early August, the average life expectancy for those diagnosed with ALS is two to five years. “I’m five plus and still going,” he wrote. “That makes me a Lou Gehrig — one of the lucky ones!”

Pelchat still enjoys teaching and recently conducted trachestomy tube training at a local nursing home where their daugh-ter Leah Milligan is a nurse. He also instructed a speech pathology graduate student on the DynaVox’s many features. Pelchat said he would not have under-gone a tracheostomy if not for this de-vice and the numerous communication abilities it affords him. Besides giving him a voice, the DynaVox lets him use the Internet, access his computer to write a weekly column for the Coos County Dem-ocrat, and maintain his website (http://rpelch57.wix.com/alsdisease), where he shares advice on living with ALS.

It troubles him that many DynaVox users, who don’t have supplemental health care coverage like he does, can’t afford to access the Internet on the device because of Medicare cutbacks. “Medicare will no longer cover the computer aspect,” he said. “But Inter-net access is so important for indepen-dence. It’s wrong to take it away. ”

Pelchat perseveres in the face of this deadly disease thanks to the love and support of family and friends. “Being close to grandkids, friends and family allows for me to feel some sense of normalcy and maintain some pride in

PUTNUM TELEHEALTH PRO-

Pelchat conducts a telemedicine appointment with Dr. Cohen close to home.

Pelchat at home with his wife, Anita, and granddaughter, Lilianna

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who I am when this disease strips the human dignity and normalcy away.”

He refers to Anita as his “caregiver extraordinaire,” and daughter Leah and son Nate, an IT specialist at Weeks, also provide assistance. And when the Pelchats needed a van modified for wheelchairs, this tight-knit North Coun-try community helped raise $16,000.

“We lived a respectful life, so in a sense, we earned it,” said Pelchat, who taught at Groveton High School and Lancaster Elementary School for 26 years, worked as a lifeguard at the local recreation center, and was a youth sports coach and referee. “But it’s still amazing.”

Ever the teacher, Pelchat was eager to help others by sharing his story. “It’s very important that people don’t feel helpless. You can live with ALS. It’s not easy, but you can do it.”

PUTNUM TELEHEALTH PRO-

Technical Support

POWERFUL DEVICE - INSTANT MESSAGESGOOGLE GLASS is known as wearable technology, but neurosurgery resident Brandon Root, MD, describes it more simply: “It’s a computer on your face.” Neurosurgeon Robert Singer, MD, performed the first Google Glass surgery at Dartmouth-Hitchcock Medical Center in June as part of a pilot study that Neurosurgery is conducting. Singer is excited about the device’s clinical and educational applications. Glass allows quick access to data without breaking sterility, gives students and consultants a surgeon’s perspective, and enables the live-streaming and archiving of operations. He notes that third-party software is required for Health Insurance Portability and Accountability Act (HIPPA) compliance. “But they’re pretty powerful devices and might be a very nice solution not only in the hospital, but also remotely for telemedicine with the Dartmouth-Hitchcock Center for Telehealth.”

Robert Singer, MD

What are your thoughts about where Dartmouth-Hitchcock (D-H) is in its efforts to create a sustainable health system. How are you feeling about to the future?

Dr. Weinstein: We have a clear sense of where we want to go, we’re making great progress and, most of all, we have really great teams across D-H, pulling together in a united purpose: to create a sustainable health system that will improve the lives of the people and communities we serve for generations to come.

We have done a tremendous amount of work over the last few years. D-H was an early adopter and is now nationally recognized as a leader in accountable care and risk-based payment models. We have excelled in quality measures (especially for our low readmission rates) and are helping to lead change in the delivery of health care (especially through the High Value Healthcare Collaborative — see page 27 for more information). As hospitals in our region have considered their futures, they have sought out D-H to help them to imagine their futures as part of a broader health system that is focused on delivering value.

Based on Medicare data compiled by the health care intelligence company Sg2. D-H consistently ranks at or near the top when benchmarked against the leading hospitals in the country on key performance criteria related to effective disease management, care delivery and management of post-acute care. For example, D-H ranked first when compared with Boston’s leading academic medical centers and second only to Mayo Clinic among top national academic health systems featured in US News and World Report’s Top 20 hospitals.

There’s certainly a lot of change taking place in health care now. Does that worry you?

Weinstein: The prospect of change can be overwhelming, especially when the future is filled with uncertainties, however, when you are confident of your strategic direction, that same change can be exhilarating because you know you are working together toward a shared vision of something that is better than what exists today.

UP CLOS Ewith Dr. James N. Weinstein

In our series of Questions and Answers from D-H leaders, Imagine talks with Dr. James N. Weinstein, CEO and president.

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Dr. James N. Weinstein, CEO and president, consults with one of his patients.

To provide the necessary context, it’s important to understand where we are headed as an organization. D-H continues to pursue a model of increasing integration and is moving toward a payment environment that will be substantially capitated (where reimbursement is based on caring for a set population of patients, not for the number of procedures) within the next decade. That means changes in how we operate. By the end of June 2017, we need to have the capability to deliver excellent, patient- and family-centered care under any payment model. The transition will have its challenges, but I’m excited about moving out of the fee-for-service world, which is a major driver of overuse, overtreatment and high health care costs.

There has been a lot of focus nationally on health charges and how they vary. There was a recent story about one California hospital charging $10 for a blood test and another charging $10,000 for the same test. Why is health care pricing such a black box?

Weinstein: Health care shouldn’t be a black box. I often say it should be like a cereal box. You can look at a cereal box and quickly see the cost, the quality of the ingredients, the nutritional value and, from the calorie and cholesterol count, what the risk or benefit might be. We should be able to do the same thing with health care. Patients should be able to know,

going in, what the costs are likely to be, what the quality will be and how they are likely to do after the procedure or treatment.

I’m proud that we at D-H post our prices and give patients an online calculator that allows them to estimate what their out-of-pocket costs will be. More

UP CLOS E

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important though, is that, since 2003, we have posted online our clinical and patient satisfaction results so patients and families can make fully informed decisions about treatments. This is the kind of transparency we need across the health care profession.

D-H is an academic health system with a three-part mission of patient care, research and teaching. What role do research and education play in today’s health care environment?

Weinstein: Research and education are vitally important. With our partners at the Geisel School of Medicine and the undergraduate and graduate schools of Dartmouth College, we are performing clinical and population-based research that is transforming care, unlocking keys to disease that allow us to develop new treatments, and increasing our understanding of the U.S. health care system and population health. Just in our cancer center alone, we have 355 clinical trials in progress!

We are training the doctors of tomorrow and engaging in new collaborations to educate nurses, technicians, and other health care workers who are so critical to our ability to provide high-quality, compassionate care.

And of course, we are one of only 60 academic medical centers in the country to receive a Clinical and Translational Science Award (CTSA). Our SYNERGY program is a major engine of research here at Dartmouth and I’m excited that population health is a core part of the CTSA.

Tell us about the term “Culture of Caring.” Where did that come from and what does it mean to you?

Weinstein: You know, I get hundreds of emails from patients, families, and colleagues, telling me about incidents of kindness, thoughtfulness, skill and tenderness — not just with our patients, but with

each other and visitors to our sites. I was talking to my wife, Mimi, about this one evening and she said, “What you’re talking about isn’t a series of individual acts, but a culture. Dartmouth-Hitchcock has a culture of caring.” That’s where that phrase came from, and I truly believe it describes who and what we are.

That’s probably a good note to end on. Is there anything else you want to say?

Weinstein: Yes. Remember, it’s not the “What” or the “How,” it’s the “Why.” A lot of the things we’ve discussed today are about how we’re going to operate in the future and what’s going to be different. They’re important questions, but unless we understand the “Why” — Why we’re doing what we’re doing, they’re just disconnected pieces. For the tens of thousands of people who walk through our doors everyday — 15,000 a day at DHMC alone — we need to know why we are here.

So why are we here? To create a sustainable health system, to improve the lives of the people and communities we serve, for generations to come.

If we focus on that and have that as the guiding force for all the decisions we make, the what and the how will fall into place.

I talk a lot about the word, “Imagine.” Martin Luther King talked about a dream. He didn’t say “I have a Plan”; he said “I Have a Dream.” It’s what we imagine, what we dream, what we work toward, that’s important. How we get there is just a matter of transportation to reach our goal, to benefit our patients and their families at some of their most vulnerable times.

Creating a sustainable health system in, a culture of caring, to improve the lives of the people and communities we serve, for generations to come. That’s D-H, that’s us, together with our patients and their families, creating our future together.

“It’s what we imagine, what we dream, what we work toward, that’s important. How we get there is just a matter of transportation to reach our goal, to benefit our patients and their families at some of their most vulnerable times.”

Dr. James N. Weinstein

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FOREFRONT DISCOVERY AT D-H

UNLOCKING A COMMON PARASITE’S CANCER-ATTACKING SECRETS

Toxoplasma gondii (T. gondii) is a sin-gle-celled parasite that lives in the intestines of warm-blooded animals, including humans. While most peo-ple feel no effects from the parasite, it can cause flu-like symptoms in some. Interestingly, researchers have found that the way the human immune system responds to and attacks T. gondii closely resembles how the immune system attacks a cancerous tumor.

In their Geisel School of Medicine laboratory, David Bzik, PhD, pro-fessor of Microbiology and Immu-nology, and Barbara Fox, a senior research associate of Microbiology and Immunology, created “cps,” an immunotherapeutic vaccine. Even in a person with a weakened immune system, such as a cancer patient, cps stimulates vaccine responses.

Research in mouse models shows that the cps vaccine is extremely aggressive in combating melanoma and ovarian cancer, resulting in high rates of cancer survival.

SIMPLIFYING BREAST CANCER SURGERY

A new combination of magnet-ic resonance imaging (MRI) and optical scanning, developed by doctors and researchers at Dart-mouth-Hitchcock Norris Cotton Cancer Center and engineers from Dartmouth College’s Thayer School of Engineering, locates small breast cancer tumors with great accuracy. The new method, which is a pre-surgery procedure, gives a surgeon a 3-D image of a tumor. It simplifies surgery in patients where the tumors are too small to be felt.

It’s the first time that optical scan-ning and MRI have been combined to localize breast cancer, according to Richard Barth Jr., MD, section chief for General Surgery at Dart-mouth-Hitchcock. The new meth-od locates breast tumors during a pre-operative MRI and maps the tu-mor with an optical scan to identify the tumor’s size, shape and location. The scan and MRI together create an interactive 3-D image that the surgeon sees on a computer screen.

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PROVIDING A CONSISTENT CARE EXPERIENCE ACROSS THE D-H SYSTEM

How does a health care organization as widely located as Dartmouth-Hitchcock (D-H) — with a main campus and subsidiary clinics in Lebanon, NH, five Community Group Practic-es in New Hampshire and Vermont and clinics scattered across both states — make sure that its medical practices are both consistent across the system and state of the art?

Through the Dartmouth-Hitchcock Knowl-edge Map. This new initiative, launched this past summer, supports clinical teams in deliv-ering the latest research- and evidence-based care options. It will facilitate best-practice, evidence-based approaches to care and assure a consistent experience for patients and their families across D-H.

“D-H Knowledge Map is a resource that will support teams across the care spectrum, from wellness and prevention to acute illness man-agement,” says Nancy Morden, MD, MPH, medical director of the new program.

ACID REFLUX, MAGNETIC BEADS AND AN “AWESOME” CHEESEBURGER

Approximately 15 million people, including Ralph Thomas of Sunderland, VT, suffer from gastroesopheageal reflux disease (GERD), experiencing acid reflux’s symptoms on a chronic, often daily, basis.

Dartmouth-Hitchcock’s Ted Trus, MD, is the first surgeon in northern New England to in-stall a LINX, a new device recently approved by the Food and Drug Administration that employs a small, flexible band of earth mag-net beads, implanted around the esophagus just above the stomach, to keep the esoph-ageal sphincter closed and prevent stomach acid from leaking back into the esophagus, the cause of GERD.

Thomas was the first of Trus’ patients to re-ceive a LINX. He says that one of the things he likes best about the LINX is that, unlike more complicated surgical procedures to fix GERD, there are no dietary restrictions. “I was actually able to have a cheeseburger on my way home, which was awesome,” he says.

FOREFRONT DISCOVERY AT D-H

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AN INCLUSIVE APPROACH FOR CHILDREN WITH AUTISM

Dartmouth-Hitchcock’s Neurodevelopmental Child Psychiatry Clinic (NDPC), was established to create a comprehensive plan for children suffering from autism spectrum disorder (ASD). “You will not find centers anywhere else in the U.S. where such experts are working together from such diverse disciplines,” says Stephen Mott, MD, director of the Child Development Program at the Children’s Hospital at Dartmouth. The multidisciplinary clinic brings together specialists from cognitive neurology, psychiatry and neuropsychology.

NDPC’s inclusive approach is especially helpful with children who may be suffering from co-occurring disorders or condi-tions. “We really see the clinic as one point of care with multi-ple perspectives, all focused on one child. That is what allows us to do a comprehensive evaluation,” comments Mott.

Families travel to NDPC from all over New Hampshire, Vermont, southern Maine and northern Massachusetts for the clinic’s unique approach and the quality of its services, which includes working with families to receive care within their home community.

INNOVATION IN TRAUMA LEADS TO TOP RANKING FOR D-H

Dartmouth-Hitchcock Medical Center (DHMC) operates one of approximately 180 Level One and Level Two trauma centers across the U.S. The Trauma Quality Improve-ment Program (TQIP) has, for the third time in three years, ranked DHMC’s Trauma and Acute Care Surgery program as one of the best in the nation.

“When you consider that the severity of illness in trauma patients has increased, it makes our results all the more impressive,” says Rich-ard Freeman, MD, chair of the Department of Surgery. “It truly is excellent teamwork across nearly all of the medical center’s do-mains — from the advanced response teams to the emergency department, to the operating room and blood bank, to lab services, the inten-sive care unit (ICU) and many other care units and supportive services — that has allowed us to achieve these population-based results that are highly illustrative of how Dartmouth-Hitch-cock delivers value by providing high quality care at lower costs.”

FOREFRONT DISCOVERY AT D-H

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transition of careinnovation1414AT THE CHILDREN’S HOSPITAL at Dartmouth-Hitchcock (CHaD), moms are now the first line of treat-ment for babies born with neonatal abstinence syndrome (NAS). NAS occurs when a baby is born dependent on an opioid or narcotic drug a woman was taking while pregnant. A recent transition in care at CHaD has made it possible for moms and babies at risk for NAS to room together, creating an environment conducive to the best possible outcomes for mom and baby.

“We advocate parental presence,” says pediatrician Bonny Whalen, MD, medical director of the Newborn Nursery at CHaD. “Now moms can be with their newborns 24/7, and do what we often call ‘mother-care.’” This level of care begins with a mother and child being together in a calming environment. The fundamental components of the non-pharmacological treatment, explains Whalen, includes “skin-to-skin contact, cue-based feeding, and continued pres-ence in a soothing atmosphere: lights dimmed, low tones and limited people.”

Evidence-based research has shown that this holistic first line treatment re-sults in NAS babies requiring less med-ication and less time in the hospital.

THE FIRST LINE OF TREATMENT FOR NEONATAL ABSTINENCE SYNDROME

Moms and their babies born with neonatal abstinence syndrome room together at CHaD.

preparing for babyTHE FIRST STEP to the best possible experience for new moms and their babies was staff training, says Wha-len: “We looked at issues regarding the transition of care from the ICN to the Pediatric Unit, and found that the concerns staff had regarding babies

with NAS — respiratory difficulty, apnea, or acute issues when starting morphine — weren’t prevalent. Across all of the units, we did a lot of educa-tion with staff and physicians. We also worked on scoring and assessment so they were more consistent and reflec-tive of a baby’s condition.”

Scoring, Whalen explains, is noting a baby’s indicators of withdrawal, such as tremors, high-pitched crying or loose stools. In reviewing the way staff were performing the baby’s assessment, she says processes were also improved.

then and now“PRIOR TO THIS TRANSITION, if a newborn was experiencing withdrawal symptoms, we would monitor the baby for at least four days in the Birthing Pavilion,” explains Johanna Beliveau, MBA, RN, administrative director for patient care in Maternal Child Health and Psychiatry. “This allowed mom and baby to stay close.” If symptoms had to be managed with medication, however, the baby would be transferred to the Intensive Care Nursery (ICN), which, while appropriate for acute levels of care, was not favorable for one-on-one quiet time between a mother and baby.

“A baby might be in the ICN anywhere from one to two weeks,” says Beliveau. During that time, as there is no place for a mom to sleep in the ICN, she would go home. Once a baby was stable on medication and weaning, he or she was transferred to the Pediatric Unit where moms could once again room-in with their child. “But,” says Beliveau, “if the baby’s symptoms escalated, historically, they required transition back to the ICN. So we were in a situation where there were often multiple transfers for one family.”

Now, Beliveau explains, “we have the ability to transfer moms directly from the Birthing Pavilion to the Pediatric Unit, and they can stay there regardless of the medication or dosing.” Addition-ally, the transition opens access in the ICN for the most critical babies.

THE FIRST LINE OF TREATMENT FOR NEONATAL ABSTINENCE SYNDROME Johanna Beliveau, MBA, RN, center, talks with colleagues.

“We made our care and assessments of babies more baby-focused, trying to limit over-stimula-tion. Now we ask that moms do skin-to-skin con-tact with their baby prior to and during scoring, and to call the nurse for assessment after feeding. This way the baby will be calmer, and won’t be scored for excessive sucking due to hunger.”

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A BROADER MISSION

Whalen, (pictured right) a member of the New Hampshire Governor’s Commission

Prenatal Task Force, believes that, with the epidemic levels of opioid abuse and dependence across the region, an even

larger community effort is required. “The goal is to be able to care for these

women in their own communities, keeping moms and babies together. But, the funding is not currently available for

implementation of an intensive inpatient and outpatient residential treatment

program to expand on the success of our River Mill Addiction Treatment Program

model. We’d be able to provide help to so many more women in need. The current need far exceeds the available resources

in New Hampshire and the region.”

ANOTHER LEVEL OF SUPPORT for these mothers and babies is the volunteer program. “We recruited and trained a group of volunteers to work specifically with this population. The 24/7 responsibility can be tiring for new parents, so it’s reassuring to know their baby has someone holding them and providing a nurturing environment in their absence,” says Johanna Beliveau, MBA, RN.

The transition is rolling out in two phases. Phase one began in July, focused on women who give birth at CHaD. “At the end of August, we began planning for phase two, focusing on referrals from out-side organizations,” says Beliveau.

D-H Volunteer Christine Taylor comforts one of our newest patients.

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HAVING A CHILD IN THE HOSPITAL can be exhausting — mentally, physical-ly and emotionally. At the Children’s Hospital at Dartmouth-Hitchcock (CHaD), caregivers understand this. Nurses, physicians, child-life specialists and others who care for patients on CHaD’s 23-bed inpatient unit are com-mitted to providing the best team-based, patient- and family-centered care. But that can be challenging, given that the physical layout and design of the unit hasn’t changed significantly since it first opened two decades ago.

“The CHaD inpatient unit is currently a phys-ically demanding environment for nurses,” says Buffy Meliment, RN, BSN, unit nurse manager. “Our nurses, and most importantly, our patients and their families staying on the unit deserve a physical environment that supports the highest standards of care.”

That’s why CHaD leaders are preparing for a revitalization of the inpatient unit, sched-uled to begin in the Winter of 2015. New features include multiple nursing stations located close to patients’ rooms; a new fam-ily lounge with a kitchen, computer access, patient education materials and natural

daylight; comfortable and easy-to-clean rubberized flooring; an improved medication and nutrition preparation area; and a beauti-ful, therapeutic play area.

“With this redesign, we will have a physical space that works with us to provide the best care to our young patients and their fami-lies,” says Meliment.

FOR MORE INFORMATION ABOUT SUPPORTING THE CHaD INPATIENT PROJECT, contact Carol Olwert in the Office of Development at 603.653.0723 or email her at Carol.Olwert@Hitchcock.org.

responding to needNATIONALLY, 3.9 out of every 1,000 newborns suffer from NAS; at CHaD that number is drastically higher — 18.6 out of every 1,000. “In this area,” says Beliveau, “we have a large population of women dealing with addiction issues and need programs that support them while in the hospital.”

Whalen, who does outreach on pre-natal care at the River Mill Addiction

Treatment Program in Lebanon, NH, agrees. “Many of these women have experienced trauma in their lives. We are here to support them — non-judg-mentally — as they struggle with substance abuse, opioid dependence and pregnancy. There are things they can do to help lessen their child’s withdrawal, and discussing these things during pregnancy can be helpful. They need to hear how important they are in the care of their baby.”

The work CHaD has accomplished in the field of neonatology is now being modeled in other hospitals. Working with partners like Northern New En-gland Perinatal Quality Improvement Networks, and the international Ver-mont-Oxford Network, Whalen says, “we’re able to help with resources and idea sharing for best practices. We’ve had requests from hospitals throughout the region and country for our parent education booklet, and several model our guidelines. We also continue to do outreach for pregnant women.”

For now, Whalen and others contin-ue to spread the word, sharing best practices through education and the transition of care at CHaD. “The prima-ry reason and value of this transition is that this is the best possible care situa-tion for these babies and their families, giving them the environment to be successful in this situation, helping them manage symptoms and leave the hospital sooner to get home to where they really want to be.”

A HEALING SPACE FOR CHILDREN AND FAMILIES

PRIMARY CARE AT THE LEADING EDGE:A CONVERSATION WITH DON CARUSO, MD, MPH

INNOVATION in health care is often associated with advances in specialty services such as surgery and the breakthroughs in technology that help

make them possible. But as the nation’s health care system continues to move away from an episode-driven, fee-for-service approach and toward a coordinated, preventive model of care delivery, exciting innovations are also taking place in the arena of primary care.

In his new role as Primary Care Service Line Leader for Dartmouth-Hitchcock (D-H), Don Caruso, MD, MPH, who also serves as Medical Director of Dartmouth-Hitchcock Keene/Cheshire Medical Center, talks about how D-H is leading some of these changes across its region.

INNOVATIONS PRIMARY CARE

Don Caruso, MD, MPH

How is Primary Care different at D-H?

For the first time, D-H is establishing a system-wide service line for primary care, meaning that we’ll be focused on standardizing the way care is provided across all of our sites. Moving toward a more unified approach, where we’re using the same evidence-based care processes, supported by the same sys-tems and tools, will help us to improve health and lower the cost of care.

How is this system-wide approach enhancing primary care services at D-H?

It’s allowing us to build upon the medi-cal home foundation we’ve established and add a population health approach to care — which involves not just caring for patients who walk through the door, but embracing responsibility for the health of our region’s entire population.

Using financial data from payers (insur-ance companies) and patient data from our electronic medical records, we’re able to identify patients by particular health risks and to design care that more closely matches their needs. For example, in the past if a patient was diagnosed with diabetes, we would provide all of the resources available, whether they needed them or not, in an effort to improve their outcomes. Now we’re able to identify patients by high

risk, medium risk and low risk. High-risk patients get the most intensive levels of care, including a designated care coordi-nator who monitors them closely, trying to keep them out of the hospital and as healthy as possible.

Since medium-risk patients typically manage their blood sugars pretty well and don’t need to see the physician on a regular basis, we’ve created a collabo-rative care nurse position to provide the education and support they need, so they don’t end up in the high-risk group. For the low-risk, healthy individuals, we employ patient data coordinators with great interpersonal skills to manage our patient registries and reach out to provide health screening reminders and wellness information as appropriate.

One recent system-wide innovation involves mental health. Can you de-scribe what that entails?

We know that mental illness impacts a patient’s ability to manage their illness or disease, so we’ve integrated be-havior health across the primary care system at D-H. Our sites now have a psychologist or psychiatrist, depend-ing upon the community’s needs, who can see patients and also consult with physicians and care teams on appro-priate interventions. In addition, we’ve recently integrated into the practices a behavioral health coordinator, who can

reach out to patients and help them manage their medications, make sure they’re getting to their counselors and help them with any social issues that need rectifying, such as transportation. A recent study we’ve been involved in, looking at outcomes based on this mod-el of care, clearly shows that it makes a difference for patients.

Are there some efforts that you would like to see modeled across the D-H system?

One example in the Keene community involved hypertension, a major driver of heart disease in Cheshire County. Before we put a care coordinator model in place, which included strong engage-ment from the community, Cheshire Medical Center was at the national norm of 18 to 19 percent for readmis-sions for people over age 65. We now run consistently at 8 to 9 percent.

Another area we’ve really been working hard on is chronic obstructive pulmo-nary disease (COPD), a major reason why respiratory illness has historically been a leading cause of admission at Cheshire. Taking the population health approach, we provided flu and pneu-monia vaccines to the at-risk patients in the community, and also a “COPD Res-cue Pack,” for the highest-risk patients, to help them begin treatment earlier at home if they ran into trouble.

How do the strengths of D-H’s health system support your efforts?

The fact that we are part of a leading academic health system that is dedicated to research and education, as well as clinical care, helps us stay on the cutting edge of technology and medical knowledge. Having a strong focus on improving population health and access to the right kinds of resources directly sup-ports our efforts to find innovative ways to provide the highest level of primary care at lower costs.

The emphasis should be on provid-ing evidence-based care and doing the right thing by the patient. 19

THE LETTER that Julie Haubrich, a high school guidance counselor from Loudon, New Hampshire, received from Puerto Rico, when she adopted Walk-er as a young rescue dog back in 2004, had described the Golden Retriever to a tee. “It said that even as a puppy he was mellow, had a very sweet disposition and got along with all of the other dogs,” recalls Julie.

Those traits have made Walker a community favorite and unofficial mascot at the ball fields in Loudon, where Julie’s 8-year-old son Noah plays baseball and soccer in the town’s recreation leagues. “Walker’s favorite thing is to go down to the ball field on a sun-ny day, with the wind blowing and all of the people around,” says Noah. “He doesn’t ask for attention, but he gets an awful lot of it.”

This past spring, however, Walker seemed a little more subdued than usual. “That’s when I noticed there was something red and swollen in the back of his mouth,” says Julie, thinking it was perhaps an ab-scessed tooth. A visit with her veterinarian revealed much worse — oral melanoma. “We were shocked; even with treatment options like surgery, Walker’s life expectancy was only about five months.”Julie Haubrich with son, Noah,

and their Golden Retriever, Walker

THE NEW FRONTIERIN CANCER RESEARCH

PROMISING DISCOVERIES SAVES LIVES - INCLUDING MAN’S BEST FRIEND

Innovative research led by Jack Hoopes, DVM, PhD, shows promise for cancer patients of all kinds.

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Julie heard about an experimental treatment at Dartmouth-Hitchcock (D-H). Since the new treat-ment was being developed and tested both in mice implanted with human breast tumors and in dogs with naturally occurring tumors that were identical to Walker’s tumor — Julie was able to enroll him in the treatment program.

The treatment, known as magnetic nanoparticle hyperthermia, involves injecting many microscop-ic iron oxide nanoparticles into a tumor. These non-toxic particles can be engineered to bind spe-cifically to cancer cells. Once they enter the tumor, they’re exposed to a magnetic field, which produces enough heat to kill the cancer cells. Because the nanoparticles can be directed to the tumor cells, it’s possible to be very specific with the treatment. This is the goal of all cancer treatments — to destroy the tumor cells without harming the surrounding normal tissue.

AN EXCELLENT MODEL OF STUDY

“Although there are some minor differences, dogs and humans have the same types and incidence of cancer,” explains study director P. Jack Hoopes, DVM, PhD, a researcher at D-H’s Norris Cotton Cancer Center (NCCC) and a professor of Surgery and Radiation Oncology at the Geisel School of Medicine and at the Thayer School of Engineering. He has spent his career researching new cancer therapy techniques.

Above, a CT scan of Walker’s head. Below, tumor cells readily take up magnetic nanoparticles (black objects). When a tumor containing nanoparticles is exposed to an alternating magnetic field, the nanoparticles will heat and kill the tumor cells.

Jack Hoopes, DVM, PhD

21

“Luckily, many of the tumor types we study in mice and dogs have a similar human cancer counterpart and they respond the same way to treatment,” he says. “The dog study is very gratify-ing, not only because the treatments can be easily and effectively transferred to human patients, but because we can help the dogs, too,” says Hoopes.

Nanoparticle therapy offers a number of positive and unique cancer treat-ment opportunities. “So far, we have largely pursued the direct injection of nanoparticles into tumors,” Hoopes ex-plains. “Over the next few years, we’ll concentrate on the systemic delivery of targeted nanoparticles, with the hope that they will seek out and find tumor cells in the body. We’ll also work to develop accurate imaging techniques for nanoparticles, find ways to deliv-er higher doses of nanoparticles to tumors, and more effectively combine nanoparticle treatment with conven-tional therapies.”

DARTMOUTH’S CENTER OF CANCER NANOTECHNOLOGY EXCELLENCE

Hoopes’ studies are part of a broader effort undertaken by the Dartmouth Center of Cancer Nanotechnology Excellence (DCCNE), a collaborative research initiative that combines the expertise and resources of scientists, engineers and clinicians from Geisel, the Thayer School of Engineering at Dartmouth and NCCC.

Since it received a $12.8-million grant from the National Cancer Institute, with the charge of applying nanotech-

One major project within the Dartmouth Center of Cancer Nanotechnology Excellence (DCCNE) that has recently been attracting much attention from the scientific and medical communities is being led by Steve Fiering, PhD.

“Our approach is different in that, rather than using the nanoparticles to try to kill all of the cancer cells, we’re looking at ways that we can apply magnetic hyperther-mia to stimulate the immune system,” explains Fiering, a researcher at Norris Cotton Cancer Center and profes-sor of Microbiology and Immunology and of Genetics at the Geisel School of Medicine at Dartmouth.

Fiering and his team have found that treating a primary tumor with lesser amounts of heat actually causes a

systemic immune response in mice that can slow the growth of untreated tumors that may not even be de-tectable yet.

“We think this could be a major new addition to treat-ment options because it addresses one of the funda-mental problems with metastatic tumors—their ability to suppress the immune system, to make it go to sleep, if you will, while they grow and spread to other areas of the body,” he says. “This could lead to the development of a pretreatment, for example, that could be given to a patient before surgery that would help their immune system fight the cancer and make the overall treatment more successful.”

Pictured above: Patrick Lizotte, Dartmouth College student, left, with Steve Fiering, PhD.

Waking up the Immune System

22

nology to provide new and more effec-tive ways to diagnose and treat cancer, the DCCNE (one of nine such centers in the country) has been making steady progress.

“Unlike with chemotherapy, which can stop working or be too toxic for the body to tolerate, nanoparticle therapy can be repeated as many times as nec-essary,” says Ian Baker, PhD, a material scientist who serves as both director of the DCCNE and Thayer’s Sherman Fairchild professor of Engineering. “We have found that nanoparticle therapy can be very effective when combined with chemotherapy, radia-tion and surgery.”

Baker adds: “I think what distinguishes our work here at Dartmouth is that we’re more focused on therapeutics than diagnostics, and our grant is whol-ly focused on using magnetic nanopar-ticle hyperthermia.”

Hoopes’ nanoparticle treatments, es-pecially when combined with radiation treatments, have shown such positive outcomes—in either curing the cancers or significantly extending the dogs’ lifespans—that he and his clinical and basic science colleagues are currently seeking FDA approval for the first U.S.-based human clinical trials. The initial trial will focus on breast cancer and will include a diverse cohort of D-H

physicians, including Drs. Kari Rosen-kranz, Peter Kaufman, Thomas Sroka and Lionel Lewis.

A HOPEFUL PROGNOSIS

Meanwhile, Walker’s treatments—he is the twelfth and latest participant in Hoopes’ dog study—are showing promising results. “His tumor is no lon-ger visible,” says Julie. “He seems to be bouncing back beautifully. It’s nice to see him acting so happy and healthy.”

“The other day, Walker was scratching the rug and then he gave a little bark and ran into our family room,” says

Noah. “He kept begging us to pet him. It reminded me of how he used to act when he was a puppy,” says Lisa.

“You know, initially I had concerns about subjecting my dog, who is like a member of our family, to experimental treatments,” Julie says. “But it’s just been a great experience. Dr. Hoopes and his whole team have been so conscientious and caring, it feels like we’re going to our own veterinarian. We’re very grate-ful for all they’ve done for Walker. But I know there is a bigger purpose to this. I’ve had friends and family members who have had cancer. Knowing that this may ultimately help people like them makes it all the more meaningful.”

Pictured far left: Courtney Mazur, Geisel School of Medicine staff, left, with Adwiteeya Misra, student, Dartmouth College.

Pictured close left: Jack Hoopes, DVM, PhD, center, examines Walker with his owners Julie and Noah Haubrich.

23

Leadin Tem faccat lictiisquiat. Oluptat-urpreper isquid que maximuscil modi-onserro optatus, vendi bea as dolo-rum sitate

24 EPSIS, a serious and potentially life-threatening complication of an infection, is a notori-ously difficult condi-

tion to detect and treat. Patients with sepsis often exhibit symptoms — such as a fever, confusion and elevated pulse — that can easily be attributed to other illnesses like the flu or food poisoning.

Sepsis can progress very quickly, setting off a body-wide inflammatory response that can lead to shock, organ failure and death. A one-hour delay in providing antibiotics to a patient in severe sepsis, for example, raises mor-tality by almost 8 percent. And while many providers know how to treat sepsis, few have been able to establish a consistent, evidence-based care pro-cess for achieving improved outcomes. It’s no surprise then, that sepsis is the leading cause of hospital deaths in the U.S., affecting about 750,000 patients per year and costing an estimated $17 billion annually to treat.

Despite these challenges, Dart-mouth-Hitchcock (D-H) is quickly be-coming a model for implementing rapid improvements in sepsis care. “We’ve basically been able to replicate in six months what other organizations have done over several years,” says Andreas Taenzer, MD, MS, who is helping to lead a major initiative at D-H to im-prove care and outcomes for patients with sepsis.

TARGETING SEPSIS TEAMWORK DRIVES EXCEPTIONAL CARE

Learning from the BestHow has D-H done it? By adopting best practices from national leaders in sepsis care, utilizing the expertise of its performance improvement group, and drawing on exceptional teamwork across its organization, says Taenzer.

“We’ve been able to accelerate our improvement process — in areas like the time it takes to administer antibiotics, the average length of stay and the mortality rate for sepsis patients admitted via the Emergency Department,” he says.

Through Taenzer’s work as a clini-cal liaison to the High Value Health Collaborative’s (see sidebar) efforts to improve sepsis outcomes nationally, D-H gained access to patient data and best practice information from leaders such as Intermountain Health in Salt Lake City, Utah, and North Shore Long Island Jewish Health System in New York, that have demonstrated excel-lence in sepsis management.

Emergency Department and ICU Leading the Way

Since most septic patients are cared for in the Emergency Department (ED) and Intensive Care Unit (ICU) environ-ments, those areas have been targeted initially. First to launch (in April) and show improvement results has been the ED. The ICU, which kicked off its sepsis work later in the spring, is mak-ing good progress with implementing the interventions tailored to its patient population.

Guiding the ED and the ICU through these implementations had been the responsibility of Sam Shields, MBA, a

performance improvement expert with D-H’s Value Institute (a division within D-H that leads quality improvement work throughout the organization), who serves as the project leader.

A high-level team quickly evaluated processes, made recommendations and helped unit staff test those recom-mendations, and then the unit staff implemented improvements in care and efficiency.

Key to this process during the ED’s implementation, was the recogni-tion that the unit needed engage-ment from front-line staff — those caring for patients at the bedside.

“The ED set up a core nursing group who took ownership of the project and has worked closely with residents, physicians and other team members,” says Shields. “As a result, we were able to aggressively drive the changes and implement solutions within 90 days — a very difficult thing to achieve in care settings like these.”

In addition, having good data allowed the ED to pinpoint problem areas and track its progress, says Patricia Lanter, MD, an emergency medicine specialist and project sponsor. “We’ve also got-ten great engagement from key areas like the pharmacy, our systems support group and the lab,” she says.

Research shows that patient outcomes can be dramatically improved if the clinical team recogniz-es sepsis early and gets a blood sample for lactate level (to measure the amount of lactic acid in the body), sends blood cultures, gives antibiotics and provides adequate fluids — all within three hours of symptom recognition (what is known as the sepsis 3-hour bundle).

25

Speeding Recognition, CareThe ED’s process included adopting an early recognition tool based on the set of symptoms that identifies a potential-ly septic patient, what the group called “super SIRS” (systemic inflammatory response syndrome) criteria. “We started utilizing a float nurse to help care teams react more quickly and initiate appropriate sepsis care,” says Jennifer Norris, RN, a unit supervisor in the ED helping to lead the project. “In doing so, we’re now able to prevent some patients from progressing to severe sepsis, and our approach is also helping expedite our care in patients who don’t have sepsis, but are very sick.”

“I think the project has also enhanced communications between care team members in the ED, especially the nurses and physicians,” says Amy Curley, a clini-cal nurse specialist in the ED.

The ED’s focus now is on what it needs to do to sustain the high level of engage-ment and performance it has achieved. They meet weekly with ICU staff to share lessons learned and improve patient hand-offs, as the ICU works to implement the same changes and process improvements for its patients. Next, D-H will focus on improving the detection and treatment of sepsis across its general care units.

“The fourth and final component will be to roll the effort out to all of the hospitals and care centers in the community,” says Taenzer. “In order to impact the outcomes of all patients across the state, we need to work with other providers to intervene earlier. We’re not there yet, and it’s going to take a lot of work to sustain this effort, but we’ve come an astonishingly long way in a very brief period of time.”

Amy Curley, MSN, APRN, CEN, left, with

Jill Toth, BSN, RN26

“IT’S A SHINING example of how the High Value Healthcare Collabo-rative (HVHC) is leading change and improvement in health care, through collaboration, transparency, and a commitment to higher quality and bet-ter outcomes, at lower cost,” says Dr. James N. Weinstein, CEO and presi-dent of Dartmouth-Hitchcock and one of five founding partners of HVHC.

Formed in 2010 by D-H, Denver Health, Intermountain Health, Mayo Clinic and The Dartmouth Institute for Health Policy & Clinical Practice (TDI) — with the triple aim of im-proving care, improving health and reducing costs — HVHC has grown to encompass 19 health care delivery sys-tems that serve more than 70 million people across the United States.

In addition to sepsis, HVHC is ad-dressing five health conditions and treatments that have high cost and wide variation nationally. The projects, targeting diabetes, congestive heart failure, hip and knee replacement and

spine surgery, have been launched in more than 160 clinical sites across the U.S. and are funded in part by a $26 million Health Care Innovation Award from the Centers for Medicare and Medicaid Innovation. Additional high-variation, high-cost conditions that affect diverse populations will be added over time.

HVHC’s innovative approach holds some distinct advantages over tradi-tional research methods. “We’ve cen-tralized the Institutional Review Board (IRB) process — a federally mandated committee that oversees research projects involving human partici-pants — with Dartmouth serving as the IRB of record for HVHC studies across all members. The projects are being led by physicians and other providers, and all of the members are sending data to TDI, which serves as the facilitator and data convener for the Collabora-tive,” says Jon Lurie, MD, MS, HVHC Program Lead for D-H. “Having 19 systems testing interventions for the same conditions and treatments on

THE RAPID GAINS made in Dartmouth-Hitchcock’s (D-H’s) recent efforts to improve sepsis identification and treatment (see main article) show what is possible when leading health systems agree to work together, pooling resources and sharing data on best prac-tices that can then be adapted to patient populations at the local and regional levels.

a national scale allows us to quickly generate and share new knowledge.” Rather than evaluating interventions locally and comparing results, HVHC collects and analyzes data pooled from all HVHC health systems.

Identifying and accelerating wide-spread adoption of best-practice care models — and innovative value-based payment models — are goals of HVHC. To this end, earlier this year the Ex-ecutive Committee of HVHC formed its Payment Reform Group, which produced a white paper that is helping to frame discussions with payers such as Medicare.

“As the shared data with HVHC members has shown opportunities to improve value, we’ve recognized that, unless payment for care is reformed, those improvements in value cannot be sustained,” says Payment Reform Group Chair James Rohack, MD, a cardiologist from Scott & White Healthcare in Tex-as and past president of the American Medical Association. “Achieving a true high-value health care system requires alignment of the practitioner, hospital, patient and payer. Getting that align-ment will require a thoughtful evolution that balances the needs of the individual patient with the needs of the popula-tion that individual is part of.”

THE POWER OF COLLABORATION: SHARING OUTCOMES, IMPROVING CARE

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DARTMOUTH-HITCHCOCK BOARD OF TRUSTEES – 2014

The Dartmouth-Hitchcock Board of Trustees is a dedicated group of individuals who volunteer their time, energy and expertise to ensure that Dartmouth-Hitchcock is well positioned to create a sustainable health system and to achieve the healthiest population possible in our region and beyond.

Duane A. Compton, PhD Hanover, NH

William J. Conaty Sunapee, NH

Vincent S. Conti Cape Elizabeth, ME

Denis A. Cortese, MD Fountain Hills, AZ

Barbara J. Couch Hanover, NH

Paul P. Danos, PhD Treasurer Hanover, NH

Peter A. DeLong, MD Norwich, VT

Matthew B. Dunne Hartland, VT

Michael J. Goran, MD Bodega Bay, CA

Senator Judd A. Gregg Rye Beach, NH

Barbara C. Jobst, MD Hanover, NHLaura K. Landy Morristown, NJJennie L. Norman Secretary Harrisville, NHRobert. A. Oden, Jr., PhD Chair Hanover, NHSteven A. Paris, MD Bedford, NH

Richard J. Powell, MD Hanover, NHRichard I. Rothstein, MD Etna, NHHugh C. Smith, MD Rochester, MNAnne-Lee Verville Vice Chair Hopkinton, NHDr. James N. Weinstein CEO and President Lyme, NH

Robert A. Oden, Jr., PhD28

Dear Friends,If I have but a single message to convey in these comments, let it be this: thank you. Thank you to all who have given to support the mission and, most importantly, the patients and families served by Dartmouth-Hitchcock and the Geisel School of Medicine at Dartmouth.

The generosity of more than 35,000 donors in FY 2014 provided $37 million, funds that can and will be used to benefit our patient care, research and education programs. These efforts, evidence of which can be found throughout this publication, have, of course, a common and profoundly important purpose: to improve the health and heath care of the people and communities we serve.

On the following pages are listed but a fraction of those who have given during the period July 1, 2013 to June 30, 2014. Space allows us here to honor only donors of $1,000 or more and this we do most gratefully. But know that all contributions, of all sizes, are honored in our hearts and our very sincere gratitude extends to all who join us in supporting the work of Dartmouth-Hitchcock and the Geisel School of Medicine.

On behalf of my fellow trustees, thank you.

Prof. Robert A. Oden, Jr.Chair, Dartmouth-Hitchcock Boards of Trustees

Anonymous (69)

Dr. and Mrs. William A. Abdu

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Estate of Dr. James C. Alex

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Mr. and Mrs. Theodore E. Bachelder

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Estate of Bradley G. Ball

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Wendy D. Barclay

Mr. and Mrs. Richard L. Barnaby, Jr.

Prof. Cynthia Barnhart and Mark Baribeau

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Ray and Cynthia Barrette

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Elizabeth Bengtson, M.D.

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Ann and David Bradley

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Nathanael R. Brayton

Stephen K. Brayton

Thomas F. and Patricia A. Brennan

Dr. Donald K. Brief

Pauline Brine

Barbara K. Bristol and Galway Kinnell

Jennifer and Peter Brock

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Marlene Brody

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Rodney and Sandra Buck

Dr. John H. Buckner

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Mr. and Mrs. Patrick A. Burns

INDIVIDUALS (Please see pages 38 and 39 for listings of foundation and organization donors.)

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The Preston T. and Virginia R. Kelsey Distinguished Chair in Cancer: Inspired by Collaboration

“Collaboration is at the core of how we live and work at the Cancer Center, how we advance the cause of combating cancer every day,” says Mark Israel, MD, director of Dartmouth-Hitchcock Norris Cotton Cancer Center. Israel’s leadership and the culture of collaboration that he has fostered inspired the Reverend Preston Kelsey and Virginia Kelsey to make a $5 million gift to the Geisel School of Medicine to endow a distinguished chair for the Cancer Center. The newly established chair supports the director of the Cancer Center in advancing innovative research that translates into clinical and preventive cancer care. In June, Israel was named the inaugural holder of the chair.

The Reverend Preston Kelsey (left) and Virginia Kelsey (middle) admire the leadership of Dr. Mark Israel (right), who has led

Dartmouth-Hitchcock’s Norris Cotton Cancer Center since 2001. 30

Linda C. Burroughs

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Mark W. Chapman and Martha Blakemore Chapman

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Dr. Mildred Chen

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Mr. and Mrs. Courtland J. Cross

Mr. and Mrs. William C. Crowder

Dr. and Mrs. John F. Crowe

Dr. and Mrs. John M. Crowe

Judy and Tom Csatari

Mark G. Cunha

Penny and Andrew Cunningham

Dr. Sandra J. Cunningham

Jim and Gail Curley

John A. and Judith A. Currier

Mr. and Mrs. Philip R. Currier

Sally Curtin

Mr. and Mrs. Robin C. Curtiss

Dr. and Mrs. Aristotle J. Damianos

Dr. and Mrs. Miguel Damien

Barbara E. Daniell

Elena and Jere Daniell

Mr. and Mrs. Craig D. Darling

Castle N. Day

Marsha Day-Donahue and Roger Donahue, Jr.

Philip de Toledo

Dr. and Mrs. Kenneth E. DeHaven

Dr. and Mrs. G. Robert Delong

Susan Dentzer and Charles Alston

Charles Depuy, Jr. and Mary Ann Haagen

R. Paul Detwiler and Dr. Neilly Buckalew

Jesse F. Devitte

Bill and Patty Dewhirst

Mr. and Mrs. Michael J. Di Franco

Dr. Robert M. Di Mauro

Estate of Susan E. Diamond

Cheryl Dickson

Dr. James A. DiNardo

Mr. and Mrs. Jeffrey A. Dionne

Dr. and Mrs. James J. DiResta

Drs. Anthony DiScipio and Jean Liu

Frank J. Dluzniewski

Trey and Amy Dobson

Francis X. Dolan

Dr. and Mrs. Emil R. Dominguez, Jr.

John J. Donahoe II and Eileen E. Chamberlain

Drs. Eric D. and Marleen B. Donnenfeld

Mr. and Mrs. Liam S. Donohue

Mr. and Mrs. D. Brian Dorsey

Meggin L. Dossett and Joshua Tuohy

Vincent J. Dowling

Mr. and Mrs. Robert N. Downey

John C. and Helen E. Downing

Patricia M. Doykos

Mr. and Mrs. Allan M. Doyle, Jr.

Dr. David Doyle

Dr. Laurie F. Draughon

Diane and Sam Dugan

Mr. and Mrs. William P. Dunk

Drs. Keith R. and Katherine K. Dunleavy

Gail I. Durant

Drs. Brian G. and Jean E. Dwinnell

Drs. Diane Dwyer and Joseph Gall

Mr. and Mrs. Robert W. Eames

Dr. Wendy L. Osterling Eastman and Jack Eastman

Katie Eaton

Mr. and Mrs. Robert J. Eckenrode

Lewis M. Eisenberg

Drs. R. Mark Ellerkmann and Ariane Cometa

Dr. and Mrs. Robert M. Ellsworth

Mr. and Mrs. Edward E. Emerson, Jr.

Tom Endyke

Otto A. Engelberth

John S. Engelman

Stephen Ensign

Dr. Marjorie A. Erickson

Mr. and Mrs. Joel C. Eshbaugh

Mr. and Mrs. Charles C. Evangelakos

Mr. and Mrs. Daniel S. Evans

Mr. and Mrs. Edwin D. M. Evarts

Mr. and Mrs. George H. Evarts

Mr. and Mrs. Peter M. Fahey

Mr. and Mrs. Harlan W. Fair

Russell and Carol Faucett

Charles and Charlotte Faulkner

Violetta and Quentin Faulkner

Mr. and Mrs. James N. Fawcett

Mr. and Mrs. Barry M. Feinberg

Dr. John D. Feldmann

Mr. and Mrs. Craig Ferguson

Mr. and Mrs. Philip J. Ferneau

Aubrey and Tina Ferrao

Julie and Randy Fields

Mr. and Mrs. Robert J. Fieldsteel

Drs. Elliott Fisher and Nan Cochran

Ryan M. Fitzsimons

Dr. and Mrs. Timothy P. Flood

Mr. and Mrs. Douglas C. Floren

Lila May W. Flounders

Patrick J. Flynn

Mark Formica and Linda Brunini-Formica

Susan and Don Foster

Dr. Diane Louise Fountas

Joan P. Fowler

Jonathan R. Fox

David T. Foy

Marjorie L. Frenette

Mr. and Mrs. Calvin W. Frese

Dr. and Mrs. Allan R. Frost

Drs. M. Allen Fry and Jennifer J. Brokaw

Carolyn and Milton Frye

Dr. and Mrs. Freddie Ho Keung Fu

Elizabeth H. Fuller

Dr. Ann Furtado

Mr. and Mrs. Vincent J. Fusca III

Dr. Imre Gaal, Jr.

Dr. Stephen J. Galli

Mr. and Mrs. Dale N. Garth

Dr. Theodore H. Gasteyer II

Dr. Marc Gautier and Sarah H. Davie

Victoria P. Geduld

Richard Geisler

Dr. and Mrs. Jay D. Geller

Dr. and Mrs. George P. Gewirtz

Dr. Majid Ghazi and Tahereh Keshavarz

Dr. and Mrs. Steven Gillis

Gertrude M. Goff

Mr. and Mrs. Daniel A. Gold

Maya D. Goldschmidt

Mr. and Mrs. Jeffrey P. Goodell

Dr. and Mrs. David C. Goodman

Dr. Jane S. Gore

INDIVIDUALS (continued)

Learn more about giving to Dartmouth-Hitchcock and the Geisel School of Medicine at http://giving.dartmouth-hitchcock.org. 31

Dr. E. Ann Gormley and Richard Wallace

Mr. and Mrs. Wayne G. Granquist

Mr. and Mrs. Robert J. Grappone

Liz and Alex Gray

Mark R. Green

Dr. and Mrs. Jonathan A. Greenberg

Russell J. Greenberg

Mr. and Mrs. Richard F. Greene

Estate of Robert J. Greene

Dr. and Mrs. Jeffrey S. Greenwald

Kathy and Judd Gregg

Drs. Todd Grey and Lorraine Szczesny

Julia N. Griffin and John A. Steidl

Wayne J. Griffin

Hugh and Shana Griffiths

Mr. and Mrs. Alfred L. Griggs

Robert T. Grimley

Martin L. Gross and Deirdre M. Sheerr-Gross

Douglas M. Grossman

Mary Lou Guerinot and C. Robertson McClung

Drs. Margaret F. Guill and Marshall A. Guill III

Mr. and Mrs. Mark S. Gullotti

Jocelyn Fleming Gutchess

Paul and Veronica Guyre

Tuan Ha-Ngoc

Harold Haddock, Jr.

Dr. Tenagne W. Haile-Mariam

Jeffrey E. Hale

Phyllis A. Pierce Hale

Barbara F. Hall

Reverends Lyle and Lisbeth Hall

Robert S. Halper

Tish and Roger Hamblin

Patricia Hamel

Mr. and Mrs. William J. Hamilton

Dr. and Mrs. Charles Hamlin

Alice F. Hance

Mr. and Mrs. Stephen L. Handley

Susan Hanifin and Kevin Cotter

Philip J. Hanlon and Gail M. Gentes

George Hano

Hanson Family

Janet T. Hanson

Dr. and Mrs. (deceased) Russell W. Hardy, Jr.

Josie Harper

Dr. and Mrs. Allan C. Harrington

Mr. and Mrs. Roby Harrington III

Chip and Wendy Harris

Dr. Leslie L. Harris

Mr. and Mrs. Philip D. Harrison

Dr. and Mrs. James M. Hartford

Lori R. Hartglass and Ralph J. Schwan

Meryl D. Hartzband

Jeffrey Hastings and Kathy Emery-Hastings

John H. Hatheway

Monte and Jane Haymon

Guy B. and Teresa R. Haynes

Drs. Arthur P. Hays and Eugenia T. Gamboa

Mr. and Mrs. James J. Healy, Jr.

Dr. and Mrs. John A. Heaney

Estate of Alan G. Hearn

Dr. Anne M. Hebert and John P. Cooke

Thomas A. Hedges

Mr. and Mrs. George P. Heinrich

Dorothy Behlen Heinrichs and Jay A. Heinrichs

Marian Heiskell

Dr. Bonnie Henderson and Edward Henderson

Mr. and Mrs. Timothy J. Herbert

Ned E. Herrin

Derik Hertel

Mr. and Mrs. John H. Hewitt

Robert A. Hickin

Dr. Simon C. Hillier and Kimberley Hillier

Maureen M. Hirtle

Mr. and Mrs. Jeremy P. Hitchcock

William R. Hively and Helen D. Skeist

Mr. and Mrs. David G. Hobart

Mr. and Mrs. David P. Hochman

Caroline J. Hoen

Dr. Eric K. Hoffer and Anne W. Gordon

Mr. and Mrs. Earl T. Hoffman

Drs. Pamela M. and Marc Hofley

Russell A. Holden

Estate of Helen H. Holland

Mr. and Mrs. Robert D. Holley

Dr. Alison Holmes and Michael Holmes

Mr. and Mrs. J. Kimpton Honey

Robert and Stephanie Hood

Drs. P. Jack Hoopes and Vicki Scheidt

Dr. Harriet W. Hopf and Leo M. Hopf

Walter R. Horak

Dr. John Houde and Jennifer Rybeck Houde

Deanna S. Howard

Dr. Jiong-Ming Hu and Yi-Jun Chen

Mr. and Mrs. John A. Hubbard

Robert P. Hubbard

Thomas and Julia Hull

David S. Hume, Jr.

Kelly and André Hunter

Matt Hurley

Charles and Elva Hutchinson

Mr. and Mrs. Arthur H. Hutton

John G. Hutton, Jr. and Dorothy M. Warren

Dr. and Mrs. John W. Hyland

Dr. Thomas W. Irvine

Mr. and Mrs. Robert H. Irwin

Dr. and Mrs. Mark A. Israel

Mr. and Mrs. Thomas C. Israel

Marge and Ward Ives

Marisa Jackson

Dr. and Mrs. Ross A. Jaffe

Mr. and Mrs. Daniel P. Jantzen

Mr. and Mrs. Christopher T. Jenny

Mr. and Mrs. John A. Jesser

Dr. David G. Johnson

Ellen Foscue Johnson

Dr. Paul B. Johnson and Joan Eckberg

Dr. and Mrs. Stephen J. Johnson

Tony and Linda Johnson

Bob and Lynn Johnston

Mr. and Mrs. A. Wilson Jones

Arthur and Barbara Jones

Kim and Stephen Kantor

Dr. and Mrs. Bertrand P. Kaper

Drs. Catherine and Samuel L. Katz

Deke and Nancy Kaufman

Dr. and Mrs. Haig H. Kazazian, Jr.

Al and Jo Keiller

Dr. E. Lynne Kelley and Charles F. Kelley

Dr. Elizabeth A. Kelley and Robert H. Dumanois

Drs. Michael S. and Nancy G. Kelley

Dr. James V. Kelsey

Preston T. and Virginia R. Kelsey

Ann D. Kent

Dr. Carolyn Kerrigan and David Greenwood

Dr. and Mrs. Walter C. Kerschl

Dr. and Mrs. Richard I. Kertzner

Drs. Thomas J. and Rebecca L. Kesman

Drs. William M. and Cynthia Nichols Kettyle

Anne M. and Donald A. Keyser

Robin Kilfeather-Mackey

Robert D. Kilmarx

Mr. and Mrs. Kevin B. Kimberlin

Bruce and Mary King

Mr. and Mrs. Davis B. Kitchel

Frederick P. Koallick

Dr. and Mrs. James Kolb

Barbara and Eugene Kopf

Ella M. Korenman

Dr. and Mrs. Thomas S. Kosasa

Mr. and Mrs. Mark Koulogeorge

Posy and John H. Krehbiel

Sarah J. R. Krimmel

Thomas R. Kuhns, M.D.

Dr. Benedikt Kurz and Sandia Wang

Andrea Lacey

Drs. John M. and Margaret J. Lagnese

Drs. David R. Lambert and Andrea S. Hinkle

Mr. and Mrs. John R. Lamoureux, Jr.

David Lancaster

Laura K. Landy and Robert P. Corman

Lorena R. Laprade and Gary A. Florucci

Drs. Laurie and John (deceased) Latchaw

Estate of Edward Connery Lathem

Chip and Gayle Lawrence

James S. Lawrence

Drs. Peter F. and Karen R. Lawrence

Carola B. Lea

Constance C. Leahy

Mr. and Mrs. David P. Leatherwood

Dean Francis LeBaron

Mr. and Mrs. Stephen J. LeBlanc

Dr. and Mrs. T. David Lee, Jr.

Jane E. Lemire

Mr. and Mrs. Skip Leonard

Dr. Michael B. Leslie and Dane Rasmussen

Mr. and Mrs. Charles E. Lessard

Sue and Dick Levy

George and Dominique Lightbody

Nathan R. Linstad

Mr. and Mrs. Kenneth C. Lippmann

Don Livingston

Dr. Granville L. Lloyd

Noam Lockshin and Lauren Gottlieb

Dennis and Marcella Logue

INDIVIDUALS (continued)

32

Dolan Family Foundation: Compassion in Every Step

Medicine is on one hand a science-based practice and on the other hand a deeply humanistic profession. Integrating these two sides with compassion as the central guiding philosophy is the goal of a new initiative at the Geisel School of Medicine. Funded by a generous grant from the Dolan Family Foundation, the effort aims to infuse compassion-centered medicine into all aspects of training for Geisel medical students and residents, as well as nurses, chaplains, social workers and other health trainees at Dartmouth-Hitchcock. “We would like our message of ‘compassion in every step’ to be resonant in the minds and speech of each one of our providers, as well as deeply integrated throughout our institutions,” said the late Pano Rodis, MD, who initiated the project with Joseph O’Donnell, MD, senior advising dean at the Geisel School.

Dr. Matthew P. Longnecker and Stephanie J. London

Jean T. Longpre (deceased)

Drs. Jennifer J. Loros and Jay C. Dunlap

Michael and Nancy Loucks

Mr. and Mrs. Douglas M. Loudon

Irene R. Lover

Drs. Klaus and Patricia Lubbe

Dr. Maria Joan Lui

Bud and Terri Lynch

Mr. and Mrs. Daniel T. Lynch

Mr. and Mrs. Dennis P. Lynch

The Hon. John H. Lynch and Dr. Susan E. Lynch

Prof. and Mrs. Robert M. Macdonald

Shawn MacIver

Mr. and Mrs. Thomas H. MacLeay

Dr. and Mrs. Abraham J. Madkour

Dr. and Mrs. Donald A. Mahler

David and Ann Malenka

Dr. Lisabeth Maloney and Joseph Maloney

Dr. Alan J. Mandel

Carla Manley-Russock and Robert Russock

Mr. and Mrs. Daniel J. Marchetti

Mr. and Mrs. Gordon L. Marshall

Therese and Jeffrey Marshall

Drs. Howard Martin and Donna Ambrosino

Drs. Meredith A. Martin and Thomas L. Treadwell

Michael D. Martin

Mr. and Mrs. Peter B. Martin

William and Judith Martin

W. William Martinez and Marie M. Pomainville

Dorothy J. Matthews

Drs. Jennifer L. R. and Peter L. Mayer

Buckley McAllister and Beth Morrow

Tom and Victoria McCandless

Katherine McCormack

Drs. Martha Dawes McDaniel and Stephen K. Plume

Dr. John E. McGillicuddy

Dr. John E. McGowan, Jr.

Dr. and Mrs. Charles A. McKay, Jr.

Martha McLafferty and Jonathan Skinner

Dr. and Mrs. Michael H. McLaughlin

Peter McLaughlin and Jane Kitchel McLaughlin

Wilbur F. McLean, Jr.

Daniel W. McNeill

Olivia Meek

John S. Mehler

Dr. Vincent A. Memoli

Dr. and Mrs. Edward Merrens Geisel medical students, like Shelsey Weinstein ’16, are

learning the art of compassion-centered medical care with the help of patients like Dia Draper, a cancer survivor.

INDIVIDUALS (continued)

3333

Missy Project: Bringing Aneurysm Care Closer to Home

Patients diagnosed with brain aneurysms no longer have to travel long distances to access neurovascular expertise at Dartmouth-Hitchcock (D-H). Thanks to funding from the Missy Project — a foundation named for 12-year-old Marisa “Missy” Magel, who lost her life to an aneurysm — D-H now offers a neurovascular telemedicine program overseen by neurosurgeon Robert Singer, MD, and Sarah Pletcher, MD, director of D-H’s Center for Telehealth. During virtual aneurysm clinic visits, Singer talks to patients face-to-face using real-time video. “I’m looking at imaging, explaining pathology and then giving an opinion as to what the next step is,” he says.

The D-H program also includes urgent 24/7 tele-consultation to community hospital emergency departments. “I believe it’s going to save a lot of lives,” says Mary Magel, executive director of the Missy Project.

Dr. Robert Singer conducts a telehealth consult with a patient who is many miles away.34

Mr. and Mrs. Peter C. Mertz

Drs. Gregg Meyer and Bonnie Blanchfield

Mr. and Mrs. Robert S. Meyer

Michael and Deborah Meyers

Mary Page Michel and Michael Morrill

Mr. and Mrs. Daniel W. Miley

Dr. and Mrs. Donald W. Miller, Jr.

Kurt H. Miller

Mr. and Mrs. Marc Milowsky

Mr. and Mrs. Stephen E. Milstein

Mr. and Mrs. Dennis B. Mitchell

Dr. and Mrs. Richard M. Moccia

Dr. and Mrs. John F. Modlin

F. Corbin Moister, Jr.

Dr. Kenneth Moller III and Tracey Burton

Dr. and Mrs. Paul M. Montrone

Dr. and Mrs. Jason H. Moore

Mr. and Mrs. Roger S. Moore

Dr. and Mrs. John M. Moran

Robert M. and Jessica Rowse Moran

Mr. and Mrs. Richard G. Morgan

Nancy L. Morrell

Dr. Michael F. Morris

Winifred W. Morrissey

Drs. Richard A. and Christie L. Morse

Michael S. Morton

Eleanor Mudge

Dr. Sharon M. Mullane

Randall C. Mullen

Dr. and Mrs. Albert G. Mulley, Jr.

Anthony Mure

Miles and Patrice Mushlin

Mr. and Mrs. Gary A. Myers

Thomas and Christy Nault

Charles E. Nearburg

Dr. and Mrs. D. Dirk Nelson

Dr. Elizabeth Nelson

Dr. and Mrs. Eugene C. Nelson

Eunice P. Nelson

Linda L. Nelson

Dr. Georgia L. Newman and David P. Young, Ph.D.

Mr. and Mrs. Peter A. Nieves

Mr. and Mrs. John A. Niles

Dr. and Mrs. Brian W. Nolan

Linda D. Norman

Dr. Mark R. Northfield

Mark and Peggy Notestine

Ellen M. Oberkotter

Judy and Kip Oberting

Dr. Jeanne E. O’Brien and Brian Leary

Mr. and Mrs. Donald L. O’Bryant

Rob and Teresa Oden

Dr. and Mrs. Joseph F. O’Donnell, Jr.

Dr. and Mrs. Makio Ogawa

Thomas A. O’Grady

Dr. and Mrs. Ernst M. Oidtmann

Dr. George D. Olsen and Deborah M. Olsen

Dr. and Mrs. Marvin J. Ordway

Dr. P. Pearl O’Rourke

Peter R. Orszag and Bianna Golodryga

Estate of Dr. Barbara M. Osborne

Daniel and Pamela O’Shaughnessy

David and Mary Otto

Marilyn M. Paganucci

Mr. and Mrs. J. Brian Palmer

Mr. and Mrs. Jeremiah A. Palmer

Dr. and Mrs. Steven Paris

Dr. and Mrs. George W. Parker

Dana Patterson 1991 Revocable Trust #1

Mr. and Mrs. Wayne A. Pauley

Dr. and Mrs. Francis J. Pauli

Dr. and Mrs. Norman C. Payson

Rick and Claudette Peck

Dr. Vincent D. Pellegrini, Jr.

Abbie and Don Penfield

Drs. Susan M. Pepin and Anthony J. Dietz

Frances Pepper

Dr. and Mrs. Nick P. Perencevich

Kimberly M. Perez

Dr. Raymond P. Perez

Dr. Loryn W. Peterson

Dr. and Mrs. Ervin Philipps

Dr. and Mrs. William G. Phippen

Liz and Bill Pierce

Winthrop Piper

Mr. and Mrs. V. James Polus

Dr. Misty Blanchette Porter and Thomas Porter

Mr. and Mrs. Randall S. Poulin

Dr. and Mrs. Elliot D. Prager

Scott Prager

Patricia and Herbert Prem

Mr. and Mrs. Christopher Provost

Anne L. Putnam

Jane Quale

Keith Quinton and Barbara Fildes

K. Philip Rahbany

Dick and Sallie Ramsden

Earl Ransom and Amy Huyffer

Mr. and Mrs. J. Irving Rawding

Francena and Roy Raymond and Family

Signa L. Read

Andrea Reimann-Ciardelli and Dr. Thomas L. Ciardelli

Mr. and Mrs. Jeffrey T. Reisert

Drs. Glenn Rennels and Margaret Forsyth

Mr. and Mrs. Philip C. Rentz

Mr. and Mrs. Eric C. Resnick

Grant and Jo Reynolds

Mr. and Mrs. James A. Reynolds

Dr. and Mrs. Jason E. Reynolds

Dr. John E. Richards, Jr.

Peter M. Richards

Mr. and Mrs. Scott C. Richbourg

Margaret and Matt Rightmire

William and Sharon Risso

Dr. and Mrs. Andrew B. Roberts

Dr. and Mrs. David W. Roberts

Mr. and Mrs. Kenneth D. Roberts

Mr. and Mrs. Thomas R. Rochester

Dr. and Mrs. Bradley M. Rodgers

Linda and Rick Roesch

Jill and Gary Rogers

Dr. and Mrs. Leland E. Rogge

Dr. and Mrs. Scott W. Rogge

Peter D. Roos

Dr. Joseph M. Rosen and Stina L. Kohnke

Mr. and Mrs. David A. Rosenblum

Mr. and Mrs. E. John Rosenwald, Jr.

George M. Rountree and Kendall L. Hoyt

Mr. and Mrs. Daniel S. Rowell

Samuel B. Rowse

Drs. Alan A. Rozycki and Diane Kittredge

Fred and Joan Rueckert

Dr. and Mrs. Robert M. Rufsvold, Jr.

Aaron Ruiz

Elizabeth Ruml

Elisabeth W. Russell

Gordon W. Russell

Peter L. Rutledge

Drs. Stephanie Z. and Stephen R. Ruyle

Dr. Eva M. Rzucidlo

Prof. M. Anne Sa’adah

Dr. Joyce A. Sackey-Acheampong and Kwaku J. Acheampong

Brady J. Sadler

Mr. and Mrs. Biria D. St. John

Orson L. St. John, Jr.

Lori A. Saleski

Mr. and Mrs. David J. Saltman

Drs. Nina Sand-Loud and Keith J. Loud

Dr. and Mrs. John H. Sanders, Jr.

Mr. and Mrs. Frank Sands

Dr. Margaret A. Satchell

Mr. and Mrs. Richard Sayles

Dr. James Scharback and Gail Weiner

Timothy C. Scheve

Mr. and Mrs. John T. Schiffman

Lisa and Daniel Schimmel

Mr. and Mrs. Mark C. Schleicher

Mr. and Mrs. Ronald B. Schram

Steven and Sandra Schubert

Anne Schuchat

Drs. Gary and Lynn Schwartz

Mr. and Mrs. Robert L. Schwartz

Dr. and Mrs. Joseph D. Schwartzman

Robert T. and Joan M. Scott

Dr. and Mrs. Samuel S. Scott III

Mr. and Mrs. Walter A. Scott

Mr. and Mrs. Thomas A. Scully

Dr. and Mrs. Dilip K. Sengupta

Mr. and Mrs. Michael S. Shannon

Estate of Nancy Shea

Drs. Matthew L. and Janet C. Sherman

Betty F. Shoemaker

Rick and Shelly Shreve

Drs. Christopher R. and Margaret A. Shuhart

Mr. and Mrs. Andrew C. Sigler

David Sigler

Dr. Bruce Sigsbee

Barbara and Donald Silver

Susan and Clayton Simmers

James F. Simmons

Dr. and Mrs. Robert J. Singer

INDIVIDUALS (continued)

Learn more about giving to Dartmouth-Hitchcock and the Geisel School of Medicine at http://giving.dartmouth-hitchcock.org. 35

Mr. and Mrs. John M. Skotnicki

Dr. Barry D. Smith

Dale and Kathy Smith

Diane L. Smith

Drs. Hugh C. and Aynsley M. Smith

Mr. and Mrs. Nathaniel A. Smith

Mr. and Mrs. Austin L. Smithers

Gary D. and Lisa L. Snyder

Arthur P. Solomon and Sally E. Lapides

Dr. and Mrs. Wiley W. Souba, Jr.

Mr. and Mrs. John T. Souther

Mr. and Mrs. David P. Spalding

Mr. and Mrs. Charles H. Spaulding

John Spellman and Cindy McCollum

Richard Spencer

Drs. Mark E. Splaine and Joyce A. DeLeo

Mr. and Mrs. David F. Springsteen

Terrance Stadheim

Mr. and Mrs. Edward H. Stansfield

Mr. and Mrs. David G. Staples

Prof. and Mrs. Vincent E. Starzinger

Mr. and Mrs. James F. Staton

Mr. and Mrs. Marshall E. Stearns

Elizabeth S. Steele

Mr. and Mrs. John L. Steffens

Dr. and Mrs. Bennett M. Stein

Dr. Harise Stein and Peter D. Staple

Jeffrey Steinkamp

Mr. and Mrs. John G. Stephens

Ken and Ilene Stern

Jane and Bill Stetson

Mr. and Mrs. Bayne Stevenson

Paul and Sandra Stewart

Matthew E. Stoller and Melissa A. Powell

R. Gregg Stone III

Dr. and Mrs. James C. Strickler

Sylvia Janice Stringos

Mr. and Mrs. Scott M. Stuart

William and Carolyn Stutt

Gladys Sullivan

William J. Sullivan

Lois H. Surgenor

Dr. Jeffrey L. Susman

Drs. Harold M. Swartz and Ann B. Flood

Mr. and Mrs. James P. Sweeney

Mr. and Mrs. Kurt M. Swenson

Dr. and Mrs. Rand S. Swenson

Drs. Mojdeh and Farhad Talebian

New Hampshire Charitable Foundation: Screen and Intervene

Asking the right questions can make all the difference when it comes to identifying risky behavior in young people. Grants from the New Hampshire Charitable Foundation, made possible by the Conrad N. Hilton Foundation, are helping D-H physicians and other caregivers throughout New Hampshire do just that. Based on screening tools developed and tested at Dartmouth-Hitchcock, the Screening, Brief Intervention and Referral to Treatment Program (SBIRT) is designed to significantly reduce substance abuse among youth, ages 12 to 22—a reduction that is desperately needed. New Hampshire has some of the highest rates of substance abuse among youth in the nation. Dartmouth-Hitchcock is working on the issue at the community level, too, through the Upper Valley Substance Misuse Prevention Network.

INDIVIDUALS (continued)

36

David and Peggy Epstein Tanner

Sheila Harvey Tanzer

Mr. and Mrs. Edward C. Taylor

Mr. and Mrs. John E. Taylor, Jr.

Lydia M. Taylor

Drs. Josephine J. and John M. Templeton

Carolyn C. Tenney

Mr. and Mrs. Stuart Tenney

Dr. Lloyd B. Tepper

Mr. and Mrs. Paul F. Terrio, Jr.

Dr. and Mrs. Charles A. Thayer

Dr. Sally B. L. Thompson

Dr. Warren G. Thompson

Mr. and Mrs. Burton J. Thurber

Ella S. Tobelman

Dr. Lisa Toffey and James Toffey

Warren J. Trace

Mr. and Mrs. Scott D. Tracy

Mr. and Mrs. Toby J. Trudel

Rebecca G. Tucker

Dr. Peter A. Tuxen

Mr. and Mrs. C. Jerome Underwood

Margaret C. Vail

Dr. James C. Vailas

Mr. and Mrs. Nicholas J. Vailas

Drs. Teresa A. Van Buren and Henry T. Sachs III

Estate of Guy W. Van Syckle, M.D.

Mr. and Mrs. Roy T. Van Vleck

A. Keith Van Winkle

David E. VanGuilder

James and Lucinda Varnum

Mr. and Mrs. Ronald D. Verge

Anne-Lee Verville

Mr. and Mrs. Drury L. Vinton

Mr. and Mrs. Peter F. Volanakis

John M. Von Bargen

David and Linda von Reyn

Glenn N. Wagner and Sally Jane Rutherford

Lucy R. Waletzky, M.D.

Heather Duggan Walker and Robert Walker

Drs. Amy E. Wallace and William B. Weeks

Claire Walton

Mr. and Mrs. Neal W. Wasserman

Allan Waters

Bruce and Marion Waters

Mr. and Mrs. Warren H. Watts

Alan W. and Robin J. Weber

Mr. and Mrs. David Z. Webster, Sr.

W. Brinson Weeks, Jr.

Mr. and Mrs. Kenneth E. Weg

Lorne Weil

Dr. and Mrs. James N. Weinstein

Dr. and Mrs. William H. Weintraub

Robin E. and Donald M. Weisburger

Dr. and Mrs. Frank M. Weiser

Mr. and Mrs. Robert J. Weissman

Mr. and Mrs. Richard A. Weissmann

Dr. H. Gilbert Welch and Linda A. Doss

Wendy A. and Robert L. Wells, Jr.

Lauren Wendel and Christopher Dougherty

Dr. David Wennberg and Anne Carney

Mr. and Mrs. William S. Wesson

Alfred and Loralee West, Jr.

Dr. Loyd A. West

Margot F. West

Dr. Robert S. Wetmore

Robert O. Wetzel

Lynne and Hunt Whitacre

Frederick E. Whitcher

Dr. and Mrs. Jon C. White

Mr. and Mrs. Peter G. Wilds

Dr. and Mrs. Christopher W. Wiley

Sally S. Wilkins

Alicia J. Willette, DDS

Jennifer A. and Stanton N. Williams

Dr. and Mrs. John H. Williams

Debra Williamson

Dr. Douglas Williamson and Leslie Williamson

Mr. and Mrs. Gordon R. Williamson

Susan K. Williamson

Dr. Marta Willoughby and Justin Willoughby

Patricia Comstock Wilson

Donald Winterton

JoAnne L. Withington

Dr. Martin Wohl and Marisa Labozzetta

Mr. and Mrs. Daniel H. Wolf

James R. Woodworth

President Emeritus James Wright and Susan DeBevoise Wright

Mr. and Mrs. Joshua B. Wright

Pamela L. Wright

Mr. and Mrs. William W. Wyman

John and Patty Xiggoros

The Yanofsky Family

Dr. and Mrs. Philip A. Yazbak

Dr. Mark P. Yeager

Kevin P. and Siobhan A. Yorgensen

Dr. and Mrs. Oglesby H. Young

Walter O. and Carole Young

Dr. and Mrs. Leo R. Zacharski

Dr. and Mrs. David S. Zamierowski

Dr. and Mrs. Douglas P. Zipes

Dr. and Mrs. Robert M. Zwolak

INDIVIDUALS (continued)

Catherine Shubkin, MD, uses standard questions to screen a young patient for risky behavior. 37

Adirondack Community Trust - Evergreen Fund

American Academy of Otolaryngology-Head & Neck Surgery Foundation

American Cancer Society

American Federation for Aging Research

American Medical Association Foundation

The Beveridge Family Foundation

Bristol-Myers Squibb Foundation

Brougher Family Foundation

Buchanan Family Foundation

Burrows Foundation

The Jack & Dorothy Byrne Foundation

C&S Charities, Inc.

The Capital Group Companies, Inc.

Children’s Fund of the Upper Valley

CHMC Anesthesia Foundation

The Commonwealth Fund

Convent General Knights of the York Cross of Honour (A Masonically Affiliated Organization)

Couch Family Foundation

Cure With Hope

Kevin Scott Dalrymple Foundation

Arthur Vining Davis Foundations

Cleveland H. Dodge Foundation

Dolan Family Foundation

Dropkick Murphys’ Claddagh Fund

Dunkin’ Donuts & Baskin Robbins Community Foundation, Inc.

Dan Duval Charitable Fund

The Fairholme Foundation

Fine and Greenwald Foundation

Fisher Cats Foundation

Flagg Foundation

Sylvester M. Foster Foundation

Foundation for Informed Medical Decision Making

Foundation for the National Institutes of Health

Francis Family Foundation

The Bill and Melinda Gates Foundation

General Electric Foundation

The Genesis Foundation for Children

William Goldman Foundation

William T. Grant Foundation

The Greater Cincinnati Foundation

The Greenspan Foundation

Grimshaw-Gudewicz Charitable Foundation

Julia and Seymour Gross Foundation

Hamill Family Foundation

Hendricks/Felton Foundation

Hypertherm H.O.P.E. Foundation

Infectious Diseases Society of America

John Hancock Financial Services Matching Gift Program

Jordan & Kyra Memorial Foundation

JustGive

Katz Family Foundation

Kiva Foundation

LeBaron Foundation

Mollie Parnis Livingston Foundation, Inc.

Lumina Foundation for Education

Lynch Family Charitable Foundation

D. Hugh MacNamee Memorial Trust Fund

Josiah Macy, Jr. Foundation

Macy’s Foundation

Thomas Marshall Foundation

Jeffrey P. McKee Foundation

Mellam Family Foundation

Merck Partnership for Giving

Moglia Family Foundation

Monarchs Care Foundation

Gordon and Betty Moore Foundation

Mt. Roeschmore Foundation

John J. Murphy Foundation

New Hampshire Charitable Foundation

Joanna M. Nicolay Melanoma Foundation

Novartis Foundation

NRO Charitable Giving

Orthopaedic Research and Education Foundation

Owens Family Foundation

Page Hill Foundation

S. Richard & Patricia R. Penni Charitable Trust

Gustavus and Louise Pfeifer Foundation

Pfizer Foundation

Point of View Foundation

Princeton Area Community Foundation

Prudential Foundation

Samuel Rosenblum Foundation

Albert J. Ryan Foundation

Salmon Foundation

The Berthold T. D. and Thyra Schwarz Foundation

Scleroderma Research Foundation

Suzanne and Walter Scott Foundation

Speedway Children’s Charities

James & Janice Stanton Foundation

Susan G. Komen for the Cure

The Sweet Peas Foundation

Fred Swymer Memorial Fund

J. T. Tai & Company Foundation

H.L. Thompson, Jr. Family Foundation

John and Evelyn Trevor Charitable Foundation

Vermont Community Foundation

Wal-Mart Foundation

Arthur K. Watson Charitable Trust

West Family Foundation

Arthur Ashley Williams Foundation

Marie C. and Joseph C. Wilson Foundation

The Woodbury Foundation

YIPPEE Foundation

FOUNDATIONS

Annual Fund A Community Action

Every year, grateful patients, community members and employees help keep Dartmouth-Hitchcock and the communities it serves strong by donating to the Dartmouth-Hitchcock Annual Fund (DHAF). Among this loyal group is Susan Cohen. “I believe in supporting organizations that take care of me and my community,” says Cohen, a retired English teacher and longtime resident of the Upper Valley. In FY2014, 3,180 donors contributed to DHAF, raising a total of $843,712. Their gifts are being put to work immediately, helping to create a sustainable health system to improve the lives of the people and communities served by Dartmouth-Hitchcock for generations to come.

38

Abbott Rental & Party Store

Abiomed, Inc.

Adimab, LLC

Adobe Systems Incorporated

Advanced Cardiovascular Imaging

Allan’s Vending Service

Alliance HealthCare Services

AllianceData

Alpha Phi Sorority

AlphaGrahics

American International Group

Amgen

Amoskeag Beverages

Anagnost Investments

ANSYS

Appalachian Housewrights, Inc.

Apple Therapy Services

Associated Grocers of New England

Autodesk, Inc.

AutoFair Group

AV3 Properties

Bank of America

Banks Chevrolet

Barbara Coburn Fine Art

Bauer Hockey, Inc.

Bayside Distributing

BaySon Company

Bedford Ambulatory Surgical Center

Bella Clothing & Shoes

Bellwether Community Credit Union

Bio X Cell

Biogen, Inc.

Blue Sky Restaurant Group

Boloco Restaurant

Booz Allen Hamilton

Boston Beer Company

Boston Medical Center Healthnet Plan

Brady Sullivan Properties

R.C. Brayshaw & Co.

Brookfield Office Properties

Buttura & Gherardi Granite Artisans

C&M Machine Products

Caldwell Law

Canary Systems

Cape Air/Nantucket Airlines

Carroll Concrete

Casella Waste Systems

Casner & Edwards

Catholic Medical Center

Centurion Insurance Group

CGI Employee Benefits Group

Chuckles, Inc.

Clear Channel Radio WGIR-FM & AM

Coca-Cola Bottling Company of Northern New England

Coldwell Banker Redpath & Company

Collision Works, Inc.

Compass Healthcare Advisers

Corning Incorporated

Covidien

Cross Insurance

Damon Insulation Corp.

Dartmouth College Class of 1958

Dartmouth Coach

Derry Sports & Rehab

Design Source

Devine, Millimet & Branch, P.A.

DCU - Digital Federal Credit Union

Direct Flow Medical

Dothan Brook School PTO

Downs Rachlin Martin PLLC

Drynk Restaurant

Durgin and Crowell

DYN, Inc.

Eastman Golf Association

Emerson Athletics

Edwards Lifesciences

Eisai Inc.

Ellen’s 1/2 Pint Farm

Elliot Hospital

Epic Systems Corporation

Evergreen Capital Partners

Executive Health & Sports Center

Fields of Vision Eye Care, Inc.

Fire and Iron Station 83

First Republic Securities Co.

Fischer Skis US

Fit Werx, Road & Triathlon Cycling Specialists

Foley Distributing

Frederick’s Pastries

FUJIFILM Dimatix

Fulcrum Associates

Game Creek Video

Garnet Hill

Gate City Electric, LLC

Gilberte Interiors

Glass and Gear/A & M Daniel, LLC

Global Forest Partners LP

Gold’s Gym

Google

Grand Chapter of New Hampshire Order of Eastern Star

Granite United Way

Great New Hampshire Restaurants

Green Mountain Coffee Roasters

Hanover Inn

Hanover Veterinary Clinic

Harvey Construction Corporation

HDR Architecture

Heiser BHC, Inc.

HHP, Inc.

J.M. Huber Corporation

HVAC Unlimited LLC

IBM Corporation

ImmuNext

Institute for Responsible Management

Irving Oil

ITDistributors

Jake’s Market & Deli

Jewett Construction Co., Inc.

Johnson & Johnson

Ken Jones, Inc.

Kendal at Hanover

Kimball Union Academy

Kimberly-Clark Corporation

ORGANIZATIONS

Susan Cohen has been giving to the Dartmouth-Hitchcock Annual Fund for almost 20 years. 39

IMAG INE

King Arthur Flour

Kinney Pike Insurance

Kiwanis Club of Manchester

Kohl’s Department Stores

Kraft Foods Group

Lafayette Fireside Inn

Lake Sunapee Bank

Lakes Region Community College Nursing Department

Latis Imports

Lebanon High School Student Activities Fund

Lebanon Paint & Decorating

Ledyard National Bank

Legacy Supply Chain Services

The Leigh Bureau

Lincoln Financial Group Foundation

Logo Loc

Los Ninos Children’s Medical Clinic

M2S

MacLean-Fogg Company

Malco Distributors of New England

Manchester High School Central

Mascoma Savings Bank

Mass Bay Brewing Company

Massachusetts Mutual Life Insurance Company

The Meat House

Medtronic, Inc.

Melanoma Research

Members First Credit Union

Memorial High School

Merrimack Mortgage Company

Milford Lumber Company and Muir Showrooms

Millennium Running, LLC

Monadnock Mountain Spring Water Inc.

Mondelez Global LLC

Monster Worldwide

Moore School - 7th/8th Grade

Morgan Stanley

Mount Moosilauke ATV Club

Mount Sunapee Resort

Mountain View Publishing

MTS Services

Municipal Resources, Inc.

MVP Health Care

Mark Myers Photography

Nashua Ambulatory Surgical Center

Nathan Wechsler & Company

New England Healthcare Engineers

New Hampshire Congress of Parents & Teachers

New Hampshire Fisher Cats

New Hampshire Football Officials Association

New Hampshire Industries

New Hampshire Musculoskeletal Institute

New Hampshire Public Television

New Hampshire Steel Fabricators

New Hampshire Union Leader

New Hampshire Orthopaedic Center

Newforma

Next Level Performance

NH Images Photography & Video

NH Treats, LLC

North Country Smokehouse

Northeast Delta Dental

O’Connor & Drew, P.C.

Ohiyesa, Inc.

Olympus Biotech

OneBeacon Insurance Group

Optima Bank & Trust

Orr & Reno Professional Association

P&G Pharmaceuticals

Palace Theatre

Partners Healthcare

Pembroke Hill School

Pepsi Bottling Group

Philadelphia Children’s Alliance

Pink Tie Productions

Planet Aid

Polar Beverages

Polartec

Precision Contract Manufacturing Image-Tek

Pro-Cut International Limited

Provider Power

Provincial Grand Lodge, U.S.A. - The Royal Order of Scotland (A Masonically Affiliated Organization)

QLLA Charities, Inc.

QVT Financial LP

Ramunto’s Brick & Brew Pizzeria

Ranstad

Ray the Mover

Red Bull North America

Resource Systems Group

The Richards Group

Ride and Ski New England

River Valley Club

Riverbend Veterinary Clinic

RiverStone Resources, LLC

Roedel Companies

RSD Real Estate

St. Denis Parish

St. Joseph Hospital

Salt Hill Pub

Sam’s Club

Service Credit Union

Sig Sauer, Inc.

Sirius American Insurance Corporation

Sirius Group

SkillSoft Corporation

SPC Marcom Studio

Spectrum Marketing

Spirit of Children Fund

The Sports Authority

State Farm

Stave Puzzles

Stewart Property Management

Sulloway & Hollis, PLLC

Systems & Communications Sciences, Inc.

Systems Plus Computers, Inc.

Target

Tasco Security, Inc.

TD Ameritrade Clearing

Team Alzheimer’s

The Point Radio Network

Thermal Dynamics Corporation

Tidewater Catering Group

Timken Aerospace

TransCanada

Trumbull Hall Troupe

Turner Construction Company

UBS Financial Services, Inc.

UBS Matching Gift Program

UCB Pharma

Unum Group

USA Gymnastics

The Utility Club of Lyme

R.L. Vallee, Inc. dba Maplefields

Vectronix

Verizon Wireless Arena

The Vermont Country Store

Vermont Mutual Insurance Company

VFW John F. Harrington Post 417

VFW Ladies Auxiliary Department of New Hampshire

Von Bargen’s Jewelry

VP Resales LLC

Wal-Mart Stores

WellPoint, Inc.

Wells River Savings Bank

WesBell Electronics

Wheelock Street Capital

Frank W. Whitcomb Construction

White Mountains Insurance Group, Ltd.

Wicks Insurance Group

Wilson Sporting Goods Company

Windows & Doors by Brownell

Women Against Prostate Cancer

Xenith

Young’s Propane

Zurich American Insurance Company

ORGANIZATIONS (continued)

40 Learn more about giving to Dartmouth-Hitchcock and the Geisel School of Medicine at http://giving.dartmouth-hitchcock.org.

IMAG INE

Imagine a health systemthat focuses on health,not just health care.

Imagine a system wherecare is based on value,not volume,

On the health of our population,not market share,

On new payment models thatreward quality not quantity of procedures,

On care that patients want and need,delivered affordably,conveniently and close to home.

Imagine a sustainable health system with one goal:to improve the lives of the people andcommunities we serve,for generations to come.

I M A G I N E

One Medical Center DriveLebanon, NH 03756603.650.5000

dartmouth-hitchcock.org

NON-PROFIT

U.S. POSTAGE

PAIDWHITE RIVER JCT. VT

PERMIT NO. 211

Imagine highlights Dartmouth-Hitchcock’s leadership role in providing the best in patient care, translational research, medical education and community service. The stories featured in this publication exemplify our mission to create a sustainable health system to improve the lives of the people and communities we serve, for generations to come.

IN THISissuePOPULATION HEALTH

Pets to humans: Advances in cancer care.

SUSTAINABLE HEALTH SYSTEM

Primary Care at the leading edge.

PATIENT STORY Telemedicine brings

health care home.

ON THE COVER Don Caruso, MD, and Lori

Guyette, RN, with a patient and her mother.

DONOR RECOGNITION ISSUE