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Re-energizing the research program in general internal medicine
and health care research is one of the goals of that division's
new chief, Joseph P. Frolkis, a 1980 graduate of the CWRU School
of Medicine who began in his new role earlier this year. 
"As the national health care focus shifts from acute illness
toward the management of chronic diseases, the research agendas
of programs in academic general internal medicine have become
increasingly relevant," Frolkis said. "These include examining
the barriers to the delivery of preventive services; exploring
the causes and consequences of disparities in health care, especially
as they affect vulnerable populations like the elderly and the
urban poor; and elucidating how the organization of health care
delivery impacts quality, cost and clinical outcomes."
Frolkis came to CWRU/University Hospitals of Cleveland's Department
of Medicine from the Cleveland Clinic Foundation, where he had
been the director of clinical operations in the section of preventive
cardiology since 1998. Prior to moving to CCF, he had a long association
with Mt. Sinai Medical Center, where he did his internal medicine
residency and was chief resident.
After completing his training, he stayed on staff, where from
1983 until 1998, he directed the hypertension control center and
lipid research center. He also was chief of the division of primary
care medicine and director of the Mt. Sinai primary care clerkship
for fourth-year CWRU medical students.
He became an assistant professor of medicine at CWRU in 1984
and today is associate professor.
UHC's division of general internal medicine comprises faculty
in three areas: hospitalists who care for patients in the hospital
and work with community physicians to manage their patients when
they are admitted; ambulatory generalists who teach medical students
and residents how to provide ambulatory and primary care and who
see patients in the Douglas Moore Center; and geriatricians.
The division also includes 11 internists and geriatricians at
the Louis Stokes Cleveland Department of Veterans Affairs Medical
Center. Frolkis hopes to recruit more clinical physicians for
each of these areas, in addition to hiring researchers in both
geriatrics and general medicine.
"Despite the increasing specialization in medicine, I strongly
feel that academic generalists are uniquely positioned to contribute
to the education of medical students and residents and to the
research mission of the medical school and university," asserts
Frolkis. "The breadth of their training makes them ideal teachers
on the general medical floors and outpatient clinics, where they
can offer a comprehensive perspective on patient care often lost
on the subspecialty units. In addition, they are the natural champions
of the advantages of continuity of care, which has been linked
not only to greater patient satisfaction but better clinical outcomes
as well."
Frolkis' own interest is in the prevention and treatment of
cardiovascular disease. A particular focus is translating the
research findings from the evolving science of vascular biology
into the modification of both traditional (cholesterol, hypertension,
diabetes) and non-traditional (C-reactive protein, homocysteine)
risk factors for vascular disease.
As a general internist, however, he is also focused on the impact
of both patient and physician non-compliance with recommended
guidelines on suboptimal clinical outcomes.
"The so-called Îtreatment gapâ is really a hidden but lethal
epidemic," Frolkis said. "When, despite broadly-disseminated guidelines
based on sound science, only 20 to 30 percent of patients are
getting to recommended targets for cholesterol and blood pressure,
we are pretty clearly continuing to lose the battle against cardiovascular
disease-consistently the leading cause of death in America."
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