Dr. Rania Habib (Host): Welcome to AHN MedTalks, an informative resource for physicians across various specialties, as we delve into the latest medical insights and best practices, ensuring you stay at the forefront of your field.

I'm your host, Dr. Rania Habib. Joining us today is Dr. Joseph Ahearn. Professor of Medicine and Chair of the AHN Autoimmunity Institute. Thank you so much for joining me today, Dr. Ahearn. I am so excited to learn more about your fabulous institute.

Joseph Ahearn, MD (Guest): Well, thanks for the invitation, Dr. Habib. I am certainly looking forward to telling you all about it.

Host: What is the AHN Autoimmunity Institute and when was it established?

Joseph Ahearn, MD (Guest): So the Institute was established in 2018, and it's a unique, actually, unprecedented venture designed to take care of patients with really any of the 100 plus autoimmune diseases we know about. So some of the unique aspects, first of all, we have actually 15 different specialties practicing in the same suite together.

Yeah, we have 16 exam and consultation rooms. And as you probably know, patients with autoimmune diseases, they can either have a systemic autoimmune disease like lupus, which can attack any organ, or an organ specific autoimmune disease, which may, for example, attack the thyroid, or the nervous system, or the pancreas, like diabetes.

And so, a patient, say, with lupus or rheumatoid arthritis would typically go to a rheumatology clinic. If they have Graves or Hashimotos, go to an endocrinologist. Myasthenia gravis or multiple sclerosis, they go to a neurologist. Well, we have brought all of those specialists together in the same suite to take care of patients with literally any of the autoimmune diseases. And, sometimes patients have more than one, so it's extremely convenient.

Host: That is fantastic.

Joseph Ahearn, MD (Guest): Yeah, we're, really proud of it. And there's another unique aspect that goes along with this. We have no physician offices, no traditional physician offices. Instead, we have what we call a huddle hall. So it's a hallway, a corridor, so to speak, that surrounds the entire suite. And that's where all the specialists and the support staff, they gather, they communicate, they collaborate actually in real time while the patient is sitting there.

Host: Wow.

Joseph Ahearn, MD (Guest): So they've, they're able to touch base, a rheumatologist talks to a nephrologist about the patient's kidneys. And then they can really go back and give a concerted opinion to the patient while they're actually still in the office.

Host: Wow. This institute sounds unprecedented and unique in the world, and you've highlighted a few aspects that distinguish your institute from others, but why else would you say your institute is so unique?

Joseph Ahearn, MD (Guest): Yeah, so the third aspect, which what amplifies really the unique structure and approach, is we have a care transformation team. These are four specialists who address the care needs of autoimmune patients that typically fall through the cracks. So, we have a clinical pharmacologist, an expert in, in, in drugs and vaccines. Patients often juggle many, many different prescriptions. They don't know the side effects, the interactions. So, we have the clinical pharmacologist. We have a nutrition expert. These days, as you know, patients are more and more aware and concerned about what they eat, how it affects their disease, how it affects their treatment.

So, we have a nutrition specialist. We have a social worker. And then we have a behavioral health specialist. So a recent study identified more than half of patients with an autoimmune disease have anxiety, depression, profound fatigue, and this is usually not addressed. There's no time for providers to ask about these complicated manifestations, these secondary aspects. So we have a behavioral health specialist, extremely popular among our patients, who can address these typically overlooked and or ignored, usually the patients don't even bring them up.

So that's been popular. And then, along with all of this, obviously we have all the medical records in a single location. So when patients come to schedule a new appointment, we require that they collect all of their medical records because they often have many years of complicated histories with many specialists. That's usually the hardest part of making the appointment actually is getting those records because they're all over the city, sometimes the country. So we have them all in one location. So, all together. There's been a labor of love and the patients have embraced it thoroughly.

Host: You can tell, and you know, one of the hardest parts of diagnosing autoimmune diseases is like you said, they can have symptoms from so many different groups. So I love the fact that you're bringing all these specialists into one group and they can speak to each other because as you know, it's very difficult to get two physicians on the phone to speak about a patient. So this is fantastic.

Joseph Ahearn, MD (Guest): Exactly. And, for example, secondary manifestations, many of our patients have headaches. They may have had headaches for years, migrainous or otherwise. Well, we have a neurologist who's a headache specialist. And that's support we can provide.

Host: And I love the fact that you're focusing on behavioral health, nutrition, you have the social worker there. These are all elements that like you said, fall through the cracks. So obviously you are offering a very holistic care to patients. What about those beyond the Pittsburgh geographic region?

Joseph Ahearn, MD (Guest): Yeah, good question. So, we have actually cared for patients now from 40 different states.

Host: Wow.

Joseph Ahearn, MD (Guest): Yeah, in the continental U. S., we have many patients coming from California, New York State, and north as far as Montana, and down to Texas and Florida. We even have patients coming from Alaska, Hawaii, and we're very proud of the fact that our patient from Alaska said there that she's coming back for all of her appointments.

Host: Oh, wow. That definitely speaks volumes about the level of care that you're offering within your institution.

Joseph Ahearn, MD (Guest): Well, you know, it's a common story the patients give us. They have been to many providers, many different specialists, and they still don't know what's wrong with them or the therapy's not working. And I could almost write the script for them. It's so common that, there is obviously a great need for what we're doing.

Host: Oh, absolutely. And we can all think of those patients that had all these bizarre symptoms and just had to see every single specialist under the sun until they got a diagnosis. So I really do think your holistic approach and this multidisciplinary approach that you're offering at your institute is going to help those patients get to a diagnosis so much quicker, which is wonderful in and of itself. Beyond the holistic care you offer patients, is the AHN Autoimmunity Institute conducting research that might benefit patients in the immediate future?

Joseph Ahearn, MD (Guest): Sure. We absolutely are. And I've been actually conducting research for many decades, and we're at the point now where we're actually delivering discoveries to the patient at the bedside.

Host: Wow.

Joseph Ahearn, MD (Guest): Two primary areas our research focuses on, one is, as you mentioned, the difficulty in diagnosing these diseases, they are still require, it's a blend of art and science.

So you need the artistic physician with the knowledge base, the experience to evaluation, evaluate the patient's history, their physical exam, and then you need the blood tests, the imaging. But it's inexact, as we know, and we see so many patients who have misdiagnosed. So, eventually, largely if not exclusively, diagnosis is going to be scientific.

So that's what we've been focusing on. And we've actually discovered and brought many diagnostic tests to the patients that are now used across the country by rheumatologists and others. So we're excited about that. And the other area we're working on in research is conducting cutting edge clinical trials. So novel potential therapeutics for patients with lupus or inflammatory bowel disease, et cetera.

Host: Oh, that's fantastic. Who might benefit from care at the AHN Autoimmunity Institute? And as a healthcare provider, who might I refer for evaluation?

Joseph Ahearn, MD (Guest): Sure. So, we don't have a strict recipe on who provides care to the patients. So, some patients come and they're referred by their provider. It's a one time, they might be coming from Texas and they want another opinion, and we give them a one time potential diagnosis, a Therapeutic Plan, and then they go back to their referring physician and they continue there.

Some continue their care with us, but I would say it could be someone who's been diagnosed with an autoimmune disease, someone who's suspected of having an autoimmune disease. But they're not sure. We have patients, they're told it's in their head or they have an autoimmune disease and they really don't. It goes both ways.

Someone with multiple autoimmune diseases. It could be lupus and Sjogren's, Hashimoto's. It could be someone with a undiagnosed multisystem disease that they're not sure if it's autoimmune or not. It could be a patient who's not responding to their therapy. The diagnosis is correct, but the therapy is not quite right.

So those are some of the types of patients we commonly see.

Host: That's fantastic. Now, are patients able to self refer?

Joseph Ahearn, MD (Guest): They absolutely are. And we're trying to be patient centric, patient sensitive, and model ourselves after the hospitality industry, so to speak. And right from when patients check in to check out, even before that, when they call to make an appointment, we really have a top notch team from start to finish.

So, whether it's a physician referring a patient or a patient self refer, which often happens, we have a patient concierge and her name is Laura. And, Laura, I apologize for giving out your number, but I'm going to do it, it's 833 242 8246, and that's actually her, I believe it's her mobile number. And so she might not answer immediately because she gets inundated, but she will get back to you. And, that's the way to do it.

Host: No, I appreciate it. And thank you for providing that number to be able to schedule an appointment. But walk me through the referral process. Let's say I'm a physician or provider who wants to send a patient to your institution. How do we make that happen?

Joseph Ahearn, MD (Guest): Sure. So I would say you, you will call that number and let's say it's a local patient. Maybe they're being cared for locally and they want to come to either transfer their care or seek another opinion. They would call Laura and let's say they're pretty, they're confident what their diagnosis is. Maybe it's rheumatoid arthritis and they're on therapy and they want to come and see a rheumatologist and maybe our transformation team. Laura, would schedule that.

Now let's say a patient, and this again happens frequently, a patient in California. And they've been all over, they've been through the California health system, and they read about us, they want to come, and they send their records, and they're complicated. Well, I will call that patient. Laura will ask for the records, as I mentioned earlier, and I will review them myself.

I will call that patient. Sometimes I talk to the patient. Sometimes it's a family member, if they prefer, like a husband or wife. And I will ask them, okay, why do you want to come? I reviewed your records. And then I would suggest to them who they might see while they're here, how long they might want to spend here.

And then we go from there. So it really is customized. There's no rigid process.

Host: That is fantastic. So you've walked us through the referral process, how to schedule an appointment, but I'd love to hear a little bit more about the patient experience. Once a patient schedules that initial appointment, what happens? And I know you highlighted a little bit about that custom care, but I'd love to hear a little bit more about their experience.

Joseph Ahearn, MD (Guest): Well, I have an entire book of testimonials to be honest. We just conduct exit interviews. And I'm sure you've heard about Press Ganey. We do Press Ganey. We also conduct our own exit interviews in real time while the patient's there. And literally 98 plus percent of patients are extremely satisfied, you know, the top scale, and would refer someone else for their care. So that's in terms of statistical numbers, but

Host: Mm-hmm.

Joseph Ahearn, MD (Guest): Dr. Habib, I tell you, it brings tears to my eyes, some of the testimonials that these patients write. They might come from family members, spouses or parents or children, and they describe what they've been through and I would say the most common comment is I just want to thank you for listening.

Host: Oh, absolutely.

Joseph Ahearn, MD (Guest): That is, that is, you know, this is the first time someone actually listened to me. And, these can be complicated diseases and it's really heartwarming and our team realizes there was a need and we really nailed it. It's been overwhelmingly satisfying for us.

Host: Oh, absolutely. You know, I'm a pediatric cleft and craniofacial surgeon, so most of our care is multidisciplinary. So I love the fact that you have taken that multidisciplinary approach and really applied it to these extremely complicated autoimmune patients who really do need care from different specialists.

So we really thank you for this valuable information. You've developed a very unique, holistic center that is, has a very impressive multidisciplinary approach for autoimmunity at AHN. What are some of the take home points you would like to stress for the audience?

Joseph Ahearn, MD (Guest): I think number one is we are here for you. And for the physicians, these are undoubtedly complicated patients and we don't always have the answers. And we don't always put a label on patients. We don't go by the textbook always. But we're here to treat the disease and care for the patient and to help providers in their journey with their patients. That's really the bottom line, I would say.

Host: Oh, it's fantastic, and it's very impressive all the work that you and your team are doing at your institute. We appreciate your expertise so much, Dr. Ahearn. Thank you for joining us today.

Joseph Ahearn, MD (Guest): Well, thank you for your time, Dr. Habib.

Host: Thank you for listening to this edition of AHN MedTalks. To learn more or to refer a patient, please call 844-md refer. That's 844-MD r e f e r, or visit ahn.org. I'm Dr. Rania Habib. Wishing you well.