First-Person: Dr. Timothy Jacobson
March 15, 2018
Originally from the Midwest, I completed my undergraduate degree in psychology at the University of Wisconsin. After a year at the National Institutes of Health in Maryland, I moved to Rochester, Minnesota, to go to medical school at the Mayo Clinic.
I came to Portland to do my internal medicine residency at Oregon Health & Science University (OHSU), then stayed an extra year as chief resident in internal medicine. In 2002, I entered practice with Kaiser Permanente Northwest, as a hospitalist.
In 2008, I decided to seek additional training in the field of cardiology and entered fellowship training at OHSU in cardiovascular medicine. I returned to practice at Kaiser Permanente Northwest in the Cardiology Department in 2011.
I practice as a general cardiologist, and I have special interests in cardiac imaging and advanced heart failure. My practice time is spent at the Kaiser Permanente Sunnyside Medical Center campus in Clackamas, Oregon. At our Mount Talbert clinic, I am a member of the advanced heart failure team, caring for patients with prior heart transplants and left ventricular assist devices.
At the Mayo Clinic, I was impressed by how they ran such a large integrated group practice while maintaining a focus on doing the right thing and providing high-quality care. When I was a medical student from 1994 to 1998, professors at Mayo said the worst thing were HMOs — such as Kaiser Permanente.
But when I started doing clinical rotations as a resident at Kaiser Permanente in 1999, I realized that it is actually set up exactly like the Mayo Clinic, a large integrated group practice focused on providing the right care at the right time. This is why I chose to join Kaiser Permanente after my chief-resident year and again wanted to come back when I finished my cardiology fellowship.
Here are some stats that speak to the quality of care that members are getting at the Kaiser Permanente Center for Heart and Vascular Care. I think the numbers speak for themselves:
• Blood pressure control — our members have a higher control rate than national average (88 percent vs. 61 percent).
• Our cardiac treatment and prevention methods have helped reduce serious heart attacks by 72 percent.
• LVAD implants:
• One-year survival remains 100 percent (expected 80 percent).
• November 2017 CathPCI data (measures outcomes for stent and heart attack patients):
• Risk of dying after stent is 2 percent nationally, but 1.7 percent at Sunnyside.
• Significant bleeding event after stent nationally is 3.9 percent; we’re at 0.2 percent.
• Risk of dying during bypass surgery — 2.8 percent nationally; we’re at 2.1 percent.
• Risk of dying with severe heart attack nationally 6.7 percent, we’re at 3.3 percent.
• Risk of bleeding after surgery 1.1 percent, ours is 0 percent.
•We have received a 3-star rating by STS in Isolated CABG for seven consecutive years (July 2009–June 2017).
• We have received a 3-star rating by STS in Isolated AVR for five consecutive years (July 2009–June 2017).
Here’s a story that illustrates what those stats mean to one member:
Recently, a 69-year-old powerlifter came to the hospital and told us that he continues to be a personal trainer and even set record for his age by lifting 490 lbs. He had chest pain, and was diagnosed with a heart attack. He didn’t want to have a scar on his chest and didn’t want to be out of powerlifting for very long, so we leveraged the Heart Team to decide on what would be the best course of action to meet his wishes.
We were able to take him into the Cath Lab and put in four stents. Four days after discharge he was playing softball, and two weeks after discharge he was powerlifting again.
Several months later, he came back in with chest pain, and we found that he had recurrent narrowing in one of his stents likely due to the use of nonmedical performance enhancing agents. Again, we leveraged the multidisciplinary conference help him understand the best approach to his coronary artery disease was open heart surgery. He had successful surgery and has done very well since.
The work we’re doing at the Kaiser Permanente Center for Heart and Vascular Care has a big effect on people’s lives every day.