Joslin Profile - James L. Rosenzweig, M.D.
As Director of Disease Management at Joslin Diabetes Center, Dr. Rosenzweig is responsible for the development of diabetes disease management programs and the supervision of managed care programs at Joslin Clinic. He is currently supervising the development and testing of a program in the Boston area between Joslin and Beth Israel Deaconess Medical Center to help primary care physicians improve the care of their patients with diabetes. In addition, he is supervising the implementation of Joslin’s Web-based risk stratification system in a network of diabetes clinics in Mississippi in collaboration with the University of Mississippi. Dr. Rosenzweig is also an Assistant Professor of Medicine at Harvard Medical School. He serves as Chairman of Joslin’s Clinical Oversight Committee, the body responsible for the development, review and approval of all of the clinical guidelines and medical technology protocols used by Joslin Diabetes Center and Joslin Clinic. He also serves as Chairman of the Joslin Committee on Human Studies (IRB). Dr Rosenzweig has a B.A. from Yale University and an M.D. from the Yale University School of Medicine. He has been at Joslin for over 18 years.
Dr. Rosenzweig has served as Chairman of the Operations Group of the National Diabetes Quality Improvement Alliance, the major organization responsible for developing and maintaining nationally recognized performance measures for the care of patients with diabetes. He serves as a member of the Operations Work Group and Diabetes Work Group of the Physician’s Consortium for Performance Improvement, sponsored by the American Medical Association. He is a member of the Endocrine Society’s Clinical Guidelines Committee, which is responsible for writing and approving all clinical guidelines promoted by The Society. He has served on the workgroup for standardization of diabetes definitions for HCFA and the Performance Measurement Coordinating Council Clinical Logic Work Group on Diabetes for NCQA, CMS and AMA. He was also a member of the Review Committee for the Medicare Case Management Demonstration Project for Diabetes. Dr. Rosenzweig is a member of the Diabetes Management Practice Improvement Module Committee for American Board of Internal Medicine, which is in charge of setting standards for accreditation of physicians for care of patients with diabetes. He also served on the Diabetes Technical Expert Panel of the Doctor’s Office Quality Project, sponsored by the Centers for Medicare and Medicaid Services (CMS), which is developing a measurement model for assessing the quality of care provided in physicians’ offices.
Dr. Rosenzweig has published a number of original reports, reviews, book chapters and abstracts. Most recently he has developed a stratification system for patients with diabetes according to severity of illness and care requirements and used it to correlate severity of illness with total medical and pharmaceutical costs of care. Patients who were in multiple high and very high risk categories had dramatically increased medical care costs, as much as tenfold those of patients who were in none of these categories. His most recent results show that a diabetes specific risk stratification system related to required care intensity can be used to identify patients with high medical care costs, and enable care providers to select patients for case management and triage into specific care programs.
Dr. Rosenzweig has lectured on disease management and risk stratification of patients with diabetes at national meetings of the American Medical Association, the Endocrine Society, the American Diabetes Association, the National Managed Health Care Congress and the Physicians’ Consortium for Performance Improvement. He has been a plenary speaker at national meetings of renal healthcare physicians and renal specialists for the Kaiser Permanente Health Care System.
Dr. Rosenzweig's Research
To ensure that patients with diabetes receive the best care, James L. Rosenzweig, M.D., focuses on primary care providers and other professionals who are often the entry point for patients into the healthcare system. Dr. Rosenzweig develops programs to measure the performance of providers and, where necessary, help them improve their monitoring of patients so they can diagnose and triage patients into appropriate care pathways according to risk.
In a pilot program to improve the care of African-American patients with diabetes, Dr. Rosenzweig is overseeing a collaboration with providers in four clinics in the Mississippi Delta, where the incidence of diabetes is twice the national average and where most patients do not receive adequate healthcare. The clinics are linked to each other and to Joslin via a Web-based computer information system. Patient-care data, information and recommendations are transmitted over the Internet (with privacy protection) so that clinics can compare their performance and communicate with each other as well as with experts at Joslin. The program, which began in late 2003, involves nearly 10,000 patients, and Dr. Rosenzweig hopes to expand its scope.
As Chairperson of the Joslin Clinical Oversight Committee, Dr. Rosenzweig works with other Joslin physicians, nurses and educators to develop clinical guidelines to ensure optimal care of patients with diabetes at Joslin and in the community. He also is active as a leader of the National Diabetes Quality Improvement Alliance, an organization that sets the standards for measuring physician performance in diabetes care throughout the United States.
In his other role as Chairman of Joslin’s Human Studies Committee, Dr. Rosenzweig ensures that all research studies involving patients are conducted ethically and with appropriate informed consent and confidentiality.
Dr. Rosenzweig co-authored this editorial, "The Obesity and Diabetes Epidemic," which ran in the Boston Globe on August 13, 2005.
The Obesity and Diabetes Epidemic
By James Rosenzweig, M.D., and Osama Hamdy, M.D., Ph.D.
In the past year there have been improvements in the nation's battle against the epidemic of obesity. The MyPyramid, an updated version of the USDA's Food Guide Pyramid first unveiled 13 years ago, replaces a one-size-fits-all approach with an "individualized approach to improving diet and lifestyle." Combined with new dietary guidelines issued earlier this year, the government is trying to help Americans make healthier food choices.
While the effort is to be applauded, it's not enough.
The MyPyramid and dietary guidelines are effective for the 35 percent of the general public who are of a healthy weight range. But for the two out of every three Americans who are overweight or obese, the effort seems extremely deficient especially given the prevalence of type 2 diabetes, a disease strongly related to obesity, which has reached epidemic proportions. If we are truly serious about the obesity and diabetes problems, it's time to address the needs of more than 50 million Americans: those with type 2 diabetes who are overweight or obese, and the 41 million more who have pre-diabetes and are at high risk for developing diabetes and devastating complications that include cardiovascular disease.
Maintaining a healthy weight and lifestyle is important because many people who have diabetes are unaware they have it. Unfortunately, diabetes-related complications, which are quite serious, often begin before type 2 diabetes is detected. When patients are first diagnosed with diabetes, an estimated 17 percent already have cardiovascular problems, the leading cause of death in nearly 75 percent of our patients.
Americans need recommendations that are sustainable and easy to follow. Based on current studies, we at Joslin recommend that most Americans who are overweight or obese with type 2 diabetes or at risk for diabetes reduce their overall energy intake by 250-500 calories per day; reduce energy intake from carbohydrates to approximately 40 percent of daily caloric intake; increase the amount of protein to 20 to 30 percent of daily caloric intake, unless they have kidney problem that requires less protein intake; and increase their amount of fiber intake to at least 20-35 grams per day.
But that's not all.
It is easy to tell people with diabetes or pre-diabetes to lose weight and it's critical to educate overweight Americans about the importance of physical activity to improve their health, but there are no quick fixes. They need a long-term healthier lifestyle that combines an effective nutrition and efficient exercise plan.
We also need better programs, not just guidelines, for our children. For example, the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC, provides eight million low income families with vouchers for food based on a plan that hasn't changed significantly since 1974. We support the National Academy of Sciences in urging WIC to offer vouchers that at least match current nutritional research.
The need for children to get good nutrition is more important than ever. Type 2 diabetes had been considered an adult disease but is increasingly prevalent among children and adolescents, particularly in American Indians, African Americans, and Hispanic/Latinos, according to the National Institutes of Health. It is no surprise to see this new serious phenomenon when 16 percent of American children and adolescents are currently obese.
We certainly need to help students make better food choices at schools. We need to offer healthy lunches and kick fast food chains and snack and beverage machines off campus. This will be difficult because many cash-strapped communities receive financial benefits for having these restaurants and machines on campus. But it is a step that must be taken to stem the obesity and diabetes epidemic. The cost of bad nutrition to society is too high to ignore and will keep climbing. A major risk factor for heart disease, stroke and birth defects, diabetes affects virtually every tissue of the body and shortens average life expectancy by up to 15 years. Diabetes spares no group: men and women, the young and elderly, and every racial group is affected. The emotional toll and financial costs of diabetes and its complications to our health care system is already an estimated $132 billion annually in terms of healthcare costs and lost productivity. More than one of every four Medicare dollars is spent on people with diabetes. That number will get larger still if the millions of overweight people with type 2 diabetes and the additional 41 million Americans with pre-diabetes don't have appropriate recommendations to guide them in making healthier lifestyle choices.
Disease Management Press Releases
Joslin Physician and Educator to Discuss Importance of Disease Registries in Advancing Diabetes Care in Sept. 23 Talk at National Disease Management Congress in Orlando, FL
Joslin Diabetes Center Announces New Nutrition Guidelines for People with Type 2 Diabetes or Pre-Diabetes who are Overweight or Obese
Joslin Diabetes Center Collaborator Awarded Medicare Chronic Care Improvement Pilot Project
Joslin Diabetes Center Teams With Click4Care To Help Health Plans Medically Manage Members With Chronic Diseases
Joslin Presents Results of Disease Management Efforts
