Projects have shown potential to improve care.
The University of California has awarded four grants totaling $2.5 million to scale up proposals that have shown potential to improve health care while delivering a return on investment to UC medical centers.
The fellowships expand proposals that already are funded by the UC Center for Health Quality and Innovation (CHQI) and that have demonstrated they can provide better care and better health with lower costs.
The grants include UC Health projects to reduce emergency room visits among psychiatric patients, expand access to specialty care, develop a tobacco cessation network, and support efforts to standardize treatment for hip and knee replacements.
“We’re excited to extend our support to proven projects so that they can be replicated across UC medical centers,” said Karyn DiGiorgio, CHQI interim director. “By scaling up transformative projects like these, UC Health will see even more improvement in the quality and value of the health care we provide Californians.”
The grants, awarded to previously funded CHQI fellows and principal investigators, are part of UC Health’s efforts to improve patient care and increase value at medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.
The awardees include:
- Patient-centered recovery program and emergency department community placement program: $1.2 million over two years
Project director: William Perry, Ph.D., UC San Diego
Campus leads: Debra Kahn, M.D., UC Davis; Nathan Kuppermann, M.D., M.P.H., UC Davis; Tina Allee, M.D., UC Irvine; Scott Rudkin, M.D., M.B.A., UC Irvine; Erick Cheung, M.D., UCLA; Lynne McCullough, M.D., UCLA; James Bourgeois, O.D., M.D., UC San Francisco; and Steven Polevoi, M.D., UC San Francisco
Overuse of emergency department services by psychiatric patients is a national crisis. This fellowship, building on Perry’s 2011 CHQI grant, will expand to all five UC medical centers a project that provides screening, intervention and referral services to psychiatric patients with substance use disorders, with the aim of reducing the length of their stays and their return visits to the emergency department. The project began at UC San Diego, where the Patient-Centered Recovery Program reduced the average ED length of stay of psychiatric patients by 12 percent and reduced 30-day psychiatric patient return visits to the ED by 15 percent. The ED Community Placement Program has worked at UC San Diego to further reduce ED visits by placing high-risk patients into community partner programs. The project will work with the other UC medical centers to identify and develop partnerships with community service providers, so that similar results can be achieved.
- Scale-up eReferral and eConsult program: $709,000 over 18 months
Project director: Nathaniel Gleason, M.D., UC San Francisco
Campus leads: Mark Avdalovic, M.D., UC Davis; Elizabeth Rosenblum, M.D., UC San Diego
Access to specialty physicians at UC medical centers commonly involves wait times of several weeks, which is anathema to patient-centered care. The eReferral and eConsult program improves coordination between primary care and specialty physicians in order to expand access and reduce avoidable in-person appointments. It aims to improve patient outcomes, save patients time, reduce out-of-pocket costs for patients and reduce the overall cost of care. Gleason received a 2013 CHQI fellowship to begin this program at UC San Francisco. The program provides primary care physicians with point-of-care decision support on referral appropriateness (eReferral) and allows them to receive timely specialist recommendations on clinical questions that do not require an in-person evaluation of the patient by the specialist (eConsult). At UCSF, eConsults now represent 8 percent of referrals to participating specialties and have reduced referral rates for standard office visits by 20 percent, improving access to specialty care and saving costs. This grant will expand the project to include UC Davis, UCLA and UC San Diego, with the option to amend the proposal to include UC Irvine and possibly UC Riverside.
- UC Tobacco Cessation Network: $541,000 over two years
Project director: Elisa Tong, M.D., M.A., UC Davis
Campus leads: Linda Sarna, R.N., Ph.D., UCLA; Mark Avdalovic, M.D., UC Davis; Alpesh Amin, M.D., M.B.A., UC Irvine; Sheldon Greenfield, M.D., UC Irvine; Allison Diamant, M.D., UCLA; Timothy Fong, M.D., UCLA; Robert El-Kareh, M.D., M.S., M.P.H., UC San Diego; Tyson Ikeda, M.D., UC San Diego; Eliseo Pérez-Stable, M.D., UC San Francisco; Sujatha Sankaran, M.D., UC San Francisco; and Jyothi Marbin, M.D., Children’s Hospital Oakland
UC has shown its commitment to provide a healthy environment for faculty, staff, students and visitors by implementing a systemwide tobacco-free policy that began in January 2014. This project aims to further reduce tobacco use and exposure – the leading cause of preventable death – by developing a UC Tobacco Cessation Network. Building on a pilot project that Tong started at UC Davis with a 2013 CHQI fellowship, the UC-wide network will use electronic medical records to address tobacco use and exposure at every clinical encounter. There will be assistance with counseling and medication for greater success, with the Joint Commission tobacco treatment measures serving as a framework. The network will partner with the California Smokers’ Helpline, a UC San Diego-based free telephone counseling service that doubles the chances of quitting, to create a two-way electronic referral, and with the UCSF-based Smoking Cessation Leadership Center to promote systemwide training opportunities. Champions at each site will coordinate electronic medical record modifications, conduct outreach and education to inpatient and outpatient departments and nursing units for workflow integration, and collaborate as a network through information sharing and evaluation. This project is expected to demonstrate a significant return on investment and national leadership on health systems change for tobacco cessation.
- Bundled payments for hip and knee replacements: $78,000 over one year
Project director: Kevin Bozic, M.D., M.B.A., UC San Francisco
Campus leads: Zeev Kain, M.D., UC Irvine; Ranjan Gupta, M.D., UC Irvine; Scott Ball, M.D., UC San Diego; Lisa Rhodes, UC San Diego; Mervyn Maze, M.B.Ch.B., UC San Francisco; Lorrayne Ward, UC San Francisco
Bundled payment, where providers are reimbursed a set fee for an episode of care, is a health reform aimed at improving the coordination, quality and efficiency of care. This project will build on Bozic’s 2011 CHQI fellowship to establish bundled payments for hip and knee replacements at UC San Francisco. It will establish a learning collaborative with UC Irvine and UC San Diego that seeks to standardize clinical practices and administrative procedures for hip and knee replacements to both improve patient outcomes and reduce costs. This will enable UC to compete for regional and national employer-based contracts for hip and knee replacements.
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University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 17 health professional schools on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.
About the UC Center for Health Quality and Innovation
UC Health launched the Center for Health Quality and Innovation in October 2010. The center is designed to promote, support and nurture innovations at UC medical center campuses and hospitals to improve quality, access and value in the delivery of health care. For more information, visit http://health.universityofcalifornia.edu/innovation-center.
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