Report finds return on investment of more than 5 to 1.
UC San Diego Dr. Greg Maynard leads a five-campus UC project to reduce dangerous blood clots (venous thromboembolism, or VTE), which prevented an estimated 140 VTE occurrences in 2013 for an annual savings of $1.45 million.
By Alec Rosenberg
A University of California center that fosters health care innovation at UC’s five medical centers is proving to be a boon to both patient health and the bottom line.
A report assessing the impact of grants made by the Center for Health Quality and Innovation (CHQI) found that UC’s investment is paying off with improvements such as fewer blood clots and improved post-surgery care at UC hospitals. Based on current cost savings, revenues and additional funds received, the projected net financial gain in 2016 of the center’s grants will be about $40 million from a $7.3 million allocation from UC medical centers — a return on investment of more than 5 to 1.
“The investment has been a good one,” said Dr. John Stobo, UC Health senior vice president and CHQI chairman. “The innovation center has done a lot of good in terms of improving quality and saving costs.”
CHQI was established in 2010 to foster innovations developed at UC medical center campuses and hospitals in order to improve quality, access and value in the delivery of health care. To date, the center has issued a total of 50 grants. In addition to funding from UC’s five medical centers, CHQI also has awarded $7.7 million it received from the UC Office of Risk Services for grants designed to reduce the risk of clinical harm to UC patients.
“We’ve been able to support innovative projects that produce better outcomes for patients, reduce costs and are being expanded across the UC Health system,” said CHQI Executive Director Karyn DiGiorgio. “This report helps quantify our impact.”
A five-campus project led by UC San Diego’s Greg Maynard to reduce dangerous blood clots (venous thromboembolism, or VTE) prevented an estimated 140 VTE occurrences in 2013 for an annual savings of $1.45 million.
A project at UC Irvine reduced the median length of stay for high-risk abdominal surgery patients by two days, resulting in fewer complications and projected annual savings of $816,000 (Maxime Cannesson).
The 2012 UC San Diego colorectal postoperative program reduced length of stay by 4.5 days for high-risk surgical patients and 0.9 days for moderate-risk patients, resulting in projected annual savings of $553,000 (Elisabeth McLemore).
A 2012 UCSF palliative care intervention resulted in 45 additional palliative care consults in the intensive care unit, generating $167,000 in annual savings from reduced ICU bed-days (Wendy Anderson).
A 2012 UC Davis specialty pharmacy initiative led to contracts that generated $18,000 in revenue at UC Davis and $1.36 million in revenue at UCSF during a CHQI fellowship (John Grubbs).
The 2012 UCLA elective surgery discharge program increased net revenues through a discharge pharmacy program for surgical services by $639,000 during a CHQI fellowship (Michael Yeh).
The report projects at least $25 million in grant-generated cost savings and revenues by the end of 2016. Also, seven project teams have received an additional $16 million in external funding based on their CHQI work, including a UCSF-led radiation safety project (Rebecca Smith-Bindman), a UC Davis pediatric telehealth project (James Marcin) and a UCSF-led eConsult project (Nathaniel Gleason).
In addition, 16 papers in national journals have been published based on work funded by CHQI.
The report did not assess the center’s other activities, such as hosting three systemwide colloquiums and convening multicampus collaboratives to develop and implement evidence-based practices.
The report was prepared by the center’s Innovation Evaluation Committee, which includes Michael Ong of UCLA, Patrick Romano of UC Davis, Andrew Auerbach of UCSF, Sheldon Greenfield of UC Irvine, Theodore Ganiats of UC San Diego and Stephen Shortell of UC Berkeley, and Karyn DiGiorgio, executive director of the center. CHQI plans to issue a yearly update, and by 2016 expects to present an in-depth review of the overall impact of the programs funded by the center.
Health care workers give back at Care Harbor event.
An estimated 4,000 people showed up for this year's Care Harbor free clinic held at the L.A. Sports Arena, an increase from last year's 3,000 who attended. This year, about 50 health care workers from UCLA volunteered their services. (Photos by Ann Johansson, UCLA)
It was a typical misunderstanding that could have led to disastrous consequences. The man had run out of medication to control his hypertension. But he couldn’t afford to get it refilled, or so he thought.
So instead of picking up a simple, generic medication at Wal-Mart or Target for $4, the man decided to go without it and unknowingly put himself at risk for a stroke. All because he didn’t realize he could obtain the medication cheaply.
UCLA Dr. Patrick Dowling checks a patient's arm.
Fortunately, he was one of hundreds who were treated by UCLA health care workers volunteering at the Care Harbor’s annual health clinic held Sept. 11-14 at the Los Angeles Sports Arena. His story is typical of many who come to this free clinic for the poor and underserved, said Dr. Patrick Dowling, chief of the UCLA Department of Family Medicine at the David Geffen School of Medicine.
About 30 percent of those who saw a UCLA health care worker at the clinic had prescriptions that went unfilled.
“These are people with hypertension and diabetes who can’t afford to get these medications — or think they can’t — and wind up in the ER, costing thousands when they simply needed to maintain their medications,” said Dowling, who, along with Dr. Carol Mangione, headed a UCLA contingent of about 50 volunteer health care workers. Mangione is the Barbara A. Levey M.D. and Gerald S. Levey M.D. Endowed Chair and professor of medicine and health services.
The man’s predicament, which was remedied by a simple referral to a local pharmacy, also explains why UCLA’s participation in the annual free clinic is so important and gratifying for the volunteers, among them, nurses; cardiologists; ear, nose and throat specialists; family medicine physicians and ophthalmologists from the Stein Eye Institute. Their ranks also included family medicine sports medicine doctors, International Medical Graduate (IMG) program participants, and medical residents and students from UCLA.
This year, an estimated 4,000 people attended the clinic, up from around 3,000 last year. Mostly poor and uninsured, they came for dental work, eye care, general internal health care and other services.
The volunteers also gain something valuable, said Dr. Brenda Green, a third-year family medicine resident at UCLA. She is a graduate of the IMG program, which assists bilingual, bicultural immigrant medical school graduates from Latin America who reside in the U.S. legally, with earning a California medical license and obtaining a residency in family medicine.
Working at the Care Harbor clinic gave her the opportunity to work with the underserved populations that she will treat once she’s finished her residency. To be in the IMG program, physicians must commit to practicing in one of the state’s more than 500 underserved communities for two to three years after completing their three-year family medicine residency.
“I love working with the Hispanic population since I speak Spanish and I can communicate with them,” said Green, who volunteered at the clinic last year as well.
Most of the people she saw suffered from chronic pain or women’s health problems; diabetes was particularly common, she said. The clinic offers referrals to patients who are diagnosed with other untreated health conditions, some of them serious.
“There’s a strong Hispanic population, and diabetes is prevalent among them,” said Green. “A lot of it is uncontrolled.”
A medical student in the IMG program, Daniel Handayan found that volunteering at the clinic gave him the opportunity to use some of the skills he had learned at the Universidad Autonomo de Guadalajara, where medical students are exposed to clinical care earlier than in the U.S.
“I wanted to give back to Los Angeles,” said Handayan, who was born in Pasadena. “This is a great opportunity to use the skills I learned in Mexico.” He was one of nine IMG students who participated during the four-day clinic.
“They’re valuable because of the language and culture,” Dowling said.
Janet Napolitano meets with Doctors Academy students at UCSF Fresno.
UC President Janet Napolitano talks with high school students from UCSF Fresno’s Doctors Academy at a discussion that included officials from UCSF (pictured from left are UCSF Fresno Associate Dean Joan Voris, Doctors Academy founder Katherine Flores and UCSF Chancellor Sam Hawgood), UC Merced and UC medical students and residents. (Photos by Francis Fung, UCSF Fresno)
By Alec Rosenberg
University of California President Janet Napolitano visited UCSF Fresno today (Sept. 5), where she encouraged high school students to pursue their dreams of becoming doctors and help address the severe physician shortage in the San Joaquin Valley.
Napolitano met with 20 students from UCSF Fresno’s Doctors Academy, a challenging academic preparation program at three high schools in Fresno County. The star students, who come from educationally disadvantaged backgrounds, had questions about whether they could afford college and how they could overcome their self-doubt.
The path to become a physician is long and intense, but it’s a worthy journey that’s within reach, said Napolitano and colleagues who included UCSF Chancellor Sam Hawgood, UC Merced Chancellor Dorothy Leland and UC medical students and residents.
“Never doubt that you have what it takes to succeed as a doctor, nurse or whatever field you’re considering,” said Napolitano, who described how she overcame challenges in college, explained its affordability and encouraged students to consider applying to UC. “You are exactly the kind of smart, motivated and compassionate students UC wants.”
High school students at UCSF Fresno’s Doctors Academy tell UC President Janet Napolitano why they are in the Doctors Academy and interested in becoming health professionals.
Napolitano’s message resonated with Doctors Academy students such as Sunnyside High School senior Carlos Villalobos, who wants to become a physician in the valley so he can serve his community. “I feel it’s my calling,” he said.
Villalobos had been interested in attending an Ivy League college, but after listening to Napolitano, he was inspired to change his mind.
“I want to go to UC,” Villalobos said. “I got to see how big a family we are with UC.”
Indeed, UC trains nearly half of the medical students and residents in California. In the San Joaquin Valley, UCSF, UC Merced and UC Davis all have efforts to address health issues and the shortage of physicians practicing in the region.
The UCSF Fresno Medical Education Program was established in 1975. UCSF Fresno annually now trains approximately 290 medical residents and fellows (an increase of 100 in the past 10 years) and about 250 medical students on a rotating basis. Since its inception, the program has graduated more than 2,000 resident physicians. About 40 percent of medical residents who graduate from UCSF Fresno stay in the area to provide care for community members.
“It shows the efficiency of training residents locally — they tend to stay here,” said Dr. Joan Voris, UCSF Fresno associate dean.
UCSF Fresno also has pipeline programs to prepare health care professionals. The Doctors Academy serves 336 high school students. The Junior Doctors Academy is an academic enrichment program for 186 motivated seventh- and eighth-grade students, while the Health Careers Opportunity Program at Fresno State provides academic support to prepare select students for entry into graduate programs and health professional schools
Dr. Katherine Flores, a Fresno native who was raised by her migrant farmworker grandparents and became the first in her family to attend college, founded the Doctors Academy in 1999 to open doors for students like her. All Doctors Academy graduates go on to college, with 98 percent matriculating into four-year colleges and universities. Three students from the inaugural class have received medical degrees and are in primary care residencies.
“In the Central Valley, we don’t have enough health care providers,” said Flores, who directs the UCSF Fresno Latino Center for Medical Education and Research. “We wanted to grow our own.”
The Doctors Academy students also met with San Joaquin Valley PRIME students. PRIME is an innovative training program focused on meeting the needs of California’s underserved populations, with 330 total students in six programs. UC Davis, UC Merced and UCSF Fresno collaborate on SJV PRIME, which launched in 2011 and now enrolls 27 students — all of whom have expressed interest in staying in the Valley to practice and/or work with underserved communities.
Maricela Rangel-Garcia, a third-year SJV PRIME student and Clovis native who was part of the inaugural class at UC Merced, encouraged Doctors Academy students to find mentors.
“The doubt will never go away,” she said. “Don’t be afraid to reach out to new people who will help you along the way.”
Agustin Morales, a fourth-year SJV PRIME student and Mexico native who received a bachelor’s degree from UC Santa Cruz, agreed.
“Look for people who are positive, inspirational, who will guide you in unfamiliar terrain,” said Morales, who is interested in internal medicine and plans to apply for residency at UCSF Fresno. “You end up empowering yourself to do what you want to do.”
Along with SJV PRIME, UC Merced continues to develop health sciences research programs. It has established a Health Sciences Research Institute, offers a minor in public health and collaborates with UCSF Fresno on research into valley fever.
As part of her visit to Fresno, Napolitano met with UC Merced and UCSF campus leaders to discuss health issues in the San Joaquin Valley and how UC is addressing needs and the funding challenges associated with efforts to help improve health in the region. For example, the Doctors Academy used to receive nearly $1 million a year in federal grant funding, but that has stopped. Also, state funding only covers about one-third of all PRIME slots.
In the meantime, the San Joaquin Valley has just 45 primary care physicians per 100,000 people, while the recommended level is 60 to 80.
UCSF Fresno medical resident Andres Anaya, a Fresno native, encourages high school students from UCSF Fresno Doctors Academy to become physicians. (From left: Sidra Suess, a fourth-year San Joaquin Valley PRIME student, and Erica Gastelum, a UCSF Fresno pediatric resident.)
UCSF Fresno medical resident Andres Anaya encouraged Doctors Academy students to join him in addressing that shortage. Anaya was born the eldest son of Mexican immigrants, both of whom are deaf. His first language was American Sign Language. At the age of 5, he began translating for his family. His college guidance counselor told him college wasn’t for everyone. Later in life, he suffered an industrial accident, which landed him in the emergency department and left him temporarily paralyzed.
“It changed my perception,” Anaya said. “Everything became possible.”
Anaya graduated from UCSF medical school and now is a physician in Fresno.
“Every day I get to do something I love,” Anaya said. “I’m literally living the dream. I’m home.”
Band of surgeons, started at UCLA, plays gigs to raise money for charity.
From left: Drs. Solomon Poyourow, Phuong Nguyen, Jason Roostaeian and Robert Kang.
Watch out Weezer and Smashing Pumpkins. Help the Doctor, an indie rock band made up of four surgeons moonlighting as hip musicians, is generating cutting-edge buzz.
A project that began as a much-needed release from their demanding careers has become a successful band, complete with a fan base, a sold-out performance at the House of Blues and gigs at the Troubadour, the Roxy, the Viper Room and the Dragonfly.
UCLA plastic surgeon Dr. Jason Roostaeian
Dr. Jason Roostaeian, a plastic surgeon on staff at Reagan UCLA Medical Center, performs on bass and vocals alongside his colleagues and fellow plastic surgeons Dr. Robert Kang, with vocals and guitar, and Dr. Phuong Nguyen, adding lead vocals and guitar. Completing the fab four is oral surgeon Dr. Solomon Poyourow on drums.
The four surgeons met during their residency training at the medical center in 2011 and discovered they shared a passion for music that started long before they became doctors. They had all played for different bands.
So they decided to put their talents to work to help raise funds for organizations like “Facing Forward,” which provides pro bono surgeries for children with severe facial and skull deformities. “Being able to create music together is the fun part, but now having the opportunity to help raise money for charities has made it truly special for us,” Roostaeian said.
The group decided to use the title, “Help the Doctor,” based on a common operating room experience, Roostaeian said in an email. “As surgeons, you would give each other flack if your assistant surgeon or nurses were not helping the way you saw fit.”
At first, the band members used aliases on stage — Jay Roost, Rip Towns, P. Danger and Sol Power. “We wanted to separate our professional names from stage names because we feared it would give patients the wrong impression,” Roostaeian said. “However, at this point, most of our patients appreciate the fact that we perform and give to charity so we’d rather use our real names.”
Coordinating practice time for four busy doctors can be challenging. While Roostaeian works at UCLA, the others are in private practice, at City of Hope and at the University of Toronto temporarily doing a fellowship.
Typically, they squeeze in jam sessions when they can, usually after full days of surgery when everyone shows up in scrubs, said Kang. “It’s not easy, but the end product has been well worth it!” Roostaeian said.
For their next gigs, the UCLA plastic surgeon said they are looking at possible dates in late November. Meanwhile, fans, many of whom are UCLA doctors, nurses and staff, can listen to their music on the band’s Facebook page and iTunes.
But don’t look for Help the Doctor to go on tour soon. “I wouldn’t call the band a second career,” said Roostaeian. “Plastic surgery is my career. Creating music is a passion of mine that I have always had, and I am just happy to be able to continue it, especially with such a great group of guys and for charity. It really doesn’t get any better.”
First step toward collaborating systemwide to address need for treatments.
Leonard Abbeduto, director of the UC Davis MIND Institute, speaks at the UC summit on autism in Sacramento. (Photo by UC Davis)
By Alec Rosenberg
Researchers from across the University of California convened Thursday (Aug. 14) for a first-ever summit on autism — an initial step toward collaborating systemwide to address the urgent need for treatments.
Epidemiologists and geneticists joined neuroscientists and psychiatrists as more than 50 researchers from five UC campuses participated in the daylong summit at the UC Davis MIND Institute in Sacramento. They shared what they are doing in autism research and discussed ways to increase coordination and have a greater impact in improving the lives of children with autism and their families.
Autism spectrum disorder is one of health’s toughest challenges — a lifelong developmental condition with varying symptoms and severity that can affect social interactions, behavior and the ability to think, learn and problem solve. It has no single known cause and no known cure, though early behavioral-based treatments can help. And its prevalence is rising rapidly: Estimates are that autism affects more than 3 million individuals in the U.S., increasing the need for breakthroughs.
“How can we provide high-quality care for kids when the numbers are increasing dramatically and the resources are not?” said Leonard Abbeduto, Tsakopoulos-Vismara Endowed Chair and director of the UC Davis MIND Institute. “We’re all here because we want to impact the lives of kids and families.”
The autism summit, sponsored by the UC Office of the President, is the first step in an 18-month process aimed at accelerating progress toward treatments and strategies for prevention. The effort will include drafting a strategic plan for a coordinated approach to UC autism research, identifying research opportunities, increasing the number of multicampus grants and launching a series of public statewide autism forums to discuss ways of translating research into improved services.
“These are ambitious goals, but this is the group to make it happen,” Abbeduto said.
Harnessing UC’s expertise
The campuses participating in the summit — Davis, Irvine, UCLA, San Diego and San Francisco — are those with interdisciplinary autism research programs, integrated health care systems and programs that train pediatric health care professionals. Other UC campuses will participate in follow-up meetings.
The summit arose from discussions within the systemwide UC BRAID (Biomedical Research Acceleration, Integration and Development), which identified autism as an area of expertise that was ripe for increased coordination.
“This is really the beginning,” said Dan Cooper, chair of the Department of Pediatrics and director of the Institute for Clinical and Translational Science at UC Irvine. “The summit is designed to harness the unique basic science and translational research talent across the UC system in a way that will profoundly benefit children and adults with autism and related disorders.”
As one of the world’s largest and most prestigious research institutions, UC is uniquely positioned to address the mysteries surrounding autism.
“If we combine and band together, the promise is tremendous,” said Elysa Marco, a cognitive and behavioral child neurologist at UC San Francisco. “I think this represents a wonderful opportunity for us to do something greater.”
A timely collaboration
Thomas Insel, director of the National Institute of Mental Health, who delivered a summit presentation by videoconference, encouraged UC’s efforts, which he said could be a model at the statewide level.
“If you can get a group of people across the state sharing things, that’s a great way to accelerate our understanding and development of treatments,” said neurologist Jeffrey Neul of UC San Diego.
Autism is considered a public health crisis, with an incidence that has increased by more than 600 percent during the past two decades. The U.S. Centers for Disease Control and Prevention estimates that autism now affects 1 in 68 children. More than 350,000 Californians live with autism today.
Los Angeles Unified School District alone has 10,000 students with autism, said James McCracken, the Joseph Campbell Professor of Child Psychiatry and director of the Division of Child and Adolescent Psychiatry at UCLA. He’s optimistic that the UC autism summit will lead to positive outcomes.
“It’s an exciting first step,” McCracken said.
Making an impact
At the summit, researchers split into six working groups aimed at tackling different aspects of autism: genetic risk factors; environmental risk factors; neurobiology; diagnosis, symptoms and developmental trajectories; treatment, pharmacology and services; and research infrastructure.
They identified opportunities for collaboration such as multicampus research projects, hosting workshops to share data and provide training, and developing a systemwide autism patient registry and research repository. They encouraged using the UC ReX (Research eXchange) Data Explorer, a UC BRAID effort that enables UC investigators to identify potential research study cohorts at the five UC medical centers. Several mentioned that offering incentives would spur broader collaborations.
Ultimately, UC summit participants want to help prevent autism and speed treatments and cures. They’re working on many fronts, from behavior to medications to stem cells.
UC Davis MIND Institute researcher Sally Rogers helped develop the Early Start Denver Model, an intensive early intervention therapy for children with autism that fuses play- and relationship-based approaches with teaching practices of applied behavior analysis (a model developed at UCLA).
The Early Start Denver Model is being used around the world. Last week, Rogers trained a group that included participants from Brazil, Canada, Mexico, Spain and Turkey. She wants to have an even bigger impact and sees potential in a universitywide autism collaboration.
“It’s about trying to enhance the quality of life,” Rogers said.
UC San Diego transforms HIV care as part of DSRIP pay-for-performance initiative.
UC San Diego Dr. Amy Sitapati (left) directs the Owen Clinic, which has become a model medical home for HIV patients.
By Rebecca Vesely, Special to UC Newsroom
Though incurable, HIV today is a manageable, chronic condition. With advances in drug therapy, those infected with HIV in North America can expect to live into their early 70s — almost as long as the general population.
However, HIV is a chronic illness that typically requires a complex treatment regimen and has the added layer of social stigma.
At UC San Diego Health System, providers have implemented a novel multidisciplinary approach to HIV care management that is improving outcomes for patients. This approach could be a model for chronic care management in other populations.
UC San Diego’s HIV care delivery transformation began under the California HIV/AIDS Research Program and was implemented as a special Delivery System Reform Incentive Program (DSRIP). DSRIP is a novel, pay-for-performance initiative in which California’s 21 designated public hospitals receive Medicaid dollars in exchange for meeting pre-set milestones.
California’s public hospitals had the option of participating in a fifth DSRIP category focused on HIV care. UC San Diego is one of the state’s 10 public hospitals working in this category.
UC San Diego, through DSRIP Category 5, was able to overhaul its outpatient care delivery for HIV/AIDS patients into a medical home model.
“This is what the ‘triple aim’ is all about,” said Dr. Angela Scioscia, chief medical officer at UC San Diego Health System. “This project has been truly transformative. We took a clinic that had lost its way in terms of structure and turned it into a model for care delivery.”
Also known as the Owen Clinic, the UC San Diego HIV/AIDS outpatient center is located on the third floor of a medical office building across the street from UC San Diego Medical Center at Hillcrest. The clinic treats about 3,500 patients annually. Last year, 500 new patients joined, with the demand for services growing by approximately 40 percent in the past five years, said Dr. Amy Sitapati, Owen Clinic director.
About 70 percent of patients served at the clinic are in Medi-Cal managed care plans. DSRIP support enabled the clinic to hire more staff, with a total of 60 personnel, both full- and part-time.
The clinic uses a team-based approach, with four teams, each led by a primary care physician. Two of the teams have Spanish-language fluency.
Each morning, the teams meet in “huddles” and review the patient panel for that day. A computer printout shows patient names, ages and reasons for the visit, status on preventative screenings and viral loads. The printouts also show each patient’s Veterans Aging Cohort Study (VACS) score, an evidence-based score that assesses HIV patient risk of mortality. The Owen Clinic may be the only outpatient clinic in the country using patient VACS scores in daily huddles.
Knowing a patient’s risk of mortality helps to frame the office visit because providers understand before the patient walks through the door his or her need for additional support services, Sitapati said. A patient with a high VACS score might need more time in the clinic to meet with a staff pharmacist or psychiatrist or social worker, for instance.
Comprehensive, coordinated services are available to all patients. Because of the complexity of many of these patients’ treatment regimens (patients take on average seven medications each day), the staff aims to make each visit as productive as possible. For instance, staff pharmacists on site work together with physicians to educate patients about their prescriptions, help them find affordable options, get adequate reimbursement from payers and avoid adverse reactions to drugs.
Eight to 10 drugs are commonly used in HIV treatment, meaning there are between 30 and 50 total drug combinations. Finding the right balance for patients can be a challenge, especially with myriad side effects, co-payments and insurance pre-authorization requirements to fill a prescription.
“There are a lot of barriers to patients taking the right medications,” Sitapati said.
Incorporating health information technology
Access to health information technology resources has been crucial to the clinic’s transformation. UC San Diego assigned a four-person team of health IT specialists — including a physician informaticist, a data analyst, a programmer analyst and a Master of Public Health team member — to work on the clinic’s patient-centered medical home innovation projects. Having a clinical informatics team that understands the patient population, is invested in the clinic’s success and is aligned with the project’s vision and goals has been absolutely critical, Sitapati said.
Ongoing communication with patients is an important component to care. Patients at the clinic are avid adopters of MyUCSDChart, a Web portal that sends reminders for appointments and preventative screenings.
In 2013, there were an average of 1,003 MyUCSDChart patient encounters per month, up from 288 MyUCSDChart encounters in 2012. These patient portal interactions are on par with in-person and phone visits in 2013, which averaged 1,135 office visits and 1,455 average phone calls per month in 2013.
Perhaps one of the most valuable clinic informatics tools is SmartSet — an electronic medical record tool that allows clinicians to order lab tests in batches for patients who haven’t received recent laboratory screenings. The Centers for Disease Control and Prevention recommends annual screening for sexually transmitted diseases (STDs) in HIV-positive individuals. The SmartSet allows clinicians to quickly identify patients due for screenings and then order tests without manually ordering each lab for each patient, increasing clinic efficiencies and productivity.
Focusing on care transitions
The Owen Clinic focuses on care transitions for its patients. The clinic has a dedicated “nurse transition specialist” skilled in HIV/AIDS care to assist patients moving between inpatient care and the Owen Clinic. The nurse transition specialist program is part of another DSRIP project at UC San Diego.
These proactive, integrated approaches are garnering results. Viral load monitoring rose from a baseline of 63 percent in 2011 to 81.9 percent for the period of January through December 2013. Screening for both chlamydia and gonorrhea increased from 57.4 percent in 2011 to 84.2 percent for the period of January 2013 through December 2013. Wrap-around services for HIV care — including nutrition, substance abuse counseling, pharmacy, psychiatry and case management — increased 34 percent.
UC Health is enhancing care through a first-of-its-kind program.
UC Davis' medication management program is but one way the university's medical centers are improving medical care through the Delivery System Reform Incentive Program. (Photo by Charles Casey, UC Davis)
How do you make a renowned health system even better?
From improving medication management to providing a medical home for HIV patients, the University of California is enhancing care across its medical centers through a first-of-its-kind program.
UC and California’s other designated public hospitals are participating in the Delivery System Reform Incentive Program (DSRIP), a pay-for-performance initiative that aims to expand access to care, enhance quality and improve population health.
UC San Diego Dr. Amy Sitapati (left) directs the Owen Clinic, which has become a model medical home for HIV patients.
The program, effective from 2010-15, was created as part of California’s Medicaid Section 1115 Waiver, which supports California public hospitals and academic medical centers, recognizing their provision of health services for a “disproportionate share” of low-income patients compared to other hospitals.
California’s DSRIP provides a potential $3.3 billion in funding over five years for participating public hospitals based upon achieving specific milestones related to innovations in care delivery and improved outcomes. Collectively, UC medical centers set 733 milestones across 60 projects to capture up to $500 million in at-risk funding over five years. The program aligns with national health reform goals of increasing access to quality, affordable care. Since its inception, other states have launched similar programs.
UCLA Dr. Michelle Bholat (right) gives a lesson on electronic medical records to international medical graduates (from left) Hendry Perez Pascual, Marcus Medina and Gloria Monsalve.
UC’s DSRIP efforts show the university’s commitment to meeting the goals of health reform. UC medical centers are working locally on their campuses and together across the system to improve the outcomes and experience of patients. For example, a project to improve response time to patients with severe sepsis and septic shock has resulted in improvements that were previously not thought possible. As a result, sepsis mortality rates are declining at all UC medical centers.
This series of stories exemplifies ways that UC medical centers are making innovative improvements:
Berkeley Lab’s Ashok Gadgil puts engineering to work for humanity.
Ashok Gadgil demonstrates use of the Darfur stove to Mary Robinson, former president of Ireland and former UN High Commissioner for Human Rights. (Photo by Roy Kaltschmidt, Berkeley Lab)
By Kate Rix
When Ashok Gadgil arrived in Washington this spring to be inducted into the National Inventors Hall of Fame, a quote on the back of the event program spoke directly to his own personal philosophy.
It was from Abraham Lincoln: “The patent system added the fuel of interest to the fire of genius.”
“This is the first time the body made a decision not just to recognize patents which have led to improvements in the developed world, but also began to say, what do invention and patent do for the bottom 3 billion people?” Gadgil says of his induction, seated in his office above the UC Berkeley campus. “It signals to those of us who work on problems not because they’ll lead to corporate profit or a better weapons system, that this is another important role of creativity.”
Gadgil was one of 15 inventors admitted into the Hall of Fame this year. He was inducted specifically for UV Waterworks, a disinfecting device that uses ultra violet light to generate the electricity needed to kill pathogens in water. The technology provides safe drinking water for 5 million people every day in deep rural communities of India, the Philippines and Ghana.
Gadgil (pronounced GOD-gill) directs the Energy and Environmental Technologies Division at Lawrence Berkeley National Laboratory. His other inventions include a fuel-efficient cookstove and a method to remove arsenic from groundwater. Overall, his body of work has helped millions of others, in the spirit of what Lincoln called “the fuel of interest” combined with humanitarianism.
Safe water for mere pennies
UV Waterworks systems provide safe drinking water a cost of about 2 cents for 12 liters.
“My goal was to see what people could pay if they make $1 or $2 a day,” Gadgil says. “We are asking for 2 cents for 10 liters, so they can avoid getting diarrhea several times a year.”
UV Waterworks has saved an estimated 1,000 children’s lives, Gadgil said. “That’s not too bad, though the number could be 10 or 50 times larger.”
While Gadgil invented the system, the UC Regents hold the patent and the publicly traded corporation WaterHealth International lined up investors, including Johnson & Johnson and Dow Chemical.
Fuel-efficient stove lessens women’s risks
Also making an impact is the Berkeley Darfur Stove, which replaces the traditional “three stone” cooking fire for Darfuri refugees in western Sudan. The old method of cooking required women to walk — for up to seven hours, five times a week — outside the safety of the camps to collect wood. Encounters with armed militia during those treks almost certainly result in rape.
In 2005 Gadgil led a fact-finding mission to Darfur, interviewing women and observing how they cook. He realized he could design a stove that uses 75 percent less fuel to cook the same amount of food in the same pot, reducing the number of firewood collection trips.
The stoves were designed at Lawrence Berkeley Lab but are manufactured in a factory in Darfur and sold for $20 each, generating income for factory workers. Some 15,000 cookstoves are in use in Darfuri camps, plus additional stoves modified for use in Ethiopia.
Gadgil’s team continues to refine the cookstove technology, in pursuit of even cleaner ways to use biomass fuel. Another project, however, hearkens back to clean drinking water. Gadgil and his lab developed a method to remove naturally occurring arsenic from groundwater in Bangladesh and India, binding iron to microscopic arsenic molecules so they become large enough to be captured by a filter. The technology recently was licensed to an Indian business with a plan to install filtration plants in villages where the water will be sold.
The existence of a business model is core to Gadgil’s guiding principles as an inventor. While some of his colleagues in science turn their nose at the idea of making a profit from research, Gadgil — who applied to business school before engineering graduate studies — sees sustainability and potential in financial gain.
‘A model where everybody prospers’
“You cannot go to scale and help a billion or 2 billion people without everybody along the way making a dime,” he says. “Charity is critical to filling cracks in the system, but there is not enough charity to go around. If you want to lift people from an existence we consider beneath human dignity, you have to have a model where everybody prospers.”
Gadgil was not always so focused on using his skills to help people in the developing world. As a student at the Indian Institute of Technology Kanpur he worked hard, did well in school and that was enough.
In 1971 Gadgil had an acceptance letter from every university to which he had applied, except Berkeley. He was about to start courses at CalTech when the letter came from Berkeley to say that they had secured funding to offer him a spot in the graduate civil engineering program.
“A friend of mine told me that Berkeley is a deep and vast ocean and that I would not experience the intellectual depth anywhere else,” he recalls. “He was right. I took courses in everything under the sun. I could sit in the back of the room and take classes in political economy of development.”
He recalls a lesson from one of his professor, former Cal physicist Arthur Rosenfeld: A good scientist takes in the bigger picture of how the real world works.
“I was just very, very good at physics,” he says. “Being here doing my Ph.D. changed my thinking. I credit that to the Berkeley experience.”
All five UC medical centers ranked nationally by U.S. News & World Report.
The University of California has two of the nation’s top 10 hospitals and all five of its medical centers rank among the nation’s best hospitals, according to U.S. News & World Report’s annual survey.
U.S. News also ranked UC medical centers No. 1 in their metropolitan areas – UCLA Health System in Los Angeles, UCSF Medical Center in San Francisco, UC San Diego Health System in San Diego and UC Davis Medical Center in Sacramento. UC Irvine Medical Center ranked best in Orange County and fourth in the Los Angeles region.
“The U.S. News rankings reflect the excellence throughout the UC Health system,” said Dr. John Stobo, UC Health senior vice president. “Our academic medical centers are dedicated to providing the best possible patient care, training tomorrow’s leaders and tackling health’s toughest challenges.”
For the 2014-15 America’s Best Hospitals survey, U.S. News evaluated about 4,700 hospitals nationwide in 16 adult specialties, reviewing patient safety, reputation and other factors, with just 144 ranking nationally in even one specialty. UCLA and UCSF were among two of only 17 hospitals that entered the Best Hospitals Honor Roll by scoring high in at least six specialties.
“The data tell the story – a hospital that emerged from our analysis as one of the best has much to be proud of,” says Avery Comarow, the health rankings editor at U.S. News. “A Best Hospital has demonstrated its expertise in treating the most challenging patients.”
UCLA Health System’s hospitals in Westwood and Santa Monica ranked fifth nationally and best in the western United States and California. UCLA ranked among the top 50 hospitals nationally in 15 of the 16 specialties: cancer (9); cardiology and heart surgery (12); diabetes and endocrinology (9); ear, nose and throat (11); gastroenterology and GI surgery (5); geriatrics (3); gynecology (11); nephrology (8); neurology and neurosurgery (7); ophthalmology (5); orthopedics (11); psychiatry (8); pulmonology (16); rheumatology (8); and urology (4).
UCSF Medical Center ranked eighth nationally. UCSF placed among the top 50 hospitals nationally in 11 specialties: cancer (8); diabetes and endocrinology (5); ear, nose and throat (8); gasteroenterology and GI surgery (25); geriatrics (12); gynecology (6); nephrology (4); neurology and neurosurgery (5);
orthopedics (14); rheumatology (10); and urology (6).
UC San Diego Health System ranked among the top 50 hospitals nationally in 11 specialties: cancer (25); cardiology and heart surgery (23); diabetes and endocrinology (32); ear, nose and throat (22); gastroenterology and GI surgery (38); geriatrics (19); nephrology (15); neurology and neurosurgery (25); orthopedics (44); pulmonology (6); and urology (16).
UC Davis Medical Center ranked nationally in 10 specialties: cancer (34); cardiology and heart surgery (24); ear, nose and throat (31); geriatrics (25); gynecology (35); nephrology (19); neurology and neurosurgery (42); orthopedics (26); pulmonology (15); and urology (48).
UC Irvine Medical Center, which made the Best Hospitals list for the 14th consecutive year, ranked nationally in three specialties: ear, nose and throat (33); geriatrics (39); and nephrology (50).
Survey results are available online at http://health.usnews.com/best-hospitals. Overall, the Mayo Clinic in Rochester, Minnesota, ranked first; Massachusetts General Hospital in Boston was second; Johns Hopkins Hospital in Baltimore was third; and the Cleveland Clinic was fourth.
UC system united in effort to help put world on path to sustainably, nutritiously feed itself.
UC President Janet Napolitano plants oregano with Matt Orke in the student-run community garden at UCLA. (Photo by Reed Hutchinson, UCLA)
By Alec Rosenberg
University of California President Janet Napolitano and chancellors from all 10 campuses are joining forces on an audacious and far-reaching goal: harnessing the collective power of UC to help put the world on a path to sustainably and nutritiously feed itself.
President Napolitano unveiled the UC Global Food Initiative today (July 1) over the course of three events, starting at the Edible Schoolyard in Berkeley, followed by a presentation to the California State Board of Food and Agriculture in Sacramento, and finally at the UCLA community garden in the Sunset Canyon Recreation Center.
The initiative brings together the university’s research, outreach and campus operations in an effort to develop and export solutions throughout California, the United States and the world for food security, health and sustainability, Napolitano said during the morning briefing.
“It is a commitment to apply a laser focus on what UC can do as a public research university — in one of the most robust agricultural regions in the world — to take on one of the world’s most pressing issues,” Napolitano said.
The Edible Schoolyard is a 1-acre garden and kitchen classroom at the Martin Luther King Jr. Middle School, founded by Chez Panisse chef and owner Alice Waters. It has become a model for teaching children how to grow and eat a healthy, sustainable diet. It features vegetables, herbs, vines, berries, flowers, fruit trees and chickens.
UC President Janet Napolitano (right) tours the Edible Schoolyard at Berkeley’s Martin Luther King Jr. Middle School with founder and restaurateur Alice Waters. (Photo by Robert Durell)
Waters gave Napolitano a tour of the garden and then at a press conference gave her a basket of eggs from the garden’s chickens, quipping that she was “putting all her eggs” in Napolitano’s basket.
“I’m extremely excited and very hopeful because I know that she believes as I do that public education is the best way to solve the problems of the world,” said Waters, a UC Berkeley alumna.
Vision and leadership
Napolitano received an equally warm reception from state agricultural leaders.
“There is no better time to launch this initiative than today,” said board President Craig McNamara. “Count on us at the State Board of Food and Agriculture. We are your partners.”
The initiative will harness UC’s leadership in the fields of agriculture, medicine, nutrition, climate science, public policy, social science, biological science, humanities, arts and law, among others.
It comes at a crucial time, Napolitano said. A billion people — most of them in the developing world — suffer from chronic hunger or serious nutritional deficiencies. More than half a billion — primarily in the industrialized nations of the world — are obese. Against this backdrop, climate change and population growth fuel additional uncertainty and urgency about how to sustainably feed the world.
“This initiative shows great vision and leadership from President Napolitano and the University of California,” said Karen Ross, secretary of the California Department of Food and Agriculture. “Climate change and population growth will greatly strain our ability to provide healthy food to people here and around the world.
“President Napolitano’s proposal to leverage the strategic assets of the entire UC organization makes it a valuable partner in addressing the significant challenges and opportunities for our production agriculture and food system.”
Napolitano said that she and campus chancellors decided to launch the Global Food Initiative after recognizing that the university system is uniquely positioned to play a leading role in addressing the related challenges of nutrition and sustainability.
Playing to strengths
Henry Brady, dean of UC Berkeley’s Goldman School of Public Policy, was among a half dozen UC leaders and members of the university’s Food Initiative Working Group to join Napolitano at the Edible Schoolyard. Also in attendance were UC Santa Cruz professor Daniel Press, executive director of the Center for Agroecology & Sustainable Food Systems at that campus, and Ann Thrupp, executive director of the Berkeley Food Institute at UC Berkeley.
Brady said that the initiative’s strength comes from the depth of work and research across the 10-campus system. Each location brings its own area of expertise, he noted.
“We at the Berkeley Food Institute are trying to see how we can transform the food system to be more sustainable and we want to do it through good science, good policy, good thinking,” Brady said.
Press echoed Napolitano’s sentiment that UC’s involvement comes at a crucial moment.
He said that UC Santa Cruz had long been the “mothership” of organic agriculture in California and the U.S.
“We feel a lot of what people are talking about with sustainable agriculture and justice in the food system — these are things we’ve been working on for 40 years,” Press said. “Now the world is much more receptive.”
Helene Dillard, dean of the College of Agriculture and Environmental Sciences at UC Davis, talks with reporters in Sacramento. (Photo by Robert Durell)
Helene Dillard, dean of the College of Agricultural and Environmental Sciences at UC Davis, who joined Napolitano at the meeting with the state board, said that people at UC Davis are particularly excited about the initiative because it aligns so well with work already under way at the campus.
UC Davis last year launched the World Food Center to focus on transformative research at the intersection of food, agriculture, health and public policy.
“We’re already the No.1 agricultural school in the nation and the world,” Dillard said. “Having the UC system focusing on this really plays to our strengths.”
At UCLA, Napolitano was joined by UCLA Executive Vice Chancellor and Provost Scott Waugh; Wendy Slusser, associate vice provost for the UCLA Healthy Campus Initiative; students who manage the garden; and Los Angeles and Riverside school district officials.
UCLA’s initiative is an integrated effort aimed at making the campus the healthiest university in the country, promoting health and wellness of students, faculty and staff, and helping other communities achieve the same objectives. The Healthy Campus Initiative was envisioned and supported by philanthropists Jane and Terry Semel. Jane Semel was present for the announcement.
Napolitano toured the garden with members of the student group DigUCLA. She also planted an oregano plant and learned about gardening basics from the students.
Slusser said that she was excited to learn that the Healthy Campus Initiative served as a starting point for what has grown into a larger and stronger UC-wide effort. “On a personal note, the initiative is bringing me back to my roots since food has been the driving force in my medical and academic career, and also my father is a fourth-generation California rancher. So thank you, President Napolitano, and thank you to all our UCLA and community partners for working so hard in making us stronger together to promote health, wellness and happiness through food.”
UC is California’s land-grant university and has played a key part in helping California become the nation’s leading agricultural state. UC’s Division of Agriculture and Natural Resources has experts in every county in California, helping farmers, ranchers and others cope with tough issues like drought.
But UC’s leadership goes beyond agriculture. Students, faculty and staff have turned UC’s campuses into living laboratories for sustainable food practices. UC also is on the frontlines of addressing issues of food inequality and health, from developing flood- and drought-resistant crops to developing a highly efficient cookstove that addresses food security issues posed by displaced persons in Darfur.
Napolitano noted that the Berkeley Food Institute is studying the relationship between pest control, conservation and food safety on Central Coast farms; the World Food Center at UC Davis stands with 26 other centers dedicated to food and agriculture on that campus; students and faculty at UC Santa Cruz are transforming the field of agroecology; and the cutting-edge Healthy Campus initiative at UCLA taps all members of the campus community.
“We do much,” Napolitano said, “but, together, we can do more.”
Examples of projects that will be undertaken in the first phase of the UC Global Food Initiative include:
Expanding experiential learning, including demonstration gardens;
Creating a course catalogue of all food-related courses available on UC campuses;
Leveraging food purchasing power to encourage sustainable farming practices to serve nutritious fare in dining halls and cafeterias;
Data mining of existing information to help develop insights and action plans for agriculture and responses to climate change;
Organizing food pantries, so that food reaches hungry mouths instead of going to waste; and
Developing policies to better enable small growers to become suppliers.
Supporting student involvement
To support student engagement, Napolitano also announced the creation of the President’s Global Food Initiative Student Fellowship Program. The Office of the President will provide $7,500 to each UC campus to be used for three fellowships of $2,500 each. At the campuses’ discretion, these fellowships will go to undergraduates or graduate students, to fund student-generated research, related projects or internships that focus on food issues.
Keith Gilless, dean of UC Berkeley’s College of Natural Resources, said he was excited to see the system collaborate on such an important goal.
“I’ve been working my whole career to see how does the UC system as a whole come together so the sum is greater than its parts,” Gilless said. “The time is right to mobilize the university’s resources both to advance science and practices and to raise public consciousness about food issues broadly.”
UC San Diego's Ralph Greenspan (center) is helping lead the Cal-BRAIN initiative.
The California budget signed by Gov. Jerry Brown today (June 20) creates a statewide research grants program called Cal-BRAIN, an initiative led by UC San Diego. With an initial allocation of $2 million, Cal-BRAIN – short for California Blueprint for Research to Advance Innovations in Neuroscience – is a state complement to the federal BRAIN Initiative announced by President Barack Obama in April 2013. It aims to “accelerate the development of brain mapping techniques, including the development of new technologies.”
UC San Diego played a significant role in the national initiative and will now lead the state effort to revolutionize our understanding of the brain and the diagnosis and treatment of brain disorders of all kinds. By improving our ability to see what goes on in the brain in much greater detail and at a much faster timescale, we aim to make discoveries around autism, Alzheimer’s, PTSD and other behavioral health issues and injuries that affect everyone from our children to our homeless veterans.
In this leadership role, UC San Diego will guide the collaboration among the UC campuses and is currently discussing a significant financial investment of non-state, university resources in Cal-BRAIN.
Ralph Greenspan, director of UC San Diego’s Center for Brain Activity Mapping, established at the university in May 2013, is co-author with Paul Alivisatos, director of the Lawrence Berkeley National Laboratory, of a proposal to the University of California Office of the President and to the state Legislature that served as a blueprint for the bill just signed into law.
The proposal calls for organizational hubs in Southern and Northern California, at UC San Diego and Berkeley Lab, to coordinate research activities, facilitate communication and seek additional funds from private and industry partners.
Both Cal-BRAIN and the national initiative are expected to spur not only a new academic discipline but also a new industry cluster of “neurotechnology.” And the tools and inventions needed for mapping the brain will also likely have broad applications to a range of disease monitoring beyond the brain and even to fields beyond health.
“UC San Diego’s leadership role in Cal-BRAIN is of vital importance — not only to the university and the San Diego region but for the state as a whole,” said UC San Diego Chancellor Pradeep K. Khosla. “We will be developing the next technology cluster in ‘neurotech’ just as we did in high-tech, clean-tech and more, creating high paying jobs and world renowned results. I am confident that, with our strengths in neuroscience and biotechnology in San Diego, we will be producing ground-breaking research with significant social impacts.”
Since helping state Senate Majority Leader Ellen Corbett to convene the first hearing on California’s possible role in the BRAIN Initiative at UC San Diego in October 2013, Greenspan and other representatives from the university have traveled numerous times to Sacramento, presenting the case for Cal-BRAIN before members of the state Senate and state Assembly.
Senate President Pro Tem Darrell Steinberg (D-Sacramento) and state Sen. Marty Block (D-San Diego) were early champions. Assembly Speaker Toni Atkins (D-San Diego) also supported the bill.
“UC San Diego is a world leader in the biosciences, and it is a perfect fit to have UC San Diego serve as the Southern California hub of Cal-BRAIN,” Atkins said. “Cal-BRAIN will help develop brain mapping technologies and has the potential to make significant advances in treating conditions such as Alzheimer’s and Parkinson’s. I am proud San Diego will be at the forefront of this important effort.”
Greenspan – who is also associate director of the Kavli Institute for Brain and Mind at UC San Diego and professor in residence of neurobiology and cognitive science – is one of the original writers, as was Alivisatos of LBNL, of the white paper that sparked the national BRAIN Initiative.
“Our vision was for Cal-BRAIN to serve as a driver for trying out different possible technologies and converging on a unified approach for doing effective brain mapping, in which UC San Diego will play a key role,” Greenspan said. “Cal-BRAIN is a great start to realizing the ultimate goal: mapping the brain’s trillions of connections in real time.”
Behind the scenes at UC San Diego Health System’s trauma center.
Dr. Raul Coimbra (left) helps lead UC San Diego Health System's Level-1 Trauma Center. (Photo by Erik Jepsen, UC San Diego)
It’s 10 o’clock on a Tuesday morning and the UC San Diego Health System Level-1 Trauma Center is quiet. The only sounds are beeps and tones from machines monitoring the health and status of a handful of patients, the subdued bustle of staff tending to their work and family members visiting their sick or injured loved ones in the adjacent Surgical Intensive Care Unit.
Then, suddenly, a page sounds: A new trauma patient is en route. With trained, almost automatic response, trauma nurses, residents, fellows and surgeons move into position at the trauma resuscitation bay unit. When paramedics arrive with the patient, every second will count.
Seven trauma team members stand around a steel table, all with specific roles. With advanced technology and verbal communication with paramedics on scene, the trauma team is prepared and ready to execute a treatment plan before the patient is even in the hospital.
“We are always in a state of readiness,” said Dr. Raul Coimbra, new surgeon in chief at UC San Diego Medical Center – Hillcrest and chief of the division of Trauma, Burn, Surgical Critical Care and Acute Care Surgery at UC San Diego Health System. “Each second we effectively save with one patient, will be used to treat the next, making for a stronger workflow and collaboration with trauma surgeons and achieving the ultimate goal of improved patient care and survival rates.” The doors open. Paramedics roll the patient into the trauma resuscitation area. Trauma team members take over. If you are envisioning a chaotic scene from the television show “Grey’s Anatomy,” think again. The team calmly and efficiently assesses the patient, a male who fell and severely injured himself while vacationing in Mexico.
More than 3,200 patients are admitted to the trauma center each year. Trauma surgeons treat injuries that include not just injuries from falls, but the consequences of motor vehicle accidents, assaults, gunshot and stab wounds and burns.
UC San Diego Health System’s trauma center is one of only four in the nation where trauma patients are treated in a free-standing trauma center not located within the emergency room, as trauma patients require a highly specialized medical team with a unique skill set.
“Trauma patients come directly to the trauma center for the most critical care, bypassing the emergency department,” said Coimbra. “There is a dedicated trauma team that cares for this population from the time they are admitted until discharge from the hospital.”