UC Davis partnership aims to provide strategic advice and mentoring services to facilitate better care.

Kenneth Kizer, UC Davis

The California Department of Health Care Services (DHCS) announced today (Feb. 9) that it has established a partnership with the Institute for Population Health Improvement (IPHI) at UC Davis Health System to improve the quality of care provided by the state’s $46 billion per year Medi-Cal program.

“This partnership will provide strategic advice and mentoring services to guide our capacity for quality improvement, population health management and organizational change,” said Neal Kohatsu, DHCS’ medical director. “It will help strengthen our relationships with partner hospitals by emphasizing bi-directional communication, education and interventions that drive improvement in population health.”

The five-year, $4.25 million agreement calls for, among other things, the IPHI to design and support a statewide Medi-Cal quality improvement plan, develop a systems-level strategy for DHCS to assess hospitals’ success in achieving the goals set forth by the Medicaid Section 1115 waiver’s Delivery System Reform Incentive Pool (DSRIP) program, convene a Medi-Cal Performance Advisory Committee of experts in clinical sciences, system thinking, quality improvement and organizational change, and provide quality improvement training and mentoring for DHCS managers.

“The department is focused on improving and enhancing quality care and reducing health care-related costs,” said DHCS Director Toby Douglas. “Our agreement with IPHI will help us achieve these interconnected goals.”

Medi-Cal is a joint state-federal health insurance program that serves more than 7.6 million low-income and medically high-risk Californians. The DSRIP program is a new component of Medi-Cal that provides federal funds to public hospitals that have demonstrated success in expanding capacity and making services more coordinated, efficient and patient-centered. DSRIP is part of California’s five-year, $10 billion “Bridge to Reform” Medicaid Section 1115 waiver, which aims to strengthen the Medi-Cal program and prepare safety net providers for nearly one million newly eligible Medi-Cal beneficiaries in 2014. The 1115 waiver is an agreement between the state of California and the federal Centers for Medicare & Medicaid Services (CMS) that “waives” certain Medicaid requirements in order to test new strategies for improving care and service delivery.

Kenneth W. Kizer, one of the nation’s preeminent authorities on public health and health care quality improvement and founding director of IPHI, will lead the effort.

“This partnership will result in better health care for millions of Californians and better value for taxpayers who fund the program,” said Kizer, who also is a distinguished professor at the UC Davis School of Medicine and Betty Irene Moore School of Nursing. “We will be developing a clearly defined quality improvement plan for the Medi-Cal program that will include specific quantitative goals and performance measures to track improvement in health care processes and health outcomes, equitable access to care, the prudent use of resources and appropriate matching of resources with needs. In evaluating the DSRIP program and helping develop a systems-level strategy, we expect to make specific recommendations for DHCS and individual hospital systems that will help them achieve DSRIP program milestones and more.”

The plan’s goals and performance measures will reflect the shared values and best practices of the federal Department of Health and Human Services’ National Quality Strategy. DSRIP program evaluations will address interventions in each hospital system plan, including the implementation of electronic health records and use of other health information technology, implementation of patient-centered medical homes, use of evidence-based population health management methods and integration of clinical services to improve the coordination and continuity of care. Kohatsu believes that “Dr. Kizer’s extensive knowledge and history of transforming health care in California and across the nation make him an outstanding director of this statewide initiative.”

Kizer is a member of the Institute of Medicine of the National Academy of Sciences and a fellow of the National Academy of Public Administration. As director of the former California Department of Health Services for Gov. George Deukmejian from 1984 to 1991, he pioneered Medi-Cal managed care, led California’s response to the HIV/AIDS epidemic, launched California’s famed Tobacco Control Program and established a number of leading programs that have become national models of excellence. Some of these include the “5 a Day for Better Health” nutrition program, the California Cancer Registry and California’s birth defects monitoring program.

As undersecretary for health in the U.S. Department of Veterans Affairs (VA) for President Clinton from 1994 to 1999, Kizer engineered the internationally acclaimed transformation of the VA health care system, which included the most rapid and largest ever deployment of a system-wide electronic health record and a comprehensive quality improvement and performance management system that has been cited as a model by Harvard University and others. As founding president and chief executive officer of the National Quality Forum (NQF), Kizer led efforts to establish national standards for reporting of health care quality. Today, NQF-endorsed performance measures are widely used by the federal government and throughout American health care.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute-care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

UCLA program, funded through Affordable Care Act, provides high-risk pregnant teens with home visits from nurses.

Deborah Koniak-Griffin, UCLA

The U.S. Department of Health and Human Services has chosen an adolescent pregnancy-intervention program designed by the UCLA School of Nursing as a model program for funding under the health care reform law.

The Public Health Nursing Early Intervention Program (PHN-EIP) for Adolescent Mothers, which was designed to improve pregnancy outcomes among young Latina and African American adolescents, is one of only two nurse models approved for implementation by Health and Human Services. This means that agencies and states that implement the model program may be eligible to receive funding under the Patient Protection and Affordable Care Act’s Maternal, Infant and Early Childhood Home Visiting Program (MIECHV).

“According to the Centers for Disease Control, over 400,000 teenagers gave birth in 2009,” said Deborah Koniak-Griffin, a professor at the UCLA School of Nursing and director of the school’s Center for Vulnerable Populations Research. “Unfortunately, the babies of these young girls are more likely to be born into poverty, have low birth weight requiring hospitalization and suffer childhood health problems than babies born to older mothers.”

The UCLA-designed program was first implemented in conjunction with the San Bernardino County Department of Public Health. High-risk pregnant young women received home visits from the middle of their pregnancy through the end of their child’s first year. Prenatal visits focused on the use of prenatal health care, preparation for childbirth, self-care during pregnancy, and preparation for motherhood. For the first year after the child was born, mothers received information on family planning, infant care and well-baby health care.

“The costs to the U.S. health care system are substantial — about $9 billion each year — so it is in the interest of the states to enhance the health outcomes for those teens who do become pregnant, and for their babies,” Koniak-Griffin said.

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New federal funding — up to $1B — available for next generation of health care innovations.

The U.S. Department of Health and Human Services announced Monday (Nov. 14) it will award up to $1 billion to innovative projects across the country that test creative ways to deliver high-quality medical care and save money. The Health Care Innovation Challenge will give preference to projects that rapidly hire, train and deploy health care workers.

The Center for Medicare & Medicaid Innovation will host a webinar from 11 a.m. to noon Thursday (Nov. 17) to provide an overview of the initiative and answer questions. To join, visit the webinar site. Participants wanting to only listen to audio may dial (888) 567-1602 or (201) 604-5049 and request “Center for Medicare & Medicaid Innovation Webcast” (no passcode).

Awards will be expected to range from approximately $1 million to $30 million over three years, according to the center. Applications are open to providers, payers, local government, community-based organizations and particularly to public-private partnerships and multipayer approaches. Each grantee project will be evaluated and monitored for measurable improvements in quality of care and savings generated. Letters of intent are due Dec. 19 with applications due Jan. 27.

For more information, visit http://innovation.cms.gov/initiatives/innovation-challenge/index.html.

For a variety of reasons, doctors who treat Latinos are less likely to believe they can provide high-quality care.

Arturo Vargas-Bustamante, UCLA

Experts have written about health care disparities between Latinos and non-Latino whites, mostly from a policy standpoint. They’ve also looked at the same disparities from the perspective of the patient, in terms of access, use and the quality of health care.

But how do the physicians feel about the quality of care they provide? What challenges do doctors face in treating Latino patients, compared with physicians whose patients are primarily white and non-Latino?

Research out of UCLA and the City University of New York has found that primary care physicians who treat Latinos are less likely than physicians treating primarily white patients to believe they can provide high-quality care. Among the reasons: inadequate time with patients, patients’ lack of ability to afford care, patients not adhering to recommended treatments and difficulties in communicating.

The study appears in the current edition of the journal Health Affairs.

Researchers used data from the 2008 Community Tracking Physician Survey, a nationally representative sample of U.S. physicians that included demographic information and patient characteristics.

“From this survey, we analyzed physicians’ self-reported ability to provide high-quality care to Latinos and compared it to that of physicians treating primarily whites,” said Arturo Vargas-Bustamante, an assistant professor of health services at the UCLA School of Public Health and lead author of the study along with Jie Chen, an assistant professor at CUNY’s College of Staten Island.

Latinos differ from other minority patients in their socioeconomic and demographic characteristics, as well as their patterns of health care access, use and spending, Vargas-Bustamante said, and these differences are likely to influence physicians’ perceptions of the quality of care they deliver.

Latinos represent more than 15 percent of the U.S. population, he noted, and they constitute the largest ethnic minority group in the country. And the Affordable Care Act of 2010, Vargas-Bustamante said, is likely to benefit larger proportions of minority individuals, particularly Latinos, who currently experience the highest uninsurance rate across racial and ethnic groups.

“We wanted to understand the challenges that providers face in delivering high-quality care to underserved populations,” he said. “Overcoming such challenges will be critical to ensure that the insurance expansion under the Affordable Care Act will succeed in providing better health for all.”

What the researchers found, Vargas-Bustamante said, was disturbing. Physicians who primarily treat Latino patients don’t feel they can provide high-quality care. But in addition to the problems specific to Latinos, these physicians still must contend with all the common problems of providing health care regardless of ethnicity, including insurers’ rejection of claim decisions, medical errors, a relative lack of available specialists and the lack of timely transmission of reports among physicians.

Vargas-Bustamante noted that, when implemented, the Affordable Care Act can potentially address some of these quality challenges.

“An increased supply of medical personnel, for example, would allow primary care physicians to allocate more time to patients and improve follow-up,” he said. “Also, more cultural competence will come from the strengthening of primary care providers, which would address problems with communicating and in improving treatment compliance.”

The researchers received no outside funding for this study.

The UCLA School of Public Health is dedicated to enhancing the public’s health by conducting innovative research; training future leaders and health professionals; translating research into policy and practice; and serving local, national and international communities.

Student-coordinated electives provide opportunities for active and collaborative learning.

UC San Francisco's Laura Schmidt lectures on health care reform

Second-year medical student Jeff Doyon had a hunch that his health care reform elective might get some interest from fellow classmates, but he didn’t anticipate a line stretching out the door on its first day.

A year after the passage of the federal Patient Protection and Affordable Care Act, students at UCSF are showing up in large numbers to learn about the landmark legislation two years before they were scheduled to learn about it. Signed into law by President Barack Obama on March 23, 2010, the act reforms certain aspects of the private health insurance industry and public health insurance programs, including increasing insurance coverage of pre-existing conditions, expanding access to insurance to more than 30 million Americans and mandating an increase in total national medical expenditure.

“Reform is on everyone’s mind here,” Doyon said. “We are just starting our medical training and want to know how it’s going to affect our approach to providing care.”

More than 80 students attended the standing-room-only lecture led by Laura Schmidt, Ph.D., M.S.W., M.P.H., who kicked off the course on Sept. 21 with an overview of U.S. health care and past reform efforts.

“I was excited to see so many interested students,” Schmidt said. “I think they thirst for an understanding of where doctors fit into the vast maze we call our health care system and are deeply motivated by concerns about health equity and the fairness of a system that leaves so many uninsured. It speaks volumes to the kind of curious and engaged people UCSF attracts.”

The UCSF School of Medicine ranks among the top four medical schools in the nation, based on a 2011 survey conducted by U.S. News & World Report. Drawing many of the nation’s top pre-medical students, the school encourages them to not only excel at medicine, but to become health leaders by developing courses for peers across the health care professions. The students in attendance during this elective represented the schools of medicine, nursing and pharmacy and Doyon expressed hope that they could learn from each other as they asked questions about how the law would affect their respective fields.

Doyon’s elective, called “Affordable Care Act and the Future of Healthcare Reform,” approaches the legislation from the perspective of various stakeholders, including patients, nurses, small businesses, and both public and private insurance companies. It will also feature a lecture dedicated solely to California — nearly half of Californians are on government-sponsored health insurance, so the law will affect millions of people in that program alone.

“Given all the changes in our health care system, I think it’s important to stay up to date on what policies will affect my career,” said Ruben Lachica, a second-year medical student and executive director of Mabuhay Health Center, a free Filipino clinic in San Francisco. “I think it’s especially important for me to be informed on this issue for the advocacy work I want to get into.”

Average attendance for student-coordinated electives ranges from a dozen to more than 100, according to David Rachleff, curriculum coordinator for the UCSF School of Medicine. The student-created classes, he said, are meant to provide first- and second-year students with opportunities for active and collaborative learning.

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We must “reimagine and redefine” nursing, says UCLA nursing school dean.

Courtney Lyder, UCLA

One of the nation’s leading voices in patient care and safety says that the key to successfully navigating the challenges and changes that health care reform will bring is the ability to “reimagine and redefine” what nursing is all about.

“The addition of as many as 35 million more people with health insurance will create enormous demands that the current system is simply not prepared to handle,” said Courtney Lyder, dean of the UCLA School of Nursing. “Today’s shortage of primary care physicians will only be exacerbated unless we look to nurses and nurse practitioners to fill the gaps in providing needed care.”

Presently, nurses make up the largest segment of the health care workforce, with more than 3 million nursing professionals in the U.S. and as many as 19 million worldwide. Still, Lyder believes that most people are not aware of the many roles nurses play or of the fact that they are the “heart and soul” of medical institutions across the U.S. and around the world.

“Without too much fanfare, and away from the media spotlight, nurses are redefining and expanding their roles, championing quality-of-care improvements, spearheading research innovation, advocating for patients’ rights and generally challenging the status quo,” Lyder said. “And they have been doing all this while not surrendering their historical role as patient advocate and trusted bedside clinician.”

Still, according to Lyder, nursing’s greatest role may lie ahead.

Even before health reform, the Association of American Medical Colleges predicted a shortage of primary care physicians, estimating that an additional 45,000 would be needed by 2020 to keep up with demand. But fewer and fewer students in medical school are choosing primary care medicine, opting instead for specialties that may bring a higher income, more prestige and a less demanding lifestyle.

The professionals most qualified to fill this primary care gap are nurse practitioners, Lyder said. Nurse practitioners are registered nurses who have completed graduate-level education (either a master’s or doctoral degree) and who are able to deliver some medical care without the direct supervision of a physician. This includes prescribing or renewing prescriptions for most drugs (California is the only state where this can’t be done); ordering blood tests; performing routine medical examinations; monitoring chronic conditions; counseling patients about prevention; and treating colds, sore throats and the flu.

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UC Press publishes John McDonough’s guide to the Affordable Care Act.

This indispensable guide to the Affordable Care Act, our new national health care law, lends an insider’s deep understanding of policy to a lively and absorbing account of the extraordinary — and extraordinarily ambitious — legislative effort to reform the nation’s health care system. Dr. John E. McDonough, D.P.H., a health policy expert who served as an adviser to the late Sen. Edward Kennedy, provides a vivid picture of the intense effort required to bring this legislation into law. McDonough clearly explains the ACA’s inner workings, revealing the rich landscape of the issues, policies, and controversies embedded in the law yet unknown to most Americans. In his account of these historic events, McDonough takes us through the process from the 2008 presidential campaign to the moment in 2010 when President Obama signed the bill into law. At a time when the nation is taking a second look at the ACA, Inside National Health Reform provides the essential information for Americans to make informed judgments about this landmark law.

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The gap in access to primary care could expand, according to UC Davis researchers.

UC Davis Dr. Richard Kravitz (left) on hospital rounds with medical students.

The amount of time physicians spend on the job can vary widely based on specialty, according to UC Davis research published July 11 in the Archives of Internal Medicine. More than 25 work hours per week separated the most time-consuming specialty of vascular surgery and the least time consuming of pediatric emergency medicine.

Coupled with their previous research on physician pay, the authors note that primary care physicians (pediatricians, family practitioners, geriatricians and internal medicine specialists) have working hours toward the middle of the range but earn toward the lower end of the wage scale. Together, the outcomes indicate that the gap in access to primary care physicians is likely to expand.

“It is doubtful that medical students will want to enter primary care if there continues to be such a mismatch between hours worked and wages compared with other specialties,” said J. Paul Leigh, professor of public health sciences and lead author of the study. “Policymakers who make medical payment decisions should strive for better balance.”

Leigh said the current study has important implications for health care reform, which will greatly increase demand for primary care doctors who are already in short supply.

“We can expect 30 million more Americans to have insurance soon, and they’ll all need primary-care physicians to help manage their care,” said Leigh. “The results could be an even bigger shortfall in primary care providers than currently expected.”

In conducting the work-hours study, Leigh and his colleagues used data from a nationally representative sample of physicians in the 2004 to 2005 Community Tracking Survey. More than 6,000 physicians working in 41 different specialties were included. Work hours involved time spent on all medically related activities. Data was analyzed for physicians who worked 20 to 100 hours per week and at least 26 weeks in a year.

In addition to vascular surgery, specialties with work hours that far exceeded the average were critical care, neonatal and perinatal medicine, and thoracic surgery. In addition to pediatric emergency medicine, specialties involving the fewest work hours were occupational medicine, dermatology, and physical medicine and rehabilitation.

“The specialists at the top of the work-hours ladder tend to provide more intensive care, often in hospital settings,” said Richard Kravitz, professor of internal medicine and a study co-author. “Vascular surgeons, for instance, perform highly complex surgeries, often on an urgent basis. The specialists toward the bottom of the ladder, on the other hand, tend to have more controllable hours.”

In general, physicians with the fewest hours care for more stable patients, usually in outpatient settings, or have fixed shifts, said Kravitz, whose research focuses on improving quality of care and patient satisfaction. He added that the study results help explain current difficulties in recruiting physicians into certain specialties.

“Two specialty areas with particular difficulties in meeting population needs are primary care and general surgery,” said Kravitz. “Looking at our data, it is easy to understand why. Primary care physicians have middling hours and low pay. General surgeons work long hours and have middling pay.”

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The grants to improve patient safety include proposals with investigators from UC Davis, UC Irvine, UCLA, UC San Diego, UCSF and UC Berkeley.

UCSF's Rebecca Smith-Bindman is the principal investigator on one of the grants awarded by the UC Center for Health Quality and Innovation

The University of California’s new Center for Health Quality and Innovation has awarded nine grants totaling $3.4 million to UC faculty and staff to improve patient care throughout California.

The grants include proposals to stop blood clots, reduce hospital readmissions, decrease falls in hospitals and limit patient exposure to radiation — collaborative efforts that will make patients safer.

Building on UC’s strengths in groundbreaking research and medical care, the Center for Health Quality and Innovation (CHQI) aims to improve patient care while decreasing costs, one of the key goals of health care reform. These objectives will be especially important in 2014 when millions more Californians become eligible for insurance coverage under health care reform.

“We’re harnessing UC’s intellectual power to transform health care delivery for all Californians,” said CHQI Executive Director Terry Leach. “Our faculty and staff, many of whom sit on national boards and organizations, want to improve the quality of care to all Californians, and this initiative will help make that happen.”

UC Health launched the center in October to promote and advance innovations in clinical care that will improve patient outcomes and quality of care within the UC system and beyond. The center is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and is chaired by the UC senior vice president for health sciences and services. The center received initial funding of $5 million — $1 million each from medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

Center officials hope to begin a second round of grants in the fall focusing on proposals that improve operational efficiency and quality by demonstrating a return on investment, and seek additional funding from interested stakeholders to support this effort.

UC faculty and staff submitted nearly 100 proposals for the first round of grants, with 61 advanced to CHQI for further review. The nine grants awarded aim not only to improve clinical care but to create a systems’ approach to change while embracing the perspective of patients and enhancing their experience along the continuum of care.

The grant winners include:

• Integrating Patient Care and Health Professions Education to Improve Care Transitions: The UC Health Quality Improvement Network, $750,000 over three years
  Principal investigator: Ulfat Shaikh, M.D., M.P.H., UC Davis
  Co-investigators: Alpesh Amin, M.D., M.B.A., UC Irvine; Nasim Afsarmanesh, M.D., UCLA; Brian Clay, M.D., UC San Diego; Sumant Ranji, M.D., UCSF
  Fragmented care following hospital discharge is a common problem that leads to poorer patient outcomes, including unplanned and costly readmissions. This proposal will develop infrastructure for a quality improvement network involving trainees at UC’s five medical centers, with care transitions as the first focus area. This collaboration will help improve patient care transitions during hospital discharge.
• UC Collaborative to Reduce Hospital Acquired Venous Thromboembolism: Stop the Clot, $750,000 over three years
  Principal investigator: Gregory Maynard, M.D., UC San Diego
  Co-investigators: Patrick Romano, M.D., M.P.H., UC Davis; Richard White, M.D., UC Davis; Alpesh Amin, M.D., M.B.A., UC Irvine; Nasim Afsarmanesh, M.D., UCLA; Ian Jenkins, M.D., UC San Diego; Andrew Auerbach, M.D., M.P.H., UCSF
  Venous thromboembolism (VTE), the blocking of a blood vessel by a blood clot, is among the most common preventable causes of hospital death. This proposal will create a systemwide effort to reduce UC’s already low VTE rate by at least 20 percent through focusing on preventive measures in adult medical-surgical hospital patients.
• Standardization and Optimization of Computed Tomography Patient Radiation Dose Across the University of California Medical Centers, $750,000 over three years
  Principal investigator: Rebecca Smith-Bindman, M.D., UCSF
  Co-investigators: John Boone, Ph.D., UC Davis; Ramit Lamba, M.D., UC Davis; James Anthony Seibert, Ph.D.,  UC Davis; Mayil Krishnam, M.D., UC Irvine; Christopher Cagnon, Ph.D., UCLA; Michael McNitt-Gray, Ph.D., UCLA; Thomas Nelson, Ph.D., UC San Diego; Robert Gould, Sc.D., UCSF; Diana Miglioretti, Ph.D., Group Health Cooperative
  Computed tomography (CT) exams quadrupled between 1994 and 2007. While an important medical advance, CT exams also deliver substantially higher radiation than conventional X-rays. Moreover, CT radiation doses vary highly. This proposal aims to standardize and optimize CT doses across UC medical centers so that patients receive the lowest dose possible to produce the necessary medical benefit.
• A Consortium of Trauma Centers for the Development of a Decision Instrument for Selective Chest Computed Tomography in Blunt Trauma, $375,000 over three years
  Principal investigator: Robert Rodriguez, M.D., UCSF
  Co-investigators: Daniel Nishijima, M.D., UC Davis; Mark Langdorf, M.D., M.H.P.E., UC Irvine; William Mower, M.D., Ph.D., UCLA; Anthony Medak, M.D., UC San Diego; Gregory Hendey, M.D., UCSF
  CT use for trauma evaluation has increased dramatically in the past 15 years, leading to exposure of potentially harmful radiation to a disproportionately young patient population, increased costs and greater time in the emergency department. This proposal aims to reduce unnecessary chest CT in blunt trauma patients, thereby conserving resources and decreasing unnecessary radiation to patients. Four non-UC academic medical centers also may join in this study.
• Individualizing Assessments of Risk to Reduce Falls in UC Hospitals, $375,000 over three years
  Co-principal investigators: Catherine Walsh, G.N.P., UCLA; Teryl Nuckols, M.D., M.S.H.S., UCLA
  Co-investigator: Carla Graf, R.N., C.N.S., UCSF
  In 2010, UCLA’s Ronald Reagan Medical Center implemented the 5P Fall Prevention Method (assess a patient’s pain, personal needs, positioning, placement and focus on preventing falls), reducing falls by 30 percent. This proposal will develop programs to train nurses, physicians and physical therapists about the 5P method, implement it at Santa Monica UCLA Medical Center and UCSF Medical Center, assess its effectiveness, examine costs, and disseminate the program and results to UC hospitals and nationally.
• The UCSD Patient-Centered Recovery Program, $286,440 over two years
  Principal investigator: William Perry, Ph.D., UC San Diego
  Nationally, the number of people using emergency services who have mental health diagnoses has increased 40 percent over the past two decades, and among these, substance abuse diagnoses are the most common. This proposal is designed to reduce emergency room visits and hospital readmissions among mental health/substance abuse patients by providing screening, brief intervention, referral to treatment services, and a patient-centered recovery and case management program.
• Implementation and Assessment of a Formal Curriculum for Bedside Ultrasound Training, $50,000 for one year
  Principal investigator: Elizabeth Turner, M.D., UC Irvine
  Co-investigators: John Christian Fox, M.D., UC Irvine; Mark Allen Rosen, M.D., UC Irvine
  Bedside ultrasound involves portable ultrasound exams performed and interpreted by the physician at the point of care. Studies show this can provide better patient outcomes, but standardized training in point-of-care ultrasonography is lacking. This proposal will implement a formal bedside ultrasound educational program and validate that learners gain competence to allow its integration into practice.
• Exercise and Activity Monitoring, Feedback and Outcome Measures to Improve Continuing Care, $50,000 for one year
  Principal investigator: Bruce Dobkin, M.D., UCLA
  Co-investigators: William Kaiser, Ph.D., UCLA; Maxim Batalin, Ph.D., UCLA
  Stroke is the most common cause of neurological disability in adults. UCLA’s Ronald Reagan Medical Center admits 400 patients a year with acute stroke; its inpatient rehabilitation unit manages 240 patients. These patients have marked muscle weakness in addition to neurological deficits. This proposal will use wireless health innovations developed by UCLA engineers, computer scientists and clinicians to monitor home exercise, provide feedback and obtain measures of activity to improve patient care.
• The Patient Support Corps: A Service Learning Program for Improved Care and Education, $50,000 for one year
  Principal investigator: Jeff Belkora, Ph.D., UCSF
  Co-investigator: Joan Bloom, Ph.D., UC Berkeley
  This proposal expands on an innovative form of patient support pioneered at the UCSF Breast Care Center, which deploys 10 part-time premedical interns as paid support staff for patients. This program will deploy UC Berkeley undergraduates in patient support roles.

For more information:
UC Davis, Charles Casey, (916) 734-9048, charles.casey@ucdmc.ucdavis.edu
UC Irvine, John Murray, (714) 456-7759, jdmurray@uci.edu
UCLA, Roxanne Moster, (310) 794-2264, rmoster@mednet.ucla.edu
UC San Diego, Debra Kain, (619) 543-6202, ddkain@ucsd.edu
UCSF, Karin Rush-Monroe, (415) 502-NEWS, karin.rush-monroe@ucsf.edu

Immigrant status will keep many children from obtaining affordable health care coverage.

Ninez Ponce, UCLA

Restrictions on eligibility for health care reform programs will result in the potential exclusion of up to 220,000 children from affordable health care coverage in California, according to a new policy brief from the UCLA Center for Health Policy Research.

The number represents approximately 20 percent of all uninsured children in California.

Of those children, up to 40,000 may be eligible for coverage but may not apply, due to confusion about new rules governing access to both the California Health Benefit Exchange and the state’s expanded Medi-Cal program.

The Patient Protection and Affordable Care Act of 2010 (ACA) restricts its health insurance expansions in ways that exclude many uninsured children in California who are immigrants or have immigrant parents. And the policy brief’s authors note that immigrant parents, potentially misinterpreting eligibility requirements for these new programs, may not enroll their eligible citizen children.

“Health care reform restrictions raise some very unpleasant questions about our willingness as a society to let children go without care,” said the study’s lead author, Ninez Ponce, a faculty associate with the center and an associate professor at the UCLA School of Public Health. “And confusion over the rules may result in even eligible children being cut off from coverage.”

Using data from the 2007 California Health Interview Survey (CHIS), the study’s authors estimate that under the ACA, approximately 30,000 undocumented immigrant children will be barred from participating in the Health Benefit Exchange, a newly established marketplace for health care plans with subsidies for lower-income Californians. Although their parents will be able to purchase private insurance outside of the exchange, they would not benefit from its protections or competitive prices.

In addition, approximately 150,000 uninsured children will be excluded from the ACA-funded Medi-Cal expansion due to their status as either undocumented immigrants or legal immigrants who have lived in the U.S. for fewer than five years.

An estimated additional 40,000 children who are legal citizens of the U.S. also may be excluded from the ACA coverage expansions as a result of confusion over their parents’ citizenship status. Specifically, parents who are non-citizens without a green card — who themselves are excluded from public programs and the exchange — may perceive that the documentation restrictions also apply to their qualified citizen children, the study’s authors predict.

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It can help reduce unnecessary and costly testing and referrals to specialists.

Klea Bertakis, UC Davis

Physicians who have more personalized discussions with patients and encourage them to take a more active role in their own health care can help lower medical costs and reduce the need for some health care services, according to new research from UC Davis Health System.

Researchers said the lower medical costs stem from physicians and patients having more confidence that together they have reached a correct diagnosis and decided upon a good strategy to improve the patient’s health. What’s been termed “patient-centered care” can help eliminate or reduce unnecessary and costly testing and referrals to specialists, said family practice physician Klea Bertakis and study co-author Rahman Azari, a professor of statistics at UC Davis.

“Patient-centered care has been identified by the Institute of Medicine as one of the key actions for improving our nation’s health,” said Bertakis, principal investigator of the study and professor and chair of the UC Davis Department of Family and Community Medicine. “Our study shows that including patients in more of the treatment and care-planning discussion is not only the right thing to do, it is also cost-effective.”

In conducting the study, which appears in the current issue of the Journal of the American Board of Family Medicine, Bertakis and Azari randomly selected more than 500 new adult patients to receive care by family physicians or general internists. Each examination over the course of one year was videotaped and carefully analyzed and coded to measure the extent of discussions between patients and physicians. Factors indicating patient-centered care included discussing family and social history, nutrition and exercise, the patient’s beliefs about his or her health, and counseling on the patient’s emotions or interpersonal relations. The factors were then compared to the number of a patient’s health care visits as well as charges over the course of a year.

The study found that the number of specialty care visits, hospitalizations and diagnostic services were significantly reduced, as were total health care charges and specialty care charges, among patients who received more patient-centered care. The trends were still significant when patient gender, health status and socioeconomic factors were taken into account.

According to Bertakis, the observed reduction in the use of services and costs for patients who received patient-centered care likely represents the elimination of non-essential medical care.

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UC Davis researchers continue forging new ground to transform health care delivery.

Joy Melinkow, UC Davis

Health care reform is now on the top of the national agenda, but at UC Davis Health System, researchers have been contributing provocative and impactful work to improve health care in America for nearly two decades.

As the nation struggles to keep health care costs down and as policymakers, insurance companies and health care providers grapple with the new Affordable Care Act, UC Davis researchers continue forging new ground to transform health care delivery. An examination of wage disparities among physician specialties, the role of nurses in health care reform efforts, cost-effectiveness of cancer screenings and creation of better health care quality measures are among the ongoing projects.

UC Davis faculty, for example, are charting the future of health care for women and the field of nursing, through their work with the influential Institute of Medicine.

Likewise, members of the UC Davis Center for Healthcare Policy and Research (CHPR) are bringing their groundbreaking work and expertise to bear on efforts to improve health care access, delivery, cost-effectiveness and outcomes.

“The mission of our center is to enhance research and education around quality and outcomes of health care,” says Joy Melnikow, director of CHPR and a UC Davis professor of family and community medicine. “There is no question that the center is contributing to and informing national health care reform.”

The center’s charge has been to help lead work in comparative effectiveness research, which involves the direct comparison of existing health-care interventions to determine which treatments work best, for whom, and under what circumstances.

President Obama has said that evidence-based medicine is key to making sure Americans get the best care while keeping the cost of care affordable. That includes standardizing care, based on the results of comparative effectiveness research.

Comparative effectiveness research is now a focus in the national debate, but CHPR members have been doing this type of work since 1994.

“The findings of this kind of research are the building blocks for decision-making to develop reforms that will lead us to health care that has increased benefits, reduced harms and controlled costs,” Melnikow says. “The core of our mission advances the information needs for health-care reform.”

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