May 1 symposium to be Blum Center’s inaugural event.

UCLA has formed the UCLA Blum Center on Poverty and Health in Latin America, where faculty and students from multiple disciplines will work with other institutions to conduct research, develop training programs and promote innovative policy solutions aimed at addressing key social and health-related issues in the region.

“As a public university, UCLA has a duty to address the world’s challenges, and our cross-disciplinary strengths in medicine, public health, humanities, social sciences, research and public policy position us to make a difference,” said UCLA Executive Vice Chancellor and Provost Scott Waugh. “We have strong ties to Latin America and welcome the opportunity to strengthen our collaborations with other academic institutions, nonprofit groups and nongovernmental organizations in the region. The UCLA Blum Center is a team effort that draws faculty and students from across campus who are committed to redressing issues of poverty and health in Latin America.”

Dr. Michael Rodriguez, professor and vice chair of research in the department of family medicine at the David Geffen School of Medicine at UCLA, will serve as the center’s director.

“The programs of this new center reflect our mission to work collaboratively with a wide range of UCLA disciplines, as well as Latin American partnering institutions, to identify and promote solutions in health policy and practice,” Rodriguez said. “We expect to build the center into a preeminent authority in our three focus areas — research, policy and training on the social determinants contributing to health inequalities in Latin American populations.”

UCLA issues policy note, hosts webinar April 25.

California faces a shortage of medical specialists for the state’s estimated 1 million children with serious medical conditions. Why?

According to a new UCLA Center for Health Policy Research policy note and related April 25 webinar, although pediatric subspecialists who care for the sickest children require additional training, they are generally paid less than physicians who care for adults.

The result is a disincentive to specialize and a subsequent dearth of experts capable of caring for children with severe and often multiple diseases or health conditions that vary in severity. These include chronic conditions such as asthma as well as acute and complex diseases affecting the heart, lungs, and other bodily systems.

Access to pediatric subspecialty care is also particularly difficult for children of color, which account for 64 percent of children with special health care needs in the state, as well as the uninsured and those living in rural areas.

The study’s lead author Daphna Gans, and co-authors, recommend improving access to pediatric subspecialists by reducing the cost of subspecialty training. For instance, a federal loan repayment program should be available to pediatric subspecialists.

Other recommendations include addressing payment and reimbursement issues and increasing the use of nurse practitioners and physician assistants in children’s health care.

Read the policy note

Study shows flaws in use of discharge diagnoses to determine validity of ER visits.

Visits to the emergency room are not always for true medical emergencies – and some policymakers have been fighting the problem by denying or limiting payments if the patient’s diagnosis upon discharge is for “nonemergency” conditions.

A new UC San Francisco study challenges that framework by showing that criteria used as a basis to determine the appropriateness of an ER visit and to deny payment is inherently flawed. The study analyzed nearly 35,000 visits to hospital emergency departments around the country.

The research is published online Wednesday in JAMA, The Journal of the American Medical Association.

Overuse of the ER for nonemergency visits is often touted as a costly problem in the United States. The new study highlights the complexity of the issue by showing that using discharge diagnoses to determine the validity of an ER visit could have serious implications, including dissuading patients from using the ER when they really need it.

While many patients are given a diagnosis upon discharge that their condition was treatable through primary care, other similar patients actually required immediate emergency care or to be admitted to the hospital, the researchers found.

The authors conclude that strategies aimed at narrowly reducing use of the emergency room are unlikely to improve a community’s general health or to lower health system costs.

“This study highlights the flaws of a system that fails to distinguish between information available at arrival in the emergency department and information available at discharge,” said lead author Maria C. Raven, M.D., M.P.H., a UCSF assistant clinical professor of emergency medicine. “Attempting to discourage patients from using the ER based on the likelihood that they would have nonemergency diagnoses risks sending away patients who require emergency care. The majority of Medicaid patients, who stand to be disproportionately affected by such policies, visit the ER for urgent or more serious problems.”

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UCSF celebrates 40-year record of leadership in health policy research, teaching and service.

UCSF’s Philip R. Lee Institute for Health Policy Studies honored its 40th anniversary with a milestone celebration at San Francisco City Hall that reflected on its roots, extolled its accomplishments, and envisioned a robust future.

“How fitting that we come together in this beautiful and historic building – the building where [founding director] Phil Lee served as the first president of San Francisco’s Health Commission under Mayor Dianne Feinstein,” said Claire Brindis, Dr.P.H., director of the Institute for Health Policy Studies (IHPS). “I thank Phil Lee and Lew Butler (founding associate director) for being dissatisfied with the status quo and for being revolutionary and bold in your creation of the institute 40 years ago.”

The IHPS was established as UCSF’s first multidisciplinary health policy and health services research group with a number of lofty goals, not the least of which were to: assure access to care, eliminate health disparities, reduce health care costs, expand the capacity and distribution of the current and future health care workforce, evaluate health care policies and practices, and translate research findings for policy makers, stakeholders and the public.

Their vision is as compelling now as it had been in 1972, said Brindis, a professor of pediatrics and health policy who is also co-founder and a director of UCSF’s Bixby Center for Global Reproductive Health.

“The same themes that shaped our 40 years of history continue to have great importance in the current health policy environment, particularly in light of the implementation of the Affordable Care Act,” she said. “Traditional health systems are undergoing transformational changes in health care delivery and financing. Purchasers, providers, consumers, and other stakeholders are calling for better outcomes and reduced costs. Consumers are mobilizing in their well-justified call for patient-centered care and shared decision-making with providers.”

And even though the institute has turned 40, there is clearly no mid-life crisis. What emerged at the 40th anniversary gathering of about 450 people on Feb. 27 was a sense of pride and purpose – reinforced by UCSF’s record of excellence in shaping health policy on a local, national and international level.

“Celebrating the institute’s anniversary – and the many ways that UCSF’s advancement of health policy has improved health outcomes locally and globally – strengthens our resolve to make our vision of high-value health systems worldwide a reality,” said UCSF Chancellor Susan Desmond-Hellmann, M.D., M.P.H., who described the institute as an incubator, innovator, and engine for change.

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HMO enrollees in poor health have hardest time communicating with doctors.

In the nation’s most diverse state, some of the sickest Californians often have the hardest time communicating with their doctors. So say the authors of a new study from the UCLA Center for Health Policy Research that found that residents with limited English skills who reported the poorest health and were enrolled in commercial HMO plans were more likely to have difficulty understanding their doctors, placing this already vulnerable population at even greater risk.

The findings are significant given that, in 2009, nearly one in eight HMO enrollees in California was considered “limited English proficient” (LEP) and approximately 842,000 LEP individuals were enrolled in commercial HMOs. And while roughly a third (36.4 percent) of LEP enrollees in commercial HMOs reported being in fair or poor health, this same group accounted for nearly two-thirds (63.5 percent) of those reporting communication troubles with their doctors.

LEP individuals will make up a sizable portion — as much as 36 percent — of California’s newly insured population after the implementation of the Affordable Care Act, including those projected to be enrolled through the state’s health insurance exchange, Covered California.

“The sickest people are having the hardest time talking to their doctors,” said Max Hadler, a research associate at the Center for Health Policy Research and the main analyst for the study. “If a patient can’t communicate, how can their doctor treat them effectively? Appropriate interpreter services and translated materials are a consumer right and key to providing high-quality care and reining in the growth in health care costs.”

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Leading gun-policy experts offer recommendations.

Garen Wintemute, UC Davis

Research by Garen Wintemute, director of the Violence Prevention Research Program and professor of emergency medicine at UC Davis, forms the basis for several recommendations put forward earlier this month at the summit on Reducing Gun Violence in America, an event organized by the Johns Hopkins University’s Bloomberg School of Public Health that brought together 20 of the world’s leading gun-policy experts representing the fields of law, medicine, public health, advocacy and public safety to summarize relevant research and its implications for policymakers and concerned citizens.

Wintemute presented the results of his leading-edge studies at the summit and consulted on the group’s collective recommendations to inform the policy debate and help lawmakers and opinion leaders reduce gun violence in the U.S. His presentations on “Broadening denial criteria for the purchase and possession of firearms” and “Comprehensive background checks for firearm sales: Evidence from guns shows” are featured in the book “Reducing Gun Violence in America: Informing Policy with Evidence and Analysis.”

Published by Johns Hopkins University Press, the book includes summit presentations by legal scholars who weighed in on the constitutionality of recommended policies and other researchers who provided new data on public support for a wide array of policies designed to reduce gun violence.

“Research clearly shows that it is possible to change policies to reduce gun violence without violating constitutional rights,” Wintemute said. “We know a violent criminal history increases the risk for future firearm violence and crime and that denying gun purchases to this high-risk population is both feasible and effective. Yet few states have policies expanding denial criteria to include persons convicted of any violent misdemeanor crimes, such as assault and battery and brandishing a firearm.

“We also know that alcohol abuse is a major risk factor for firearm-related violence of all types, yet there are no policies in place that deny individuals with a history of abuse from purchasing or possessing a firearm.The recommendations from the summit address these and other shortcomings in federal policy, including the need forcomprehensive background checks for all firearms sales, especially private-party sales, a leading source of guns among those who are prohibited from owning them legally.”

Wintemute’s investigations have produced a uniquely rich and informative body of research on firearms violence that directly improves the health and safety of Americans and that has positioned California as a national leader in efforts to break the cycle of gun violence.

Wintemute’s studies have shown that In California, where policies denying firearm purchases to persons convicted of all violent misdemeanors have existed since 1999, criminal convictions account for 80 to 90 percent of denials, and convictions for violent crimes account for 40 to 55 percent of denials. His work has found that alcohol abuse is a risk factor for crime, and that the prevalence of excessive drinking is increased among firearm owners along with other behaviors that increase the risk for violence. And his landmark work on private-party gun sales has demonstrated the need for comprehensive background checks for all gun sales nationwide.

“Such changes won’t end firearm violence, but they will reduce it, and that is a goal worth fighting for,” he said.

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Commentary sheds light on FDA approval process for implantable body parts.

Rita Redberg, UC San Francisco

A UC San Francisco-led commentary is calling attention to a little-known regulatory loophole that allows unsafe and untested medical devices to reach the marketplace and harm patients.

UCSF and the Australian Joint Registry published this month a perspective in the New England Journal of Medicine that reveals the complex history of how metal-on-metal hip implants reached the marketplace.

The implants are categorized by the U.S. Food and Drug Administration (FDA) as high-risk surgical devices, yet have been allowed into the marketplace without first going through clinical trials, where a product is tested to determine its safety and effectiveness. They failed at a dangerously high rate, often requiring reparative surgery at least four times as often as traditional hip replacement surgery.

The perspective’s authors are calling for changes in how the FDA approves metal-on-metal hip replacement devices and other high-risk devices for the marketplace.

“If those hip implants are recalled, besides the problem of having to remove them because they’re very painful, they can release chromium ions into the blood stream which pose an unknown risk,” said Rita F Redberg, M.D., M.Sc., professor of medicine and director of the UCSF Women’s Cardiovascular Services. “Patients would also undergo significant disability having a second, third or fourth hip operation.”

“Some patients’ mobility will decline to the point of needing walkers or wheelchairs to get around and other serious events up to and including death can occur from subsequent operations,” Redberg explained. “And that’s just for the metal-on-metal implants.”

U.S. hospitals perform 48 million medical procedures each year, according to the U.S. Centers for Disease Control and Prevention. Of that number, roughly 676,000 patients undergo total knee replacement surgeries and 327,000 undergo total hip replacement surgeries. While the commentary focuses on metal-on-metal hip implants, Redberg noted that there are many more devices that slip through the same FDA loopholes.

“This could be potentially very dangerous. Many Americans – patients and even physicians –  are not aware of how many devices in this country are on the market without having clinical data of safety and effectiveness,” she said.

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Who pays for clinical trial has direct impact on reported outcome.

Lisa Bero, UC San Francisco

Drugs and medical devices tend to appear more beneficial in scientific papers if they were manufactured by the company that sponsored the study, showing that who pays for the clinical trial has a direct impact on the reported outcome, according to a new analysis by researchers at UC San Francisco and the Cochrane Collaboration.

Lisa Bero, Ph.D., a UCSF professor of clinical pharmacy and health policy who heads the San Francisco branch of the U.S. Cochrane Centre, at UCSF; and Joel Lexchin, M.D., a professor of health policy at York University, in Toronto. A definitive analysis in 2003 by Bero and Lexchin found discrepancies across drug studies sponsored by pharmaceutical companies.

Clinical studies on drugs and medical devices are routinely used by physicians worldwide to assess which medications are most effective and appropriate for their patients. However, that research is increasingly sponsored by the pharmaceutical or device companies that make these products, either because the companies directly perform the studies or fund them. The team set out to assess whether that sponsorship continues to have an impact on results.

“We found that papers reporting the results of industry-sponsored studies present a more favorable picture of the effects of drugs and medical devices than those reporting on studies that were not sponsored by industry,” said Andreas Lundh, of the Nordic Cochrane Centre at the Rigshospitalet in Copenhagen, Denmark, who led the new research and is first author on the paper.

“Of a particular interest was our finding that when two drugs were compared head-to-head in an industry-sponsored study, the drug that came out most favorable in a specific study was most often the drug manufactured by the sponsor of that study,” Lundh said.

The current analysis more than doubled the number of studies from the 2003 review, to a total of 48, and included papers on both drugs and medical devices for conditions ranging from heart disease to psychiatric illnesses. The number of favorable results was 24 percent higher in industry-sponsored studies, compared to non-industry sponsored ones, and included reports of both greater benefits from the drug or medical device and fewer harmful side effects. The team also found that industry-funded papers were more likely to report conclusions that were inconsistent with the papers’ results sections.

“This is really important because it means that people must take sponsorship into account when evaluating whether they should believe the results of a study. This is still rarely done,” said Bero, who is in the UCSF School of Pharmacy. “A fundamental question now is that when a systematic review is entirely based on industry-sponsored studies and finds a favorable result for the sponsor’s product, can we really trust it?”

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Workplace injuries, illnesses can have quick-spreading economic effects.

J. Paul Leigh, UC Davis

Low-wage workers, who make up a large and growing share of the U.S. workforce, are especially vulnerable to financial hits that can result from on-the-job injuries and illnesses, according to a policy brief released by researchers at The George Washington University and based on a study conducted at the University of California, Davis.

The policy brief, “Mom’s Off Work ’Cause She Got Hurt: The Economic Impact of Workplace Injuries and Illnesses in the U.S.’s Growing Low-Wage Workforce,” was released along with a white paper showing that such workplace injuries and illnesses cost the nation more than $39 billion in 2010.

“Workers earning the lowest wages are the least likely to have paid sick leave, so missing work to recuperate from a work-related injury or illness often means smaller paychecks,” said the lead policy brief author, Celeste Monforton, a professorial lecturer in environmental and occupational health at The George Washington University School of Public Health and Health Services. “For the millions of Americans living paycheck to paycheck, a few missed shifts can leave families struggling to pay rent and buy groceries.”

The policy brief analyzes and contextualizes research by health economist J. Paul Leigh, professor of public health sciences at UC Davis. At the request of Monforton and colleague Liz Borkowski, a researcher with The George Washington University School of Public Health and Health Services, Leigh returned to data he analyzed for a UC Davis study published in the December 2011 issue of the Milbank Quarterly, which estimated the overall costs of occupational illnesses and injuries in the U.S. at $250 billion annually (see press release online). The new study specifically evaluated costs of occupational injury and disease within low-wage occupations.

“Research on work-related injuries and how they affect the lives of lower-wage employees is extremely rare,” said Leigh. “The 2011 and current studies prove that the safety of workers and how their job-related injuries are paid for need more attention from policymakers, and that this is especially true for those working at lowest end of the pay scales.”

For the new study, Leigh zeroed in on approximately 31 million people — 22 percent of the U.S. workforce — in 65 occupations for which the median wage is below $11.19 per hour. Janitors, housecleaners, restaurant workers and others earning that wage full-time will bring home just $22,350 per year — an amount that means a family of four must subsist at the poverty line.

Leigh calculated that in 2010, 596 low-wage workers suffered fatal on-the-job injuries and 12,415 died from occupational ailments such as black lung disease or certain kinds of cancer. Another 1.6 million suffered from non-fatal injuries, and 87,857 developed non-fatal occupational health problems such as asthma. The costs of the 1.73 million injuries and illness amounted to $15 billion for medical care and another $24 billion for lost productivity — the cost when injured or sick workers cannot perform their jobs or daily household duties.

The policy brief explains that workers’ compensation insurance either does not apply or fails to cover many of these costs, which can bankrupt families living on the margin. In some cases, employers do not have to offer this kind of insurance to employees. And even workers who do have the coverage often get an unexpected surprise after an on-the-job injury or illness: Insurers generally do not have to provide wage replacement until the worker has lost between three and seven consecutive shifts. Workers at the low end of the wage scale are often discouraged from reporting on-the-job injuries as work-related — which leaves them with no insurance benefits at all, the brief says.

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UCLA infectious diseases doctor played key role in finance strategy for therapy.

Claire Panosian Dunavan, UCLA

A new international program, conceived in part by a UCLA physician, has rapidly transformed access to lifesaving anti-malarial drugs by providing cheap, subsidized artemisinin-based combination therapies in seven African countries that account for a quarter of the world’s malaria cases.

The first independent evaluation of the Affordable Medicines Facility–malaria (AMFm) program was recently published in the journal The Lancet. The program is based at the Global Fund in Geneva, an international financing institution dedicated to disbursing funds to prevent and treat infectious diseases. The evaluation shows that the program improved access to key artemisinin combination therapies, or ACTs, which offer broader protection and less antibiotic resistance than anti-malaria medications currently available in those African nations.

The Oct. 31 Lancet study was accompanied by an editorial by a panel of some of the world’s most eminent scientists in this field, which praised AMFm’s ability to reach critical populations but also warned that despite the program’s success, its future funding could be threatened.

“Losing African children to malaria is such an unnecessary tragedy,” said Dr. Claire Panosian Dunavan, a clinical professor of infectious diseases at the David Geffen School of Medicine at UCLA, who was one of eight co-authors of the Lancet editorial. “Now that the global subsidy for ACTs has been proven to work through AMFm, I would hate to see the program end.”

Panosian Dunavan, an expert in tropical diseases, is also one of the original authors of the 2004 Institute of Medicine report “Saving Lives, Buying Time,” which first proposed a global subsidy for modern anti-malarial drugs and led to the development of the AMFm program.

“Over the last 10 years, I’ve learned a lot from my economist colleagues,” she said. “Leveraging private markets to deliver lifesaving treatments to the global poor is indeed possible, as this global subsidy for malaria drugs has now demonstrated.”

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New public-private partnership launched between university and health insurer.

John Stobo

Anthem Blue Cross and University of California Health — UC’s medical centers and health professional schools — announced today the launch of a groundbreaking alliance aimed at addressing some of the most critical issues facing the state’s health care delivery system.

Under this new agreement, Anthem and UC Health will focus on care innovation and California health policy development with the purpose of improving access to affordable, quality health care for California residents. The parties have named this joint venture the California Health Alliance. Both expect an enduring and productive association that will benefit the people of California.

With all five of the world-class UC academic health centers in Anthem’s network, both organizations have a long-standing history of serving residents throughout the state and are uniquely positioned to understand the health care needs of Californians. And, as the state prepares to expand health care through the Affordable Care Act (ACA), both organizations believe that today, more than ever, a collaboration of this type can effectively address the impact expected on the state’s health delivery system as more residents prepare to access medical services.

Among some of the initial areas of focus of this alliance will be the development of accountable care models to better manage costly chronic conditions and the expansion of alternate delivery systems, such as telemedicine to encourage wellness and prevention and to provide access to health care for residents in rural areas. In addition, this new alliance is expected to provide opportunities for research, analysis, literature development and policy recommendations.

“We know that residents of the state look to a future that includes access to quality health care that is affordable,” said Pam Kehaly, president of Anthem Blue Cross. “By teaming with the University of California Health, we are bringing together some of the most innovative minds to help us achieve a common goal: to improve the health and wellness of California residents.”

“As two of the state’s leading organizations, this new affiliation has the ability to revolutionize California’s health care delivery system,” said Dr. John Stobo, senior vice president for UC Health. “By coming together, we know we can develop meaningful research, policy and best practices that can be leveraged on a broader scale to help improve the state’s health care system and the health of the population at large.”

Media contacts:
Leslie Porras, Anthem Blue Cross
(818) 234-3368
leslie.porras@wellpoint.com

University of California Media Office
(510) 987-9200

About Anthem Blue Cross:
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Additional information about Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.

About UC Health:
University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 18 health professional schools and programs on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.

Fuller role could help serve the country’s increasing health care demands.

Courtney Lyder, UCLA

One of the nation’s leading voices in patient care and safety is calling on lawmakers and regulators to remove “outdated barriers” and allow nurse practitioners to practice to the full extent of their experience and education.

“There are more than 155,000 nurse practitioners in the United States who provide high-quality, cost-effective primary care to patients across the country,” said Courtney H. Lyder, dean of the UCLA School of Nursing. “As America confronts a growing shortage of primary care physicians, it is more important than ever that these nurse practitioners be allowed to fully use their skills and compassion to help serve the country’s increasing health care demands.”

Nurse practitioners are registered nurses who have completed graduate-level education (either a master’s or a doctoral degree) and who are able to deliver some a wide range of primary, acute and specialty care services. This includes prescribing or renewing prescriptions for most drugs; ordering blood tests; performing routine medical examinations; monitoring chronic conditions; counseling patients about prevention; and treating colds, sore throats and the flu.

In a policy briefing published in October by the Robert Wood Johnson Foundation and Health Affairs, which addresses the scope of practice issues, currently 18 states and the District of Columbia allowed nurse practitioners to diagnose and treat patients and prescribe medications without a physician’s involvement, while 32 states required physician involvement to diagnose and treat or prescribe medications or both. For example, Montana allows nurse practitioners to work without any doctor supervision. By contrast, Texas requires a doctor’s direct (on-site) supervision at least 20 percent of the time.

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