Health care reform opens opportunities.

UCLA nurse practitioner Abigail Striblea talks to a patient at the Union Rescue Mission in the skid row area of downtown Los Angeles.

Afflicted with pulmonary arterial hypertension and breathing difficulties, Carol Volckmann was unable to get much help from physicians near her home in the Cascade Mountains in Washington state. Desperate, she began consulting physicians elsewhere and ultimately chose UCLA pulmonologist Dr. Rajan Saggar.

Volckmann said the result was “excellent care,” as well as a new and vital member of her health care team: Kathy McCloy, one of 160 nurse practitioners (NPs) spread across the UCLA Health System.

Hundreds of miles south and a world away at the UCLA School of Nursing Health Center at the Union Rescue Mission in the skid row section of downtown Los Angeles, nurse practitioner Hannah Bampton spends Wednesday nights with homeless families.

“Dr. Saggar prescribed very aggressive medication for my treatment,” said Volckmann, who speaks with McCloy regularly from Washington. “Then Kathy came in and spent a lot of time with me and my husband, making us feel comfortable. This could all be very scary, but we don’t feel scared because we know she’s right there for us.”

“I’m available all night for families that need to be seen for anything,” Bampton said. “By doing that, we’ve decreased the number of unnecessary urgent care visits. Someone might call 911 if there was no one there. But with a night nurse there, the kid doesn’t need to go to an ER, because I’m going to help him here.”

McCloy and Bampton are a new breed of health care provider that figures to play a pivotal role in health care in this country. Increasingly, it is a nurse practitioner whom patients see when they go to their doctor’s office. They also visit them at clinics, in retail pharmacies and hospitals.

Patients make more than 600 million visits to the nation’s 157,000 nurse practitioners every year, according to the American Association of Nurse Practitioners. Those visits are expected to increase as 35 million new patients enter the health care system in the next few years as a result of the Affordable Care Act.

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Related link:
Community impact: Nurse-run clinics

$5.4M for projects at UC medical centers.

The University of California has awarded 11 grants totaling $5.4 million for projects designed to improve patient care and reduce the risk of clinical harm to UC surgery patients.

About 110,000 patients undergo surgery each year at UC medical centers. The risk fellowship grants include projects to improve outcomes for neurosurgical patients, increase the quality of care for high-risk colorectal surgery patients, and decrease surgical site infections in patients undergoing procedures such as knee and hip replacements throughout UC Health.

More than 30 projects were submitted for this round of funding, sponsored by a new joint venture between the UC Center for Health Quality and Innovation (CHQI) and UC’s systemwide Office of Risk Services called the Center for Health Quality and Innovation Quality Enterprise Risk Management. The projects were reviewed using an enterprise risk management focus on improving collaboration between specialties and practitioners.

The grants are part of UC Health’s efforts to improve patient care and satisfaction at medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

Along with the grants, risk fellows will receive training in leadership and change management from the UCSF Center for Health Professions, which also has trained previous innovation center awardees.

“We believe that one of the single most important tools that we can give our awardees is training in leadership and change management,” said innovation center Executive Director Terry Leach. “We are asking them to work with us to change the culture of care from within their institutions, and we want to arm them with information about their own negotiation and leadership styles, as well as those of the individuals who they will need to influence.“

The awardees include:

Multisite projects

• UC Care Check: A Standardized Multidisciplinary Approach to Improve Neurosurgical Patient Outcomes and Care Experiences, $1.25 million, three-year project
  Project directors: James Harrison, M.P.H., Ph.D., Catherine Lau, M.D., UCSF
  Campus leads: Jeffrey Uppington, M.D., UC Davis; Alpesh Amin, M.D., MBA, UC Irvine; Nasim Afsarmanesh, M.D., UCLA; Gregory Seymann, M.D., S.F.H.M., UC San Diego

• High-Risk Colon and Rectal Surgery Intervention Program, $1 million, three-year project
  Project director: Michael Stamos, UC Irvine
  Campus leads: Kathrin Troppmann, M.D., UC Davis; Clifford Ko, M.D., M.S., M.S.H.S., UCLA; Sonia Ramamoorthy, M.D., F.A.C.S., F.A.S.C.R.S., UC San Diego; Madhulika Varma, M.D., UCSF

• Developing Standardized Operative Bundles to Decrease Surgical Site Infections, $1.35 million, three-year project
  Project director: Francesca Torriani, M.D., F.I.D.S.A., UC San Diego
  Campus leads: Stuart Cohen, M.D., UC Davis; Susan Huang, M.D., UC Irvine; Zach Rubin, M.D., UCLA; Shira Abeles, M.D., UC San Diego; Catherine Liu, M.D., UCSF; Amy Nichols, R.N., MBA, UCSF

Single-site projects

• Enhanced Recovery After Surgery (ERAS): A UC-wide Initiative to Decrease Postoperative Morbidity After Major Surgery, $200,000, three-year project
  Project director: Maxime Cannesson, M.D., Ph.D.,  UC Irvine

• Development and Implementation of Comprehensive Periprocedural Handover Processes, $167,000, two-year project
  Project director: Anahat Dhillon, M.D., UCLA

• The UC Collaborative to Improve Management of Perioperative Anticoagulant Care and Transitions (The UC IMPACT Project), $250,000, three-year project
  Project director: Margaret Fang, M.D., UCSF

• Project to Eradicate Postoperative Delirium in High-Risk Patients (PEPOD), $167,000, two-year project
  Project director: Jacqueline Leung, M.D., UCSF

• Optimizing Care of the Surgical Patient With Hyperglycemia Across the Continuum of Care, $250,000, three-year project
  Project director: Greg Maynard, M.D., M.Sc., UC San Diego

• Delivering Value-Based Neurosurgery Care (NERVS protocol) and Enhanced Professional Communication for Comprehensive Risk Prevention, $250,000, three-year project
  Project director: Nancy McLaughlin, M.D., UCLA

• Improving Communication and Perinatal Outcomes With the Use of Standardized Handoffs for Nurses, Residents and Staff Physicians, $250,000, three-year project
  Project director: Karen Noblett, M.D., UC Irvine

• Co-managed Geriatric Hip Fracture, $250,000, three-year project
  Project director: Philip Wolinsky, M.D., UC Davis

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.

About the UC Center for Health Quality and Innovation
UC Health launched the Center for Health Quality and Innovation in October 2010. The center is designed to promote, support and nurture innovations at UC medical center campuses and hospitals to improve quality, access and value in the delivery of health care. For more information, visit http://health.universityofcalifornia.edu/innovation-center.

Talks airing on UCTV.

>>UC awards 11 grants to improve care to surgery patients
>>View colloquium talks on UCTV
>>View speaker presentations
>>View agenda

By Alec Rosenberg

The University of California is taking steps to be at the forefront of health care reform in providing higher quality care that is more efficient, affordable and effective for Californians.

The challenge is to accelerate these efforts to meet the demands of a changing health care market, speakers said at the UC Center for Health Quality and Innovation’s second annual colloquium, May 3 at the Oakland Marriott City Center.

About 275 people attended the colloquium, and the talks can be viewed on UCTV beginning today (May 14). (View UCTV schedule.) Speakers included innovation center leaders and grant recipients as well as health insurance executives and the head of a business coalition focused on health care. (View agenda, speaker presentations.)

“The hospital of old is not the health system of the future,” said innovation center Executive Director Terry Leach. “The new paradigm with health care reform is population management” and thinking about innovative delivery methods such as team-based care, telemedicine and group visits, where such approaches improve the quality of care.

UC Health launched the innovation center in October 2010 with funding from its medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco. The center’s goal is to help achieve the “triple aim” of better health care and better population health while better controlling costs of care.

The center “has been very successful in terms of sending a message that we think work in these areas is very important to the University of California,” said its chairman, Dr. John Stobo, UC senior vice president for health sciences and services. UC Health needs to build on the center’s initial successes, continue to leverage UC’s strengths in research and education, and work more rapidly to roll out clinical improvements systemwide, Stobo said.

Keynote speaker Mark Laret, an innovation center board member and UCSF Medical Center CEO, encouraged the audience to think differently about health care as leaders in other industries have done, such as Apple’s Steve Jobs.

“Our lives have been vastly improved by people who dared to think differently,” Laret said. “Society is giving us a new challenge. … We have to figure out how are we going to become more nimble.”

In a panel discussion, health insurance executives pointed to collaborations with UC and other organizations that have improved care and effectively controlled costs.

“We have an affordability crisis. We can solve it. What we need is cooperation,” said Paul Markovich, Blue Shield of California president and CEO. An example, he said, is the accountable care organization that Blue Shield formed in San Francisco with UCSF, Dignity Health and Hill Physicians, which has saved $10 million.

Anthem Blue Cross has partnered with hospitals, including UC medical centers, on agreements that tie rates to a hospital quality program focused on performance in patient safety, patient health outcomes and member satisfaction. In November, Anthem and UC Health formed an alliance that will focus on care innovation and California health policy development with the purpose of improving access to affordable, quality health care for California residents.

“We’re actively talking to providers,” said Aldo De La Torre, Anthem Blue Cross vice president of provider contracting. “Together we can bring a solution to the problems Paul (Markovich) has laid out.”

Meanwhile, Health Net formed a tailored network for UC employees that includes UC medical centers among the providers, which has saved $72 million in two years, said Steven Sell, president of Health Net’s Western Region Health Plan and of Health Net of California. Health plans are looking for continued efforts to reduce the cost of care, increase the quality of care and improve population health, Sell said.

Employers want increased value in health care, with better quality and more affordability, said David Lansky, president and CEO of the Pacific Business Group on Health, whose members include Safeway, Target, Walmart and UC.

Innovation center grant recipients from UC’s five medical center campuses gave examples of their efforts to increase value through projects such as expanding telehealth, avoiding unnecessary medical tests and enhancing care after surgery.

Dr. Ralph Green of UC Davis, who attended the colloquium, said the event highlighted the important role that UC can play as a system.

“There is so much talent distributed among all of the campuses that collectively I think UC could provide leadership not only to others in academic medicine but nationally in terms of how to make health care better,” Green said.

Systemwide project seeks to improve quality of care for ICU patients and families.

Wendy Anderson, UC San Francisco

The University of California is leveraging its expertise to enhance patient care at UC medical centers systemwide, awarding a $1 million grant to expand specialized care for seriously ill patients.

The two-year project, led by Wendy Anderson, M.D., M.S., of UC San Francisco, seeks to improve the quality of care for patients in the intensive care unit (ICU) and their families. The project will expand a training program for bedside nurses to increase the integration of palliative care into ICUs across UC Health.

Palliative care is specialized medical care for seriously ill patients and their families that focuses on quality of life: managing pain, symptoms and stress of serious illness, and helping to ensure that patients get the type of care they want. Palliative care improves care for patients and their families, and also decreases costs. While the field has been growing rapidly – two-thirds of U.S. hospitals with more than 50 beds now have a palliative care team – access is still limited. Even in hospitals that have palliative care, many seriously ill patients do not receive it.

The grant is being awarded by a new joint venture between the UC Center for Health Quality and Innovation and UC’s systemwide Office of Risk Services. The joint venture, called the Center for Health Quality and Innovation Quality Enterprise Risk Management, is part of an effort to improve patient care and satisfaction throughout UC Health.

“We are focused on transforming health care so that it improves the quality of the care we give, the efficiency of the care we give and improves population health,” said Terry Leach, executive director of the UC Center for Health Quality and Innovation. “I can’t think of a better example than to improve care to the seriously ill.”

The project, led by Anderson and her co-investigators, Steven Pantilat, M.D., from the UCSF School of Medicine and Kathleen Puntillo, R.N., Ph.D., from the UCSF School of Nursing, aims to increase the integration of palliative care in the ICUs of the medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UCSF.

ICU stays can be incredibly difficult for patients and families alike. Patients frequently experience pain and other symptoms, and may receive treatments that are not consistent with their wishes. Families often suffer from emotional distress both during and after patients’ ICU stays. When integrated into ICUs, palliative care can improve management of patients’ symptoms, decrease family members’ distress, help ensure that the care provided matches patient preferences and increase satisfaction. It also can support ICU providers and decrease ICU length of stay and costs.

Anderson, a UCSF assistant professor of medicine, received a UC innovation center fellowship last year during which she and the UCSF team trained 68 UCSF bedside nurses to provide palliative care in the ICU. This new grant will help establish a collaborative of ICU and palliative care nurse and physician leaders from throughout UC Health. It will expand a nurse training program for ICU bedside nurses and identify and implement best practices in ICU-palliative care integration across UC medical centers.

“The UC medical centers have world-class palliative care services,” Anderson said. “But palliative care isn’t routinely involved in the care of patients in the ICU. We want to make sure that every patient and family member in the ICU at all the UC medical centers has access to palliative care.”

The team plans to provide palliative care training to 600 bedside nurses at UC medical centers over two years and put in place systems to sustain and continue to expand the integration of palliative care into the care of seriously ill patients.

Campus leaders working with Anderson on the palliative care project include:

UC Davis
Eric Moore, R.N., M.B.A.; Janice Noort, R.N., N.P., M.S., A.C.H.P.N.; Diana Pearson, R.N., M.S.N., C.C.R.N.

UC Irvine
Deborah Boyle, R.N., M.S., A.O.C.N.S.; Michelle Grywalski, R.N., B.S.N.; Solomon Liao, M.D.

UCLA
Bruce Ferrell, M.D.; Jeannette Meyer, R.N., M.S.N., A.C.H.P.N.; Edith O’Neil-Page, R.N., M.S.N., A.O.C.N.S.

UC San Diego
Julia Cain, R.N., M.S.N., A.N.P.; Heather Herman, R.N., M.S., A.N.P.; William Mitchell, M.D.

UCSF
Susan Barbour, R.N., M.S., W.O.C.N., A.C.H.P.N.; Jenica Cimino, B.A.; Denah Joseph, M.F.T.; Michelle Milic, M.D.; Steven Pantilat, M.D.; Kathleen Puntillo, R.N., Ph.D.; Kathleen Turner, R.N., C.H.P.N., C.C.R.N.-C.M.C.

Media contacts:
University of California Office of the President
(510) 987-9200

Karin Rush-Monroe
UC San Francisco
(415) 502-NEWS

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.

About the UC Center for Health Quality and Innovation
UC Health launched the Center for Health Quality and Innovation in October 2010. The center is designed to promote, support and nurture innovations at UC medical center campuses and hospitals to improve quality, access and value in the delivery of health care. For more information, visit http://health.universityofcalifornia.edu/innovation-center.