TAG: "Patient care"

UC innovation grants produce healthy returns


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.”

Examples include:

  • 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.

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UCLA volunteers help the underserved at free clinic


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.

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Pediatric transplant recipients, families celebrate at UCSF picnic


19th annual picnic points to growing success of organ transplants.

About 300 transplant recipients, donors and family members attended the 19th Annual Chris Mudge UCSF Pediatric Transplant Picnic on Aug. 23.

On a bright summer Saturday, dozens of children and their family members gathered at McNears Beach Park in San Rafael, listening to music, kayaking, having their faces painted, smashing piñatas, even playing with costumed Smurfs. For this group, the outlook wasn’t always this sunny.

The children are part of a special group: they’re pediatric transplant recipients from UCSF Benioff Children’s Hospital San Francisco.

The 19th Annual Chris Mudge UCSF Pediatric Transplant Picnic on Aug. 23 gave children who received transplants from UCSF and their families an opportunity to come together for support, to share knowledge and to celebrate having another chance at life. The 300 attendees included those who had received pre- and post-liver, kidney and small bowel transplants, as well as physicians, transplant surgeons, nurses and others from the UCSF Transplant Service.

“Some of my patients now are married and come to the picnic,” said Phil Rosenthal, M.D., former medical director of the pediatric liver transplant program and current director of pediatric hepatology at UCSF. “A lot of our families look forward to coming back to this picnic each year to reconnect.”

One of those returning patients was Justin Erickson of Redwood City. In 1992, he needed a liver transplant due to biliary atresia, a life-threatening condition in which the bile ducts are blocked.

Twenty-two years later, the 31-year-old city of San Carlos employee is a husband and father of a 5-month-old daughter.

“The first five years after the transplant, it was a real rough battle,” said Erickson, who has attended every picnic. “I had a lot of ups and downs, but I’m doing pretty good now. It’s amazing all the things I’ve accomplished and the goals that I’ve met after the transplant.”

In sharing his personal experience, Erickson has advice for pediatric patients and their families awaiting a transplant at UCSF.

“If you are looking to have a transplant at UCSF, hold your hopes up,” he said. “You definitely are talking to the right caregivers. Benioff Children’s Hospital San Francisco is the place to be with the cutting-edge technology and the doctors that have the know-how.”

Erickson is living proof of the growing success of organ transplants. Before, a 50-percent success rate was considered satisfactory. Now, thanks to medical advances and improved immunosuppressive drugs to combat infection and rejection, more than 90 percent of transplant patients are surviving, including children.

Founded in the 1960s, the UCSF Transplant Service is a world leader in clinical transplantation and has developed innovative techniques while producing superior outcomes. UCSF began pediatric kidney transplants in 1964 and pediatric liver transplants in 1989, making it among the oldest children’s transplant services in the country.

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Lightning strike survivor reunites with rescuers


Off-duty lifeguard who saves lives is saved by others.

Dr. Gil Cryer (from left), chief of trauma and emergency surgery at Reagan UCLA Medical Center, talks with lightning strike survivor Robert Kilroy and Molly Steele, a nurse in the neuroscience/trauma Intensive Care Unit, where Kilroy stayed during his recovery. (Photo by Reed Hutchinson, UCLA)

July 27 started out as a typical Sunday for Robert Kilroy, a 56-year-old off-duty seasonal Los Angeles County lifeguard and a chiropractor. The Marina Del Rey resident went to his favorite spot in Venice Beach and was chest-deep in the ocean teaching his daughter Emily Kilroy, 15, how to surf.

Suddenly, a rare bolt of lightning from an unexpected summer storm struck the beach, injuring numerous people and tragically killing one young man. The next thing Kilroy knew, he woke up in the Emergency Department at Ronald Reagan UCLA Medical Center.

What transpired that afternoon was a series of events that led to Kilroy’s remarkable survival and the opportunity for him and his daughter to reunite Thursday on Venice Beach with the men and women who played a role in his recovery.

What Kilroy does not remember from that day is being electrocuted after the bolt of lightning splintered from the sand into the water. His heart stopped, he went down and his lungs filled with ocean water.

Emily saw her dad floating, in full cardiac arrest. Pulling him to shore, she yelled for help. Immediately, first responders from the Los Angeles County Fire Department Lifeguards started CPR, which got his blood circulating and his heart pumping again. The Los Angeles Fire Department paramedics inserted a breathing tube and rushed him to Ronald Reagan UCLA Medical Center.

“He was unconscious, but his heart was working. However, since his brain had been without oxygen, our main concern at that time was ‘Will his brain recover?’” recalled Dr. Gil Cryer, chief and director of the UCLA Trauma/Emergency Surgery and Critical program, at a press conference Thursday.

Kilroy was moved to the neuro-ICU where he woke up fairly quickly and was communicating almost right away, which the team was gratified to see. Over the next few days they monitored his condition, performed procedures to help clear his lungs and kept him sedated to allow the ventilator to help him breathe and allow his lungs to recover.

“Each day he kept improving, and he really made a remarkable recovery,” said Molly Steele, a nurse in the neuroscience/trauma ICU at Ronald Reagan UCLA Medical Center, who helped care for Kilroy.

In additional to the Emergency Department team and the Neuro-I.C.U., Kilroy was cared for by a handful of departments at UCLA, including cardiology, critical care anesthesiology/surgical, electroencephalography, neuro-critical care medicine, nutrition, the pharmacy, and respiratory and speech therapy.

Five days later, Kilroy was discharged from UCLA and has since returned to work and his normal everyday activities, including swimming in the ocean. At the press conference, he jokingly mentioned that people now ask him what it feels to be struck by lightning (he does not remember) and if he now has any superpowers (he has none).

On a more serious note, he described what the experience has taught him.

“One thing that I have learned is just how amazing it is to save somebody’s life. I have done it many times before as a lifeguard and never gave it much thought,” Kilroy said. “This time, it was my life that was saved, and it has brought on a new and much greater significance. “

He added, “All that has transpired has heightened my awareness of how much I have to be grateful for and how important it is for me to continue to grow that awareness.“

His daughter Emily said she plans to learn CPR, and said she was thankful for everyone who helped save her father’s life. “They kept my dad alive … it’s just the most meaningful thing that’s ever really happened in my life.”

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Rethinking primary care


Team-based approach to care shows effectiveness, efficiency.

The green team at the Family Health Center at San Francisco General Hospital discusses its approach for the patients coming in that afternoon. (Photo by Elisabeth Fall)

Since the passage of the Affordable Care Act, primary care has been receiving a lot more scrutiny. In many cases across the nation, the health care system hasn’t been providing the most effective or efficient care.

“We’ve had to do a bit of soul-searching in primary care because we weren’t delivering the goods very well,” said Kevin Grumbach, M.D., chair of UCSF’s Department of Family and Community Medicine.

Kevin Grumbach, UC San Francisco

“It was hard to get appointments, and we weren’t meeting all the patients’ needs, especially if you look at diabetes care and rates of preventative cancer screening,” he said. “It’s not enough to just say we need to try harder; we need to rethink the system. So that’s behind this push to rethink what the roles of people are on the provider team.”

Increasingly, studies suggest that a more team-based approach to care could be a big part of the solution. UC San Francisco research has been key in showing the effectiveness and cost-efficiency of the “patient-centered medical home,” and in driving implementation of this model in multiple centers at San Francisco General Hospital.

Instead of the primary care physician trying to do everything in a 20-minute appointment, a whole team of health care providers is responsible for the patient’s care – from nurses to doctors to community health workers to mental health specialists to pharmacists. The team works together to anticipate the patient’s needs, communicate their findings with each other, and make sure no aspect of the patient’s health slips through the cracks.

From the patient’s perspective, it’s a one-stop shopping experience: In a single doctor’s visit, a patient could receive treatment from his or her primary care doctor, do a preventative screening with a nurse and a technician, and visit with a mental health specialist. In this approach, more is more – but it actually costs less.

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Coalition teams to help reduce heart attacks, strokes in San Diego County


UC San Diego part of regional project awarded $5.8M Health Care Innovation grant.

Approximately 84 million people in the United States suffer from some form of cardiovascular disease, and about 720,000 Americans have a heart attack every year, which works out to one every 44 seconds. To address these alarming statistics, the Be There San Diego Initiative has been awarded a $5.8 million Health Care Innovation grant for a coalition project to help reduce heart attacks and strokes in San Diego County.

The initiative’s program, San Diego: A Heart Attack and Stroke Free Zone, is a regional collaboration of health care organizations and stakeholders to improve health care delivery and patient outcomes.

The goal during the three year project is to enroll 4,000 high-risk patients and lower their blood pressure and cholesterol levels through evidence-based practices and a better understanding of the importance of treatment adherence. The project will also promote heart attack and stroke prevention measures, test novel, cost-effective technology solutions and provide educational opportunities both for patients and within the physician community.

Partners in the Be There Initiative include UC San Diego Health System, Arch Health Partners, Scripps Health, Sharp HealthCare, Kaiser Permanente, Palomar Medical Center, Naval Medical Center, Veterans Administration, the San Diego County Medical Society Foundation, the County of San Diego Health and Human Services Agency, community clinics and others. UC San Diego Health System serves as the fiscal agent for the project.

“Health organizations that are competitive in the market will be working together for the benefit of San Diego patients,” said Anthony DeMaria, M.D., principal investigator of the Heart Attack and Stroke Free Zone program and cardiologist at UC San Diego Health System. “This approach will decrease our community’s risk for cardiovascular disease and could result in saving millions in the county by preventing half of the heart attacks and strokes that would have otherwise occurred in the participating patient population.”

Patients will be educated about the program, consented and enrolled through their physician’s office beginning later this year. Participants will also receive blood pressure cuffs to monitor levels at home and work closely with a health care coach.

“Because it’s a silent condition, we find that many patients are unaware of having hypertension, and only about 40 percent of patients diagnosed with high blood pressure take their medication, which can directly lead to cardiovascular disease. We hope through the Heart Attack and Stroke Free Zone program, we can increase this to 80 percent,” said Katherine Bailey, executive director of the Be There Initiative.

The Health Care Innovation grant supporting the project is made possible by the Centers for Medicare and Medicaid Services (CMS) through the Affordable Care Act and is part of an ongoing effort to advance innovative solutions in delivering and improving patient care across the nation.

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Patient-centered research projects receive funding


UC Berkeley, UC Davis among recipients.

Heather Young, UC Davis

Two University of California research projects have been approved for funding in the latest round of awards by the Patient-Centered Outcomes Research Institute (PCORI).

A research project led by the Betty Irene Moore School of Nursing at UC Davis was approved for a $2.1 million award to study improving health for individuals with diabetes. Associate Vice Chancellor for Nursing and Dean Heather M. Young will lead the research project at UC Davis. The study will focus on individuals with diabetes and determine if innovative approaches, including mobile technology and nurse coaching, help those people better manage the chronic disease.

Young noted that researchers from other centers and organizations — including the UC Center for Information Technology Research for the Improvement of Society (CITRIS), the UC Davis Clinical Translational Science Center and the Initiative for Wireless Health and Wellness at UC Davis — contributed to foundational research for this study and will play important roles in completing this three-year project.

Stephen Shortell, UC Berkeley

Also, a research project led by the Center for Healthcare Organizational and Innovation Research (CHOIR) at the UC Berkeley School of Public Health was approved for a $2.1 million award to study the delivery of care to patients with diabetes and cardiovascular diseases. Under the leadership of professors Stephen Shortell and Hector Rodriguez, center researchers will study the impact of patient activation and engagement in two large accountable care organizations — Advocate Health Care in Chicago and HealthCare Partners in Los Angeles. The study will see whether patients with diabetes or cardiovascular diseases who receive care from practices that more fully involve their patients have better clinical outcomes and satisfaction with their care than those that do not.

The studies are two of 33 proposals PCORI approved for $54.8 million in funding this week to advance the field of patient-centered comparative effectiveness research and provide patients, health care providers, and other clinical decision makers with information that will help them make better-informed choices.

Earlier this year, the National Institutes of Health and PCORI joined together to support a clinical trial to test individually tailored interventions to prevent fall-related injuries. That award, made by the NIH’s National Institute on Aging and funded by PCORI as part of the two organizations’ Falls Injuries Prevention Partnership, is expected to total $30 million over the five-year project.

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Providing a medical home for HIV patients


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.

‘Truly transformative’

“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.

Team-based approach

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.

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Advancing brain surgery to benefit patients


Minimally invasive brain surgery at UC San Diego Health System.

Clark Chen, UC San Diego

In a milestone procedure, neurosurgeons at UC San Diego Health System have integrated advanced 3-D imaging, computer simulation and next-generation surgical tools to perform a highly complex brain surgery through a small incision to remove deep-seated tumors. This is the first time this complex choreography of technologies has been brought together in an operating room in California.

“Tumors located at the base of the skull are particularly challenging to treat due to the location of delicate anatomic structures and critical blood vessels,” said neurosurgeon Clark C. Chen, M.D., Ph.D., UC San Diego Health System. “The conventional approach to excising these tumors involves long skin incisions and removal of a large piece of skull. This new minimally invasive approach is far less radical. It decreases the risk of the surgery and shortens the patient’s hospital stay.”

“A critical part of this surgery involves identifying the neural fibers in the brain, the connections that allow the brain to perform its essential functions. The orientation of these fibers determines the trajectory to the tumor,” said Chen, vice chairman of academic affairs for the Division of Neurosurgery at UC San Diego School of Medicine. “We visualized these fibers with restriction spectrum imaging, a proprietary technology developed at UC San Diego. Color-coded visualization of the tracts allows us to plot the safest path to the tumor.”

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UC hospitals rank among the nation’s best


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.

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UC children’s hospitals rank among best in U.S.

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New approach to remove blood clots


Catheter-based system removes clots without open heart surgery.

Victor Pretorius (left) and Mitul Patel, UC San Diego

When a large blood clot was discovered attached to the end of a catheter inside the right atrial chamber of a patient’s heart, doctors faced a daunting challenge. If the clot came loose, the consequences would likely be catastrophic for the patient, who suffered from pulmonary hypertension – a dangerous narrowing of blood vessels connecting the heart and lungs.

But experts at the UC San Diego Sulpizio Cardiovascular Center (SCVC) are now able to save patients like this one from potentially fatal outcomes by using a new technology capable of removing blood clots, infected masses or foreign bodies from major cardiac blood vessels without performing open-heart surgery.

The SCVC is the first in San Diego County to use the AngioVac system developed by AngioDynamics. The AngioVac is a catheter-based device in which thin tubes are inserted into two major veins in the body through the neck or groin area. Under X-ray guidance, the flexible tubes are advanced to the proximal veins, right-sided heart chambers and/or lung arteries. Each is equipped with an expandable, balloon-shaped funnel tip that, when attached to a bypass circuit, vacuums the targeted material, such as a blood, clot out of the body.

“In some cases, medications can be used to dissolve blood clots, but this treatment option does not work for all patients, especially those who are in a life-threatening situation,” said Mitul Patel, M.D., FACC, interventional cardiologist at UC San Diego Health System. “This new device allows our team to safely extract material, preventing the patient from having to undergo invasive, high-risk surgery.”

Open-heart surgery takes much longer to perform and often requires the surgeon to divide the breastbone lengthwise down the middle and spread the halves apart to access the heart. After the heart is repaired, surgeons use wires to hold the breastbone and ribs in place as they heal.

“Removing a blood clot through open-heart surgery results in longer hospitalization, recovery and rehabilitation times compared to the minimally invasive approach provided by this new device,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System.

The AngioDynamics device does not eliminate the need for a surgery called pulmonary thromboendarterectomy (PTE) to remove chronic blood clots in the lung arteries, a surgery that cardiothoracic surgeons at UC San Diego Health System have special expertise in performing.

Nearly 100,000 Americans die each year when a clot breaks away from a blood vessel wall and lodges in the lungs or heart. Several factors can cause a blood clot, including certain medications (oral contraceptives and hormone therapy drugs), deep vein thrombosis, family history, heart arrhythmias, obesity, surgery, prolonged sitting or bed rest, and smoking.

The new procedure is performed by a multidisciplinary team comprised of anesthesiologists, cardiothoracic surgeons and interventional cardiologists. Six patients at UC San Diego Health System have undergone the procedure so far, which can be completed in as little as one hour with patients typically able to walk and leave the hospital the following day.

“The success of this new device would not be possible without the collaboration of our colleagues dedicated to helping patients with a vast array of cardiovascular issues,” said Patel. “As the only academic hospital in San Diego County, we are excited about this new technology and what it offers as a new treatment option for our patients at SCVC.”

To learn more about treatment options at UC San Diego Sulpizio Cardiovascular Center, click here.

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Sen. Boxer highlights efforts to prevent medical errors


She visits UCSF Medical Center.

U.S. Sen. Barbara Boxer (second from right) tours UCSF Medical Center on July 2 to learn how it is working to reduce preventable deaths. Susan Barbour (left), R.N., talks about pressure ulcer prevention. (Photo by Cindy Chew)

Every year, between 210,000 and 440,000 Americans die as a result of preventable errors in hospitals, according to a special report released at UC San Francisco by Democratic Sen. Barbara Boxer.

She presented the updated report detailing the most common and harmful errors at our nation’s hospitals and highlighted what UCSF Medical Center is doing to prevent them.

“We have the opportunity to save not just one life, but to save hundreds of thousands of lives,” Senator Boxer said during her visit to UCSF Medical Center on July 2. “Many people will be shocked to hear this, but medical errors are one of the leading causes of death in America today. These deaths are all the more heartbreaking for families because they are preventable.”

Boxer said she is grateful to UCSF for the steps it has taken to save patients’ lives.

“If we all work together – doctors, nurses, hospital administrators, patients, patient advocates, medical technology pioneers, public health experts and federal officials – we can prevent so much heartbreak for families and stop these tragedies before they occur,” said Boxer at a press conference following a tour of UCSF Medical Center.

Preventable errors in hospitals, such as hospital-acquired infections, adverse drug reactions, patient falls and bedsores, total $19.5 billion annually and that the economic costs of medical errors, including lost productivity, could be as much as $1 trillion a year, according to Boxer’s report.

“We’re one of the nation’s top hospitals,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “But that is meaningful only as it relates to every single patient who walks through our doors, and how we administer their care, follow up and safety. We’re proud of the great strides we’ve made as a leader in patient safety and to partner with Senator Boxer to help all hospitals become places where safe care is offered to every patient, every day.”

While touring UCSF Medical Center, Senator Boxer was shown the interdisciplinary approach UCSF takes to address major hospital issues such as sepsis, ulcer prevention, medication errors and hand hygiene.

As part of its interdisciplinary approach, UCSF creates teams comprised of nurses, pharmacists, doctors and medical center leaders, in addition to staff in medical records and environmental services. Those teams focus on understanding the underlying causes that may have allowed an error to occur and on collaborative problem solving. An open discussion ends with a clear action plan, which might involve implementing a new system, purchasing a piece of equipment, or training doctors and nurses in communication strategies.

UCSF processes and results for sepsis prevention

Sepsis is a potentially fatal, full-body inflammation caused by infection, and one of the main sources of sepsis is hospitals themselves.

“At UCSF we now treat sepsis as a true emergency with a focus on immediate interventions proven to help patients,” said Joshua Adler, M.D., chief medical officer at UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. “This approach has involved innovations in our electronic health record systems, use of rapid response personnel, novel nursing protocols, and continuous evaluation of our performance.”

UCSF’s electronic sepsis surveillance system continuously searches for warning signs, alerts clinicians to the potential presence of sepsis, and provides a means to activate “Code Sepsis”. The Code Sepsis team – a rapid response team, critical care nurse practitioner, and pharmacist – has helped UCSF to treat sepsis as an emergent situation requiring immediate attention and action. “With this approach we have reduced the mortality rate for sepsis by nearly 25 percent since 2012,” Adler said.

Processes and results for ulcer prevention

Ulcers resulting from being bedridden, and thus immobile for a lengthy time, are an ongoing challenge for hospitals. In addition, to training all patient care providers in pressure ulcer prevention, UCSF conducts quarterly pressure-ulcer prevalence study days. On these days, every patient in the hospital is examined for evidence of a pressure ulcer. The total number of pressure ulcers counted is divided by the total number of patients examined to obtain a percentage of patients with pressure ulcers.

UCSF has reduced the rate of hospital acquired pressure ulcers among adult and pediatric patients by 79 percent, from 4.98 percent in fiscal year 2008 to 1.03 percent in fiscal year 2014.

Preventing inpatient medication errors

In 2011, UCSF launched what is believed to be the nation’s most comprehensive automated hospital robotic pharmacy that is designed to prepare and track medications, with the goal of improving patient safety. The pharmacy operation is now linked to the electronic health record system, creating an end-to-end electronic system in which a nurse at the bedside scans the barcode on the patient’s wristband, scans the medication and then scans the bar code on his/her own ID badge. Only after confirming all the information matches is the medication administered. UCSF administers over 10,000 doses of medication daily.

“The barcoding system is a way to minimize the potential for an error at every step of the medication delivery process,” said Laret.

Hand hygiene training and surveillance

Hand hygiene is considered one of the most effective approaches for reducing hospital-related infections. In July 2010, UCSF implemented a hand hygiene education and surveillance program. Since then the rate of hand hygiene has improved from 75 percent to about 92 percent each month. The data are collected and monitored by cameras in some hospital areas, and a daily report is distributed. Some floors even feature real-time monitoring that displays hand hygiene compliance rates.

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Sen. Boxer praises UC efforts to prevent medical errors

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