TAG: "Patient care"

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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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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Advancing brain surgery to benefit patients


Minimally invasive brain surgery at UC San Diego Health System.

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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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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UC Davis Children’s Hospital receives Excellence in Life Support Award


Award recognizes exceptional commitment to evidence-based processes, patient care.

UC Davis Children’s Hospital has received the Excellence in Life Support Award from the international Extracorporeal Life Support Organization (ELSO) for its Extracorporeal Life Support Program. The program provides lifesaving support for failing organ systems in infants, children and, in some cases, adults.

The Excellence in Life Support Award recognizes centers worldwide that demonstrate an exceptional commitment to evidence-based processes and quality measures, staff training and continuing education, patient satisfaction and ongoing clinical care. UC Davis Children’s Hospital also received this award in 2012.

The ELSO Award signifies to patients and families a commitment to exceptional patient care. It also demonstrates to the health care community an assurance of high-quality standards, specialized equipment and supplies, defined patient protocols and advanced education of all staff members.

Extracorporeal life support (ECLS), also known as extracorporeal membrane oxygenation or ECMO, is one of the most advanced forms of life support available to patients experiencing acute failure of the cardiac and respiratory systems. The ECLS machine does the work of the heart and lungs, artificially oxygenating the blood and returning it to the body, allowing the patient’s heart and lungs to rest and heal.

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$10M grant to bring online respite to dementia caregivers


UCSF, UNMC to offer education, support and care.

Katherine Possin, UC San Francisco

UC San Francisco and the University of Nebraska Medical Center have been awarded a $10 million grant from the Centers for Medicare & Medicaid Innovation to create a new Web-based model of dementia care. It will provide around-the-clock consultations for patients and their families, online education and, for a subset of patients, remote monitoring with smart phones and home sensors.

The Dementia Care Ecosystem will not replace clinicians, but rather bring educational resources developed over the last decade by the UCSF Memory and Aging Center (MAC) to patients and their families, while enabling clinicians to monitor their patients from afar.

“Our hope is this is going to radically improve the way dementia patients are cared for,” said Katherine Possin, Ph.D., who is an assistant professor of neuropsychology at UCSF. “We hope we’ll show this works, and that it can be adopted nationwide.”

Each patient will have a navigator, who will check in by telephone or with a personal visit, as well as by monitoring communication with patients and their families through an Internet dashboard, created with the help of Salesforce. Navigators will be people without a formal medical degree and will be supervised closely by nurses, social workers and pharmacists with expertise in dementia care.

These navigators will triage calls, making sure that patients see nurses and doctors when necessary and helping with other things that don’t require medical expertise, such as a hazardous situation in the home that could cause the patient to fall. Meanwhile, patients and their families will be able to get training online to help make financial plans and work through tough medical decisions before their loved ones have reached a crisis stage.

Researchers hope to create a virtual care system that is supportive enough to protect the mental and physical health of caregivers, who tend to neglect their own needs. If caregivers learn to cope better, patients may be able to remain at home longer before moving into assisted living. Last year, according to the Alzheimer’s Association, about 15.5 million people in the United States were caring for friends and family members with dementia. Nearly 60 percent said the work was highly stressful and more than a third reported symptoms of depression.

Bruce Miller, UC San Francisco

“Our ecosystem will have wisdom and experience continuously piped in every day to caregivers who are overwhelmed,” said Bruce Miller, M.D., director of the MAC, who holds the A.W. and Mary Margaret Clausen Distinguished Professorship in Neurology at UCSF. “Typically, these people have a hard time getting through to anyone in the medical system.”

Some patients in the study will have an added level of technology-based care. They will use smart phones and electronic wristbands to record their activity levels, count the number of steps they take and measure how far they range from home. And a small number will have sensors placed inside their homes to detect behavior changes that could signal the onset of a health problem, like being up all night, staying in bed all day or going to the bathroom more times than usual.

“If someone, instead of getting up two times a night, is getting up four or five times a night, we might send a nurse the next morning to their home to get a urine sample, and if it’s bad start the patient on antibiotics,” said Steve Bonasera, M.D., Ph.D., an associate professor of geriatrics at UNMC, who did his fellowship at UCSF. “We’re going to be monitoring people who are a seven- or eight-hour drive from my office in Omaha.”

The system will also monitor the drugs that patients take and flag high risk and inappropriate medications, such as antipsychotics and benzodiazepines that can send patients with certain forms of dementia to the emergency room. It will also flag medications that should not be combined.

Initial projections are that the improved caregiver support, more continuous access to medical help and medication management will reduce emergency room visits by a half, cut hospitalizations by almost a third and delay the move into a nursing home for six months. This is projected to save $4.3 million over the three years of the grant.

The MAC already has a well developed website that attracts traffic from around the world. Some of the center’s recorded lectures on caring for people with dementia have been viewed hundreds of thousands of times. Researchers said that once families have easy access to educational resources, office visits will become less pressured and patients and their families will be able to take more time to absorb information and make important decisions.

“The idea of 24/7 telephone access to clinicians with expertise in dementia has really resonated with caregivers,” said Jennifer Merrilees, R.N., Ph.D., a clinical nurse specialist at the MAC who will oversee the care that is dispensed online. “That’s what’s really made their faces light up when I’ve described it to them.”

Beginning this fall, 2,100 patients, all diagnosed with varying stages of dementia, will be enrolled through San Francisco General Hospital and Trauma Center, UCSF Medical Center and the UCSF MAC clinics and Chinatown Clinics, as well as UNMC and other service organizations in Nebraska serving the elderly.

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Using bubbles to reveal fertility problems


New ultrasound procedure can identify blockages in fallopian tubes.

Sanjay Agarwal, UC San Diego

Many women struggling to become pregnant may suffer from some degree of tubal blockage. Traditionally, an X-ray hysterosalpingogram (HSG) that uses dye is the most common procedure to determine whether a blockage exists, but it can cause extreme discomfort to the patient. UC San Diego Health System’s doctors are the first fertility specialists in the county to use a new ultrasound technique to assess fallopian tubes by employing a mixture of saline and air bubbles that is less painful, avoids X-ray exposure and is more convenient to patients during an already vulnerable time.

Using the FemVue Sono HSG, the physician delivers the mixture of saline and air bubbles into the uterus through a small catheter, which then flows into the fallopian tubes. Under ultrasound, the air bubbles are highly visible as they travel through the tubes, allowing the physician to determine if a blockage exists.

“The traditional X-ray approach involves higher pressure and usually causes significant cramping as the dye is administered. The anticipated pain prevents some women from even attempting the test. Others cannot do the test because they are allergic to the dye. Assessing the tubes for a blockage is a key component of the diagnostic workup in fertile couples, and not doing so because of pain or allergy is a real concern,” said Sanjay Agarwal, M.D., director of fertility services in the Department of Reproductive Medicine at UC San Diego Health System. “The new approach is not only much more comfortable for patients, it also uses saline, so the issue of an allergy does not arise. We are also able to assess the cavity of the uterus at the same time – all without X-rays.”

Kristina, a mother who has been trying to conceive a second child for almost a year, agreed: “I was willing to do whatever it took to address the fertility issues we were facing, but after everything we had been through emotionally, it was a relief to undergo a procedure that wasn’t physically painful.”

The ultrasound is performed in the clinic, and at present, ideal candidates include those with a prior pregnancy and those at low risk for tubal disease.

“Like the traditional X-ray HSG, the new test should be performed after the period has ended but before ovulation. The fact that the patient can schedule this ultrasound-based test in the clinic and not in radiology prevents a delay in care and allows the patient’s physician to be more involved in the process,” said Agarwal, also director of the UC San Diego Center for Endometriosis Research and Treatment (CERT).

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UCLA spotlights cost-effective health care programs


Innovation event shares what many agencies are doing to help community residents.

Dr. Mimi Choi, medical director for St. John's Well Child and Family Center, staffs an exhibit on the Healthy Homes, Healthy Families program, one of a dozen highlighted by the Institute for Innovation in Health at UCLA for using resources effectively. (Photo by Reed Hutchinson)

Health care innovators gathered last week to share ideas about how to provide the best care for Los Angeles County area patients, use resources effectively, and reduce preventable hospitalizations and emergency room visits in order to lower health care costs.

A dozen agencies attended “Los Angeles Innovates — Meeting New Demands for Access to Healthcare,” an event sponsored by the Institute for Innovation in Health at UCLA to share what many agencies and institutions are doing to help community residents.

“The goal is to make sure we quickly adopt what is working,” said Dr. David Feinberg, president of UCLA Health System and chief executive officer for the UCLA Hospital System, who spoke to health care administrators and staff at the event. “We need to copy shamelessly from each other.”

The event was held in the new Martin Luther King Jr. Community Hospital in South Los Angeles, which is set to open next year and features a variety of innovations, including “smart beds” that alert a nurse’s mobile device if a patient lowers the rail on a hospital bed.

Dr. Elaine Batchlor, chief executive officer of the new hospital, said she was proud to host the gathering as “innovation is the cornerstone of the work we’re doing to launch this hospital,” which is being opened in a partnership between Los Angeles County and the University of California.

“We want to transform health care for the community, and we’re here to learn from each other the best ways to improve our operations,” Batchlor said.

Molly Coye, UCLA’s chief innovation officer, stressed that if a program is working well at UCLA, for example, the strategy should be openly available so that health care agencies are not constantly reinventing the wheel.

“What innovation is about is taking something new that is not widely spread and spreading it further,” Coye said, adding that one such innovation designed to make end-of-life care better for the elderly also reduces health care costs by 30-45 percent.

“We want to be able to ask in five years: Are people doing better? Are they getting more able to manage their own lives? Are they staying in their own homes longer? Do they have better access to care?” Coye said. “If we can decrease emergency room visits and hospitalizations and decrease health care costs, we’ll be able to reach more people who need help because we’re spending less on the patients we’re treating now.”

One such innovation shared at the event was UCLA’s Alzheimer’s and Dementia Care Program, which provides comprehensive and coordinated care and services for patients. A nurse practitioner develops an individualized care plan for each patient, with referrals to neurologists, psychiatrists and geriatric specialists for consultation and medication adjustments. The goal is to help caregivers navigate the health care system and avoid costly hospitalization and emergency room visits.

The program has helped more than 700 patients to date, said Leslie Chang Evertson, a care manager in the program.

“We’ve found that the program makes patients and caregivers feel supported,” she said. “We help improve their ability to provide quality care within the home for as long as possible.”

Other programs highlighted at the event include:

  • Talking Survey and Tablet Health Coach by L.A. Net. This allows physician practices to collect and securely transmit survey data electronically from patients in their waiting rooms and provides individualized health education and coaching videos based on the responses to survey questions. Low literacy and non-English-speaking patients benefit from the surveys and patient education materials given to them on tablets and via headphones while they’re in the waiting room.
  • Clinical Pharmacy Services Integrated into a Safety Net Clinic by USC and AltaMed. This program provides on-site pharmacist consultation for chronic care patients with diabetes, hypertension, asthma, heart failure and hyperlipidemia. Integrating clinical pharmacy services improves the health outcomes of chronic care patients and decreases high-cost emergency room visits and hospitalizations.
  • EConsults by the Los Angeles County Department of Health Services and L.A. Care. This is a Web-based, secure communication portal that allows primary care practitioners to initiate and receive electronic consultations from specialists. The program results in a 20-40 percent decrease of in-person specialist visits and enables the safe peer-to-peer exchange of clinical information.
  • Healthy Homes, Healthy Families from St. John’s Well Child and Family Center. This program provides holistic medical care, education and social advocacy to help children who suffer from illnesses such as asthma and lead poisoning as a result of slum housing conditions. The program provides clinical treatment for affected children and addresses conditions in the home environment that cause the illnesses.
  • Heart Failure Automated Remote Monitoring System and Depression Automated Remote Monitoring System in the Los Angeles County Department of Health Services. These systems use automated voice-recognition telephone monitoring to track patients. For heart failure patients, it allows nurses to intervene before complications require a lengthy hospital stay. The system results in earlier detection, intervention and management of deterioration from stable chronic patients at a 95 percent lower cost compared to having nurses make the calls. For a patient with depression, it allows for monitoring and immediate intervention when necessary.  The system frees up nurses to provide more direct patient care.
  • Home Palliative Care developed with support from Partners in Care Foundation. This program provides multispecialty teams to deliver home-based palliative care to patients who have late-stage chronic conditions and pain-management needs that often are addressed in hospitals. Care teams include physicians, nurses, aides, social workers and therapists.
  • Inpatient Frailty Project by Cedars-Sinai Health System. This program identifies high-risk elderly patients once they’re admitted to a hospital and follows them with more in-depth assessment using clusters of risk factors found to be predictors of adverse events, extended hospital stays and readmissions. The program identifies and mitigates risk factors both in the hospital and in the home after a patient is discharged.
  • Vets to Home: VA Project 120 by the VA Greater Los Angeles Healthcare System. Serving the severely mentally ill and chronically homeless veteran population, the program uses a “street to home” model that enables the delivery of comprehensive psychiatry, primary care, social work and transportation to medical appointments to address the needs of the veterans whether in their residences or on the street.
  • VA Homeless Patient-aligned Care Team from the VA Greater Los Angeles Healthcare System. To reduce emergency room visits and hospitalization, this program brings primary care service to homeless veterans, who are high users of emergency room and hospital services.
  • Community Health Detailing by HealthBegins. This program allows community residents to learn about and map resources and then update an online Yelp-like database to help clinics quickly find resources for patients with health-related social needs. In a pilot program with a South Los Angeles high school, more than 100 students mapped more than 500 local resources for use by community clinics.

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Redesigning the well-child checkup


UCLA study suggests new models for improving preventive care to low-income families.

Sandra Contreras, a parent coach, meets with Kioki Johnson and her family during a well-child checkup at Wee Care Associates. (Photo by Sandra Chacon)

Well-child visits are the foundation of pediatric primary care in the U.S. Accounting for more than one-third of all outpatient visits for infants and toddlers, the appointments are intended to give doctors the opportunity to identify health, social, developmental and behavioral issues that could have a long-term impact on children’s lives.

However, several studies have shown that the current system of well-child care leaves room for improvement. One major concern is that well-child care guidelines issued by the American Academy of Pediatrics call for physicians to provide more services than can realistically be completed within a 15-minute office visit. As a result, many children do not get all of the preventive care services that they need — and the problem is more acute for low-income families, thanks largely due to their greater psychosocial and developmental needs for and greater need for parenting education.

In a yearlong study led by Dr. Tumaini Coker, an assistant professor of pediatrics at Mattel Children’s Hospital UCLA, researchers developed a new design for preventive health care for children from birth through age 3 from low-income communities. The team partnered with two community pediatric practices and a multisite community health center in greater Los Angeles.

“The usual way of providing preventive care to young children is just not meeting the needs of the low-income families served by these clinics and practices,” said Coker, who also is a researcher with the hospital’s UCLA Children’s Discovery and Innovation Institute. “Our goal was to create an innovative and reproducible — but locally customizable — approach to deliver comprehensive preventive care that is more family-centered, effective and efficient.”

The researchers created two working groups of pediatric clinicians, staff, clinic leadership and parents to design the new models of care. One working group was at South Bay Family Health Care, and another working group combined the efforts of two pediatric practices, the Yovana Bruno Pediatric Clinic in Duarte and Wee Care Associates (led by Dr. Toni Johnson-Chavis), in Compton and Norwalk.

To design the new models of care, researchers gathered input from two sources. First, they solicited ideas from pediatricians, parents and health plan representatives about topics such as having non-physicians provide routine preventive care and using “alternative visit formats” — meeting with health care providers in alternative locations, meeting in groups as opposed to one-on-one, or getting providers’ advice electronically instead of in person, for example. Secondly, the teams surveyed existing literature on alternative providers, locations and formats for well-child care.

Using that input, the clinic working groups developed four possible new models of care that it submitted for review by a panel of experts on preventive care practice redesign. Based on the panel’s rankings, the working groups selected two models to implement and test — one for the private practices and the other for the community clinic.  The private practices adopted a one-on-one visit format while the community clinic used a group-visit format, but the two models shared several characteristics:

  • A trained health educator, or “parent coach,” at each facility who relieves the physician of some of the more routine services and provides preventive health education and guidance, parenting education, and comprehensive but efficient preventive health services related to development, behavior and family psychosocial concerns.
  • A considerably longer preventive care visit.
  • A website that enables parents to customize their child’s specific needs prior to their visit.
  • Scheduled text messages or phone calls enabling the health care team to communicate with parents.

These findings were reported online today (June 16) in the journal Pediatrics.

The next stage of research is already under way: The team is testing the model selected by the two private practices in those clinical settings, with families randomly chosen to receive the care using either the new delivery model and or the old one. Researchers will compare outcomes for the two groups of children by the end of 2014. The community clinic is currently implementing its selected model, and testing will begin there in July.

“For clinics and practices that provide child preventive health care to families living in low-income communities, the process we used to develop the new models — or the new models themselves — could help them bring innovation to their own practices,” Coker said.

The study was funded by grants from the National Institutes of Health’s National Institute of Child Health and Development and the Health Resources and Service Administration.

The study’s other authors were Dr. Paul Chung and Dr. Paul Shekelle of UCLA, Candice Moreno of the University of Illinois College of Medicine and Dr. Mark Schuster of Harvard Medical School. The authors have no financial ties relevant to this article to disclose.

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Joint Commission certifies UC Irvine hip, knee replacement programs


Gold Seal of Approval denotes commitment to highest quality patient care.

UC Irvine Health has earned The Joint Commission’s Gold Seal of Approval for its hip and knee joint replacement programs by demonstrating compliance with the organization’s national standards for health care quality and safety in disease-specific care.

UC Irvine Health underwent a rigorous on-site review in May. A Joint Commission expert evaluated the programs for compliance with standards of care specific to the needs of patients and families, including infection prevention and control, leadership and medication management.

The commitment to these standards is reflected in the UC Irvine Health Joint Replacement Surgical Home. Developed at UC Irvine Medical Center, this model coordinates the roles of orthopaedic surgeons, anesthesiologists and nursing staff before, during and after surgery to ensure that patients receive the most efficient and comprehensive care available. The surgical home model has measurable standards for perioperative care and ensures that potential improvements are identified and incorporated into the program.

“The ability to achieve such high level of care and patient satisfaction is only possible due to the dedication and hard work put in daily by our joint replacement surgical home team,” said Ran Schwarzkopf, M.D., assistant clinical professor, UC Irvine Health Department of Orthopaedic Surgery and head of the hip and knee surgery service. “It is this team work that allows us to be a center of excellence in total hip and knee replacement surgery.”

The Joint Commission’s Disease-Specific Care Certification Program, launched in 2002, is designed to evaluate clinical programs across the continuum of care. Certification requirements address three core areas: compliance with consensus-based national standards; effective use of evidence-based clinical practice guidelines to manage and optimize care; and an organized approach to performance measurement and improvement activities.

“In achieving Joint Commission certification, UC Irvine Health has demonstrated its commitment to the highest level of care for its patients undergoing knee or hip joint replacement,” says Jean Range, M.S., R.N., C.P.H.Q. executive director, Disease-Specific Care Certification, The Joint Commission. “Certification is a voluntary process and I commend UC Irvine Health for successfully undertaking this challenge to elevate its standard of care and instill confidence in the community it serves.”

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UCLA Medical Group earns highest rating in industry quality survey


Elite ranking in CAPG Standards of Excellence survey.

UCLA Medical Group has received a four-star “elite” ranking, the highest possible designation, in the eighth annual CAPG Standards of Excellence survey.

The survey is a voluntary, critical self-assessment for CAPG’s 180 medical group members in California and 29 other states. It measures how well-equipped health care systems are to deliver a better patient experience, better population health and better overall affordability — the “triple aim“ outlined by the Institute for Healthcare Improvement.

UCLA Medical Group is one of 45 physician organizations to achieve the coveted “elite” status in the survey, which for the second consecutive year was conducted by CAPG in collaboration with the National Committee for Quality Assurance.

The results of the survey were released at CAPG’s national conference of health care experts, held from June 5 to 8 in Los Angeles.

“We are constantly challenging ourselves to do more for our patients while controlling costs,” said Dr. Samuel A. Skootsky, chief medical officer of the UCLA Faculty Practice and Medical Group. “Participation in the Standards of Excellence survey provides an opportunity to evaluate and improve on our processes. It is gratifying to see the success of these efforts acknowledged through our four-star rating.”

“What started eight years ago has now become an industry standard in measuring the tools required for sophisticated health care systems to deliver accountable and value-based care in the physician practice setting,” said Donald Crane, president and CEO of CAPG. “The industry validation continues to solidify the Standards of Excellence’s value in helping physician practices improve the coordination of patient care and thrive in a health care marketplace undergoing immense transition.”

This year, 86 medical groups that cover 11.1 million members through HMO models of care and an estimated 5 million through PPO coverage or government programs participated in the CAPG assessment. They were evaluated in six key domains:

Care management practices
Providing timely, safe, effective, efficient care and constantly improving care.

Health information technology 
The technical tools required to support care management practices, as well as individual care coordination, population awareness, performance measurement and feedback.

Accountability and transparency
Responding to the demands of the people the organization serves.

Patient-centered care
The ability to promote a service-oriented culture.

Group support of advanced primary care
Giving the “patient-centered medical home” a systemwide functionality and revitalizing the discipline of primary care.

Administrative and financial capability
How physician groups respond to the financial challenges of health care reform.

Survey results and additional information can be found at www.capg.org/index.aspx?page=84.

CAPG represents more than 180 multispecialty medical groups and independent practice associations in California and 29 other states, serving as a voice for physician organizations that provide comprehensive health care through coordinated and accountable physician group practices.

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A day in the trauma center


Behind the scenes at UC San Diego Health System’s trauma center.

Dr. Raul Coimbra (left) helps lead UC San Diego Health System's Level-1 Trauma Center. (Photo by Erik Jepsen, UC San Diego)

It’s 10 o’clock on a Tuesday morning and the UC San Diego Health System Level-1 Trauma Center is quiet. The only sounds are beeps and tones from machines monitoring the health and status of a handful of patients, the subdued bustle of staff tending to their work and family members visiting their sick or injured loved ones in the adjacent Surgical Intensive Care Unit.

Then, suddenly, a page sounds: A new trauma patient is en route. With trained, almost automatic response, trauma nurses, residents, fellows and surgeons move into position at the trauma resuscitation bay unit. When paramedics arrive with the patient, every second will count.

Seven trauma team members stand around a steel table, all with specific roles. With advanced technology and verbal communication with paramedics on scene, the trauma team is prepared and ready to execute a treatment plan before the patient is even in the hospital.

“We are always in a state of readiness,” said Dr. Raul Coimbra, new surgeon in chief at UC San Diego Medical Center – Hillcrest and chief of the division of Trauma, Burn, Surgical Critical Care and Acute Care Surgery at UC San Diego Health System. “Each second we effectively save with one patient, will be used to treat the next, making for a stronger workflow and collaboration with trauma surgeons and achieving the ultimate goal of improved patient care and survival rates.” The doors open. Paramedics roll the patient into the trauma resuscitation area. Trauma team members take over. If you are envisioning a chaotic scene from the television show “Grey’s Anatomy,” think again. The team calmly and efficiently assesses the patient, a male who fell and severely injured himself while vacationing in Mexico.

More than 3,200 patients are admitted to the trauma center each year. Trauma surgeons treat injuries that include not just injuries from falls, but the consequences of motor vehicle accidents, assaults, gunshot and stab wounds and burns.

UC San Diego Health System’s trauma center is one of only four in the nation where trauma patients are treated in a free-standing trauma center not located within the emergency room, as trauma patients require a highly specialized medical team with a unique skill set.

“Trauma patients come directly to the trauma center for the most critical care, bypassing the emergency department,” said Coimbra. “There is a dedicated trauma team that cares for this population from the time they are admitted until discharge from the hospital.”

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