TAG: "Patient care"

UC Health center breaks down barriers to sharing innovations

Center for Health Quality and Innovation holds fourth annual colloquium.

UC San Francisco's Rebecca Smith-Bindman is one of the UC Center for Health Quality and Innovation grant recipients who spoke at the center's fourth annual colloquium in Oakland.

By Alec Rosenberg

The University of California’s Center for Health Quality and Innovation has funded projects to improve care at UC medical centers, from higher survival rates for heart attacks to fewer blood clots and lower radiation doses.

But extending such improvements across all five UC medical centers continues to be a challenge, speakers said Wednesday (April 22) at the innovation center’s fourth annual colloquium in Oakland.

In four years, the innovation center has funded 50 projects, with a report finding that its grants produce a 5-to-1 return on investment, said Dr. John Stobo, UC Health executive vice president.

“While each project has been worthy in addressing cost, quality and safety, we have not been as successful in spreading projects from one or two medical centers to all UC medical centers and beyond,” Stobo said. “We are at a crossroads.”

The innovation center was established in October 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.

Panelists provided an in-depth assessment of barriers to implementing systemwide change in the hopes of identifying solutions to sharing effective projects more broadly.

“That’s the only way we are going to get better,” said moderator Dr. Robert Wachter, professor and associate chair of the Department of Medicine at UC San Francisco. “We may have been too ambitious. Start smaller. Get it right. Build on your successes.”

Reducing radiation doses

The use of computed tomography (CT) exams has risen dramatically in the past 20 years, with about 1 in 5 patients receiving a CT scan each year. While the technology is an important medical advance, it’s estimated that 2 percent of cancers may be caused by CT radiation exposure. CT scans deliver much more radiation than conventional imaging, doses are highly variable and often are higher than needed, said innovation center grantee Dr. Rebecca Smith-Bindman, professor in residence in the Department of Radiology at UCSF.

Smith-Bindman leads the UC DOSE project to optimize and standardize computed tomography radiation doses for patients across UC medical centers. The project has helped reduce CT doses by 25 percent at UC medical centers, generated nine papers and led to more than $10 million in additional grants to expand the work to other hospitals.

But getting buy-in across UC has been difficult, involving many phone calls and urging colleagues to implement changes, which has worked in some cases but not always, she said.

“I have become increasingly frustrated by the tension between research and improving the clinical service,” Smith-Bindman said. “As a researcher, I do not have clout alone to influence day-to-day practice or to motivate ongoing interest in this topic.”

Stopping blood clots

Blood clots are a leading cause of preventable deaths in hospitals nationwide. Among the most deadly of these conditions is venous thromboembolism, VTE, which occurs when a blood clot that develops in a deep vein of the leg or pelvis, dislodges and travels to the lung to form a pulmonary embolism.

A five-campus project led by Dr. Greg Maynard reduced the VTE rate at UC medical centers by 24 percent from 2011 to 2014, preventing about 170 VTE cases and saving $2 million a year.

Still, Maynard has trained other organizations in the VTE protocol and said that they were able to ramp up improvements more quickly than UC medical centers. Standardizing information technology systems would help, said Maynard, who became chief quality officer at UC Davis Medical Center in March after working at UC San Diego.

“It starts with making it a priority at the top,” Maynard said.

Healing hearts

More than 200,000 people have cardiac arrests in U.S. hospitals each year. Less than a quarter of them survive. The Advanced Resuscitation Training (ART) program developed at UC San Diego has reduced the incidence of cardiac arrest at UC San Diego hospitals and doubled survival for remaining victims to about 40 percent. A key factor in those improvements has been having support from the chief medical officer and chief nursing officer, said Dr. Rebecca Sell, assistant professor of clinical medicine at UC San Diego.

An innovation center grant has expanded the ART program, which focuses on prevention, identifying early indicators and creating a culture of resuscitation, to the other UC medical centers. While early results have been promising, “it requires a lot of collaboration,” said Dr. Matt Aldrich, associate professor of anesthesia at UCSF. “There’s a lot of herding cats.”

“It’s hard enough to change one department,” added Dr. Edward Lee, assistant clinical professor of general internal medicine at UCLA.

UC Davis has taken a bottom-up approach that has helped overcome concerns with a “let’s-do-this” mentality, said Dr. Aaron Bair, professor of emergency medicine at UC Davis.

Strength in numbers

Nearly 100 people attended the colloquium. Attendees said they found the discussion fruitful.

“This is great,” said Dr. Catherine Lau, a UCSF hospitalist who is entering the third and final year of an innovation center project to improve neurosurgical patient outcomes and care experiences. “It’s really about sustainability and changing the culture.”

Innovation center Executive Director Karyn DiGiorgio agreed.

“The Center for Health Quality and Innovation plans to keep focusing on scaling up successful projects across UC Health,” DiGiorgio said.

Despite facing barriers, it’s important for UC Health to continue to look at things from a systemwide basis, Stobo said. He pointed to UC Health’s year-old Leveraging Scale for Value initiative, where UC’s five medical centers are working to collaborate as a system to save in the range of $100 million to $150 million a year, focusing initially on supply chain, revenue cycle and clinical laboratories.

“I feel energized about what we can do to spread innovations and help UC Health and the UC system demonstrate the way for others,” Stobo said.

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Police officer makes ‘miracle’ recovery after stroke surgery

‘Hearing that makes me feel really lucky.’

By Justin Petruccelli, UC Irvine

David Castañeda had grown used to the idea of dodging bullets in his 19 years as a policeman. But the disaster he dodged when he suffered a stroke in 2013 has even his stroke specialists at UC Irvine Health calling his recovery “a miracle.”

“Hearing that makes me feel really lucky,” Castañeda says.

The 44-year-old Riverside police officer had just finished serving a warrant with his department’s SWAT team when he suddenly collapsed. He was taken by ambulance to Riverside Community Hospital, where doctors administered clot-busting drugs and transferred him by helicopter to UC Irvine Medical Center.

After touching down at the medical center, Castañeda was rushed into surgery, where Dr. Shuichi Suzuki spent almost four hours removing two clots that had lodged in the right side of his brain. The neurovascular specialist with the UC Irvine Health Comprehensive Stroke and Cerebrovascular Center feared that Castañeda might lose all movement on his left side. But when Suzuki checked his patient a few hours later, Castañeda was awake — and moving his left thumb.

“They pretty much have said that for David to even make it through the night was a miracle,” says Castañeda’s wife, Denise.

Exceeding expectations

Castañeda’s recovery was just beginning. Told he might need to spend six months in a rehabilitation center, he stunned everyone by walking the next day. Soon nurses and staff members from all over the hospital were coming to see his progress. He was discharged less than a week after his surgery.

“He’s young, but I was still surprised by how quickly his symptoms resolved,” says Suzuki, noting that most stroke patients are older and need more recovery time.

Although Castañeda suffered no long-term effects to his cognitive or motor skills, he lives with constant headaches and fatigue, and he must take blood thinners and cholesterol medication to prevent further clotting problems. Foods he used to love no longer taste good. But he’s been able to make those adjustments with help from his UC Irvine Health team.

“Everyone’s been incredible,” Denise says. “I didn’t know what to expect, even when we came home. But the number they gave me went right to the nurse in the ICU. We have the best of the best doctors. He got the best care.”

First signs of trouble 

Castañeda’s doctors believe he made a small tear in his right carotid artery (known as a dissected artery) while lifting weights two days before his stroke. That would account for the nausea, headaches and fatigue he experienced before he collapsed. 

“If I had to do it over again, I’d have gone straight to the doctor on that first day,” he says.

Being aware of stroke symptoms and acting on them quickly is vital, says Dr. Lama Al-Khoury, Castañeda’s neurologist at the stroke center. Even relatively routine stoke treatments like clot-busting drugs are more effective the sooner they’re given. During a stroke, a patient can lose about 2 million brain cells every minute, so every second truly counts.

“The most important thing is alerting the patients and the community to call 911 right away if any sudden acute neurologic symptoms occur,” Al-Khoury says. “We have treatments of choice that work only early on. There is a window there, but it doesn’t mean you have a lot of time.”

Contributing factors

Castañeda’s case is unusual, not only because it involved a dissected artery (the cause of about 2 percent of ischemic strokes), but also because he was younger than most stroke patients and didn’t have any of the common factors that contribute to stroke — obesity, smoking and heavy alcohol consumption. Al-Khoury worries that she’s seeing strokes more frequently in younger people because they’re not controlling those risk factors.

“People don’t take good care of themselves,” she says.

Castañeda has retired from police work. Since his stroke, he has enough energy for about two hours of physical activity each day, so he makes them count. He spends time with his family and watches his three children play sports. It’s a different life, but one he credits to the care he received at UC Irvine Health.

“We were told that this is the place to go for stroke, and I’d say it lives up to that.”

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UC San Diego, El Centro Regional sign management services agreement

Health systems form strategic relationship to enhance patient care in Imperial Valley.

On May 5, UC San Diego Health System and the city of El Centro entered into a long-term management services agreement on behalf of El Centro Regional Medical Center (ECRMC), the city-owned hospital, with the goal of enhancing the delivery of high-quality health care to patients in the Imperial Valley.

“The Hospital Affiliation Task Force has dedicated significant resources to search for a strategic partner that would enhance the availability and quality of health care services for the entire Imperial Valley, and we have found that partner in UC San Diego Health System,” said Mayor Efrain Silva.

“In addition to providing important operational and clinical support, our relationship with UC San Diego Health System will help local patients gain greater access to a comprehensive continuum of care in El Centro and San Diego, including an array of specialized medical and surgical services. Additionally, our employees will have direct access to best practices and expertise of the region’s top-ranked health system,” said Tomas Virgen, interim CEO, ECRMC.

“Through this collaboration, the two health systems will strive to deliver superior health outcomes, service experience and affordability to patients in Imperial Valley,” said Paul Viviano, CEO, UC San Diego Health System. “We are proud to have El Centro Regional Medical Center be part of our mission of delivering outstanding patient care through commitment to the community, groundbreaking research and inspired teaching.”

The management services agreement will launch with UC San Diego Health System conducting a comprehensive assessment of ECRMC’s operational and clinical needs, to be followed by joint development of a management plan for select ECRMC departments, programs and functions. Hospital employees will remain employees of ECRMC. The health systems also will collaborate to provide clinical team members at ECRMC with access to joint research projects and educational opportunities, such as Grand Rounds and continuing medical education through the UC San Diego School of Medicine.

If needed, patients of ECRMC will have direct access to tertiary and quaternary care services of UC San Diego Health System. These include highly specialized and advanced diagnostic, imaging, surgical, oncologic and cardiac services typically only found in academic health centers.

UC San Diego Health System currently supports the Imperial Valley by providing tertiary care for complex cardiovascular disease, primary angioplasty for acute myocardial infarction, telemedicine stroke consultations and advanced care for high-risk pregnancies, trauma and burn patients. Future areas of specialty support will include endocrinology, allergy and immunology, cardiology, rheumatology, and nephrology.

The relationship between UC San Diego Health System and ECRMC follows the recent affiliation of Imperial Valley Family Care Medical Group (IVFCMG) with the UC San Diego Health Physician Network. IVFCMG   ̶   Imperial County’s largest multispecialty group with 13 clinics including locations in El Centro, Brawley and Calexico   ̶   is continuing its efforts through the UC San Diego Health network to enhance the depth and quality of multispecialty health care services and clinical trials available to patients in the Imperial Valley and surrounding communities. Other local physicians will have the opportunity to become part of the growing UC San Diego Health Physician Network.

Viviano noted that the growing network of physicians, hospitals and other providers in the UC San Diego Health System care network presents opportunities to develop and offer narrow network and other innovative health insurance products to local employers, with the goal of delivering quality patient outcomes while managing the total cost of care.

ECRMC is an acute-care medical center, serving the health care needs of the Imperial Valley since 1956. In addition to the 161-bed hospital, ECRMC also owns and operates the Oncology & Hematology of Imperial Valley, Wound Healing Center and outpatient clinics in El Centro and Calexico. The outpatient centers provide exceptional primary and specialty care for residents seeking enhanced wellbeing and improved quality of life.

UC San Diego Health System, the region’s only academic health system, has been ranked #1 in San Diego for four consecutive years by U.S. News & World Report. Leapfrog Group has twice named UC San Diego Health System to its annual list of Top Hospitals, a distinction given to select hospitals nationwide for demonstrating excellence in hospital safety and quality. The Leapfrog Top Hospital award is an elite distinction given to less than seven percent of all eligible hospitals. UC San Diego Health System has also repeatedly received A safety scores from the independent organization.

UC San Diego Health System is comprised of UC San Diego Medical Center in Hillcrest and Thornton Hospital, Moores Cancer Center (one of only 41 National Cancer Institute-designated comprehensive cancer centers in the country, and the first and only San Diego-based National Comprehensive Cancer NetworkMember Institution), Shiley Eye Institute, Sulpizio Cardiovascular Center and Jacobs Medical Center (opening 2016) in La Jolla, as well as other primary and specialty practices located throughout Southern California.

Media contacts:
Jackie Carr
UC San Diego
(619) 543-6163

Cathy Kennerson
El Centro Regional Medical Center
(760) 339-7107

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UCSF, Hospice by the Bay collaborating to enhance end-of-life care

Alliance will strengthen palliative care, hospice services in the Bay Area.

By Scott Maier, UC San Francisco

UC San Francisco and Hospice by the Bay have formed an alliance to expand quality patient care for seriously and terminally ill patients in the Bay Area.

In the past 20 years, hospice and palliative care have evolved considerably from end-of-life care to addressing the spectrum of quality of life and symptom management needs of patients living with life-limiting illness. According to the National Hospice and Palliative Care Organization (NHPCO), an estimated 1.5 million-1.6 million patients received hospice services in 2012.

“Affiliating with organizations such as Hospice by the Bay – whose specialized services increasingly will be in demand as our population ages – is critical to UCSF’s goal of creating a comprehensive Bay Area network that addresses the multifaceted health care needs of patients and families, now and in the future,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals.

Specifically, the affiliation will allow the organizations to:

  • Expand home-based palliative and hospice care services, including new geographic areas.
  • Evaluate and collaborate on best practices for transitioning patients from active, curative treatments through palliative care and symptom management to end-of-life home care.
  • Create a nationally recognized program to train the next generation of physicians, nurses and other health professionals on end-of-life practices.
  • Share resources in raising patient awareness of the benefits of palliative and hospice care.

Incorporated in 1975 as Hospice of Marin, Hospice by the Bay is the oldest hospice in California and second oldest in the United States. Headquartered in Larkspur, it serves Marin, San Francisco, North San Mateo and Sonoma counties and the city of Napa.

“In today’s fragmented health care system, our goal is to continue to develop and deliver best practices for caring for patients and their families,” said Kitty Whitaker, R.N., M.S., Hospice by the Bay CEO. “We want to be part of a seamless continuum from curative treatment to palliative and home care to end-of-life hospice care.”

At UCSF, the Palliative Care Service is dedicated to the care and comfort of seriously ill patients and their families. Patients are cared for by their doctors, with consultation from palliative care staff. The palliative care team includes doctors, nurses, pharmacists, social workers, chaplains and ethicists who help patients address a broad range of issues.

Seven out of 10 Americans say they would prefer to die at home, yet only 25 percent actually do. Even those who may be eligible for hospice care might not realize the full benefit of the comprehensive services available to them and their families.

Patients are qualified to receive hospice care if they have a life expectancy of six months or less. However, the median time that patients are in hospice care is 18.5 days, according to an NHPCO study. This so-called “length of service” can be influenced by a number of factors, including disease course, timing of referral and understanding options for care.

The agreement between UCSF and Hospice by the Bay seeks to bridge these discrepancies.

The shared vision of the UCSF-Hospice by the Bay relationship is to provide the highest quality of care to patients receiving hospice and palliative care services and their families throughout the Bay Area, including the most vulnerable patient populations. The intent of the affiliation is to create a leading hospice and palliative care clinical program that would be measured by the number of patients served, residents trained and programs established at other health care providers, and increase research activities to better serve future patients.

Through the joint agreement, Hospice by the Bay will maintain its current status as an independent, nonprofit organization and continue to provide care for patients throughout Northern California. It also will continue its current partnerships and relationships with other health care providers, as well as raise charitable donations to support its community-based programs, including care for the underserved.

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UC San Diego, Scripps partner in hospice care, training, research

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Higher tech, higher touch

At new UCSF Medical Center at Mission Bay, tech touches are helping improve patient care.

Eleven-year-old Brett Demy looks over the members of his care team at UCSF Benioff Children's Hospital San Francisco using a bedside digital tablet available in all patient rooms. (Photo by Elisabeth Fall)

By Kathleen Masterson, UC San Francisco

Personalized digital media walls. Push-button, custom dinner orders. Robot deliveries.

This isn’t a futuristically imagined hospital from “The Jetsons.” It’s all part of UCSF Medical Center at Mission Bay, where technological touches aren’t just making patients more comfortable – they’re freeing up care teams to focus more on health and safety.

“When we first started planning the medical center 10 years ago, we focused on creating the most healing environment we could,” said Pamela Hudson, executive director of clinical systems at UCSF Medical Center at Mission Bay. In addition to designing rooms and technology for patients, “we really wanted to give our staff the mind space they needed to focus more on the patient.”

Outside hospital walls, texting phones and digital tablets are now the norm, but health care has been slower to adapt because of issues surrounding patient privacy and reliability of the communication device – especially when dealing with life and death.

UCSF has rolled out cutting-edge technology at Mission Bay that’s finally brought modern convenience to patient care.

Empowering patients with a screen tap

Digital tablets can be handy during a hospital stay for entertainment between clinical check-ins, but a new bedside tablet system at UCSF is empowering patients to play an active role in their own care.

For 11-year-old Kellen Durham, he used the tablet’s private email app to send questions to his doctor, and order meals from another app pre-programmed to show only foods that met his specific dietary needs.

“Typically the staff would come in to talk about his specific question he would post using the tablet,” said Kellen’s mother, Ginger. “All his concerns were being addressed, and I think that made him feel like he was important in making his own decisions.”

UCSF is among the first in the United States to implement this clinical communication system, developed by Oneview Healthcare.

“A big part of the new technology is to allow patients to have more of an interactive conversation with their care teams, and to be a part of their own care,” said Anson Daine, M.S.N., and a key member of the Mission Bay transition training team.

Kellen spent several weeks at UCSF Benioff Children’s Hospital San Francisco for treatment for chronic pancreatitis, which often left him fatigued. He turned to the technology to stay engaged, setting reminders in the goal-setting section of the app to brush his teeth or take a shower to give himself little prods on days he wasn’t feeling well.

“His ability to set goals for himself was also very empowering,” said Durham’s mother. “He had a physical thing to look at, to check off, and that helped to motivate him to get out of bed and do other things.”

When he wasn’t working on those goals, she noted, he certainly enjoyed playing video games on the system too.

Connecting caregivers when seconds matter

Other technology is more invisible to patients but has a real impact on how smoothly – and safely – the hospital runs.

The nurse call button by the patient’s bedside doesn’t just buzz a generic alarm in the hallway. It’s tied into a new wireless clinical communication system that texts the nurse on duty. If the nurse doesn’t respond within two minutes, the call is automatically forwarded to the next nurse, and if s/he doesn’t respond, it’s forwarded to the charge nurse of the unit.

The system recognizes the difference between non-emergency and other calls and texts the most appropriate person in the chain. “The system is triaging needs based on which button is pushed and sending the alarms to the appropriate person,” said Daine.

Making pagers a thing of the past

The new alert system is tied into a bigger innovation: allowing patient care staff to finally evolve beyond 90’s-era pagers and securely communicate through calls and text.

Nearly all hospital staff carry a cellphone running software specifically designed by Voalte, a health care communication company. Unlike spotty cell coverage, the system runs on a robust wifi network that reaches almost every corner of the hospital and allows calls and texts to continue on elevators.

“This has been a runaway success story since the hospital opened,” said Daine.

Nurses now can text each other for help with a patient, to check on a transport team coming to move a patient, or to request a room cleaning. Even if staff members don’t know a specific name, they can request assistance by job description too – the system automatically directs the call or text to whoever is signed in under “Spanish translator” or “obstetrician.”

In an emergency, the system sends texts in addition to traditional alarms, and those texts can come in a full minute or more before the alarm sounds. For some, those seconds could make a big difference.

Raising the bar with robots

The new hospital complex is almost three football fields long, a serious distance for staff to push dirty linens, which can weigh more than a ton.

Enter the robot. A fleet of 25 robots, to be precise, and one of the largest hospital robot fleets in the world.

The robots can be spotted quietly whirring down the hallway at a human walking pace, waiting patiently for an elevator or pausing outside the operating room with surgical instruments after texting a nurse that his or her delivery is ready. Different bots transport medicines, meals, recycling and waste, surgical instruments and lab specimens.

Not only are the robots efficient, they also play a key role in hospital safety, Hudson said. “When you look at injuries to employees, especially at medical centers, they occur when they’re lifting large equipment or moving heavy linens,” she said.

Plus robots can lift, transport and deliver important specimens or medicines far more reliably and efficiently than humans. Medications, for instance, can only accessed when a clinician enters a special code as well as his or her fingerprint.

This frees up the time of busy caregivers, said Josh Adler, M.D., UCSF Medical Center’s chief medical officer.

“This allows them to spend more time right at patient’s bedside, and not searching for a particular medicine, or worrying if a medicine will be delivered at the time the patient needs it.”

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UC San Diego, Scripps partner in hospice care, training, research

Joint fellowship program is only physician training program of its kind in San Diego County.

By Heather Buschman, UC San Diego and Steve Carpowich, Scripps Health

UC San Diego Health System and Scripps Health are partnering to provide improved continuity of patient care, fellowship training and research in hospice and palliative medicine. Under a new five-year agreement, Scripps will work with UC San Diego to provide outpatient and inpatient hospice care for UC San Diego patients, allowing UC San Diego physicians to better coordinate post-acute care for patients with chronic illness. The joint fellowship program is the only physician training program of its kind in San Diego County.

“We look forward to collaborating with Scripps to offer comprehensive, patient-centered care to our patients in need of long-term or end-of-life medical care, support and comfort,” said Paul Viviano, CEO, UC San Diego Health System and associate vice chancellor, UC San Diego Health Sciences. “In addition, the hospice and palliative medicine fellowship program will train many physicians in the core principles of pain and symptom management, communication skills and care coordination for patients with serious and life-limiting conditions.”

UC San Diego patients who select Scripps Hospice for post-acute hospice care will benefit from UC San Diego and Scripps providers working closely together to ensure the highest quality and continuum of care.

“Scripps is pleased to partner with UC San Diego on this integrated program to improve patient care, physician training and research,” said Scripps Health president and CEO Chris Van Gorder. “This initiative fits with Scripps’ mission to collaborate with others to deliver the continuum of care that improves the health of our community.”

The hospice and palliative medicine training program is an extension of a fellowship that was previously offered through San Diego Hospice. Gary Buckholz, M.D., UC San Diego, and Holly Yang, M.D., Scripps Health, co-direct the joint fellowship program, which will be housed at UC San Diego beginning in July. The program will engage faculty from both organizations, exemplifying the teamwork required to meet the physical, emotional, social and spiritual needs of palliative care and hospice patients and their families.

Candidates for the fellowship program represent many different specialties, including internal medicine, family medicine, emergency medicine, pediatrics, surgery, neurology, radiology and others. Once accepted, physician-trainees will divide their time among hospice and palliative care training and rotations at UC San Diego and Scripps. Specializing in hospice and palliative medicine gives a physician the knowledge and skills to prevent and relieve the suffering of patients and families, while working with an interdisciplinary team of doctors, nurses, pharmacists, counselors, social workers and other health care providers.

The agreement also includes provisions for Scripps and UC San Diego to collaborate on clinical trials and research programs involving hospice and palliative care.

Scripps Hospice is one of the largest providers of hospice services in the San Diego region. It builds on a foundation of experience developed through Scripps Home Health and Palliative Care Services. Scripps has been offering home health services for more than 25 years, providing tens of thousands of patient visits annually. Scripps’ highly regarded palliative care program provides pain management, emotional, psychosocial and spiritual care to patients facing life-limiting illness.

The fellowship program helps fill a growing need for hospice and palliative care physicians. According to the American Academy of Hospice and Palliative Medicine, the U.S. physician workforce is failing to keep pace with increasing demands for hospice and palliative care services, as more people live longer with chronic diseases. The Centers for Disease Control and Prevention estimates that more than 117 million people — half of the U.S. adult population — have at least one chronic health condition.

Media contacts:
Heather Buschman
(619) 543-6163

Steve Carpowich
(858) 67807183

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UCSF Medical Center, John Muir Health affiliate

Relationship to serve as cornerstone of Bay Area network to provide more integrated care.

By Karin Rush-Monroe, UC San Francisco

UCSF Medical Center and John Muir Health have finalized an agreement that will serve as the foundation for a Bay Area health care network intended to provide patients with high quality care at an affordable price.

The two health systems also have formed a new development company that will enable them to collaborate on building new medical facilities, increase the number of physicians in the health care network, and provide physicians and patients new tools to improve coordination of care, with the ultimate goal of an enhanced patient experience.

Under the agreements, both organizations remain independent. Together, UCSF Medical Center and John Muir Health:

  • Have invested in a collaborative effort, called the Bay Area Accountable Care Network, to form a regional health care network. Establishing a Bay Area-wide network will provide patients from throughout the Bay Area and Northern California with a competitively priced option to access, close to where they live or work, many of the Bay Area’s most trusted and respected hospitals, health systems and physician organizations.
  • Will equally own and operate a new development company. The formal affiliation will enable both organizations to build on their strengths and work together to develop joint initiatives and a shared services organization to support programs and initiatives focused on better health care, at lower costs, for Bay Area patients.

“UCSF Medical Center, and John Muir Health are leading the development of a comprehensive Bay Area network of providers who share a common commitment to providing safe, high quality, patient centered care at an affordable price. We intend to offer this network to health plans who serve patients throughout the Bay Area,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “We look forward to working not just with each other, but with other health organizations throughout the Greater Bay Area, in order to provide an exceptional health care experience for patients.”

The two organizations will apply for a restricted Knox-Keene license effective in the Greater Bay Area. This license, which is issued by the California Department of Managed Health Care, would enable the Bay Area Accountable Care Network to contract directly with health plans to develop an insurance product that provides access to high-quality care at an affordable price.

As a next step, UCSF Medical Center and John Muir Health will coordinate their Epic electronic medical record systems and patient communication portals to enable better physician and patient communications. UCSF Medical Center and John Muir Health also anticipate, with other provider partners, building enhanced physician practice management services to create alternatives for physicians throughout the Bay Area who wish to be participating providers in the Bay Area Accountable Care Network.

“Our affiliation brings together two forward-thinking organizations that share a vision for how health care will be delivered in the future,” said Cal Knight, president and CEO of John Muir Health. “We’re pleased to have finalized our affiliation so we can further our joint initiatives and efforts to develop a Bay Area Accountable Care Network. We’re focused on meeting the needs of patients by providing better access to high-quality and affordable care throughout the Bay Area from trusted and respected physicians, hospitals, outpatient facilities and health systems.”

Both John Muir Health and UCSF Medical Center already have experience in successful care models developed under the Affordable Care Act, such as accountable care organizations (ACOs), that have demonstrated lower health care costs and improved health care quality. These experiences, as well as those of other organizations that choose to be part of the provider network, will be translated into the Bay Area Accountable Care Network. The goal is to provide the right care at the right time and in the most appropriate setting, whether that is the primary care physician’s office, an outpatient center or a hospital. When better coordination of care results in lower costs, the savings achieved are passed along to consumers in the form of lower health care benefit premiums.

By working more closely, the two organizations also will offer more convenient access to care for patients in Northern California. For example, an outpatient clinic for liver transplant services will be established at the John Muir Health’s Walnut Creek Outpatient Center. This will allow patients who are waiting for transplants, or have recently received transplants, at UCSF Medical Center, which is nationally recognized for the quality of its program, to receive clinical services such as blood testing and monitoring at the new location. John Muir Health’s Physician Network is a comprehensive network of primary care and specialist physicians, covering virtually all conditions except transplants.

In addition, both organizations are widely recognized for the quality of care they provide. U.S. News & World Report recently ranked UCSF Medical Center, John Muir Medical Center, Walnut Creek and John Muir Medical Center, Concord as the top three hospitals in the San Francisco-Oakland area. In addition, the John Muir Physician Network recently received the highest possible “elite” ranking from the California Association of Physician Groups.

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‘Smart bandage’ detects bedsores before they are visible to doctors

UC Berkeley findings could provide major boost to tackling a growing health problem.

By Sarah Yang, UC Berkeley

Engineers at the University of California, Berkeley, are developing a new type of bandage that does far more than stanch the bleeding from a paper cut or scraped knee.

Thanks to advances in flexible electronics, the researchers, in collaboration with colleagues at UC San Francisco, have created a new “smart bandage” that uses electrical currents to detect early tissue damage from pressure ulcers, or bedsores, before they can be seen by human eyes – and while recovery is still possible.

“We set out to create a type of bandage that could detect bedsores as they are forming, before the damage reaches the surface of the skin,” said Michel Maharbiz, a UC Berkeley associate professor of electrical engineering and computer sciences and head of the smart-bandage project. “We can imagine this being carried by a nurse for spot-checking target areas on a patient, or it could be incorporated into a wound dressing to regularly monitor how it’s healing.”

The researchers exploited the electrical changes that occur when a healthy cell starts dying. They tested the thin, non-invasive bandage on the skin of rats and found that the device was able to detect varying degrees of tissue damage consistently across multiple animals.

Tackling a growing health problem

The findings, published today (March 17) in the journal Nature Communications, could provide a major boost to efforts to stem a health problem that affects an estimated 2.5 million U.S. residents at an annual cost of $11 billion.

Pressure ulcers, or bedsores, are injuries that can result after prolonged pressure cuts off adequate blood supply to the skin. Areas that cover bony parts of the body, such as the heels, hips and tailbone, are common sites for bedsores. Patients who are bedridden or otherwise lack mobility are most at risk.

“By the time you see signs of a bedsore on the surface of the skin, it’s usually too late,” said Dr. Michael Harrison, a professor of surgery at UCSF and a co-investigator  of the study. “This bandage could provide an easy early-warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy. Just take the pressure off.”

Bedsores are associated with deadly septic infections, and recent research has shown that odds of a patient dying are 2.8 times higher when they have pressure ulcers. The growing prevalence of diabetes and obesity has increased the risk factors for bedsores.

“The genius of this device is that it’s looking at the electrical properties of the tissue to assess damage. We currently have no other way to do that in clinical practice,” said Harrison. “It’s tackling a big problem that many people have been trying to solve in the last 50 years. As a clinician and someone who has struggled with this clinical problem, this bandage is great.”

Cells as capacitors and resistors

The researchers printed an array of dozens of electrodes onto a thin, flexible film. They discharged a very small current between the electrodes to create a spatial map of the underlying tissue based upon the flow of electricity at different frequencies, a technique called impedance spectroscopy.

The researchers pointed out that a cell’s membrane is relatively impermeable when functioning properly, thus acting like an insulator to the cell’s conductive contents and drawing the comparison to a capacitor. As a cell starts to die, the integrity of the cell wall starts to break down, allowing electrical signals to leak through, much like a resistor.

“Our device is a comprehensive demonstration that tissue health in a living organism can be locally mapped using impedance spectroscopy,” said study lead author Sarah Swisher, a Ph.D. candidate in electrical engineering and computer sciences at UC Berkeley.

To mimic a pressure wound, the researchers gently squeezed the bare skin of rats between two magnets. They left the magnets in place for one or three hours while the rats resumed normal activity. The resumption of blood flow after the magnets were removed caused inflammation and oxidative damage that accelerated cell death. The smart bandage was used to collect data once a day for at least three days to track the progress of the wounds.

The smart bandage was able to detect changes in electrical resistance consistent with increased membrane permeability, a mark of a dying cell. Not surprisingly, one hour of pressure produced mild, reversible tissue damage while three hours of pressure produced more serious, permanent injury.

Promising future

“One of the things that makes this work novel is that we took a comprehensive approach to understanding how the technique could be used to observe developing wounds in complex tissue,” said Swisher. “In the past, people have used impedance spectroscopy for cell cultures or relatively simple measurements in tissue. What makes this unique is extending that to detect and extract useful information from wounds developing in the body. That’s a big leap.”

Maharbiz said the outlook for this and other smart bandage research is bright.

“As technology gets more and more miniaturized, and as we learn more and more about the responses the body has to disease and injury, we’re able to build bandages that are very intelligent,” he said. “You can imagine a future where the bandage you or a physician puts on could actually report a lot of interesting information that could be used to improve patient care.”

Other lead researchers on the project include Vivek Subramanian and Ana Claudia Arias, both faculty members in UC Berkeley’s Department of Electrical Engineering and Computer Sciences; and Shuvo Roy, a UCSF professor of bioengineering. Additional co-authors include Amy Liao and Monica Lin, both UC Berkeley Ph.D. students in bioengineering; and Yasser Khan, a UC Berkeley Ph.D. student in electrical engineering and computer sciences, who fabricated the sensor array.

Study co-author Dr. David Young, UCSF professor of surgery, is now heading up a clinical trial of this bandage.

The project is funded through the Flexible Resorbable Organic and Nanomaterial Therapeutic Systems (FRONTS) program of the National Science Foundation.

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Infant leaves UCLA’s Mattel hospital for home with a transplanted heart

Drayvn is the hospital’s second youngest heart transplant recipient.

Drayvn Johnson got a heart transplant when he was 23 days after he was born with a heart defect and only one coronary artery. Now 5 weeks old, he left Mattel Children's Hospital UCLA for home today with his mother, Nicole Eggleston. (Photo by Reed Hutchinson, UCLA)

By Amy Albin, UCLA

Staff at Mattel Children’s Hospital UCLA witnessed a happy ending today (March 11) instead of what could have easily been a tragic one  when they bid farewell to 5-week-old Drayvn Johnson, who went home with his mother, Nicole Eggleston, and two older brothers after becoming the hospital’s second youngest heart transplant recipient. He was only 23 days old when he received his new heart, which was the size of a strawberry.

“All of our heart transplant patients are special, but I think this one was special because we knew there was a risk we might not find a donor in time,” said Dr. Juan Alejos, professor of pediatric cardiology and director of the Pediatric Heart Transplant Program at Mattel Children’s Hospital UCLA

Dravyn was born with a condition called pulmonary atresia in which the pulmonary valve does not form properly. It was discovered during Eggleston’s pregnancy in a sonogram performed at 22 weeks. Doctors had thought initially that his heart could be repaired with a series of corrective surgeries performed over the first few years of Dravyn’s life.

However, when he was born in early February at an Orange County hospital, doctors found that he had only one coronary artery instead of two and determined that surgery would be too risky for the baby.

At 5 days old, Drayvn was airlifted to Mattel where doctors confirmed that the only hope for his survival was an urgent heart transplant. Miraculously, within two days after Drayvn’s name went on a list for a transplant, a donor was found. And Drayvn got his new heart. The hospital’s youngest heart recipient was a 16-day-old infant who received a transplanted heart in 1994.

The UCLA Pediatric Heart and Heart-Lung Transplant Program is one of the major referral centers for the western United States. The team has performed more than 300 pediatric heart transplants since 1984 when it did its first such surgery. The program is a coordinated effort among pediatric cardiologists, cardiothoracic surgeons, dentists, nurse practitioners, transplant coordinators, nutritional specialists, social workers and child developmental specialists. For more information, visit http://transplants.ucla.edu/heart.

The family has set up a website to help raise funds for Drayvn’s care.

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UC San Diego Health System named one of nation’s best

Truven Health Analytics includes UC San Diego on list of nation’s 100 Top Hospitals.

By Jackie Carr, UC San Diego

UC San Diego Health System was named one of the nation’s 100 Top Hospitals by Truven Health Analytics. This is the third time UC San Diego Health System has been recognized for this prestigious honor.

The Truven Health 100 Top Hospitals study identifies hospitals and leadership teams that provide the highest level of value to their communities based on a national balanced scorecard. The scorecard measures overall organizational performance across 11 key analytic measures including patient care, operational efficiency and financial stability.

“It is an incredible honor for UC San Diego to be named a top performing health system in the country,” said Paul Viviano, CEO, UC San Diego Health System. “This national recognition is the result of the extraordinary devotion of our staff and faculty to achieve excellence for our patients through improved safety, shorter hospitals stays, increased satisfaction, lower costs and demonstrably superior clinical outcomes.”

UC San Diego Health System is listed as a top hospital among 3,000 U.S. hospitals and is recognized among the nation’s most prominent teaching institutions, including Duke University Hospital, Emory University Hospital and Stanford Hospital.

To conduct the 100 Top Hospitals study, Truven Health researchers evaluated close to 3,000 short-term, acute-care, nonfederal hospitals. Risk-adjusted methodologies were used to analyze public information — Medicare cost reports, Medicare Provider Analysis and Review (MEDPAR) data, and core measures and patient satisfaction data from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare reports. Hospitals do not apply, and winners do not pay to market this honor.

“This year’s 100 Top Hospitals represent the highest national standards in hospital care and management today. They set the benchmarks for peers around the country to follow — consistently delivering outstanding quality of care, satisfaction and community value at a reasonable cost,” said Jean Chenoweth, senior vice president for performance improvement and the 100 Top Hospitals program at Truven Health Analytics. “The majority of the 2015 award winners have produced year-to-year performance improvement, as well. This speaks to the consistent focus on excellence by the entire organization and the men and women who serve patients.”

The study shows that if all hospitals in the U.S. performed at the level of this year’s winners:

  • 126,471 additional lives could be saved
  • 108,926 additional patients could be complication-free
  • $1.8 billion in inpatient costs could be saved
  • The average patient stay would decrease by half a day
  • Episode-of-illness expense would be 2 percent lower than the peer average

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Looking back and ahead, Shiley’s vision remains clear

UC San Diego emerges as regional hub for eye care, research, education, community service.

By Scott LaFee, UC San Diego

Time may blur, but the first quarter-century of the Shiley Eye Center – it celebrates that anniversary this year – remains sharply defined in its accomplishments and focus on the future.

When the $8 million center debuted in 1991, launched by a $1 million leadership gift from the late philanthropist Donald Shiley and his wife, Darlene, it stood alone – quite literally. The neighboring Perlman Ambulatory Care Center (now Perlman Medical Offices) and UC San Diego Thornton Hospital were both two years from completion. More to the point, the new Shiley Eye Center represented the first institution in San Diego entirely dedicated to eye care and science.

“No other major city had been without an eye center,” said Dr. Stuart Brown, then-chair of the Department of Ophthalmology and the center’s founding director at the opening gala in 1991. “And now we will be allowed to achieve our mission and our greatest potential.”

The ambition of the Shiley team was to establish an eye center unrivaled in the region. To a remarkable degree, they have succeeded. It’s a vision that has accelerated under the current Shiley director and ophthalmology chair, Dr. Robert N. Weinreb. “The Shiley has emerged as a hub for clinical care excellence, outstanding vision research and broad-based eye health education. By investing in unsurpassed facilities, equipment and brainpower, we have become a destination for preventing and curing blinding eye diseases for the residents of San Diego and beyond.” said Weinreb.

This week, Shiley expands upon that success, changing its name to the UC San Diego Donald P. and Darlene V. Shiley Eye Institute, which will encompass the Shiley Eye Center, the Anne F. and Abraham Ratner Children’s Eye Center, the Hamilton Glaucoma Center and the Joan and Irwin Jacobs Retina Center. The institute is part of the UC San Diego Health System.

“The new name more accurately captures the fullness of the work being done at Shiley,” said UC San Diego Chancellor Pradeep K. Khosla. “The institute and department of ophthalmology, working hand-in-hand with the School of Medicine and other programs across campus, will leverage every possible tool and expertise, from genetics, bioengineering and pharmacy to pathology, neurosciences and stem cell research, to improve the treatment of eye diseases, find new cures and hasten the day when blindness is entirely preventable.”

The institute will include the new Richard C. Atkinson Laboratory for Regenerative Ophthalmology, created last year with an anonymous $6.5 million gift from a grateful patient. The new lab will investigate cell replacement therapies, tissue engineering and other biomedical advances to reverse vision loss and blindness. Researchers will explore novel stem cell approaches and work closely with the Sanford Clinical Stem Cell Center at UC San Diego Health System, which was established in 2013.

Nearby, a new Vision Research Center is in the early stages of planning along with the creation of a framework to fund the project. The center is envisioned to accelerate the translation of new research into treatments for patient with blinding ophthalmic diseases.

“The center is intended to help bridge the gap between laboratory and clinic by bringing together brilliant minds and diverse talents in a shared facility,” said Weinreb. “This integrated approach will speed the transformation of discoveries into clinical applications that can be tested through clinical trials.”

If past is prologue, the future looks bright. Over the years, Shiley physicians and researchers have made major contributions to preventing and curing eye diseases such as macular degeneration, glaucoma, diabetic retinopathy, corneal disorders and cataracts.

Recently, for example, they have been involved in developing an artificial retina, a smart contact lens that wirelessly monitors intraocular pressure (a key risk factor in glaucoma) and the use of self-renewing stem cells to repair or restore vision lost to diseases like macular degeneration, glaucoma and corneal opacity. They are even helping explore the possibility of whole eye transplants.

Clinical care remains a cornerstone. In 2014, there were 106,470 patient visits and 4,862 surgeries. Patients ranged in age from one day to 105 years. The Shiley Eye Mobile conducted 12,238 vision screenings, 2,011 eye exams, dispensed 1,288 pairs of free glasses and referred 107 children for more serious follow-up care.

“It was always very clear that my late husband had a special place in his heart for the Shiley Eye Center,” said Darlene Shiley. “I will never forget how moved he was by Dr. Brown’s description of the work being done and the work that still needed to be addressed. And now, decades later, Dr. Weinreb is focused on patient-centric care excellence and leading the Shiley into new areas of eye research and treatment. Successful past, bright future – how lucky we all are to have such dedicated physicians, researchers, staff and eager volunteers.”

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UCSF receives $100M gift to advance health sciences mission

Landmark gift cements Chuck Feeney’s role as UC system’s top philanthropist.

Chuck Feeney

By Jennifer O’Brien, UC San Francisco

UC San Francisco has received a $100 million gift from visionary philanthropist Charles F. “Chuck” Feeney to support its new Mission Bay hospitals, world-class faculty and students, and research programs focused on the neurosciences and aging.

This donation brings the longtime supporter’s total UCSF giving to more than $394 million, making Feeney the single largest contributor to the University of California system.

“I get my gratification from knowing that my investments in medical research, education, and the delivery of health care at UCSF will provide lifelong benefits to millions of people not only in the Bay Area but also around the world,” said Feeney, who, despite his global presence as a successful entrepreneur and discerning philanthropist, prefers remaining out of the limelight. “I can’t imagine a more effective way to distribute my undeserved wealth.”

Reflecting on Feeney’s contributions, UCSF Chancellor Sam Hawgood, M.B.B.S., said, “As we celebrate UCSF’s 150th anniversary this year, it is only fitting that we acknowledge the unique role Chuck has played in our history. While his impact has been felt most profoundly during this past decade, his generosity will carry on forever at our university, in the San Francisco community, throughout the Bay Area and globally, as our faculty and students advance knowledge and provide the finest clinical care. We are honored that he has decided to invest again in UCSF.”

Feeney’s gifts to UCSF are most visible at the university’s Mission Bay campus, where he has provided indispensable support to create advanced facilities and foster the environment for the biomedical research and patient care that goes on within them.

Before the latest funding, Feeney’s most recent gift to the campus was to UCSF Global Health Sciences, enabling the October 2014 opening of Mission Hall, which houses global health researchers, scientists and students under the same roof for the first time. Feeney, who coined the term “giving while living,” also generously supported the building of the Smith Cardiovascular Research Building and the Helen Diller Family Cancer Research Building.

“Chuck Feeney has been our partner at Mission Bay for more than 10 years,” added Hawgood. “He immediately embraced the Mission Bay concept, and he has enthusiastically helped us shape a larger vision for the campus and finance its development because he knew that our research and clinical programs could not flourish without state-of-the-art buildings.”

Gift to support four primary areas

The Campaign for the UCSF Medical Center at Mission Bay
Funds will support the $600 million philanthropy goal of the $1.5 billion hospitals project. The latest donation builds upon the transformative $125 million matching gift Feeney made to support the hospitals complex and its programs in 2009, the largest gift received toward the campaign.

The opening of the 289-bed hospital complex – which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital, and the UCSF Ron Conway Family Gateway Medical Building – was the culmination of more than 10 years of planning and construction. Strategically located adjacent to UCSF’s renowned Mission Bay biomedical research campus, the new medical center places UCSF physicians in close proximity to UCSF researchers and nearby bioscience companies who are working to understand and treat a range of diseases, from cancer to neurological disorders.

“It’s been thrilling to see the reactions of our patients and their families as they encounter the amazing care offered at our new UCSF Mission Bay hospitals,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “This world-class experience would never have been possible without the support of Chuck Feeney who, as the largest contributor to the project, helped us create the hospitals of our dreams. Every patient cured, every breakthrough discovered at Mission Bay, will be thanks in part to Chuck. His legacy is unparalleled.”

Neuroscience and aging
The gift also supports UCSF’s pre-eminent neuroscience enterprise, including its Sandler Neurosciences Center and neurology programs at Mission Bay.

The center, a five-story, 237,000-square-foot building that opened in 2012, brings under one roof several of the world’s leading clinical and basic research programs in a collaborative environment. UCSF’s neurology and aging efforts are focused on finding new diagnostics, treatments, and cures for a number of intractable disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, migraine, epilepsy and autism. The programs also seek to integrate neuroscience and clinical disciplines with public health initiatives in order to disseminate and implement novel findings from research centers of excellence, as well as conduct community outreach to raise awareness about the diseases of aging.

“Chuck Feeney has taken a keen interest in the challenges of aging,” said Hawgood. “In turn, he has recognized UCSF’s extraordinary talent in the neurosciences, among both basic researchers and those who translate research into clinical care and public policy. This gift will build on UCSF’s strengths while encouraging strong partnerships at other research institutions around the world where Chuck also has made important investments.”

Student scholarships and housing
Even with its extraordinary academic firepower, UCSF has extremely limited funds to support scholarships for professional students in its schools of dentistry, medicine, nursing and pharmacy. Part of the gift will provide scholarship support, bolstering UCSF’s ability to recruit the best and brightest students, regardless of their financial circumstances.

Recent decreases in state funding led to tuition increases and higher demand for scholarships. This, in turn, increased student debt. Combined with Bay Area housing prices that are among the highest in the nation – from 2011 to 2013, the median rent increased by 24 percent – the prospect of overwhelming debt can deter economically vulnerable students as well as those from middle-class backgrounds from attending UCSF. By minimizing debt upon graduation, the scholarships will help ensure that a UCSF education remains in reach for students from underserved populations, as well as for those students who choose to become health care leaders in underserved communities.

“Scholarships give our students the gift of freedom: to make career choices based on purpose and passion, rather than the price of education; to use time to study, explore science, and volunteer to help others, rather than working to make ends meet; and to succeed because someone who never met them saw enough potential to invest in their dreams,” said Catherine Lucey, M.D., vice dean for education at UCSF’s School of Medicine. “These scholarships catalyze our schools’ ability to find, recruit, educate and nurture the workforce our country needs: talented professionals whose life experiences enable them to provide compassionate care to today’s diverse communities and advance science to improve the health of future communities.”

Faculty recruitment
The donation also will help UCSF recruit the next generation of promising faculty in an increasingly competitive marketplace.

New funding will attract junior faculty – who frequently find it more challenging to secure research funding – and provide initial startup funds as they launch their research careers and clinical practices. With decreasing federal support for young investigators, this gift will underwrite a new generation of brilliant upcoming faculty.

“While Chuck’s unprecedented generosity has been focused primarily on Mission Bay, he understands the power of the entire UCSF enterprise, from our cutting-edge stem cell research at Parnassus to our innovative cancer programs at Mount Zion,” Hawgood said. “We’re thrilled that Chuck has inspired other philanthropists to join him in creating one of the most vibrant life science communities in the world, where progress will ripple far beyond Mission Bay and the campus for generations to come.”

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