TAG: "Patient care"

UC awards four grants to expand health care innovations


Projects have shown potential to improve care.

The University of California has awarded four grants totaling $2.5 million to scale up proposals that have shown potential to improve health care while delivering a return on investment to UC medical centers.

The fellowships expand proposals that already are funded by the UC Center for Health Quality and Innovation (CHQI) and that have demonstrated they can provide better care and better health with lower costs.

The grants include UC Health projects to reduce emergency room visits among psychiatric patients, expand access to specialty care, develop a tobacco cessation network, and support efforts to standardize treatment for hip and knee replacements.

“We’re excited to extend our support to proven projects so that they can be replicated across UC medical centers,” said Karyn DiGiorgio, CHQI interim director. “By scaling up transformative projects like these, UC Health will see even more improvement in the quality and value of the health care we provide Californians.”

The grants, awarded to previously funded CHQI fellows and principal investigators, are part of UC Health’s efforts to improve patient care and increase value at medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

The awardees include:

      • Patient-centered recovery program and emergency department community placement program: $1.2 million over two years
        Project director: William Perry, Ph.D., UC San Diego
        Campus leads: Debra Kahn, M.D., UC Davis; Nathan Kuppermann, M.D., M.P.H., UC Davis; Tina Allee, M.D., UC Irvine; Scott Rudkin, M.D., M.B.A., UC Irvine; Erick Cheung, M.D., UCLA; Lynne McCullough, M.D., UCLA; James Bourgeois, O.D., M.D., UC San Francisco; and Steven Polevoi, M.D., UC San Francisco

        Perry

        Overuse of emergency department services by psychiatric patients is a national crisis. This fellowship, building on Perry’s 2011 CHQI grant, will expand to all five UC medical centers a project that provides screening, intervention and referral services to psychiatric patients with substance use disorders, with the aim of reducing the length of their stays and their return visits to the emergency department. The project began at UC San Diego, where the Patient-Centered Recovery Program reduced the average ED length of stay of psychiatric patients by 12 percent and reduced 30-day psychiatric patient return visits to the ED by 15 percent. The ED Community Placement Program has worked at UC San Diego to further reduce ED visits by placing high-risk patients into community partner programs. The project will work with the other UC medical centers to identify and develop partnerships with community service providers, so that similar results can be achieved.

      • Scale-up eReferral and eConsult program: $709,000 over 18 months
        Project director: Nathaniel Gleason, M.D., UC San Francisco
        Campus leads: Mark Avdalovic, M.D., UC Davis; Elizabeth Rosenblum, M.D., UC San Diego

        Gleason

        Access to specialty physicians at UC medical centers commonly involves wait times of several weeks, which is anathema to patient-centered care. The eReferral and eConsult program improves coordination between primary care and specialty physicians in order to expand access and reduce avoidable in-person appointments. It aims to improve patient outcomes, save patients time, reduce out-of-pocket costs for patients and reduce the overall cost of care. Gleason received a 2013 CHQI fellowship to begin this program at UC San Francisco. The program provides primary care physicians with point-of-care decision support on referral appropriateness (eReferral) and allows them to receive timely specialist recommendations on clinical questions that do not require an in-person evaluation of the patient by the specialist (eConsult). At UCSF, eConsults now represent 8 percent of referrals to participating specialties and have reduced referral rates for standard office visits by 20 percent, improving access to specialty care and saving costs. This grant will expand the project to include UC Davis, UCLA and UC San Diego, with the option to amend the proposal to include UC Irvine and possibly UC Riverside.

      • UC Tobacco Cessation Network: $541,000 over two years
        Project director: Elisa Tong, M.D., M.A., UC Davis
        Campus leads: Linda Sarna, R.N., Ph.D., UCLA; Mark Avdalovic, M.D., UC Davis; Alpesh Amin, M.D., M.B.A., UC Irvine; Sheldon Greenfield, M.D., UC Irvine; Allison Diamant, M.D., UCLA; Timothy Fong, M.D., UCLA; Robert El-Kareh, M.D., M.S., M.P.H., UC San Diego; Tyson Ikeda, M.D., UC San Diego; Eliseo Pérez-Stable, M.D., UC San Francisco; Sujatha Sankaran, M.D., UC San Francisco; and Jyothi Marbin, M.D., Children’s Hospital Oakland

        Tong

        UC has shown its commitment to provide a healthy environment for faculty, staff, students and visitors by implementing a systemwide tobacco-free policy that began in January 2014. This project aims to further reduce tobacco use and exposure – the leading cause of preventable death – by developing a UC Tobacco Cessation Network. Building on a pilot project that Tong started at UC Davis with a 2013 CHQI fellowship, the UC-wide network will use electronic medical records to address tobacco use and exposure at every clinical encounter. There will be assistance with counseling and medication for greater success, with the Joint Commission tobacco treatment measures serving as a framework. The network will partner with the California Smokers’ Helpline, a UC San Diego-based free telephone counseling service that doubles the chances of quitting, to create a two-way electronic referral, and with the UCSF-based Smoking Cessation Leadership Center to promote systemwide training opportunities. Champions at each site will coordinate electronic medical record modifications, conduct outreach and education to inpatient and outpatient departments and nursing units for workflow integration, and collaborate as a network through information sharing and evaluation. This project is expected to demonstrate a significant return on investment and national leadership on health systems change for tobacco cessation.

      • Bundled payments for hip and knee replacements: $78,000 over one year
        Project director: Kevin Bozic, M.D., M.B.A., UC San Francisco
        Campus leads: Zeev Kain, M.D., UC Irvine; Ranjan Gupta, M.D., UC Irvine; Scott Ball, M.D., UC San Diego; Lisa Rhodes, UC San Diego; Mervyn Maze, M.B.Ch.B., UC San Francisco; Lorrayne Ward, UC San Francisco

        Bozic

        Bundled payment, where providers are reimbursed a set fee for an episode of care, is a health reform aimed at improving the coordination, quality and efficiency of care. This project will build on Bozic’s 2011 CHQI fellowship to establish bundled payments for hip and knee replacements at UC San Francisco. It will establish a learning collaborative with UC Irvine and UC San Diego that seeks to standardize clinical practices and administrative procedures for hip and knee replacements to both improve patient outcomes and reduce costs. This will enable UC to compete for regional and national employer-based contracts for hip and knee replacements.

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

UC Davis
Dorsey Griffith
(916) 734-9118
dorsey.griffith@ucdmc.ucdavis.edu

UC San Diego
Jacqueline Carr
(619) 543-6427
jcarr@ucsd.edu

UC San Francisco
Karin Rush-Monroe
(415) 502-NEWS (6397)
karin.rush-monroe@ucsf.edu

About UC Health
University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 17 health professional schools on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.

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

Related link:
Register to attend UC innovation center colloquium

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Stroke treatment, outcomes improve at hospitals taking part in UCLA-led initiative


Study finds jump in patients receiving clot-busting drug within “golden hour.”

Gregg Fonarow, UCLA

Administering a clot-dissolving drug to stroke victims quickly — ideally within the first 60 minutes after they arrive at a hospital emergency room — is crucial to saving their lives, preserving their brain function and reducing disability.

Given intravenously, tPA (tissue plasminogen activator) is currently the only Food and Drug Administration–approved therapy shown to improve outcomes for patients suffering acute ischemic stroke, which affects some 800,000 Americans annually.

Now, a UCLA-led study demonstrates that hospitals participating in the “Target: Stroke” national quality-improvement program have markedly increased the speed with which they treat stroke patients with tPA. Researchers looked at more than 1,000 hospitals participating in the initiative, which was conceived by UCLA faculty and is conducted in collaboration with the American Heart Association/American Stroke Association.

The findings of the study are published in today’s (April 23) issue of JAMA, the Journal of the American Medical Association.

The researchers report that at participating hospitals, the average time it took to deliver tPA to patients fell from 74 minutes to 59 minutes. This speedier treatment, they said, was accompanied by improved outcomes, including reduced mortality, fewer treatment complications and a greater likelihood that patients would go home after leaving the hospital instead of being referred to a skilled nursing facility for advanced rehabilitation.

“These findings reinforce the importance and clinical benefits of faster administration of intravenous tPA. Through this national initiative, more patients were able to be treated with this beneficial therapy and in a safer, more effective fashion,” said first author Dr. Gregg C. Fonarow, UCLA’s Eliot Corday Professor of Cardiovascular Medicine and Science and director of the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

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Benioffs donate another $100M to UCSF children’s hospitals


Donation to strengthen children’s health care across San Francisco Bay Area.

UC San Francisco announced today a second gift of $100 million from Lynne and Marc Benioff to UCSF Benioff Children’s Hospital and also its affiliate, Children’s Hospital & Research Center Oakland.

The gift will be used to strengthen the existing talent and programs in basic and clinical research and patient care at the two premier institutions, as well as attract new expertise, in order to accelerate the development of innovative solutions for children’s health on both sides of the San Francisco Bay, as well as nationally and globally.

“We are thrilled to advance our vision of improving health of the children in Oakland and San Francisco, and to fuel positive changes in the care of our youngest patients today and for future generations,” said Sam Hawgood, M.B.B.S., interim chancellor of UCSF, dean of the UCSF School of Medicine and a neonatologist. “This gift significantly strengthens the abilities of both institutions to attract and retain top talent in pediatric health, as well as to support the next evolution of research and clinical programs.”

In recognition of the two hospitals’ affiliation on Jan. 1, 2014, Children’s Hospital Oakland will be named UCSF Benioff Children’s Hospital Oakland, and UCSF Benioff Children’s Hospital will be named UCSF Benioff Children’s Hospital San Francisco. Together, the hospitals will be named UCSF Benioff Children’s Hospitals.

UCSF Benioff Children’s Hospitals are two leading Bay Area children’s hospitals with longstanding commitments to public service. Both institutions, as well as UCSF Medical Center, care for all children who seek help, regardless of their family’s ability to pay, and provide millions of dollars of uncompensated care and community services for low-income, homeless and underinsured patients. From free children’s health screenings to staffing clinics, the hospitals help meet the needs of Northern California’s most vulnerable populations.

“The generosity and commitment of Marc and Lynne Benioff will strengthen Oakland’s thriving medical research community and ensure doctors on both sides of the bay have world-class facilities to care for children, regardless of income,” said California Gov. Edmund G. Brown Jr.

UCSF Benioff Children’s Hospital San Francisco will be part of a 289-bed integrated hospital complex for children, women and cancer patients that will open Feb. 1, 2015, at UCSF Mission Bay.

Construction of the new children’s hospital is on schedule and below budget. The 183-bed hospital increases the capacity of the current UCSF Benioff Children’s Hospital San Francisco – located on the UCSF Parnassus campus – by 20 beds, and will feature a rooftop helipad to bring critically ill newborns, children and pregnant women to UCSF from community hospitals; a dedicated pediatric emergency room designed just for children; as well as private and semi-private rooms in the new intensive care nursery.

“We are building a world-class pediatric facility that puts the needs of our patients and their families at the forefront,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. “This donation ensures we can continue to advance the most innovative clinical care within the new hospital, as well as outside its walls by partnering with colleagues at our research campus and with Children’s Oakland physicians and staff.”

“This extraordinary gift will have a significant impact on the care we provide children as it will be used to strengthen facilities at Children’s Oakland as well as our education, research and community benefit missions,” said Bert Lubin, M.D., CEO of UCSF Benioff Children’s Hospital Oakland and a pediatrician.

The two hospitals have worked together for decades and are highly regarded nationally as well as internationally, each having made significant advancements in developing new treatments and achieving better health outcomes for children.

“Private support is essential for UC to deliver the highest quality care, training and research innovations needed to advance children’s health,” said Janet Napolitano, president of the University of California. “I thank the Benioffs for their generous support of UCSF and their commitment to our shared mission of building healthy communities.”

UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco are involved in more than 400 research protocols led by more than 500 investigators researching cures for hundreds of pediatric and adult diseases. The children’s hospital is one of the leading children’s hospitals in the nation, according to U.S. News & World Report.

“We have been deeply inspired by the incredible kids, doctors, researchers, and administrators at both UCSF and Children’s Hospital Oakland,” said Lynne and Marc Benioff. “We feel extremely fortunate to have this opportunity to support the best children’s hospitals in the world.”

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Integrative medicine takes modern step


UC Irvine, Orange County arts school school team to create unique healing environment.

UC Irvine Health Family Health Center in Santa Ana is hopping with activity thanks, in part, to a troupe of student dancers from neighboring Orange County School of the Arts. The collaboration is part of a novel program that brings music and arts to clinical settings creating a calmer and more comfortable environment for patients.

Six OSCA dancers recently performed two contemporary routines in the lobby of the FHC to the surprise and amusement of unsuspecting patients and their families. Dancers sat alongside patients while they carried out their unique movements that included elements of ballet, modern and lyrical dancing.

This patient-centered approach to health and wellness focuses on treating the whole person including the mind, body and spirit and is part of UC Irvine Health’s Integrative Medicine Program.

“There have been a variety of studies demonstrating the health benefits of simple mind-body interventions, which include art, music, and laughter in addition to the more familiar mind-body techniques such as meditation,” said Dr. David Kilgore, director of integrative medicine at UC Irvine Health. “Our intent is to create a welcoming and less intimidating clinical setting that helps patients feel more at ease before meeting with their physician.”

In addition to the dance performances, the clinic has hosted musical performances and a poetry reading by OCSA students. The clinic also plans on displaying students’ artwork including paintings and ceramics.

A grant from the Samueli Foundation funds the integrative medicine program. Through this donation, the program integrates the best of Western scientific medicine with broader therapeutic approaches for patients to achieve optimal health and healing. A large focus of this health center is to bring preventive medicine to an underserved population.

“Our goal is to transform our sites from being a health care provider in the community to a community center that also happens to provide quality health care,” says Dirk Zirbel, Ph.D., associate director of UC Irvine Health Family Health Centers.

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Unique use of heart-lung machine saves heart attack victim


ECMO is normally reserved for transplant patients, but quick-thinking UCLA staff used it to help James Manzi.

James Manzi and his wife, Barbara

James Manzi is lucky to be alive. When the 79-year-old Brentwood resident arrived at  Ronald Reagan UCLA Medical Center’s emergency room in full cardiac arrest, the medical team tried everything to stabilize him, including shocking his heart 29 times with a defibrillator in an attempt to restore a normal rhythm.

Often, patients whose heart attacks are as severe as Manzi’s don’t survive. Only one out of every 10 people who suffer cardiac arrest outside the hospital lives through the ordeal.

As the team worked, UCLA emergency medicine physician Dr. Eric Savitsky monitored Manzi’s diminishing response to their resuscitative efforts using a combination of bedside ultrasound of the heart and clinical indicators. This led to an emergency request for a rarely used but potentially lifesaving technology known as extracorporeal membrane oxygenation, or ECMO.

ECMO involves the use of a sophisticated pump that takes over the functions of the heart and lungs, essentially breathing for the patient by pumping oxygenated blood to vital organs so the lungs can rest. This helps reduce stress on the heart. The device is traditionally used to support adults in cardiac failure waiting for a heart transplant and to help protect the delicate respiratory systems of infants born prematurely.

Fortunately, it worked in Manzi’s case, too. His heart stabilized, allowing the cardiac team to transport him to the cardiac catheterization lab, where he underwent coronary angioplasty on an artery that was completely blocked. Following the procedure, doctors placed a stent in the artery to keep it open; blood flow was completely restored.

While Manzi’s heart function recovered enough that ECMO was removed three days after his heart attack, he had also suffered anoxic brain injury as a result of his brain not getting enough oxygen during the heart attack — a common occurrence after cardiac arrest. After five weeks in the hospital’s intensive care unit, he was transferred to UCLA’s neuro-rehabilation unit, where he completed his rehabilitation, making a nearly 100 percent recovery.

At a recent follow-up visit, UCLA cardiologist Dr. William Suh, who performed the cardiac procedures during Manzi’s heart attack, confirmed that the patient is doing remarkably well. Manzi is very grateful to the cardiac and emergency teams that went the extra mile to save his life. He’s now looking forward to his 80th birthday on April 6.

“I’ve always enjoyed my life and now appreciate it even more,” said the father of five, who also has six grandchildren. “Just being alive is wonderful.”

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UC faculty drive efforts to improve CT safety


Special journal issue is part of ongoing effort to reduce CT risks.

John Boone, UC Davis

UC Davis clinicians and physicists have recommended new strategies to make computed tomography (CT) safer, including adoption of a new metric for dose measurement, ways to manage exposure protocols that differ by CT brand and specific approaches to reduce exposure during needle biopsies. The recommendations are detailed in papers published in the March issue of the Journal of the American College of Radiology (JACR).

In response to concerns about the radiation dose in CT, JACR devoted the entire issue to CT safety. The federal government estimates that more than 80 million CT scans are performed in the United States each year. UC Davis specialists contributed three studies to the special issue.

CT is a powerful diagnostic technology that images organs and other internal structures. These scans can both detect life-threatening conditions and rule them out, giving clinicians precise information to develop a care plan. But there are risks. Ionizing radiation can damage cells and has been found to be a weak carcinogen. The challenge for radiologists and medical physicists is to find the optimal dosage for each CT exam.

“The higher the dose, the better the images,” said John Boone, vice chair of research in the Department of Radiology. “But you also want the lowest possible doses. So you need to find that balance between acceptable image quality and acceptable dosage.”

In the paper “Dose is Not Always What it Seems…,” Anthony Seibert, professor of radiology, and colleagues discuss the need to improve dose calculations. They point to an actual case, in which a pediatric patient, who had scans before and after surgery, appeared to receive an overdose on the second CT. Further investigation showed that the problem was a misleading metric – the volume CT dose index (CTDIvol), a standard measure of radiation output in CT. Manufacturers use phantoms along with instruments that measure radiation to assess CTDIvol. However, different companies use phantoms of different sizes. In addition, many dose estimates are based on adult sizes, making pediatric estimates more difficult.

“In this case, the difference was the way the manufacturers handled the metrics,” said Seibert. “A large phantom tends to underestimate dose, while a small phantom tends to overestimate it. When we compensated for the different-sized phantoms, it turned out the patient received almost the same dose in both scans.”

To help prevent future problems, the team recommended a new metric, size-specific dose estimate (SSDE), which provides a better way to measure patient doses and can also help compare scanners from different companies. It also addresses the dire need to more accurately estimate dose from CT across a range of patient sizes, from newborn to NFL linebacker.

“I think SSDE is one step closer to a dose metric that will be more accurate in depicting the actual risk to patients,” said Seibert.

This is not the only area where differences between scanners can obscure dosage. In another paper, “Methods for CT Automatic Exposure…,” Boone, Seibert and colleagues addressed the challenges of optimizing different machines.

Physicists and radiologists must set up automatic exposure protocols, which vary doses based on tissue thickness. However, since manufacturers use different methods to control doses, transferring these settings between machines can be difficult and time-consuming.

“It takes a lot of effort to optimize any given scanner,” said Boone. “Going through the procedures for every possible exam could take two years.”

To ease the way, the UC Davis team developed equations to translate settings among three machines, two made by GE and one by Siemens. The proposed approach provides a more efficient way to manage CT protocols between different CT scanners.

A third paper, “Radiation Dose Optimization for CT-Guided Interventional Procedures…,” outlines how practitioners can lower radiation doses while performing interventional procedures under CT guidance. CT is often used to guide these procedures, ensuring the needle is precisely located.

Ramit Lamba, director of CT, outlines a number of methods to reduce radiation doses for both patients and doctors performing the procedures. He recommends using ultrasound, instead of CT, to guide some biopsies. He also recommends reducing scan lengths, lowering the tube current using dose-efficient scanning modes and limiting the number of guidance scans.

The special JACR issue is one piece of an ongoing effort to reduce CT risks. As part of the University of California Dose Optimization and Standardization Endeavor (UC DOSE), all five UC medical centers are collaborating to improve CT protocols and education.

“We’re trying to educate radiologists and medical physicists because the practice of CT is not consistent,” said Boone. “If someone is using higher doses to get results they could obtain with less radiation, we need to help them find the safer alternative.”

Other researchers included Rebecca Smith-Bindman of UC San Francisco; Sarah E. McKenney, formerly of UC Davis; and Sandra L Wootton-Gorges of UC Davis.

UC DOSE is funded through a pilot grant from the University of California Office of the President.

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Electronic health records can be used to predict sepsis risk, mortality


UC Davis study shows how EHRs can help identify best practices in medicine.

Tim Albertson, UC Davis

UC Davis researchers have found that routine information — blood pressure, respiratory rate, temperature and white blood cell count — from the electronic health records (EHRs) of hospitalized patients can be used to predict the early stages of sepsis, a leading cause of death and hospitalization in the U.S. Also, they determined that just three measures — lactate level, blood pressure and respiratory rate — can pinpoint the likelihood that a patient will die from the disease.

“EHRs have become essential resources for providing relevant information on patients’ medical histories and improving the quality of care,” said study co-author Tim Albertson, chair of UC Davis Department of Internal Medicine. “We have shown that they can also be powerful resources for identifying best practices in medicine and reducing patient mortality.”

Sepsis is an immune system response to infection that can damage organs and cause permanent physical and mental disabilities. It is associated with increased blood levels of lactate, an acid produced when organs receive too little oxygen.

Patients are rarely screened for blood lactate levels, because sepsis is very hard to distinguish in its early stages. The blood test also lacks specificity, as many patients with elevated lactate do not have sepsis.

While early treatment with broad-spectrum antibiotics and intravenous fluids is associated with better outcomes for those with sepsis, the potential harm from those treatments for low-risk patients far outweighs the benefits.

“Finding a precise and quick way to determine which patients are at high risk of developing the disease is critically important,” said study co-author Hien Nguyen, associate professor of internal medicine and medical director of electronic health records at UC Davis. “We wanted to see if EHRs could provide the foundation for knowing when aggressive diagnosis and treatment are needed and when they can be avoided.”

In conducting their investigation, the researchers analyzed data from the EHRs of 741 patients with sepsis at UC Davis Medical Center during 2010. They found that vital signs combined with serum white blood cell count — measures routinely taken for hospitalized patients — could accurately predict high lactate levels and sepsis. Also, they found that lactate level, blood pressure and respiratory rate could determine a patient’s risk of death from sepsis.

The research team is now working on a specific sepsis-risk algorithm that can be automatically calculated in the EHR.

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Nursing school hopes to improve care for cancer patients with social network


Participating patients will use a tablet device as part of UC Davis project.

Several chemotherapy patients at the UC Davis Comprehensive Cancer Center will be invited to use tablets with a unique social networking tool as part of their treatment plan. Researchers at the Betty Irene Moore School of Nursing at UC Davis hope to prove that mobile health technology improves the care experience for patients as well as the quality of care while also reducing cost.

The project is part of a two-year, $199,854 grant from the McKesson Foundation and its national Mobilizing for Health Initiative. Research on mobile health technology in cancer care is new, said Jill Joseph, the associate dean for research at the nursing school. Other cancer-related mobile applications are available, but are limited to education and awareness and don’t provide disease management tools or real-time communication.

“We have ample evidence that cancer patients often receive fragmented care, experience significant distress, and may needlessly require care in emergency departments or inpatient settings, particularly during chemotherapy,” Joseph said. “Little research and development has focused on providing novel technologies to support cancer care coordination.”

Participating patients will use a tablet device, such as a Google Nexus or iPad, to connect to their unique and private Personal Health Network that includes a nurse coordinator — who manages the their care — along with family, caregivers, clinicians and other desired partners. These people can connect with one another through real-time messaging, video and audio components as well as schedule appointments, assign tasks, store and track information and more.

A nurse coordinator is assigned to support each chemotherapy patient who uses the mobile application. This coordinator monitors the patient’s care plan, triages issues and communicates with caregivers. Unlike electronic health records and other information systems common in hospitals, the social networking platform allows patients, their families and caregivers to not only access information but communicate with another and make decisions about care and health management.

“This is a new tool designed with the patient and family at the center of care,” said Katherine Kim, a recent doctoral graduate of the UC Davis nursing school who is now a visiting faculty member and project director.

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Young mother delivers baby, develops heart disease


UC San Diego Sulpizio Cardiovascular Center among first in region to implant cardiac device.

Amanda and her husband, Nathan, doting on their beautiful daughter, Kassidy, minutes after her arrival.

Three weeks after delivering her first child, Amanda began to suffer from extreme fatigue, headaches, a tight chest and stomach pain. An initial diagnosis of pneumonia changed for the worse: Amanda was experiencing heart failure. The 28-year-old’s life was at risk. She was quickly transferred to UC San Diego Sulpizio Cardiovascular Center (SCVC) where a multidisciplinary team implanted a novel cardiac device under her skin, leaving the heart untouched, to prevent sudden cardiac arrest.

“When Amanda first arrived at SCVC, she was in critical condition. It became clear within 24 hours that she needed emergency surgery or she would not survive,” said Eric Adler, M.D., director of cardiac transplant and mechanical circulatory support at UC San Diego Health System.

The new mother was diagnosed with peripartum cardiomyopathy, a rare disorder in which a woman develops heart disease within the final month of pregnancy or within five months after delivery. Adler adds that one in 2,000 women suffers from the condition, the cause is not exactly known and it can be hard to correctly diagnosis.

“I knew I had to fight for my daughter,” said Amanda. “I am not a quitter and always strive for success. I wasn’t going to let heart failure beat me.”

A left ventricular assist device (LVAD) – a mechanical heart of sorts that helps pump oxygen-rich blood throughout the body – was first implanted in Amanda.

“The patient’s heart was failing. She was in a dire situation and needed the LVAD device immediately implanted to support her heart function and restore blood circulation,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System, who implanted the LVAD in Amanda.

Amanda was also a candidate for the new Boston Scientific Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) System. The device is used for the treatment of patients at risk for sudden cardiac arrest. To date, more than 3,000 devices have been implanted in patients around the world.

The S-ICD System monitors cardiac activity and shocks the heart when it goes into a dangerous rhythm, a function not performed by the LVAD. The S-ICD does not use traditional wires, called “leads,” threaded to the heart through blood vessels. Rather, the device is implanted just under the skin near the breastbone, and heart patients who require an ICD may be candidates.

“Leads in standard ICDs have been known to fracture or disconnect at times. The S-ICD has fewer long-term complications, an easier removal process and puts the patient at less risk for infection,” said Ulrika Birgersdotter-Green, M.D., director of pacemaker and ICD services at UC San Diego Health System, who implanted the device in Amanda. “It is an advancement in defibrillation technology that is simple to implant and can be life-saving.”

Amanda was the first patient at UC San Diego Health System to receive the S-ICD. The procedure took about an hour, and she was able to walk around the next day. As she continues to heal, she will be closely monitored to see if her heart function improves. If not, she will be placed on a heart transplant list.

“As part of the region’s only academic hospital, we are dedicated to using a team approach to treat high risk patients, who five to ten years ago, may not have survived,” said Adler.

Amanda is now sharing her story to raise awareness about heart disease.

“Knowledge and early detection for heart disease, especially peripartum cardiomyopathy, are key. I hope my story helps others to understand the warning signs and the technology available for treatment,” said Amanda. “The first time I was able to hold my daughter after the procedure, I became very emotional after the journey I had just been through. Because of the team at SCVC, I am able to embrace my family every day.”

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Good Bruin Samaritans


UCLA students bring much-needed medical aid to Mexican community.

In a community less than 150 miles south of UCLA, Enrique Juarez Gonzalez, his wife, Mercedes, and their children live without running water or electricity. Their sanitation system is sub-standard, and access to health care was almost nonexistent.

There are many families just like them in Tijuana’s Colonia Margarita Moran, families that are struggling to survive in an area where poverty is rampant and opportunities are slim.

Thanks to life-changing efforts by UCLA undergraduates, a small community medical clinic is the family’s only source of medical care. It was there late last year that they received an invaluable gift that lifted a huge weight off the family’s shoulders — a wheelchair for their 14-year-old son, who had to be carried everywhere because he has cerebral palsy.

“Watching Mercedes wheel Emmanuel out of the clinic with such relief, and realizing the impact the chair will have on their family, illustrates the reason we operate our clinic,” said UCLA senior Becky Barber, who along with fellow neuroscience student Lyolya Hovhannisyan founded the UCLA chapter of Flying Samaritans in 2013. The nationwide group brings together volunteers and health care providers to deliver basic medical services, including clinical evaluations, medication and health education classes.

“On a micro-level, knowing we can improve the quality of life for people in this community makes our work here worthwhile,” said Barber. She and Hovhannisyan, both seniors and aspiring doctors, received a $10,000 scholarship from the Donald A. Strauss Foundation in 2013 to support their efforts.

Volunteer student and patient Enrique Juarez Gonzalez

Barber learned about the need in Colonia Margarita Moran after hearing about the work of Dr. Maria Sarabia, a Mexican-trained doctor and Huntington Park resident who, for roughly three years, had been providing religious education and the best medical service in the Tijuana colonia. After speaking with Hovhannisyan about Dr. Sarabia’s efforts and considering what they could do to help, they founded UCLA Flying Samaritans and its small medical clinic in Colonia Margarita Moran.

In May 2013, the group began the first of nearly a dozen visits to the clinic and saw 26 patients. Now they see more than double that number each month, with the group’s outreach efforts making more residents aware of the clinic’s services. The clinic opens the third Saturday of the month with volunteer doctors and often more than a dozen UCLA students.

Most of the ailments the volunteer doctors see are preventable, said Hovhannisyan. They include hypertension, diabetes, sexually transmitted infections and waterborne illnesses, all of which can be sharply reduced through education and outreach programming, she said.

Other factors, including little to no access to fresh fruits and vegetables, clean water or warm dry places to live, make health prevention efforts more challenging. Barber said that ongoing community assessments and speaking with locals will help them better serve the people living there.

“This is a big part of our current efforts to identify the resources available to the community and give us a better understanding of the factors that are leading to a decreased quality of life,” said Hovhannisyan. “Our clinic will target the issues we find to be most clearly decreasing quality of life and implement projects to directly address these problems.”

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UC Irvine cancer team again earns high-quality care regonition


Comprehensive cancer center among first in nation to be recertified.

Edward Nelson, UC Irvine

The UC Irvine Health Division of Hematology/Oncology is among the nation’s first practices to be recertified by American Society of Clinical Oncology for high-quality patient care. The ASCO Quality Oncology Practice Initiative assures patients and their families that an oncology practice meets rigorous standards for high-quality cancer care.

“We are incredibly proud to have attained this recertification,” said Dr. Edward L. Nelson, chief of the division of hematology/oncology and associate professor, department of medicine in the UC Irvine School of Medicine and in the department of molecular biology & biochemistry, UC Irvine School of Biological Sciences.

“Since we were among the first class of QOPI-certified practices in 2010, we have maintained a very real and substantive commitment to providing our patients the highest quality of care, setting the standard for cancer treatment in our community, and in the education of future clinicians in the highest standards of practice. This re-certification is a concrete measure of that longstanding commitment to quality and excellence.”

UC Irvine’s hematologists-oncologists treat patients at the UC Irvine Medical Center and are members of the National Cancer Institute-designated Chao Family Comprehensive Cancer Center, one of only 41 NCI-designated comprehensive cancer centers in the nation and the only one in Orange County. It is the county’s only cancer center whose missions include advancing scientific research and clinical trials in all phases that lead to potentially life-saving drugs and treatments. All five UC medical centers have NCI-designated comprehensive cancer centers.

The Quality Oncology Practice Initiative is a voluntary self-assessment and improvement program developed by ASCO to help hematology and oncology practices gauge the caliber of care they provide. Encompassing at least 80 quality measures, it lets practices compare their performance data to that of others across the country and identify areas for improvement. It is a three-year certification. The QOPI Certification Program was launched in January 2010. For the past three years the UC Irvine Health Hematology/Oncology practice has met or exceeded over 90 percent of the more than 80 measures surveyed.

“The certification reinforces that physicians at an academic medical center can meet the highest standards for delivery of quality cancer care while providing disease specific expertise and complements our strengths in laboratory research and clinical trials that have always been hallmarks of our program and which embody our three missions: discover, teach, heal,” Nelson said.

UC Irvine Health first achieved QOPI certification in July 2010. It was the first practice in California, the first at an academic medical center and the first practice in the U.S. directly affiliated with a NCI-designated comprehensive cancer center to obtain QOPI certification. Since then, more than 200 practices have been certified in the first program of its kind for oncology in the United States, including such notable institutions as Stanford, UC San Diego and M.D. Anderson, each in2013. UCI’s recertification places it among the first class of hematology-oncology practices to do so.

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UCSF, Walgreens open new pharmacy to explore models of patient-centered care


“Walgreens at UCSF” aims to improve medication use, reduce hospital readmissions.

UC San Francisco and Walgreens (NYSE: WAG) (Nasdaq: WAG) have opened a unique Walgreens store on the UCSF campus that aims to improve medication safety, decrease health care costs and help patients use medicines more effectively by offering pharmacist-based patient care and expanded health and wellness services to the community.  A joint effort among Walgreens, the UCSF School of Pharmacy and UCSF Medical Center, “Walgreens at UCSF” also will explore new models for improving overall patient care.

“Walgreens at UCSF is an ideal environment for our pharmacists to work with UCSF Medical Center and School of Pharmacy faculty to further innovate in health care while providing greater access to services for the surrounding community,” said Joel Wright, Walgreens divisional vice president, specialty solutions group. “At Walgreens, we are very pleased to share and develop best practices with UCSF pharmacists and pharmacy students, which further our commitment to help people get, stay and live well.” Walgreens at UCSF, located across the street from UCSF Medical Center, is one of Walgreens “Well Experience” stores, which offer expanded health services and are designed to foster increased patient-pharmacist interaction. With an expanded pharmacy including multiple areas for private consultations, Walgreens and UCSF pharmacists and UCSF pharmacy students are more accessible to community members and patients.

Core clinical health services include medication counseling by a pharmacist as the standard of care and comprehensive medication reviews for customers who receive prescriptions. Pharmacists will work with patients to create and update accurate, portable medication lists to take to their appointments with medical providers. This approach can help decrease drug-drug interactions and encourage patient medication adherence.

“Modern medicine has transformed many diseases from urgent, life-threatening conditions into chronic illnesses that can be managed with the right medications, but that means more and more patients are juggling multiple prescriptions, with complex instructions,” said Joseph Guglielmo, Pharm.D., a leader in the field of clinical pharmacy and dean of the UCSF School of Pharmacy. “And, in many instances, this complicated medication list is inaccurate and incomplete. This collaboration aims to transform the practice of community pharmacies to enable pharmacists to do what they’re trained to do, which is helping patients manage their health with the right medications and understand how to take them correctly.”

The collaboration builds upon Walgreens’ leadership in pioneering new approaches to pharmacy care, as well as UCSF’s long history of collaboration in teaching, research and patient care between the School of Pharmacy and UCSF Medical Center, which together piloted the first hospital-based clinical pharmacy program in the nation, in the 1960s.

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Match Day at UC San Diego School of Medicine

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UC Davis: Investigating liver cancer disparities

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