TAG: "Patient care"

UCLA Medical Group, Cigna introduce Collaborative Care program


Affiliation will improve health care and lower costs.

By Roxanne Moster, UCLA

UCLA Medical Group and Cigna have launched a collaborative care initiative to improve patients’ access to health care, enhance care coordination and achieve the goals of improved health, affordability and patient experience.

“This new affiliation provides us with an important framework in our mission to provide accountable, better coordinated patient care,” said Dr. Samuel A. Skootsky, chief medical officer of the UCLA Faculty Practice and UCLA Medical Group. “UCLA Health System has developed an innovative model of primary care to improve care coordination and provide needed services for our patients, in addition to providing exemplary specialty care. This partnership allows us to take this enhanced approach to health care for Cigna’s PPO patient population — focusing on high-value, high-quality care that is truly patient-centered and puts patients first.”

The UCLA Medical Group comprises more than 1,200 physicians who are clinical faculty members at the David Geffen School of Medicine at UCLA. They provide primary and specialty medical care at over 100 ambulatory locations as well as at the Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA, UCLA Medical Center–Santa Monica and the Resnick Neuropsychiatric Hospital at UCLA.

Under the program, UCLA physicians will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to see their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a UCLA doctor also will have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes, heart disease and obesity.

Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program, which began Jan. 1, will benefit more than 5,900 people covered by a Cigna health plan who receive care from more than 1,600 UCLA primary care doctors and specialists. Cigna now has seven collaborative care arrangements in California and 114 of them nationwide.

In places where it has been introduced, Cigna Collaborative Care is helping to improve the health of Cigna customers while effectively managing medical costs. The programs are helping to close gaps in care, such as missed health screenings or prescription refills, reinforcing the appropriate use of hospital emergency rooms, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to the home.

“Together our goal is to change the health care system from one that pays for the number or volume of services to one that places more emphasis on the quality and results of that care,” said Gene Rapisardi, president and general manager for Cigna in Southern California. “We believe this change will lead to better health, lower costs and increased satisfaction for both our customers and their doctors.”

Critical to the program’s benefits is a UCLA care coordination system based on in-office care coordinators and registered nurse clinical advisors, employed by UCLA, who will help patients navigate the health care delivery system. The care coordinators and clinical advisors are aligned with a team of Cigna case managers to ensure a high degree of collaboration between UCLA physicians and Cigna, which will ultimately provide a better experience for the individual.

The UCLA care coordinator team will enhance care by using patient-specific data from Cigna to help identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators are part of the physician-led care team that will help patients get the follow-up care or screenings they need.

Care coordinators can also help people schedule appointments, provide health education and refer patients to Cigna’s clinical support programs that may be available as part of their health plan, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs for quitting smoking or managing weight.

Cigna will compensate UCLA physicians for the medical and care coordination services they provide. Additionally, physicians may be rewarded through a “pay for value” structure for meeting targets for improving quality of care and lowering medical costs.

Cigna has been at the forefront of the accountable care organization movement since 2008 and now has 114 Cigna Collaborative Care arrangements with large physician groups that span 28 states, reach more than 1.2 million commercial customers and encompass more than 48,000 doctors, including more than 23,000 primary care physicians and more than 25,000 specialists.

Cigna Collaborative Care is one component of the company’s approach to physician engagement for health improvement, which also includes the innovative Cigna–HealthSpring care model for Medicare customers. Today, more than 1.5 million Cigna and Cigna–HealthSpring customers benefit from nearly 280 engaged physician relationships across 31 states, with more than 79,000 doctors participating, including more than 33,000 primary care physicians and more than 46,000 specialists.

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UC Davis burn center receives Beacon Award for Excellence


Caregivers recognized for improving patient outcomes, meeting high standards.

Members of the Burn Unit at UC Davis Medical Center

By David Ong, UC Davis

The American Association of Critical-Care Nurses (AACN) recently conferred a bronze-level Beacon Award for Excellence on the Firefighters Burn Institute Regional Burn Center at UC Davis Medical Center.

The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work environments — recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that earn this three-year, three-level award with a gold, silver or bronze designation meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

AACN President Vicki Good praised the commitment of the caregivers at the Firefighters Burn Institute Regional Burn Center for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence.

“These dedicated health care professionals join other members of the exceptional community of nurses who set the standard for optimal patient care,” Good said. “The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.”

The bronze-level Beacon Award for Excellence earned by the Firefighters Burn Institute Regional Burn Center signifies success in developing, deploying and integrating unit-based performance criteria for optimal outcomes.

The Burn Center earned a bronze award by meeting the following evidence-based Beacon Award for Excellence criteria:

  • Leadership Structures and Systems
  • Appropriate Staffing and Staff Engagement
  • Effective Communication, Knowledge Management, Learning and Development
  • Evidence-Based Practice and Processes
  • Outcome Measurement

Other Beacon Award designations include silver and gold. Recipients who earn a silver-level award demonstrate continuous learning and effective systems to achieve optimal patient care; gold-level awardees demonstrate excellent and sustained unit performance and patient outcomes.

The Burn Center’s Beacon Award for Excellence recipients will be published in AACN Bold Voices, the monthly award-winning member magazine distributed to more than 100,000 acute and critical care nurses nationwide. AACN also honors awardees at the National Teaching Institute & Critical Care Exposition, the world’s largest educational conference and trade show for nurses who care for acutely and critically ill patients and their families.

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UC San Diego to host region’s first camp for stroke survivors, caregivers


Therapeutic retreat offers support, education and a bit of fun.

Alexander Khalessi, UC San Diego

By Jackie Carr, UC San Diego

On Jan. 23-25, more than 15 stroke survivors and their caregivers will go on a mini-vacation in La Jolla as part of a therapeutic retreat for those whose lives have been affected – sometimes turned upside down – by stroke. The 50s-themed stroke camp is being co-hosted by UC San Diego Health System, which has one of the nation’s first certified Comprehensive Stroke Centers.

“Stroke camp is part of UC San Diego’s larger commitment to the care of neurovascular patients and their families,” said Alexander Khalessi, M.D., director of endovascular neurosurgery and surgical director of neurocritical care at UC San Diego Health System. “Beyond receiving the best possible neurological care or developing new therapies, we support patients through their recovery and get them back to their lives.”

The camp will be the first Refresh & Retreat Stroke Camp in California, with the flare of an American Bandstand theme, complete with an invitation to bring “your letter sweaters, poodle skirts and dancing shoes.” The event is sponsored with Covidien, a global health care leader.

Stroke care has advanced rapidly in recent years, but strokes still involve some permanent loss of healthy brain tissue due to either a lack of blood flow or bleeding within the brain itself. As a result, many stroke survivors require significant time to recover and rehabilitate. During this healing process, it is the caregivers – often a spouse or family member – who may suddenly find themselves overwhelmed and socially isolated by their new responsibilities.

“Stroke camp is about pampering the caregivers and recognizing the toll strokes take on them,” said Julie Jurf, R.N., stroke care coordinator, UC San Diego Health System. “The camp’s aim is to bring fun, respite and renewal to stroke survivors, their families and caregivers.”

Jurf will volunteer at the retreat to assist caregivers.

“I will be pushing a wheelchair, standing in line for food, or doing whatever needs to be done so that my caregiver can go for a swim or relax,” she said. “Even just a two-day break can go a long way to bring renewal to people’s life.”

Khalessi added that stroke camp provides patients with support and encouragement, offers a welcome rest for their caregivers, and provides an opportunity to bond with other stroke survivors.

Over three days, attendees will be invited to participate in a variety of camp-like activities, including drum circles, craft-time and 50’s bingo, as well as survivor and caregiver break-out discussion sessions that allow attendees to vent, share and console as needed.

In addition, Khalessi, a national expert in catheter-based and open cranial neurosurgeries for stroke, aneurysms and other blood vessel disorders of the brain, will lead a tour of the Center for the Future of Surgery at the UC San Diego School of Medicine. This facility is a national destination for developing and refining new life-saving stroke treatments, now transforming the standard of care for stroke patients.

“Stroke is a disease that had no solutions 30 years ago. It is now a treatable medical and neurosurgical emergency. Even five years ago, stroke care involved a single drug and supporting patients through their new disabilities,” Khalessi said. “We now have catheter-based procedures and devices that allow for rapid and safe restoration of blood flow in the most severe forms of stroke, involving large vessels of the brain,” a procedure known as stent thrombectomy that in a recent study published in the New England Journal of Medicine greatly improved stroke patients’ prognoses.

“We have phenomenal new treatments for hemorrhagic stroke, or bleeds within the brain, due to cerebral aneurysms or high blood pressure, using minimally invasive surgical or catheter-based techniques,” he said. “These strokes are no less devastating and were a death sentence a decade ago.”

The designation of a Comprehensive Stroke Center at UC San Diego Health System is formal recognition of its ability to receive and treat the most complex stroke cases around the clock, every day of the year, with a multidisciplinary team of neurologists, neurosurgeons, cardiologists and rehabilitation specialists.

Approximately 680,000 American’s each year survive a stroke, making stroke the nation’s leading cause of disability. A patient’s ability to benefit from the latest in stroke-care technologies hinges upon a third party recognizing stroke and ensuring that the patient is brought to a hospital where comprehensive stroke care can be provided.

About Retreat & Refresh Stroke Camp
Retreat & Refresh Stroke Camp is a nonprofit based in Peoria, Illinois. It has sponsored 105 stroke camps nationwide since 2004. The nonprofit’s founder and executive director, Marylee Nunley, is caregiver to her husband John, who had a stroke in 2001. For more information, visit http://strokecamp.org.

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New report ID’s transparency as a means to improve patient safety


Open communication the ‘magic pill’ needed to improve many issues related to safety.

Robert Wachter, UC San Francisco

Open communication and a free flow of information represent the “magic pill” needed to improve many of the issues in health care related to safety, according to a new report released by the National Patient Safety Foundation’s Lucian Leape Institute. “Shining a Light: Safer Health Care Through Transparency” defines transparency as “the free, uninhibited flow of information that is open to the scrutiny of others,” and calls for sweeping action within and across organizations, between clinicians and patients, and in public reporting.

“We hope this report will help convince people that transparency is not only the right thing to do, but that it will lead to improved outcomes, fewer errors, more satisfied patients and reduced costs of care,” said UC San Francisco’s Robert M. Wachter, M.D., associate chair of the Department of Medicine. He and Gary Kaplan, M.D., F.A.C.M.P.E., chief executive officer, Virginia Mason Health System, both members of the NPSF Lucian Leape Institute, served as co-chairs of this initiative.

The report addresses four distinct yet overlapping domains where the open exchange of information is necessary to improve safety:

  • Between clinicians and patients to ensure patients are well informed at all stages of their care
  • Among clinicians to ensure the practices of high performers are shared with their peers
  • Between organizations to allow greater collaboration on safety protocols and events
  • With the public through meaningful measures and data that is understandable and useful to health care consumers

The authors provide specific recommendations relevant to each domain and to the areas of measurement and leadership. In all, more than three dozen recommendations are outlined in the report addressing issues such as disclosure of conflicts of interest, shared decision making with patients, and development of core competencies for communicating about medical errors and quality measures to patients, families, other medical professionals and the public.

“Transparency has been largely overlooked as a patient safety tool, in part because it requires a foundation of a safety culture and strong organizational leadership,” said Kaplan. “The barriers are not necessarily easy to overcome, but we will never truly achieve safe patient care without improvements in transparency in each of the domains we cite.”

Increased transparency, the report says, will yield broad benefits by promoting accountability; catalyzing improvements in quality and safety; promoting trust and ethical behavior; and facilitating patient choice. The result of two roundtable meetings that included participants with a broad range of expertise, the report also includes case studies of how transparency is applied in practice.

“We are grateful to our roundtable participants for the time and expertise they contributed to this report,” said Tejal K. Gandhi, M.D., M.P.H., C.P.P.S., president and CEO of NPSF and president of the Lucian Leape Institute. “This is a complex issue, and it is not going to happen overnight, but we believe advances in transparency will significantly improve patient safety.”

This is the fifth in a series of reports about issues that the NPSF Lucian Leape Institute has identified as transforming concepts to improve patient safety. The first, “Unmet Needs: Teaching Physicians to Provide Safe Patient Care” (2010), addresses the need for teaching quality and safety principles in medical education. In 2012, the Institute published “Order from Chaos: Accelerating Care Integration,” which looks at the problem of fragmented care and possible solutions. “Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care” (2013), details the profound problem of physical and psychological risks to the health care workforce. “Safety Is Personal: Partnering with Patients and Families for the Safest Care” (2014) looks at patient and family engagement in health care. All Institute reports are available for download on the website.

In addition to Drs. Leape, Gandhi, Kaplan and Wachter, current members of the NPSF Lucian Leape Institute include Janet Corrigan, Ph.D., M.B.A., distinguished fellow, Dartmouth Institute for Health Policy and Clinical Practice; Susan Edgman-Levitan, P.A., executive director, John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital; Gerald B. Hickson, M.D., senior vice president for quality, safety and risk prevention, Joseph C. Ross Chair in Medical Education & Administration, assistant vice chancellor for health affairs, Vanderbilt University Medical Center; Julianne Morath, R.N., M.S., president and CEO, Hospital Quality Institute of California; Paul O’Neill, former chairman and CEO, Alcoa, and 72nd secretary of the U.S. Treasury; and Dennis S. O’Leary, M.D., president emeritus, The Joint Commission.

Members of the institute’s Roundtable on Transparency will discuss the new report in a live webinar on Feb. 12 from 9-10 a.m. Pacific Time. Registration is free of charge and open to all. Details are available at http://bit.ly/LLItransparency.

For more information about the report or the NPSF Lucian Leape Institute, visit www.npsf.org/lli.

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Project launched to promote innovations in emergency medical services


UC San Diego, Mount Sinai seek to foster better, more efficient delivery of care.

By Scott LaFee, UC San Diego

UC San Diego Health System, in collaboration with Mount Sinai Health System in New York City, announced today (Jan. 7) the launch of a new project entitled “Promoting Innovations in Emergency Medical Services.”

Supported by the National Highway Traffic Safety Administration, Office of Health Affairs, the Department of Homeland Security and the Department of Health & Human Services, the project will address how to better disseminate and implement innovative Emergency Medical Services (EMS) delivery models, while overcoming persistent regulatory, financial and technological barriers.

The effort, which will culminate with development of a national framework tool to provide guidance and foster better, more efficient delivery of health care within EMS across the country, is funded by a two-year, $225,000 federal grant.

Co-project directors are James Dunford Jr., M.D., professor emeritus at UC San Diego School of Medicine and EMS medical director for the city of San Diego, and Kevin Munjal, M.D., assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai.

“Our hope is to engage with a diverse group of stakeholders to create a pathway for the widespread implementation of best practices and delivery system reforms in emergency medical services across the U.S.,” said Munjal.

Experts have long recognized that EMS could serve as a vital link in a coordinated health care system focused on population health management by helping identify and modify risk, assess and facilitate treatment of chronic conditions and improve coordination of care for acute complaints.

“This is a fantastic opportunity for EMS to merge imagination, sound medicine and health information technology to improve care and lower cost,” said Dunford. “Tomorrow’s innovations will likely improve domestic preparedness, increase patient access to care, decrease health care costs and improve community resilience.”

Dunford added that novel urban and rural EMS programs have begun filling gaps in systems of care. Terms such as “community paramedicine” and “mobile integrated health care” are being used to describe how the full clinical, operational and financial capacity of EMS could be harnessed.

As EMS agencies strive to innovate within the current infrastructure, noted Munjal, they face challenges from existing laws, regulations, even fixed mind-sets. He said the project team is aware of the delicate balance between enabling innovation while still protecting public health and safety through regulatory oversight and maintaining a statewide systems approach to the provision of emergency medical care. “State offices of EMS play a vital role in fostering innovation and will be vital stakeholders in this project,” said Munjal, “which seeks to develop model legal, regulatory and financial frameworks to assist and encourage state and local health systems to test new EMS delivery models.”

Key aspects of the project include:

  • Collection of input from EMS and community health care stakeholders from around the country.
  • Regional stakeholder meetings will be held in San Diego and New York in May 2015, with a focus on incorporating national input into overcoming local barriers to EMS innovation.
  • A national steering committee will be convened in Washington, D.C., in September 2015.
  • An iterative approach to drafting materials and soliciting feedback through in-person, telephonic and online encounters with stakeholder groups.
  • Creation of a National Framework Document that will be broadly representative and thoroughly vetted and will be used as a tool to provide a useful pathway to harness the full potential of EMS.

For more information, visit www.emsinnovations.org.

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Helping seriously ill children and their families cope with the unfathomable


Hospital team delivers compassionate care as a child dies.

UCLA social worker Gina Korfeind, a member of the Children's Pain and Comfort Care team based at Mattel Children's Hospital, and some of the families the team has helped get through the trauma of losing a child or sibling. (Photo by Ann Johansson)

By Marina Dundjerski

The news Jeannie Malabanan received last January was devastating. Following a year of difficult and aggressive chemotherapy for a rare bone tumor, the cancer at the base of her daughter Ashlee’s spine had metastasized to her brain. After a recurrence of her symptoms, Ashlee began to have seizures and was re-hospitalized at UCLA.

That’s when the Children’s Pain and Comfort Care (CPCC) team was called in to assist. “They talked to us and supported us, and provided Ashlee with as much quality care as was possible during this end-stage of her life,” Malabanan said. “Basically, they helped our family to process and survive this ordeal.”

Ashlee decided to forego further treatment and to stay in the hospital. “It was a hard choice for us to accept — as a parent, you want to keep your child alive for as long as you can,” her mother said. “But I know keeping Ashlee alive was not what she wanted. She didn’t want to just be breathing and not have any quality of life.”

During the two weeks when Ashlee was hospitalized, the CPCC team worked with her primary medical team and others to provide whatever assistance was possible. “They came by regularly to make sure her last days were as comfortable as possible as she fell deeper into her terminal illness,” Malabanan recalled. “They let us know that we were not alone and that if we wanted them, they would be with us every step of the way.”

The Chase Child Life Program of Mattel Children’s Hospital UCLA created a plaque with Ashlee’s palm print, and the CPCC team had her fingerprint replicated on more than a dozen pendants for family members to wear. When Ashlee lost consciousness, her wishes were known. Arrangements were made so that family members could stay with her; they never left Ashlee’s side until the end. She was 21 years old when she died.

Since it was established in 2008, UCLA’s CPCC program in Mattel Children’s Hospital UCLA has worked to succor pediatric, adolescent and young-adult patients like Ashlee in their days of need and to help their families grapple with the unfathomable: the death of a child. While the broad-based CPCC team includes a psychologist, three physicians, nurse practitioner, a social worker bereavement coordinator and chaplain, among others, the frontline clinical-service team, including physicians and nurse practitioner, sees some 200 patients a year in the hospital setting and another 325 patients through its outpatient clinic.

Taking an interdisciplinary approach to address the core goals of care decisions, pain and symptom management and bereavement support, the team has a mission to enhance the comfort and quality of life for children with complex medical conditions and for their families. They work to relieve symptoms of disease or its treatment and to address psychological, social and spiritual needs.

Said Malabanan: “That extra support and compassion is amazing. I’m so grateful that they were there for Ashlee and for us.”

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Boy battling cancer honored as UCLA’s No. 1 sports fan


He’s chosen as first Kid Captain by the basketball team and Mattel Children’s Hospital UCLA.

Logan Nobriga, with ball, and friends cheering at Bruins basketball game.

By Amy Albin, UCLA

Logan Nobriga, a 10-year-old-boy who is battling cancer, never expected he’d see his story played out on the giant monitor at Pauley Pavilion. But on Wednesday, he stood on the basketball court before the tip-off of a game watching a video about the fight of his young life.

Logan, who comes from Oak Park, was honored at the Bruins’ game against UC Riverside as the first “Kid Captain” selected by Mattel Children’s Hospital UCLA and the UCLA Men’s Basketball team. The new program will recognize UCLA pediatric patients who face life-threatening illnesses with courage, strength and determination.

Logan, who has spent half of his young life in the battle against acute lymphoblastic leukemia (ALL), is an inspiration to everyone, a hospital staff member said.

“Logan, who transforms his hospital room into a ‘sports zone,’ has been known to play a couple of wild games of basketball in the hospital, even when he was in the intensive care unit,” said Hilary Gan, a child-life specialist with the Chase Child Life program at Mattel. “Recently, he donated his birthday presents to the other children in the hospital.”

On Wednesday night, Logan high-fived Bruin players as they entered the court at the start of the game and then took a complimentary courtside seat with a friend he invited before having dinner at Pauley Pavilion.

“My college basketball team is definitely UCLA,” said Logan, a huge sports fan, in the video.

IIn 2009, he was diagnosed with ALL, a type of cancer of the blood and bone marrow. In 2013, he relapsed and is currently receiving chemotherapy as an outpatient.

“Having ALL … you don’t get to do a lot of other things that kids do,” he said on the video. So being treated as UCLA’s No. 1 Bruin fan with all the perks, including getting the game ball, was a special moment for him.

“We are excited to partner with our colleagues at Mattel Children’s Hospital UCLA to recognize these special young patients who inspire us all with their stories of hope and courage,” added Paul Engl, general manager of IMG College Los Angeles, the official sports marketing agency for UCLA Athletics.

See Logan’s story:

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UC San Diego Health System names chief experience officer


Thomas Savides to fill newly created role.

Thomas Savides, UC San Diego

By Jackie Carr, UC San Diego

Thomas Savides, M.D., has been named as the first chief experience officer at UC San Diego Health System. In the newly created role, Savides will be responsible for the strategy, leadership and implementation of the plan to improve the total health care experience of patients, families, providers and staff.

“At UC San Diego Health System, we recognize that engaged employees drive the patient experience and understand that every encounter we have with patients and their loved ones influences their perceptions of the care we deliver, the compassion we show and the value we provide,” said Paul Viviano, CEO, UC San Diego Health System. “We are excited to have Dr. Savides champion employee engagement and patient experience so that we can exceed our patients’ expectation in everything we do.”

Savides is tasked with helping to develop and lead a cultural transformation that results in new levels of patient care excellence that are grounded in innovative health care programs. He will motivate and inspire employees to continually strive for service excellence while promoting a culture where patient service and satisfaction are top of mind and continuously improved.

In 1993, Savides joined the UC San Diego Division of Gastroenterology. He is a nationally recognized expert in interventional gastrointestinal endoscopy, and currently serves as professor of clinical medicine, vice chair of strategic affairs for the Department of Medicine and clinical services chief in the Division of Gastroenterology.  During his tenure at UC San Diego Health System, Savides has served in other leadership positions including chair of Health Sciences Faculty Council, member of the UC San Diego Medical Group Board of Governors, interim chief of gastroenterology and GI clinical services chief.

Through his demonstrated expertise in leading organizational and cultural change, Savides will help to ensure that service excellence practices are sustained and remain highly visible to all employees, physicians and volunteers across the health system enterprise.

Savides completed his internal medicine and gastroenterology training at UCLA Medical Center after receiving his medical degree from UC San Diego School of Medicine and undergraduate degree from Harvard College. Savides has authored more than 175 publications including original research articles, invited reviews, books, chapters and videos.  He has been a governing board member of the American Society for Gastrointestinal Endoscopy and president of the San Diego Gastroenterology Society.

He consistently is named a “Top Doc” in San Diego Magazine’s “Physicians of Exceptional Excellence” annual survey performed in collaboration with the San Diego County Medical Society, as well as U.S. News & World Report’s “Top Doctors” in gastroenterology in the United States. He is a two-time recipient of UC San Diego Health System’s Attending Physician of the Year Award, and also received UC San Diego Health Sciences’ Faculty Award for Excellence in Clinical Care.

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The art of healing


The concept is drawing increasing interest from the medical and science communities.

By Kathleen Masterson and Suzanne Leigh, UC San Francisco

Seated at a table dotted with paintbrushes, pencils and curios, Hideka Suzuki is creating an abstract on a small canvas. It’s not an idle craft project; for her, it’s a form of therapy.

“Sometimes I don’t even know what I’m thinking until I sit down and start drawing. Then my feelings come out on paper,” said Suzuki, a teacher in remission from uterine cancer.

She’s a participant at Art for Recovery, a pioneering program at the UCSF Helen Diller Family Comprehensive Cancer Center that has brought patients together since 1988 under the philosophy that creating art – no skills required – has a central role in healing.

It’s hard to empirically measure that impact because so many of art’s benefits are indirect, said Theresa Allison, M.D., Ph.D., an assistant professor in the UCSF Division of Geriatrics who has a background in musical anthropology. But, she said, therapies that benefit a patient’s emotional wellbeing can have real impact on overall health.

“We are finally at a tipping point, where the health sciences recognize the impact of loneliness and depression on health care outcomes, and we recognize the positive impact of visual and performing arts on symptoms management,” Allison said.

“Now we’re starting to ask why, and to bring in the science to study art’s impact. National funding agencies are starting to support this, and we’re going to see a lot of research emerge in upcoming years.”

Over the last few decades, a growing body of studies and anecdotal evidence suggesting that art is healing have driven the incorporation of art into medical settings. Nearly half of the health care institutions in the United States reported including arts in health care programming, ranging from art and music therapy to featuring visual art in hospitals.

“It’s a huge opportunity to think about using different modes of healing,” said Julene Johnson, Ph.D., a cognitive neuroscientist and professor at the UCSF Institute for Health & Aging. She’s running a study measuring the health impacts of singing in a choir. “The nice thing about the arts is our long, long history of using music and arts for healing across thousands of years, and the fact that it’s relatively low cost to implement.”

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UCSF nursing expands palliative care training


Nursing school starts palliative care minor for advanced practice nursing students.

UCSF School of Nursing professor DorAnne Donesky works with a patient, teaching her to exercise safely without overtaxing her lungs. (Photo by Elisabeth Fall)

By Kathleen Masterson, UC San Francisco

People who live with serious chronic illness often bounce in and out of the hospital, struggle to get the treatment they need and overall experience a poor quality of life.

Now, increasing research is supporting what many health care providers have long known: comprehensive palliative care that treats both symptoms and a person’s emotional needs can significantly improve a patient’s daily life – and in many cases prolong life, too.

These known successes are a big part of why the UCSF School of Nursing started a new palliative care minor for advanced practice nursing students.

The recent push also came from both hospitals looking to hire and nursing students who asked for more palliative care training, said DorAnne Donesky, Ph.D., ANP-BC, a nursing professor who spearheaded the creation of the minor with palliative care physician Wendy Anderson, M.S., M.D.

“Employers also came to us saying, ‘We’re hiring lots of palliative care providers and new graduates who are coming to us are not well prepared,’” said Donesky. Hospital hiring teams told Donesky that they would hire nurses specifically trained in palliative care first if they were choosing between multiple job candidates.

Donesky has seen the benefits of palliative care firsthand with her patients who have chronic lung and heart conditions.

She recalls one patient diagnosed with Chronic Obstructive Pulmonary Disease and heart failure whose doctors gave her a few months to live. The patient was put on hospice, given medication and nonpharmacologic strategies for symptom control and trained with breathing techniques. With this simple but attentive care, she “graduated” from hospice and a year later she’s medically stable, enjoying her family, home and daily gym exercise.

Meeting a growing need

The UCSF palliative care minor is designed to match the national competencies for palliative care so students can take the certification exam.  The minor includes two base courses and an elective, and Donesky also works with students to get them a clinical placement with a palliative care faculty mentor.  For certification students need 500 hours of practice, which they begin to accumulate during the minor.

Palliative care focuses on treating the whole patient with the goal of improving quality of life by addressing everything from symptoms to emotions to family members’ concerns. Research has shown that palliative care improves patients’ symptoms, including pain and depression. And some data suggest that compared to regular care, it prolongs life.

“People are realizing that symptom management and quality of life are really important, separate aspects of care,” said Donesky.

In addition to offering patients standard medications for pain and symptoms, palliative care nurses also teach patients non-pharmaceutical approaches to managing their own health. Donesky said her patients with lung illnesses benefit from learning simple breathing techniques and incorporating exercise into their daily routines. These successes aren’t only good for the patient, it also helps to avoid unnecessary and costly emergency department visits and lengthy hospital stays. While this coordinated care relies on a team of health care providers, in most cases it’s more efficient and more cost effective.

“Palliative care is a team sport,” said Donesky; the core team typically includes a nurse, a physician, a chaplain and a social worker, but varies depending on a patient’s needs. Together these providers work to give patients back some control over their health by training them with techniques to manage pain and self care.   

Donesky said when people hear palliative care, many think of the dying.  While hospice does provide palliative care for end of life patients, palliative care as a whole is really about creating the best quality of life for patients with acute or chronic illnesses or cancer that can be managed, sometimes for years or decades.

Treating the emotional side, too

Oftentimes a big part of treatment is helping patients cope with the emotional distress that their diagnosis brings up.

“A lot of patients are in distress related to relationships that have not been mended, or thinking about where their place is in the world, will their life have meaning, what will be their legacy after they’re gone. Those more spiritual issues are also addressed in palliative care,” said Donesky.

That’s why a big focus of the UCSF palliative care minor is communication skills, from difficult conversations with patients’ families to addressing a patient’s emotional concerns.

Donesky has an extensive background in navigating these kinds of health care communications, including ongoing training with VitalTalk, a highly respected training program that developed out of NIH-funded research. She’s incorporating these techniques in teaching her students.

“As clinicians, it’s scary to talk about these topics, we might be afraid we’re going to open a can of worms,” said Donesky. “But if instead of resisting, we jump in, and say, ‘I suspect you’re having concern with: fill in the blank.’ Often, it just opens the floodgates, and it doesn’t take that long to solve it.”

Donesky said employers specifically want to hire nurses who have advanced training in managing and negotiating these kinds of conversations.

UCSF nursing master’s student Julia Itsikson agrees.

“I believe communication is a cornerstone of this whole program,” Itsikson said. “This is really the bottom line, how do you approach sensitive topics at critical pivotal moment of somebody’s life — it’s not easy.”

Itsikson was accepted into the palliative care minor, which just began this quarter. In addition to coursework, Itsikson is doing clinical work at Laguna Honda Hospital and Rehabilitation Center, where there’s an entire unit that focuses on palliative care.

Itsikson said learning firsthand from an experienced nurse has been invaluable: “I watch my preceptor and it just blows me away every time; the words she finds, her mannerism, her tone of voice – all of this is so critical and important.”

Donesky said as the palliative care minor becomes more established, she’d like to create a multidisciplinary continuing education training that would be open to all kinds of health care providers, including nurses, social workers, chaplains, pharmacists, physical therapists and dentists.

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UC San Diego Health, I.V. Family Care Medical Group sign affiliation


Agreement will enhance health care in the Imperial Valley.

By Jackie Carr, UC San Diego

UC San Diego Health System and Imperial Valley Family Care Medical Group (IVFCMG) announced a comprehensive affiliation that will enhance the depth and quality of multispecialty health care services and clinical trials available to patients in the Imperial Valley and surrounding communities.

“California health care providers must collaborate to offer the best possible health services across the state. With this affiliation, our goal is to improve access to care so that patients in Imperial Valley can benefit from a broad array of high-quality services at the best possible value,” said Paul Viviano, CEO, UC San Diego Health System. “Together with Imperial Valley Family Care Medical Group and their superb physicians and staff, we can fulfill our mission of delivering outstanding patient care through commitment to the community, groundbreaking research and inspired teaching.”

Viviano added that UC San Diego Health System looks forward to working closely with Pioneers Memorial Hospital, El Centro Regional Medical Center and the medical community to complement existing services while serving the overall health needs of the region.

“This affiliation with UC San Diego Health System is an excellent way to bring the benefits of academic medicine to the Imperial Valley community,” said Vachas Palakodeti, M.D., president, IVFCMG. “The primary goal is to provide a broader base of medical care for the entire Imperial Valley by connecting with the region’s only academic health system — one of the top-ranked health systems in the nation.”

As terms of the affiliation, IVFCMG will become a member of the UC San Diego Health Physicians Network. The relationship will increase access to specialty care and more than 2,500 clinical trials for patients in the Imperial Valley. Communication and delivery of services between the two organizations will be streamlined by integrating electronic medical records, providing telemedicine and direct access to specialists.

Patients in Imperial Valley who are in need of advanced medical and surgical care will receive priority transfers to UC San Diego Health System, including the Sulpizio Cardiovascular Center, Moores Cancer Center and Hillcrest Medical Center – one of the nation’s first comprehensive stroke 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. This affiliation will further expand this long-standing relationship.

Additionally, UC San Diego Health System and IVFCMG will pursue a model of delivery in which best practices for patient care for chronic diseases are identified and shared. This approach to managing health care is designed to improve patient outcomes by optimizing and standardizing care based on evidence-based practices.

Established in 1995, IVFCMG is the largest physician’s multispecialty group with 13 clinics in Imperial County including El Centro, Brawley and Calexico. The physicians and medical staff of IVFCMG provide a broad range of medical services, including internal medicine and family practice and specialty clinics in cardiology, gastroenterology, general surgery, nephrology and neurology.

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UC San Diego opens first angioedema treatment center


Nation’s first dedicated center for diagnosing, treating diverse forms of swelling.

Bruce Zuraw, UC San Diego

By Jackie Carr and Christina Johnson, UC San Diego

UC San Diego Health System in partnership with the U.S. Hereditary Angioedema Association (HAEA), a nonprofit patient advocacy organization, has opened the nation’s first dedicated center for diagnosing and treating diverse forms of swelling, known collectively as angioedema.

The U.S. HAEA Angioedema Center at UC San Diego Health System will serve as an international referral center for people with all types of angioedema and will work closely with basic science laboratories at UC San Diego School of Medicine to better understand the condition and develop new treatments.

“The opening of this center is an incredible step toward building a national center of excellence for the diagnosis and treatment of angioedema,” said Bruce Zuraw, M.D., professor of medicine, the center’s director and the inaugural recipient of the U.S. HAEA Endowed Chair at UC San Diego. “With our research and clinical expertise and partnership with the U.S. Hereditary Angioedema Association, we can improve patients’ lives, save lives and ultimately find a cure.”

Marc Riedl, UC San Diego

Physicians at the center will offer comprehensive, holistic approaches to angioedema, emphasizing the importance of educating patients, families and the medical community about the condition in all its forms. Using the latest therapeutic tools, physicians will ensure that patients are correctly diagnosed and will then use novel therapies to treat and prevent acute swelling events that occur sporadically, often without clearly identifiable triggers, which may be life threatening.

“The disease may be misdiagnosed as a food or medication allergy, a bowel disorder or a gynecological condition, leading to unnecessary surgeries or even death if a patient has a swelling attack in the throat,” said Marc Riedl, M.D., associate professor of medicine and the center’s clinical director.

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