TAG: "Population health"

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


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

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

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

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

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

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

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

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

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

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Mother’s place of birth is a risk factor for autism in U.S.-born children


Risk varies by race and ethnicity.

Beate Ritz, UCLA

Can the place where a woman is born and raised be a risk factor for autism in her child? According to new research out of UCLA, the answer is yes.

In the U.S., the prevalence of autism has been reported to be highest among non-Hispanic white children, but a new study from the UCLA Fielding School of Public Health offers evidence that other ethnic groups actually are at a higher risk for the disorder. Using data from racially diverse Los Angeles County, which is home to a large number of recent immigrants, the researchers found that the mother’s place of birth is a risk factor for autism among U.S. children.

Specifically, they found that when compared with children born to white American mothers, children of foreign-born women who are black, Central or South American, Filipino and Vietnamese had a higher risk of autism. The same held true for children of U.S.-born African American and Hispanic women. The risks were adjusted for maternal age, education levels, socioeconomic status, whether the families had health insurance and other factors known to influence the diagnosis rate.

The study appears in the current online edition of the journal Pediatrics.

Autism spectrum disorders are complex developmental disorders that affect how a person behaves, interacts with others, communicates and learns. Until now, though, scientists have had a difficult time determining possible prenatal risk factors other than the mother’s age and complications during pregnancy. However, recent European studies have reported an association between the nation where a woman is born and her children’s risk for autism.

“Epidemiology has a long tradition of using migration studies to understand how environmental and genetic factors contribute to disease risk in populations,” said Dr. Beate Ritz, the paper’s senior author, and a professor and chair of the Fielding school’s Department of Epidemiology. The fact that 22 percent of 6-year-olds born in the United States have immigrant parents opened a unique opportunity for us to consider the influence of nativity, race and ethnicity on the causes of autism spectrum disorder.”

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Athena is first network to adopt electronic data sharing standard for cancer


Guide will help UC network improve patient care.

The five University of California medical centers and their affiliates participating in the Athena Breast Health Network are using a new guide for sharing electronic data for breast cancer treatment. Developed by the American Society of Clinical Oncology (ASCO) and approved through ASCO’s Health Level Seven International committee (HL7), the guide will become a national data exchange standard. With the guide, Athena can utilize structured data capture tools for coordination of care, registry submission and research.

“ASCO applauds the leadership of both Athena and the Institute for Population Health Improvement in adopting this data sharing treatment plan and guide,” said ASCO President Clifford A. Hudis.“Their use of these standards will help physicians and practices move towards secure sharing of electronic information, so that they can improve patient care.” through the Athena Breast Health Network.

Electronic health records often contain data that cannot easily be shared among physicians or contributed to quality improvement, public health reporting or analytics. In addition, the current exchange standards did not include disease-specific templates needed for continuity of cancer care. To fill this void, ASCO hosted a Data Interoperability Standards Summit in February 2013 to encourage collaboration in developing standards that will overcome these barriers. The society selected adjuvant treatment for breast cancer as the focus for the first oncology standard. The draft standard was approved by open ballot through HL7, an accredited Standards Developing Organization (SDO) and the leading global SDO focused solely on health care, in May 2013.

Athena’s Breast Health Network participated in the larger Interoperability to Support Practice Improvement (INSPIRE) project, sponsored by the UC Davis Institute for Population Health Improvement (IPHI) and the California Office of Health Information Integrity (CalOHII). INSPIRE will produce breast cancer treatment plans and summaries for the Health Information Home, a patient-centered repository supporting care coordination. Integrated into the patient history, the information can support clinical care, registry reporting, and ultimately streamline clinical trials and quality improvement. In adopting this guide, Athena can now use a standardized format to transmit data across the systems supporting the project. The project is sending test data and expects to initiate transmission of patient data starting in the summer of 2014.

“It was critical to understand clinician work flow and to simplify data collection at the point of care,” said Michael Hogarth, professor of medicine at UC Davis. “We investigated clinician workflows and systems that would identify opportunities for structured data capture. We selected the widely implemented CDA standard as a foundation for the data exchange piece of our demonstration project. This is a strong step toward our goal of continuous improvement.”

ASCO is now expanding the guide for electronic data sharing with data relevant to the treatment of colon cancer and plans to submit the expanded guide to HL7 for review and approval in the fall 2014.

Project INSPIRE is funded as part of the Department of Health and Human Services Grant #90HT0029/01-02 (ARRA) to California Health and Human Services Agency in collaboration with UC Davis Institute for Population Health Improvement (IPHI) and California Health eQuality (CHeQ).

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UCLA helping change the way a community eats, one store at a time


Euclid Market is latest store to be transformed.

Transformation of Euclid Market's exterior

Transformation of Euclid Market's exterior

Big chain grocery stores, farmers markets and other sources of healthy foods are usually in short supply in low-income communities. Public health experts refer to these areas as “food swamps” for their lack of available nutritious foods.

One such area is in the Boyle Heights neighborhood of East Los Angeles, where fast food reigns and meals are frequently purchased at corner markets. These small stores tend to be rundown, uninviting and focused on selling the bane of healthy eating — junk food.

At noon on Saturday, Dec. 14, the UCLA–USC Center for Population Health and Health Disparities (CPHHD) and the UCLA Fielding School of Public Health will join with local community members in Boyle Heights to celebrate the grand reopening of the neighborhood’s Euclid Market, which has been transformed into the opposite of what most corner markets are.

Instead of drab, there is fresh paint. Instead of the prominent placement of junk food and beer, the front of the store now highlights healthy foods like fresh fruits and vegetables, bottled water and nutritious snacks.

The Euclid Market is the third store in the East Los Angeles–Boyle Heights area to undergo a CPHHD-supported transformation. The first opened in November 2011, the second in February 2012.

The latest conversion, funded by the National Heart, Lung and Blood Institute of the National Institutes of Health and led by the UCLA Fielding School of Public Health, is part of a collaborative strategy with community members to change eating habits and reduce disease risk among the area’s dominant Latino population, which is plagued by high rates of obesity-related chronic diseases. Obesity stands as one of the nation’s most significant public health problems.

“Both of the existing transformed stores in the East L.A. area are reporting increased profits and greater foot traffic, so that’s good news for the small business owner,” said Alex Ortega, the director of the CPHHD and a professor of public health at the Fielding School.

“But it’s even better news for the people in those areas because having access to nutritious food that’s convenient to buy will help folks change their bad eating habits,” he added. “The goal, of course, is to see improvements in the overall health of our underserved communities.”

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Trauma care quality improvement needs national focus


Expert says systems-level performance measures need to be explicitly defined and validated.

Ambulance at emergency roomThe ability to objectively measure and compare the quality and long-term outcomes of trauma care nationwide will be imperative under the new health care payment models that are evolving, UC Davis Institute for Population Health Improvement Director Kenneth W. Kizer told attendees of the Trauma Quality Improvement Program (TQIP) meeting of the American College of Surgeons last month.

Inconsistencies in the quality and capacity of the country’s trauma care systems require a comprehensive effort to define systems-level quality and outcomes standards, he said.

Kizer delivered the remarks during his keynote address to nearly 600 attendees at the TQIP national meeting in­ Phoenix on Nov. 18, providing a historical context and an overview of the quality of health care and trauma care nationally and making recommendations for trauma care in the emerging value-based health care economy.

“There is compelling evidence that seriously injured persons are significantly more likely to survive if treated at trauma centers, compared to non-trauma centers. Yet more than a third of serious traumatic injuries occur in areas not having a designated trauma-care system,” Kizer said.

“Studies conducted during the past 10 years also have shown that many seriously injured persons are not treated at trauma centers even when their injuries occur within the catchment areas of designated trauma care systems,” he said.

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High-tech health care services expanded for 3.5M Californians


Health information exchange improving coordination of care in 12 rural counties.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

Communication of clinical information needed to provide safe and effective, high quality health care is now easier in 12 rural California counties as a result of an initiative launched earlier this year by the UC Davis Institute for Population Health Improvement (IPHI).

Through nearly $775,000 in grants awarded under IPHI’s California Health eQuality (CHeQ) program to four designated health information exchange (HIE) providers, the adoption of HIE is significantly accelerating in rural California. As a result of CHeQ’s Rural HIE Incentive program, HIE options for exchanging patient care-related information electronically have been created for more than 30 acute care and critical access hospitals, community clinics and behavioral health providers, serving nearly 3.5 million rural Californians. More than 700 physicians in these 12 counties will benefit from having better access to patient information.

CHeQ also is targeting an additional $200,000 to fund “Direct” accounts, a service much like secure email, to individual physician offices, small clinics, hospitals, and other providers in these rural counties that are not yet served by a health information organization or have HIE options. The Direct service will become available in early 2014.

Health information exchange refers to the secure electronic communication of health-related information among doctors, hospitals and other providers so that they have important patient-related information wherever and whenever it is needed to support patient care. Establishing HIE services to support electronic communication of health information in rural areas has proven to be particularly challenging, which is why IPHI launched the Rural HIE Incentive Program. HIE options for some areas were largely inaccessible or simply did not exist.

“Patients in rural areas often have to travel long distances to multiple different health care providers to get needed care — especially for medical specialist service — increasing the likelihood that some providers will not have all the information they need,” said Kenneth W. Kizer, IPHI’s director and a distinguished professor at UC Davis. “CHeQ’s rural HIE incentive initiative has provided a catalyst for developing these services in large areas of California. This will result in better coordination and higher quality patient care being provided in these areas.”

Redwood MedNet of Ukiah, one of the four Rural HIE Incentive Program awardees, knows how beneficial HIE is to their rural communities.

“The Rural HIE Incentive Program has been extremely useful for us,” said William Ross, Redwood MedNet program manager. It adds HIE functionality to low-resource facilities such as community clinics and critical access hospitals in historically underserved areas.”

In addition to Redwood MedNet, the three other service providers under the Rural HIE Incentive Program are Inland Empire HIE (Riverside), Orange County Partnership Regional Health Information Organization (OCPRHIO) (Orange) and Axesson (Santa Cruz).

The 12 counties benefitting from this initiative are Colusa, Fresno, Humboldt, Kings, Madera, Mendocino, Napa, San Luis Obispo, Solano, Sonoma, Tulare and Yolo.

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UC Davis institute to direct Health Leadership Program


Sierra Health Foundation grant will help restart program for nonprofits, public agencies.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

The UC Davis Institute for Population Health Improvement (IPHI) received a $125,000 grant from the Sierra Health Foundation to restart the foundation’s popular Health Leadership Program for nonprofits and public agencies. Faculty from the University of San Francisco School of Management also will collaborate on the project.

“We are enthusiastic about the return of our Health Leadership Program, as it provides a valuable opportunity for nonprofit and public agency leaders to strive for and reach a new level of effectiveness,” said Sierra Health Foundation President and CEO Chet P. Hewitt. “We are fortunate to have found such committed and knowledgeable partners to help us continue building upon the legacy of this important program.”

Established in 2001, the Health Leadership Program was originally delivered by the State Capital Center of the University of Southern California in conjunction with the Marshall School of Business. The program, initially co-directed by Rich Callahan and Dave Logan, has helped 270 leaders in the nonprofit and public sectors to become better skilled with a stronger vision for their organizations and communities.

The 2014 program will build upon this work to develop the skills of current and emerging leaders in organizations that work to improve community health and well-being and reduce health disparities across a broad range of issue areas such as education, employment, access to health services and youth development.

“California’s rapidly changing health care and community service environment presents unprecedented challenges for the leaders of nonprofit organizations and public agencies that work to make our communities healthier for all,” said Kenneth W. Kizer, director of the Institute for Population Health Improvement at UC Davis. “And we are committed to developing innovative and creative leaders who are well prepared to meet these challenges.”

The 2014 Health Leadership Program is newly designed for 25 current and emerging leaders with 12 days of in-class leadership development activities and discussions addressing disparities through organizational capacity building and policy change. The program primarily draws on faculty and presenters with strong health and social services experience, as well as extensive health and human services networks locally, regionally, statewide and nationally.

Program details and applications for participation in the Health Leadership Program will be available in spring 2014, and classes will begin in the fall.

“I am very enthusiastic about partnering again with Sierra Health Foundation to offer a new, dynamic, cutting-edge leadership program,” said Rich Callahan, chair of the Department of Public and Nonprofit Administration at the University of San Francisco’s School of Management. “This newest program builds on the successes of our previous 10-year partnership to advance the leadership skills needed to support the foundation’s important work in addressing health disparities and health access, and aligns closely with the University of San Francisco’s commitment to social justice.”

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UC Davis institute funds state’s first ‘Blue Button’ project for Medi-Cal


Patients to have online access to their prescription data for improved patient safety.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

As part of its mission to accelerate the adoption of health information exchange throughout California, the UC Davis Institute for Population Health Improvement’s California Health eQuality program awarded $400,000 to L.A. Care, the nation’s largest publicly operated health plan, to develop Blue Button functionality.

Blue Button will allow L.A. Care members to access their own prescription data online. The project is the first in California and among the first in the nation to develop the tool for Medicaid beneficiaries.

L.A. Care offers free or low-cost health insurance programs to more than one million Los Angeles County residents, giving members access to more than 10,000 physicians, specialists, hospitals and pharmacies.

The Blue Button initiative is a Web-based feature that allows patients to easily view and download their health information and share it with health care providers and caregivers. The U.S. Department of Veterans Affairs initiated Blue Button in 2010. In 2012, the Office of the National Coordinator for Health Information Technology began encouraging its broader use.

“Having a list of medications available through the Blue Button will help L.A. Care members take an active role in managing their care, increase effective communication with their providers and avoid potential prescription errors,” said Kenneth W. Kizer, distinguished professor and director of the Institute for Population Health Improvement at UC Davis. “The lessons learned from this project can serve as a model for all managed care health plans in the state to adopt the same Blue Button functionality to improve patients’ access to their data.”

L.A. Care expects to begin extending the Blue Button service to Medi-Cal Managed Care beneficiaries by early 2014.

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UC Davis institute receives grants to support health policy presence


Institute for Population Health Improvement to raise awareness of evidence-based policies.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

The Institute for Population Health Improvement (IPHI) has received grants totaling $423,236 from the California HealthCare Foundation and The California Endowment to increase awareness of evidence-based policies to address a wide range of health issues facing California and the nation.

The new grants support the establishment of the California Health Policy Forum in IPHI and management of the Sacramento Health Policy Briefings series, provide centralized leadership for both programs within IPHI, and broaden UC Davis’ presence in policy issues at the state capitol. The programs are designed to inform legislative and state agency staff, and are open to anyone interested in the topics, including the public and students.

“The California HealthCare Foundation and The California Endowment have a long history of supporting efforts to provide independent and nonpartisan platforms for education, idea sharing and conversations about important health-related issues facing the state,” said Kenneth W. Kizer, IPHI director and a distinguished professor at the UC Davis School of Medicine and the Betty Irene Moore School of Nursing. “The grants will enable these programs to better serve their target audiences.”

A $214,325 grant from the California HealthCare Foundation supports outreach and logistical coordination for the Sacramento Health Policy Briefings series. These briefings focus on health care service delivery and related policy issues. An Oct. 31 briefing held at the California State Association of Counties Conference Center, for example, focused on bringing greater transparency to cancer care in California.

A $100,000 grant from The California Endowment and a second grant from the California HealthCare Foundation for $108,911 will establish the California Health Policy Forum within IPHI and focus on building capacity among legislative and state agency staff responsible for developing and implementing health policy. A wide range of health, health care and population health topics will be addressed, and IPHI will be developing all of the topics, content and speakers for the project’s briefings and policy briefs. A component of the grant from The California Endowment further strengthens efforts to develop evidence-based health policy in California by supporting state health policy staff attendance at conferences and educational forums to obtain the latest evidence, innovations and thinking on pressing health issues.

Kizer is the principal investigator on the grants and Karen K. Shore, an established policy thought leader in the state, will direct the program.

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UCLA gets $7M to study links between substance abuse, HIV


Study will focus on minority men who have sex with men.

Pamina Gorbach, UCLA

Pamina Gorbach, UCLA

The National Institute on Drug Abuse has awarded UCLA a $7 million grant to investigate the links between substance abuse and HIV among Latino and African-American men who have sex with men.

Researchers will examine how non-injected drugs and alcohol can directly interact with the virus and other infectious diseases, to damage these men’s health. Enrollment in the study begins in January.

Called MASCULINE (MSM and Substances Cohort at UCLA Linking Infections Noting Effects), the study will be led by Pamina Gorbach, a professor of epidemiology at UCLA’s Fielding School of Public Health and a professor of infectious diseases at the David Geffen School of Medicine at UCLA, and Steven Shoptaw, a professor of family medicine at the Geffen School and director of the UCLA Center for Behavioral and Addiction Medicine.

For the study, researchers will establish and maintain an extensive repository of tissue, blood and fluid samples. This repository will be headed by Dr. Peter Anton, a professor of digestive diseases at the Geffen School. Anton, Gorbach and Shoptaw are also members of the UCLA AIDS Institute.

“Alcohol, non-injection use of cocaine and methamphetamine are linked to HIV sexual risk behaviors and transmission of infectious disease,” Gorbach said. “But little is known about how these substances can affect biology to produce health threats among those living with or at risk for HIV — especially among minority men who have sex with men.”

MASCULINE will be a companion study to the Multisite AIDS Cohort Study, the first and largest study specifically created to examine the natural history of AIDS. It will be conducted through the Fielding School’s Behavioral Epidemiology Research Group.

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Expanded role of paramedics shows promise for closing health care gaps


Feasibility study is first of its kind in California.

Paramedic with patientIn a new report, the UC Davis Institute for Population Health Improvement (IPHI) recommends that the state launch pilot programs to test a new model of community-based health care that would expand the role of paramedics under certain circumstances.

In “Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care,” Kenneth W. Kizer, director of the IPHI and professor of emergency medicine in the UC Davis School of Medicine and Betty Irene Moore School of Nursing, and his colleagues explore a new model of community-based care in which paramedics, after undergoing additional training, would function outside of their usual emergency response and transport roles to facilitate more appropriate use of emergency departments and to increase access to primary care for medically underserved populations.

This feasibility study is the first of its kind in California and reflects the perspectives of stakeholders from nearly 40 different organizations, including emergency medical services (EMS) associations, health-care providers, health plans and payers.

“Expanding the role of paramedics is a very promising model of community-based care that uses existing health-care workers in new and innovative ways,” said Kizer. “It is a model of care that several other states and countries have implemented to better leverage the skills of paramedics to meet specific community needs and to help ensure that emergency departments are more appropriately utilized.”

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Study links sugar to diabetes


Results provide evidence that not all calories are equal from a diabetes-risk standpoint.

Sanjay Basu, UC San Francisco

Does eating too much sugar cause diabetes?

For years, scientists have said “not exactly.” Eating too much of any food, including sugar, can cause you to gain weight; it’s the resulting obesity that predisposes people to diabetes, according to the prevailing theory.

But now the results of a large epidemiological study conducted at UC San Francisco suggest that sugar may also have a direct, independent link to diabetes.

Researchers examined data on global sugar availability and diabetes rates from 175 countries over the past decade. After accounting for obesity and a large array of other factors, the researchers found that increased sugar in a population’s food supply was linked to higher diabetes rates, independent of obesity rates. Their study was published Feb. 27 in PLOS ONE.

The study provides the first large-scale, population-based evidence for the idea that not all calories are equal from a diabetes-risk standpoint.

Robert Lustig, UC San Francisco

“It was quite a surprise,” said Sanjay Basu, M.D., Ph.D., an assistant professor of medicine at the Stanford Prevention Research Center and the study’s lead author. The research was conducted while Basu was a medical resident at UCSF and working with Robert Lustig, M.D., a pediatric endocrinologist at UCSF Benioff Children’s Hospital and the paper’s senior author.

“We’re not diminishing the importance of obesity at all, but these data suggest that at a population level there are additional factors that contribute to diabetes risk besides obesity and total calorie intake, and that sugar appears to play a prominent role.”

Specifically, more sugar was correlated with more diabetes: For every additional 150 calories of sugar available per person per day, the prevalence of diabetes in the population rose 1 percent, even after controlling for obesity, physical activity, other types of calories and a number of economic and social variables. A 12-ounce can of soda contains about 150 calories of sugar. In contrast, an additional 150 calories of any type caused only a 0.1 percent increase in the population’s diabetes rate.

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