TAG: "Population health"

UC Davis to host town hall on proposed school of population, global health

Event will be April 16 in Sacramento.

By Carole Gan, UC Davis

A town hall meeting to discuss the proposed UC Davis School of Population and Global Health will be held on Thursday, April 16, from noon to 1 p.m., at the Education Building, 4610 X St., Room 1204, in Sacramento.

UC Davis Chancellor Linda Katehi recently assigned Kenneth Kizer the responsibility to lead an effort to create a new School of Population and Global Health at UC Davis. Kizer is the director of the Institute for Population Health Improvement at UC Davis Health System and a distinguished professor at the School of Medicine and the Betty Irene Moore School of Nursing. Kizer also serves as a member of the Institute of Medicine’s Board on Population Health and Public Health Practice.

Katehi asked Kizer to explore the creation of the new school based on a recognition of the trans-disciplinary approaches needed to address growing health challenges resulting from changing demographics, greater global connectivity, climate and other environmental changes, new technologies and modern society itself.

The proposed school envisions aligning education and training in human and animal health sciences, agriculture, environmental and life sciences, and the social sciences to better prepare leaders, scholars and practitioners to address the many health challenges of an increasingly crowded and connected planet.

Those planning on attending should RSVP by April 9 to Kathleen MacColl at kcmaccoll@ucdavis.edu or (916) 734-7722.

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UCLA launches first-of-its-kind study of U.S. transgender population

Information collected could be used to help craft better policy.

Ilan Meyer, UCLA

By Lauren Jow, UCLA

Researchers at the Williams Institute at UCLA School of Law, Columbia University and The Fenway Institute at Fenway Health are launching a first-of-its-kind study of the transgender population in the United States that they expect will create a more accurate and detailed picture of the issues faced by transgender individuals.

The study, which is being led by Ilan Meyer, Williams Senior Scholar of Public Policy at the Williams Institute, will provide researchers and policymakers with unbiased estimates about the demographics, health outcomes and health care needs of the transgender population by relying on a randomly selected sample of the U.S. population. The study, titled “TransPop: U.S. Transgender Population Health Survey,” also will provide insights into the methodology of surveying transgender people.

“With awareness about transgender people growing in the public and among researchers and policymakers, there are new opportunities to establish policies that address the needs of transgender people in the United States,” said Meyer, the study’s principal investigator. “Timely and accurate data about the transgender population is crucial for designing evidence-based public health and policy interventions.”

To date, most of what researchers know about the transgender population comes from studies that do not use random selection methods, Meyer said. While those studies have provided valuable information about transgender lives, they may not accurately represent the population.

Goals for the study include:

  • To describe basic demographic parameters of the U.S. transgender population including race/ethnicity, gender identity, age, place of residence, education, employment and income.
  • To describe basic health outcomes and health behaviors, including general health status, mental health, smoking, history of suicide attempts, disability, quality of life and health care access (including insurance coverage).
  • To describe experiences of transgender people with interpersonal and institutional discrimination, including experiences in healthcare, employment, housing and law enforcement.
  • To describe transgender identity history and transition-related experiences, including access to gender-affirming mental health services, hormone treatment and surgery, when relevant.

The findings from the study will show how various groups of transgender people differ and to what degree. That level of detail could highlight concerns that were previously underreported and help service providers develop more targeted programs.

The researchers will use a survey of 350,000 U.S. adults, conducted by Gallup, a global survey organization that delivers analytics and advice. Gallup survey participants will be screened during a one-year period, and those who identify as transgender will be invited to participate in the TransPop study. The researchers estimate that 300-500 transgender-identified individuals will participate.

In addition to Meyer, TransPop investigators are Jody Herman, scholar of public policy at the Williams Institute; Dr. Walter Bockting, professor of medical psychology and co-director of the LGBT Health Initiative at Columbia University; and Sari Reisner, research fellow, department of epidemiology at Harvard T.H. Chan School of Public Health and research scientist at The Fenway Institute at Fenway Health. The study is affiliated with UCLA’s California Center for Population Research.

The study is supported by the NIH Office of Social and Behavioral Science and is part of “Generations,” a larger five-year study funded by a federal grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1R01HD078526) to the Williams Institute.

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Welltopia: A new online resource for California

Comprehensive website aims to reduce health disparities.

By Carole Gan, UC Davis

Welltopia, a new website launched today (Feb. 25) by the California Department of Health Care Services (DHCS) and the UC Davis Institute for Population Health Improvement (IPHI), offers a wide range of essential resources to help Californians, especially those on limited incomes, build healthier lives and communities.

Designed to complement the popular Welltopia by DHCS Facebook page, the new website serves as a comprehensive resource connecting individuals, families and communities to credible information that addresses the social determinants of health and other leading causes of preventable death.

Many studies have shown that access to health care, education, employment, housing, nutritious foods and physical activity are among the fundamental drivers of health for individuals and their communities. Making reliable information and resources available for people of all ages is key to creating healthy environments.

“We developed Welltopiato be a convenient and trusted source of information covering all three aspects of health — physical, mental and well-being,” said Neal Kohatsu, DHCS medical director. “We’ve made every effort to ensure that the resources are both accurate and accessible to consumers.”

The Welltopia site organizes information into five categories — Well Body, Well Mind, Jobs & Training, Health Insurance, and Basic Needs. It includes information on nutrition, physical activity, smoking cessation, alcohol- and drug-abuse prevention, stress management, health insurance, residency, and social services, among others. The site also contains videos, photos and graphics with information about health-related programs. There are free applications, such as fitness trackers, women’s health information, recipes and food journals to track daily calorie intake, and links to CalFresh, education, job placement resources and other social services.

“Welltopia should be the first stop for persons seeking reliable information about the many determinants of health,” said Kenneth W. Kizer, IPHI director. “Its friendly format quickly guides users to practical and trustworthy sources.”

The Department of Health Care Services manages California’s form of Medicaid, known as Medi-Cal, which helps millions of low-income Californians obtain access to affordable, high-quality health care, including medical, dental, mental health, substance use disorder services, and long-term services and supports. DHCS aims to preserve and improve the health of all Californians.

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How important is long-distance travel in spread of epidemics?

Model of disease spread proves common assumption wrong.

The current Ebola outbreak shows how quickly diseases can spread with global jet travel.

Yet knowing how to predict the spread of these epidemics is still uncertain, because the complicated models used are not fully understood, says a UC Berkeley biophysicist.

Using a very simple model of disease spread, Oskar Hallatschek, assistant professor of physics, proved that one common assumption is actually wrong. Most models have taken for granted that if disease vectors, such as humans, have any chance of “jumping” outside the initial outbreak area – by plane or train, for example – the outbreak quickly metastasizes into an epidemic.

Hallatschek and co-author Daniel Fisher of Stanford University found instead that if the chance of long-distance dispersal is low enough, the disease spreads quite slowly, like a wave rippling out from the initial outbreak. This type of spread was common centuries ago when humans rarely traveled. The Black Death spread through 14th-century Europe as a wave, for example.

But if the chance of jumping is above a threshold level – which is often the situation today with frequent air travel – the diseases can generate enough satellite outbreaks to spread like wildfire. And the greater the chance that people can hop around the globe, the faster the spread.

“With our simple model, we clearly show that one of the key factors that controls the spread of infection is how common long-range jumps are in the dispersal of a disease,” said Hallatschek, who is the William H. McAdams Chair in physics and a member of the UC Berkeley arm of the California Institute for Quantitative Biosciences (QB3). “And what matters most are the rare cases of extremely long jumps, the individuals who take plane trips to distant places and potentially spread the disease.”

This new understanding of a simple computer model of disease spread will help epidemiologists understand the more complex models now used to predict the spread of epidemics, he said, but also help scientists understand the spread of cancer metastases, genetic mutations in animal or human populations, invasive species, wildfires and even rumors.

The paper appears in this week’s online early edition of the journal Proceedings of the National Academy of Sciences.

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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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