As part of efforts to reduce the cost of health care while also improving quality, the UCSF Center for Healthcare Value (CHV) has announced winners of its "Caring Wisely" initiative.
The initiative gives awards of up to $50,000 for interventions to reduce health care costs at UCSF Medical Center. The CHV team awarded funding for two projects from among 20 proposals submitted through UCSF Open Proposals.
“The Caring Wisely initiative helped to bring out even more of the creativity, collaboration and innovation that exists within our world-class hospital,” said Joshua Adler, MD, chief medical officer of UCSF Medical Center and UCSF Benioff Children's Hospital. “I anticipate that progress will be made in response to several proposals, and in particular, the two winning proposals represent opportunities that are right for both the medical center and for patients.”
The winning proposals are:
Reduction of Red Blood Cell (RBC) Transfusions
Team members: Kathryn Curcione, RN, BSN, ONC, NE-BC; Delene Johnson, MS, MT, SBB; Molly Rankin, PA-C; Traci Hoiting, RN, MS, NEA-BC; and Jeff Lam, RN, MSN
Patient Blood Management (PBM) is a relatively new multidisciplinary, multimodal approach to optimize a patient’s own hemoglobin before surgery, minimize intraoperative blood loss and optimize physiologic tolerance of anemia. Approximately $15 million is spent annually on purchasing blood products at UCSF Medical Center, and when testing costs, laboratory and nursing labor, and nursing supplies are factored in, each red blood cell (RBC) transfusion costs at least $1,000. The team identified a need to increase awareness of the clinical implications of transfusion, and the alternatives, with a focus on patient outcomes, inappropriateness, cost and availability.
The goal of the project is to reduce RBC transfusions by 5 percent for adult non-ICU patients over the course of one year while impacting neither patient safety nor increasing length of hospital stay.
Nebs No More After 24
Team members: Christopher Moriates, MD; Maria Novelero, MA, MPA; Michelle Mourad, MD; Katie Quinn, MPH; Theodore Omachi, MD, MBA; Raman Khanna, MD; James Harrison, PhD; Brian Smith, RRT; Brian Daniel, RRT; Christy Dant, RN; and Andrea Mazzini
Nebulized bronchodilator therapies, or nebs, are commonly used in the inpatient setting for the treatment of obstructive pulmonary symptoms. Neb administration, however, requires direct respiratory therapist care, making it a resource-intensive therapy. Metered Dose Inhalers (MDIs) have been shown to be equally effective as nebs, but are commonly misused by patients. Therefore, administering unnecessary nebs is also a missed opportunity to educate patients on proper use of their MDIs. Eliminating inappropriate nebs and providing inpatient MDI education can likely improve care while lowering costs.
Project goals include decreasing neb usage in all hospitalized patients by at least 15 percent; providing better patient education on proper MDI self-administration; and improving physician and nursing knowledge regarding the use of appropriate respiratory therapies.
To optimize these interventions, winning teams will receive assistance from experts in implementation science, led Ralph Gonzales, MD, MSPH, professor of Epidemiology and Biostatistics and director of the Implementation Science program at UCSF’s Clinical and Translational Science Institute (CTSI).
“The intermingling of expertise from the CHV team, UCSF’s Implementation Science faculty, and the medical center ensured a rigorous vetting process resulting in two solid projects that we’re confident can achieve results,” Gonzales said.
Caring Wisely is led by the Medical Center Initiative, one of several areas of focus for the CHV. This effort aims to support UCSF’s standing as a model academic medical center by seeding demonstration projects within the delivery system as proofs of principle, and integrating successful initiatives into general practice.
“It’s great to see UCSF and the medical center spearheading opportunities for innovation and improving value that have a real benefit to society,” said Christopher Moriates, MD, a clinical instructor in the division of Hospital Medicine in the UCSF School of Medicine and the leader of one of the winning teams.
The CHV was launched in 2012 with support from the UCSF Office of the Chancellor and the dean of the UCSF School of Medicine. Additional funding comes from the Grove Foundation, which has also committed to continued support contingent on the achievement of key milestones.
The CTSI is supporting the launch the CHV by providing administrative and technical support. More information about the CHV is available in a Q&A with acting CHV Director Clay Johnston, MD, PhD, who is also director of CTSI and associate vice chancellor of research.