New UC Grants Promote Team Approach to Improving Patient Care

Rebecca Smith-Bindman, MDUCSF's Rebecca Smith-Bindman, MD, is the principal investigator who will work with collaborators at UC Davis, UC Irvine, UCLA, UC San Diego, UCSF and the Group Health Cooperative on a UC-funded project that aims to standardize and optimize computed tomography (CT) doses across UC medical centers so that patients receive the lowest dose of radiation possible to produce the necessary medical benefit.

 

UCSF researchers will play key roles in several newly funded projects that take a team approach to finding ways to stop blood clots, reduce falls in hospitals and limit patient exposure to radiation.

The University of California’s (UC) Center for Health Quality and Innovation (CHQI) has awarded nine grants, totaling $3.4 million, to UC faculty and staff with the goal of improving health care delivery in California.

The CHQI aims to improve care while decreasing costs, key goals of health care reform. These objectives will be especially important in 2014 when millions more Californians become eligible for insurance coverage under health care reform.

“Through these grants, the CHQI is creating opportunities for some of the brightest health care innovators to work collaboratively across UC campuses, and identify ways to deliver better health care,” said Mark Laret, CEO of the UCSF Medical Center and the UCSF Benioff Children’s Hospital. The CHQI received initial funding of $5 million – $1 million each from medical centers at UCSF, UC Davis, UC Irvine, UCLA, and UC San Diego.

“As academic medical centers, we also have the advantage of quickly translating these findings into higher quality, safer treatment for the most important people in health care – our patients,” said Laret.

UC Health, which includes UC’s five academic medical centers, 10 hospitals and 16 health professional schools, launched the center in October.

The center is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and the UC senior vice president for health sciences and services.

Center officials hope to begin a second round of grants in the fall focusing on proposals that improve operational efficiency and quality by demonstrating a return on investment, and seek additional funding from interested stakeholders to support this effort.

UC faculty and staff submitted nearly 100 proposals for the first round of grants, with 61 advanced to CHQI for further review.

The nine projects are:

Standardization and Optimization of Computed Tomography Patient Radiation Dose Across the University of California Medical Centers

  • $750,000 over three years
  • Principal investigator: Rebecca Smith-Bindman, MD, UCSF
  • Co-investigators: John Boone, PhD, UC Davis; Ramit Lamba, MD, UC Davis; James Anthony Seibert, PhD,  UC Davis; Mayil Krishnam, MD, UC Irvine; Christopher Cagnon, PhD, UCLA; Michael McNitt-Gray, PhD, UCLA; Thomas Nelson, PhD, UC San Diego; Robert Gould, ScD, UCSF; Diana Miglioretti, PhD, Group Health Cooperative

Computed tomography (CT) exams quadrupled between 1994 and 2007. While an important medical advance, CT exams also deliver substantially higher radiation than conventional X-rays. Moreover, CT radiation doses vary highly. This proposal aims to standardize and optimize CT doses across UC medical centers so that patients receive the lowest dose possible to produce the necessary medical benefit.

A Consortium of Trauma Centers for the Development of a Decision Instrument for Selective Chest Computed Tomography in Blunt Trauma

  • $375,000 over three years
  • Principal investigator: Robert Rodriguez, MD, UCSF
  • Co-investigators: Daniel Nishijima, MD, UC Davis; Mark Langdorf, MD, MHPE, UC Irvine; William Mower, MD, PhD, UCLA; Anthony Medak, MD, UC San Diego; Gregory Hendey, MD, UCSF

CT use for trauma evaluation has increased dramatically in the past 15 years, leading to exposure of potentially harmful radiation to a disproportionately young patient population, increased costs and greater time in the emergency department. This proposal aims to reduce unnecessary chest CT in blunt trauma patients, thereby conserving resources and decreasing unnecessary radiation to patients. Four non-UC academic medical centers also may join in this study.

The Patient Support Corps: A Service Learning Program for Improved Care and Education

  • $50,000 for one year
  • Principal investigator: Jeff Belkora, PhD, UCSF
  • Co-investigator: Joan Bloom, PhD, UC Berkeley

This proposal expands on an innovative form of patient support pioneered at the UCSF Breast Care Center. The program will deploy UC Berkeley undergraduates in patient support roles.

Individualizing Assessments of Risk to Reduce Falls in UC Hospitals

  • $375,000 over three years
  • Co-principal investigators: Catherine Walsh, GNP, UCLA; Teryl Nuckols, MD, MSHS, UCLA
  • Co-investigator: Carla Graf, RN, CNS, UCSF

In 2010, UCLA’s Ronald Reagan Medical Center implemented the 5P Fall Prevention Method (assess a patient’s pain, personal needs, positioning, placement and focus on preventing falls), reducing falls by 30 percent. This proposal will develop programs to train nurses, physicians and physical therapists about the 5P method, implement it at Santa Monica UCLA Medical Center and UCSF Medical Center, assess its effectiveness, examine costs, and disseminate the program and results to UC hospitals and nationally.

Integrating Patient Care and Health Professions Education to Improve Care Transitions: The UC Health Quality Improvement Network

  • $750,000 over three years
  • Principal investigator: Ulfat Shaikh, MD, MPH, UC Davis
  • Co-investigators: Alpesh Amin, MD, MBA, UC Irvine; Nasim Afsarmanesh, MD, UCLA; Brian Clay, MD, UC San Diego; Sumant Ranji, MD, UCSF

Fragmented care following hospital discharge is a common problem that leads to poorer patient outcomes, including unplanned and costly readmissions. This proposal will develop infrastructure for a quality improvement network involving trainees at UC’s five medical centers, with care transitions as the first focus area. This collaboration will help improve patient care transitions during hospital discharge.

UC Collaborative to Reduce Hospital Acquired Venous Thromboembolism: Stop the Clot

  • $750,000 over three years
  • Principal investigator: Gregory Maynard, MD, UC San Diego
  • Co-investigators: Patrick Romano, MD, MPH, UC Davis; Richard White, MD, UC Davis; Alpesh Amin, MD, MBA, UC Irvine; Nasim Afsarmanesh, MD, UCLA; Ian Jenkins, MD, UC San Diego; Andrew Auerbach, MD, MPH, UCSF

Venous thromboembolism (VTE), the blocking of a blood vessel by a blood clot, is among the most common preventable causes of hospital death. This proposal will create a systemwide effort to reduce UC’s already low VTE rate by at least 20 percent through focusing on preventive measures in adult medical-surgical hospital patients.

Implementationand Assessment of a Formal Curriculum for Bedside Ultrasound Training, $50,000 for one year

  • Principal investigator: Elizabeth Turner, MD, UC Irvine
  • Co-investigators: John Christian Fox, MD, UC Irvine; Mark Allen Rosen, MD, UC Irvine

Bedside ultrasound involves portable ultrasound exams performed and interpreted by the physician at the point of care. Studies show this can provide better patient outcomes, but standardized training in point-of-care ultrasonography is lacking. This proposal will implement a formal bedside ultrasound educational program and validate that learners gain competence to allow its integration into practice.

Exercise and Activity Monitoring, Feedback and Outcome Measures to Improve Continuing Care

  • $50,000 for one year
  • Principal investigator: Bruce Dobkin, MD, UCLA
  • Co-investigators: William Kaiser, PhD, UCLA; Maxim Batalin, PhD, UCLA

Stroke is the most common cause of neurological disability in adults. UCLA’s Ronald Reagan Medical Center admits 400 patients a year with acute stroke; its inpatient rehabilitation unit manages 240 patients. These patients have marked muscle weakness in addition to neurological deficits. This proposal will use wireless health innovations developed by UCLA engineers, computer scientists and clinicians to monitor home exercise, provide feedback and obtain measures of activity to improve patient care.

The UCSD Patient-Centered Recovery Program

  • $286,440 over two years
  • Principal investigator: William Perry, PhD, UC San Diego

Nationally, the number of people using emergency services who have mental health diagnoses has increased 40 percent over the past two decades, and among these, substance abuse diagnoses are the most common. This proposal is designed to reduce emergency room visits and hospital readmissions among mental health/substance abuse patients by providing screening, brief intervention, referral to treatment services, and a patient-centered recovery and case management program.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Photo by Cindy Chew

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