In Clinical Practice, the Institute has long been a leader in research and policy translation related to technology evaluation, drugs, and pharmaceuticals. IHPS boasts a path-breaking program on the production of research and medical evidence that touches on issues related to industry sponsorship, conflict of interest, and research integrity.  

In award-winning work, Institute faculty have developed and put into practice decision-making tools that facilitate the delivery of patient-centered care. IHPS is also at the forefront of understanding how genetic technologies and personalized medicine will shape and re-shape clinical practice of the future. 

Our research in clinical practice spans three areas:

Drugs and Pharmaceuticals
Medical Evidence and Technology
Decision-Making

In the area of medical evidence and technology, several IHPS faculty, including Drs. Lisa Bero, Rita Redberg, Drummond Rennie, and Tracey Woodruff are developing the UCSF Center for Research Integrity and Science Policy, which is committed to the rigorous investigation of bias in scientific research, the promotion of research integrity, and the use of sound evidence in health and public policy.The Center comprises a research program, training program, and dissemination unit, as well as a network of researchers across the world involved in conducting research related to bias and research integrity.

Another aspect of medical evidence is illustrated through the work of Dr. Michael Cabana, and the Physician Asthma Care Education (PACE) project. The goal is to understand, evaluate and address inappropriate variation in physician practice and its impact on quality of care, particularly asthma care.

In the area of decision-making, Dr. Grace Lin is examining key components of high quality decision-making and is developing a patient-reported survey instrument to measure decision quality for patients with stable coronary artery disease (CAD).

In another example, Dr. Dan Dohan is examining how patients with advanced cancer make decisions about their treatment choices, with a particular focus on how patients decide whether or not to participate in early phase clinical trials.

Understanding how patients make that decision and how the process might be improved to be more efficient and more humane is at the core of this study.

In the area of decision making, IHPS is the co-sponsor of the Decision Services unit at the UCSF Breast Care Center. Dr. Belkora trains and supervises premedical interns who provide decision support to patients. 

Decision Services is a demonstration project sponsored by the Foundation for Informed Medical Decision Making and the UCSF Breast Care Center. The Decision Services staff consists of interns who spend a year in a post-baccalaureate, pre-medical program at the Breast Care Center.

These premedical interns help patients review high quality information (in the form of decision aids) before their medical appointments. Decision aids are print, audio-visual, or web-based educational materials that present the known evidence about treatments and outcomes. The premeds then accompany patients to their meetings with doctors and assist them with listing questions, taking notes, and making audio-recordings. The resulting question lists, audio-recordings, and summaries are known as communication aids. Randomized controlled trials have shown that these decision and communication aids are associated with increased patient knowledge, question-asking, and information recall. Other studies have found that such informed and involved patients enjoy more patient-centered care and experience better psychosocial and physical outcomes. The Decision Services unit provides these evidence-based decision and communication aids to patients, and studies the process of integrating these tools into clinical care. The program reaches over 1,000 clinic visitors every year with its decision and communication aids and publishes implementation studies in the literature.

Recognition

The Mayo Center for Innovation recognized Decision Services with its 2009 TRANSFORM award for innovation. The US Agency for Healthcare Research and Quality featured Decision Services as one of the first 100 innovations in its Innovations Exchange. The US Department of Health and Human Services featured Decision Services in its 2010 National Healthcare Quality report as an example of Patient and Family-Centered Care. As a demonstration project, the Decision Services unit has now inspired additional collaborations within UCSF (e.g. with the Department of Orthopaedic Surgery) and in community settings through the Patient Support Corps.

Dissemination

As Director of the Patient Support Corps, Dr. Belkora provides technical assistance to member organizations implementing patient support programs. Members of the Patient Support Corps include UCSF, UC Berkeley, Dartmouth, the Cancer Support Community, the Mendocino Cancer Resource Center, Breast Cancer Connections, the Humboldt Community Breast Health Project, and the Edinburgh Cancer Centre.