Healthcare Systems

Ed Yelin, PhD

Healthcare System faculty examines outcomes, quality, and measurement of healthcare delivery systems with research and practice that spans from the individual clinic to hospital and healthcare systems. They also play a leadership role in translating research findings into policy, program, and healthcare delivery practices. IHPS faculty have informed the development of value-based purchasing approaches and have undertaken cost and cost-effectiveness studies across a wide domain of conditions and systems both domestically and internationally. Healthcare system faculty also conducts research on the healthcare workforce with a particular focus on nursing and primary care providers. The Institute is particularly interested in ensuring that our healthcare system delivers appropriate care to at-risk populations including children and the elderly.

Our research in healthcare systems spans five areas related to how our healthcare system works.

·       Health Insurance and Managed Care
·       Healthcare Workforce and Leadership
·       Economics and Cost
·       Healthcare Reform
·       Outcomes, Quality, and Measurement

In the area of health insurance and managed care, Institute researchers, such as Drs. Ed Yelin, Janet Coffman, and Wade Aubry, have made important contributions to the State of California through the California Health Benefits Review Program (CHBRP).  In response to requests from the California State Legislature, they and other CHBRP colleagues provide independent analysis of the medical, financial, and public health impacts of proposed health insurance benefit mandates proposed by Senate or Assembly members.

Within Healthcare Workforce and Leadership, Dr. Janet Coffman investigates healthcare workforce issues including regulations, shortages, geographic distribution, diversity, education, and health information technology. Consistent with UCSF's commitment to translating research into practice, Dr.  Jeff Belkora consults with educational institutions, community non-profits, and private sector industry in designing, implementing, evaluating, and reporting of programs that improve leadership, teamwork, and decision-making.

In the area of Economics and Cost, Dr. Joanne Spetz’s research focuses on the economics of the health care workforce.  She has led national and state surveys of registered nurses, nurse employers, and nursing schools; developed forecasts of nurse supply and demand in California; and evaluated programs to expand the supply of nurses.

Within Healthcare Reform, a number of IHPS faculty are involved in monitoring and evaluating health care reform implementation. For example, Dr. Andy Bindman, director of the California Medicaid Research Institute (CaMRI), and research investigators from across all ten-UC campuses are conducting research and evaluations on behalf of California’s Medicaid program, private foundations and federal entities. To date, CaMRI’s research has included: Medicaid coverage expansions in California, geographic variation in Medicaid service utilization, and patterns of beneficiaries’ use of long-term services and supports.

Also within this area, Dr. Annette Gardner, PhD, MPH has been studying health care safety net readiness to implement health care reform in California.  In her recent study, Laying the Foundation for Health Care Reform: Local Initiatives to Integrate the Health Care Safety Net, she characterizes five diverse county health care safety nets that have launched safety net integration initiatives, such as adoption of the patient-centered medical home and integrating primary care and mental health. In a forthcoming report, she describes the financial impacts of federal and state reforms on California's community health centers,  including opportunities under the Affordable Care Act and challenges posed by the state's budget. 

Diane Rittenhouse

The area of outcomes, quality, and measurement, includes a number of IHPS researchers, including Drs. Diane Rittenhouse, Laura Schmidt, and Jim Wiley who are investigating how safety-net primary care practices in the Greater New Orleans Area have transformed their operations to become recognized by the National Committee for Quality Assurance as patient-centered medical homes (PCMHs). As part of their study, they are assessing how PCMH-guided practice transformation impacts patient outcomes, patient and provider experience, and costs, in an effort to better meet the needs of underserved communities. 

Also within this area, Dr. Emily Finlayson and colleagues at UCSF have been studying population-based functional outcomes after major surgery in nursing home residents. The team utilizes national Medicare claims and the Minimum Data Set for Nursing Homes to examine outcomes including analyses of operative morbidity and mortality after common procedures that are generally considered ‘low risk’, evaluation of functional status trajectories after colon cancer surgery, and the impact of procedure choice on continence after rectal cancer surgery.