IHPS Featured Research May 2020

This Time Must Be Different: Disparities During the COVID-19 Pandemic
Bibbins-Domingo K.
Ann Intern Med. 2020 Apr 28. doi: 10.7326/M20-2247


Racial and ethnic disparities in the U.S. COVID-19 pandemic show an urgent need to invest resources in these communities and, in planning for a vaccine, heeding the lessons of past vaccination campaigns and implementing strategies that address current gaps in vaccination rates and specific issues in minority communities writes Kirsten Bibbins-Domingo, PhD, MD, MAS in a recent Annals of Internal Medicine article.

Kirsten Bibbins-Domingo, PhDKirsten Bibbins-Domingo, PhD, MD, MAS
Dr. Bibbins-Domingo’s research interests include patterns of poor health at younger ages and in racial and ethnic minority populations. Dr. Bibbins-Domingo is an NIH-funded researcher who uses observational studies, pragmatic trials, and simulation modeling to examine effective clinical, public health, and policy interventions aimed at prevention. She leads the UCSF Cardiovascular Disease Policy Model group that conducts simulation modeling, disease projections, and cost-effectiveness analyses related to cardiovascular disease in the US and in other national contexts. Dr. Bibbins-Domingo is the Chair of the Department of Epidemiology and Biostatistics and Vice Dean for Population Health and Health Equity in the UCSF School of Medicine.



Hospital Medicine Management in the Time of COVID-19: Preparing for a Sprint and a Marathon
Megha Garg, MD, MPH, Charlie M Wray, DO, MS
J. Hosp. Med 2020;5;305-307. Published online first April 8, 2020. doi:10.12788/jhm.3427


In a recent Journal of Hospital Medicine article, Megha Garg, MD, MPH (IHPS faculty) and Charlie M. Wray, DO, MS, write that hospital management in the short-term during the COVID-19 pandemic is helped by regular communication, optimizing inpatient resources, using hospitalists for their most relevant skills, and considering long-term implications of staffing decisions. Recognizing that morale, motivation, and burnout will be issues, a focus on sustainability and wellness becomes increasingly important as the pandemic continues.  Creating “operational champion” roles for frontline clinicians, setting aside defined time for staff to discuss and reflect on their experiences and celebrating small victories all help healthcare systems and hospital medicine providers prepare for this ongoing challenge.

Megha Garg, MD
Megha Garg, MD, MPH
Dr. Garg’s is a clinician-educator involved in the UCSF School of Medicine Bridges curriculum.
She is the Director of the first year medical student course focused on health disparities,
social justice, and health policy.

 


Rapid Design and Implementation of an Integrated Patient Self-Triage and Self-Scheduling Tool for COVID-19
Judson TJ, Odisho AY, Neinstein AB, Chao J, Williams A, Miller C, Moriarty T, Gleason N, Intinarelli G, Gonzales R.
Am Med Inform Assoc. 2020 Apr 8. pii: ocaa051. doi: 10.1093/jamia/ocaa051


In a recent Journal of Informatics in Health and Biomedicine article, Ralph Gonzales, MD, MSPH, and colleagues described the rapid implementation of a patient portal self-triage and self-scheduling tool for COVID-19, potentially helping to prevent unnecessary ED and urgent care visits, and reducing potential infectious exposures and transmissions.  The tool provides patients with 24-hour access to personalized recommendations and information regarding COVID-19, including self-scheduling, which allows patients to be triaged and scheduled in a median of two minutes.

Although over a dozen COVID-19 symptom checkers are now available from private companies, academic medical centers, and government organizations like the CDC, this is the first known implementation of a COVID-19 symptom checker that is fully integrated with the patient’s medical record and enables direct appointment scheduling.

In the first two weeks of deployment, the tool was completed over 1000 times, and nearly one in 60 eligible patients completed it at least once. The tool was primarily used by symptomatic patients, but also included more than 300 sessions by asymptomatic patients. 

This self-triage and self-scheduling tool was presented to the UCSF EHR vendor and is now part of their base content, meaning that it is available for use by their other customers.

Ralph Gonzales, MDRalph Gonzales, MD, MSPH
Dr. Gonzales is currently leading several project teams in designing, implementing and evaluating new ways to improve primary care-specialty care communication and care coordination, focusing on strategies that achieve the triple aim of improving quality, outcomes and decreasing costs. One includes the use of eReferrals and eConsults to streamline the referral and coordination process; another project is evaluating new team-based strategies to reduce unnecessary follow-up visits in specialty care. Dr. Gonzales is Associate Dean for Clinical Innovation and Chief Innovation Officer for UCSF Health.


Experiences of Patients with Rheumatic Diseases in the US During Early Days of the COVID-19 Pandemic
Michaud K, Wipfler K, Shaw Y, Simon TA, Cornish A, England BR, Ogdie A, Katz P.
ACR Open Rheumatol. 2020 Apr 20. doi: 10.1002/acr2.11148


In a recent peer-reviewed article in ACR Open Rheumatology, Patti Katz, PhD, and colleagues found many participants in a U.S.-wide longitudinal observational registry of patients with rheumatic diseases who answered a supplemental COVID-19 questionnaire had important changes to their healthcare, with many altering medications without professional consultation or due to hydroxychloroquine shortage. As evidence accumulates on the effectiveness of potential COVID‐19 treatments, effort is needed to safeguard access to established treatments for rheumatic diseases.

Patti KatzPatti Katz, PhD
Dr. Katz’s research interests include the impact of lifestyle factors, such as physical activity, obesity, sleep and stress, affect clinical and quality of life outcomes among individuals with rheumatoid arthritis and lupus.  She is also deeply involved in the development, validation, and optimization of patient-reported outcomes measures to ensure that patients’ perspectives are adequately represented in research and clinical care.
 


Ensuring and Sustaining a Pandemic Workforce
Fraher EP, Pittman P, Frogner BK, Spetz J, Moore J, Beck AJ, Armstrong D, Buerhaus PI.
N Engl J Med. 2020 Apr 8. doi: 10.1056/NEJMp2006376


As hospitals and nursing homes gear up for expected increases in critically ill patients, they should examine all opportunities to expand their workforce capacity writes Joanne Spetz, PhD, and colleagues, in a recent New England Journal of Medicine article. While some are temporary solutions – such as redeploying practitioners from other clinical fields, issuance of temporary or emergency licenses, and reactivating retired practitioners - other efforts such as expanding scopes of practice, cross-state licensure, and allowing greater use of telehealth services should be part of a longer term strategy. Once the pandemic has subsided, workforce changes should be evaluated and the results used to inform wiser use of the workforce and improved responses to future pandemics.

Joanne Spetz, PhD

Joanne Spetz, PhD
Dr. Spetz’s research interests include the economics of the health care workforce, shortages and supply of
registered nurses, organization and quality of the hospital industry, impact of health information technology.


 


Rapid Response of an Academic Surgical Department to the COVID-19 Pandemic:
Implications for Patients, Surgeons, and the Community

Lancaster EM, Sosa JA, Sammann A, Pierce L, Shen W, Conte MC, Wick EC.
J Am Coll Surg. 2020 Apr 9. pii: S1072-7515(20)30312-4. doi: 10.1016/j.jamcollsurg.2020.04.007


A rapid response by the UCSF surgical department was facilitated by the development of a small, tightly knit leadership team and utilizing and evolving guidelines to serve as starting points are the findings of Elizabeth Wick, MD and Julie Ann Sosa, MD, MA, FACS, along with their colleagues, in a recent Journal of the American College of Surgeons article.  By developing an enabling infrastructure, a department can nimbly respond to crises like COVID-19 by promoting trust among colleagues and emphasizing an unwavering commitment to excellent patient care. Sharing principles and practical applications of these changes is important to optimize responses across the country and the world.

Elizabeth Wick, MD
Elizabeth Wick, MD
Dr. Wick is a recognized national leader in research to reduce surgical site infections and formulating strategies for improving perioperative care. She led an AHRQ-funded national collaborative to improve surgical safety and reduce surgical site infections in 250 hospitals across the US and abroad. Dr. Wick is interested in harnessing the electronic health record to better measure performance and is working on automating surgical site infection measurement using advanced informatics.

 


Julie Ann Sosa, MD
Julie Ann Sosa, MD, MA, FACS
Dr. Sosa is an NIH-funded investigator whose research is largely focused on outcomes research, health care delivery, hyperparathyroidism, and thyroid cancer, with an emphasis on clinical trials. Current work is focused around discrete choice experiments in thyroidology and understanding the etiology of the thyroid cancer epidemic together with colleagues in epidemiology and environmental science. She is the Chair of the Department of Surgery at UCSF.