A Message from CHPR Director Joy Melnikow
National health-care reform will be a transformational milestone in 21st-century U.S. history. The Affordable Care Act (ACA) has the potential to revolutionize access to health care for millions of Americans. ACA’s changes are new for most Americans, but not for staff, students and faculty at UC Davis Center for Healthcare Policy Research (CHPR).
For nearly 20 years, CHPR faculty and staff have contributed to the evidence base on health-care access, quality, outcomes and costs that helped to shape the vision for ACA. The center continues to conduct groundbreaking research that assists in implementing the law and achieving its goal of better health outcomes.
CHPR’s contribution to national health-care reform is a source of great pride for UC Davis. With UC Davis Medical Center nearby, CHPR teams are uniquely positioned to identify critical needs for innovative research that will help find new and better ways for improving outcomes, improving quality, and controlling costs. The genesis of CHPR’s research often reflects our own providers’ experiences working with patients. This experience brings home the need for fundamental change in the ways our society conceives of and delivers health services.
I have had the privilege of being part of CHPR since its founding and am honored to be serving in my fourth year as director. I am fortunate to work with talented staff and inspirational researchers from disciplines across UC Davis, ranging from economics and sociology to primary care, surgery, epidemiology and statistics. I am excited to share examples of pioneering research at CHPR that is paving the way to better health and health care throughout the country.
Training providers to improve self-care skills of patients with depression and diabetes
The combination of depression and diabetes is quite common. Most patients with these conditions struggle with self care and are seen in primary care settings, yet primary care physicians (PCPs) are seldom trained in self care. Anthony Jerant, professor of family and community medicine, and CHPR colleagues have developed SEE IT, Self-Efficacy Enhancing Interviewing Techniques, an intervention that teaches PCPs to interact in ways that improve patients' knowledge and confidence in taking action to manage complex health conditions.
Dr. Jerant led a pilot study that demonstrated physicians-in-training could easily and effectively incorporate SEE IT in primary care settings. With a grant from the National Institute of Mental Health, Dr. Jerant is now studying whether fully trained primary care physicians also can adopt the standardized communication intervention techniques, and whether doing so improves patient outcomes. SEE IT could be a valuable tool for physicians in helping patients' manage their chronic illnesses, behaviors and symptoms.
Improving outcomes for discharged heart-failure patients
Reducing rehospitalization rates of heart-failure patients is a key target for enhancing outcomes and saving costs. Studies demonstrate that post-discharge follow-up with multiple home visits by a nurse reduces readmission rates, but it is a cost-prohibitive solution. As an alternative, small studies show lower hospital readmission rates when remote telemonitoring is combined with telephone follow-up by nurses. With funding from the Agency for Healthcare Research and Quality, Patrick Romano, professor of medicine and pediatrics, helps lead Better Effectiveness After Transition for Heart Failure Patients (BEAT-HF), the first large-scale, multi-center, randomized control trial of this innovative approach.
The study’s collaborators are five University of California medical centers and Cedars-Sinai Medical Center. The project compares the benefits and costs of traditional care for elderly patients with heart failure against a new intervention that couples post-discharge telephone follow-up (without home visits) and remote telehealth monitoring through devices that automatically transmit patients’ daily biometric information and symptoms. The study creates the additional valuable opportunity to compare differences in care and outcomes among the participating sites in order to develop new best practices for national use.
Optimizing breast cancer screening for underserved women
Every Woman Counts (EWC) provides free clinical breast exams, mammograms, pelvic exams and Pap tests to California’s underserved women. When digital mammography emerged as a new breast cancer-screening technology, EWC needed a comparative analysis to help the organization make policy decisions for allocating limited resources relative to digital and film mammography. The diagnostic accuracy of digital mammography is not better than film overall, but it is more sensitive for detecting cancers in women under age 50. Digital mammography costs nearly twice that of film mammography.
With funding from California Program on Access to Care, CHPR colleagues and I created a cost-effectiveness model that projected outcomes and costs of different mammography policy options. We tailored the model to EWC characteristics, including fixed limited budget, need for broad geographic access to care and age distribution of women served. The findings produced evidence-based recommendations for a mammography policy that would lead to detecting the greatest number of breast cancers in the EWC population.
These are only a few examples of the leading-edge research that enables CHPR to make influential policy recommendations to the nation’s public health decision makers. I congratulate all CHPR team members for a job well done — and a job never finished.
I encourage you to share with family and friends the outstanding role that CHPR plays in health-care reform by conducting research, informing public policy decision makers and educating patients, providers and communities. We can — and are — impacting the health policies that improve lives and transform health care.
Joy Melnikow, MD, MPH
Director, Center for Healthcare Policy and Research
Professor, Family and Community Medicine