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CHPR Open House- 2013 Expansion

Please join us in celebration of the Center for Healthcare Policy and Research 2013 Expansion. 
Learn what the CHPR is doing and how we can serve YOU.

Date: June 20, 2013
Time: 4:00pm to 6:00pm
Location:
Center for Healthcare Policy and Research
2103 Stockton Blvd.
Sacramento, CA, 95817
Link to Map of Location

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Three UC Davis recipients awarded fellowships from UC innovation center

CHPR Researchers Receive New Awards Totaling $5.7M: Department Expands

UC Davis researchers afilliated with the Center for Healthcare Policy and Research (CHPR) have recently been awarded new funding for four separate projects totaling almost $6M.  All four project proposals were prepared by the CHPR in conjunction with the Principal Investigators and their research collaborators, and all four projects will be administered and housed at the Center for Healthcare Policy and research.

As a result of the new awards, the CHPR will expand to the first floor of the Grange Building.  They currently occupy the second floor of that building. 

Details about each of the four awards are listed below: 

"N-of-1 Trials Using mHealth in Chronic Pain"
Principal Investigator:  Richard Kravitz, UC Davis Department of Internal Medicine
Funding Agency: National Institute of Health
Type: R01
Total Award: $3,905,813

Chronic musculoskeletal pain is an enormous problem, and treatments are often prescribed in a “trial and error” fashion. This project seeks to develop a mobile phone application (“app”) that allows patients and their health care providers to run rigorous, personalized experiments (“n-of-1 trials”) comparing two different pain treatments. Once the app is developed, the investigators will enroll 296 patients in a randomized study that looks at long term pain outcomes among patients assigned to undergo an n-of-1 trial using the app versus usual care. The project enlists mobile technology to help patients engage actively and collaboratively with their clinicians to identify the pain treatment that works best for them.

Other UC Davis researchers involved in this project are:

"Provider Training to Support Patient Self-efficacy for Depression Care"
Principal Investigator:  Anthony Jerant, UC Davis Department of Family and Community Medicine
Funding Agency: National Institute of Mental Health
Type: R34
Total Award: $698,602

This study will determine whether practicing primary care providers (PCPs) can be trained to support patient self-care of depression and co-existing diabetes during office visits, and begin to explore whether this might improve depression and diabetes outcomes. This is important because most patients with these conditions struggle with self-care and are seen in primary care, yet PCPs are seldom trained to support self-care.

Other UC Davis researchers involved in this project are:

"Promoting Patient-centered Counseling to Reduce Inappropriate Diagnostic Tests"
Principal Investigator:  Joshua Fenton, UC Davis Department of Family and Community Medicine
Funding Agency: Patient Centered Outcomes Research Institute (PCORI)
Total Award: $687,729

 Enhancing the value of health services is an urgent national health priority. Enhancing value entails reducing inappropriate or unnecessary care while maintaining or improving healthcare quality and safety. While many factors may contribute to inappropriate care delivery in the U.S., patient requests have been shown to influence clinical decision-making regarding inappropriate services. Patient-centered communication, however, can potentially avert inappropriate care while maintaining a trustful patient-doctor relationship. Tools to enhance patient-centered communication may therefore play a critical role in reducing inappropriate care and enhancing healthcare value and safety.

In response to the PCORI’s interest in “the development, refinement, and testing of interventions to enhance patient-centered care,” we propose to develop and to evaluate a novel intervention using standardized patients (SPs) -- or actors playing the roles of patients -- to enhance physicians’ patient-centered counseling skills regarding two frequently overused, potentially inappropriate services in primary care: magnetic resonance imaging (MRI) for acute low back pain and bone densitometry in women at low-risk for osteoporosis. We will further evaluate whether intervention effects on physician patient-centeredness generalize to counseling regarding other costly, unnecessary diagnostic tests.

Other UC Davis researchers involved in this project are:

"Exploring Disparities: Urinary Indontinence treatment seeking in mid-life women"
Principal Investigator:  Elaine Waetjen, UC Davis Department of Obstetrics and Gynecology
Funding Agency: National Institute of Health
Type: R21
Total Award: $418,168

Urinary incontinence (UI) is a frequent midlife problem that disproportionately affects women. While a number of effective treatments exist for UI, women can be inhibited in seeking care for this problem. This study proposes to explore racial/ethnic, socioeconomic, and educational level disparities in treatment seeking behavior for UI over time using 10 years of annual questionnaire and physical measures data from the Study of Women’s Health Across the Nation (SWAN), a multi-racial/ethnic, community-based, prospective cohort study of women transitioning through menopause.

With longitudinal logistic regression and discrete proportional hazards statistical modeling, we will analyze the complex interplay between demographic characteristics and longitudinal changes in UI characteristics, economic, social psychological, and health factors that may affect: 1) not seeking UI treatment and reported reasons for not seeking treatment from health care providers, and 2) the types of treatments prescribed for and tried by community-dwelling midlife women who do seek UI care. With information from this study, public health educators can target messages to specific groups with bothersome UI symptoms at risk for not accessing UI care. For health care providers, a better understanding of what factors make a woman more or less likely to report UI to them and try their recommended treatments will allow them to improve and individualize assessment of and treatment plans for their incontinent patients.

Other UC Davis researchers involved in this project are:

De la Torre appointed interim vice chancellor for student affairs

Adela de la Torre, an agricultural and health economist and nationally recognized expert on Latino and Chicano health issues, has been appointed interim vice chancellor for Student Affairs as UC Davis launches a national search for a permanent replacement for Fred Wood.

De la Torre officially assumes her new post Aug. 1, after UC President Mark G. Yudof and UC Regent Fred Ruiz, chair of the Board of Regents Committee on Compensation, approved the interim appointment Thursday (July 26). The action will be reported to the full board at its September meeting.

Her appointment is for one year, through July 31, 2013, or until the appointment of a permanent replacement. Wood, whose last day was June 28, left UC Davis to become the chancellor of the University of Minnesota, Crookston.

As interim vice chancellor for Student Affairs, de la Torre will manage more than 750 full-time equivalent employees and an annual operating budget of $657 million. The Student Affairs portfolio includes: enrollment services; academic support services; student housing and residential education; student health and psychological services; student life, campus community and campus climate; internships and career services; campus unions, bookstores and food service; Student Affairs development, commercial activities and related capital projects.

In filling the interim position, Chancellor Linda P.B. Katehi has said it was important to appoint a member of the Academic Senate who has the ability and credibility to negotiate and be effective on behalf of Student Affairs in conversations with the Academic Senate. (more)

Jerant Awarded Funding to Improve the Self-Care Skills of Patients with Depression and Diabetes

CHPR Director Joy Melnikow Appointed to Let's Get Healthy California Task Force

Sacramento – California Health and Human Services Agency Secretary, Diana S. Dooley announced today the members appointed to the Let’s Get Healthy California Task Force and the Expert Advisors charged with developing a 10-year plan to make Californians healthier. CHPR Director and professor of Family and Community Medicine Joy Melnikow is among the appointed members.  The appointments are made pursuant to Governor Edmund G. Brown, Jr.’s Executive Order.

The Task Force will be Co-Chaired by Secretary Dooley and Don Berwick, MD MPP who is a senior fellow at the Center for American Progress (CAP), is the former president and CEO of the Institute for Healthcare Improvement and served by appointment of President Obama as the Administrator of the Centers for Medicare and Medicaid Services until December, 2011.

“With the leadership of Dr. Don Berwick and California’s world-class talent in health, technology, education and research, it wasn’t hard to assemble this energetic group of leaders for our work ahead,” said Secretary Dooley. “With the knowledge, diversity and experience of these appointees and the support of so many others committed to our success, I look forward to receiving an innovative plan to reduce the burdens of chronic and preventable diseases and improve the health of all Californians.”

The Task Force and the Expert Advisors will work together to gather, evaluate and prioritize the best ideas and practices and organize them into a 10-year plan to improve quality, control costs, promote personal responsibility for individual health, and advance health equity. The report will establish baselines for key health indicators, identify obstacles, inventory best practices, provide fiscally prudent recommendations and create a sensible framework for measuring improvements in key areas including:

• Reducing diabetes, asthma, childhood obesity, hypertension, and sepsis-related mortality.
• Reducing hospital readmissions with 30 days of discharge.
• Increasing the number of children receiving recommended vaccines by age three.

The first meeting of the Task Force will be held in Los Angeles on June 11, 2012. The plan will be presented by December 15, 2012. 

Fenton Receives $688K from Patient-Centered Outcomes Research Institute

Joshua J. Fenton, Assistant Professor in the Department of Family and Community Medicine, has been awarded a grant from the Patient-Centered Outcomes Research Institute (PCORI). 

The award, in the amount of $687,729, was made for the proposal entitled "Promoting Patient-Centered Counseling to Reduce Inappropriate Diagnostic Tests."  Dr. Fenton will serve as the principal investigator in this study. 

UC Davis co-investigators include Peter Franks and Anthony Jerant, from the Department of Family and Community Medicine, Richard L. Kravitz and Debora A. Paterniti, from the Department of Internal Medicine, and Heejung Bang from the Department of Public Health Sciences. 

Project Description (Abstract): 

Enhancing the value of health services is an urgent national health priority.  Enhancing value entails reducing inappropriate or unnecessary care while maintaining or improving healthcare quality and safety.  While many factors may contribute to inappropriate care delivery in the U.S., patient requests have been shown to influence clinical decision-making regarding inappropriate services.  Patient-centered communication, however, can potentially avert inappropriate care while maintaining a trustful patient-doctor relationship.  Tools to enhance patient-centered communication may therefore play a critical role in reducing inappropriate care and enhancing healthcare value and safety.  

In response to the PCORI’s interest in “the development, refinement, and testing of interventions to enhance patient-centered care,” we propose to develop and to evaluate a novel intervention using standardized patients (SPs) -- or actors playing the roles of patients -- to enhance physicians’ patient-centered counseling skills regarding two frequently overused, potentially inappropriate services in primary care: magnetic resonance imaging (MRI) for acute low back pain and bone densitometry in women at low-risk for osteoporosis.  We will further evaluate whether intervention effects on physician patient-centeredness generalize to counseling regarding other costly, unnecessary diagnostic tests.  Specific aims are:

            1) To use stakeholder focus groups to develop an educational intervention for primary care physicians based upon simulated office visits with standardized patients (SPs) requesting two commonly overused services.

            2) To evaluate in a randomized trial the effectiveness of the intervention in enhancing physician patient-centered counseling behavior and reducing inappropriate or unnecessary test ordering. 

            3) To explore the durability of intervention effects and whether effects generalize to the delivery of other unnecessary primary care services.

The Center for Healthcare Policy and Research will coordinate administration of this research project. 

Kravitz Quoted in Newsweek Magazine

April 26-- Richard Kravitz, a member of the CHPR Executive Committee and professor of Internal Medicine at UC Davis School of Medicine, has been quoted in Newsweek magazine. 

The article, published on April 16, focuses on the amount and quality of time physicians spend with their patients and patient satisfaction.

Dr. Kravitz, whose research interests include clinician-patient interactions, was quoted twice in the article, speaking about the bonds of trust between physicians and patients.  You can read the article here:    http://www.thedailybeast.com/newsweek/2012/04/15/why-your-doctor-has-no-time-to-see-you.html

De la Torre Honored through Honor Society Naming

April 26-- CHPR Executive Committee member Adela de la Torre has had a new Latino honor society named after her at Northern Illinois University.

UC Davis alumna Emily Prieto, director of NIU’s Latino Resource Center, founded the honor society and named it after her mentor, professor and chair in the UC Davis Department of Chicana/o Studies.

Prieto holds three degrees from UC Davis: a Bachelor of Arts in community rhetoric (2002), a Master’s Degree in sociocultural studies (2005) and a doctorate in language, literacy and culture (2007). She has been director of the NIU Latino Resource Center since August 2007.

The Dr. Adela de la Torre Honor Society aims to recognize and promote excellence among Latinos, build student leaders and help render service through a unified effort, according to the society’s mission statement.

De La Torre, a national expert on Chicano and Latino health issues, last year received a five-year, $4.8 million federal grant for a Central Valley study titled "Niños Sanos, Familia Sana" (Healthy Children, Healthy Family), to discover the best ways to help Mexican-heritage children maintain healthy weights.

CHPR research team receives 2011 Dean's Team Award

March, 2012 - The CHPR research team was recently honored to receive the 2011 Dean's Team award. During a ceremony held on March 8, 2012, the awards were presented to the team members by Dean Claire Pomeroy. 

Research team members are pictured above, from left to right: Zhuo Yang, Colleen Cameron, Ben Timmons, Carolyn Coleman, Teresa Farley, Joy Melnikow. Not pictured are Laura Bates Sterner, Meghan Soulsby, and Dominique Ritley.

Dean Claire Pomeroy is at far right. 

Many thanks to the CHPR research team for their excellent work.  In addition to award certificates, the department received $5000.00 for further team training and development. 

Romano, Chin receive pilot award from CTSC

- Award Amount: $20,000
- PI: Patrick Romano
- Funder: UC Davis Clinical and Translational Science Center

Dr. Patrick Romano and David Chin have received an award to conduct a pilot project in collaboration with Dr. Ashley Trask in the Pharmacy Department and Department of Internal Medicine. The project titled, “Does the Teaching Service Measure Up? Comparing Different Models of Physician Care and the Effect of Trainee Workload on Medication Order Errors” compares two inpatient physician models-of-care and multiple attributable patient outcomes using electronic health record data.

ABSTRACT

Background and Significance: Residency training is an important and necessary component of healthcare delivery. In many specialties, much of this training occurs in a hospital or analogous “on-the-job” environment.  An inexorable element of any human training process is error. In recent years, efforts have been made to improve the postgraduate training environment and to obviate the likelihood of error that compromises patient care. However, these efforts have been largely focused on limiting the number of work hours a trainee may work in a given time period, and other factors that may contribute to trainee errors have not been investigated. In a series of seven recent papers (with another currently under review),1-7 I and my colleagues at the University of Pennsylvania demonstrated that the 2003 work hour rules implemented by the Accreditation Council for Graduate Medical Education had little measurable effect on patient outcomes (with the possible exception of mortality for high-risk medical conditions at Veterans Affairs hospitals), suggesting the need for additional research to determine “what works” to reduce medical errors in residency training programs. Multiple factors contribute to quality-of-care in the training environment, yet few studies assess the quality of care delivered by trainees in a hospital setting. To our knowledge, the quality of care provided by an attending/trainee team has not been compared to attending-alone service.

Hypotheses:
(1) Hospitalized internal medicine patients at UCDMC admitted to attending/trainee teams experience more medication errors, nosocomial infections, and ICU transfers when compared to patients admitted to attending-only teams (after adjusting for observable patient characteristics).
(2) The odds of internal medicine residents’ medication order errors on attending/trainee teams is associated with postgraduate clinical experience, time of day/day of cycle, patient load, and patient acuity.       

Aims and Experimental Plan: We will obtain electronic health record data to conduct a retrospective pilot study to compare two inpatient physician models-of-care and multiple attributable patient outcomes.  We will then identify trainee risk factors obtained from EHR and the Department of Internal Medicine that may be associated with medication order errors on teaching services.  A retrospective cohort design will be used, with cohorts of at-risk patients on teaching and non-teaching internal medicine services selected from a Clarity database exported from Epic.  

Questions to be Answered: Our work will help to answer multiple important questions: (1) Do internal medicine teaching services provide lower quality/safety of care than non-teaching services, given equal attending experience and training? (2) What potentially modifiable physician-trainee risk factors are associated with medication order errors? (3) Can EHR be used to evaluate associations between hospital, physician, and environmental factors and medication-related quality of care?       

UC Davis physician named to national panel evaluating how physicians are paid

SACRAMENTO, Calif.) —  Richard Kravitz, UC Davis professor of internal medicine, has been named to a newly formed independent commission that will assess how physicians are paid. Kravitz's research has long focused on the causes and consequences of physician behavior, the physician-patient relationship, and how patients influence the quality of their own care. He joins a panel established by the Society of General Internal Medicine and chaired by former U.S. Senator Bill Frist and the former president of the Robert Wood Johnson Foundation, Steven Schroeder.

Patient Satisfaction Linked to Higher Healthcare Expenses and Mortality

February 13, 2012

(SACRAMENTO, Calif.) — A team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more health-care and drug expenditures, and have higher death rates than patients who are less satisfied with their care.

Published today in the Archives of Internal Medicine, the national study is believed to be the first to suggest that an overemphasis on patient satisfaction could have unanticipated adverse effects.

"Patient satisfaction is a widely emphasized indicator of health-care quality, but our study calls into question whether increased patient satisfaction, as currently measured and used, is a wise goal in and of itself," said Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine and lead author of the study.

Prior studies have shown that patient satisfaction strongly correlates with the extent to which physicians fulfill patient expectations, according to Fenton.

"Doctors may order requested tests or treatments to satisfy patients rather than out of medical necessity, which may expose patients to risks without benefits," he said. "A better approach is to explain carefully why a test or treatment isn't needed, but that takes time, which is in short supply during primary-care visits." 

Patient-satisfaction surveys are commonly conducted by health systems to evaluate patients' perceptions of their encounters with physicians. The results can be used to establish quality-improvement measures with the hope of strengthening patient loyalty. (more)

Lecture:  The Ethics of Healthcare in Global Perspective

• Speaker:  T.R. Reid, Washington Post correspondent and Bureau Chief
• Date:  Thursday, March 1, 2012
• Time:  6 p.m. to 8 p.m.
• Location:  Lecture Hall on the University of the Pacific, McGeorge School of Law campus, 3200 Fifth Ave., Sacramento,
• Admission is free, open to all.
• Visit the Event Website to register for this event. 

Two UC Davis pediatricians lauded for contributions to child health

February 7, 2012
(SACRAMENTO, Calif.) —Two UC Davis pediatricians have received the 2012 Eli Gold Faculty Achievement Prize for their contributions to UC Davis Children's Hospital and the Department of Pediatrics.

Assistant Professor Mark Underwood, a neonatologist, and Associate Professor Ulfat Shaikh, a general pediatrician and CHPR member and researcher, share the honor. It is the first time that two recipients have been chosen for the annual award, which is named for the department's former chair.

The award acknowledges UC Davis Department of Pediatrics faculty members who, by way of their contributions to the department, children's hospital and School of Medicine, have achieved prominence in clinical, teaching, research or community service. The recipients' qualifications are judged by their innovativeness, impact on child health and impact on UC Davis Children's Hospital or the broader community.

"These two faculty members are wonderful examples of pediatric academicians who are enhancing the futures of our children and educating the clinicians of tomorrow," said Department of Pediatrics Chair Anthony Philipps. "They truly are credits to the entire institution." (read more)

Worker's Compensation Premium Hikes Linked with Stock Losses, Rather than Claims

September 19, 2011

(SACRAMENTO, Calif.) — Skyrocketing workers' compensation claims payments are often blamed for rising premiums, but a UC Davis study has found that the number of claims has dropped during the past two decades. Published in the September-October issue of Public Health Reports, the study shows that higher premiums are instead associated with decreases in the Dow Jones Industrial Average and interest rates on U.S. Treasury bonds.

"Insurance companies appear to have been setting premiums according to their returns on the stock and bond markets, not according to the number of claims they have," said J. Paul Leigh, UC Davis professor of public health sciences and senior author of the study. "They invest because they need a financial cushion to pay for claims and, if they lose, raise premiums to recoup their losses."  (read more) 

Nishijima wins CHPR Comparative Effectiveness Pilot Award

July 28, 2011

Daniel K. Nishijima, M.D., M.A.S., Assistant Professor in the Department of Emergency Medicine, has been awarded $17,200 in pilot funding from the CHPR for his proposal entitled "Comparison of a Clinical Decision Instrument versus Usual Care to Risk Stratify Children for Intra-abdominal Injury after Blunt Abdominal Trauma:  A Cost-Effectiveness Analysis."  The proposal was one of several submitted in response to a recent call for pilot award proposals in the area of comparative effectiveness research. 

The specific aims of Dr. Nishijima's project are to analyze an existing, population-based data set to determine CT utilization practices in pediatric patients with blunt abdominal trauma in the United States, and to model the cost-effectiveness of a clinical decision instrument compared to usual care for pediatric patients with blunt abdominal trauma.  The goal of the research is to improve the utilization of CT imaging in injured pediatric patients and improve the translation of current evidence into clinical practice. 

Dr. Nishijima will work with co-Investigators James F. Holmes, M.D., M.P.H., Bryn Mumma, M.D., and Joy Melnikow, M.D., M.P.H. 

UC Davis CHPR researchers find work hours vary widely by physician specialty, could expand gap in access to primary care

July 15, 2011

(SACRAMENTO, Calif.) — The amount of time physicians spend on the job can vary widely based on specialty, according to UC Davis research published July 11 in the Archives of Internal Medicine. More than 25 work hours per week separated the most time-consuming specialty of vascular surgery and the least time consuming of pediatric emergency medicine.

Coupled with their previous research on physician pay, the authors note that primary-care physicians (pediatricians, family practitioners, geriatricians and internal medicine specialists) have working hours toward the middle of the range but earn toward the lower end of the wage scale. Together, the outcomes indicate that the gap in access to primary-care physicians is likely to expand.
“It is doubtful that medical students will want to enter primary care if there continues to be such a mismatch between hours worked and wages compared with other specialties,” said J. Paul Leigh, professor of public health sciences and lead author of the study. “Policymakers who make medical payment decisions should strive for better balance.”

Leigh said the current study has important implications for health-care reform, which will greatly increase demand for primary-care doctors who are already in short supply. (Read full article)

May 10, 2011: ASIAN-AMERICAN SMOKERS LESS LIKELY TO GET ADVICE ABOUT QUITTING FROM HEALTH-CARE PROVIDERS

(SACRAMENTO, Calif.) — Research has demonstrated that smokers are far more likely to quit if their doctor or other health-care provider advises them to do so, but new research from UC Davis has found that Asian-Americans are not getting the advice as often as the general population.
Elisa K. Tong and Moon S. Chen of the UC Davis Cancer Center reported this month that less than a third of Chinese-Americans, Korean-Americans and Vietnamese-Americans reported receiving quitting advice from their providers in the past year, in contrast to 46 percent of smokers in the general population.

“Advising a patient to quit smoking is considered the standard of care, and it doubles their chances of quitting,” said Tong, an internal medicine physician and tobacco control expert. (Continue reading)

May 6, 2011:  Patricia Zrelak to receive Employee Excellence award for Diversity

CHPR Administrative Nurse Researcher and manager of the UC Davis Stroke Program Patricia Zrelak will receive the annual UC Davis Health System's Employee Excellence award for diversity. 

The award will be bestowed at the annual Employee Excellence Awards and Diversity Celebration Breakfast on Tuesday, May 24, 2011.  Congratulations to Pat for this well-deserved recognition for her excellent work. 

April 29, 2011:  Bakerjian receives award at Western Institute of Nursing Conference

Assistant Adjunct Professor in the School of Nursing and CHPR member Debra Bakerjian was given the prestiious Western Institute of Nursing/John A. Hartford Foundation Regional Geriatric Nursing Research Award for a New Researcher, competing with nominees from across the western United States.  The award was presented at the Western Institute of Nursing Conferece in Las Vegas in April, 2011.  (Read more) 

April 29, 2011:  Von Friederichs-Fitzwater to be honored with prestigious award at May 7 Race for the Cure

CHPR Member Marlene von Friederichs-Fitzwater has won the 2011 Joyce Raley Teel Award for outstanding dedication to breast health in the Sacramento Valley.  She will receive the award on May 7 during the 15th annual Race for the Cure at Cal Expo.  (Read more) 

April 27, 2011:  CHPR Executive Committee Member wins $4.8 million grant to fight child obesity

(Davis, CA - Sacramento Bee) - University of California, Davis professor and CHPR member Adela de la Torre has won a $4.8 million grant to combat child obesity in the Central Valley.  (read more)

April 25, 2011:  Stroke Care Program at UC Davis Receives Quality Achievement Award

The UC Davis Stroke Program, managed by CHPR  Researcher Patricia Zrelak, has been awarded a 2011 Get With the Guidelines Stroke Gold Plus Quality Achievement Award from the American Heart Association/American Stroke Associateion for its commitment to and success in implementing excellent care for stroke patients.  (read more) 

The print version of the CHPR newsletter has been retired.  Stories of interest to the CHPR membership and staff will continue to be posted here.  Please continue to submit your news items.  All submissions with relevance to the mission of the Center will be considered for inclusion.  If you have news to submit, please send your information to:

Laura Bates Sterner
laura.sterner@ucdmc.ucdavis.edu 
(916) 734-7918