Riverside University Health System
AMBULATORY CARE REDESIGN AWARD
Santa Clara Valley Medical Center
DATA-DRIVEN ORGANIZATION AWARD
Zuckerberg San Francisco General Hospital
TOP HONOR (KAISER PERMANENTE CLINICAL SYSTEMS DEVELOPMENT AWARD)
University of California, San Francisco
PERFORMANCE EXCELLENCE AWARD
Top Honor - Zuckerberg San Francisco General
The City and County of San Francisco, with a population of approximately 800,000, has California’s 8th highest violent crime rate. Annually, 3,000 to 4,000 visits to the Zuckerberg San Francisco General Hospital (ZSFG) Emergency Department are for injuries related to assault, and of these, 500 to 600 lead to inpatient hospitalization. Upon witnessing the necessity for an intervention, in 2001, the ZSFG Trauma Recovery Center (TRC) was designed to treat some of California’s most vulnerable citizens: survivors of violent crime who experience the devastating aftermath of violence.
Although the ZSFG Emergency Department and Level 1 Trauma Center can provide high-quality medical care, there is a struggle to manage the enormous psychosocial issues facing survivors after hospital discharge. Approximately 50% of people who survive a violent crime develop psychological or social difficulties unless given effective mental health treatment.
The ZSFG TRC developed a new model of care for survivors that combines outreach, clinical case management, and trauma-informed evidence-based mental health and substance abuse services. This model also incorporates coordination with law enforcement, medical care and social services to help survivors deal with the emotional wounds and practical impact of violence. This innovative model has been proven to be both clinically and cost-effective. For example, TRC services increased survivors’ return to employment by 56%, and reduced homelessness by 41% compared to survivors that did not have TRC services. Ninety-three percent of clients said that TRC services helped them feel better emotionally, 83% said TRC helped them cope better with medical problems, and 87% had improvements in dealing with alcohol and drug problems. In addition, TRC services have been shown to cost 34% less than usual care.
The spread of this program is far-reaching. On October 8, 2017, Governor Jerry Brown signed AB-1384, which creates statewide standards for Trauma Recovery Centers across California, and noted that the UCSF/ZSFG Trauma Recovery Center is the pilot and model on which other centers should be based. Thanks to the work of ZSFG, many health systems in California will have the necessary tools to provide appropriate care to survivors of violence.
Performance Excellence - UCSF Health
With the expansion of health care coverage to more Californians, the University of California, San Francisco (UCSF) Primary Care Practices experienced a sudden surge of patients needing care. In order to continue providing excellent care, UCSF hired many panel managers to provide proactive, population-based care to patients outside of their hospital visits. But even with more staff, thousands of new patients still needed timely follow-up and care management. To improve health outcomes, the team turned to an automated telephonic outreach program and a workflow optimization dashboard. The goals were to establish standardization across clinics, eliminate unnecessary manual efforts, and effectively engage the growing population beyond the walls of the practice.
The utilization of health technology was integral in expanding the outreach and care management capacity of the organization. Over six months, 28 patients were screened for cervical, colorectal or breast cancer under the traditional model at the pilot clinic site. Under this new program, 222 patients were screened in the same timeframe, leading to an 8-fold increase in the number of UCSF patients screened for cancer. The technology-assisted panel management program was expanded beyond the pilot site to all UCSF Primary Care Practices and played a significant role in UCSF’s ability to achieve 90th percentile performance for the three related PRIME cancer screening metrics.
The new model provides an opportunity to not only proactively detect potential early cancer across a primary care population of more than 80,000 patients but also to become more efficient in patient engagement. Since the program’s inception, panel managers feel more productive and effective in their day-to-day work. Nurse managers no longer have to spend time prioritizing outreach initiatives and monitoring the work of panel managers. This allows key staff to invest more time in providing patient care and less time on failed outreach.
The program has expanded to other University of California (UC) medical centers and the UC Office of the President is actively exploring the opportunity to offer the technology services to the entire UC Health System.
Data-Driven Organizations - Santa Clara Valley Medical Center
With the demands of multiple reporting requirements including the Medi-Cal 2020 waiver programs, Santa Clara Valley Medical Center (SCVMC) recognized the need to strengthen their capacity to record, monitor, and analyze health metrics at the health system level. There was a strong impetus and need to improve the system’s Electronic Health Record (EHR) to enhance functionality and embed reporting within health records. In order to achieve this, SCVMC worked diligently to adapt their current EHR to achieve HIMSS ® Stage 7 as a certified EHR that goes beyond capturing data, to routinely analyzing and leveraging that data to improve health outcomes.
Reaching this level of advanced technology is extremely rare for a public healthcare system; only 5% of nationwide healthcare organizations achieve HIMSS ® Stage 7 Acute Care certification, and only 10% have achieved HIMSS ® Stage 7 Ambulatory certification. Securing certification allowed SCVMC to highlight key case studies that demonstrate the range of improvements and outcomes achieved by a data-driven organization. Examples include the addition of patient care scores to patient schedules, allowing clinicians to better prepare for treating complex patients; streamlining patient flow through workflow optimization from ED to discharge; incorporating the eConsult specialty referral platform to improve access to specialty appointment. Improved outcomes came from more effective infrastructure and operational investments, like at the SCVMC Logistics Center, which houses an interdisciplinary team and more effective data governance committees, and enhances leadership engagement with the initiatives.
This level of technological sophistication distinguishes SCVMC as the first county healthcare system in California to achieve this level of integration, underscoring the remarkable transformation of organizational culture that has occurred system-wide just four years after starting the current EHR implementation. This program has spread throughout all outpatient ambulatory clinics and is currently being rolled out to all specialty centers in the system and primary care behavioral health.
Ambulatory Care Redesign - Riverside University Health System
Like many other parts of California, Riverside County has faced a shortage of providers to care for a growing population. The expansion of healthcare coverage in the last decade has further increased demand. Together, these elements created an access challenge for patients seeking health care in Riverside County and at Riverside University Health System (RUHS). To increase access and provide optimal care coverage, RUHS clinic leadership, staff, and providers came together to create an alternative visit pathway using telephone visits to improve patient access and support patient-centered care at the right place and at the right time. The telephone visit pathway was also designed to meet the needs of providers in a resource neutral manner.
The RUHS telephone visit program first began as a pilot with one primary care provider at one clinic in 2013. The pilot process involved weekly workgroup meetings and numerous Plan-Do-Study-Act (PDSA) cycles, which involved mapping and testing new processes and training front desk and back office staff, schedulers and providers. In the early stages of the program, RUHS closely monitored appointment backlogs for providers who were and were not providing telephone visits and found that backlogs consistently improved among providers utilizing telephone visits. The program has since grown to presently include 54 primary care providers at 12 clinic sites. In just the 2016-2017 year, RUHS primary care providers completed more than 7900 telephone visits.
The implications of the telephone visits program are far-reaching. In addition to improving appointment wait times, RUHS has piloted telephone visits as a population health strategy to care for patients with poorly controlled diabetes. Phone visits are used in this population to discuss medication management, provide motivational interviewing, and support lifestyle modifications with improved self-management support. Early results from this pilot show an increase in appropriate A1C testing and an improvement in A1C control.
RUHS will next expand the telephone visit program to all specialty care clinic sites within their system. In addition, RUHS has spread their learning to other public healthcare systems and clinics in California and nationally, through their work with the Safety Net Institute and the Center for Care Innovations, hosting several site visits and conducting telephone visit training workshops for a variety of organizations.