Week 31: Across the Continuum
I had lunch with our nine chief residents last week. They were introduced in an earlier post. They are fully in their stride as leaders of our internal medicine training program. We talked about the critical work they do, not only to ensure that our trainees receive their duty assignments, but about new educational innovations across our training sites that will equip our residents to be competent and empathetic internists. I learned about their role in triaging and managing the many requests for patient transfers from outside hospitals or providers to Ronald Reagan UCLA Medical Center. I was impressed by how they have been adeptly managing the staffing challenges brought about by COVID infections. I reminded them that they are leaders now who will become the influencers of tomorrow and we look forward to partnering with them to achieve their goals.
The journey for junior faculty recently completing fellowship training and aspiring towards a career in academic medicine is a long one. There is the expectation that they will pursue an area of research or scholarship that uniquely distinguishes them from their peers. To get there requires mentorship and support. An important milestone is the ability of our junior faculty to obtain nationally competitive career development awards that secure salary support for the protected time required to develop their independent research programs, while continuing to receive mentorship from senior faculty. I was therefore pleased to learn that Dr. Ramin Salehi-Rad, was the recipient of a Career Development Award from the Department of Veterans Affairs.
The proposal entitled: Flt3l gene-modified cDC1 in situ vaccination in NSCLC: mechanisms and therapeutic application seeks to understand ways to improve the outcomes of patients with non-small cell lung cancer (NSCLC), by exploring a novel approach that will immunize lung cancers with engineered cells that will boost the tumor killing immune response. Under the mentorship of Dr. Steven Dubinett, our interim dean and distinguished faculty member in our division of pulmonary and critical care medicine, the award will enable Dr. Salehi-Rad to pursue studies as summarized below.
"Despite recent advents of immunotherapy, many patients with NSCLC do not respond to therapy or relapse following an initial response; therefore, there is a critical need for the development of synergistic approaches that augment the efficacy of immunotherapy. One approach to improve responses to immunotherapy is to utilize in situ vaccination (ISV) with rationally engineered cytokine-secreting antigen presenting cells to generate broad tumor-specific T cell responses. This proposal seeks to understand the molecular mechanisms of ISV with cytokine-secreting elite antigen cross-presenting conventional type 1 dendritic cells (cDC1) in murine NSCLC to facilitate the development of novel DC-based immunotherapy for patients with lung cancer."
Like a relay, the next milestone in the journey is competing successfully for a large federal grant to continue work developed during the career development phase. I am pleased to share a recent example of such a transition by Dr. Folasade (Fola) May, an assistant professor in our division of digestive diseases, who recently received her first independent (RO1) award from the National Institutes of Health. The 5-year award of greater than $2M is entitled: Multilevel health system intervention to increase surveillance colonoscopy for high-risk colorectal polyps
The award will support research evaluating a multilevel health system intervention aimed at increasing surveillance colonoscopy for patients with high-risk colorectal polyps. This project will use natural language processing and artificial intelligence to identify patients who are at high-risk of developing colorectal cancer. Intervention components will be directed towards the patient, their physician, and CareConnect to ensure that surveillance colonoscopy is performed in a timely manner. Dr. May will collaborate with faculty from across UCLA Health including GIMHSR, pathology, health economics and informatics on this research project.
Dr. May is director of the Melvin and Bren Simon GI Quality Improvement Program, associate director of the UCLA Kaiser Permanente Center for Health Equity in the UCLA Jonsson Comprehensive Cancer Center, and assistant director of the UCLA Specialty Training and Advanced Research Program.
Our department is committed health equity. I recently learned of an initiative by the division of geriatrics that seeks to support the needs of patients with dementia in the state of California.
The number of Californians aged 65 and older living with Alzheimer’s disease is expected to more than double by 2040. A critical step in meeting the needs of this growing population is early recognition of cognitive decline. Dementia Care Aware is a new state-wide initiative that provides training, tools, and resources for primary care providers (PCPs) on conducting cognitive health assessments and then helping them improve their dementia care. Dementia Care Aware (DCA) is designed for all PCPs and their healthcare teams with a focus on Medi-Cal providers to help increase access to quality care for underserved patient populations demonstrating a higher prevalence of Alzheimer’s disease and related dementias.
In support of the Dementia Aware Initiative, members of our geriatrics division Dr. David Reuben, Dr. Michelle Panlilio, and Katherine Serrano participated in development of a screening tool and training in its use. The UCLA team will also help practices, community health centers, and health systems improve the care of their patients living with dementia beginning with the administration of a Readiness Assessment Instrument that will identify the practices’ specific goals for improving dementia care and the culturally-competent resources that can be brought to accomplishing these goals.
Based on responses to this instrument, the UCLA team will recommend individualized options and assist with implementation. The range of options to improve dementia care include (from least resource intensive to most resource intensive):
- A Dementia Care Aware toolkit for care planning after dementia is diagnosed and optional participation in the Dementia Curriculum of the UCLA Intensive Course in Geriatric Medicine.
- Participation in the Alzheimer’s Association’s Extension for Community Healthcare Organizations (ECHO) training series.
- Referral to the developers of other models of comprehensive dementia care for technical assistance in adaptation and implementation.
- Implementation of the UCLA Alzheimer’s and Dementia Care (ADC) Program, customized to the adopting practice’s goals and resources. The ADC is an award-winning, health system-based co-management model of advanced practice providers (usually Nurse Practitioners or Physician Assistants) Dementia Care Specialists working with primary care and specialty physicians that is designed to meet dementia care needs. The program has demonstrated effectiveness on all components of the triple aim of better care, better health, and lower costs, including saving Medicare $2404 per beneficiary per year. The local program has continued to grow with over 3513 participants and their families having been served and over 750 currently active. Moreover, the ADC program has been disseminated to 14 health care practices nationwide (including UC Davis and UC San Diego).
Through Dementia Care Aware and other dissemination efforts supported by the John A. Hartford Foundations, a paradigm model of dementia care developed by our geriatrics division can help persons living with dementia and their caregivers throughout California and nationwide.
Finally, as I continue to introduce new faculty who have joined the department of medicine starting July 1, let me introduce you to:
GIM Primary Care
Welcome on board!
My granddaughter and her parents returned to their home over the weekend.
Her parents saw the post of me getting an In-N-Out burger in the office, so they tried encouraging her to emulate her grandfather.
I had to set the record straight though.
Our house here is quiet again, so cheer me up.