1. < Cardiology/Epi

Tomorrow is election day. This represents the opportunity within our democracy to have our voices heard on issues that impact our lives and values. Recognizing that we do not all agree, it is concerning that the political discourse has become increasingly polarized devolving into acts of hatred, intolerance and even violence. It is important to us as a department and institution that we create an environment in which all voices are heard, while respecting differences with civility. Many of us have noted with concern an alarming increase in hate speech directed against various groups. This afternoon UCLA Health and the DGSOM will be hosting a Community in Action session to address a rise in antisemitic and other discriminatory language and acts, locally and across the nation. Register at this link: Community in Action to participate in this event this afternoon 11/7 at 6 pm via Zoom.

In addition to openly confronting hate, it is also essential to apply scholarship and research to better understand the causes and consequences of discrimination to inform public policy. In October, UCLA announced the launch of the 3-year pilot project, Initiative to Study Hate, inviting fellows from across 20 disciplines to lead research aimed at understanding and mitigating hate, and that will support the design of interventions in health care, education, public policy, and other fields. I was pleased to learn that two members from our GIMHSR division, Dr. Carlos Irwin Oronce and Dr. Evan Michael Shannon, will be leading studies as a part of this social impact project which is launching at a time when we are seeing an increase in social, political, and economic tension that is being expressed as violence and/or hate.

Dr. Oronce’s project, titled “Evaluating the Spillover Effects of the 2021 Atlanta Mass Shooting on the Population-Level Mental Health of Asian Americans,” will examine how the 2021 Atlanta spa mass shooting impacted population-level mental health of Asian American’s, particularly Asian American women. Using data from the California Health Interview Survey and the US Census Bureau’s Household Pulse Survey, this observational study uses a differences-in-differences design to compare the mental health of Asian Americans to non-Asian American populations, before and after the mass shooting. This research will help us better understand how exposure to hate and violence committed against Asian American women impacts community health. Dr. Oronce will be joined by scholars in the Fielding School of Public Health and the Luskin School of Public Affairs.

Studies have found that hospital security personnel are summoned for emergent patient situations that affect 1-2% of non-psychiatric inpatients. A recent follow-up study demonstrated that when adjusted for covariates, Black patients had a 37% higher chance of experiencing a security emergency response, when compared to White patients. In the research project, “Race, Ethnicity, and Utilization of Security Emergency Responses Among Non-Psychiatric Patients,” Dr. Evan Shannon will explore whether these findings can be generalized to UCLA Health. Using quantitative and qualitative methods, Dr. Shannon will compare the rates of security emergency responses and security emergency responses requiring physical restraint among racially and ethnically diverse patient populations admitted to a UCLA Health hospital. Researchers will adjust for possible confounding factors by using multivariable logistic regression models. They will also conduct interviews and surveys with patients who identify as Black and/or Latinx, their families and caregivers to determine common experiences and themes. Dr. Shannon will collaborate with Mikel Whittier, director of UCLA Health’s Office of Health Equity, Diversity, and Inclusion.

Another hot button issue in our local and national politics revolves around issues of housing insecurity and the growing numbers of unhoused members of our community. Although our mission is to provide world-class patient care, we know that health is impacted by many factors outside of the walls of the hospital or community practice. We often see patient health outcomes worsening due to social determinants such as food insecurity, housing instability, and pollution. Last week, Dr. Katherine Chen published, “Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review,” which evaluates how interventions aimed at preventing homelessness could impact health outcomes.

According to Dr. Chen, the review included 26 articles that described three randomized trials, 20 observational studies and identified moderate-certainty evidence that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Chen and researchers found that interventions such as emergency rent assistance, legal assistance with waitlist priority for public housing, long-term rent subsidies, and homeownership assistance demonstrated mixed or low certainty of evidence for impacting health outcomes.

Overall, Dr. Chen and researchers recommend that interventions aimed at preventing homelessness may need to be accompanied by other initiatives aimed at addressing social determinants of health. They conclude that “as health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway, interventions should focus to ensure the most effective and equitable health impact.”

Climate change, environmental degradation and their impact on health represents another active area of political discourse. Dr. Jesus Araujo, from the division of cardiology, and Dr. David Eisenman, from the division of GIMHSR, are joining a multidisciplinary team of researchers to conduct the Aliso Canyon Health Research Study. You may remember the gas blow-out which took place in the northwest San Fernando Valley in 2015-2016. It is estimated that the blow-out released 109,000 metric tons of methane into the atmosphere. This $21 million grant will study the short term and long-term health outcomes in local communities resulting from the gas blow-out. Dr. Araujo will serve as the health and well-being core co-lead and Dr. Eisenman will serve as the community stakeholders communications core lead. Read the press release from the UCLA Fielding School of Public Health here.

Last week, Medicine Grand Rounds addressed the issue of criminalization of abortion. This is a subject on which there is much disagreement, and passionately held views on both sides of the debate. The lecture presented perspectives not often considered during debates.

Last week on Tuesday, November 1, department of medicine professional group (DMPG) leadership and I were happy to welcome nearly 900 DMPG faculty via zoom and in-person at our annual meeting. While we experienced technical difficulties with audio for our zoom audience, we will be sharing a summary of the presentations and select PowerPoint slides later this week so that you can access the information presented.

The DMPG accomplished many impressive feats in fiscal year 2022. We reached nearly 2.3M patient encounters, over 4.2M wRVUs, and surpassed the $1B mark in clinical revenue. I discussed the important contribution of non-RVU revenue to support our faculty compensation, and the physical and human resource infrastructure that sustains our department’s clinical activities.  I applaud your collective hard work in achieving these milestones, as well as recognize the leaders who are driving these collaborative efforts within the DMPG that propelled this growth. As we look towards the future of our department, we are in a strong position to invest in new initiative’s that will advance our missions. Most importantly, we are doing so with a strong focus and commitment to advancing faculty and staff well-being.

In the 2022 DMPG Survey, 57.7% of respondents identified that they were burning out. The message was re-iterated throughout our regional townhalls. Since then, the department of medicine (DoM) and the Wellness Committee have instated many wellness initiatives that include expansion of a professional coaching program, connecting faculty to wellness resources, and partnering with division wellness efforts. I am pleased to share that we will be adding sustainability blocks, streamlining education and CME hours, increasing flexibility in the use of personal days, previously called “sick days” and continuing to centralize of wellness resources online to ensure that these efforts are more visible and easier to access. We will continue to build on this foundation to ensure that faculty are supported in their professional development.

During my DMPG presentation I showed a list of Super Doctors. I recognize that these lists do not reflect the depth and breadth of our clinical excellence, or all the exceptional work performed throughout our department and across our missions. That said, I was intrigued to learn that among the DoM, we have nearly 300 Super Doctors and Rising Stars, who have been identified by their peers as excelling in their fields and demonstrating leadership within their practice. Each year, Super Docs awards anywhere between 1,800 – 2000 physicians in greater Los Angeles area. While the Super Doctors list certainly does not capture all the talent within our department, the DoM currently makes up 11% of all Super Doctors across Southern California. It is one example that demonstrates the strength of our reputation amongst our peers. You can view the list of Super Doctors and Rising Stars here. Congratulations to all faculty who have been awarded the Super Doctor or Rising Star distinction. A new list will be released in January 2023, and I look forward to celebrating the growing body of Super Doctors and Rising Stars among our ranks.

Our education mission continues to grow. Our recruitment strategy is ensuring that we are recruiting talented and diverse trainees who are going on to become leaders in medicine or pursuing advance training in top-ranked programs. It is uplifting to see how highly invested DoM faculty are in nurturing the development of our trainees. Likewise, our research mission had a successful 6 months of fundraising from January 2022 – June 2022, raising over $274M in extramural funding.

It truly was a joy to share this great news with members of our DMPG last week. I look forward to building on these successes through our department’s strategic planning process which will guide us over the next 5-10 years.

Thus, it is with great pleasure that we announced last week the appointment of Libby Shin into the new role of Executive Director: Office of the Chair of Medicine, David Geffen School of Medicine, and UCLA Health. I look forward to working closely with her on a diverse portfolio of initiatives. Libby will serve as project lead on the development and implementation of the department’s strategic plan, in addition to other roles.

In early 2023, the DoM will begin the development of our strategic plan. With broad and comprehensive input from diverse voices across DoM, our process will ultimately establish a roadmap that will articulate our mission, vision, values, and priorities to guide us in our next decade of growth.

We expect the planning process to occur in phases over approximately 9 months and look forward to inviting the DoM community to engage in this work through focus group, town hall, survey, and design team participation. Please look for more information in January. I want to thank the members of the initial strategic planning steering committee for their assistance to date in helping us evaluate proposals from strategic planning consultants, and evaluation and selection of the group that will work with us in this important endeavor. We will be reaching out to many more of you to solicit your active participation at various stages of this process.

Dale

P.S.

I used the Westwood Plaza ballot drop box last week. If you work on campus no excuses, please.  Let your voice be heard.