Year 2. October 9. Celebrating Our Commitment to Health Equity.
Throughout Southern California, department of medicine (DoM) faculty are providing essential medical care to communities in high need. You may find faculty at community hospital partners such as Martin Luther King Jr. Community Hospital, Olive-View UCLA Medical Center, or leading the UCLA Health Sickle Cell Center of Excellence to reach communities that are historically medically underserved. As we look towards the future, the department is committed to expanding our community outreach and ensuring that we are doing our part to address health care inequities. In the future, I will share more information about our growing partnerships with FQHC’s such as To Help Everyone (T.H.E.) Health and Wellness Centers which will allow us to provide primary and specialty care services in their service area. Today, I highlight additional initiatives where our faculty are providing impressive leadership, demonstrating our core values embracing equity diversity, inclusion and justice (JEDI) across our missions of patient care, research, and education.
Providing High-Quality, Comprehensive Care to our Unhoused Neighbors
In 2022, the UCLA Health system launched the Homeless Healthcare Collaborative (HHC) to provide medical and behavioral health care services to community members experiencing homelessness. In Los Angeles County, over 70,000 people are experiencing homelessness with only 5-10% receiving medical care from street outreach teams. Since the programs launch, UCLA Health medical providers, which includes 10 faculty from the DoM, have provided care to over 9,000 unhoused Angelenos in the communities of Downtown LA, South and West LA, and North Hollywood. It is a privilege to share with you a few words from the DoM faculty who have played key roles in providing high-quality, trauma-informed, comprehensive care which includes chronic disease management, infectious disease screening, wound care, and much more.
“I am proud to be part of the HHC team for the 2nd year. With the continued expansion of this collaborative, it has been gratifying to form relationships with people in the community and see their health and living situation improve over time. Having completed my residency at Olive View, a safety net hospital in LA, I have been looking forward to using my training and applying the resources from UCLA Health to best care for the underserved while being mindful of their unique circumstances.”
“I’ve been working with HHC for the last year and a half. I've provided medical care to the unhoused for many years, and I knew when UCLA started this program that I wanted to help. It’s exciting to bring the skill and care of UCLA nurses and doctors to this community. For me, it’s about meeting people where they are, understanding their unique challenges, and thinking creatively about how to best provide them with care. As HHC continues to grow, I’m hoping to focus on more preventive care and greater management of the chronic diseases that are often so poorly controlled in the unhoused population.”
“I have been with HHC since April 2022. I previously had done global health work, splitting my time between Los Angeles and Liberia, West Africa for about 8 years. I joined HHC as I was looking for a similar opportunity to deliver healthcare to communities in need and in settings that are proximate to the patients. It has been an incredible privilege to serve with the HHC team.”
“My time with the HHC began after realizing my interest in working with this vulnerable population 1.5 years ago, after exposure during COVID when the Internal Medicine Residency Global Health pathway turned to local under-resourced care. After each shift over the last 1.5 years, I have been left with a feeling that I am truly making a difference, helping an often forgotten and misunderstood population with sizeable unmet healthcare needs. The fulfillment, sense of purpose and balance that it has brought to my work in medicine is unmatched.”
“I've been fortunate enough to have been a part of UCLA's Homeless Healthcare Collaborative since April 2022. I joined because I wanted a larger role in preventative medicine for our neighbors in the community and to help improve their health by delivering care to them in a model designed to overcome some of the barriers they may face. It's inspiring to be a part of such a talented and passionate team and seeing the tangible results in the patients we serve is what brings me back every time.”
“I have been working with HHC since Summer 2022. I signed up to join shortly after joining UCLA faculty in Fall 2021 because I was struck by the staggering crisis of homelessness in LA after moving from Boston and wanted to be actively involved in taking care of some of our city’s most vulnerable people. It has been incredible, invigorating and inspiring to be a part of this group and taking care of people experiencing homelessness across LA. I believe that street medicine and mobile clinic care delivery is essential to ensure that persons experiencing homelessness receive the healthcare they need as there are so many barriers for these folks to access traditional brick and mortar clinics. I am also excited to be co-leading an evaluation of HHC and its impact on the patients it serves.”
"Working with the UCLA HHC as a provider since March 2022 has been a transformative experience that has showcased the remarkable growth of a compassionate and mission-driven organization. HHC's unwavering commitment to providing equitable clinical care to the unhoused community of Los Angeles is a mission that I am proud to be a part of. Working with the nurses, social workers, and community health workers to break down barriers and ensure access to healthcare for this vulnerable population has not only expanded my understanding of healthcare disparities but has also reinforced the belief that collective action can lead to meaningful change in our society. Go HHC!"
“I joined the HHC team a little over a year ago. As soon as I learned about the initiative, I knew I wanted to participate. It's been nothing short of amazing so far. The team is fabulous, and everyone is kindhearted and highly empathetic. We have the same goal: to help those much less fortunate than us.
Why did I join? Well, I know how it feels to struggle in life. I grew up in Poland, and my family was not always as blessed as we are now. I have a lot to be thankful for, including being part of the UCLA system; it sounds cheesy but it’s completely true. As a result, I can’t imagine a better way to return it to the world than to help people who are struggling all around LA. Also, after moving from NYC, where I lived for nine years, it broke my heart to see how many homeless are overlooked and became a part of the background for the people of LA. I want to change that perception. The problem is not people experiencing homelessness but the circumstances that lead to it. Only by people like us getting involved and helping their situation, can we give them any chance to better their circumstances. I want to know their names and make them feel like they matter, because they truly do.”
I am proud to recognize this group of faculty, which also includes Grace Huang, MD, (Hospitalist) and Ramzy Jandali, MD (Hospitalist), who are participating in the HHC’s goal to provide equitable health care to our unhoused community members.
Division of Cardiology Leads Heart Care at California Hospital Medical Center
The UCLA Cardiology team has been providing patient care at California Hospital Medical Center (CHMC) in Downtown LA for the past 5 years. CHMC is a hospital serving predominantly MediCal patients and the underserved community in downtown Los Angeles, and only a few blocks away from Skid Row which houses the one of the largest homeless populations in LA. This mission work began after UCLA cardiology leadership was made aware that patients at CHMC were receiving substandard cardiac care. The cardiology faculty obtained privileges at this hospital and led many efforts to turn around their cardiac catheterization laboratory. Now, UCLA Health provides the majority of cardiology services at California Hospital.
Our cardiology team has provided care to over 15,000 patients and performed over 30,000 procedures (ECG, non-invasive and invasive procedures) at this location. In addition, we have developed a close working relationship with the MediCal IPAs serving the downtown community, which has created a pathway for outpatient care and follow-up. This has been hugely beneficial to the patients as they often lack access to high-quality cardiology care, and our participation has resulted in reduced repeat hospitalizations. The cardiology division is most appreciative of the team that has provided care in an excellent manner to often-complex patients with limited resources, aligning with our department’s and UCLA's core values and mission. This team includes Drs. Jonathan Gordin, Nidhi Thareja, William Finch, Ramtin Anousheh, Olcay Aksoy, Duc Doand Ravi Dave. The faculty at this location noted that they are most thankful for the support from leadership, including: Dr. Dale Abel, Dr. Evelyn Curls, Dr. Eve Glazier and Dr. Gregg Fonarow.
Seven DoM Faculty Awarded DGSOM JAM Scholarly Project Funds
In addition to providing high-quality patient care, our faculty are leading important research about how we can address health inequities faced by members in our communities and diversifying the field of medicine. This week, we celebrate the seven faculty who received a JAM Seed Grant Award from the Justice, Equity, Diversity and Inclusion (JAM) Council of the David Geffen School of Medicine (DGSOM) to support projects aimed at advancing health care for all. The award recipients shared a few words about their projects.
Lorraine Anderson, MD
Allergy & Immunology
“Developing an Inpatient Core Curriculum for the Clinical Immunology and Allergy Fellowship”
"This project originated from an identified need to strategically address health disparities and inequities within the allergy/immunology specialty, particularly those connected with various socio-economic and demographic factors such as age, sex, sexual orientation, race, religion, and socio-economic status. Recognizing the substantive impact of such disparities on patient outcomes and acknowledging our ethical and moral imperatives, this initiative aims to enhance the educational framework for fellows and trainees. The enhanced curriculum will foster a deep understanding of the existing evidence regarding health disparities, whilst providing tools and interventions to navigate and mitigate these disparities effectively.
Central to our approach is the delivery of a balanced, inclusive education that adapts to the evolving needs of our specialty and the diverse patient demographic we serve, with an ultimate goal of uplifting the equity of care provided within the allergy/immunology specialty.
The development of this curriculum focuses on creating a learner-centered environment, prioritizing in-person, small group, bi-monthly didactic sessions. In an effort to seamlessly integrate education concerning health disparities, inequities, and social determinants of health, these sessions will be embedded in the core allergy immunology lectures. Accompanied by pre- and post-didactic quizzes, these assessments aim not only to gauge the participants’ assimilation of knowledge, skills, and attitudes but also to identify any misalignments between learning needs and the goals established by the Accreditation Council for Graduate Medical Education (ACGME). Focused on in-patient allergy and immunology, this curriculum endeavors to equip fellows with the requisite skills to identify and address health disparities, thereby fostering equitable patient outcomes in the treatment of complex allergy/immunology conditions.
Thank you to the UCLA leadership team and the JAM program for the grant awarded for our Diversity, Equity, and Inclusion (DEI) initiative. This significant investment reinforces our unified commitment to establishing an equitable and inclusive healthcare environment. It strengthens our pathway towards comprehensive wellness for our team and the communities we serve. In the spirit of the UCLA Health mission statement, 'To deliver leading-edge patient care, research, and education,' this initiative will enable us to embody and act upon the values of diversity and inclusion, ensuring that our actions and policies reflect a commitment to excellence and equity in every facet of our work. We appreciate the opportunity to enact meaningful change within our organization and beyond."
Lovelee Brown, MD
General Internal Medicine & Health Services Research
“Value of Virtual Residency Interviews for Prospective Applicants”
"The grant will be used to pursue a pilot program in partnership with several residency training programs to see how a third-party software program will assist with mission driven screening of residency applicants, create mission driven competencies for holistic review and equitable applicant scoring practices. The hope is that through this initiative we can reduce administrative burden to training programs all while elevating applicants who best fit our institution's mission."
Estelle M. Everett, MD
“Assessing Psychosocial Factors with Diabetes Technology Use”
"Automated Insulin Delivery (AID) systems mimic how a healthy pancreas controls blood sugar in the body to assist in management of type 1 diabetes. An AID is a system involving three pieces of diabetes technology: (1) a continuous glucose monitor (CGM) that tracks blood glucose levels every few minutes using a tiny sensor that is inserted under the skin, (2) an insulin infusion pump which delivers insulin through a catheter inserted under the skin, and (3) a program that receives information from the CGM then calculates how much insulin is needed to regulate the person’s current blood sugar level and responds by directing the insulin pump to administer the required insulin dose. Although these devices have revolutionized diabetes management and shown great promise for helping patients with diabetes achieve blood sugar targets, they have some limitations.
AID systems are not completely “hands off;” patients must regularly maintain the device components to be sure they are working properly and manually dose insulin for any meals they consume, as well as replacing device components regularly. Moreover, incorporating multiple external devices into activities of daily living may be challenging for some patients. To better understand how to help patients incorporate these devices into their lives to maximize their impact on diabetes management, additional work is needed to understand the psychosocial burdens of AP systems. We are proposing to do a brief, cross-sectional survey of UCLA patients ages 18 and older who have type 1 diabetes (ICD-10 code E10) and were diagnosed at least one year prior and receiving care in Endocrinology at UCLA. This survey will inquire about satisfaction with current mode of diabetes treatment, barriers and challenges to diabetes technology use, and impact of mode of treatment on diabetes related quality of life. The goal of this study is to better understand the psychosocial burden of diabetes management and diabetes technology and identify patient populations at higher risk of high psychosocial burden with diabetes technologies. As we know diabetes technology use is lower in racial-ethnic minorities and those of lower socioeconomic status, in a subgroup analysis we will evaluate whether these groups have higher rates of psychosocial burden with technology use. This information will be used to develop an intervention to address these barriers and burdens associated with diabetes technology use, which we hope will ultimately improve the quality of life and outcomes in those living with diabetes."
Daniel Kozman, MD, MPH
General Internal Medicine & Health Services Research
“Evaluating the impact of deepening an academic medical center's (AMC) community partnerships on safety net system capacity, clinician satisfaction and the AMC's emergency department utilization”
"My proposed project is to evaluate the impact of deepening an academic medical center's community partnerships on safety net capacity, career satisfaction, and the AMC's emergency department utilization.
The purpose of this study is to determine whether resource investments in community partnerships outside of those typical for an AMC may yield valuable returns on investment with regard to 1) improving recruitment and retention of faculty committed to addressing broader community needs, and thereby reducing the cost of workforce member turnover, and 2) decreasing academic medical center emergency department utilization. These outcomes are to be evaluated while the DOM undertakes a new initiative to strategically partner with multiple local safety net institutions to jointly hire clinical faculty to work on site within the safety net setting. By increasing the primary and subspecialty care capacity of these partnering safety net institutions, these jointly appointed faculty are hypothesized to be best positioned to address their patients’ needs more expeditiously and thoroughly, in the outpatient setting, mitigating disease complications and thereby preventing avoidable ED visits and hospitalizations."
Folasade May, MD, PhD, MPhil
“Improving Follow-up After Abnormal Colorectal Cancer Screening in Safety-Net Settings”
"Timely and appropriate follow up after abnormal findings are discovered during colonoscopy screening for cancer represents a challenge. This is true for many patients, but is exacerbated by those with limited resources. The goal of the project is to develop and evaluate algorithms and operational enhancements that will result in more complete follow up, particularly in safety net health care settings."
Evan M. Shannon, MD
General Internal Medicine & Health Services Research
“Evaluating the relationship between extreme heat events and social determinants of health on adverse events for Veterans with cardiometabolic disease”
"I am evaluating the relationship between extreme heat events, race and ethnicity, and social determinants of health for California Veterans with underlying cardiometabolic disease. I am assessing the association between extreme heat events and adverse outcomes, including mortality, ED visits and hospital admission for these Veterans, and examining if the effects differ at different levels of race and ethnicity, neighborhood vulnerability and homelessness."
Nisha Viswanathan, MD
General Internal Medicine & Health Services Research
“Improving access to Long COVID care through FQHC provider education in communities with high social vulnerability”
"This JAM grant will go to improving Long COVID testing and treatment at FQHCs in the UCLA catchment area. We will focus on course material development and provider training for those who see lower income patients, with pre and post assessments to evaluate training effectiveness. This will hopefully improve equity in healthcare delivery for this novel medical condition.
With 2 million Californians struggling with Long COVID, improving access to care where patients are at is essential to managing this condition. This grant will help pave the way for enhancing that care delivery."
Kimberly Narain, MD, MPH, PhD, and colleagues publish “Pharmacist-Led Diabetes Control Intervention and Health Outcomes in Hispanic Patients With Diabetes” in JAMA Network Open
In the latest from Dr. Kimberly Narain, she and colleagues from the division of general internal medicine and health services research and the department of family medicine, explore how pharmacy led interventions improve HbA1C for Hispanic adults with type 2 diabetes. Research has demonstrated that among patients living with type 2 diabetes (T2D), Hispanic patients have a higher risk of developing diabetes-related complications. In this quality improvement study, Dr. Narain and researchers used the patient’s electronic health record data at UCLA Health and a difference-in-differences study design to evaluate exposure to the intervention UCMyRx.
This impacted HbA1c concentration and systolic blood pressure among Hispanic patients with T2D, relative to those receiving regular care. Based on the EHR, pharmacists review lab results, vital signs, perform medication reconciliation, and develop personally tailored interventions to address adherence barriers and increase guideline-concordant care. The results demonstrated that in the 931 Hispanic adult participants, exposure to the UCMyRx intervention resulted in a statistically significant reduction in HbA1c concentration but did not impact systolic blood pressure. Read the full study HERE and a highlight from UCLA Health.
DoM Office of EDI Awarded $50,000 Grant to Support JEDI Efforts
Last week, the DoM Office of EDI shared their October newsletter which included the news that they have received a $50,000 grant from the David Geffen School of Medicine to support our department’s EDI initiatives. The EDI team prepared a 2021-22 report of our activities, demonstrating how they have connected with DoM faculty, trainees and staff through Grand Rounds, our newsletter, presentations at resident blocks and DMPG onboarding sessions, collaborations with various affinity groups, and more. You may view the report HERE.
I presented the report to UCLA Health leadership and other department chairs. The report was evaluated by a team of 12 evaluators who examined it similar to an NIH Study Section. Among the 24 departments in the DGSOM, our department did extraordinarily well, receiving 4’s and 4.5’s which resulted in receiving a top tier $50,000 award. This will be used to support clinical practice affinity groups, staff EDI activities and trainee EDI activities. Congratulations to the EDI team for receipt of this award and thank you for the exemplary effort you lead to promote our EDI values within the DoM and the health system.
I encourage you to get involved in our department's EDI efforts. Below are two upcoming opportunities that are available to faculty.
- The AMA is holding the National HealthEquity Grand Rounds on Creating Accountability Through Data: From Racism to Neglect to Transparency and Repair. It will take place virtually on October 10th from 11AM - 12:30 PM. Register HERE!
- Join the DoM EDI Office on Friday, October 27th from 6-8 PM at Luskin Conference Center for a gathering to build community among DoM First-Generation College Graduates. Register HERE by 10/12 to attend.
Arleen F. Brown, MD, PhD Inducted into the National Academy of Medicine’s Member Class of 2022
This past weekend, Dr. Arleen Brown, from the division of general internal medicine and health services research, was inducted into the National Academy of Medicine (NAM). Members of the 2022 class, joined leaders and members of the NAM in Washington DC for a celebration in honor of their advancements and contributions to the medical sciences, health care and public health. This prestigious recognition honors Dr. Brown's research focused on improving health outcomes, enhancing health care quality, and reducing disparities for adults with chronic conditions such as diabetes, cardiovascular disease, and stroke, particularly those with complex medical and social needs. Her research has included studies to improve diabetes care for older adults and minority patients and studies to understand clinical, socioeconomic, and health system influences on chronic disease management in under-resourced communities. We recently honored Dr. Brown here at home when she was elected to the AAP and honored at this year’s STAR symposium as a Distinguished STAR Alumni. You may learn more about her research accomplishments HERE.
Welcome Chris Moriates, MD to the DoM!
On November 1, 2023, Dr. Chris Moriates will be joining the DoM as the section chief for the hospitalist section at the VA Greater Los Angeles Healthcare System. Dr. Moriates is the assistant dean for Health Care Value and an associate professor with tenure in internal medicine and medical education at Dell Medical School at The University of Texas at Austin. He is also the Executive Director at Costs of Care, a global nonprofit cultivating change agents focused on making health care more affordable and equitable. He is already a Bruin having completed his undergraduate degree at UCLA, and we are pleased to welcome him back to UCLA as a member of our department and the VA GLA. Read the full announcement HERE.
Birthday season is continuing to break out in the DoM.
Last week we celebrated the first birthdays of Tisha Wang and Albert Haro. Albert is either competitive or has greater lung capacity than Tisha! You can decide…