1. < Uncategorized

As we approach Veterans Day, I want to recognize the important work our UCLA Department of Medicine (DoM) colleagues are doing to improve the health and well-being of those who have served our country. As such, I want to highlight a few of many examples of the ways in which our faculty, trainees and staff are working in partnership with our Veteran’s to honor their service, by improving their health and well-being in innovative ways.

Building Better Systems for Veteran Care

The Division of Hospital Medicine at the VA Greater Los Angeles Healthcare System [VAGLAHS] plays an outsized role in the training of our residents and fellows. Many of our faculty in this section are highly regarded leaders of our education mission. Additionally, there are many other facets of their accomplishment that are important to celebrate. This includes, securing federal research grants, publishing more than 40 peer-reviewed papers and earning national recognition for scholarship. In particular, I am especially proud to highlight the strides they have made in improving care for our veterans.

To address this, VA hospitalists George Tran, MD, and Tyler Larsen, MD, developed a framework called HOME, which guides physicians through four key topics to discuss with patients during discharge: Hospitalization reason, Outpatient follow-up, Medication changes and Emergencies or warning signs that should prompt a patient to seek medical attention. Physicians are encouraged to use the teach-back method, asking patients to explain what they have understood.

The team worked with informatics colleagues to reorganize the hospital’s discharge instructions around the same model, so the information they take home is clear and reinforces physicians’ verbal guidance.

Another important quality-improvement effort at VAGLAHS focuses on the transitions of care for Veterans who are hospitalized with chronic obstructive pulmonary disease (COPD). Over the past three years, faculty and residents have worked to standardize care for hospitalized Veterans with COPD, from inpatient treatment through outpatient follow-up.

The project began three years ago when one of the chief residents in quality and safety (CRQS) worked with pulmonary and hospital medicine faculty to create a registry to track Veterans with COPD and improve appropriate follow-up care. The following year, another CRQS advanced this project by developing a targeted pulmonary consultation process to standardize care and follow-up. Now, a current CRQS and the team are additionally working to identify eligible patients who could benefit from nighttime bilevel positive airway pressure (BiPAP) therapy. “Patients are receiving gold-standard care for COPD more reliably because of programs our residents and faculty built together,” Dr. Moriates says.

The project has continued to grow even as residents leading it have graduated, thanks in part to the division’s faculty quality improvement (QI) directors, who work closely with each new group of chief residents.

“We can pass the baton forward and expand our improvement projects, because we've created structures within our division and have the support of our hospitalist faculty and colleagues in other divisions,” Dr. Moriates says.

These are just two examples of the division’s broader QI efforts, which have also included strengthening coordination of deep vein thrombosis prevention with orthopedic surgery and redesigning psychiatry consultation workflows to reduce delays. This clinical operations work has contributed to improvements in inpatient experience scores, with VAGLAHS recognized earlier this year as one of the fastest-improving facilities nationally.

VA Greater Los Angeles Food Hub Earns National Recognition

Supporting Veterans’ health also means addressing needs that extend beyond the hospital. Another initiative at VA Greater Los Angeles is receiving national recognition for doing just that.

For Veterans facing food insecurity, the VAGLAHS Food Hub provides more than just groceries. The program integrates food assistance with nutrition education, supportive services and connections to healthcare resources. That comprehensive approach has now earned national recognition.

Operating in a region with one of the nation's highest concentrations of food-insecure Veterans, the Food Hub was established in April 2025 in anticipation of plans to house up to 6,000 Veterans on the West Los Angeles VA campus. The program also serves the broader population of more than 80,000 Veterans receiving care through VAGLAHS.

Veterans who visit the Food Hub can receive nutrition education and connect the same day with social workers and peer Veteran support. The program draws on clinical care, supportive services and community partnerships to support Veterans' overall well-being.

Veterans say the Food Hub's value extends well beyond the groceries it provides. One Veteran shared in the program's 2025–2026 impact report, "This Food Hub has saved my life. They have the basic necessities that we need, and they give them to us with compassion and care, and they never make us feel less than."

Another Veteran said, "When you come in here, they give you helpful hints on everything from how to cook the food to how to go to the [Veteran's] Garden. They even told me about how at the [Veteran's] Garden you can grow your own food or be a part of a job training program. I mean, this place is amazing!."

The award also recognizes innovation behind the scenes. Dr. Ong worked through exceptions to VA policy that allowed the Food Hub to receive funding from Genentech through GLAVREF, helping support services that connect Veterans with nutrition education and other resources.

Dr. Ong emphasized that the Food Hub's success reflects the contributions of many partners and colleagues.

"The two individuals who co-lead the Food Hub, Jennifer Allen and Shari Kushins-Moore, are amazing," he said. Dr. Ong also highlighted the support of Zhaoping Li, MD, PhD, chief of the UCLA Division of Clinical Nutrition and VAGLAHS Medicine Service chief, who has championed the Food Hub and related initiatives focused on food insecurity, including the Veterans Garden. He also recognized Kaitlyn Fruin, MD, whose work has helped advance those efforts.

The work also carries personal significance for Dr. Ong.

"My father was a Veteran, and I deeply appreciate the service our Veterans have provided to all of us," he said.

In Conversation With... Manuel Celedon, MD, Chief of the Division of Addiction Medicine, Department of Medicine at the VA Greater Los Angeles Healthcare System

I am also pleased to introduce Manuel Celedon, MD, inaugural chief of the Division of Addiction Medicine at VA Greater Los Angeles Healthcare System.

Dr. Celedon joined the VA as a faculty member in 2016 after completing his residency in emergency medicine at Harbor-UCLA. Over the past decade, he has taken on several leadership roles at the VA. As chief of the new division, he will help advance integrated addiction care for Veterans and expand training opportunities.

Read on to learn how a first-generation college student became a national leader in addiction medicine and what he hopes to accomplish as the division’s inaugural chief.

What initially drew you to medicine?

I didn't grow up with a roadmap to a professional career. I was a first-generation college student and my parents, who immigrated to this country, had limited ability to guide me beyond telling me to do well in school. Money was always tight at home, so the practical question of what I would do with my life carried a lot of weight. I was good at science, but I was not good at math, so I asked myself a simple question: What do kids who are good at science usually do? The answer kept leading me toward the medical field. Around the same time, someone close to me had a family physician for a parent, and I saw that he had a stable, comfortable life and talked about his work with real fondness. That stuck with me. I wasn't one of those people who was born to be a doctor, and I have many friends who were. I think of myself as one of the lucky ones, because a practical approach to choosing a career led me to work I love and can't imagine doing differently.

In medical school, I wanted to become the kind of doctor who could answer nearly any question a patient or family brought to me. That led me toward generalist medicine. During my clinical rotations, I realized I enjoyed the challenge of acute care more than outpatient work, and I noticed my mind wandering after the second or third hospital day of many cases. And it seemed clear that emergency medicine was where I belonged.

Addiction medicine came later, and it came about organically. Around 2018 or 2019, I read an article in an emergency medicine publication about starting buprenorphine in the emergency department. It wasn't a new idea, but it was new to me. I shared my thoughts with Dr. Jonie Hsiao, a colleague and unofficial mentor, who spearheaded the development of one of the VA’s first programs for emergency department medication for opioid use disorder. Through that work, I connected with others across the VA doing similar work and that is how my path in addiction medicine began.

How has your experience in emergency medicine shaped your approach to treating patients with substance use disorders?

My exposure to addiction care was more hands-on once I became an attending at VA. Treating withdrawal and pain, starting buprenorphine and connecting patients to follow-up care are all within reach for frontline clinicians. That work also opened up questions well beyond opioids. I've become increasingly interested in managing alcohol withdrawal more effectively, reducing barriers to methadone for opioid use disorder, and, most recently, figuring out how to care for patients with stimulant use disorders in acute settings, where the evidence and best practices are still evolving. Much of the impact comes from simple things that cost nothing, like keeping an open stance, using nonjudgmental language and being deliberate about not stigmatizing substance use. Those habits can make the difference between a patient who walks out and one who engages in treatment.

What are some of the biggest challenges in providing addiction care? How do you hope the new division will help address them?

The barriers we see here show up across patient populations and health care settings, and they are the same ones that make addiction care hard for anyone. Addiction is a chronic condition, much like diabetes, heart disease or obesity. It often comes with medical, psychiatric and social comorbidities that have to be part of the plan. Many substance use disorders are highly treatable, and medications for opioid use disorder and tobacco use disorder can be life-changing, yet many patients still don't get access to them. When those symptoms go unaddressed, patients can look complex or unwilling to engage, when in reality they are suffering from conditions we know how to treat.

While the field has come a long way over the past two decades, we still have a long way to go, both within health care and in society, to prioritize addiction care, remove barriers to treatment and improve access to it. Too often, patients encounter care models that are reactive, requiring them to be ready, available and persistent at exactly the moment they reach out for help. Changing that means building models of care that are proactive and responsive to what people with substance use disorders actually need, and meeting them where they are rather than where it's convenient for us.

Some of the barriers are practical and concrete. Housing is a major one. Patients who are unstably housed have a hard time keeping appointments, storing medications safely or sticking to a recovery plan, and no amount of clinical skill fully compensates for that.

Telehealth is another area with real promise. For patients facing transportation problems, work obligations or distance from a clinic, virtual care can mean the difference between getting treatment and not. Used thoughtfully, it can extend our reach without sacrificing the therapeutic relationship. Finally, medication is powerful, but it is rarely enough on its own for everyone. Many patients need psychosocial interventions, such as counseling, peer support and skills-based care, to achieve lasting recovery. Making those services accessible and integrated with medical care is essential.

As the inaugural chief of the Division of Addiction Medicine, what are your top priorities?

My first priority is building the acute care infrastructure that makes substance use disorder care a routine part of hospital medicine. That means updating standard operating procedures, implementing substance use disorder clinical protocols and working closely with pharmacy to make sure evidence-based pharmacotherapy is accessible in every hospital setting. It also means revising order menus so the right treatments for withdrawal, pain and substance use disorders are available at the point of care and not buried in a separate process. Clinicians shouldn't have to reinvent the wheel each time a patient with a substance use disorder comes through the door. The goal is to streamline substance use disorder care, so it fits naturally into the systems we already use.

Education is equally important. Teaching is central to both VA and UCLA, and I want the division to bring others along in this work. That includes internal medicine residents, palliative care fellows, addiction psychiatry fellows and addiction medicine fellows, and in time I'd like to include gastrointestinal, cardiology, infectious disease and other specialties whose patients also experience substance use. Each group encounters substance use disorder care in a different way, and I hope they leave with the skills and confidence to address it in their own practice.

I'm also mindful of the hidden curriculum. When we build protocols, order sets and workflows, we are teaching trainees what matters and what counts as normal care. If those systems treat addiction as a specialty niche or an afterthought, that's what learners will carry forward. If they treat it as a routine part of medicine, that's what they'll learn to do.

In three years, I hope my colleagues will say they feel empowered to treat substance use disorders in their patient populations, regardless of specialty or clinical setting. I want the emergency physician, the hospitalist, the cardiologist and the surgeon to see substance use disorder care as part of their job, supported by good systems and a team they can call on. If we get there, addiction care will no longer depend on a few clinicians who happen to feel comfortable with it. It will be part of how the whole institution takes care of patients.

Is there anything else you'd like to share?

The work I'm doing would not be possible without the people who built this effort before me. Dr. Zhaoping Li, Steven R. Simon, MD, MPH, and Mr. Timothy Graham, our medical center director, each saw the value of addiction care early and created the conditions for it to grow. Their vision and support are the reason we have the programs, partnerships and momentum we have today. I see my role as building on that foundation, and I'm grateful to have inherited such a strong starting point. I also hope the division will carry that same spirit forward, with a commitment to supporting the next generation of clinicians and the Veterans they serve.

DoM LEADERS Awarded Grants to Advance Better Care for People Living with Dementia

I am delighted to share that two UCLA Department of Medicine faculty members have received National Institute on Aging (NIA) IMPACT Collaboratory awards to advance care for people living with dementia. Their projects address different but equally important aspects of dementia care: helping patients and families plan for future medical decisions and promoting safer prescribing practices.

"Talking about what is important to the person living with early dementia can ensure that a patient’s goals and values always guide medical care and help clarify decisions about treatment that will be needed later," Dr. Walling explains. "Many families find that this lessens the stress around decision-making."

Dr. Walling and her team will pilot the new intervention, called UC Health Care Planning–Dementia, across 20 UCLA primary care clinics. It uses automated electronic health record (EHR) messages, timed to clinic visits, to connect patients and their care partners with PREPARE for Your Care resources, which help people evaluate and communicate their preferences for future medical treatment. An ACP navigator will conduct additional outreach to encourage participation, including among family members or legally authorized representatives who may need to make decisions on patients' behalf.

The pilot will help determine the feasibility of conducting a larger clinical trial to evaluate the intervention's effectiveness.

By integrating these resources into routine primary care, Dr. Walling and her team hope to help more patients communicate their wishes early, giving families greater clarity when difficult decisions arise. As Dr. Walling notes: "Everyone benefits from advance care planning.”

Dr. Mafi and his colleagues are testing how a simple intervention built into the electronic health record (EHR) might help clinicians make safer prescribing decisions. When clinicians start a new antipsychotic prescription for a patient with dementia, an alert reminds them of the medications’ risks, defaults the order to a lower dose and shorter supply and offers a handout on non-drug approaches that caregivers can use. Clinicians who override the default dose or duration will be prompted to briefly document their reasoning.

Researchers will evaluate prescribing patterns and patient outcomes, including falls, hospitalizations and deaths. They will also interview clinicians and caregivers to better understand how the intervention works in practice. “The goal is to learn not just whether the alert works, but for whom it works best and how it fits into real clinical workflows,” Dr. Mafi says.

This project builds on an earlier UCLA Health trial led by Catherine A. Sarkisian, MD, published in July in the Journal of the American Geriatrics Society. That trial did not significantly reduce prescribing overall, but an exploratory analysis suggested that the alert was most effective among clinicians who prescribed these medications most frequently. The new trial is a larger, confirmatory study designed to test that hypothesis. It will randomize all of the approximately 220 UCLA Health clinicians who prescribe antipsychotics to patients with dementia to receive the alert or usual care, with the primary analysis focused on the highest-volume prescribers and secondary analyses across all prescribers. Drs. Sarkisian and Walling are co-investigators on the new trial. If successful, the approach could have implications far beyond UCLA Health. Because the alert was built with standard tools in Epic, a widely used EHR platform, it could offer a low-cost, scalable way to improve care nationwide.

“The bigger idea reaches beyond antipsychotics: Health systems fire the same alerts at every clinician, and alert fatigue is the predictable result. If we can learn which alerts actually change behavior, and for whom, we can design alerts that do the most good with the least noise,” Dr. Mafi says.

"The idea at the center of the alert, ‘first, do no harm,’ is as old as medicine itself. This grant is a chance to test rigorously whether we can make it a default setting in the chart."

In Closing

I want to thank all the faculty, trainees and staff whose work is highlighted in this week’s message. Their dedication to improving patient care is a source of great pride for our department.

As we mark Veterans Day, I want to express my gratitude and sincere appreciation to the Veterans in our community for their service and to the many colleagues who devote their careers to caring for them. I thank them for their dedication.

Dale

P.S.

One of the nice things about running in Santa Monica foothills on weekends are the surprise encounters with colleagues on the trail. That’s me and Dr .Yaqoot Khan, clinical chief in the UCLA Division of Rheumatology.

---