A key component of health care reform involves the improvement of quality, access and value when delivering health services, particularly for patients admitted to a hospital. To help meet these needs, the University of California established the Center for Health Quality and Innovation, which provides financial support for health quality initiatives across the UC health system.
The center has now awarded nine grants totaling $3.4 million to six UC institutions for projects aimed at better understanding and alleviating common obstacles to health quality, including frequent falls, excess radiation from scans, hospital-acquired conditions and issues of care coordination among multiple health professionals. Of the nine studies, six include UCLA health care experts as participants.
Rising above hospital falls
Between 2 percent and 15 percent of hospital patients in the U.S. experience falls. Nearly a third of these result in injuries, and sometimes even death. At Ronald Reagan UCLA Medical Center, however, falls declined by 30 percent when the hospital instituted a program called "5Ps." In many hospitals across the country, nurses on rounds use an hourly process called "4Ps" to assess patients' pain, personal needs, positioning in a bed or chair, and the placement of items they might need. At UCLA, nurse Catherine Walsh, the accreditation manager for in-patient nursing and interventional areas for the UCLA Department of Nursing and a member of the department's falls prevention committee, created the "5Ps" program by adding "preventing falls" to the hourly rounding process. During each nursing visit, factors that could result in falls are identified and mitigated, reducing risk on an ongoing basis during hospitalization. Walsh and Dr. Teryl Nuckols, a UCLA associate professor of general internal medicine and health services research, who are co-leaders of the project, and their team received a grant of $375,000 to develop educational programs for health professionals and to expand the use of the "5Ps" program to other UCLA hospitals and UC medical centers.
Getting patients back on their feet
Stroke patients spend a long time in the hospital. At UCLA, the average patient stays for 18 days, from onset through rehabilitation. Other patients recovering from critical illnesses may stay even longer. All these extended stays result in dramatic muscle weakening -- a loss of about 1 percent of muscle mass each day while on bed rest -- underscoring the need to boost exercise programs to help patients recover. But many patients, due to lack of motivation, don't benefit from exercise programs, and when they do exercise, it's often not enough. A team headed by Dr. Bruce Dobkin, a UCLA professor of clinical neurology, received a $50,000 grant to create a program that involves the use a network of wireless sensors and a special exercise bike that can fit in a bed or on the floor. The program will allow health professionals to monitor activity in the hospital and at home, provide instant feedback to patients, and gather information to design more effective rehabilitative exercise programs. The sensors include accelerometers, developed by faculty at UCLA's Wireless Health Institute, that a patient can wear comfortably, and mathematical algorithms are used to interpret the type, quantity and quality of daily activities.
Improving care following hospital discharge
The transition between hospital and outpatient settings is a particularly vulnerable time for patients, as their condition is at risk of deteriorating shortly after they exit the hospital doors. In fact, about one-fifth of Medicare patients are readmitted to the hospital within 30 days, with half of those readmissions considered preventable. By bringing together teams from different clinical sites to improve processes and learn from each other, patient care can be enhanced, particularly when patients transition from the hospital to a primary care provider. Such quality improvement programs assess patients for readmission risks when they enter the hospital, help patients and caregivers understand these risks, and follow up with both patients and physicians shortly after discharge. Dr. Nasim Afsarmanesh, an assistant clinical professor and director of quality and safety at Ronald Reagan UCLA Medical Center, and her colleagues from other centers were granted $750,000 to create a quality improvement network that will collaborate to design and implement interventions to improve these important transitions of care.
Standardizing CT scan protocols
A computerized tomography (CT) scan can yield a tremendous amount of diagnostic information, but it is also important to assess the amount of radiation a patient receives from these scans. In order to reduce the total amount of radiation, and to meet the terms of a new California law requiring the reporting of radiation exposure, health practitioners need to set standards that allow for high-quality diagnostic CT scans with a minimum amount of radiation. To create necessary exposure standards, a team including UCLA radiology researchers Dr. Michael McNitt-Gray and Dr. Christopher Cagnon was given a grant of $750,000 to create standard protocols for CT scans of all types which will balance radiation exposure and image quality. The team will also establish educational programs for all UC medical centers to create practice standards that could be used nationwide.
Reducing radiation from unnecessary CT scans
Many hospitals will automatically order a CT scan of any patient admitted with blunt chest injuries. Yet many of these scans, while exposing patients to ionizing radiation, may not provide any benefit. One reason so many patients receive these scans is that information that could help health professionals decide whether such scans are necessary is scarce. Dr. William Mower, a UCLA professor of emergency medicine, and his colleagues received $375,000 to create a decision-making process that will help practitioners analyze key signs, allowing them to differentiate patients who could likely have injuries requiring a CT scan from those with no risk of those types of injuries. The grant will allow the researchers to identify the key clinical signs that a patient has internal chest injuries in order to make the selection process practicable in emergency and hospital settings.
Preventing pulmonary embolism and deep vein thrombosis
Blood clots in the lung and the rest of the body afflict hundreds of thousands of Americans each year and rank among the most common preventable causes of death in hospital patients. Treatments to prevent these clots are available but are used only 30 to 50 percent of the time with eligible patients. Dr. Nasim Afsarmanesh, an assistant clinical professor and director of quality and safety at Ronald Reagan UCLA Medical Center, and her colleagues received $750,000 to find ways to reduce the occurrence of these clots in hospitalized patients. The group will create teams at each UC medical center to collect data and create tools to enhance performance and prevention rates.
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