UCSF 2.0: Improving Community Health

 

One of the major topics of discussions about the future of UC San Francisco is how the University will continue to work with the community to improve health and address disparities.

UCSF has a long tradition of working to improve the health of the community – from the days faculty responded to treat the injured in the great 1906 San Francisco earthquake to today’s free health screenings.

For geriatricians Louise Aronson, MD, associate professor of medicine, and Alex Smith, MD, assistant professor of medicine who is on staff at the San Francisco Veterans Affairs Medical Center, UCSF 2.0 gave them the chance to call attention to the huge unmet need to provide health care for the growing elderly population. They were both part of Team Aging, which finished in first place in UCSF 2.0's online game, and they participated in focus groups.

“Aging has to be on the agenda for the future,” Smith said. “There is a demographic imperative with the aging of baby boomers. UCSF cannot plan for the future without planning to care for seniors.”

The market to serve seniors is wide open and UCSF could be engaged in new models of care, said Aronson, whose clinical practice is through the Housecalls Program. Aronson, director of the UCSF-based Northern California Geriatrics Education Center, believes geriatric care represents a great opportunity for UCSF to lead.

“In all sectors of society, caring for the elderly is draining resources and if we can work together we can serve the elderly better and save resources,” she said.

In an effort to improve health and health equity in the city, San Francisco Mayor Ed Lee expanded and aligned three successful community health collaboratives into one body, called the San Francisco Health Improvement Partnership (SFHIP).

SFHIP builds off the existing program administered by the Community Engagement and Health Policy program at UC San Francisco’s Clinical and Translational Science Institute(CTSI) and facilitated in collaboration with community partners and the San Francisco Department of Public Health (SFDPH).

Kevin Grumbach, MD, director of the CTSI Community Engagement and Health Policy program and chair of the UCSF Department of Family and Community Medicine, says the key to SFHIP's work is engaging community residents and health partners to define, measure and address mutually agreed upon health priorities. As such, SFHIP Partnership Work Groups are working on interventions to address San Francisco’s most important health issues related to physical activity and nutrition, children’s oral health, alcohol policy and Hepatitis B.   

Today, we have to be much more about building systems of care working with the broader community to make a difference.

For Grumbach, who graduated from UCSF School of Medicine in 1982 and has served on the faculty for 33 years, UCSF has much to be proud about and much more to bring all stakeholders to the table to achieve greater gains in community health and health equity.

“UCSF is an amazing place and the reason I have devoted my entire professional career here is because we have amazing people who have made this a biomedical research powerhouse,” he said. “What we can do better is translating these discoveries into the pragmatic delivery of care. Today, we have to be much more about building systems of care working with the broader community to make a difference.”

Melding Precision Medicine with Population Health

Nancy Adler, PhD, director of the Center for Health and Community, who has been studying and addressing health disparities for decades, agrees. She is working with Laura Gottlieb, MD, MPH, an assistant professor of Family and Community Medicine at UCSF, in a CHC program that is working with several San Francisco hospitals to screen families of children who come into the emergency room for their social needs.

Once a family’s needs are identified, trained college volunteers connect them to a variety of services. A parent with a child, who comes to the ER with asthma due to living in a house with mold, for example, could be connected to a lawyer who can assist in getting the landlord to remedy the situation. The program is now being run at San Francisco General Hospital and Trauma Center (SFGH) and at UCSF Benioff Children’s Hospital Oakland and will start at UCSF Benioff Children’s Hospital San Francisco at Mission Bay when it opens in February 2015.

Another group at the CHC is also looking at the impact on children’s health while living in public housing by examining medical records of those who visit ERs in hospitals across San Francisco. Accessing the data was challenging, but in addition to the Pediatric Emergency Department at UCSF Benioff Children's Hospital on the Parnassus campus, SFGH, California Pacific Medical Center and the housing authority all shared their data.

“One of the things we’re trying to do is meld precision medicine with population health,” Adler said, adding that the consideration of social, behavioral and environmental factors is important to bring precision to the full spectrum of health.