Scale and significance of the problem
New pathogens and developments in diagnostics and therapeutics are transforming healthcare. Comprehensive planning for paradigm-changing advances, when possible, can mobilize the full range of expertise available in a complex institution like UCSF and in our community partners. Systematic planning can identify new research opportunities, reduce institutional costs and improve patient care.
One healthcare challenge that can serve as exemplary for other implementation opportunities is the treatment of hepatitis C virus (HCV) infection. HCV is a large epidemic-more than 200 million cases worldwide- causing substantial morbidity and mortality. Current treatments have serious limitations but new drug development has been remarkable with soon-to-be-approved drugs achieving close to 100% cure rates after only 12 weeks of use with low toxicity. These drugs will cause an explosive increase in treatment volume over the next 1-2 years despite a high cost (est. $70,000).
Lessons learned in this demonstration project will apply to pending breakthroughs including the discovery of effective drugs to prevent or treat Alzheimer’s disease and the identification of genetic causes of common diseases with resulting targeted interventions.
Current approaches (nationally)
No comprehensive model of HCV treatment exists and no other attempts have been presented that approach this proposal in establishing a comparison for implementing efficient systems for other diseases and new challenges. HCV care is currently fragmented, delivered by hepatologists, infectious disease specialists of general internists with limited collaboration or involvement by teams as proposed here.
Proposed approach and why it is innovative
We will design optimized systems of care and research organization to monitor, evaluate and adjust the screening of patient populations, to stage underlying liver disease and to initiate therapy when indicated. As each of the three primary UCSF-related medical centers; Parnassus, San Francisco General Hospital and the VA Medical Center have large but demographically distinctive patient populations and payment systems, comparing experience through data sharing will enrich the development of the HCV response model and increase its generalizability. Linking the information collected across UCSF with data from the network of the five University of California medical centers through the UC BRAID system of CTSI with 12 million covered lives will further strengthen the lessons learned from this project, representing an innovative use of “big data” in healthcare.
The HCV model project will be dynamic. As drugs are approved and as demand for care increases, the team will monitor data from each medical center to compare population screening rates and success in each step of the treatment “cascade” familiar from the HIV experience.
The project will be innovative and outward looking in working from the start with community members and with experts at UCSF expert in engaging the very different communities most affected by the HCV epidemic.
The HCV project will continually attend to how the systems found effective might be similarly deployed against other health care imperatives, particularly as the entire structure of American healthcare adjusts to the rollout of the Affordable Care Act.
The project will build from an existing cross-campus planning group of clinicians, basic scientists and epidemiologists, adding information technology to created data linkages across the three UCSF medical centers and with UC BRAID and economists and pharmacists to model cost and policy implications. Community members and community engagement experts will increase project impact and broad participation. Implementation scientists will develop models which can inform other healthcare challenges an d global health experts will consider applications in resource-limited settings.
Projected impact (estimate resources needed)
HCV infects 200 million worldwide. Designing a coordinated and effective response to new curative treatments would have an immediate benefit to those affected, decrease further transmission and provide a crucial model for other emerging healthcare priorities.
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