Gaps to close:

1. Time spent on non-value-added patient care reduces access to critical clinic services
2. Lack of demographic and clinical metrics data available to providers limits health care equity delivery 

For chronic disease and preventive care management, the patients' value-added time includes receiving appropriate reminders for medical testing, undergoing proper testing at the correct intervals, periodic feedback of testing results from providers, and just-in-time intervention from providers. Using panel management by combining remote monitoring, a clinic registry, and dashboard feedback will improve clinic access and health equity.

There is wide variability in knowledge of the most appropriate medication doses, maximum safe doses, and safely measurable quantities for providers who order medications and pharmacists verifying their orders.  This knowledge gap can result in ordering medication doses that exceed maximum safe doses, doses that are unnecessarily difficult for pharmacy technicians to accurately prepare, doses that are challenging f

Food insecurity is associated with increased healthcare costs and poor health outcomes. National level data shows that individuals suffering from food insecurity are more likely to have ED visits, hospitalizations and longer inpatient stays than individuals who are food secure (Berkowitz ‘18).  Clinically, food insecurity is associated with higher rates of chronic diseases, mental health diagnoses, mortality rates, and obesity (Jih ‘19, Walker, Healthy People). It also leads to reduced productivity and quality of care, and sub optimized clinical outcomes (Samuels). However, it is not standard practice to screen for, or treat, food insecurity in adult primary care practices despite the growing awareness of the need to address social determinants of health.  Thus, there is variability in screening for and treating this costly issue (Kopparapu). 

What is the problem? Ulcerative colitis is a chronic inflammatory bowel disease with many phenotypes, including mild, self-limited disease and progressive fulminant colitis. Although many will have a mild disease course, hospitalization is required for up to 25% of patients at some point in their disease course.

Proficiency in diagnostic and therapeutic procedures including the use of ultrasound for paracenteses, thoracentesis, lumbar punctures, and peripheral vascular access are considered core competencies for medical trainees and internists working in the inpatient setting. Time limitations and provider comfort to successfully perform a procedure have led to a preference to refer patients to inundated procedurally-oriented specialists such as interventional radiology.

Cardiac rehabilitation is a multi-disciplinary outpatient program of exercise training and health behavior counseling for heart disease patients. It is guideline-recommended because it reduces hospitalizations and mortality and improves quality of life. However, fewer than 1 in 4 eligible patients attend cardiac rehabilitation, and there are disparities in participation related to gender, race/ethnicity, and socioeconomic factors. 

The COVID-19 pandemic has highlighted ever-present disparities in healthcare that exist among people of color because of a long history of institutionalized racism and structural inequities. Although those who identify as Latinx account for 15.2% of San Francisco’s population, 42.2% of COVID-19 positive cases occurred in this population and 20.1% of COVID-19 deaths. Similarly, those who identify as Black account for 5% of San Francisco’s population, yet 8.3% of COVID-19 fatalities in our city.

The Craniofacial Center is the medical home for patients with orofacial clefting, craniosynostosis, and associated conditions. Team visits include 2-6 encounters on a single day and generate revenue in Plastic Surgery, Pediatrics, Medical Genetics, OHNS, Neurologic Surgery, Ophthalmology, Audiology, and more. Provider- and department-level scheduling constraints create additional complexity. Since 2020 we’ve used a hybrid model with some in-person but mostly video visits.

The Minimally Invasive Gynecologic Surgery(MIGS) Division is a new division developed in 2019.  As we are new, we recognize the need for approaches to best serve our patients.  Within our MIGS Division, we serve patients with chronic pelvic pain using a multidisciplinary approach that includes surgery, physical therapy, pain medicine, integrative medicine and mental health. To serve our patients best, we need to provide education about these multimodal approaches to care.