Works in Progress

Division of General Internal Medicine (DGIM)

Improving Advance Care Planning in the Primary Care Setting (Bridges Medical Students)

Faculty Champions: Christopher Bautista, MD, Maki Aoki,

To improve advanced care planning (ACP) in DGIM for all patients older than 65. The goal is to increase the percentage of patients with Advance Directive (AD) forms in the EMR via services and resources including cipher calls, access to an ACP navigator, the MERI What Matters Most Workshop for patients and staff, and MERI Center resiliency programs for DGIM staff.

Helen Diller Family Comprehensive Cancer Center

Faculty Champions: Ted Scheel, MSW, Tammy Baltic, NP    

Cancer patient ACP education tools and resources through (1) creation of the 1600 Divisadero Street infusion center ACP Education Center, (2) inclusion of an ACP screening question in the cancer center new patient questionnaire, (3) social work availability for ACP patient queries, and (4) a centralized repository of Cancer Center ACP Resources.

Interventional Radiology/ Radiology

Faculty Champion: Andrew Taylor, MD
With residents: Rana Rabei, MD, Jessica Hightower, MD, Yoon-Jin Kim, MD

To evaluate current practices of pleurX catheter placement and their impact on patient quality of life by conducting a retrospective assessment of procedure utilization and implementation at Mount Zion (where the majority of such catheters at UCSF are placed). The project will assess patients with cancer and advanced liver disease. Metrics include demographics (including distance travelled for the procedure, complication rates, frequency of repeated procedures. After the retrospective evaluation, the goal is to implement an improved referral and recommendation system to improve quality of life via promoting in-dwelling catheters (vs. repeated intermittent drainage) where safe and appropriate.

Neurology Movement Disorders Practice

Primary Palliative Care Education for UCSF Neurology Residents

Faculty Champion: Maya Katz, MD

To improve advance care planning (ACP) with seriously ill inpatient neurology patients using a primary palliative care (PPC) education program aimed at neurology residents. The project aims to increase the percentage of completed advance directive documents uploaded to APEX for inpatients through optimization and dissemination of PPC training, and sustainability of training skills.

Osher Center for Integrative Medicine

Faculty Champion: Kathleen Cavanaugh, NP
With Palliative Care Faculty: Brieze Keeley, MD, Stephanie Cheng, MD

Building “Osher-branded/approved” integrative medicine recommendations for symptom management among cancer patients, available throughout the UCSF EMR. The project contains 4 phases: (1a) Protocol preparation and implementation (1b) Application of protocol and grading system of listed symptoms based on literature review (2) Implementation of EMR dot phrases and booklets (3) Development of website for patients and providers (4) Videos for patients and providers. Symptoms to evaluate include the following: pain, nausea, constipation, insomnia, and neuropathy.

Pain Clinic

Faculty Champion: Ann Cai Shah, MD

Launch a new Interventional Cancer Pain Clinic in January 2020, to start along with the opening of the UCSF Precision Medicine Cancer Building (for consultation), and to work in concert with the UCSF Pain Clinic procedure rooms at Mount Zion (for the interventional procedure).  The goal is to provide additional pain management options through interventional procedures such as nerve blocks and implantable devices to complement medication management for patients who may need additional pain management or are unable to tolerate their current medication regimen.  By co-locating within the PCMB for consultations and utilizing the procedure capacity on the Mount Zion campus, patients will have easier access and have an opportunity for more comprehensive pain management.


Behavioral service delivery for children of color

Faculty Champion: Amanda Posner, MD

To improve access and utilization of mental health interventions for children of color, 5 years and younger. Due to a combination of factors including toxic stress and inappropriate social conduct, the given population does not receive timely intervention treatment. The goal is to increase routine screening and further evaluation in speech, behavioral and occupational therapy. As part of these efforts, a 3-month assessment will be conducted to measure the following rates of (1) No show and follow-ups (2) Screening and referral (3) Providers that provide adequate advocacy. In addition, to offer educational seminars to staff about white fragility to take steps in building a safe and healthy work environment for staff, patients and families.

Radiation Oncology

Implementation of a palliative radiation oncology service at UCSF

Faculty Champion: Steve Braunstein, MD
With new Faculty: Lauren Boreta, MD

To implement a palliative radiation service to improve the overall health and care of radiology patients, including Mount Zion radiology patients when they are admitted to hospital. The project aims to assess the current radiation consultation service through a retrospective evaluation to identify areas of improvement pre- and post- implementation. Areas of improvement may include utilization of shorter courses of radiation, educational programs, telemedicine, and prospective collection of patient-reported outcomes.

Women’s Health

Faculty Champion: Molly Heublein, MD       

To Improve advance care planning (ACP) in order to improve the provision of healthcare for seriously ill patients and to establish a framework that routinizes practice by addressing urgent problem of care. As part of UCSF-wide primary care, collaborating with DGIM in their MERI QI project (see above)