UCLA Awarded 6 UC Health Quality Grants for Hospital Care - Manufacturing Close-Up

To help meet healthcare reform needs, the University ofCalifornia established the Center for Health Quality and Innovation,which provides financial support for health quality initiativesacross the UC health system.

According to a release, the center has now awarded nine grantstotaling $3.4 million to six UC institutions for projects aimed atbetter understanding and alleviating common obstacles to healthquality, including frequent falls, excess radiation from scans,hospital-acquired conditions and issues of care coordination amongmultiple health professionals. Of the nine studies, six include UCLAhealth 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, andsometimes even death. At Ronald Reagan UCLA Medical Center, however,falls declined by 30 percent when the hospital instituted a programcalled '5Ps.' In many hospitals across the country, nurses on roundsuse an hourly process called '4Ps' to assess patients' pain,personal needs, positioning in a bed or chair, and the placement ofitems they might need. At UCLA, nurse Catherine Walsh, theaccreditation manager for in-patient nursing and interventionalareas for the UCLA Department of Nursing and a member of thedepartment's falls prevention committee, created the '5Ps' programby adding 'preventing falls' to the hourly rounding process. Duringeach nursing visit, factors that could result in falls areidentified and mitigated, reducing risk on an ongoing basis duringhospitalization. Walsh and Dr. Teryl Nuckols, a UCLA associateprofessor of general internal medicine and health services research,who are co-leaders of the project, and their team received a grantof $375,000 to develop educational programs for health professionalsand to expand the use of the '5Ps' program to other UCLA hospitalsand UC medical centers.

Getting patients back on their feet

Stroke patients spend a long time in the hospital. At UCLA, theaverage patient stays for 18 days, from onset throughrehabilitation. Other patients recovering from critical illnessesmay stay even longer. All these extended stays result in dramaticmuscle weakening -- a loss of about 1 percent of muscle mass eachday while on bed rest -- underscoring the need to boost exerciseprograms to help patients recover. But many patients, due to lack ofmotivation, don't benefit from exercise programs, and when they doexercise, it's often not enough. A team headed by Dr. Bruce Dobkin,a UCLA professor of clinical neurology, received a $50,000 grant tocreate a program that involves the use a network of wireless sensorsand a special exercise bike that can fit in a bed or on the floor.The program will allow health professionals to monitor activity inthe hospital and at home, provide instant feedback to patients, andgather information to design more effective rehabilitative exerciseprograms. The sensors include accelerometers, developed by facultyat UCLA's Wireless Health Institute, that a patient can wearcomfortably, and mathematical algorithms are used to interpret thetype, quantity and quality of daily activities.

Improving care following hospital discharge

The transition between hospital and outpatient settings is aparticularly vulnerable time for patients, as their condition is atrisk of deteriorating shortly after they exit the hospital doors. Infact, about one-fifth of Medicare patients are readmitted to thehospital within 30 days, with half of those readmissions consideredpreventable. By bringing together teams from different clinicalsites to improve processes and learn from each other, patient carecan be enhanced, particularly when patients transition from thehospital to a primary care provider. Such quality improvementprograms assess patients for readmission risks when they enter thehospital, help patients and caregivers understand these risks, andfollow up with both patients and physicians shortly after discharge.Dr. Nasim Afsarmanesh, an assistant clinical professor and directorof quality and safety at Ronald Reagan UCLA Medical Center, and hercolleagues from other centers were granted $750,000 to create aquality improvement network that will collaborate to design andimplement interventions to improve these important transitions ofcare.

Standardizing CT scan protocols

A computerized tomography (CT) scan can yield a tremendous amountof diagnostic information, but it is also important to assess theamount of radiation a patient receives from these scans. In order toreduce the total amount of radiation, and to meet the terms of a newCalifornia law requiring the reporting of radiation exposure, healthpractitioners need to set standards that allow for high-qualitydiagnostic CT scans with a minimum amount of radiation. To createnecessary exposure standards, a team including UCLA radiologyresearchers Dr. Michael McNitt-Gray and Dr. Christopher Cagnon wasgiven a grant of $750,000 to create standard protocols for CT scansof all types which will balance radiation exposure and imagequality. The team will also establish educational programs for allUC medical centers to create practice standards that could be usednationwide.

Reducing radiation from unnecessary CT scans

Many hospitals will automatically order a CT scan of any patientadmitted with blunt chest injuries. Yet many of these scans, whileexposing patients to ionizing radiation, may not provide anybenefit. One reason so many patients receive these scans is thatinformation that could help health professionals decide whether suchscans are necessary is scarce. Dr. William Mower, a UCLA professorof emergency medicine, and his colleagues received $375,000 tocreate a decision-making process that will help practitionersanalyze key signs, allowing them to differentiate patients who couldlikely have injuries requiring a CT scan from those with no risk ofthose types of injuries. The grant will allow the researchers toidentify the key clinical signs that a patient has internal chestinjuries in order to make the selection process practicable inemergency and hospital settings.

Preventing pulmonary embolism and deep vein thrombosis

Blood clots in the lung and the rest of the body afflict hundredsof thousands of Americans each year and rank among the most commonpreventable causes of death in hospital patients. Treatments toprevent these clots are available but are used only 30 to 50 percentof the time with eligible patients. Dr. Nasim Afsarmanesh, anassistant clinical professor and director of quality and safety atRonald Reagan UCLA Medical Center, and her colleagues received$750,000 to find ways to reduce the occurrence of these clots inhospitalized patients. The group will create teams at each UCmedical center to collect data and create tools to enhanceperformance and prevention rates.

The UCLA Health System, which comprises the UCLA Hospital Systemand the UCLA Medical Group and its affiliates, provides services inhealth care and treatment options.

((Comments on this story may be sent tonewsdesk@closeupmedia.com))