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Specialty Care Initiative

A coalition of key safety net stakeholders working to improve primary care – specialty care communication and coordination, clinic efficiencies, and registry development in specialty clinics. The Specialty Care Initiative is funded by Kaiser Permanente and the Blue Shield of California Foundation.

 

Overview

As part of a statewide initiative, San Francisco safety net providers formed a coalition in 2008 to focus on increasing access to, and reducing the demand for, specialty care services for patients in the safety net. The coalition’s efforts have centered on improving referral guidelines to medical, surgical, and diagnostic specialties before a patient’s specialty clinic visit and expanding the knowledge base of primary care providers in managing certain conditions in their clinics as opposed to relying on specialists to care directly for each patient with the limited specialty resources that exist in our system.

Over the past three years, the San Francisco coalition’s efforts have resulted in:

  • Increased coordination among safety net health care providers
  • Improvements in communication between primary care providers and specialists that ensures high quality patient care and safety
  • Expansion of a systematized referral process for medical, surgical, and diagnostic services
  • Development of educational tools on specific specialty conditions to enhance primary care providers’ knowledge base and capacity to care for their patients

Currently the San Francisco coalition is focusing its efforts on the transition after a patient’s specialty clinic visit:

  • Standardizing patient and visit information that is communicated to primary care providers after a specialty consultation
  • Developing guidelines for high quality specialty consultation notes
  • Specialists will serve as advisors to the eReferral ratings project, on how to use the ratings to improve care
  • Develop panel management strategies using medical assistants in specialty clinics

The coalition will convene work groups to examine these issues in Endocrinology, Gastroenterology, and Orthopaedic Surgery.

Coalition members include providers from the following organizations:

  • San Francisco Community Clinic Consortium health centers
  • San Francisco Department of Public Health – Community Oriented Primary Care clinics
  • Zuckerberg San Francisco General Hospital specialty clinics, Division of General Internal Medicine, and the Department of Family and Community Medicine

Resources

Publication

  1. Sewell JL, Day LW, Tuot DS, Alvarez R, Yu A, Chen AH. A Brief, Low-cost Intervention Improves the Quality of Ambulatory Gastroenterology Consultation Notes. Am J Med. 2013 Jun 18. (pdf)
  2. Sewell JL, Kushel MB, Inadomi JM, Yee HF. Non-English Speakers Attend Gastroenterology Clinic Appointments at Higher Rates Than English Speakers in a Vulnerable Patient Population. J Clin Gastroenterol 2009; 43:652-660. (pdf)
  3. Tuot DS, Sewell JL, Day LW, Leeds K, Chen AH. Increasing Access to Specialty Care: Patient Discharges From a Gastroenterology Clinic (pdf)

 

CME

Making It Work: Lifestyle Strategies and Clinical Tools for Diabetes, Obesity, and Atherosclerosis. May 6, 2011 (Syllabus)

 

Presentations

Specialty Care Initiative 2011-2012 Summary (pdf)

Enhancing the Primary Care-Specialty Interface, 2014 (pdf)

 

People

 

Project Lead: Alice Hm Chen, MD, MPH Profile

Project Lead: David Lown, MD, MA Profile

Lead Evaluator: Delphine Tuot, MDCM, MAS Profile

 

 

Steering Committee

Benjamin Breyer, MD, MAS – Assistant Professor, UCSF Division of Urology at ZSFG

 

Alice Hm Chen, MD, MPH – Associate Professor, UCSF Division of General Internal Medicine and CMO-SFHN

Dr. Chen’s primary interest is in issues of health care access, particularly in how poverty, race/ethnicity, and policy intersect with healthcare delivery systems to produce barriers to care.

 

Rebecca Jackson, MD – Professor, UCSF Department of Obstetrics, Gynecology, and Reproductive Science and Chief of Obstetrics and Gynecology at ZSFG

 

Elizabeth Johnson, MD – Medical Director, San Francisco Department of Public Health Community Oriented Primary Care

 

David Lown, MD – Chief Medical Officer, San Francisco Community Clinic Consortium and Family Physician at St. Anthony Medical Clinic

Dr. Lown is Chief Medical Officer of the San Francisco Community Clinic Consortium (SFCCC), a group of 11 community clinics and health centers.  Dr. Lown's professional interests relate to systems improvement, including issues around clinical practice and health care delivery redesign, as well as the use of technology to improve systems of care and health outcomes.

 

Elizabeth Murphy, MD, DPhil – Professor, UCSF Division of Endocrinology and Metabolism and Chief of Endocrinology at ZSFG

 

Justin Sewell, MD, MPH – Assistant Clinical Professor, UCSF Division of Gastroenterology and Hepatology at ZSFG

Dr. Sewell’s primary research interests are related to the interface between primary care and specialty care.  He is specifically interested in the quality of primary-specialty care communication, and developing novel methods for providing specialty care.

 

Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG

Dr. Tuot's research interests are in chronic kidney disease (CKD), provider-patient communication, CKD awareness, and implementation science.

 

Endocrinology Workgroup

Hali Hammer, MD – Professor, UCSF Department of Family and Community Medicine and Medical Director, ZSFG Family Health Center

Dr. Hammer has provided full scope primary care, including obstetrics, at the Family Health Center for the past 18 years. Dr. Hammer directs the Department’s Continuous Quality Improvement program and is an Associate Director of the UCSF/ZSFG Family and Community Medicine Residency Program.

 

Elizabeth Johnson, MD – Medical Director, San Francisco Department of Public Health Community Oriented Primary Care

 

Elizabeth Murphy, MD, DPhil – Professor, UCSF Division of Endocrinology and Metabolism and Chief of Endocrinology at ZSFG

 

Jennifer Park-Sigal, MD – Assistant Clinical Professor, UCSF Division of Endocrinology and Metabolism at ZSFG

 

Kenneth Tai, MD – Medical Director, Northeast Medical Services (NEMS)

Dr. Tai’s professional interests focus on reducing health disparities in those with limited access to health care system, such as immigrants and the elderly.  NEMS is a community health clinic in San Francisco, and a member of the San Francisco Community Clinic Consortium. With seven sites, NEMS provides comprehensive health care services to 54,000 patients who are mostly uninsured, underinsured, and low income.

 

Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG

 

Gastroenterology Workgroup

Ricardo Alvarez, MD – Medical Director, Mission Neighborhood Health Center

Dr. Alvarez is currently a fellow in the CHCF Center for Health Professions leadership program. He enjoys the challenges of finding system solutions to complex medical delivery coordination. He remains an optimist in spite of the many system challenges and ascribes to the philosophy of Emo Phillips who noted, “I’m not a fatalist; even if I were, what could I do about it?”

 

Alice Hm Chen, MD, MPH – Associate Professor, UCSF Division of General Internal Medicine at ZSFG and CMO-SFHN

 

Lukejohn Day, MD – Assistant Clinical Professor, UCSF Division of Gastroenterology and Hepatology at ZSFG and Medical Director for Medical Subspecialties at ZSFG

 

Justin Sewell, MD, MPH -- Assistant Clinical Professor, UCSF Division of Gastroenterology and Hepatology at ZSFG

 

Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG

 

Albert Yu, MD, MPH, MBA – Medical Director, Chinatown Public Health Center

 

Nephrology Workgroup

Elizabeth Davis, MD – Assistant Professor, UCSF Division of General Internal Medicine at ZSFG

 

Lukejohn Day, MD – Medical Director for Medical Subspecialties at ZSFG, Assistant Professor, UCSF Division of Gastroenterology and Hepatology

 

Sam James, MD – Professor, UCSF Division of Nephrology at ZSFG


Laurence Peiperl, MD – Clinical Consultant, Glide Health Services and Professor, UCSF Division of General Internal Medicine at ZSFG


Elsa Tsutaoka, MD – Medical Director, South East Health Center


Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG


Orthopaedic Surgery Workgroup

Terry Dentoni, RN, MSN, CNL – SFGH Director, Perioperative/Critical Care/Specialty/Emergency Nursing

Terry has worked at ZSFG since 1989 in various roles including Staff Nurse, Nurse Educator, Nurse Manager and in her current role as a nursing director.

 

Juliann Fusaro, RN, MSN, CNL – Orthopaedic Surgery

 

Harry Jergesen, MD – Professor, UCSF Department of Orthopaedic Surgery

 

Margot Kushel, MD – Associate Professor, UCSF Division of General Internal Medicine at ZSFG

 

David Lown, MD – Medical Director, San Francisco Community Clinic Consortium

Dr. Lown is a family physician at St. Anthony Medical Clinic in addition to his role as Medical Director of the San Francisco Community Clinic Consortium, a group of eleven community clinics.  His professional interests relate to systems improvement, including issues around clinical practice and health care delivery redesign, as well as the use of technology to improve systems of care and health outcomes.

 

Theodore Miclau, MD – Professor and Vice Chairman, UCSF Department of Orthopaedic Surgery, Chief of Orthopaedic Surgery at ZSFG and Director, Orthopaedic Trauma Institute

Dr. Miclau joined the faculty of the Department of Orthopaedic Surgery at the University of California, San Francisco in 1996 as an orthopaedic traumatologist at Zuckerberg San Francisco General Hospital.  He was named Vice Chairman and Director of Orthopaedic Trauma of the Department of Orthopaedic Surgery at UCSF in 2003, and became the Chief of Orthopaedic Surgery at ZSFG a year later.  He is the recipient of several prestigious awards including a five-year Career Development Award from the National Institutes of Health and a traveling fellowship from the American Orthopaedic Association.

 

Saam Morshed, MD, MPH, PhD – Assistant Professor, UCSF Department of Orthopaedic Surgery at ZSFG

 

Dana Nelson, RN – Nurse Manager, ZSFG Surgical and EKG Specialty Clinics

 

Diane Putney, NP – ZSFG Department of Orthopaedic Surgery

 

Trudy Singzon, MD – Medical Director, Ocean Park Health Center, San Francisco Department of Public Health

Dr. Singzon provides primary care, urgent care, and women’s health services to a culturally diverse, urban, underserved patient panel including children, adolescents, pregnant women, adults and seniors.

 

Brenda Stengele, MSN, NP – Director, Clinical Nursing, ZSFG Orthopaedic Trauma Institute

 

Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG

 

Urology Workgroup

Benjamin Breyer, MD, MAS – Assistant Professor, UCSF Division of Urology at ZSFG

 

Jerry Jew, MD – Associate Medical Director, Northeast Medical Services (NEMS)

 

Marika Russell, MD – Medical Director for Surgical Subspecialties at SFGH, Assistant Professor, Department of Otolaryngology at ZSFG

 

Heralio Serrano, MD – Medical Director, Castro-Mission Health Center

 

Jacqueline Tulsky, MD – Professor, UCSF Division of HIV/AIDS at ZSFG

 

Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG

 

Women's Health Workgroup

Lukejohn Day, MD – Medical Director for Medical Subspecialties at ZSFG, Assistant Professor, UCSF Division of Gastroenterology and Hepatology

 

Isabel Lee, MD – Assistant Professor, UCSF Department of Family and Community Medicine at ZSFG

 

Lydia Leung, MD – Silver Avenue Family Health Center and UCSF Department of Family and Community Medicine at ZSFG

 

Rebecca Jackson, MD – Professor, UCSF Department of Obstetrics, Gynecology, and Reproductive Science and Chief of Obstetrics and Gynecology at ZSFG

 

Rosalia Mendoza, MD – Clinical Chief of Women's Services, Mission Neighborhood Health Center

 

Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG

 

Sandy Wu, NP – Silver Avenue Family Health Center