Expanding Access

SARS-CoV-2/COVID-19 Tests: An Educational Series

Posted on May 18, 2020 in Affiliates, Expanding Access, Innovation, Quality, Research, Safety, Scroll Images

COVID-19 tests

Testing is conducted to diagnose, understand and help prevent the spread of SARS-CoV-2/novel coronavirus. We encourage people who test positive for the virus to quarantine and isolate themselves to prevent viral spread to others. This is particularly important with COVID-19, the diseased caused by SARS-CoV-2, because some infected people have no symptoms and may unknowingly infect others.

Follow our Educational Series on testing to learn about polymerase chain reaction (PCR) and serology testing, and stay abreast of the latest updates at Sutter. We feature expert perspectives from Jeffrey Silvers, M.D., Sutter Health’s medical director of infectious diseases. In Part 1 of this series, we describe SARS-CoV-2 testing with PCR.

Overview:
Polymerase chain reaction tests, known as PCR, are the most common and most accurate tests for determining whether someone is currently infected with the SARS-CoV-2/2019 novel coronavirus.

A healthcare provider administers a PCR test by taking a nose or throat swab from a patient, processing the sample in a machine, and then looking for unique genetic materials that indicate the presence of SARS-CoV-2. The test sample is commonly taken from the back of the patient’s throat or nose, generally using a long, thin swab. The swab is stored in a sterile tube and then sent to a lab for testing, where lab testing personnel extract nucleic (genetic) material from the test sample (sometimes called a “specimen”).

The purified genetic material is mixed with other compounds including some derived from the SARS-CoV-2 virus, which are known as “reagents.”

The combined solution is placed in a testing instrument. If a person’s specimen contains SARS-CoV-2, part of the virus’s genetic material will be multiplied several times (amplified) to a high enough level to yield a positive test result—meaning SARS-CoV-2 is detected. The test result is negative, or “not detected,” if the specimen lacks SARS-CoV-2.

As with all lab tests, a number of factors determine the accuracy of a COVID-19 test result. These include not only the instrument and chemical reagents used to perform the test, but also the timing and quality of specimen collection and the biology of the individual patient.

Laboratory tests are characterized by their ability to detect a positive case (sensitivity) and their ability to determine a negative case (specificity). So a sensitive test is less likely to provide a false-negative result and a specific test is less likely to provide a false-positive result.

How accurate are PCR tests?

  • Like most laboratory tests, several factors determine the accuracy of a COVID-19 test result. These include the testing instrument and chemical reagents used to perform the test, as well as the timing and quality of specimen collection and the biology of the individual patient. Laboratory tests are characterized by their ability to detect a positive case (sensitivity) and their ability to determine a negative case (specificity). A sensitive test is less likely to provide a false-negative result and a specific test is less likely to provide a false-positive result.
  • In general, PCR tests are the most effective diagnostic test to detect SARS-CoV-2 infection. However, a follow-up PCR test is sometimes indicated to confirm a negative result. PCR tests are less reliable in detecting very early infections because several days may pass before the virus starts replicating in a person’s throat and nose. Although PCR tests usually convert to negative with 10 days after first becoming positive, they may remain positive in some patients for up to three to six weeks. It is unknown whether this reflects ongoing potential contagion in these extended carriers.
  • The PCR tests are also less reliable with late disease, often starting at about 14 days after initial symptoms, because the virus is no longer replicating and the body is clearing the virus. With optimal sample collection and timing for testing, the PCR test will detect disease in most, but not all, patients with COVID-19.
  • Based on limited studies and according to the U.S. Centers for Disease Control and Prevention (CDC), most PCR tests are highly reliable with less than five percent chance of false negatives.
  • During the course of the SARS-CoV-2 pandemic, PCR testing has been refined from the initial testing procedures and has been conducted with greater automation to help reduce errors.

Are PCR tests administered at home or in pharmacies effective?

  • Rapid point-of-care PCR tests have also recently become available. On April 21, 2020 the U.S. Food and Drug Administration (FDA) approved the first at-home PCR test for COVID-19. The test permits testing of a sample collected from the patient’s nose using a designated self-collection kit that contains nasal swabs and saline. Once patients self-swab to collect their nasal sample, they mail their sample to a LabCorp lab for testing.
  • The ability to detect COVID-19 disease for home collection depends on closely following the collection instructions and the timing of collection (time point in disease). With optimal sample collection and timing of collection, the ability to detect disease can be similar to collection and testing performed at a healthcare facility.

Testing at Sutter Hospitals:
Sutter Health is following CDC guidelines on testing for SARS-CoV-2 within our hospitals and emergency departments.

As part of Sutter Health’s comprehensive response to the novel coronavirus pandemic, we sourced multiple PCR tests for COVID-19. For the safety of our patients, we continually monitor evidence on newly emerging investigational and approved diagnostic tests, and we run our own performance testing to verify results for effectiveness.

Testing with PCR can produce a positive test result in as little as five minutes, and enables us to perform “close proximity”—conducted on site or nearby—COVID-19 testing for 10 of our hospitals that see the highest volume of patients.

“Close proximity” testing at our busiest hospitals allows us to quickly diagnose and correctly treat our most vulnerable patients, which improves infection-control measures and preserves valuable personal protective equipment (such as masks and gowns) for Sutter’s frontline healthcare workers.

Sutter’s core laboratory in Livermore also supports prompt diagnosis and treatment—delivering COVID-19 test results to our hospitals and outpatient facilities within 24 to 36 hours.

Currently (May 18, 2020), Sutter is performing approximately 1,000 COVID-19 tests daily on samples collected from Sutter patients and employees, and our Sutter labs have the capacity to meet this demand. Indications for testing continue to expand as more testing supplies become available.

We implemented a process that includes repeat testing with an alternative method, on negative test results that do not “fit” with the patient’s clinical picture and other cases when clinically indicated. This helps eliminate suspicion of negative test results.

We are following test manufacturers’ recommendations for optimal swab collection and test performance. Beginning in April 2020, labs affiliated with Sutter have been performing comparison testing to further optimize test performance.

Respiratory Clinics Outside Sutter Hospitals (Ambulatory Respiratory Clinics):
For patients outside the hospital setting, Sutter offers designated respiratory sites where patients can be evaluated by a clinician to see if they meet the criteria for the COVID-19 test. There are respiratory clinics in the San Francisco Bay Area, and designated urgent care clinics in the Sacramento Valley Area.

If you feel ill, schedule a video visit or call our COVID-19 advice line at 866-961-2889 to receive guidance on whether you need to be further evaluated at a Sutter testing site. Please present identification at the testing site to confirm your appointment.

If you meet the criteria for testing, a specimen will be collected and sent to a lab for analysis. If the result is positive, your clinician will arrange for appropriate care.

Testing Locations (Specimen Collection Sites): There are approximately 24 test collection locations, primarily at urgent care locations throughout Sutter’s Northern California service area.

Patients are asked to call a phone number from their car. Staff then provide guidance and coordinate collecting test samples.

Respiratory Clinics: There are approximately 17 respiratory clinics currently located within medical office buildings, clinics, parking garages or tents:

  • Many offer car triage
  • Some require an appointment (a doctor’s note is required for all testing)
  • All of these locations also offer test collection (a doctor’s note is required for all testing)

The test samples that Sutter collects from non-hospitalized patients who have been tested for SARS-CoV-2 are sent primarily to the Sutter core laboratory in Livermore. Results are usually available in one day.

SARS-CoV-2 Testing for Sutter Healthcare Workers:
Sutter is prioritizing prompt testing of exposed, symptomatic healthcare workers to provide prompt treatment, support family safety and foster their safe return to the front lines of care. Our approach is consistent with CDC guidelines.

Part 2 of this Educational Series on SARS-CoV-2/COVID-19 tests describes antibody/serology tests. Learn more.

Program Designed to Attract Docs to Rural Areas Receives Accreditation

Posted on May 15, 2020 in Community Benefit, Expanding Access, Scroll Images, Sutter Amador Hospital, Sutter Medical Center, Sacramento, Uncategorized

The Sutter Rural Residency Program received a U.S. grant last year and this week was accredited and is ready to screen applicants. Leaders involved in the program include, from left, Dineen Greer, M.D., program director of the Sutter Family Medicine Residency Program; Sutter Amador Hospital CEO Tom Dickson; HRSA regional administrator Capt. John Moroney, M.D; Jackson Mayor Robert Stimpson; Sutter Valley Area Chief Medical Officer Ash Gokli, M.D.; former Sutter Amador CEO Anne Platt; and Robert Hartmann, M.D., longtime Amador County internal medicine physician and an instructor in the Rural Residency Program.

JACKSON, Calif. – Sutter Amador Hospital’s Rural Residency Program this week received accreditation from ACGME (Accreditation Council for Graduate Medical Education), the organization responsible for accrediting all graduate medical training programs for physicians in the United States. This Sutter Health program is designed to bring more primary-care physicians to rural regions, which have been hampered throughout the country by a shortage of family doctors.

The ACGME accreditation allows the Sutter Health Rural Residency Program to begin screening and selecting residency applicants. Those selected – two each year for six total in the program – will complete core inpatient training in Sacramento during the first year, with their next two years on the campus of Sutter Amador Hospital and in community medical offices.

The goal of the Sutter Health program is to develop a sustainable, accredited rural training track in Amador County and to ultimately expand the area’s rural primary-care workforce. In Amador County, there is a high need for primary-care physicians (PCPs) in the area as the ratio of the population to one PCP is 1,760-to-1; the ratio throughout the state of California is 1,280-to-1, according to the County Health Rankings and Roadmaps website.

“This is welcome news for Amador County, as it will provide an influx of bright, young physicians into our community to care for our families and should give us a steady supply of primary-care physicians for years to come,” said longtime Amador County internal medicine physician Robert Hartmann, M.D., who will be one of the instructors in the Rural Residency Program. “This is a major collaborative accomplishment between Sutter Amador Hospital, Sutter Medical Group physicians and the Sutter Family Medicine Residency Program.”

The Rural Residency Program was made possible through a grant from the U.S. Health Resources and Services Administration (HRSA), which allows not-for-profit Sutter Health to expand its successful Sacramento-based physician residency program to Amador County as part of the federal agency’s efforts to provide better access to quality medical care in rural areas.

Since its inception in 1995, the Sutter Family Medicine Residency Program has graduated 139 physicians, all of whom passed their Board Certification assessments on the first effort. Currently there are 21 residents in the program, and the Amador County program will expand the program to 27 residents.

“We are working to strengthen the physician pipeline throughout our integrated network so our patients receive the same high-quality care no matter where they live,” said Dineen Greer, M.D., program director of the Family Medicine Residency Program. “We have combined a strong, dedicated core faculty, community preceptors, innovative curriculum and access to Sutter hospitals so that our residents develop the skills needed to be outstanding family physicians and leaders in their communities.”

The accreditation was welcome news for the state legislators who serve the Gold Country. State Sen. Andreas Borgeas said: “The physician shortage continues to be a prevalent issue in Amador County and many rural areas of California. I offer my sincere congratulations and gratitude to Sutter Health on the program’s latest achievement, and for its targeted effort to bring much-needed family practice physicians to our community. This is a significant step to help expand access to quality care for our communities in the beautiful, remote areas of our state.”

State Assemblyman Frank Bigelow echoed Sen. Borgeas’ sentiment. “Sutter Health has long supported hospitals in more rural regions of California and they understand how family doctor shortages can have a negative impact on a community’s health,” Bigelow said. “I am so pleased they are pursuing this program and continuing their investment in bringing needed primary care physicians to Amador communities.”

Drs. Greer and Hartmann expect the program to be successful in filling the need for well-trained, community-minded primary-care physicians in Amador County and the greater Mother Lode region.

“The medical students applying for this residency opportunity will enter the program with a strong desire to serve in rural communities,” said Dr. Hartmann, “so their career focus will be the health and well-being of families in our towns and smaller cities. This is great for the future of health care in our community.”

For more on the Sutter Family Medicine Residency Program, go to www.suttermd.com/education/residency/family-medicine

Data Detectives Track the Pandemic

Posted on May 13, 2020 in California Pacific Medical Center, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Research, Scroll Images, Transformation

Like a shadow lengthening at sunset or a dark cloud slowly obscuring the sun, the novel coronavirus has the potential to spread silently before positive tests confirm diagnoses in people infected with the virus.

To help get ahead of the curve and prepare Sutter’s integrated healthcare system to manage a potential surge in infections or a re-emergence of novel coronavirus later this year, Sutter leaders are collaborating with researchers and statistical analysts to track infection rates in the Sutter patient population and predict the course of viral spread.

Sutter researchers are experts in data analysis who leverage current and new methods aligned with Sutter privacy safeguards. Their work helps strengthen Sutter’s response to the pandemic. Here’s how:

1. TRACK THE VIRUS: Sutter Health Biobank
Sutter researchers are exploring ways to detect the novel coronavirus before it spreads further, by assessing exposure rates in Sutter’s patient population. This effort is led by Gregory Tranah, Ph.D., Scientific Director of CPMC and Director of Sutter’s Center for Precision Medicine Research.

The COVID-19 Seroprevalence and Surveillance Study will identify blood and serum samples from Sutter Biobank volunteer participants that show antibodies against the novel coronavirus. “Seroprevalence” means the level of a virus or other pathogen in a population, as measured in blood.

“Understanding the surge of infection rate and spread is an important part of preparedness. Epidemiological studies of emerging COVID-19 infections can help determine the burden of disease, develop better estimates of morbidity and mortality, and guide return-to-work and personal-safety decisions based on exposure history,” says Dr. Tranah.

The Sutter Biobank has been enrolling patient volunteers to give blood samples when a blood draw is ordered for clinical reasons. From early December 2019 through March 21, 2020 over 700 Biobank participants had blood samples drawn and archived.

“These samples provide Sutter with a unique opportunity to perform population-based surveillance of COVID-19 exposure when the virus began to spread in Northern California. They represent highly diverse patient data from Sutter’s integrated network. This is meaningful information that will allow us to determine the rate and timing of peak exposure and leveling of exposure rate,” says Dr. Tranah.

“Further, we can use the Biobank samples to find potential evidence of a resurgence of COVID-19 infection this fall. Earlier detection means we can plan for early containment of the virus.”

2. MONITOR VIRAL SPREAD: COVID-19 Surveillance
Researchers and statistical analysts at Sutter’s Center for Health Systems Research (CHSR) are collaborating with Sutter’s Enterprise Data Management, Informatics, Information Services and other operational departments to perform much-needed surveillance on the COVID-19 pandemic and provide insights to Sutter leaders.

Each morning, the CHSR team prepares reports for all Sutter hospitals on the number of patients who have tested positive or are suspected of being positive for COVID-19. They also track total hospital capacity and intensive care unit bed occupancy to help front-line staff with surge-capacity planning.

“Surveillance helps us understand how COVID-19 may be spreading amongst the patients we care for and our healthcare workers, and how we can prepare for potential surges in viral infection rates in the coming months,” says Alice Pressman, Ph.D., MS, Co-Director of CHSR.

Dr. Pressman and her colleagues at CHSR are developing the COVID-19 Universal Registry for Vital Evaluations (CURVE)—a centralized resource for research and quality improvement activities for COVID-19 disease surveillance and modeling, as well as health services and epidemiologic analyses.

“The registry will allow us to conduct research to assess the impact of COVID-19 on the healthcare system, Sutter patients, and our community of employees and healthcare workers,” says Dr. Pressman.

This registry develops the structure for the minimum necessary data to be used for each project, securely within the Sutter network. In turn, the knowledge gained can help to inform patient care and operations as Sutter continues to face COVID-19.

In support of Sutter’s Advancing Health Equity initiative, the CHSR team studied the demographics and clinical characteristics of COVID-19-infected individuals and their outcomes, which helped identify patient subgroups that may be more vulnerable to the disease. Early results indicate there may be inequities by sex, race, ethnicity and socioeconomic status.

“Research during a pandemic is vital to determine which parts of our communities and sub-groups of patients are most affected, so that we can allocate resources and care for our most vulnerable patients,” says Dr. Pressman.

3. A MATHEMATICAL CRYSTAL BALL: Statistical modelling to help predict the future of viral spread
One of the challenges of the COVID-19 pandemic is that scientists don’t fully understand the impact of the virus or its prevalence in our communities.

“One way to help answer these questions is through statistical modeling,” says Dr. Pressman. “We can use infectious-disease models as tools to help us predict the future of the novel coronavirus spread and the potential impact of social distancing and containment efforts on flattening the curve.”

Dr. Pressman and her team are collaborating with researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to understand the models IHME has published for California state COVID-19 data. “We hope to apply these models to our system to help us allocate healthcare resources and make decisions about future containment efforts.”

Data crunching to help halt a pandemic:
Surveillance is the systematic collection, analysis and interpretation of health-related data. For surveillance of the novel coronavirus and COVID-19, Sutter is using surveillance systems to monitor COVID-19 disease across the system. Surveillance and biobanking can help:
• Monitor the spread and intensity of COVID-19 disease
• Understand disease severity and the spectrum of illness
• Understand risk factors for severe disease and transmission
• Monitor for changes in the virus that causes COVID-19
• Estimate disease burden
• Produce data for forecasting COVID-19 spread and impact
• Improve patient care and help improve Sutter’s response to the pandemic

The Future is Now: Video Visits Explode in Light of COVID-19

Posted on May 11, 2020 in Expanding Access, Innovation, Scroll Images

Whether at home or in the hospital, patients getting the support they need


“It is transformative—I don’t think we’ll ever go back to practicing medicine in the same way we did B.C. — before coronavirus.”

Albert Chan, M.D.

SACRAMENTO –In what may herald a cultural shift in how patients and their doctors interact, video visits have increased at an astonishing rate across Sutter’s not-for-profit integrated network of care since the outbreak of COVID-19 in California. According to Albert Chan, M.D., Sutter Health’s chief of digital patient experience, video visit volume has grown by 350-fold since the pandemic.

“Our digital health initiatives are critical to Sutter’s efforts to respond to COVID-19,” said Dr. Chan. “As we shelter-in-place, digital health enables the human connections that we need to care for our community.”

Video visits, also called telemedicine, offer an alternative way to get care from home for respiratory illness, as well as everyday concerns such as minor injuries, infections, chronic disease management and palliative care. With many clinicians in the Sutter network now offering video visits, patients can book a video visit directly with their provider through their My Health Online account or by calling their clinician’s office.

Read more about Telehealth at Sutter Health.

From Great Challenges Comes Great Opportunity

“Telemedicine is perhaps the only silver lining of this horrible pandemic,” says Aarti Srinivasin, M.D., an internal medicine physician with Sutter’s Palo Alto Medical Foundation. “It is transformative. I don’t think we’ll ever go back to practicing medicine in the same way we did B.C. — before coronavirus. Each and every day will be shaped by the way we practice medicine A.C.—after coronavirus.”

To further expand access to video visits and other digital innovations, philanthropy teams across the Sutter Health network pooled resources to make $1.5 million available for a system-wide purchase of iPads. So far, 950 iPads have been deployed to patients and clinicians in isolation while about 2,000 units have been provided to physicians to conduct video visits. Through this continued philanthropy partnership, 1,000 additional iPads will soon support telemedicine efforts, with a goal to ultimately equip thousands more physicians in Sutter’s integrated network of care.

Video Visits Inside the Hospital?

But the shift isn’t just for those who are following stay-at-home orders. Video visits have now branched beyond clinical support to patients who are hospitalized. Connection with loved ones can have a profound impact on the human spirit. In these difficult times however, it can be easy to feel isolated. The Centers for Disease Control and Prevention (CDC), continues to recommend maintaining a connection with loved ones, even if just digitally, throughout this pandemic.

To bring some comfort to hospitalized patients, Sutter’s Emergency Management System assembled a work group to lead the charge in securing iPads for Sutter hospitals. In about two weeks, the work group provisioned nearly 1,000 iPads to hospitals across the Sutter network. The iPads allow hospitalized patients to connect with family and friends, helping to improve their overall care experience.

“I had the honor of helping the son of a patient visit with his mom via FaceTime on the new iPads,” said Caryn Brustman, R.N., a clinical manager who works at Sutter Roseville Medical Center. “The son was in full military uniform and was deploying soon, but wanted the opportunity to say goodbye to his mom before he left.”

In addition to allowing patients to keep in touch with their loved ones, these iPads help frontline teams save valuable PPE. The care team can check in with a patient before entering the room, eliminating visits before a patient is ready. This also allows support staff like chaplains and social workers, who aren’t typically allowed in these rooms during the pandemic, to connect face-to-face with patients.

Grants Accelerates Video Visit Access to Palliative Care

This new era in healthcare is now also broadening the reach and potential for other means of telemedicine. A $225,000 grant from the Stupski Foundation is enabling Sutter clinicians to bring vital palliative care services via video visits to Bay Area patients facing serious illness or end-of-life. The grant will provide mobile-enabled iPads to enhance patient care and improve planning for inpatient and ambulatory palliative care teams at California Pacific Medical Center, Alta Bates Summit Medical Center, Eden Medical Center, Palo Alto Medical Foundation and Sutter East Bay Medical Foundation. The technology provides added capacity via virtual visits and will also expand access to an advance care planning (ACP) video library to facilitate patient and family engagement, virtual ACP discussions for advance health care directive, and Physician’s Orders for Life-Sustaining Treatment (POLST).

“Through the generosity of the Stupski Foundation, we will now be able to share important ACP tools at our hospitals as well as our ambulatory palliative care, Advanced Illness Management and care management programs—which could not access these resources prior to the COVID-19 outbreak,” said Beth Mahler, M.D., vice president of clinical integration at Sutter.

“We have been inspired by the pandemic response across the Bay Area, in particular from healthcare providers like Sutter Health that are expanding telehealth to deliver care,” says Dan Tuttle, Stupski Foundation director of health. “Thanks to their quick and thoughtful responses, our communities facing the greatest challenges from COVID-19 are receiving the safe, high-quality care they need locally now, and into the future.”

Community members interested in helping these efforts can visit www.sutterhealth.org/give-covid19.

Solutions for Sleeplessness: A New Study Tests Behavioral Therapy and Medications

Posted on May 6, 2020 in California Pacific Medical Center, Expanding Access, Innovation, Quality, Research

More than 20 million Americans suffer from chronic insomnia. This sleep disorder can cause emotional distress, impaired functioning and reduced quality of life. It can even contribute to an increased risk for other health problems such as depression and high blood pressure.

Researchers at Sutter Health’s San Francisco Coordinating Center (SFCC) are collaborating with investigators at the University of Pittsburgh and other leading institutions nationwide to help improve insomnia treatment. Their collective focus begins with attempts to better support people suffering from the disorder in remote communities since access to sleep clinics may be limited.

The newly launched COZI (Comparative Effectiveness of Zolpidem and Cognitive Behavioral Therapy for Insomnia in Rural Adults) study will assess the effectiveness of web-based cognitive behavioral therapy for insomnia (CBT-I) compared with a common prescription sleep medication (zolpidem) or the combination. COZI is the largest, multicenter, randomized clinical trial of its kind to be conducted in rural primary care practices.

The study uses a self-guided online approach to CBT for insomnia developed by collaborators at the University of Virginia. COZI will enroll 1,200 people ages 18 to 80 with chronic insomnia in rural primary care practices affiliated with eight U.S. academic medical centers. Treatment effects will be evaluated at nine weeks, and at six and 12 months.

Katie Stone, Ph.D.
Katie Stone, Ph.D.

“Both zolpidem and CBT-I have been proven effective in treating chronic insomnia. However, COZI is the first randomized trial to comprehensively explore how these therapies compare in providing sustained sleep improvements, as well as their potential side effects and impact on other health outcomes,” says Katie Stone, Ph.D., senior scientist at SFCC and lead investigator of COZI for Sutter.

“People in rural areas with insomnia may have difficultly traveling to sleep clinics for care. Our goal is to test an approach that delivers insomnia treatment in their homes, making it easier for them to use an innovative, convenient approach to manage their sleep disorder,” said Daniel Buysse, M.D., Professor of Psychiatry and Clinical and Translational Science at the University of Pittsburgh School of Medicine, and co-lead investigator of COZI.

“We anticipate this new approach to delivering insomnia treatment will help lead to sustained improvements in how providers care for adults in rural communities with this common sleep disorder,” said Dr. Stone.

“This project was selected for PCORI funding for its scientific merit and commitment to engaging patients and healthcare providers in a major study conducted in real-world settings. COZI may help answer an important question about chronic insomnia and fill a crucial evidence gap,” said PCORI Executive Director Nakela Cook, M.D., MPH.”

The four-year, $5.7 million study is sponsored by the Patient-Centered Outcomes Research Institute (PCORI).1

Contact Katie Stone, Ph.D. for more information about the COZI study.

A Dose of Technology to Aid Sleep Therapy:

Many clinical studies test whether a treatment works under ideal conditions in specialized research centers, but health care is rarely delivered in such idealized situations and settings. Pragmatic clinical studies such as COZI test a treatment’s effectiveness in “real-world” practice situations such as outpatient settings, and also can include a wider range of study participants—making their findings more applicable to a broader patient population.

While CBT-I is well-established as an effective strategy for treating insomnia,2,3 it is usually delivered in person by behavioral health specialists. CBT-I broadens access to insomnia treatment and provides sleep disorder education, monitoring and individualized behavioral recommendations to improve sleep. In rural communities, use of CBT-I may be even more important because these types of sleep therapies can be limited in remote areas.

Citations:

  1. PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org.
  2. Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late‐life insomnia: a randomized controlled trial. JAMA. 1999;281(11):991‐9. PubMed PMID: 10086433.
  3. Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder‐Frederick L, Frederick C, Quigg MS, Cohn WF, Morin CM. Effect of a Web‐Based Cognitive Behavior Therapy for Insomnia Intervention With 1‐Year Follow‐up: A Randomized Clinical Trial. JAMA Psychiatry. 2017;74(1):68‐75. Epub 2016/12/03.

Paying it Forward: Sutter Teams with Vitalant to Offer COVID-19 Survivor-Donated Blood Plasma to Patients

Posted on Apr 27, 2020 in Alta Bates Summit Medical Center, California Pacific Medical Center, Community Benefit, Expanding Access, Innovation, Quality, Research, Scroll Images, Transformation

Convalescent plasma, rich in protective antibodies, is the liquid component of blood.

With experts predicting that a vaccine for COVID-19 is at least a year away, Sutter and Vitalant are collaborating to offer investigational treatment with convalescent plasma—blood plasma collected from people who have recovered from COVID-19—to hospitalized patients with severe cases of the disease under requirements recently outlined by the U.S. Food and Drug Administration (FDA).

Convalescent plasma, rich in protective antibodies, is the liquid component of blood. Not-for-profit Sutter Health is the first non-academic hospital system in California to participate in this research, launching expanded access program testing the use of convalescent plasma at its affiliates California Pacific Medical Center (CPMC), Sutter Medical Center Sacramento and Alta Bates Summit Medical Center, with other Sutter sites beginning the clinical trial in the coming weeks.

“By collaborating with community partners like Vitalant, we’re bringing an opportunity for the latest cutting-edge research to our patients,” says Sean Townsend, M.D., an intensive care medicine specialist in CPMC’s Division of Pulmonary and Critical Care. “Convalescent plasma is a potentially promising treatment for COVID-19 that we will test in clinical trials across the Sutter integrated network of care. We hope to build a supply of convalescent plasma that will add to our arsenal of emerging treatments to fight the virus.”

Vitalant physician colleague, Chris Gresens, M.D., adds, “We hope this therapy will serve as a type of ‘stop-gap vaccine substitute’ by providing severely affected patients just enough of an ‘immune boost’ to help them to recover more fully and quickly.”

The plasma donor must test negative for COVID-19 and be otherwise healthy. Convalescent plasma from one donor may be used to treat as many as four hospitalized patients with the illness who consent to participate in a clinical trial of the treatment.

Convalescent plasma has been studied for the treatment of numerous illnesses, most recently for infectious diseases such as Ebola, SARS, MERS and H1N1.

How you can help:

  • Under the new U.S. FDA guidelines, eligible blood donors who have had a documented diagnosis of COVID-19, and remain asymptomatic for at least 14 days post-recovery, may donate their plasma.
  • Sutter patients and health care workers who previously tested positive for COVID-19 can book an appointment for free donor screening at Sutter walk-in clinics: make a video appointment through My Health Online or call Sutter’s COVID-19 Advice Line (866) 961-2889 for more information.
  • Vitalant will only accept donors who meet all FDA-required general donor eligibility criteria in addition to the COVID-19 convalescent plasma qualifications.
  • Non-Sutter affiliated potential donors may apply to donate plasma at a Vitalant site by completing the form at Vitalant.org/covidfree. Donors cannot walk in for this procedure; they will be contacted by Vitalant to schedule an appointment.