Innovation

Respiratory Care Clinics: How Dedicated Exam Spaces Limit the Spread of Viruses

Posted on May 26, 2020 in Carousel, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Safety, Scroll Images, Uncategorized

BAY AREA, Calif. – Its second nature for people to visit their doctor’s office or an urgent care center when they’re sick — or are worried they might be. In early March doctors across the Sutter Bay Medical Foundation prepared for patient demand at these locations by developing Respiratory Care Clinics (RCCs); an outdoor exam experience that keeps potentially contagious people distanced from those that aren’t, while allowing all who need in-person care to receive it.

“We always knew patients would have concerns that were serious enough to need an in-person exam, but not urgent enough for a trip to the emergency room,” said Kurt Vandevort, M.D., inter-regional medical director for the Palo Alto Foundation Medical Group, part of the Sutter Medical Network. “As community-based providers this middle level of care is our core competency, so it was incumbent on us to find a way to keep providing it, safely.”

By March 16th the Sutter Bay Medical Foundation had established fifteen RCCs in cities across the Bay Area, each seeing patients with COVID-19 concerning symptoms (or who reported a potential exposure to the coronavirus), outside of a nearby medical building that needed to stay open and clean for patients with urgent or medically necessary needs unrelated to COVID.

A month into their operation reporters from The Mercury News and San Francisco Chronicle took notice and wrote about these MASH-like clinics. Now, as Sutter Health resumes more routine patient visits, the RCCs will continue to separate patients with respiratory symptoms from those without, to reduce the risk of exposure to viruses, including the novel coronavirus. Read below to learn more about how the RCCs work and what to expect if you are directed to one.

Call First 

Sutter Health is focused on helping ensure patients have access to the right level of care to match their medical need, but we also understand that sometimes that’s hard for people to gauge. That’s why Sutter Health set up the COVID-19 Advice Line at 1-866-961-2889.

Staffed by a team of nurses from 8 a.m. – 6 p.m., seven days a week, every caller is screened for symptoms linked to coronavirus. Callers are then directed to the most appropriate level of care based on the severity of their symptoms. Patients may be directed to self-monitor at home, to see a provider by video visit or to come to an RCC location where they can receive an in-person exam.

“By linking the RCCs to a pre-screening process (by phone or after a video visit) we can ensure patients coming to RCC do need to be seen in-person, and aren’t ill enough to go straight to the emergency room,” said Dr. Vandevort, who is also the medical director of the RCCs established throughout the Palo Alto Medical Foundation footprint. “When patients arrive at the RCC we also have some information about their chief concerns, thanks to notes entered in our electronic medical record.”

Different, by design 

A physical exam in a parking lot or garage is strange, but the safety that these setting offer is worth the weird-factor. “To protect patients, staff and the community we designed the RCCs to first and fore-most prevent transmission of any virus from a contagious person; that’s why most of them are outdoors and anyone who comes within six feet of the patient is in full personal protective equipment” said Dr. Vandevort. “At the same time we took great pains to try to make the experience similar to what patients are used to when they go to the doctor or urgent care.”

The outdoor RCCs all have a contact-free arrival process, allowing patients to drive-up and call a phone number to “check-in” for their appointment. At every stage of the visit the patient is distanced from others by either staying in their car or in a marked off space within an exam bay.

In addition to an initial temperature check, patients will have their lungs listened to with a stethoscope, have their blood oxygen saturation checked, have their medical history and medications reviewed, and may be tested for coronavirus or the flu if symptoms indicate they should be. Depending on medical need, patients will also receive additional tests and procedures, including imaging scans, blood draws, heart monitoring and more.

The few indoor RCCs are all in buildings, or sections of buildings, that can safely be separated from other areas where patients who don’t have respiratory symptoms are being seen. The indoor RCCs have implemented all the necessary transmission precautions to ensure that spread of a virus from patient to patient or patient to staff is prevented.

Not Just COVID Care

In addition to screening and treating respiratory complaints, the RCCs have filled another important role; addressing non-respiratory related issues reported by patients who have symptoms linked to COVID (fever, cough, shortness of breath). “Just because COVID-19 is here, that doesn’t mean that other illnesses and injuries go away,” said Dr. Vandevort. “One of the best things about the RCCs is that you are being evaluated by a physician who can treat a wide variety of minor illnesses or injuries, prescribe medications or make a dosage change to an existing medication, and otherwise address a whole host of concerns. It’s what we do every day, and in these safe settings, we can keep doing our job even for patients who may have a virus and be contagious.”

In the short time the RCCs have been up and running, doctors staffing them have made unexpectedly important diagnoses and delivered increasingly complex care. “We’ve seen and treated conditions ranging from an appendicitis, to a swallowed fish bone, to an infection requiring IV antibiotics. We’ve done a lot of good.”

Twice the Team 

It’s not easy to run two clinics (one regular and one RCC), simultaneously, just feet apart, but for the safety of our patients and providers that is what we’ve done. “We had to reassign doctors and nurses so we had coverage in both the RCC and the regular urgent care at the same time, some staff now act as a front-door attendants making sure that patients are directed to the right clinic based on their symptoms, and others are runners shuttling supplies between the two spaces.”

All this investment was made for one reason: to prevent the spread of illness. But the RCCs have had several secondary benefits too.

“We’re also helping to preserve hospital capacity by keeping patients from going to the emergency department unnecessarily.” You wouldn’t normally go to the ER for a fever, and the RCCs make sure our smart use of resources stays intact, even during a pandemic.

At the same time, the RCCs have helped refer patients to a higher level of care when that was needed. “Our job is to help stabilize people so they can safely return home, but when their symptoms are serious we help get them to the hospital.”

Shining Light on Mental Health: Research at Sutter Helps Reimagine the Future of Mental Health for At-risk Youth

Posted on May 26, 2020 in Affiliates, Community Benefit, Expanding Access, Innovation, People, Quality, Research, Scroll Images, Transformation

Annie was stuck. Diagnosed with severe depression in her teens, she experienced days where mental illness slowed and dimmed her inner and outer worlds. “I couldn’t move or talk. The most I could do was twitch my fingers. And everything was like I was full of tar.”

Now 23 years old and taking courses in college, treatment and support to manage her depression have helped to open a path for Annie toward freedom and independence.(1)

Annie’s story may be familiar to many. Recognizing Mental Health Awareness Month, consider these statistics:(2)

  • 1 in 6 U.S. youths aged 6-17 experience a mental health disorder each year
  • 50% of chronic mental illnesses begin by age 14, and 75% by age 24
  • Suicide is the second-leading cause of death among people aged 10-34
  • 1 in 100,000 children aged 10 to 14 succumb to suicide each year
  • Depression affects 20-25% of Americans aged 18+ each year

As the novel coronavirus pandemic ushers in uncertainty that may evoke anxiety, depression or other mental health concerns for today’s youth, what would a new vision for their mental health look like? Sutter researchers and their collaborators across Sutter’s integrated network may offer a new path forward.

Early Interventions to Support Youth with Mental Illness
“Suicide cuts short the lives of individuals and leaves the survivors struggling with their grief and efforts to understand,” says Kristen Azar, RN, MSN/MPH, a researcher at Sutter’s Center for Health Systems Research (CHSR). “Healthcare providers can play a significant role in preventing suicide through risk screening and supportive follow-up care.”

Azar helps lead a new study at Sutter on depression and suicide risk.(3) She and CHSR colleague Ellis Dillon, Ph.D., are measuring the effects of a suicide screening tool called the Columbia Suicide Severity Rating Scale (C-SSRS) that was implemented in 2019 across Sutter’s hospitals. The screening tool was selected for its potential to enable earlier identification of people at increased risk of suicide, including people with depression.

The new study will determine if standardized use of C-SSRS across Sutter’s hospital emergency departments, inpatient settings and behavioral health acute care facilities can improve early detection of suicide risk in youth and adults, and help guide follow-up care. C-SSRS is the most evidence-based tool of its kind for early detection of depression and suicide risk.

Azar and Dr. Dillon’s project also seeks to measure suicide screening practices across Sutter ambulatory clinics and hospitals, and hopes to advance the efforts of Sutter’s Anna Kiger, DNP, DSc, MBA, RN, NEA-BC, and Ernell de Vera, RN, MBA, who implemented screening utilizing C-SSRS in the inpatient setting.

“Screening all inpatients by C-SSRS will help us detect at-risk patients early, for early and personalized treatment and support. Further, screening by C-SSRS will facilitate easier reporting and analysis of electronic health record (EHR) data on patient outcomes, strengthening our ability to care for patients with severe depression and those at high risk of suicide,” says Dr. Dillon.

Over the next 18 months the research team will examine the impact of screening patients for major depression and suicide risk using C-SSRS.

“Using this screening tool, we can study how different approaches to screening impact the detection, follow-up care and clinical outcomes of individuals with severe depression or who may be at high risk of suicide,” says Tam Nguyen, Ph.D., director of Ambulatory Care, Mental Health Services & Addiction Care at Sutter, and clinical advisor of the suicide risk screening study.

A New Vision for Youth Mental Health
Beyond screening, helping youth like Annie develop resilience to manage their mental health in their everyday lives may also help reduce suicide risk and decrease the incidence of severe depression among Sutter’s patient population.

Dr. Dillon helps lead a strategy to do so: She and CHSR co-director Alice Pressman, Ph.D., MS, partnered with Sutter Mental Health Services and experts in Sutter’s Design & Innovation team to launch and measure the impact of the project, Youth Mental Health Reimagined.

Supported by a $1 million gift from the Bichofberger family and matching funds from a Sutter Match Grant,(4) “the project embodies our collective vision to meet a clear need for at-risk youth and create a new narrative that eliminates stigma. When we eliminate stigma, we break down the barriers between mental and physical health, and start to remove a huge barrier in access to care,” says John Boyd, Sutter CEO, Mental Health Services & Addiction Care. “Mental health is human health, and we owe it to today’s youth to shape care that’s more engaging and connected to the way they live their lives.”

“We launched Youth Mental Health Reimagined as a response to the growing need for easily accessible and more robust, non-clinical mental health support for teenagers and young adults with depression, as well as their caregivers,” says Dr. Pressman.

Youth Mental Health Reimagined supports patients by providing tools and tips (e.g., a mood tracker, mindfulness exercises, as well as tips for better sleep, nutrition and physical activity) and connections with live docents. Collectively, the approach—dubbed “Scout”, and delivered virtually with people-powered support—provides resources to youth with depression who are receiving primary care or who are transitioning out of acute care settings.

The project will be implemented across inpatient and outpatient behavioral health programs at Sutter’s Mills-Peninsula Medical Center (MPMC) and in some primary care settings at Sutter’s Palo Alto Medical Foundation (PAMF).

“We used human-centered design to create ‘Scout’ as a means to help youth build resilience in real-world settings,” says Chris Waugh, Sutter Vice President and Chief Innovation Officer. “We’re thrilled to offer Sutter patients and their caregivers these resources that leverage research, creative and engaging design, and the top-quality care made possible by Sutter’s integrated network. It’s our way to help make mental health care more engaging and patient-focused, and bring support to people in their everyday lives.”

Although some existing youth mental health programs include a behavioral component and technology-based resources, Youth Mental Health Reimagined is one of the first of its kind in the U.S. to include caregivers in a holistic approach to care.

“Family and other caregivers are an essential part of the treatment and recovery process for young people with severe depression or other mental illness. They can help youth develop coping skills and healthy relationships that build resilience, and help keep them safe during periods of crisis. Youth Mental Health Reimagined gives caregivers a new opportunity to support the youth by helping them navigate ‘Scout’-delivered resources,” says Linda Strassia, Manager of Behavioral Health Clinical Services, whose team at MPMC will recruit youth to pilot test Youth Mental Health Reimagined.

Approximately 300 Sutter patients aged 13-26 years with moderate-to-severe depression and related anxiety will be enrolled to the study through December 2020, with additional patients enrolled in 2021. Two caregivers per study participant will also receive guidance on supporting patients.

Participants will be asked to complete periodic surveys to help the study researchers assess the impact of ‘Scout’ resources on patient outcomes (changes in youth quality of life, social support, physical, and mental health) and on caregiver outcomes (changes in knowledge and behaviors towards providing care and support for youth with depression).

Youth like Annie have the opportunity to experience new outcomes made possible by such mental health support. In her words, “at some point, you have to figure out what tools you have for the situation. So that’s the thing. I think it’s really important for people to have that support structure in their everyday life.”

How Sutter research translates ideas into solutions for mental wellness:

Beyond the projects described above, health systems researchers at Sutter have led other studies to help address potential gaps in caring for people with mental illnesses.(5,6)

Adolescent behavioral health:
Completed in 2018 and funded entirely by community donors, this five-year project evaluated the PAMF Adolescent Behavioral Health program. The study measured changes in primary care provider attitudes toward adolescent behavioral health, uptake of navigation services for adolescents, and uptake and outcomes of care management provided by a nurse practitioner and a cognitive-based therapy intervention called COPE (Creating Opportunities for Personal Empowerment).

Serious mental illness and emergency department utilization:
Azar recently completed research suggesting that subtypes of severe mental illness may predict patterns of emergency department use. The results of Azar’s research were published last year in Population Health Management.

This study showed that patients diagnosed with serious mental illness seek care at multiple emergency departments within a geographic region (versus any one hospital’s emergency department). These frequent utilizers of the emergency department constitute a small percentage of the population but account for disproportionally high healthcare utilization and costs.

“The findings highlight the importance of cross-institutional collaboration between health systems. This includes approaches to share data and analytics, as well as to deliver care that addresses the needs of patients with serious mental illness who frequently visit the emergency department,” says Azar.

References:

1. Annie’s real name was not used in this story, though her story is real.
2. National Alliance on Mental Illness and National Institute of Mental Health.
3. The research study “Suicidality: Examining screening, detection and follow-up care within a large multispecialty healthcare system” is funded by Janssen.
4. The gift from the Bichofberger family will support the Mental Health Reimagined pilot—Sutter Health’s pioneering system-wide engagement to transform the way people in our communities understand and talk about mental health.
5. Yang, Yan, et al. “Primary care provider utilization and satisfaction with a health system navigation program for adolescents with behavioral health needs.” Translational Behavioral Medicine 9.3 (2019): 549-559.
6. Erlich, Kimberly J., et al. “Outcomes of a brief cognitive skills-based intervention (COPE) for adolescents in the primary care setting.” Journal of Pediatric Health Care 33.4 (2019): 415-424.

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 the specified laboratory 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 (July 6, 2020), Sutter is performing approximately 2,400 COVID-19 tests daily (seven-day average) 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.

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.