Innovation

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.

Coronavirus Science: Two Studies Raise New Concerns

Posted on May 5, 2020 in Carousel, Innovation, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Pediatric Care, People, Research, Scroll Images, Uncategorized

Every day brings new scientific insights into COVID-19 and the coronavirus that causes it. Studies authored by Sutter Health experts examine the virus’s impact on children and diabetic adults.

COVID-19 and Kawasaki Disease

Recently, doctors began warning of a potential consequence of COVID-19 infection in children; some youngsters appear to develop an abnormal immune response that results in symptoms commonly associated with Kawasaki disease or toxic shock syndrome – two rare, but well-characterized inflammatory conditions. The first known U.S. case of Kawasaki disease possibly connected to COVID-19 was reported by Veena Jones, M.D., (lead author) and Dominique Suarez, M.D., both pediatric hospitalists with the Palo Alto Medical Foundation, part of the Sutter Medical Network.

Veena Jones, M.D.

Their six-month-old patient was diagnosed with classic Kawasaki disease, admitted to the hospital for treatment, and subsequently received a positive test result for COVID-19. The main reason for treatment in children with Kawasaki disease is to prevent further complications of the disease on the heart. The patient received appropriate treatment and has since fully recovered and has maintained normal heart function. But the case caused the doctors to question: could the COVID-19 infection have led the patient to develop Kawasaki disease?

“Our patient met the classic criteria for Kawasaki disease, so there was little doubt about the diagnosis or treatment plan,” said Dr. Jones. “But we do wonder if the COVID-19 infection could have caused the Kawasaki disease, especially because Kawasaki disease is widely thought to be triggered by an infection or an abnormal immune response to an infection.”

Dominique Suarez, M.D.

A careful review of the existing medical literature found that COVID-19 co-occurring with Kawasaki disease had not previously been reported, so the doctors decided to write up the case and submit it to the Journal of Hospital Pediatrics for publication. “Researchers still know very little about exactly why Kawasaki disease develops in some patients, so our hope was to accurately describe the novel case that we encountered and share that with the medical community to encourage further investigation and dialogue,” said Jones. In the race to understand the burden of COVID-19 on the human body this kind of early observation by doctors on the frontline can help inform future decisions around diagnosis and treatment.

COVID-19 and Diabetes

Since the start of the coronavirus pandemic many have warned that people with existing chronic illness who contracted the infection would become sicker than those without. Now, research authored by Sutter Health clinician David Klonoff, M.D. suggests that diabetes, one of the most serious chronic illnesses in the world, is strongly correlated with death among hospitalized patients diagnosed with COVID-19.

David Klonoff, M.D.

Accepted by the Journal of Diabetes Science and Technology, Dr. Klonoff’s paper represents the largest study yet reported on outcomes of patients with COVID-19 and diabetes or uncontrolled hyperglycemia. The observational study of 1122 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, found that those with diabetes or hyperglycemia throughout their hospital stay had a four-fold greater inpatient mortality than those without diabetes or hyperglycemia. In a further subset analysis, death rates were seven-fold greater among those who did not have evidence of diabetes prior to admission, but developed hyperglycemia during their hospitalization.

The study also demonstrated that during a hospitalization for COVID-19, the presence of diabetes or hyperglycemia was associated with a longer hospital stay and slightly worse kidney function.

“I am now analyzing the same database to determine whether COVID-19 patients with diabetes and uncontrolled hyperglycemia, who were better controlled in the hospital, had better outcomes,” said Klonoff. If an association between greater survival and achieving target glycemia (following initial hyperglycemia) is demonstrated, and acted on, lives could be saved.

“These data may have wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes.”

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.

Sutter Roseville Moves Up Opening of ER-ICU Expansion to Prepare for COVID-19 Patient Surge

Posted on Apr 27, 2020 in Expanding Access, Innovation, Quality, Safety, Scroll Images, Sutter Roseville Medical Center, Transformation

Sutter Roseville Medical Center expansion
Sutter Roseville Medical Center is opening its expansion a month early to prepare for a potential surge in COVID-19 patients.

ROSEVILLE, Calif. – Sutter Roseville Medical Center on Tuesday, April 28, is opening its expansion of emergency and critical care services a month early as part of its preparations for a potential surge of COVID-19 patients. Originally slated to open May 27, the 98,400-square-foot expansion doubles the Emergency Department and nearly doubles the number of critical-care beds, adding 58 more private rooms that can safely care for patients during a possible surge.

Sutter Roseville began the $178 million construction project in 2017 to meet the growing community’s demand for emergency services, critical-care rooms and interventional cardiac and neuro procedures. It is connected seamlessly to the existing Emergency Department on the first floor and surgical and critical care services on the second.

“When our team met in late February to discuss surge preparations for COVID-19, it was apparent that we needed to move up the opening of this expansion to ensure we had the highest level of care available for the expanding needs of our community and region,” said Sutter Roseville CEO Brian Alexander. “Our staff, construction partners, and state and local agencies all banded together and worked diligently to open this expansion 30 days early, but to the same high safety and quality standards.”

As a Level II trauma center serving a seven-county region, Sutter Roseville provides a higher level of care in emergency situations and is regularly preparing for public health crises. The expansion was designed with elements that will assist in those emergencies, including two emerging infectious disease isolation rooms and options to convert the Emergency Department’s expansive lobby into a treatment area in case of a large-scale disaster or patient surge.

Expanded emergency department looby

“When our care teams helped design this expansion, they took into account numerous possible health-crisis scenarios,” Alexander said. “Because of their foresight and planning, Sutter Roseville is prepared to care for patients during this pandemic and other public-health emergencies.”

The new expansion helps Sutter Roseville stay on the forefront of exceptional, innovative care. Its features include:

  • 34 additional emergency beds in private treatment rooms, increasing the total number of emergency beds to 68;
  • Seven emergency triage areas that are equipped to provide treatment to patients;
  • 24 additional ICU rooms, each equipped with the latest eICU telemonitoring capabilities that allow specialized physicians to assist in the care of the patients from a remote hub. Added to the 32 existing critical-care beds in the hospital, there will be 56 ICU rooms available for the sickest patients if a surge were to occur;
  • Two interventional labs providing the latest technology for cardiac catheterization procedures. A third interventional lab is currently being built with additional capabilities for neuro and radiological procedures.
New intensive care unit room

“California is being challenged in new ways during the COVID-19 public health crisis, and we are rising to that challenge in ways large and small across the state,” said California State Sen. Jim Nielsen, R-Tehama. “Here in Northern California, one of the organizations stepping up to meet the challenge is the Sutter Health network, providing new levels of emergency and critical care at Sutter Roseville Medical Center that are so urgently needed across the region.”

The expansion provides a critical need in the community beyond the current global pandemic crisis. The Sutter Roseville Emergency Department expanded in 2005 to treat up to 60,000 patients a year, but last year saw more than 84,000 patients. The additional ICU rooms and interventional labs are also necessary additions as South Placer County is seeing more elderly patients requiring a higher-level of care.

Emergency department isolation room

“Strong infrastructure is one of the hallmarks of a strong community, and our capacity for protecting and promoting public health is central to that,” said State Assemblyman Kevin Kiley, R-Rocklin. “Sutter Roseville Medical Center’s continued investment in our public health infrastructure helps drive our ability to prevent disease, heal after injury or illness, and respond to both chronic health challenges and acute ones like COVID-19. My thanks to Sutter Health for stepping up to help when and where they are needed.”

This is the latest in a series of expansions Sutter Roseville Medical Center has experienced in the past two decades, transforming it from a community hospital into a regional, tertiary medical campus. The other expansions include:

  • A newly constructed Patient Care Tower with 90 new beds.
  • Expansion of the Family Birth Center to accommodate a community need as young families moved into South Placer County.
  • The addition of a Level III NICU with 16 licensed beds to provide advanced life-saving care to critically ill newborns.
  • The construction and expansion of Sutter Rehabilitation Institute, the region’s only facility dedicated exclusively to acute rehabilitation services.
  • The Sutter Cancer Center, Roseville, a facility dedicated to and designed by those with cancer.
  • Three medical office buildings that house Sutter Roseville physicians, along with two parking garages for staff and patients.

“As a healthcare provider, as an employer and as a supporter of this community, Sutter Roseville Medical Center has already been a strong force for good here and across Placer County and the region,” said Roseville Mayor John Allard. “Expanding its top-notch emergency service and critical care – especially now – builds on a decades-long commitment to serving the people of Roseville and beyond.”

COVID-19 Heightens our Love for Mother Earth, and One Another

Posted on Apr 22, 2020 in Community Benefit, Innovation, People, Quality, Safety, Scroll Images, Transformation, Uncategorized

A message from Stephen H. Lockhart, M.D., Ph.D., Sutter Health Chief Medical Officer and Executive Sponsor of Sutter Health’s Environmental Stewardship Program

With fewer cars on the road and less traffic in the skies, some news outlets have reported a climate benefit. While none of us wanted this short-term positive effect at such high health and economic costs, we are getting a peek at an environment with less human interference — a brief glimpse at what could be possible if we took steps to reduce waste and advance alternative energy solutions in the years ahead.

As champions of health, we know that nature holds a special place in our lives, supporting our mental and physical wellbeing. It’s never been more important to take a walk outside, take a deep breath, enjoy the sunshine and wave at our neighbors — all while staying 6 feet apart, of course. Nature lifts our spirits and helps restore our hope.

Please join our Sutter team in celebrating the 50th anniversary of Earth Day. Mobilizing to care for our planet over the long term is one more way we’re showing our love for our communities and one another.

Here are a few ways you and your family can get involved with Sutter’s sustainability efforts:

1. Plant a garden. Digging your hands in the soil is good for your health. Welcome spring by planting native plants, fruits and vegetables. Take it a step further by starting a compost pile. Composting food waste reduces the amount of waste you send to a landfill, and once it fully decomposes, you’re left with a fertilizer for your garden. Check out some simple tips on composting from the EPA.

2. Donate clothing. While spring cleaning, consider donating unwanted items rather than throwing them away. Each year, nearly 40,000 gallons of water are used in the production and transport of new clothes bought by the average American household.

3. Watch creativity grow. Promote your kids’ love for our planet by encouraging them to create art from natural or recycled materials.

4. Conserve water. Install a low-flow shower head to reduce water use. In one year, a family of four can save up to 18,200 gallons of water.

5. Carry a reusable water bottle. Lessen your environmental impact by replacing your single-use plastic bottles with a stainless-steel water bottle or travel mug.

6. Calculate your carbon footprint. Simply reducing the amount of time we spend running errands, driving to work and to other activities plays a significant role in reducing our carbon footprint. Check out the EPA’s Carbon Footprint Calculator.

7. Learn about sustainability efforts at Sutter Health. Did you know that Sutter completed five solar-power projects; launched a pilot program to reduce the amount of harmful anesthetic gasses released into the atmosphere during surgeries; and increased plant-based meals by 20% in our 24 hospital cafeterias? You can find out more here.

A Higher IQ for Cancer Care at Sutter

Posted on Apr 20, 2020 in California Pacific Medical Center, Innovation, People, Quality, Research, Transformation

Machine learning for cancer research

To learn how Sutter cancer researchers are applying machine learning to cancer care, we interviewed John Chan, M.D., a gynecologic oncologist at Sutter’s California Pacific Medical Center (CPMC) and Palo Alto Medical Foundation, and the Denise & Prentis Cobb Hale Endowed Chair in Gynecologic Oncology Research.

John Chan, M.D.

How might artificial intelligence (AI) be used to improve cancer care?
AI builds smart machines capable of performing tasks that typically require human intelligence like learning, reasoning and problem-solving skills. We already see AI playing a key role in our daily routines and our interactions with media, transportation and communications.

With a surge of new knowledge in this area, researchers are applying AI and machine learning to innovate healthcare with improved diagnoses and treatment. As machine learning algorithms are exposed to more data—in some cases gleaned from the electronic heath record (EHR)—they can detect hidden patterns within data that can be used to perform a task without sophisticated programming.

Given the large number of Americans diagnosed with cancer and the huge volume of data generated during cancer treatment, there is a growing interest in using AI and machine learning to improve cancer care.

How are you applying AI and machine learning to your gynecologic oncology practice at Sutter?
Through a collaboration with the University of North Carolina and The Medical College of Georgia at Augusta University, we’re using machine learning to classify cancer patients into high- or low-risk groups, and to personalize sub-groups of uterine cancer patients who may or may not benefit from chemotherapy. Our research resulted in a clinical calculator that was described in Gynecologic Oncology.

The findings suggest a clinical calculator can help predict benefit and risk of chemotherapy treatment in patients with uterine cancer. And now we’re expanding the machine learning tool to study advanced-stage cancers and gynecologic diseases like ovarian cancer.

We plan to share the clinical calculator with providers across Sutter and with peer institutions that care for gynecologic cancer patients who live in more remote communities, or who are otherwise unable to travel to larger cancer centers. That way, more cancer patients may benefit from the research underlying this new AI-based tool. This could help increase access to safer and more effective cancer treatments, and reduce healthcare costs.

What are the potential benefits of using AI and machine learning to guide oncology treatment decisions?
Machine learning can “free think” creatively because it’s not confined by pre-existing human biases that may be present in routine clinical practice. This and other AI approaches like deep learning can help us determine levels of risk and benefit associated with various cancer treatments.

For example, an older patient with ovarian cancer may be at increased risk of treatment-related complications compared with younger patients. AI can identify risk profiles to help guide treatment decisions based on data from similar sub-groups of cancer patients.

In clinical oncology, AI has increasingly been applied to harness the power of the EHR. Specifically, AI-based natural language processing techniques may help predict the development of diseases across large healthcare systems.

At Sutter, our integrated network enables access to EHR and outcomes data from a highly diverse patient base. Machine learning can find associations and calculate risk scores to better predict treatments that will provide optimal benefit and reduced risk of treatment-related complications or adverse effects. This approach may become a new decision tool that we can add to our clinical toolkit and share with collaborators across Sutter.

Cancer care and research at Sutter: High “CQ” using machine learning:

Other Sutter physicians, researchers, and innovators across the system are applying AI to cancer care and elsewhere. Here’s how:

  • Earlier this year, Sutter partnered with Bay Area startup Ferrum Health to develop machine learning algorithms for early detection of lung cancer at radiology clinics in Sacramento. Ferrum’s AI platform read 10,000 CT scans and reports. Within 90 days, it flagged 83 cases in which it detected a mass of tissue on the scan that was not mentioned in the report.
  • Albert Chan, M.D., M.S., Sutter Health chief of digital patient experience, is leading digital transformation efforts across Sutter. He oversees a unified digital patient engagement and virtual care strategy, including leadership of Sutter’s patient portal My Health Online, telemedicine and artificial intelligence-powered solutions.
  • Through a collaboration with Stanford Medicine, Sutter Health systems researchers will launch the Oncoshare Project using a “big data” approach to improve breast cancer care. Oncoshare enables researchers to generate high-resolution maps of breast cancer treatment, and identify care pathways that yield the best outcomes for patients.

Learn more about Sutter research and clinical trials.