Access to Specialty Diagnostics

Successful implementation of medical technologies into a delivery system targeting the underserved requires a technology with relative medical advantage, responsiveness to the unique needs of underserved patients, and deliberate attention to the challenges of providing care and value in a severely resource‐constrained environment.

 

ECG

The iRhythm Zio Patch® at ZSFG

Lead: George Su, MD

The iRhythm Zio Patch® is a prescription‐only, single‐use, continuously recording electrocardiography (ECG) monitor that can be worn up to 14 days. It is indicated for use on arrhythmia suspects, i.e. those who suffer from transient symptoms such as palpitations, shortness of breath, dizziness, light‐headedness, pre‐syncope, syncope, fatigue, or anxiety.  After wearing the device, the user mails it to a processing center where data is extracted and analyzed. A full report is delivered to the ordering provider. Potential advantages of the Zio Patch® over the current Holter ambulatory ECG monitoring standard include increased diagnostic yield, improved ease of use and patient compliance, increased access, and a usage model that is not dependent on capital device investment or inventory.

We performed a formal program evaluation of implementation of the Zio Patch® at ZSFG.  The results of this study can inform policymakers (business/commercial, healthcare institutions, and payers) who serve the underserved, about the feasibility, efficacy, usability, cost‐effectiveness, potential scalability, and dissemination potential of the Zio Patch®.  This study was funded by the California HealthCare Foundation Innovations for the Underserved.

 

Sleep

SFGH Sleep Program Redesign

Lead: George Su, MD

Obstructive sleep apnea (OSA) affects 50 to 70 million Americans. Risk factors like obesity are increasingly prevalent, and 26% of adults at high risk remain undiagnosed. Furthermore, untreated disease is associated with increased rates of workplace and automobile accidents, 30% increased likelihood of death or heart attack, and increased risk for hypertension, stroke, obesity and diabetes, and depression. Over the past decade, rising demand for diagnostic testing has led to a 400% increase in number of accredited sleep testing facilities. However, underserved populations remain marginalized due to high operational costs for in-lab sleep testing and poor reimbursements.

SFGH Sleep Program Redesign was a novel partnership and service model—targeting the underserved constituency of ZSFG—that was designed to dramatically reduce costs of diagnostic sleep testing, maximize service reimbursements, and provide superior care for those suffering from OSA. ZSFG Sleep Program Redesign featured home sleep testing (HST) through a unique outsourced turnkey service model and a re‐structured patient‐centered Sleep Clinic.  Formal program implementation science evaluation of ZSFG Sleep Program Redesign was sponsored by the California HealthCare Foundation Innovations for the Undeserved.

 

Spirometry

San Francisco Community Primary Care Spirometry Program

Leads:  George Su, MD; Eula Lewis, RRT, CTTS; Stephanie Tsao, NP

Founded in 2010, the San Francisco Community Primary Care Spirometry Program provides the following critical deliverables:

  • Superior coach training: University of Washington iMTR (Interactive Medical Training Resources) Spirometry 360™ Program
  • Electronic delivery of spirometry study data to a processing center at Zuckerberg San Francisco General Hospital (ZSFG)
  • A quality assurance screening program that assesses test adherence to ATS quality criteria
  • Feedback reporting to coaches to provide ongoing skills assessment and education
  • Notification to referring providers whether studies were of sufficient quality for interpretation
  • A formal test interpretation service
  • Posting of results to a common electronic medical record
  • Overall support for community-based primary care spirometry programs (with the intent of developing capacity at each site to accept local testing referrals—“nodal” model of primary care spirometry dissemination)
  • Live-video testing/coaching support (future application)

Our program features innovative utilization of limited specialty-level resources to support enterprise-wide point-of-care spirometry in an urban safety-net setting.  Associated benefits have included improved specialty-primary collaboration, decreased ZSFG Pulmonary Function Testing (PFT) laboratory wait times, and offloading of ZSFG PFT laboratory effort to allow for more complex testing, beyond spirometry.