Specialty Care Initiative
A coalition of key safety net stakeholders working to improve primary care – specialty care communication and coordination, clinic efficiencies, and registry development in specialty clinics. The Specialty Care Initiative was funded by Kaiser Permanente and the Blue Shield of California Foundation.
Overview
As part of a statewide initiative, San Francisco safety net providers formed a coalition in 2008-2018 to focus on increasing access to specialty care services for patients in the safety net. The coalition’s efforts centered on improving referral guidelines to medical, surgical, and diagnostic specialties before a patient’s specialty clinic visit and expanding the knowledge base of primary care providers in managing certain conditions in their clinics as opposed to relying on specialists to care directly for each patient with the limited specialty resources that exist in our system.
The coalition convened workgroups to examine these issues in Endocrinology, Gastroenterology, and Orthopaedic Surgery.
San Francisco coalition’s efforts resulted in:
- Increased coordination among safety net health care providers
- Improved in communication between primary care providers and specialists that ensures high quality patient care and safety
- Expansion of a systematized electronic consultation and referral process for medical, surgical, and diagnostic services
- Educational tools on specific specialty conditions to enhance primary care providers’ knowledge base and capacity to care for their patients
- Standardization of patient and visit information that is communicated to primary care providers after a specialty consultation
- Guidelines for high-quality specialty consultation notes
- Panel management strategies for certain chronic diseases
Coalition members included providers from the following organizations:
- San Francisco Community Clinic Consortium health centers
- San Francisco Department of Public Health – Community Oriented Primary Care clinics
- Zuckerberg San Francisco General Hospital specialty clinics, Division of General Internal Medicine, and the Department of Family and Community Medicine
People
Project Lead: Alice Hm Chen, MD, MPH Profile
Project Lead: David Lown, MD, MA Profile
Lead Evaluator: Delphine Tuot, MDCM, MAS Profile
Steering Committee
Benjamin Breyer, MD, MAS – Assistant Professor, UCSF Division of Urology at ZSFG
Alice Hm Chen, MD, MPH – Associate Professor, UCSF Division of General Internal Medicine and CMO-SFHN. Dr. Chen’s primary interest is in issues of health care access, particularly in how poverty, race/ethnicity, and policy intersect with healthcare delivery systems to produce barriers to care.
Rebecca Jackson, MD – Professor, UCSF Department of Obstetrics, Gynecology, and Reproductive Science and Chief of Obstetrics and Gynecology at ZSFG
Elizabeth Johnson, MD – Medical Director, San Francisco Department of Public Health Community Oriented Primary Care
David Lown, MD – Chief Medical Officer, San Francisco Community Clinic Consortium and Family Physician at St. Anthony Medical Clinic. Dr. Lown is Chief Medical Officer of the San Francisco Community Clinic Consortium (SFCCC), a group of 11 community clinics and health centers. Dr. Lown's professional interests relate to systems improvement, including issues around clinical practice and health care delivery redesign, as well as the use of technology to improve systems of care and health outcomes.
Elizabeth Murphy, MD, DPhil – Professor, UCSF Division of Endocrinology and Metabolism and Chief of Endocrinology at ZSFG
Justin Sewell, MD, MPH – Assistant Clinical Professor, UCSF Division of Gastroenterology and Hepatology at ZSFG. Dr. Sewell’s primary research interests are related to the interface between primary care and specialty care. He is specifically interested in the quality of primary-specialty care communication, and developing novel methods for providing specialty care.
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG. Dr. Tuot's research interests are in chronic kidney disease (CKD), provider-patient communication, CKD awareness, and implementation science.
Endocrinology Workgroup
Hali Hammer, MD – Professor, UCSF Department of Family and Community Medicine and Medical Director, ZSFG Family Health Center. Dr. Hammer has provided full scope primary care, including obstetrics, at the Family Health Center for the past 18 years. Dr. Hammer directs the Department’s Continuous Quality Improvement program and is an Associate Director of the UCSF/ZSFG Family and Community Medicine Residency Program.
Elizabeth Johnson, MD – Medical Director, San Francisco Department of Public Health Community Oriented Primary Care
Elizabeth Murphy, MD, DPhil – Professor, UCSF Division of Endocrinology and Metabolism and Chief of Endocrinology at ZSFG
Jennifer Park-Sigal, MD – Assistant Clinical Professor, UCSF Division of Endocrinology and Metabolism at ZSFG
Kenneth Tai, MD – Medical Director, Northeast Medical Services (NEMS). Dr. Tai’s professional interests focus on reducing health disparities in those with limited access to health care system, such as immigrants and the elderly. NEMS is a community health clinic in San Francisco, and a member of the San Francisco Community Clinic Consortium. With seven sites, NEMS provides comprehensive health care services to 54,000 patients who are mostly uninsured, underinsured, and low income.
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG
Gastroenterology Workgroup
Ricardo Alvarez, MD – Medical Director, Mission Neighborhood Health Center. Dr. Alvarez is currently a fellow in the CHCF Center for Health Professions leadership program. He enjoys the challenges of finding system solutions to complex medical delivery coordination. He remains an optimist in spite of the many system challenges and ascribes to the philosophy of Emo Phillips who noted, “I’m not a fatalist; even if I were, what could I do about it?”
Alice Hm Chen, MD, MPH – Associate Professor, UCSF Division of General Internal Medicine at ZSFG and CMO-SFHN
Lukejohn Day, MD – Assistant Clinical Professor, UCSF Division of Gastroenterology and Hepatology at ZSFG and Medical Director for Medical Subspecialties at ZSFG
Justin Sewell, MD, MPH -- Assistant Clinical Professor, UCSF Division of Gastroenterology and Hepatology at ZSFG
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG
Albert Yu, MD, MPH, MBA – Medical Director, Chinatown Public Health Center
Nephrology Workgroup
Elizabeth Davis, MD – Assistant Professor, UCSF Division of General Internal Medicine at ZSFG
Lukejohn Day, MD – Medical Director for Medical Subspecialties at ZSFG, Assistant Professor, UCSF Division of Gastroenterology and Hepatology
Sam James, MD – Professor, UCSF Division of Nephrology at ZSFG
Laurence Peiperl, MD – Clinical Consultant, Glide Health Services and Professor, UCSF Division of General Internal Medicine at ZSFG
Elsa Tsutaoka, MD – Medical Director, South East Health Center
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG
Orthopaedic Surgery Workgroup
Terry Dentoni, RN, MSN, CNL – SFGH Director, Perioperative/Critical Care/Specialty/Emergency Nursing. Terry has worked at ZSFG since 1989 in various roles including Staff Nurse, Nurse Educator, Nurse Manager and in her current role as a nursing director.
Juliann Fusaro, RN, MSN, CNL – Orthopaedic Surgery
Harry Jergesen, MD – Professor, UCSF Department of Orthopaedic Surgery
Margot Kushel, MD – Associate Professor, UCSF Division of General Internal Medicine at ZSFG
David Lown, MD – Medical Director, San Francisco Community Clinic Consortium. Dr. Lown is a family physician at St. Anthony Medical Clinic in addition to his role as Medical Director of the San Francisco Community Clinic Consortium, a group of eleven community clinics. His professional interests relate to systems improvement, including issues around clinical practice and health care delivery redesign, as well as the use of technology to improve systems of care and health outcomes.
Theodore Miclau, MD – Professor and Vice Chairman, UCSF Department of Orthopaedic Surgery, Chief of Orthopaedic Surgery at ZSFG and Director, Orthopaedic Trauma Institute. Dr. Miclau joined the faculty of the Department of Orthopaedic Surgery at the University of California, San Francisco in 1996 as an orthopaedic traumatologist at Zuckerberg San Francisco General Hospital. He was named Vice Chairman and Director of Orthopaedic Trauma of the Department of Orthopaedic Surgery at UCSF in 2003, and became the Chief of Orthopaedic Surgery at ZSFG a year later. He is the recipient of several prestigious awards including a five-year Career Development Award from the National Institutes of Health and a traveling fellowship from the American Orthopaedic Association.
Saam Morshed, MD, MPH, PhD – Assistant Professor, UCSF Department of Orthopaedic Surgery at ZSFG
Dana Nelson, RN – Nurse Manager, ZSFG Surgical and EKG Specialty Clinics
Diane Putney, NP – ZSFG Department of Orthopaedic Surgery
Trudy Singzon, MD – Medical Director, Ocean Park Health Center, San Francisco Department of Public Health. Dr. Singzon provides primary care, urgent care, and women’s health services to a culturally diverse, urban, underserved patient panel including children, adolescents, pregnant women, adults and seniors.
Brenda Stengele, MSN, NP – Director, Clinical Nursing, ZSFG Orthopaedic Trauma Institute
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG
Urology Workgroup
Benjamin Breyer, MD, MAS – Assistant Professor, UCSF Division of Urology at ZSFG
Jerry Jew, MD – Associate Medical Director, Northeast Medical Services (NEMS)
Marika Russell, MD – Medical Director for Surgical Subspecialties at SFGH, Assistant Professor, Department of Otolaryngology at ZSFG
Heralio Serrano, MD – Medical Director, Castro-Mission Health Center
Jacqueline Tulsky, MD – Professor, UCSF Division of HIV/AIDS at ZSFG
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG
Women's Health Workgroup
Lukejohn Day, MD – Medical Director for Medical Subspecialties at ZSFG, Assistant Professor, UCSF Division of Gastroenterology and Hepatology
Isabel Lee, MD – Assistant Professor, UCSF Department of Family and Community Medicine at ZSFG
Lydia Leung, MD – Silver Avenue Family Health Center and UCSF Department of Family and Community Medicine at ZSFG
Rebecca Jackson, MD – Professor, UCSF Department of Obstetrics, Gynecology, and Reproductive Science and Chief of Obstetrics and Gynecology at ZSFG
Rosalia Mendoza, MD – Clinical Chief of Women's Services, Mission Neighborhood Health Center
Delphine Tuot, MDCM, MAS – Assistant Professor, UCSF Division of Nephrology at ZSFG
Sandy Wu, NP – Silver Avenue Family Health Center