Our project assembles a partnership between UCLA and The Los Angeles County Department of Health Services in order to determine the outcomes of patients who utilize the psychiatric emergency service in Los Angeles County at Olive View-UCLA Medical Center, Harbor-UCLA Medical Center and LAC+USC Medical Center. The limited literature on patients using psychiatric emergency services suggests that they are a vulnerable, high risk population. This CTSI Pilot/Collaborative project employs a novel methodology for data linkage and integration across County and State datasets allowing us to follow a cohort of patients and track forensic, outpatient and inpatient outcomes as well as mortality. Results will enable the Department of Health Services to make efficient, data-driven and outcomes-based decisions regarding the disposition of patients from the Psychiatric Emergency Service, thereby improving both clinical care and productivity. This project also creates a new collaboration between the Department of Health Services and UCLA CTSI and a new area of investigation that, despite its importance and relevance within the changing healthcare environment, has not yet been explored by researchers nationally.
Presentations & Documents
School truancy is associated with a variety of negative behavioral and health consequences. In addition, health factors may contribute to why students miss school. This project aims to gain better understanding of the characteristics and needs of truant youth in order to identify opportunities for improving school attendance in Los Angeles County. The project focuses on three research questions: 1) What are the characteristics and needs (e.g., academic, social, health) of truant youth?; 2) How do youth who cut or skip class encounter different school- community- and law-enforcement based systems?; and 3) What programs and policies can help meet the needs of truant youth? To answer these questions, we conducted key informant interviews with representatives from schools, law-enforcement, and community based organizations; in-depth interviews with youth who have school attendance problems; and a review of evidence-based diversion programs and interventions.
Asthmatic children with frequent asthma exacerbations require preventative long term care to reduce morbidity, yet many of these patients belong to community health care organizations (HMOs) without a network/contracted pediatric emergency department (PED). This may result in no transition from costly acute to cost effective preventative care, poor disease control and leading patients to use the PED in “revolving door” fashion. It is unclear whether lack of transition from acute to chronic asthma care occurs between the PED at Harbor-UCLA Medical Center (HUMC) and out of network community HMOs and whether this leads to increased asthma morbidity. This current study compares pediatric asthma patients who receive regular asthma care at HUMC versus community HMOs with primary outcomes being asthma control, asthma PED visits, asthma hospitalizations, preventative provider visits and asthma controller prescriptions. Results will identify barriers to smooth transition of asthmatic care between 2 health care systems that can be targeted to improve care to asthmatic children.
Diabetic retinopathy (DR) is the leading cause of blindness among working-age Americans, and among Los Angeles Latinos—the ethnic majority of patients in the Los Angeles County (LAC) safety net—the prevalence of DR is ~50%. Despite evidence that early detection and treatment can prevent blindness from DR, a significant number of persons with diabetes in our system fail to receive annual screening examinations and/or sight-saving treatments due to lack of access to specialty care. To date, the effect of a system level intervention on improving access to eye care and definitive treatment for diabetic retinopathy in an urban medically underserved, or safety net, population has not been evaluated. The objective of this project is to evaluate the impact of teleretinal screening on access to specialty ophthalmic care for diabetic patients in LAC who need monitoring or treatment for diabetic retinopathy. We propose a pre-post analysis of the LAC teleretinal screening implementation, and we aim to evaluate the number of patients screened for diabetic retinopathy, the number presenting for timely ophthalmic follow-up care and treatment, and the cost of the program.
The overall objective of the study is to test the effect on body weight of attending a group weight loss program that serve an underserved population. The group setting is more likely to be successful than traditional physician patient encounters as it incorporates two crucial aspects of the patient’s health experience: the patient’s own effectiveness in managing medical problems together with his or her health care team, and the patient’s own community for support in integrating medical recommendations into his or her daily life. Our experience has found that the group setting is well received by patients and enhances access to care.
In the next decade Latinos will make up the largest racial/ethnic minority group among U.S. adults 65 years and older. However, Latino older adults face a number of challenges, including increased burden of chronic illness and limited access to health care. This extends to Alzheimer’s disease or related disorders; the prevalence of dementia among Latinos is potentially higher than in other racial/ethnic groups as symptom onset has been shown to occur six to seven years earlier in Latinos than in non-Latinos. The objective of this cross-institutional project is to ascertain the feasibility, acceptability, and utility of the Alzheimer’s Disease Coordinated Care for Hispanic and Latino seniors intervention (ADC-HL), a community-centered, dementia care management protocol designed to reduce caregiver burden as well as dementia-related symptoms (e.g., behavioral disturbances) in 15 persons with memory loss for Hispanic/Latino families in St. Paul, Minnesota. Innovative components of this project include a focus on dementia care in an underserved community, the use of mixed methods to collect and analyze a range of qualitative and quantitative process data, and reliance on an evidence-informed approach to build and refine a coordinated care management protocol for Hispanics/Latinos with dementia and their families.
Large-scale federal investments in health information technology (HIT) are intended to spur health care providers and organizations to share patient information to better coordinate and improve quality of care. However, the uptake of HIT has lagged in ambulatory care settings that care for high proportions of low-income patients. Our pilot study seeks to generate knowledge about facilitators and barriers to the spread of electronic health information exchange (HIE) for improving quality of care among underserved populations. We have established partnerships with two health care organizations: Citrus Valley Health Partners (CVHP), a provider network serving many underserved patients in the East San Gabriel Valley, Calf., and the Federally Qualified Health Center Urban Health Network (FUHN), a group of ten clinic organizations serving the Minneapolis-St. Paul area. We are conducting key informant interviews of physicians, front office staff, IT personnel, and executives. Through these interviews, we are learning about the barriers to electronic exchange of health information within the clinics and practices, between these sites, and at city-wide or regional levels. This multi-level framework elucidates the opportunities and challenges for ambulatory care practices serving underserved populations in adopting and sustaining HIT.
The overall goal of our study is to develop an integrated care plan that effectively addresses the shared risk factors of early childhood dental decay, early childhood cavities (ECC) and obesity. It encourages parents of disadvantaged and of minority backgrounds to adopt broad self-management goals and overall comprehensive health-promoting habits. There is a pressing need for community-based participatory early intervention approaches to prevent both early childhood dental decay and obesity at a younger age. Within the recent healthcare environment, oral health (dentistry) may play an important role within the whole community approach to obesity prevention as an entry point for discussing diet and nutrition early on. Some key reasons for the importance of oral health integration into obesity prevention is that children’s oral health diseases share key risk factors with early obesity. In our study, the Infant Oral health visit promotes dietary guidance early in childhood, and oral health promotion is done in a culturally manner, which we use to discuss other broad health-promoting habits. Our immediate goal utilizes a university and community-based team to improve the ability to predict future dental decay in children and integrate oral health risk assessment with broad health-promoting habits that may one day prevent obesity in the key early years of the child development.
Community Partners: Healthy African American Families II, QueensCare Health and Faith Partnership
This project will determine the cost of low- and high-intensity interventions for depression. The project will also compare the costs of the interventions and determine whether they save money for the health system or society in general, since people who recover from chronic depression may require less public support because they will need to see a doctor less and will be able to work more. The low-intensity approach is called Resources for Services. Under this approach, we give providers and agencies technical assistance on how to (1) screen for depression, and (2) educate patients around depression and their treatment options, which include cognitive behavioral therapy and medication. We also train providers and agencies to deliver these treatments. The high-intensity approach is called Community Engagement and Planning, which calls for adapting depression-care materials to agency networks and providing intensive, in-person trainings, conferences and site visits.
Community Partners: Healthy African American Families and St. John's Well Child and Family Centers
In this project, we will study a community-based intervention to improve blood pressure control among low-income adults. We will randomly divide participants into two groups: One group of volunteers will receive a home blood pressure monitor and payments for submitting to monthly blood pressure checks. Volunteers in the second group will receive a blood pressure monitor and a financial incentive for (1) using the monitor, (2) lowering their blood pressure, and (3) recording whether they have taken their medicine. The second group also receives an intervention that helps them identify things that are important in their lives and their reasons for staying healthy.
Community Partners: Healthy African American Families (HAAF), Los Angeles Urban League
South Los Angeles, an area that is over 95% Latino and African American, has the highest rates of obesity (37%), hypertension (32%), and diabetes (11%) in Los Angeles County. In addition to preventable chronic disease, the community also has high rates of behavioral and social risk factors such as poor nutrition, smoking, low graduation rates, and high rates of unemployment.
In 2008, the HCNI partnership was formed to better understand and intervene upon health and social disparities in a low-income bi-ethnic community in South Los Angeles by designing and implementing a household survey including four components: consent form, adult interview, the health screening, and laboratory data collection. The partnership included the Los Angeles Urban League (LAUL), Healthy African American Families Phase II (HAAF II), Charles R. Drew University (CDU), and the University of California Los Angeles (UCLA). Two more academic institutions—Cedars-Sinai Medical Center and Lundquist/Harbor-UCLA Medical Center—joined the partnership when the UCLA Clinical and Translational Science Institute (CTSI) was funded in 2011.
The HCNI uses Community Partnered Participatory Research (CPPR) to achieve the following three aims: 1) understand clinical and social factors that might be intervened upon to influence health outcomes in this South LA community; 2) examine patterns of chronic condition disease prevalence and the relationship between clinical and social outcomes; and 3) engage community residents, agency representatives, and other stakeholders in collaborative data analysis, interpretation, and dissemination in order to set priorities for future intervention development.
Good News Radio Magazine Programs Highlighting HCNI
Principal Investigators: Alex Ortega, Michael Prelip and Deborah Glik
Community Partner: Volunteers of East Los Angeles (VELA)
This project provides technical assistance and training on survey methods, human subjects and research ethics, survey data collection and quality control to community members so they can conduct professional-level interviews of corner store patrons. The Corner Store Grocery Project seeks to improve the availability of healthy foods in East LA and Boyle Heights, Latino communities with large populations of new immigrants and a dearth of supermarkets.
Principal Investigators: Nina Harawa (Charles R. Drew University, UCLA) and Charles Hilliard (Charles R. Drew University)
Community Partner: Spectrum Community Services and Research
The purpose of this project is to better understand the post-incarceration needs and resources of HIV+ former prisoners. This population has a poor history of remaining in medical care, resulting in increased viral load, morbidity and disease transmission risk. We have analyzed records of 363 Spectrum case management clients, developed a focus group discussion interview guide and recruitment tools, and received IRB approval to conduct focus groups.
Principal Investigators: Moira Inkelas, Lila Guirguis, Alex Morales and Patricia Bowie
Community Partner: Magnolia Place Initiative
The Magnolia Place Initiative is a collaboration of faith-based and community groups within a 500-block portion of Los Angeles that crosses Pico Union, West Adams and the North Figueroa Corridor, west of downtown. This project used smartphones to help a group of Magnolia Place residents record images and information from their neighborhoods in ways that may contribute to meaningful change while building community capacity for research. We developed a "Holiday Campaign" around Halloween, which involved taking snapshots and mapping the observations, and created a rating scale for measuring holiday spirit. We also wrote a Spanish-language guide for the project.
Principal Investigators: David Zingmond, Jerry Kominski and Ami M. Shah
Using a variety of public data sources, we calculated the disease burden of six major clinical areas—heart disease, diabetes, pulmonary disease, cancer, HIV/AIDS and mental health—for the eight service planning areas and 26 health districts within Los Angeles County. The purpose of the project is to quantify disease "hot spots" within Los Angeles County and share our results with community stakeholders, policy makers and researchers so the data may be used to shape the design and implementation of community-driven initiatives.
Principal Investigators: Moira Inkelas, Terry Silberman, Mary Wang and Shannon Whaley
Community Partner: Los Angeles County Women, Infants and Children supplemental nutrition programs
Los Angeles County Women, Infants and Children (LAC WIC) programs provide supplemental nutrition, health care referrals and nutrition education for low-income pregnant women or women with children under age 5 who are at nutritional risk. Although LAC WIC programs are often approached with research requests, they do not have a strategic plan to vet, manage or optimize in-house research. This project will create a strategic plan that will provide guidelines and tools to facilitate research of interest to LAC WIC leaders, participants, staff and academics.
Principal Investigators: Geraldo Moreno, Carol Mangione, Mignon Moore, Laura Trejo, Ivy Lee, Carmen Reyes and Catherine Sarkisian
Community Partners: Los Angeles Community Academic Partnership for Research on Aging and Los Angeles City Department on Aging
This study will examine the barriers that prevent minority elders from participating in research, particularly those studies that involve collection of biomarkers. Minority elders face health disparities but are underrepresented in research. As a consequence, research results are potentially non-generalizable to older, minority adults.
Principal Investigators: Marie Mayan-Cho, Miriam Hernandez and Laurie Shaker-Irwin
Community Partners: Providence Access to Care/Health Education Outreach and Providence Latino Health Promoter Program
This study will develop a toolkit to assist investigators with employing and utilizing the skills of community health workers, or promotoras, to encourage participation of underserved ethnic and minority populations in research.
Principal Investigators: Lark Galloway-Gilliam, Annie Park, Jessica Jew, Ami M. Shah, Nina Vaccaro and Roberto Vargas
Community Partners: Community Health Councils and South Coalition of Community Health Centers
This study aims to improve access to quality care and reduce poor health outcomes associated with cardiovascular disease generally and congestive heart failure in particular. The study will review public health data and conduct statistical analyses to understand factors related to excess hospitalization and death from heart disease in South Los Angeles. The findings will be used to inform prevention, early detection and treatment interventions.
Principal Investigators: Beth Glenn, Hector Rodriguez and Roshan Bastani
Community Partners: Building Clinic Capacity for Quality, a program of Community Partners
This project will develop an electronic prototype for collecting information from patients about health behaviors, including physical activity, stress, anxiety, depression and tobacco use. The study will involved four safety-net clinics to address the infrequent and inconsistent assessment of behavioral risk factors in primary care.
Principal Investigators: Barbara Vickery, Eric Cheng, William Cunningham, Susan Ettner, Honglu Liu, Brian Mittman, Amytis Towfighi, Lillie Hudson, Nerses Sanossian, Tom Anderson, Robert Bryg, Jeff Guterman and Sandra Gross-Schulman
Community Partners: Healthy African American Families II, Partners in Care Foundation and Watts Labor Community Action Committee
This study, which is also funded by the American Heart Association, will assess whether lifestyle group clinics, care managers and support from community health workers may reduce the risk of a second stroke in socioeconomically disadvantaged minority patients.
Principal Investigators: Bowen Chung, Jeanne Miranda
Community Partners: Healthy African American Families II, Health Services and Society, First African Presbyterian Church, California Community Foundation
This project, Building Resiliency and Increasing Community Hope (B-RICH) proposes to pilot and then
conduct a randomized, single blind trial of a psychosocial intervention called a “Resiliency Class” (RC), to provide depression education and health promotion to individuals with depressive symptoms, by training non- professionals to offer this class to clients receiving services within diverse community settings (e.g. health care clinic, church, community advocacy organization, social services agency). This class is not designed to be therapy, but rather is designed as a class that is informed on cognitive behavioral therapy (CBT) principles used to address depressive symptoms, on how to improve mood, and to enhance resiliency in the face of stress.
Principal Investigators: Eric S. Daar, Katya Calvo and Deborah Collins
Community Partner: Long Beach Department of Health and Human Services
This study, which also involves collaborations with USC and UC San Diego, in addition to the Long Beach Department of Health and Human Services, is focused on linking people with HIV infection, or a high risk of HIV infection, to clinical care.Participants will be randomly assigned to receive treatment (for infected individuals) or prophylaxis (for at-risk individuals) with or without an intervention designed to improve adherence. The study will also evaluate incentive-based social network recruitment for HIV testing of high-risk individuals. There will be a special emphasis on African Americans who as a group are disproportionately unaware of their HIV infection status.
The one-year project advances healthy aging in LA County (LAC) by identifying and characterizing mental health and substance use (MH/SU) evidence-based interventions (EBIs) serving consumers aged 50+. It will produce an exhaustive inventory of MH/SU EBIs within LAC health and human services provider systems. We addresses both community MH/SU needs, and the capacity of providers to serve historically underrepresented older minorities, who bear excess MH/SU burden. Selected data produced by this study will be used in Dr. Vega’s proposed CTSI metrics modeling simulation pilot to support future research applications. Although a few EBIs have emerged in the past decade to address various disabling MH/SU problems in middle-age and older US adults, no central data exist on: (1) EBIs implemented in LAC, and if implemented, (2) how EBIs directly address minority and socioeconomically disadvantaged communities, and (3) what capacity HHS provider systems have in order to deliver and sustain EBIs over time. The Affordable Care Act’s emphasis on mental health parity and improved access to MH/SU services underscores the salience of estimating capacity to deliver EBIs. Newly insured people covered by ACA are disproportionately underserved, with preexisting conditions and limited quality healthcare access. There is an immediate need to assess system readiness to adopt and sustain EBIs to vulnerable populations, including identifying planned, implemented, and sustained interventions. Bridging the knowledge gap in this area is paramount to the development of a community- informed system of care and for the Healthy Aging Initiative to prioritize community-based interventions by location, subpopulation, and provider environments.
Although many evidence-based programs (EBPs) address common chronic conditions and geriatric syndromes, most of these programs were developed and studied under conditions approaching optimal efficiency, but there is very little information on their implementation in "real world" settings where there can be variation in fidelity to the program and racial/ethnic, cultural, and language diversity among participants. The extent to which these programs may be less effective in low income and minority communities has not been well characterized. Although a range of community and individual health metrics have been proposed to monitor and compare the impact of interventions, there are many challenges to implementing these measures, including ambiguity about how best to measure them and disagreement about whether and how to incorporate community health priorities into indicators of healthy aging and the metrics used to evaluate them. To address these gaps in our understanding of the use and effectiveness of EBPs in community settings in Los Angeles, we propose a one-year project to address the following aims: Aim 1: Characterize the prevalence and geographic distribution of EBPs to promote healthy aging and chronic disease prevention and management among older persons in LA County. Aim 2: Develop a community-generated shared set of measures to evaluate community health priorities and the effectiveness of initiatives to promote healthy aging among the diverse population of middle-aged and older adults of Los Angeles. This research will support the Healthy Aging Initiative's goal of developing sustainable interventions in under-resourced communities and monitoring the effectiveness of these programs.
The USC Roybal Institute’s proposed Los Angeles Healthy Aging Indicator Project will develop multiple population health metric tools (Community Metrics) and a community dissemination-engagement component corresponding to the community assessment and intervention-research functions of the Health Aging Los Angeles County initiative. As the population ages and the nation’s health and healthcare landscape is transformed, design and implementation of interventions requires detailed assessments of community health status and effective community linkages for identifying and responding to emerging need. The proposed project is designed to support community-engaged assessment and intervention to promote healthy aging in Los Angeles County, and identify critical service needs and requirements of underserved minority and socioeconomically disadvantaged populations. The process of identifying, accessing, and collating data for dissemination to community stakeholders and researchers will involve the active participation of health, social service and science disciplines, community leaders, and direct service provider collaborators. The Community Metrics have two foci: first, to provide information responsive to needs articulated by communities, front-line service providers, and researchers; second, to provide information most useful for decision-makers for program redesign and resource allocation. Its products will include briefs and reports that focus on discrete health service issues among populations aged 50 and older in Los Angeles County, and relevant place-based descriptive indicators that can be monitored over time for change. The pilot provides preliminary data to support eventual application for extramural funds to scale up and develop applications for assessing emerging needs and impacts of new interventions on aging populations and selected subgroups.
Los Angeles Alliance for Community Health and Aging (LAACHA) is implementing an innovative "Wellness Pathway" model in which adults aged >50 years with chronic medical conditions are identified by health providers and referred to community based organizations (CBOs) where they participate in evidence-based programs (EBPs) to help them manage their health conditions and maintain physical, emotional and social health. EBPs such as those focused on chronic disease self-management and physical activity are empirically proven to improve meaningful health outcomes such as quality of life and decreased hospitalizations. However, only a small fraction of adults likely to benefit from these programs have access to them. To address this large gap between need and access, the Wellness Pathway is designed to translate the EBPs into real-world community settings and be scalable across Los Angeles County. The ultimate goal of the Wellness Pathway model is to facilitate older adults' ability to "age in place," take care of basic needs, and avoid needless hospitalizations and nursing home placement. Our diverse interdisciplinary team of city, county, university and nonprofit organization-based investigators seeks support from the CTSI Healthy Aging Team Science program to rigorously evaluate the impact and sustainability of the Wellness Pathway program and collect the critical data needed to: 1) submit a grant to study the model in a larger fully powered trial to look at outcomes including hospitalizations and disability; 2) take the program to scale across L.A. County. This proposed project directly advances aging research and promotes healthy aging for older adults throughout Los Angeles County.
Clinical preventive services (CPS) (e.g., colorectal cancer screening, immunizations) reduce rates of premature death and disability, including for older adults. Currently, the use of evidence-based CPS is below Healthy People 2020 recommended levels, especially for racial and ethnic minorities. We are proposing a community-based participatory research (CBPR) project that will generate critical knowledge of local environments and community resources that will greatly facilitate efforts to deliver needed CPS and other health promotion and prevention services to adults 50 years and older in South Los Angeles. This collaborative team effort includes the Los Angeles Department of Public Health (LADPH), three safety-net clinics in South Los Angeles that are members of the Southside Coalition of Community Health Centers, local community-based organizations, and a multidisciplinary group of UCLA investigators. The specific aims are: 1) to determine current rates of CPS use by individuals 50 years and over in South Los Angeles overall and in the three partner clinics; 2) to assess the current system of CPS promotion, delivery, and follow-up to individuals 50 years and older and evaluate clinic capacity to implement new, evidence-based strategies to increase CPS use; 3) to identify and engage a network of public and private organizations in the clinics’ catchment areas to partner in the promotion and delivery of CPS. The findings will be used to support extramural grant applications to increase the use of CPS and to create a financially sustainable model of practice for extending delivery of CPS to other communities in Los Angeles County.