On the heels of the October installment of Expresso, we learned that David Julius joined the ranks of UCSF Nobel Prize laureates. It was an injection of great news for all of us, and now, three weeks later, it’s easy to forget just how monumental an accomplishment this is! And I really appreciate David’s message that he never would have achieved such success were it not for his good fortune of being a part of such an amazing community. As he said, it’s all about location, location, location.
Related to this, on October 21, Chancellor Sam Hawgood gave his 2021 State of the University address, Catalyst – an inspiring and humbling 60 minutes. If you haven’t seen it, I urge you to check it out, as well as the recording of the October 28 Chancellor Awards for Diversity Virtual Celebration.
On Thursday, November 11, our nation will honor military veterans, and here at UCSF we celebrate veterans in our campus community, notably our learners. Student Veteran and Military Support Services provides veterans and military-affiliated students at UCSF with a supportive community, mentorship opportunities, guidance on educational benefits, and tools to succeed both academically and personally (see their website, veterans.ucsf.edu, for more information). In addition, the University has had a longstanding affiliation with the San Francisco Veterans Affairs Medical Center, providing health care and psychosocial services to the individuals who have served our country.
…Did you hear that? That was the sound of thousands of members of our UCSF community making their voices heard through the 2021 UCSF Climate Survey. To those who have taken it – thank you! If you haven’t, no doubt you’ve been receiving reminder emails every Tuesday from Emma White Research. Need more motivation? We’ve got prizes! Take a look at UCSFClimate.ucsf.edu. The survey closes November 30. We need to hear about your UCSF experience – this is key to our efforts to effect change toward building and nurturing an inclusive community and culture that encompass what UCSF aspires to be – one of the best places anywhere to work and study.
This brings me to this month’s topics. We all know that digital data has exploded in our work and personal lives, not only in sheer volume, but also as far as the economy of data. I’m checking in with colleagues to tell you about two initiatives that are harnessing data to improve the health of people everywhere. As you’ll see, these efforts interface with many other programs, touching nearly every discipline and spreading across not only our University and the UC system, but California, the country, and the world. You’ll also read an important update about our efforts to bring scholars from Afghanistan to UCSF.
This month’s topics:
- Update: Efforts to help more scholars in Afghanistan
- UCSF and UCB: Pioneering computational health together
- Health Services Research Initiative: The economy of data and collaboration
If you have not gotten your flu shot, please do so immediately by going to Occupational Health clinics during regular business hours, your provider, or local pharmacy. Additional ways are available here. If you get a flu shot outside of UCSF flu clinic, which includes UCSF primary care, please get a record of that vaccination and email a copy to [email protected]. Include your employee number (which starts with 02) in the email. If you choose to decline the flu shot, you can find the declination form here. BCH Oakland (or East Bay) employees should submit documentation to [email protected].
I am always thankful for your ideas about future Expresso topics, so please write me at [email protected].
Update: Efforts to help more scholars in Afghanistan
The October issue of Expresso described UCSF efforts to extricate two outstanding scholars from Afghanistan and bring them here to pursue advanced degrees in our Institute for Global Health Sciences (IGHS). I also asked you to contribute to the fundraising goal to support this endeavor.
The complexity of the situation continues to be dire, and reports about the overall situation are ever more tragic. We have quite a few fast-moving parts, and it is important that I update you on our progress – in less than a month our scope has expanded to helping four scholars, so our fundraising goal of $100K has been increased to $150K.
The first Afghan scholar and his family have made it out of Afghanistan and are in Canada awaiting the next steps of processing. They are safe and managing well under the circumstances, but three others remain in Afghanistan, with one currently enrolled in our IGHS MS program and taking courses online. Those scholars remaining in Afghanistan are at high risk as the situation is deteriorating – food insecurity and personal safety issues remain acute and ever-present – and all three are describing high levels of distress and anxiety. IGHS and Health and Human Rights Initiative faculty are maintaining regular contact with all of these scholars to provide support.
We have raised a total of over $120K through our Together at UCSF: UCSF Afghan Scholar and Refugee Initiative to provide humanitarian support once the scholars arrive in the Bay Area – money that will only be used to support basic living expenses. And we continue to partner with local organizations in the Afghan community to coordinate additional support once each scholar arrives.
UCSF is also working with UC Office of the President on a coordinated systemwide response involving all UC campuses as well as with the national Scholars at Risk Network for support. This effort includes developing a plan with former U.S. Senators Hillary Clinton and Barbara Boxer to provide support for stranded female scholars waiting to be evacuated. We continue to coordinate with U.S. Senators Dianne Feinstein and Alex Padilla to have scholars’ names added to priority lists for evacuation.
Thank you to all who have donated compassionate time, energy, and dollars – my gratitude is immeasurable. We must not become complacent.
UCSF and UCB: Pioneering computational health together
Some ideas make so much sense, it’s hard to understand why they don’t happen more often.
The distance between UCSF’s Saunders Court and Cal’s Sather Gate is a mere 17 miles, and UC Berkeley and UCSF are two world-renowned institutions with complementary areas of expertise with shared history dating back to 1873. Shouldn’t we be working together as much as possible?
The potential of joining forces has been discussed many times over the years, and we have several success stories, e.g., QB3, Chan Zuckerberg Biohub, Joint PhD Program in Bioengineering, and the Joint Medical Program in the School of Medicine. But now, as digital technology transforms health care, e.g., electronic health records (EHRs), virtual appointments, and artificial intelligence, how we understand and treat disease is transforming, and the opportunities are too great not to expand that collaborative relationship.
Enter the Computational Precision Health Initiative, a joint venture formed just last year and funded by an anonymous $50 million grant. “In 2020, led by the Bakar Computational Health Sciences Institute, a group of faculty from both UC Berkeley and UCSF got together to brainstorm this intersection of health and computation, and we came up with this notion of a graduate program that would be a bridge between the two campuses,” says Ida Sim, who co-directs Informatics and Research Innovation at UCSF’s Clinical and Translational Sciences Institute (one of many hats she wears). She defines computational precision health (CPH) as “using computational technologies to support the practice and the delivery of health care for individuals and populations.” Ida’s UC Berkeley co-director is Maya Petersen, chair of UC Berkeley’s Biostatistics Division.
As a practicing physician, Ida wants to make sure the CPH Initiative stays rooted in finding ways to help patients. While other important programs explore and apply the power of computers to the field of medicine to better understand and treat disease, CPH is focused on the front lines. “In the delivery of health care, there are incredible opportunities to use computational technologies – machine learning, visualization, chatbots, artificial intelligence – to really improve the process by which we deliver care,” says Ida, emphasizing that care includes “the process by which patients take care of themselves.”
The initiative launched in August, and from the outset, both institutions have been very creative in designing the program to be truly collaborative between the campuses. The goal is to create a new entity that integrates the best of both optimally. (This background story provides additional details.)
What makes this effort different is that everything is structured to be 50-50: the work, the number of faculty, the number of students. Currently, the program has 14 UCSF faculty and 13 from UC Berkeley. The first eight PhD candidates are anticipated to matriculate in fall 2023. “We share such a similar vision, it’s uncanny,” Ida says. “We’re pinching ourselves.”
To show the program’s range, UCSF faculty are from anesthesia, biostatistics, epidemiology, medicine, neurology, oncology, orthopedics, pediatrics, physiological nursing, radiation, and urology, and come from ZSFG as well as the main campuses. The Berkeley professors come from biostatistics, computer science, electrical engineering, health policy, industrial engineering, operations research, statistics, the “I School,” and the Haas School of Business.
And the initiative will coalesce toward making health care delivery better. “Wellness is not something we as physicians emphasize enough in our approach to caring for patients. We’ve got to get away from that,” Ida says. “It’s about all of us being healthy, staying well, and managing diseases – many of which are chronic diseases – as individuals, and in partnership with our communities and our clinicians.”
As the UCSF and UC Berkeley histories show, something on this scale is all quite fitting for us to pursue together!
Health Services Research Initiative: The economy of data and collaboration
When projects bring together people with clinical backgrounds and those with social science training, the results are often greater than the sum of their parts. The research is much richer when we have groups of people with different disciplinary backgrounds and questions are approached from multiple perspectives, yielding an outcome that is more powerful and sophisticated, answering more questions than a single researcher could. This is why the UCSF Health Services Research Initiative holds promise of even greater successes, building upon an established, but often undiscovered history.
What exactly is health services research? The term refers to research related to health care, but it’s neither clinical nor bench science. It relates to how social factors, financing systems, organizational structures, technology, and behaviors affect access to health care quality and cost. As Bob Wachter, chair of the Department of Medicine, describes it, “It’s a field that asks the question: How do we organize ourselves to deliver on what our obligation is – which is figuring out ways of providing the best care to people that achieves the best outcomes at the lowest cost?”
UCSF’s Health Services Research Initiative (including Claire Brindis, Kirsten Bibbins-Domingo, Julie Ann Sosa, and Bob Wachter, among others) has moved forward technology infrastructure and programmatic solutions to support UCSF researchers analyzing large datasets in support of health equity.
Research into this area isn’t new to UCSF. It’s been going on for nearly 50 years, but we previously haven’t been able to bring everyone together across the campus effectively. “It’s been under-heralded,” says Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies (IHPS), where primary coordination for the initiative is taking place. The Institute was founded in 1972 and will be celebrating its 50th anniversary in 2022!
And according to Joanne, this sort of research has been happening organically in many places throughout UCSF. “We can find people all over the campus now who do this kind of work,” she says, including epidemiologists, biostatisticians, and researchers at the Center for AIDS Prevention Studies, Center for Vulnerable Populations, and the Center for Tobacco Control Research and Education, so we’re making inroads toward developing a cohesive footprint university-wide – and now with this initiative, we’re a lot closer to reaching that goal.
Julie Ann Sosa, chair of the Department of Surgery and a health services researcher, says when she came to UCSF from Duke University in 2018, she couldn’t tell immediately how much the University prioritized this field. “Compared to other institutions, health services research at UCSF is kind of invisible,” Julie Ann says. “That’s not to say people aren’t doing spectacular health services research. It just wasn’t clear to me who they were, where they were, was it important to the institution, was the institution recruiting and retaining people because of it?”
As co-participants in the Robert Wood Johnson Foundation Clinical Scholars program, Julie Ann approached Bob to see if health services research could get a higher profile at UCSF; together they brought on Kirsten Bibbins-Domingo – chair of the Department of Epidemiology and Biostatistics, vice dean for Population Health and Health Equity, and co-director of the Clinical and Translational Sciences Institute (among other titles). Those three then approached Claire Brindis, Joanne’s predecessor at IHPS, who had long sought to identify ways to weave together the many health services and population health research communities at UCSF. There was also a sense that a growing number of clinical researchers wanted to expand their work to consider population health issues.
By the time this dynamic foursome came to my office, a little over two years ago, they had a clear picture of what was needed: financial support for a major effort involving data that runs as the lifeblood of health services research. Not only getting the data, but cleaning it, managing it, and analyzing it.
Kirsten considers the project integral to the Population Health Data Initiative, which includes health services research. She had been trying to figure out some of these data issues, so when Julie Ann and Bob approached her, she gladly joined forces. “There’s all sorts of rich data out there that our researchers need to answer questions related to outcomes and processes, and the social context in which people live,” Kirsten says. Some data had been gathered more than a decade earlier, for campus-wide use through the Comparative Effectiveness Large Dataset Analysis Core, but there was a great opportunity to revisit those data purchases and go larger.
And they followed the money. When a dataset is purchased, the researcher often doesn’t have the means to inform the greater community, resulting in datasets being purchased multiple times. Case in point, an analysis of all the folks who bought the same Medicare data through the BearBuy procurement system showed $1 million was spent over five years. The benefits of a campus-wide license are well known and can be applied to purchasing datasets, enabling data to be shared.
Kirsten envisions a data hub that could operate like our core labs, informing researchers when someone buys a big, expensive, sophisticated dataset, and allowing others to reuse it. Even better, she says, more people using the data could then share the insights they gleaned and tips on how to use it. Read more about Centers of Medicare and Medicaid Services Data Reuse.
This will not only save money, it’ll save time, too – you get the data faster, without a lengthy approval process. The time and extra money can be spent on science, rather than redundant data purchases. UCSF will acquire more data, which opens more doors for researchers. Additionally, institutional knowledge regarding the datasets and what questions are best answered by each set can help jumpstart successful health services research careers. For example, Kirsten bought access to the Federal Research Data Center, which sits at UC Berkeley, facilitating access to multiple national datasets for UCSF researchers through this license. She has also spearheaded access to statewide COVID data for all UC investigators. There’s Medicare data. Medicaid data. Commercial insurance claims data. Electronic health records data.
Among the next steps, Joanne is hoping the University Library can develop a useful campus resource – a “data catalogue.” She is also working on details of how to make data access self-sustaining, which will involve a recharge structure that is fair and supports early-stage researchers. Another immediate next step is to develop a community of researchers and programmers working with each major type of dataset, starting with Medicare data.
This brings us back to the goal of health services research, i.e., to answer a lot of very important questions about how we can deliver better care to people who need it the most, at the right time, and in a way that’s efficient, cost-effective, and patient-centered. Many possibilities are emerging, as new connections are made seemingly everywhere. Among the data are insights that will show us how to advance equity for all the communities we serve.
Dan’s Tip of the Month
As we head into this year’s holiday season, I want to share some wisdom that one of my student mentees, Chris Montgomery, shared with me a short while ago. It is credited to Mother Teresa as it was found written on the wall in her home for the children of Kolkata (formerly known as Calcutta). For me the sentiment and message are universal, whether you believe in a higher power or not, and evoke the aspiration we embody at UCSF:
People are often unreasonable, irrational, and self-centered. Forgive them anyway.
If you are kind, people may accuse you of selfish, ulterior motives. Be kind anyway.
If you are successful, you will win some unfaithful friends and some genuine enemies. Succeed anyway.
If you are honest and sincere people may deceive you. Be honest and sincere anyway.
What you spend years creating, others could destroy overnight. Create anyway.
If you find serenity and happiness, some may be jealous. Be happy anyway.
The good you do today, will often be forgotten. Do good anyway.
Give the best you have, and it will never be enough. Give your best anyway.
In the final analysis, it is between you and God. It was never between you and them anyway.
Thank you for bringing your best selves to the amazing work each of you do – day in and day out. I wish you all a happy and healthy season of gratitude.