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Source: Corinna Kaarlela
415-476-2557
10 July 1998
TWO SFGH PATIENT PROGRAMS RECEIVE NATIONAL AWARDS
Two patient programs at San Francisco General Hospital have been honored by the National Association of Public Hospitals (NAPH). One of the association's top awards went to a hospital program designed to reduce the number of emergency department visits by "high-user" patients. This honor, the NAPH "Jim Wright Vulnerable Populations Award," was presented to the SFGH Emergency Department Case Management Program. An honorable mention in the "Healthy Communities Service Award" category went to an SFGH program dedicated to improving the health care response to domestic violence. Presented annually, the NAPH awards identify creative approaches for improving the delivery of health care services to poor and medically underserved communities. The awards ceremony took place at the recent NAPH annual meeting in Boca Raton, Fla. Now three years old, the SFGH emergency department case management program has shown early success in reducing the number of emergency visits, saving costs, and supporting patients through social services. The program is directed by Robert Okin, MD, chief of SFGH psychiatric services and UCSF professor of psychiatry, and Alicia Boccellari, PhD, director of SFGH psycho-social medicine and UCSF associate clinical professor of psychology. Kathy O'Brien, MSW, is program coordinator, and James Oh, MD, is medical director. In presenting the award, NAPH officials noted that the SFGH team set out to solve the problem of emergency department (ED) high-users against difficult odds. Some of these individuals visit the hospital ED as many as 50 times a year, and a majority have overwhelming medical and social needs, including homelessness, unemployment, lack of medical insurance, histories of substance abuse and psychiatric problems, and varying degrees of brain damage. The focus of the SFGH program is intensive one-on-one management of each individual in the ED high-user group. Case managers work to establish a personal relationship, providing assistance with appointments, entitlement paperwork for housing and financial aid, medical care, substance and mental health treatment, and other support services, provided both in the hospital and in the community. Preliminary analysis of 45 patients in the program show reductions in five key areas: ED visits decreased by 21 percent, hospitalizations by 30 percent, homelessness by 44 percent, substance use by 38 percent, and cost to the health delivery system by 55 percent. The SFGH domestic violence program is the second phase of a two-part project. The first phase was successful in developing a model for the assessment, documentation, intervention, and referral of domestic violence patients that could be used by all health care providers in the ED setting. Phase two, which began in 1996, has focused on taking this model to community clinics and other local settings in order to provide a consistent approach and protocol when caring for domestic violence patients or others at risk for abuse. More than 350 providers in community settings have undergone training, and the effort has resulted in a marked increase in documentation of injuries and in appropriate intervention. The program director is Beth Kaplan, MD, UCSF assistant clinical professor of surgery who works in emergency medcine at SFGH. Phase two program leaders are David Offman, MD, and Leigh Kimberg, MD, both of the Community Health Network; and Kate Monico-Klein, SF Department of Public Health. Program collaborators are Debbie Lee and Sue Martin, of the Family Violence Prevention Fund. SFGH is affiliated with UC San Francisco and is part of the Community Health Network of San Francisco, an integrated health delivery system that also includes Laguna Honda Hospital, mental health and home health services, jail health services, and neighborhood health centers.
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