Annual Report 2002-2003
Foundation Highlights
Health Care
In 2002, the Palo Alto Division received top scores in the entire state from PacifiCare, a major provider of health plans in California. "The Quality Index" rated more than 200 PacifiCare contracted medical groups on more than 40 measures related to clinical and service quality, affordability and administrative accuracy. In addition, the Palo Alto Division received the top score in women’s health, a new special index created by PacifiCare.
Blue Cross in 2002 presented Camino Medical Group (CMG) with an excellence award for outstanding performance in its Quality Scorecard. CMG was among the top 16 percent of the Blue Cross network that met all the performance criteria.
A new Quality Improvement Steering Committee, made up of Palo Alto Division physicians and administrators, was created in 2002 to develop systematic ways to improve quality of care. One area the committee is focusing on is preventive-health screening tests and procedures – recommended for healthy patients at specific ages – as an alternative to more generalized "annual physical examinations."
A new patient experience process was launched in 2002 for Palo Alto Division patients to make it easier for them to voice their ideas or concerns. A new brochure outlining the program, called "We Are Listening," also was distributed in patient waiting areas, and is updated as new issues arise.
CMG produced a new patient guide to direct new patients on how to navigate the CMG system, followed by a new patient orientation program. In 2003, CMG also established patient hotlines that allow the clinic to give up-to-date information to patients on timely issues, such as severe acute respiratory syndrome, or SARS.
The rollout of the Palo Alto Division's electronic medical record (EMR) was completed in 2002, which means that all physicians and clinicians at all sites now use the EMR instead of paper records to document their care of patients. The EMR includes computerized physician order entry, e-prescribing and instant, secure access to patient records, even when off site (such as in the hospital).
CMG expanded its version of the EMR to include online EKG results; online prescription refills, which reduce the time it takes for patients to get medication refills; a secure clinical messaging system that allows physicians to consult each other regarding their patients; and a new online referral system, which dramatically speeds up the time it takes for patients to obtain access to specialists. CMG will be converted to the Palo Alto Division's EMR by 2005.
CMG established a real-time, online linkage to El Camino Hospital's information system to allow CMG physicians to receive hospital-based data including pathology results, operative notes and hospital discharge summaries.
The Palo Alto Division implemented its "advanced access" system in the primary care areas in early 2003, which allows patients to be seen the day they wish to be seen and by their own physician. CMG is implementing "advanced access" in both primary care and specialty departments. Advanced access is part of an Operations Improvement "OI" initiative to improve overall operations.
PAMF met the April 14, 2003, compliance deadline for the Health Insurance Portability and Accountability Act (HIPAA). The new law guarantees security and privacy of patient health information. PAMF staff members had been preparing for the new federal law for more than a year.
In 2003, the Fremont Center added several new services and expanded others already available at the Palo Alto campus to meet patient needs in the Fremont area. These included basic spirometry, a screening and monitoring test for people with asthma or other common respiratory conditions, in the Department of Allergy; urodynamics, a new diagnostic method of detecting and measuring the degree of urinary problems, in the Department of OB/Gyn; travel medicine, which focuses on maintaining health when traveling overseas; and plastic surgery for reconstructive breast surgery and a variety of cosmetic surgery services.
CMG developed a new skilled nursing facilities (SNF) team to improve quality of care for patients in nursing homes. Physicians are able to spend more time with SNF patients and better understand their needs, which are much different from those of patients typically seen in a primary care physician's office. In addition, CMG began providing in-house audiology services to its patients in 2002.
More than 12,000 Palo Alto Division patients have signed up for PAMFOnline, an innovative set of Internet-based services that allow them to connect to key portions of their electronic medical record. Users also may request appointments and prescription renewals, view recent lab test results, and communicate with their primary care physician.
In 2002, CMG installed a computerized appointment reminder system to send patients automatic telephone reminders of their upcoming appointments.
In 2003, CMG created a "Diabetes Dashboard," a comprehensive aide for physicians to better manage and monitor their patients with diabetes.
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Education
"We're Talking," PAMF's teen Web site (pamf.org/teen), continues to draw large numbers of visitors. In 2002, there were 502,119 visits to the site, and 1,852 questions were asked with answers by PAMF experts posted to the site. The Web site is a source of teen-friendly factual health information, with content on general health, tobacco, drugs and alcohol, emotions and life, and sexual health and experience. The site also includes lists of hotlines. Health educators, physicians, behavioral health specialists, interns and researchers develop the content.
The PAMF Education Division continues to provide ongoing classes and individual instruction on stress management, weight management, diabetes, asthma, high-blood-pressure management and cholesterol management. Prenatal programs and lactation consultation are also offered.
As a community service, the Education Division continues to offer various monthly support groups, monthly health-related community lectures, resource centers with nurse educators and advance directive consultation. Health information is also provided on the PAMF (pamf.org) and CMG (caminomedical.org) Web sites.
The Palo Alto Division joined with the Palo Alto Unified School District in 2002 to "Bone Up on Calcium," a poster contest for area elementary school children to increase awareness about the importance of adequate calcium intake. More than 150 posters were submitted; winners were chosen by high school students, and selected posters were displayed in physician exam rooms.
In 2003, CMG partnered with the Sunnyvale School District to provide seminars for families in the community on nutrition, followed by classroom-based instruction in nutrition for sixth graders at Columbia Middle School. The pilot program will be implemented by the school in all sixth-grade classrooms. CMG also partnered with the Sunnyvale Department of Public Safety to provide classroom instruction for third graders on pet safety and how to prevent dog bites, the No. 1 pet safety issue in the city. The department is looking to expand the successful program to other cities.
The American Medical Group Association and Pfizer, Inc. honored the Palo Alto Division's Heart Failure Program in 2002 for its "original and comprehensive approach to caring for patients with heart failure." The program focuses on patient and provider education and close patient monitoring. A key goal of the program is to reduce the number of costly hospitalizations, and in a selected patient population, the program has shown a 75 percent reduction in heart failure-related hospitalizations, as well as increased quality of life for patients.
As part of Breast Cancer Awareness Month in October, the Education Division offered informational displays on breast health and breast cancer at various clinic locations. Breast cancer is the most common form of cancer for women in the United States.
In early 2003, Sheila Kitzinger, an internationally known authority on women's experience of pregnancy, childbirth and motherhood and author of 22 books, was the keynote speaker at the fifth annual Mothers Symposium, "The Universal Experience of Motherhood: Celebrated in Story." Kitzinger also spoke to birth professionals in the community on Choices in Childbirth. Both community events were a collaboration of various Bay Area agencies including PAMF.
In April 2003, PAMF was a co-sponsor with schools in San Mateo and Santa Clara counties of a community lecture addressing the challenges children face with bullying, peer pressure and cliques, attended by 450 parents. Rosalind Wiseman, author of Queen Bees and Wannabes and co-founder of the Empower Program, was the keynote speaker. Wiseman also talked to 100 school professionals in a separate presentation.
CMG highlighted teen health through the distribution of more than 1,000 laminated resource cards given to 7th graders in Mountain View and Sunnyvale schools.
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Research
Andreas Stahl, Ph.D., of the Department of Cardiovascular Biology was part of a team of scientists that discovered a heart-specific fatty acid transport protein (FATP). Their findings suggest that the newly characterized FATP may play a role in the development of lipid-related cardiac disorders, such as enlarged heart muscle, lipid-induced heart disease and damage to the heart caused by the return of blood flow after a heart attack. The work was supported by a beginning grant-in-aid awarded to Dr. Stahl by the American Heart Association.
Neil B. Ingels Jr., Ph.D., of the Department of Cardiovascular Biology is co-principal investigator in research that was awarded a five-year renewal of a National Institutes of Health grant. The research focuses on the biomechanics of the heart – the size, shape and motion of the heart and valves. Dr. Ingels' research is conducted with his long-time colleagues at the Research Institute, George Daughters and Carol Mead, and in collaboration with the research team led by D. Craig Miller, M.D., Professor of Cardiovascular Surgery at Stanford University. Dr. Ingels completed his 40th year at the Research Institute in October 2002.
The Department of Clinical Research began recruitment in 2002 within PAMF’s Department of Neurology for a new Biogen, Inc.-sponsored study involving multiple sclerosis (MS) patients. The study involves FDA-approved AVONEX, a weekly injected medication, prescribed for the "remitting and relapsing" form of MS. Four groups of participants are divided into MS patients who are stable on the treatment, non-responsive to the treatment, or have never had the treatment, plus a healthy control group not on the treatment. The purpose of the study is to determine if there are differences in how patients from the different groups respond to the drug.
The Department of Health Services Research published major findings from a study of HIV infection risk among Latino couples in California. The study showed that the females' risk comes principally from the male partners' sexual relations with other (previous or current) partners, rather than from drug use or the females' relations with other partners. The study also identified demographic, psychosocial and relationship characteristics that predisposed women and men to higher risk for HIV infection. These findings have important implications for HIV prevention efforts targeted to Latino populations. The research was supported by a grant from the National Institute of Child Health and Human Development.
Researchers in the Department of Health Services Research developed two protocols to guide the interaction between clinicians and adult patients in the choice of asthma treatment. One protocol represents a more traditional approach to clinician decision-making based on accepted asthma treatment guidelines; the other involves shared decision-making between clinician and patient. The purpose of studying the two protocols is to determine whether shared decision-making increases patients' commitment to the treatment decision and improves adherence to treatment, thereby leading to better asthma outcomes among patients whose asthma is currently poorly controlled. The study is funded by the National Heart, Lung and Blood Institute.
In collaboration with the Palo Alto Division's Department of Information Technology, a new, customized laboratory information system was implemented in the Department of Immunology and Infectious Diseases. The new system accommodates both the clinical serology testing carried out in the department and the department's activities in toxoplasmosis research. Department research has led, over the past four decades, to improved diagnosis of and therapy for toxoplasmosis.
A standard molecular diagnostic test used in the Department of Immunology and Infectious Diseases to identify Toxoplasma gondii, the parasite that causes toxoplasmosis, in lab specimens is called polymerase chain reaction (PCR). In 2003, the PCR test was modified at the Research Institute using state-of-the-art "real time" technology. The standard test had three phases and took two-and-a-half days to complete. Using real-time technology, all three phases are incorporated into one step, and results are ready in a few hours instead of days.
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Other Highlights
In 2002, three area graduating high school students, Henry Lin, Idean Pourshams and Gavitt Woodard, were each awarded a $20,000 scholarship from the Palo Alto Medical Clinic (PAMC) physician partnership. This was the first time in the scholarship's 10-year history that three students were awarded scholarships, due to an increase in the number of PAMC physicians participating in the program.
Robert W. Jamplis, M.D., former PAMF president and CEO, received the John W. Gardner Visionary Award from Pathways Hospice Foundation in 2002. Dr. Jamplis was honored "for his vision for community health care, which includes philanthropy as a key part of the endeavor, and his ability to inspire others to think creatively to enhance the health of individuals and communities." He died in February 2003.
The Palo Alto Division announced in 2002 that Jon Isenberg, M.D., was the first visiting professor of a joint PAMF-Stanford University Visiting Professorship in Gastroenterology. The professorship, which was initiated through funds donated by PAMF, brings a gastroenterologist of national renown to PAMF and Stanford to share expertise with faculty and community physicians.
In 2002, retired Palo Alto Medical Clinic physicians Harry Hartzell and Maurice Fox each received awards. Dr. Hartzell received the Esther B. Clark Award from the Children's Health Council (CHC) for service to the CHC. Dr. Fox received the Laureate Award of the Northern California Chapter of the American College of Physicians-American Society of Internal Medicine by fellows of the college.
In late 2002, more than 1,000 books were donated by Palo Alto Division employees for a children's book drive to add to the children's libraries in the Pediatrics and Family Practice departments in Palo Alto and at the Los Altos Center.
Palo Alto's new Children's Creative Learning Center opened in late 2002. PAMF donated the land for the child care center, which is located in downtown Palo Alto near the old Palo Alto Clinic site.
For the second year in a row, the Palo Alto Division's Web site (pamf.org) was honored with a 2002 "Leadership Award" by eHealthcare Strategy and Trends, an organization that focuses on electronic communications in health care. The Division received a platinum medal for best overall site for medical group or foundation in the nation.
CMG expanded its Web site (caminomedical.org) to include departmental Web sites and educational handouts specific to medical conditions.
In 2003, the Santa Cruz Medical Foundation, which includes the Santa Cruz Medical Clinic, the Sutter Maternity and Surgery Center and its Visiting Nurse Association, became the Santa Cruz Division of the Palo Alto Medical Foundation. PAMF's other health care divisions are the Camino and Palo Alto divisions.
Retired Palo Alto Medical Clinic pediatrician Joe Davis was selected to be the 2003 recipient of the Tall Tree Award for outstanding professional given by the Palo Alto Chamber of Commerce and the Palo Alto Weekly. He died in March 2003, before receiving the award.
In 2003, the Palo Alto Division tied with Sutter Health's Sacramento Sierra Region for the highest composite score – 80 percent favorable for the 23 survey questions – in Sutter's systemwide 2003 Experience of Work (EOW) survey.
CMG in 2002 established a call center that reduced the amount of time patients had to wait for their telephone calls to the clinic to be answered – waiting time dropped by more than 60 seconds, to 18 seconds. As a result, patient satisfaction with telephone access at CMG improved from 62 percent in 2001 to 83 percent in 2003.
CMG's David Quincy, M.D., was honored by the Mountain View Chamber of Commerce for his volunteer efforts as medical director of the RotaCare Free Clinic.
CMG, along with El Camino Hospital and Lucile S. Packard Children's Hospital, sponsored the keynote speaker at the annual Marvin Small Memorial lecture. Dr. Julia Lewis, professor of psychology at San Francisco State University, spoke on "The Legacy of Divorce."
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