Clinicians at Keck Medicine of USC are burned out due to the COVID 19 pandemic, competing demands on their time and insufficient support to achieve work life balance. This project was designed to establish a team-based care program at Keck Medicine of USC to reduce clinician and staff burnout in the Family Medicine Department. Burnout affects over 50% of physicians and nurses and leads to reduced access to care due to sick calls, reduced patient safety and lower quality of care.

In recent years, there has been increased focus on health equity, galvanized by events such as Black Lives Matter, and increased awareness of the porosity of borders during the COVID19 pandemic. In my role as faculty lead for DEI efforts within Stanford’s Division of Primary Care and Population Health (PCPH) as well as faculty lead for the division’s global health partnership in western Kenya, I realized that many of the challenges to health equity globally are at play domestically.

Healthcare prices are hard to understand and navigate for patients and healthcare teams. Health care affordability (out-of-pocket patient costs) is a leading health care concern for Americans and a key voting issue. More than half of Americans worry about the availability and affordability of health care, and more than a quarter have delayed care because of high costs. I am passionate about this work after having a friend lose her life savings due to healthcare costs and my own family has faced large medical bills without guidance to navigate our healthcare system.

CalAIM and recent Whole Person Care pilot programs are redesigning how care is offered to people with complex needs in the MediCal system. Housing First models have demonstrated the importance of housing for client well-being, stability, and health outcomes, yet most communities lack adequate temporary and permanent housing options. Efforts thus far have failed to demonstrate compelling outcomes due to a combination of the small sample size and the complexity inherent in interventions for people who are unhoused and often have severe mental illness with co-occurring substance use disorder.

Permanent vision loss is prevalent among the aging and will continue to rise. There are gaps and barriers resulting from fragmented care locally and globally. The health inequity among the aging, visually impaired population is also a public health issue with an economic burden on state and federal resources. The CDC reports that 4.5M over age 40 report that they are blind. This number is expected double to 9M by 2050. There are 21M more who reports having “vision problems” not correctable with conventional glasses, contact lenses, or refractive laser surgery.

We face an escalating addiction epidemic, with more than 100,000 people dying of drug-related overdoses in the US in 2021—the highest number of deaths ever recorded. San Francisco has the highest overdose death rate in California. At SFGH, more than 1/3 of hospitalized patients have a substance use disorder (SUD). Our patients with SUD have longer lengths of stay (3 v 5 days), 1.5x higher 30-day readmission rates, and 5x higher self-discharges than those without SUD.

Patients with Mental Health (MH) conditions have poorer quality outcomes and experience persistent barriers in accessing care than those without MH conditions. Individuals with a Serious Mental Illness (SMI) or Substance Use Disorder (SUD) die over 20 years earlier than individuals without such a diagnosis. People with MH diagnoses incur costs more than those without MH disease. While the current health delivery system is shifting, it often separates Physical and Mental Health care.

If voting is a sign of a healthy democracy, we are in need of serious interventions. Voting is a health “thing”. It is the one power citizens have a right to holding democracy accountable. It ensures a right to a healthier life for people and their loved ones. The impact of voting and political decisions touch every part of our daily life, from safety to housing, education, and ultimately, our health. Voting sends a signal of support or dissent for policies that ultimately shape the social determinants of health. Social determinants subsequently influence who votes and who does not.

The politicization and circulating misinformation on the COVID-19 pandemic and vaccine has led to increased vaccine hesitancy. In particular, Black and Latino communities have suffered the burden of infections and death, yet lag in their vaccination rates. Based on experience, and research done on these local communities, we know that if information is scientifically accurate, but not adapted to the local contexts, people are less likely to trust the information and may look elsewhere for answers.

An educational program was delivered that led to improved confidence handling difficult interactions involving resident trainees (and faculty) with patient (and others). The prototype was developed and tested in 2020, feedback was incorporated and a 2nd prototype was tested in 2021. A survey of participants showed trends of improvement in communication and facilitation, increased effectiveness with implementation of new skills, and increased self-awareness.