“Lost to follow up” is a too-common refrain in the ambulatory healthcare setting and is particularly problematic in primary care, whose focus and value lie in an ongoing, longitudinal relationship with the patient. Academic primary care practices often care for socially or medically complex patients and may lose 25-45% of patients to follow-up. Patients, PCP teams, and the system are all impacted differently by this challenge. Patients can experience a decline in their health status and poor outcomes if they cannot access care in ways and at times that are convenient for them.

In 2020, there were 700 overdose deaths in San Francisco, which was more than double the number of COVID deaths. Though the proximal cause of death is Fentanyl, 60% of those who died were using methamphetamines, which means that many of those deaths may have been prevented by targeting stimulant use. UCSF Citywide serves nearly 2000 people annually with serious mental illness (SMI), homelessness, and institutionalization (long-term locked psychiatric hospitalization and incarceration).

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.

Yousef "Dr. Yo-Yo" Turshani, witnessed the protests of summer 2020 and sensed an opportunity. He leveraged his role on the Pediatrics Exam committee of the American Board of Pediatrics to make a change that could have national implications. What is on the Board exam directly influences what residencies believe matters; what is taught or valued. That influences the students who learn from the docs and thereby all who work with pediatricians.

After issuing statements on racial justice during Summer 2020, health care institutions’ attention towards health justice has decreased substantially. Meanwhile, health equity work is often (1) uncompensated and (2) undertaken by people from under-represented communities. This combination results in a “minority tax” on these colleagues, causing ongoing professional and psychological harm.

While it’s clear that racism and not race has been determined the driver for racial healthcare disparities, it can be frustrating and feel merely theoretical for providers to realize impactful mitigating efforts. My plan is to provide Provider Scorecards reflecting individualized performance metrics stratified by race as a reminder of provider onus regarding health disparities and alerting them to disparities they may unintentionally perpetuate. The goal would be to create a tangible monitor for unconscious bias.

People returning from incarceration face a myriad of health inequities, including increased emergency department utilization, hospitalization and death. In the first 2 weeks post release, people are 12 times more likely to die than their community counterparts from health conditions that could be treated in the primary care setting (including SUD, cardiovascular disease, mental illness and cancer).

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.

Applied Behavior Analysis (ABA) is a type of behavioral therapy commonly used to treat children diagnosed with Autism Spectrum Disorder (ASD). The treatment is long-term, intensive, and highly individualized. If the service is poorly designed or implemented, it may lead to behavioral regression and the need to restart treatment. The goal of my CHIP is to improve the quality of ABA service with a PayFor-Value (P4V) program. Two metrics were used as lead indicators: 1) percentage of supervision conducted by board certified clinicians and 2) utilization rate of approved treatment hours.

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.