A5060400082- Geriatric Care and Nursing Homes
- Palliative Care and End-of-Life Issues
- Dementia and Cognitive Impairment Research
- Ethics in medical practice
- Healthcare Decision-Making and Restraints
- Grief, Bereavement, and Mental Health
- Patient Dignity and Privacy
- Medical Malpractice and Liability Issues
- Elder Abuse and Neglect
- Reproductive Health and Technologies
- Aging, Elder Care, and Social Issues
- Health Systems, Economic Evaluations, Quality of Life
- Mental Health and Psychiatry
- Healthcare Policy and Management
- Health and Wellbeing Research
- Artificial Intelligence in Healthcare and Education
- Intergenerational Family Dynamics and Caregiving
- Torture, Ethics, and Law
- COVID-19 diagnosis using AI
- Telemedicine and Telehealth Implementation
- Deception detection and forensic psychology
- Patient Satisfaction in Healthcare
- Chronic Disease Management Strategies
- Infrared Thermography in Medicine
- Religion, Spirituality, and Psychology
University of California Hastings College of the Law
2011-2024
San Francisco VA Medical Center
2011
American Bar Association
2011
University of California, San Francisco
2011
Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering from centralized hubs across broad geographic areas to caregivers and persons with (PWDs) independently of their system affiliations.To determine whether the in improving outcomes important PWDs, caregivers, payers beyond those achieved usual care.A single-blind, randomized clinical trial pragmatic design was conducted among PWDs caregivers. Each PWD-caregiver dyad...
Our objective was to develop and test a scalable model of dementia specialty care that complements primary with additional caregiver support education, medication consultation, in planning for future medical, financial, legal decisions consistent patient values.Care is delivered via the phone web by unlicensed Care Team Navigators (CTNs), who are trained supervised specialist nurse, social worker, pharmacist.• This "Care Ecosystem" being tested pragmatic randomized controlled trial.The...
In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias implicit bias training (IBT) for care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals alternative birthing centers provide IBT perinatal clinicians with the goal of improving clinical outcomes Black women people. However, there is as yet insufficient evidence identify what approaches, if any, achieve this goal. Engaging experiences...
Collaborative dementia care models with navigation, including the Care Ecosystem, improve outcomes for persons living (PLWDs) and their caregivers. The effects of continuous over long periods have not been studied. In this randomized clinical trial 456 PLWD-caregiver dyads high caregiver burden, we evaluated cumulative 5-year treatment effect on PLWD quality life, health utilization, depression, self-efficacy, burden. Five-year participation was associated higher lower self-efficacy (all p's...
This article examines the effects of state regulation and civil class action litigation on corporate compliance with nurse staffing quality standards, strategies to manage quality, financial status a large for-profit nursing home chain. A historical case study was used examine multiple public data sources, focusing facilities in California from 2003 2011 during after regulatory actions litigation. The results showed that issued numerous deficiencies for violations standards minimal impact...
Background: Advance care planning has been shown to improve end of life decision-making for people with dementia. However, the impact goals conversations between dementia and their caregivers not characterized. Objective: In this study, we evaluate association advance outcomes. Methods: Retrospective measures were collected via a questionnaire administered 166 after death person whom they provided care. Results: At time death, majority decedents had directives, health agents, previous...
Background: Financial mismanagement and abuse in dementia have serious consequences for patients their families. Vulnerability to these outcomes reflects both patient contextual factors. Objective: Our study aimed assess how multidisciplinary care coordination programs assist families addressing psychosocial vulnerabilities accessing needed resources. Methods: was embedded a clinical trial of the Care Ecosystem, telephone- internet-based supportive intervention with caregivers. This program...
Abstract Health systems are integrating medical-legal partnerships (MLPs) into clinical care and increasingly center “complex care” patients. These patients have intersecting medical social needs often face systemic inequities that exacerbate their chronic health conditions. This paper describes a role for MLPs in hospital quality initiatives; examines the ethics of assisting with guardianship institutionalization including marginalized groups; advocates MLP interventions designed to address...
SummaryA subset of patients cared for by the San Francisco Veterans Affairs Health Care System (SFVAHCS) are older and have complex medical, psychological, social needs. To improve coordination care these patients, SFVAHCS created Transitions Referral Coordination team, which holds a once-weekly interdisciplinary meeting managing geriatric complexity. Over 6 months, saw an almost 40% reduction in inpatients with prolonged hospitalizations (defined as length stay longer than 30 days), from...
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To develop, assess, and refine an online educational tool, Plan for Clarity, to support financial legal planning in dementia. A Delphi mixed-method study with three rounds of anonymous review by lay professional stakeholders was designed reach consensus about the content tool explore socio-cultural behavioral factors that could affect access use. Consensus showed covered key information, knowledge, communication skills planning. Study themes: 1) had be easy navigate relevant, easily...
The care and well-being of nonhuman primates in biomedical science has benefited from species-specific enrichment research, however there is a need for more study, particularly African green monkeys. monkeys’ welfare would be improved refinement as this species proven to sensitive stress been significant increase their use popularity research. Additionally, the study animal being challenged look further than just using observational data evaluate effectiveness incorporate physiological...
Biomedical imaging modalities often produce high-resolution, multi-dimensional images that pose computational challenges for deep neural networks. These are compounded when training transformers due to the self-attention operator, which scales quadratically with context length. Recent developments in long-context models have potential alleviate these difficulties and enable more efficient application of large biomedical images, although a systematic evaluation on this topic is lacking. In...
Abstract Background Dementia care management programs, including the Care Ecosystem, have been shown to improve patient and caregiver outcomes, reduce unnecessary healthcare expenditures, are focus of Medicare’s new GUIDE payment model. Until now, prior research has focused on evaluating effectiveness participating for a short (eg, 12‐month) time frame. The purpose this study was evaluate effects Ecosystem when delivered up 5 years or end life. Methods Of 804 PLWD‐caregiver dyads enrolled in...
Health systems are increasingly interested in collaborative dementia care. Implementation challenges include the limited specialist workforce, time pressures of high-volume care, increasing use telemedicine, and inadequate reimbursement. The Care Ecosystem is a telephone-based care model designed to augment existing healthcare services be amenable scale. Here we present latest evidence for Ecosystem, including effects among subpopulations at risk health disparities (rural Hispanic/Latino),...
Automated medical image classification with convolutional neural networks (CNNs) has great potential to impact healthcare, particularly in resource-constrained healthcare systems where fewer trained radiologists are available. However, little is known about how well a CNN can perform on images the increased noise levels, different acquisition protocols, or additional artifacts that may arise when using low-cost scanners, which be underrepresented datasets collected from well-funded...
Abstract Research, along with patient care and education, is a core element of the academic health system's tripartite mission; it essential to societal commitment advancing public's health. Research at systems in United States increasingly resource-constrained and, important ways, underlying financial model supporting has reached point unsustainability. This commentary reviews roles that research plays society, describes ways which current under strain, proposes an evolved series...
Continuing involvement in financial activities such as shopping or paying bills may enhance patients’ sense of autonomy but also expose them to fraud and other errors. Earlier measures decision-making dementia either address incapacity rather than actual activities; measure abilities part global scores functional impairment (e.g., Blessed, FAQ, IADL) are often ambiguous between what patients could do actually do. After enrollment the Care Ecosystem study, 97 caregivers with randomized...
Financial mismanagement and abuse in dementia can have serious consequences for patients their families. Vulnerability to these outcomes is believed reflect both patient (cognitive, psychiatric) contextual (family, psychosocial) factors. Multidisciplinary care coordination/navigation programs hold promise assisting families addressing psychosocial vulnerabilities accessing needed resources. Our study was embedded a pragmatic clinical trial of the Care Ecosystem, telephone-based supportive...