Care Without Bias

During a routine medical appointment in Pasadena, Bridget Graves — a 57-year-old management consultant who identifies as transgender — realized that her physician knew very little about the standard of care for transgender patients. Graves’ after-visit notes confirmed her suspicions. Her physician had included “transgender” under the list of maladies Graves was seen for. Graves immediately called back to request a correction but never received a response.

Graves explained that these microaggressions — including medical staff who misgender patients and physicians who resist using preferred names on medical records — keep transgender and nonbinary patients from seeking health care.

Today, the mother of five, competitive cyclist and longtime yoga teacher is a patient at Keck Medicine of USC’s innovative Gender-Affirming Care Program, a multidisciplinary collaborative providing comprehensive health care to transgender and nonbinary people while affirming their gender identity.

Graves’ sentiments on her experience before coming to Keck Medicine reflect the struggles of many in the transgender and nonbinary community to find inclusive, continuous health care.

Gender-affirming care in a medical context means supporting and respecting someone in their gender identity, however they identify in their lifetime.

Laura Taylor

“Gender-affirming care in a medical context means supporting and respecting someone in their gender identity, however they identify in their lifetime,” says Keck Medicine primary care physician Laura Taylor, the program’s medical director.

For many people, this care boils down to hormone therapies and surgical interventions. But Taylor emphasizes that at Keck Medicine, it means individualizing all of a patient’s health needs based on their personal goals. These goals can include hormones to induce different physical characteristics or surgery to change somebody’s chest or genitals, but also routine care such as preventative medicine and specialized mental health care.

Keck Medicine was already providing gender-affirming care before the program began, but the process was decentralized and patients had to seek out individual specialists, says Felipe Osorno, Keck Medicine Chief Performance and Transformation Officer. Through the Gender Affirming Care Program, Keck Medicine patients can now access a centralized model where providers holistically monitor every aspect of health, including primary care, mental health, endocrinology, gynecology, urology, physical and occupational therapy, voice training and surgery.

Discussions about starting a centralized program began in 2019, brought about by a deeper awareness of diversity, equity and inclusion across the country. Later, the pandemic and the murder of George Floyd spurred the need for action around health equity and inclusion for populations traditionally excluded from the health care system apparent.

A New Approach

Before Graves became a patient with Keck Medicine, she, like many transgender and nonbinary patients, struggled to find a medical facility where she felt safe and understood.

“Historically, the transgender and nonbinary community have experienced — and still experience — a lot of discriminatory practices in health care, substandard care and so many barriers to health care,” Taylor said. “Unfortunately, these communities often have a harder time getting insurance due to a higher risk of issues with employment and insurance companies that may not cover gender-related services.”

Other barriers to care include transportation, financial constraints, family support and — especially in conservative states — the criminalization of gender-affirming treatments.

Finding Keck Medicine of USC after an extended internet search was a breath of fresh air for Graves. “It was like night and day,” she said. “This physician asked all the right questions and was open to keeping the continuity of my medications, my hormones and what had already been working for me.” This led to her eventually working with Taylor, whose trans flag on her ID badge put Graves at immediate ease.

Having someone willing to help, who knew how to work with me and made me feel comfortable, was amazing.

Bridget Graves

During her initial intake, Graves communicated that there were certain physical exams that typically made her uncomfortable. Taylor offered to personally perform those physical exams, so that Graves wouldn’t have to worry about them in subsequent visits with other providers. Taylor also offered to do more research on an experimental therapy Graves was interested in during an upcoming medical convention for transgender health care.

“The fact that she was already scheduled to go [to a transgender convention] meant a lot to me,” Graves said. “Having someone willing to help, who knew how to work with me and made me feel comfortable, was amazing.”

The program encourages patients to establish a long-term relationship with a primary care physician to foster this kind of continuity of care. The goal is to manage preventative and routine health care alongside gender-specific therapies without patients having to explain themselves repeatedly or see multiple physicians and specialists where the environment may be less supportive.

Starting De Novo

Taylor points out that while other places have historically offered gender-affirming care in Los Angeles — including LQBTQ+-friendly clinics, nonprofits and other academic health systems — a high need remains. “There are not enough doctors and health care providers who are adequately trained to do this care, and it hasn’t been a part of medical education,” Taylor says. “This is particularly harmful to the [transgender and nonbinary] community because often people have to educate their health care team.”

Assistant Professor of Clinical Surgery Roberto Travieso, the surgical director for the program, says one of their goals is for transgender or nonbinary patients to receive care that is supportive and respectful of their gender identity — regardless of whether their needs are complex (surgery) or routine (treating high blood pressure).

“Transgender and nonbinary people have the same health care concerns that others have outside of specifically gender-affirming surgeries and therapies,” Travieso says. While the program is adding services that were not available before — such as newly available surgeries and the consolidation of specifically gender-affirming care such as hormone therapy and primary care — Travieso stresses that the program is sparking institutional change: “We’re also making sure that this training and emphasis goes throughout the entire health enterprise to involve every facet of health care available through Keck.”

To accomplish this, Travieso, Taylor and Osorno — along with Process Architect Lindsey Morrison — regularly brainstorm with a large group of Keck Medicine colleagues. They discuss issues such as the wording on clinical intake forms, the appearance of medical record systems and where to place pronouns on documents so they’re clearly visible.

“Because we’re starting something de novo, we have the potential to avoid mistakes that have been made elsewhere, where patients don’t feel welcome,” Travieso says. Early on, he and the team realized that the key to the program’s success would be including the community during the planning stage.

Allied Collaboration

In March 2022, Keck Medicine of USC announced a strategic collaboration with The TransLatin@ Coalition — one of the largest trans-led nonprofit organizations in the country that advocates for the medical, social and economic needs of transgender, gender nonconforming and intersex immigrants. The collaboration underscores the health system’s commitment to working with the transgender and greater LGBTQ+ community with the goal of greater health equity for all.

It’s important to have this type of partnership between large institutions and community-led organizations; our collective work is great.

Bamby Salcedo

“We’re very appreciative and grateful for our partnership with Keck Medicine,” says activist Bamby Salcedo, president and CEO of The TransLatin@ Coalition. “It’s important to have this type of partnership between large institutions and community-led organizations; our collective work is great. We’re looking forward to ensuring that together, we continue to support and provide optimal health care to the local trans, gender nonconforming and intersex (TGI) community of Los Angeles.”

As a gay man who identifies as Latinx, Osorno is proud of Keck Medicine’s approach to the collaboration. “It was very meaningful for USC to both welcome the transgender community into our campus and have a celebration with our CEO and their leadership. The symbolism of that is very important because it’s saying, ‘We see you, we hear you, we’re here with you and we recognize you.'”

Keck Medicine leadership promoted mutual listening within the collaboration by hosting bilingual focus groups at USC facilities and at the coalition’s headquarters in Koreatown to ensure that transgender and nonbinary community members had a say in crystalizing the program’s vision.

Keck Medicine physicians heard heartbreaking stories of constant misgendering and individuals going to dangerous lengths — including self-administering hormones — to access the gender-affirming therapies they needed.

Based on that feedback, Morrison spearheaded the training of thousands of Keck Medicine staff — from nurses to admitting staff to those who interact with patients on the phone. — because one negative or harmful interaction could be enough to turn away a patient in need.

The partnership also produced a peer navigation model: hiring a part-time social worker from the trans community to be the point of contact for patients and to help navigate the program.

According to Travieso, the program’s creation pairs well with Keck Medicine’s overall mission of making health care more accessible to everyone. “It’s not just us physicians who are working day to day; it comes from the top leadership and administration who have expressed significant support for the program and made it one of the core goals of the health care system.”

The program leaders urge people to donate to the continued evolution of the program as the state anticipates an increase in what is being called medical refugees — individuals forced by anti-transgender policies in other states to travel to California to receive the gender-affirming care they deserve.

“Our vision long-term is to provide gender-affirming care to anyone, regardless of their ability to pay,” Osorno said. “With this intentional philosophy, we really hope to become the preeminent gender-affirming care program on the West Coast.”

The post Care Without Bias appeared first on USC News.

Care Without Bias

Health

Care Without Bias

By listening and collaborating with trans communities, Keck Medicine of USC is creating the preeminent gender-affirming care program on the West Coast.

February 28, 2023

Chinyere Cindy Amobi

During a routine medical appointment in Pasadena, Bridget Graves — a 57-year-old management consultant who identifies as transgender — realized that her physician knew very little about the standard of care for transgender patients. Graves’ after-visit notes confirmed her suspicions. Her physician had included “transgender” under the list of maladies Graves was seen for. Graves immediately called back to request a correction but never received a response.

Graves explained that these microaggressions — including medical staff who misgender patients and physicians who resist using preferred names on medical records — keep transgender and nonbinary patients from seeking health care.

Today, the mother of five, competitive cyclist and longtime yoga teacher is a patient at Keck Medicine of USC’s innovative Gender-Affirming Care Program, a multidisciplinary collaborative providing comprehensive health care to transgender and nonbinary people while affirming their gender identity.

Graves’ sentiments on her experience before coming to Keck Medicine reflect the struggles of many in the transgender and nonbinary community to find inclusive, continuous health care.

Gender-affirming care in a medical context means supporting and respecting someone in their gender identity, however they identify in their lifetime.

Laura Taylor

“Gender-affirming care in a medical context means supporting and respecting someone in their gender identity, however they identify in their lifetime,” says Keck Medicine primary care physician Laura Taylor, the program’s medical director.

For many people, this care boils down to hormone therapies and surgical interventions. But Taylor emphasizes that at Keck Medicine, it means individualizing all of a patient’s health needs based on their personal goals. These goals can include hormones to induce different physical characteristics or surgery to change somebody’s chest or genitals, but also routine care such as preventative medicine and specialized mental health care.

Keck Medicine was already providing gender-affirming care before the program began, but the process was decentralized and patients had to seek out individual specialists, says Felipe Osorno, Keck Medicine Chief Performance and Transformation Officer. Through the Gender Affirming Care Program, Keck Medicine patients can now access a centralized model where providers holistically monitor every aspect of health, including primary care, mental health, endocrinology, gynecology, urology, physical and occupational therapy, voice training and surgery.

Discussions about starting a centralized program began in 2019, brought about by a deeper awareness of diversity, equity and inclusion across the country. Later, the pandemic and the murder of George Floyd spurred the need for action around health equity and inclusion for populations traditionally excluded from the health care system apparent.

A New Approach

Before Graves became a patient with Keck Medicine, she, like many transgender and nonbinary patients, struggled to find a medical facility where she felt safe and understood.

“Historically, the transgender and nonbinary community have experienced — and still experience — a lot of discriminatory practices in health care, substandard care and so many barriers to health care,” Taylor said. “Unfortunately, these communities often have a harder time getting insurance due to a higher risk of issues with employment and insurance companies that may not cover gender-related services.”

Other barriers to care include transportation, financial constraints, family support and — especially in conservative states — the criminalization of gender-affirming treatments.

Finding Keck Medicine of USC after an extended internet search was a breath of fresh air for Graves. “It was like night and day,” she said. “This physician asked all the right questions and was open to keeping the continuity of my medications, my hormones and what had already been working for me.” This led to her eventually working with Taylor, whose trans flag on her ID badge put Graves at immediate ease.

Having someone willing to help, who knew how to work with me and made me feel comfortable, was amazing.

Bridget Graves

During her initial intake, Graves communicated that there were certain physical exams that typically made her uncomfortable. Taylor offered to personally perform those physical exams, so that Graves wouldn’t have to worry about them in subsequent visits with other providers. Taylor also offered to do more research on an experimental therapy Graves was interested in during an upcoming medical convention for transgender health care.

“The fact that she was already scheduled to go [to a transgender convention] meant a lot to me,” Graves said. “Having someone willing to help, who knew how to work with me and made me feel comfortable, was amazing.”

The program encourages patients to establish a long-term relationship with a primary care physician to foster this kind of continuity of care. The goal is to manage preventative and routine health care alongside gender-specific therapies without patients having to explain themselves repeatedly or see multiple physicians and specialists where the environment may be less supportive.

Starting De Novo

Taylor points out that while other places have historically offered gender-affirming care in Los Angeles — including LQBTQ+-friendly clinics, nonprofits and other academic health systems — a high need remains. “There are not enough doctors and health care providers who are adequately trained to do this care, and it hasn’t been a part of medical education,” Taylor says. “This is particularly harmful to the [transgender and nonbinary] community because often people have to educate their health care team.”

Assistant Professor of Clinical Surgery Roberto Travieso, the surgical director for the program, says one of their goals is for transgender or nonbinary patients to receive care that is supportive and respectful of their gender identity — regardless of whether their needs are complex (surgery) or routine (treating high blood pressure).

“Transgender and nonbinary people have the same health care concerns that others have outside of specifically gender-affirming surgeries and therapies,” Travieso says. While the program is adding services that were not available before — such as newly available surgeries and the consolidation of specifically gender-affirming care such as hormone therapy and primary care — Travieso stresses that the program is sparking institutional change: “We’re also making sure that this training and emphasis goes throughout the entire health enterprise to involve every facet of health care available through Keck.”

To accomplish this, Travieso, Taylor and Osorno — along with Process Architect Lindsey Morrison — regularly brainstorm with a large group of Keck Medicine colleagues. They discuss issues such as the wording on clinical intake forms, the appearance of medical record systems and where to place pronouns on documents so they’re clearly visible.

“Because we’re starting something de novo, we have the potential to avoid mistakes that have been made elsewhere, where patients don’t feel welcome,” Travieso says. Early on, he and the team realized that the key to the program’s success would be including the community during the planning stage.

Allied Collaboration

In March 2022, Keck Medicine of USC announced a strategic collaboration with The TransLatin@ Coalition — one of the largest trans-led nonprofit organizations in the country that advocates for the medical, social and economic needs of transgender, gender nonconforming and intersex immigrants. The collaboration underscores the health system’s commitment to working with the transgender and greater LGBTQ+ community with the goal of greater health equity for all.

It’s important to have this type of partnership between large institutions and community-led organizations; our collective work is great.

Bamby Salcedo

“We’re very appreciative and grateful for our partnership with Keck Medicine,” says activist Bamby Salcedo, president and CEO of The TransLatin@ Coalition. “It’s important to have this type of partnership between large institutions and community-led organizations; our collective work is great. We’re looking forward to ensuring that together, we continue to support and provide optimal health care to the local trans, gender nonconforming and intersex (TGI) community of Los Angeles.”

As a gay man who identifies as Latinx, Osorno is proud of Keck Medicine’s approach to the collaboration. “It was very meaningful for USC to both welcome the transgender community into our campus and have a celebration with our CEO and their leadership. The symbolism of that is very important because it’s saying, ‘We see you, we hear you, we’re here with you and we recognize you.’”

Keck Medicine leadership promoted mutual listening within the collaboration by hosting bilingual focus groups at USC facilities and at the coalition’s headquarters in Koreatown to ensure that transgender and nonbinary community members had a say in crystalizing the program’s vision.

Keck Medicine physicians heard heartbreaking stories of constant misgendering and individuals going to dangerous lengths — including self-administering hormones — to access the gender-affirming therapies they needed.

Based on that feedback, Morrison spearheaded the training of thousands of Keck Medicine staff — from nurses to admitting staff to those who interact with patients on the phone.  — because one negative or harmful interaction could be enough to turn away a patient in need.

The partnership also produced a peer navigation model: hiring a part-time social worker from the trans community to be the point of contact for patients and to help navigate the program.

According to Travieso, the program’s creation pairs well with Keck Medicine’s overall mission of making health care more accessible to everyone. “It’s not just us physicians who are working day to day; it comes from the top leadership and administration who have expressed significant support for the program and made it one of the core goals of the health care system.”

The program leaders urge people to donate to the continued evolution of the program as the state anticipates an increase in what is being called medical refugees — individuals forced by anti-transgender policies in other states to travel to California to receive the gender-affirming care they deserve.

“Our vision long-term is to provide gender-affirming care to anyone, regardless of their ability to pay,” Osorno said. “With this intentional philosophy, we really hope to become the preeminent gender-affirming care program on the West Coast.”

The post Care Without Bias appeared first on USC Today.

Keck Medicine of USC launches Gender-Affirming Care Program

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LOS ANGELES — When Bridget, 57, moved from the East Coast to Los Angeles, she sought health care to maintain and monitor her hormone therapy.

She was quickly disappointed. One provider admitted they knew nothing about transgender health, and another labeled her transgender status as a “medical problem.”

She then discovered the Keck Medicine of USC Gender-Affirming Care Program and met with Laura Taylor, MD, a Keck Medicine family medicine specialist and medical director of the program. Taylor has been Bridget’s primary care doctor ever since.

As Bridget experienced, transgender people often face barriers to equitable health care. According to a 2021 study from the Center for American Progress, one in three transgender adults said they had to teach their doctors about transgender health to receive appropriate care. Nearly one-half reported having negative or discriminatory experiences with a health care provider.

To address the many health care disparities faced by transgender individuals, Keck Medicine has launched the Gender-Affirming Care Program to meet the comprehensive needs of the transgender, nonbinary and gender-diverse community. Services include everything from routine health care, such as preventive cancer screenings, yearly checkups and flu shots, to gender-affirming hormone therapy and surgery.

The program is comprised of physicians from several disciplines including family medicine, plastic surgery, gynecology, urology and otolaryngology. Specialists in voice, occupational and physical therapy are also available to patients.

A nurse navigator coordinates care with the providers to ensure patients receive seamless specialized treatment. The physicians and program staff have collectively received more than 600 hours of gender-affirming sensitivity and inclusivity training.

“Our program brings together a multidisciplinary group of physicians across specialties to address the specialized needs of this underserved population,” said Taylor. “We’re proud to offer a full range of health care services in a safe and supportive environment.”

Another key aspect of the Gender-Affirming Care Program is that it was designed with input from the local transgender community.

“Due to historic marginalization of the transgender population, some within the community view medical providers with distrust,” said Roberto Travieso, MD, surgical director of the program. “It was important to make our local community part of the process as we built the program.”

As part of its outreach, Keck Medicine partnered with The TransLatin@ Coalition, the largest trans-led nonprofit organization in Los Angeles that advocates for the needs of transgender, gender non-conforming and intersex immigrants across the country.

This collaboration helps Keck Medicine establish a strong foundation within the transgender community and provides ongoing feedback on how the program can best serve patients.

The Gender-Affirming Care Program was in development for several years, but came to full fruition with the arrival of Taylor and Travieso to Keck Medicine, respectively in 2020 and 2021. Taylor is trained in LGBTQ+ health care and Travieso is fellowship-trained in gender-affirming surgery.

The program leaders hope to hire and train more gender-affirming practitioners, build more mental health services into care and foster additional community partnerships.
Meanwhile, for patients like Bridget, the Gender-Affirming Care Program is a gift.
“I am doing really well under Dr. Taylor’s care, and feeling happy and healthy,” she said.
###
For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

The post Keck Medicine of USC launches Gender-Affirming Care Program appeared first on USC News.

Greener Gases 

Keck Medicine of USC is phasing out one of the most commonly used — and environmentally toxic — anesthetics for its surgeries, desflurane.

The discontinuation of desflurane is part of a universitywide effort to re-examine both USC’s and Keck Medicine of USC’s impact on climate change and to implement healthier, sustainable solutions whenever possible.

The operating room is one of the biggest — if not the biggest — waste generators in any hospital, says Arash Motamed, medical director for Keck Main Perioperative Operations and Keck Medicine of USC Sustainability.

“They’re very resistant to degradation; they stay in that environment for many years,” says Motamed, an associate professor and vice chair of clinical operations for the department of anesthesiology at the Keck School of Medicine of USC.

In June, the Association of Anesthetists noted the inconvenient truth about anesthetics.

It cited research showing that anesthetics are responsible for 0.1% of the world’s carbon emissions. At the hospital level, inhaled anesthetics make up more than 5% of acute hospital carbon emissions and 50% of perioperative emissions.

Anesthetics in the atmosphere

During a surgery with anesthetics, a patient breathes in an anesthetic gas, which circulates through the body and keeps the person unconscious. After the operation, the anesthetics are turned off, the concentration in the body decreases and the patient regains consciousness.

Keck’s operating rooms have three primary anesthetics, Motamed says. Each achieves similar effects but has different drawbacks.

Desflurane is very quick to come on and very quick to come off — that’s why people love it. But it’s expensive and horrible for the environment.

Aren Nercisian, anesthesiologist at Keck Medicine of USC

“Desflurane is very quick to come on and very quick to come off — that’s why people love it,” says Aren Nercisian, an anesthesiologist at Keck Medicine of USC. “But it’s expensive and horrible for the environment.”

Desflurane is the most commonly used. Yet, studies show desflurane is so harmful to the environment that an eight-hour surgery causes as much damage to the atmosphere as driving a car from Los Angeles to Maine.

“The contribution to emissions is huge,” said Howard Hu, holder of the Flora L. Thornton Chair in Preventive Medicine and chair and professor of population and public health sciences at the Keck School of Medicine of USC. “That insight became a clarion call for us to do something about it.”

In its own call to action on pollution reduction, the California Society of Anesthesiologists noted that desflurane lingers the longest of any anesthetic — 14 years — in the atmosphere’s lowest layer, the troposphere, just above the Earth’s surface. On the other hand, sevoflurane remains in the troposphere for just over a year while isoflurane lingers for 3.2 years.

Helping the environment, cutting costs

Global warming potential (GWP) is a way to quantify the amount that an agent contributes to global warming over a period of time. Nercisian, who leads sustainability efforts for the anesthesiology department at Keck Medicine of USC, explains that GWP measures how much energy the emission of 1 ton of a gas will absorb over a given period, relative to the emissions of 1 ton of carbon dioxide.” The larger the GWP, the more it warms the Earth compared to carbon dioxide. The GWP of carbon dioxide is 1.

Desflurane has a 20 times higher global warming potential than sevoflurane, Nercisian says.

Desflurane has the highest global warming potential — 2,540 — compared with sevoflurane, which has a GWP of 130.

The triple aim of a health system should be improving patient experience, improving the health of the population and reducing the cost of health care … sustainable delivery of care should be the fourth aim.

Arash Motamed

The three also differ in cost. Desflurane tends to be the most expensive. And so far, no studies have indicated whether one is worse for patients than the others.

“There’s never been a study to prove that you have better outcomes with sevoflurane vs. desflurane vs. isoflurane,” Nercisian says. “Though some agents have specific advantages.”

Keck Medicine of USC has not ordered more desflurane in the past year.

“According to Institute for Healthcare Improvement, the triple aim of a health system should be improving patient experience, improving the health of the population and reducing the cost of health care,” Motamed says. “Howard Hu, chair of Population and Public Health Sciences at USC, says that sustainable delivery of care should be the fourth aim. I couldn’t agree more.”

The post Greener Gases appeared first on USC News.

Greener Gases 

Science/Technology

Greener Gases 

Keck Medicine of USC is curbing the environmental impacts of anesthesia in operating rooms — and saving money 

December 12, 2022

Grayson Schmidt

Keck Medicine of USC is phasing out one of the most commonly used — and environmentally toxic — anesthetics for its surgeries, desflurane.

The discontinuation of desflurane is part of a universitywide effort to re-examine both USC’s and Keck Medicine of USC’s impact on climate change and to implement healthier, sustainable solutions whenever possible.

The operating room is one of the biggest — if not the biggest — waste generators in any hospital, says Arash Motamed, medical director for Keck Main Perioperative Operations and Keck Medicine of USC Sustainability.

“They’re very resistant to degradation; they stay in that environment for many years,” says Motamed, an associate professor and vice chair of clinical operations for the department of anesthesiology at the Keck School of Medicine of USC.

In June, the Association of Anesthetists noted the inconvenient truth about anesthetics.

It cited research showing that anesthetics are responsible for 0.1% of the world’s carbon emissions. At the hospital level, inhaled anesthetics make up more than 5% of acute hospital carbon emissions and 50% of perioperative emissions.

Anesthetics in the atmosphere

During a surgery with anesthetics, a patient breathes in an anesthetic gas, which circulates through the body and keeps the person unconscious. After the operation, the anesthetics are turned off, the concentration in the body decreases and the patient regains consciousness.

Keck’s operating rooms have three primary anesthetics, Motamed says. Each achieves similar effects but has different drawbacks.

Desflurane is very quick to come on and very quick to come off — that’s why people love it. But it’s expensive and horrible for the environment.

Aren Nercisian, anesthesiologist at Keck Medicine of USC

“Desflurane is very quick to come on and very quick to come off — that’s why people love it,” says Aren Nercisian, an anesthesiologist at Keck Medicine of USC. “But it’s expensive and horrible for the environment.”

Desflurane is the most commonly used. Yet, studies show desflurane is so harmful to the environment that an eight-hour surgery causes as much damage to the atmosphere as driving a car from Los Angeles to Maine.

“The contribution to emissions is huge,” said Howard Hu, holder of the Flora L. Thornton Chair in Preventive Medicine and chair and professor of population and public health sciences at the Keck School of Medicine of USC. “That insight became a clarion call for us to do something about it.”

In its own call to action on pollution reduction, the California Society of Anesthesiologists noted that desflurane lingers the longest of any anesthetic — 14 years — in the atmosphere’s lowest layer, the troposphere, just above the Earth’s surface. On the other hand, sevoflurane remains in the troposphere for just over a year while isoflurane lingers for 3.2 years.

Helping the environment, cutting costs

Global warming potential (GWP) is a way to quantify the amount that an agent contributes to global warming over a period of time. Nercisian, who leads sustainability efforts for the anesthesiology department at Keck Medicine of USC, explains that GWP measures how much energy the emission of 1 ton of a gas will absorb over a given period, relative to the emissions of 1 ton of carbon dioxide.” The larger the GWP, the more it warms the Earth compared to carbon dioxide. The GWP of carbon dioxide is 1.

Desflurane has a 20 times higher global warming potential than sevoflurane, Nercisian says.

Desflurane has the highest global warming potential — 2,540 — compared with sevoflurane, which has a GWP of 130.

The triple aim of a health system should be improving patient experience, improving the health of the population and reducing the cost of health care … sustainable delivery of care should be the fourth aim.

Arash Motamed

The three also differ in cost. Desflurane tends to be the most expensive. And so far, no studies have indicated whether one is worse for patients than the others.

“There’s never been a study to prove that you have better outcomes with sevoflurane vs. desflurane vs. isoflurane,” Nercisian says. “Though some agents have specific advantages.”

Keck Medicine of USC has not ordered more desflurane in the past year.

“According to the Institute for Healthcare Improvement, the triple aim of a health system should be improving patient experience, improving the health of the population and reducing the cost of health care,” Motamed says. “Howard Hu, chair of Population and Public Health Sciences at USC, says that sustainable delivery of care should be the fourth aim. I couldn’t agree more.”

The post Greener Gases  appeared first on USC Today.

Keck Medicine of USC Looks East

Health

Keck Medicine of USC Looks East

With the recent USC Arcadia Hospital affiliation, Keck Medicine of USC continues its tradition of innovation, growth and community partnership.

November 28, 2022

Chinyere Cindy Amobi

Picture this: A patient arrives at a local hospital’s emergency room short of breath. Emergency room physicians run scans that reveal a bilateral pulmonary embolism. The community hospital doesn’t have a pulmonary embolism response team but partners with an academic hospital that has one—so the two hospitals coordinate the patient’s transfer.

Less than two hours later, doctors from the academic medical center—specializing in interventional radiology, pulmonology and pulmonology hypertension—successfully remove the embolism. The patient, now out of danger, isn’t expected to have lingering problems.

This orchestration of care is just one of the many ways Keck Medicine of USC hopes the San Gabriel Valley community will benefit from its recently announced partnership with Methodist Hospital of Southern California in Arcadia, now known as USC Arcadia Hospital.

The new collaboration will expand the university’s and its medical enterprise’s footprint as a leading provider of health care in Southern California and beyond. In 2024, a new, state-of-the-art medical office building in Pasadena for various Keck Medicine practices will open, enabling partnerships that send Keck Medicine physicians as far as Visalia and Las Vegas.

“Having specialized university physicians readily available to support community physicians through doctor-to-doctor communication and collaboration provides timely information that may be critical to informing a patient’s treatment plan,” says Keck Medicine of USC CEO Rod Hanners. Through this affiliation, San Gabriel Valley patients can access the complex care they need from Keck Medicine’s clinicians, while continuing their ongoing care with their community physicians.

With the strength of education, research and clinical care represented by the university’s five health-related schools (which represent 55% of the university’s total research, 70% of total full-time faculty and 54% of fulltime staff), Keck Medicine is well-poised to provide this level of care. Through team-based collaboration, Keck Medicine utilizes the diverse expertise of the university’s many health disciplines.

Expanding Keck Medicine’s clinical enterprise is also vital to fulfilling USC President Carol L. Folt’s vision for USC health sciences.

In her State of the University address from the Health Sciences Campus last April, Folt said her goals included a commitment to growing the university’s health sciences for maximum impact. She also supports expanding the schools’ research, clinical practice, community outreach and student aid through the USC Campaign for Health and cross-school collaboration that “addresses some of the greatest issues and opportunities of our time.”

Interdisciplinary Collaboration for Team-Based Care

Exterior shot of USC Arcadia Hospital
USC Arcadia Hospital began operating in 1903 as Methodist Hospital of Southern California; it became affiliated with the Keck Medicine health system on July 1, 2022. (Photo/Ricardo Carrasco III)

Steven Shapiro, USC’s senior vice president for health affairs who oversees Keck Medicine of USC and the Keck School of Medicine of USC, hopes the USC Arcadia Hospital affiliation moves the needle on all three goals.

Shapiro, a physician-scientist who was hired last year to promote greater collaboration across the university, aims to position USC as an important clinical leader in the increasingly competitive Los Angeles health care market.

One priority of the collaboration is building a care model that combines disparate disciplines to provide comprehensive care.

Instead of visiting multiple health centers for care, patients can work with one integrated team who understands their health background, from primary care to more complex specialty services.

The nation’s aging population highlights why this team-based care is needed.

“Most of the health problems we see in our country are related to aging,” Shapiro says. Each of USC’s health science schools contributes to an effective care team, including social workers who keep in touch with patients, pharmacists who deliver the most effective medications and specialists in gerontology who understand aging patients.

He also sees community partnerships, such as the USC Arcadia Hospital acquisition, as an opportunity to move away from the U.S. health care system’s episodic model of treatment. USC’s medical enterprise will embrace a more “continuous care model,” where cross-disciplinary partnerships combine with community understanding and specialty services to deliver the best patient care possible.

“All these different groups coming together will allow us to provide team-based care in the clinical setting,” Shapiro says. “This kind of collaboration gives us a diversity of opinions and ideas to approach the research problems we have as well. We believe taking advantage of all the great schools we have at USC is a great start.”

Preserving Local Values

The collaboration comes at a critical time: Across the nation, individual corporations and academic health centers are consolidating health care and controlling health care markets. With less competition in those regions, larger entities are free to set higher prices that are often passed down to patients in the form of more expensive hospital bills and insurance premiums.

While Southern California has a more diverse health care market than much of the country, the region is starting to the diverse San Gabriel Valley in a sustainable way while expanding the reach of its clinical enterprise,” Robinson says. As a result, local stand-alone hospitals struggle to thrive and offer quality, affordable care to their patients.

To ensure that Keck Medicine’s newest collaboration preserves USC Arcadia Hospital’s connection to its community and its patients while delivering a high level of care, both sides of the partnership must engage in a period of learning and understanding, says physician Jehni Robinson, president of USC Care Medical Group, chair of the department of family medicine and associate dean for primary care at the Keck School.

Likewise, Robinson describes cultural humility as an ongoing and “critically important journey” that involves working toward faculty and staff reflecting the communities they’ll be serving as Keck Medicine’s medical enterprise continues to expand.

Robinson says that Keck Medicine has approached community partnerships in the past with an eye for what each region needs and a recognition of the high-quality care these hospitals already provide.

By joining Keck Medicine, USC Arcadia Hospital will be able to preserve its 100-plus-year history of providing primary health care.

By joining Keck Medicine, USC Arcadia Hospital will be able to preserve its 100-plus-year history of providing primary health care. The San Gabriel Valley community will also benefit from the addition of Keck Medicine’s expertise in treating more complex cases that require highly specialized skills, technology and resources. The majority of care will still occur at USC Arcadia Hospital. Still, highly complex cases that require specialized academic medicine (such as organ transplants and robotic surgery) can be seamlessly handled at Keck Medical Center of USC on the USC Health Sciences Campus.

“I think it’s a real opportunity for a win-win scenario where Keck Medicine can provide highly specialized care to the diverse San Gabriel Valley in a sustainable way while expanding the reach of its clinical enterprise,” Robinson says.

Over the coming years, Keck Medicine will invest in USC Arcadia Hospital’s physician recruitment and professional development, equipment, infrastructure and services in neurosciences, cardiac care and oncology.

Additionally, the health system will develop academic and training relationships for USC residents and fellows at USC Arcadia Hospital.

A History of Successful Partnerships

With this affiliation, Keck Medicine now has two community hospitals in the northeast area of Los Angeles. USC Arcadia Hospital joins USC Verdugo Hills Hospital, which has served La Cañada Flintridge, Glendale and the greater foothills community for more than 40 years.

In 2009, Keck Medicine began a tradition of successful collaborations with regional hospitals and health enterprises, improving access to academic medicine in local communities.

Then-USC President Steven B. Sample hailed the purchase of the USC University Hospital (now Keck Hospital of USC) and USC Norris Cancer Hospital to establish what was then known as the USC Academic Medical Center as one that would “create deeper connections among disciplines on both campuses in order to enhance research, teaching and patient care.”

The medical system—which changed its name to Keck Medicine of USC in 2011—further expanded in 2013 with the acquisition of USC Verdugo Hills Hospital. The Keck Medicine system bolstered its community-based services through that hospital’s 24-hour emergency department, primary stroke center, maternity/labor and delivery, cardiac rehabilitation, and imaging and diagnostic services.

Throughout this time, Keck Medicine also established stand-alone outpatient clinics across Southern California and partnerships with other community hospitals to help bring specialized care to areas without. Affiliated physicians provide care in more than 80 outpatient locations in Los Angeles, Orange, Kern, Tulare and Ventura counties.

Keck Medicine leaders say this growth is essential to maintaining USC’s position as a leading academic health center.

“We’re an outstanding health system, but we’re relatively small for an academic health system,” Shapiro says. “The larger we are, the more resources we have to provide the best care possible for our patients in state-of-the-art facilities and to support the academic mission that helps us do the science and translate it back to our communities.”

Hanners agrees, describing the relationship between the university and its growing medical enterprise and community partnerships as a “virtuous cycle.” “This growth creates the margins that allow the health system to support the academic mission, which then spurs new discoveries that help us provide better services at the bedside for our patients,” he says.

With this newest partnership, Hanners hopes the medical enterprise can continue to learn meaningful and intentional ways to connect with diverse communities and the dedicated hospital staff that serve them.

“We’re very focused on meeting with the medical staff out there in the community and reassuring them that we’re here to fill gaps, raise the level of care and provide services that they otherwise are not getting—not compete with them and take away their livelihoods,” Hanners says.

This is something that we are very proud of and, we believe, differentiates our approach to working with community providers.

Rod Hanners

Fueled by lessons from the Verdugo Hills partnership years before, Keck Medicine’s physician leaders held town halls early in the acquisition process to engage with Arcadia hospital leadership to alleviate concerns, answer questions and build trust “doctor-to-doctor.”

“This is something that we are very proud of and, we believe, differentiates our approach to working with community providers,” Hanners says. “It is a team concept where we want to be an asset to the community providers in helping improve the care for their patients.”

All in all, Keck Medicine’s leaders are excited by the university’s expansion into the unique eastern communities of the San Gabriel Valley.

“I think we are limitless in terms of the opportunities that we have to make a difference for individual patients, families and communities,” Robinson says. “We get to take the important work we’re doing and open up access to it for the diverse communities we serve. I’m very excited to be part of Keck Medicine of USC at this critically important moment.”

The post Keck Medicine of USC Looks East appeared first on USC Today.

Keck Medicine of USC Looks East

Picture this: A patient arrives at a local hospital’s emergency room short of breath. Emergency room physicians run scans that reveal a bilateral pulmonary embolism. The community hospital doesn’t have a pulmonary embolism response team but partners with an academic hospital that has one–so the two hospitals coordinate the patient’s transfer.

Less than two hours later, doctors from the academic medical center–specializing in interventional radiology, pulmonology and pulmonology hypertension–successfully remove the embolism. The patient, now out of danger, isn’t expected to have lingering problems.

This orchestration of care is just one of the many ways Keck Medicine of USC hopes the San Gabriel Valley community will benefit from its recently announced partnership with Methodist Hospital of Southern California in Arcadia, now known as USC Arcadia Hospital.

The new collaboration will expand the university’s and its medical enterprise’s footprint as a leading provider of health care in Southern California and beyond. In 2024, a new, state-of-the-art medical office building in Pasadena for various Keck Medicine practices will open, enabling partnerships that send Keck Medicine physicians as far as Visalia and Las Vegas.

“Having specialized university physicians readily available to support community physicians through doctor-to-doctor communication and collaboration provides timely information that may be critical to informing a patient’s treatment plan,” says Keck Medicine of USC CEO Rod Hanners. Through this affiliation, San Gabriel Valley patients can access the complex care they need from Keck Medicine’s clinicians, while continuing their ongoing care with their community physicians.

With the strength of education, research and clinical care represented by the university’s five health-related schools (which represent 55% of the university’s total research, 70% of total full-time faculty and 54% of fulltime staff), Keck Medicine is well-poised to provide this level of care. Through team-based collaboration, Keck Medicine utilizes the diverse expertise of the university’s many health disciplines.

Expanding Keck Medicine’s clinical enterprise is also vital to fulfilling USC President Carol L. Folt’s vision for USC health sciences.

In her State of the University address from the Health Sciences Campus last April, Folt said her goals included a commitment to growing the university’s health sciences for maximum impact. She also supports expanding the schools’ research, clinical practice, community outreach and student aid through the USC Campaign for Health and cross-school collaboration that “addresses some of the greatest issues and opportunities of our time.”

Interdisciplinary Collaboration for Team-Based Care

Steven Shapiro, USC’s senior vice president for health affairs who oversees Keck Medicine of USC and the Keck School of Medicine of USC, hopes the USC Arcadia Hospital affiliation moves the needle on all three goals.

Shapiro, a physician-scientist who was hired last year to promote greater collaboration across the university, aims to position USC as an important clinical leader in the increasingly competitive Los Angeles health care market.

One priority of the collaboration is building a care model that combines disparate disciplines to provide comprehensive care.

Instead of visiting multiple health centers for care, patients can work with one integrated team who understands their health background, from primary care to more complex specialty services.

The nation’s aging population highlights why this team-based care is needed.

“Most of the health problems we see in our country are related to aging,” Shapiro says. Each of USC’s health science schools contributes to an effective care team, including social workers who keep in touch with patients, pharmacists who deliver the most effective medications and specialists in gerontology who understand aging patients.

He also sees community partnerships, such as the USC Arcadia Hospital acquisition, as an opportunity to move away from the U.S. health care system’s episodic model of treatment. USC’s medical enterprise will embrace a more “continuous care model,” where cross-disciplinary partnerships combine with community understanding and specialty services to deliver the best patient care possible.

“All these different groups coming together will allow us to provide team-based care in the clinical setting,” Shapiro says. “This kind of collaboration gives us a diversity of opinions and ideas to approach the research problems we have as well. We believe taking advantage of all the great schools we have at USC is a great start.”

Preserving Local Values

The collaboration comes at a critical time: Across the nation, individual corporations and academic health centers are consolidating health care and controlling health care markets. With less competition in those regions, larger entities are free to set higher prices that are often passed down to patients in the form of more expensive hospital bills and insurance premiums.

While Southern California has a more diverse health care market than much of the country, the region is starting to the diverse San Gabriel Valley in a sustainable way while expanding the reach of its clinical enterprise,” Robinson says. As a result, local stand-alone hospitals struggle to thrive and offer quality, affordable care to their patients.

To ensure that Keck Medicine’s newest collaboration preserves USC Arcadia Hospital’s connection to its community and its patients while delivering a high level of care, both sides of the partnership must engage in a period of learning and understanding, says physician Jehni Robinson, president of USC Care Medical Group, chair of the department of family medicine and associate dean for primary care at the Keck School.

Likewise, Robinson describes cultural humility as an ongoing and “critically important journey” that involves working toward faculty and staff reflecting the communities they’ll be serving as Keck Medicine’s medical enterprise continues to expand.

Robinson says that Keck Medicine has approached community partnerships in the past with an eye for what each region needs and a recognition of the high-quality care these hospitals already provide.

By joining Keck Medicine, USC Arcadia Hospital will be able to preserve its 100-plus-year history of providing primary health care.

By joining Keck Medicine, USC Arcadia Hospital will be able to preserve its 100-plus-year history of providing primary health care. The San Gabriel Valley community will also benefit from the addition of Keck Medicine’s expertise in treating more complex cases that require highly specialized skills, technology and resources. The majority of care will still occur at USC Arcadia Hospital. Still, highly complex cases that require specialized academic medicine (such as organ transplants and robotic surgery) can be seamlessly handled at Keck Medical Center of USC on the USC Health Sciences Campus.

“I think it’s a real opportunity for a win-win scenario where Keck Medicine can provide highly specialized care to the diverse San Gabriel Valley in a sustainable way while expanding the reach of its clinical enterprise,” Robinson says.

Over the coming years, Keck Medicine will invest in USC Arcadia Hospital’s physician recruitment and professional development, equipment, infrastructure and services in neurosciences, cardiac care and oncology.

Additionally, the health system will develop academic and training relationships for USC residents and fellows at USC Arcadia Hospital.

A History of Successful Partnerships

With this affiliation, Keck Medicine now has two community hospitals in the northeast area of Los Angeles. USC Arcadia Hospital joins USC Verdugo Hills Hospital, which has served La Canada Flintridge, Glendale and the greater foothills community for more than 40 years.

In 2009, Keck Medicine began a tradition of successful collaborations with regional hospitals and health enterprises, improving access to academic medicine in local communities.

Then-USC President Steven B. Sample hailed the purchase of the USC University Hospital (now Keck Hospital of USC) and USC Norris Cancer Hospital to establish what was then known as the USC Academic Medical Center as one that would “create deeper connections among disciplines on both campuses in order to enhance research, teaching and patient care.”

The medical system–which changed its name to Keck Medicine of USC in 2011–further expanded in 2013 with the acquisition of USC Verdugo Hills Hospital. The Keck Medicine system bolstered its community-based services through that hospital’s 24-hour emergency department, primary stroke center, maternity/labor and delivery, cardiac rehabilitation, and imaging and diagnostic services.

Throughout this time, Keck Medicine also established stand-alone outpatient clinics across Southern California and partnerships with other community hospitals to help bring specialized care to areas without. Affiliated physicians provide care in more than 80 outpatient locations in Los Angeles, Orange, Kern, Tulare and Ventura counties.

Keck Medicine leaders say this growth is essential to maintaining USC’s position as a leading academic health center.

“We’re an outstanding health system, but we’re relatively small for an academic health system,” Shapiro says. “The larger we are, the more resources we have to provide the best care possible for our patients in state-of-the-art facilities and to support the academic mission that helps us do the science and translate it back to our communities.”

Hanners agrees, describing the relationship between the university and its growing medical enterprise and community partnerships as a “virtuous cycle.” “This growth creates the margins that allow the health system to support the academic mission, which then spurs new discoveries that help us provide better services at the bedside for our patients,” he says.

With this newest partnership, Hanners hopes the medical enterprise can continue to learn meaningful and intentional ways to connect with diverse communities and the dedicated hospital staff that serve them.

“We’re very focused on meeting with the medical staff out there in the community and reassuring them that we’re here to fill gaps, raise the level of care and provide services that they otherwise are not getting–not compete with them and take away their livelihoods,” Hanners says.

This is something that we are very proud of and, we believe, differentiates our approach to working with community providers.

Rod Hanners

Fueled by lessons from the Verdugo Hills partnership years before, Keck Medicine’s physician leaders held town halls early in the acquisition process to engage with Arcadia hospital leadership to alleviate concerns, answer questions and build trust “doctor-to-doctor.”

“This is something that we are very proud of and, we believe, differentiates our approach to working with community providers,” Hanners says. “It is a team concept where we want to be an asset to the community providers in helping improve the care for their patients.”

All in all, Keck Medicine’s leaders are excited by the university’s expansion into the unique eastern communities of the San Gabriel Valley.

“I think we are limitless in terms of the opportunities that we have to make a difference for individual patients, families and communities,” Robinson says. “We get to take the important work we’re doing and open up access to it for the diverse communities we serve. I’m very excited to be part of Keck Medicine of USC at this critically important moment.”

The post Keck Medicine of USC Looks East appeared first on USC News.

USC Arcadia Hospital and Keck Medicine of USC celebrate new affiliation

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USC Arcadia Hospital and Keck Medicine of USC.
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On October 3, leaders from the University of Southern California, including those from Keck Medicine of USC, joined elected officials to celebrate and visit USC Arcadia Hospital, which became affiliated with the Keck Medicine health system on July 1.

Despite the unseasonably warm autumn day, guests gathered on the lawn outside of Lewis Hall to recognize and honor this momentous partnership. U.S. Representative Judy Chu (D-Pasadena) and Los Angeles County Supervisor Kathryn Barger were also in attendance.

“Today we celebrate the union of the university and this hospital — two organizations that have deeply influenced our community for more than a century — coming together to write the future,” said Steven Shapiro, MD, senior vice president for health affairs at USC. “No one organization can give its patients the range of health care they will need over the course of their lifetime in this rapidly evolving world. It is only by coming together that we can serve our community with the routine and advanced medicine available today, and the path-breaking treatments of tomorrow.”

USC Arcadia Hospital began operating in 1903 as Methodist Hospital of Southern California — with five beds in a two-story house on Hewitt Street in Downtown Los Angeles. In 1909, the Women’s Home Missionary Society of the Southern California Conference of the Methodist Church, founders of the hospital, began to raise funds for a new facility. The existing house was outfitted with 18 beds and used temporarily until a new 100-bed facility was dedicated on the site in May 1915. It was the first major hospital built in Los Angeles of reinforced concrete.

The Hope Street location was further expanded to 225 beds in 1925. In 1951, it was approved for internship and residency training by the American Medical Association. The hospital’s operating rooms were the first in Los Angeles to be air-conditioned, and it also featured the first post-operative recovery room in the city. Today, USC Arcadia Hospital is a full-service, 348-bed community hospital serving a population of nearly half a million. In a single year, the hospital delivers nearly 2,000 babies, and treats more than 40,000 adults and children through its emergency department.

“Our coming together as one marks a new beginning for medical care in the San Gabriel Valley,” said Carol Folt, PhD, president of the university. “As one united team, we’ll always keep innovation and compassion top of mind, but we’ll reach even more people. What we have achieved separately is nothing compared to what we will achieve together. Our local community is keeping what it already has — but it’s gaining expanded access to a whole new range of physician specialties.”

The hospital’s affiliation with USC brings San Gabriel Valley residents convenient access to Keck Medicine’s specialized care, research, and breakthrough technology. Over the coming years, Keck Medicine will invest in USC Arcadia Hospital’s equipment, infrastructure and services including an expansion of neurosciences, cardiac care and oncology services, which will complement the multispecialty outpatient services that Keck Medicine currently provides in Arcadia.

As the celebration drew to a close, Chu presented hospital leadership with a certificate of congressional recognition and reiterated the impact USC Arcadia will continue to have throughout the region.

“Standing here today, the purpose of this hospital is palpable,” said Dan Ausman, MPA, president and CEO for USC Arcadia Hospital. “In my 11 years with the organization, I’ve witnessed how the hospital has dispensed world-class care in a community setting. Our goal is to have this hospital remain the jewel that it is, and to serve the community for another 119 years.”

— Matthew Vasiliauskas

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