Public Health Translational Research

UCSF Center for Vulnerable Populations (CVP)

Established in October 2006, the UCSF Center for Vulnerable Populations (CVP) is a pioneering center focused on improving health care for San Francisco’s most vulnerable residents. Vulnerable populations include individuals that lack health insurance, have limited English proficiency and health literacy, and live in adverse social conditions like chronic poverty and social isolation. The mission of the CVP is to conduct and disseminate innovative research and advance health communication to prevent and treat chronic diseases (e.g. diabetes, heart failure) in people most at risk.Dean Schillinger

Dean Schillinger, MD is the Director of CVP based at San Francisco General Hospital, a research center carrying out innovative research to prevent and treat chronic diseases such as diabetes.  In April 2008, Dr. Schillinger was also named Chief of the California Diabetes Program in the California Department of Public Health, a UCSF-administered program funded primarily by the U.S. Centers for Disease Control and Prevention. 

Kirsten Bibbins Domingo, PhD, MD, MAS-CR is also a member of the CVP based at San Francisco General Hospital, as is Urmimala Sarkar, MD, MPH.  Publication listings for all of these research professionals are listed below.

 

Kristin Bibbins-Domingo                   Urmimala Sarkar

 

 

This past year, CVP researchers conducted innovative projects ranging from developing communication tools to improve diabetes management, advancing health literacy, creating a policy model to monitor disparities in heart disease, developing community education to prevent lead poisoning, and many others.

 

A central part of the CVP mission is to disseminate research and innovations to clinicians and patients to improve clinical practice.  The Center is also committed to disseminating key findings to diverse stakeholders including scientists, allied health professionals, community groups and community members.  During 2008, the CVP disseminated results widely through peer-reviewed publications, newsletters, and international, national, state, and local presentations.  They plan to broaden their dissemination efforts for 2009 through ethnic media outlets and community forums to better reach diverse audiences most affected by chronic disease.

The CVP has received significant media coverage:

Broadcast Media
  • Dr. Schillinger was featured on the Radio Bilingüe program, Linea Abierta.  The show also featured a panel of patients sharing their experiences living with diabetes, along with Javier Carrillo of the California Diabetes Program.    The show covered health promoting behaviors to prevent and control diabetes and discussion on the type 2 diabetes epidemic as it affects Latinos.  There was also a Q and A period at the end where callers joined the discussion from Merced, Bakersfield, Chicago, Washington State and other areas (due to the Satellite broadcast of the show).   Below is a link to the show that was conducted in Spanish (fast forward past the first 10 minutes of news/program updates).   http://www.archivosderb.org/?q=es/node/2267
  • Drs. Schillinger and Handley were interviewed on March 1, 2009 on a local television program, Comunidad del Valle, which reaches a primarily English-speaking audience whose influence reaches large segments of the Latino community. The interview focused on the work at the Center for Vulnerable Populations that centers on innovative communication strategies between primary care centers and vulnerable populations in the community who don’t receive the information they need to manage chronic illnesses, due to such factors as limited literacy, language barriers and lack of health insurance.  The interview can be viewed on the following link:  http://www.nbcbayarea.com/station/community/UCSF_Center_for_Vulnerable_Populations_Bay_Area.html
  • The Agency for Health Related Quality Care interviewed Dr. Dean Schillinger on his role as a practicing clinician at a safety net hospital (San Francisco General Hospital).  Dr. Schillinger discussed challenges in a safety-net hospital including limited literacy and non-English communication barriers.  Listen to the podcast of this interview.
  • Dr. Hilary Seligman made a guest interview appearance, on Forum with Michael Krasney, KQED Radio.  “Diabetes Spike.”  November 10, 2008.  Please click here to download.
Print Media
Peer Reviewed Articles

The CVP completed a fact sheet highlighting key findings from the Improving Diabetes Efforts across Language and Literacy (IDEALL) study.  The fact sheet highlights the efficacy of automated telephone support management as both effective and cost-effective for diabetes symptom management, especially among patients with limited English proficiency and limited health literacy. 

Dean Schillinger, Margaret Handley, Urmimala Sarkar, and colleagues co-authored new publications related to the IDEALL (Improving Diabetes Efforts across Language and Literacy) study.  These publications are highlighted below:

Schillinger D, Handley M, Wang F, Hammer H. Effects Of Self-Management Support On Structure, Process And Outcomes Among Vulnerable Patients With Diabetes: A 3-Arm Practical Clinical Trial. Diabetes Care. 2009; 32(4):559-566.

Schillinger, D, Hammer, H, Wang, F, et al. Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System. Health Education and Behavior. 2008; 35(5):664-82.

Handley M, Shumway M, Schillinger D. Cost Effectiveness of an Automated Telephone Self- Management Support Intervention with Nurse Care Management Among Vulnerable Patients with Type-2 Diabetes. Ann Fam Med. 2008 Nov-Dec;6(6):512-8.

Sarkar, U, Handley, M, Gupta, R, et al. Use of an Interactive Telephone-based Self-Management Support Program to Identify Adverse Events Among Ambulatory Diabetes Patients. Journal of General Internal Medicine. 2007; 23(4): 459-65.

Other Peer Reviewed Articles

Bibbins-Domingo K, Pletcher MJ, Lin F, Vittinghoff E, Gardin JM, Arynchyn A, Lewis CE, Williams OD, Hulley SB.  Racial differences in incident heart failure among young adults. New England Journal of Medicine 2009; 360(12):1179-90.

Sarkar U, Wachter R, Schroeder S, Schillinger D. Refocusing the lens: a conceptual model for patient safety for ambulatory chronic disease populations. Joint Commission Journal on Quality and Patient Safety 2009: 35(7):377-383. 

Sudore R, Schillinger D. Interventions to Improve Care for Patients with Limited Health Literacy. J Clin Outcomes Manag. 2009 Jan;16(1):20-9.

Wallace A, Seligman H, Davis T, Schillinger D, Arnold C, Bryant-Shilliday B, Freburger J, DeWalt D. Literacy Appropriate Educational Materials and Brief Counseling Improves Diabetes Self-Management. Patient Educ Couns. 2009 Jan 22. [Epub ahead of print]

Fang M, Panguluri P, Machtinger EL, Schillinger D. Characterizations of Stroke Among Patients Taking Warfarin for Stroke Prevention: Implications for Health Communication. Pat Ed  Counsel. 2009 Jan 24. [Epub ahead of print]

Dewalt DA, Davis TC, Wallace AS, Seligman HK, Bryant-Shilliday B, Arnold CL, Freburger J, Schillinger D. Goal setting in diabetes self-management: Taking the baby steps to success. Patient Educ Couns. 2009 Apr 7. [Epub ahead of print]

Wallace AS, Seligman HK, Davis TC, Schillinger D, Arnold CL, Bryant-Shilliday B, Freburger JK, Dewalt DA.Literacy-appropriate educational materials and brief counseling improve diabetes self-management. Patient Educ Couns. 2009 Jun;75(3):328-33.

Chew L, Schillinger D, Maynard C, et al. Glycemic and Lipid Control among Patients with Diabetes at Six U.S. Public Hospitals. J Health Poor Underserved. 2008 Nov;19(4):1060-75.

Mold JW, Pasternak A, McCaulay A, Manca D, Rubin G, Westfall J, Beasley J, Hickner J, Fagnan LJ, Handley M, Haddy R, Hankey T.Definitions of common terms relevant to primary care research. Ann Fam Med. 2008 Nov-Dec;6(6):570-1.

Urmimala Sarkar, John D. Piette, Ralph Gonzales, Daniel Lessler, Lisa Chew, Brendan Reilly, Jolene Johnson, Melanie Brunt, Jennifer Huang, Marsha Regenstein, Dean Schillinger. Perceived Benefit of Communication and Preferences for Self-Management Support Among Diabetes Patients in Public Hospital Health Systems, Patient Education and Counseling 2008;70(1):102-10.

Urmimala Sarkar, Margaret Handley, Reena Gupta, Audrey Tang, Elizabeth Murphy, Kaveh Shojania, Hilary Seligman, Dean Schillinger. Opening the Black Box: Exploring Patient Safety Threats Among Ambulatory Chronic Disease Patients. Journal of General Internal Medicine 2008: 23(4):459-65.

Urmimala Sarkar, Dean Schillinger. Does lower diabetes-related numeracy lead to increased risk for hypoglycemic events? (letter) Annals of Internal Medicine 2008:149(8):594

Sarkar U, Piette J, Gonzales R, Lessler D, Chew L, Reilly B , Johnson J, Brunt M, Huang J, Regenstein M, Schillinger, D. Perceived Benefit of Communication and Preferences for Self-Management Support Among Diabetes Patients in Public Hospital Health Systems, Patient Education and Counseling 2008;70(1):102-10.

Sarkar U, Handley M, Gupta R, Tang A, Murphy E, Shojania K, Seligman H, Schillinger, D. Opening the Black Box: Exploring Patient Safety Threats Among Ambulatory Chronic Disease Patients. Journal of General Internal Medicine 2008: 23(4):459-65.

Bibbins-Domingo K, Coxson P, Pletcher M, Lightwood J, Goldman L.  Adolescent overweight and future adult coronary heart disease.  N Eng J Med 2007; 357(23):2371-9.

Sarkar U, Fisher L,  Schillinger D. Is Self-Efficacy Associated with Diabetes Self-Management Across Race/ Ethnicity and Health Literacy? Diabetes Care 2006. 29: 823-829.

Piette JD, Bibbins-Domingo K, Schillinger D.  Health care discrimination, processes of care, and diabetes patients’ health status. Patient Educ Couns 2006; 60(1):41-48.

Lightwood J, Bibbins-Domingo K, Coxson P, Wang YC, Goldman L.  Forecasting the future economic burden of current adolescent overweight: An estimate of the Coronary Heart Disease Policy Model. Am J Public Health, in press.

Non-Peer Reviewed Publications
  • As Chief of the California Diabetes Program, Dean Schillinger co-authored a publication entitled Diabetes in California Counties, issued April 2009.  This document provides background information, facts, and statistics about diabetes across California counties, through data collected from the 2005 California Health Interview Survey.  The information can be used by county health departments, community-based organizations, and those providing clinical services to make strategic decisions about their current and future activities. http://www.caldiabetes.org/content_display.cfm?ContentID=1160
  • Agency for Health-Related Research Quality (AHRQ) highlighted Dean Schillinger’s work in their Health Care Innovations Exchange which is a national program designed to support health care professionals in sharing and adopting innovations that improve the delivery of care to patients. This resource highlights innovative strategies and quality-related tools, with the aim of improving organizations’ ability to innovate and adopt new ideas, and interact with innovators and adopters.
  • The AHRQ recognized Dean Schillinger’s work developing and implementing a visual medical schedule (VMS) and teach-back protocol to address anticoagulation control for underserved patients at SFGH.  The VMS is a single piece of paper that includes digitized images of the patient’s warfarin regimen on a weekly calendar. The words are printed in English and, if appropriate for the patient, in Spanish or Cantonese as well.  After describing the updated warfarin dose illustrated on the VMS, a clinical staff member asks the patient to repeat the dosing schedule (teach-back method), and, if necessary, corrected his or her understanding one time only. The teach-back method was designed to reinforce the VMS in a manner that approximates how a typical clinician would interact with the patient, serving as a “double check” to make sure that the patient does not misinterpret the VMS, leading to potential harm.  The New York University/Bellevue Medical Center adopted this innovation.

    Computerized, Multilingual Visual Medication Schedule and Teach-Back Protocols Improve Anticoagulation Control for Low-Literacy Patients http://www.innovations.ahrq.gov/content.aspx?id=1883

  • Automated, Telephone-Based Interactive, Language-Appropriate Monitoring Engages and Improves Health Behaviors of Low-Income Diabetes Patients http://www.innovations.ahrq.gov/content.aspx?id=1863

    The Automated Telephone Diabetes Management (ATDM) program, a part of the Improving Diabetes Efforts Across Language and Literacy (IDEALL) project, provided automated telephone monitoring of individuals with poorly controlled type II diabetes who receive their care at four safety net clinics in San Francisco. An adjunct to regular clinic care, the system made weekly automated, interactive calls to participants in their native language (English, Spanish, or Cantonese), with follow up calls made as needed by a nurse care manager with appropriate language skills. Preliminary results suggest the intervention engaged patients in the self-management of their condition, improved health behaviors, increased detection of adverse and potentially adverse situations, and significantly enhanced the capacity of nurse managers to serve patients.  Kaiser Medical Center in Southern California is implementing this innovation in their clinics.

  • Dean Schillinger and Hilary Seligman helped develop a Living with Diabetes Guide supported by the American College of Physician (ACP) Foundation.  Over 1,000,000 copies of these guides have been distributed and are available here.
Two peer-reviewed publications focus on the diabetes guide

Wallace A, Seligman H, Davis T, Schillinger D, Arnold C, Bryant-Shilliday B, Freburger J, DeWalt D. Literacy Appropriate Educational Materials and Brief Counseling Improves Diabetes Self-Management. Patient Educ Couns. 2009 Jan 22. [Epub ahead of print]

DeWalt D, Davis T, Wallace A, Seligman H, Bryant-Shilliday B, Arnold CL, Schillinger D. Goal Setting in Diabetes Self-Management: Taking the Baby Steps to Success.  Patient Educ Couns. 2009 Apr 7. [Epub ahead of print]

 
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