The UCSF. A Preclinical, Interdisciplinary. Curriculum

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1 The UCSF San Francisco Hepatitis B Collaborative A Preclinical, Interdisciplinary Service-Learning Advocacy Curriculum Albert Y. Yu, MD, MPH, MBA Director, SFDPH Chinatown Public Health Center Clinical Professor UCSF Dept of Family & Community Medicine

2 Local API Landscape - 31% of SF residents selfidentified as Asian - Diverse AAPI ethnic groups - Abundant Community partnership opportunities UCSF Community - Asian Health Caucus - Large # of AAPI students among all 4 schools - Curricular focus: HDWG - Faculty resources The HD Imperative - Compelling Evidence - IOM, AMA, ACGME, AAMC, LCME - Medical school HD curricula imperative Clinical Imperative - Preventable & treatable - Prevalence of CHB: AAPI 8-15%, general 0.3% - HCC ranks as leading causes of death for API - SF highest rate of liver cancer is the U.S.

3 The Journey AHC Preclinical student activism 2002 FCM-110 clerkship CQI curriculum 2004 Student desire to raise Hepatitis B awareness to underserved AAPI citizens NICOS visit B-Wise Project SFDPH/Stanford 3 For Life program Vision, Training & Execution Health Disparity scientific knowledge procedural skills organizational infrastructure community partnerships

4 Chronic Hepatitis B and Liver Cancer ARE two the Greatest Health Disparities Between AAPIs and Caucasian Americans!

5 Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever does Margaret Mead

6 San Francisco Hepatitis B Collaborative Mission To partner with community health centers and organizations and jointly address health disparities in HBV care within AAPI communities Strategies Create an interdisciplinary, service-learning curriculum Build an organizational infrastructure that can sustain ongoing development and transition of student leaders Organize and operate a student-run mobile HBV clinic Foster sustainable partnerships with community organizations and agencies serving AAPI clients Engage health professional students in community outreach and advocacy Leverage the expertise of UCSF faculty

7 Organizational Structure SFHBC Internal Affairs External Affairs Technical Support Patient Education Finance Elective Clinic Research

8 The Curriculum Objectives Acquire knowledge in Hepatitis B education, detection, prevention, treatment, and community outreach Gain understanding and competence working with AAPI clients Develop skills to organize a student-run, HBV clinic and an organizational committee infrastructure Appreciate inherent challenges in community outreach and efforts to foster collaborative community partnerships

9 The Curriculum Design & Methods Seminar Series (10 weekly sessions) HBV epidemiology, clinical manifestation, virology, screening, treatment, prevention, and community resources Hepatitis A and C co-infections Cultural competency (Limited English Proficiency) Universal safety precautions Patient education (role-plays) Procedural Training (two 2-hr sessions) Phlebotomy and intramuscular injection Clinical Practicum (student-run, t mobile clinic) i Administration and clinic logistics, patient education, phlebotomy and injection, patient follow-up, clinical data management, and partnership engagement

10 A Humble Beginning in Springfield, Illinois 21 months ago Student enrollment st year 72 students Student-Run t HBV clinic i FCM faculty practice Monthly Saturday morning Total 5 pilot clinics Piloted different e recruitment strategies Total screened: 131 Medicine 22 Pharmacy 45 Nursing 1 Dentistry 4

11 The Second Year: Patient tracking database Committee organizational infrastructure t Student leadership development ALF Think B Grant Community partnerships Asian Health Services in Oakland Vietnamese Community Center in Tenderloin Korean Reform Church in San Jose Kenko No Hi Health Fair in Japantown NICOS Chinatown Health Fair UCSF Think B Week UCSF Colloquium Presentation

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13 The Third Year: AAMC Grant Community partnerships API Wellness Center API at risk for HIV Bayanihan Community Center Filipino SFDPH Chinatown Public Health Center UC Berkeley STFM presentation and 2 AAMC posters AMSA Paul R. Wright Excellence in Medical Education Award

14 SF Hepatitis B Free Resolution establishing the goal of universal hepatitis B screening and vaccination for Asian and Pacific Islander residents of San Francisco. Resolution (Fiona Ma): passed unanimously by SF Board of Supervisors on Nov. 7, 2006 Proclamation support from Mayor Gavin Newsom, Governor Arnold Schwarzenegger and President Bush s Advisory Commission i on Asian Americans and Pacific Islanders

15 SF Hepatitis B Free First City in the United States to Use A Citywide Community-Based Approach To Test, Vaccinate & Educate all Asian & Pacific Islanders for Hepatitis B

16 The Fourth Year: SF Hospital Council Grant UCSF Mount Zion Clinic 1 st Saturday of each month 11/3/07 / start date Screening & Vaccination SFDPH Chinatown Public Health Center 2 nd Saturday of each month 11/10/07 start date Full spectrum: screening, vaccination, and clinical care Community outreach and health fairs

17 UCSF-CPHC Hepatitis B Clinic Health education by UCB undergraduate students Free screening UCSF students (paired) CPHC staff provides direct supervision and assistance (MEA, NP) Client database Manage by 2 students and faculty Sits behind SFDPH firewall Screening data are updated before each clinic Screening results and implications Face-to-face education by UCB students No immunity initiate vaccination ($10/dose) immediately unless declined CHB with insurance or established PCP letter to PCP, educational handout CHB without insurance initiate care at CPHC

18 CHB Clinical Care at UCSF-CPHC Team Approach (1-1.5 hour with each pt) Med and Pharm or MS1 and MS2 UCB translators if required Preceptor (MD or NP) Chronic care coordinator (Brian Toy) Chronic care protocol (2 days) Day 1: Conduct assessment & focused PE, offer prevention education, order surveillance labs and ultrasound, enroll into fed/state/local insurance programs by CPHC eligibility staff Day 2: Review lab results, administer HAV vaccine if necessary, establish primary care and ongoing surveillance monitoring for CHB

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20 Enrollment & Commitment

21 The Now: New CDC Recommendation screen all people born in Asia for hepatitis B UCSF Mount Zion Clinic SFDPH Chinatown Public Health Center Community outreach and health fairs Asian Pacific Islander Health Parity Council Community-Based Organization Outreach SFHBF Steering and Evaluation Committee Disseminate through publication

22 Lessons Learned Critical Success Factors Think Globally, Work Locally Leverage faculty expertise and resident support Make it relevant to your constituents Money Speaks Build Organizational Machinery Stay on Message Foster Community Partners and Coalition i Solve Transitional Leadership Conundrum Timing is Everything Nothing is Impossible Enthusiasm without the Vote is not enough Canvass Workers Need Tools

23 The physician, who knows only medicine, knows not even medicine. Mark Twain

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