SFHIP: San Francisco Health Improvement Partnership Work Groups

The SFHIP initiative was developed in 2010 by CTSI's Community Engagement and Health Policy program in collaboration with wide ranging community and civic partners. The effort was built on the underlying premise that by working together in a coordinated, focused, and well-informed manner, academic and community groups can achieve synergies and foster innovation to achieve substantial gains in community health and health equity. CTSI provided the infrastructure and support for planning and coordination of this phase of SFHIP, and will continue to support this effort through five existing Work Groups (see detailed information below).
By focusing on Collective Impact and cross-sector coordination, SF HIP is better positioned to achieve measurable improvements in health.
Kevin Grumbach, MD, Co-director of CTSI's CE&HP program
In June, 2013, CTSI and SFHIP combined its formative work into one aligned framework that includes two other community health improvement collaborators: San Francisco's non-profit hospitals and their Community Benefits Partnership (CBP) and Building a Healthier San Francisco (BHSF) projects; and the San Francisco Department of Public Health and its community health improvement process.
Motivated by a common vision, shared values, and community-identified health priorities, SFHIP seeks to employ the Collective Impact model drive community health improvement efforts in San Francisco. The road map for SFHIP is San Francisco's Community Health Improvement Plan (CHIP), the development process that has engaged nearly 700 community residents and local public health system partners. The CHIP identifies these shared health priorities in San Francisco:
  • Ensure Safe + Healthy Living Environments
  • Increase Healthy Eating + Physical Activity
  • Increase Access to High Quality Health Care + Services

The CHIP has also identified goals, objectives, measures, and strategies for each priority. Building on this foundation, SFHIP aims to "move the needle" on community health in the next three to five years, and future iterations of the CHIP will drive SFHIP going forward.

CTSI's ongoing support includes coordination of Work Groups focused on five disease areas:
  • Physical Activity & Nutrition (PAN)
  • Children's Oral Health
  • Alcohol Policy & Heavy Users of Multiple Services (HUMS)
  • Hepatitis B

Physical Activity and Nutrition (PAN)

Improving Health Outcomes Associated with Obesity-related Chronic Disease

  • As is true nationally, the obesity epidemic in San Francisco disproportionately affects communities of color and low-income populations.
  • SFHIP is aligned with national and local initiatives (First Lady’s Let’s Move campaign, San Francisco's ShapeUp SF campaign).
  • SFHIP-- along with the Southeast Food Access (SEFA) Food Guardians and a number of community-based organizational partners-- is partnering with the SF Department of Public Health (SFDPH), with support from Kaiser Permanente's Community Benefits program, on a Healthy Eating Active Living (HEAL) Zone initiative in the Bayview Hunters Point (BVHP) community of San Francisco.
  • SFHIP has played a strategic role in bridging scientific evidence on community-based and policy-level obesity prevention interventions with neighborhood stakeholders’ perspectives to systematically prioritize and evaluate local interventions.  Initial work has focused on the Bayview Hunters Point neighborhood, where some of the greatest obesity-related disease burdens exist in SF, and where there is a history of effective and powerful work being done to improve food access with leadership from SEFA.
  • Other SFHIP efforts on PAN have included:
    • grant investments in Bayview community-based efforts to innovate new approaches to increasing physical activity and healthy food access
    • capacity-building for community partners in program planning and evaluation design, to increase evidence-based practice and improve capacity to measure program impact
    • providing technical and infrastructure assistance in the development of a community plan for improved transportation to help get BVHP residents to improve access to fresh foods and physical activity programs.  This plan was developed in partnership with the County Transportation Authority, BMagic, the HEAL Zone and others.

Sugar-sweetened Beverage (SSB) Consumption

As part of SFHIP efforts on PAN, UCSF researchers have met with local policymakers, SFDPH staff working to prevent obesity and community-based health advocates to discuss the development of regulatory measures that could help reduce consumption of SSBs. Research has shown SSBs to be a major contributor of obesity and diabetes, disproportionately impacting low-income, African American and Latino communities.

Breastfeeding Partnership Work

As part of a broader effort to reduce obesity-related disease disparities, early SFHIP efforts were made in support of SF breastfeeding promotion by:

  • helping to gather and analyze data on local breastfeeding initiation and duration
  • supporting the convening of a citywide coalition to address the needs of low-income women and increase adherence to workplace accommodation policy locally
  • supporting the convening of a citywide forum of local employers to educate on adherence policy, share best-practices, and recruit partners for future efforts

Partners included:

  • UCSF faculty, School of Medicine
  • SFDPH’s Maternal, Child and Adolescent Health (MCAH) section
  • San Francisco Breastfeeding (SFBF) Coalition

Partnership projects included:

  • development of an epidemiological profile of lactating women in SF for 2012
  • the strengthening of an SF Breastfeeding Coalition infrastructure via resources to support website development and coalition coordination
  • supporting local community-based partner Central American Resource Center of SF (CARECENSF) by partnering UCSF faculty and learners with CARECEN’s promotora program to provide evidence-based peer health education to Latinas of child-bearing age in SF.  Through this partnership, UCSF faculty and learners were able to share what they learned by investigating barriers and facilitators to support breastfeeding among Latina immigrant women at San Francisco General Hospital.  Additionally, CARECEN's promotoras are helping their peers learn about the health benefits of breastfeeding, while also teaching UCSF partners how to best communicate health information to immigrant Latina women in SF.

Questions? Contact Roberto Ariel Vargas, MPH, at rvargas@fcm.ucsf.edu.

Children's Oral Health

The Children’s Oral Health Partnership Working Group was established in 2011 to spearhead SF HIP’s work to improve children’s oral health in San Francisco. Bringing together, civic, community and academic partners, the PWG is focused on preventing dental decay in children and developing interventions that are measurable, sustainable and scalable.      

To join our mailing list click here: listserv@listsrv.ucsf.edu. If you have questions, please contact Randy Quezada.

Promotora Project (view presentation)

Alcohol Policy

Alcohol-related public safety is a major concern in San Francisco, particularly in low-income communities of color. Scientific evidence and community experience demonstrate that high density of corner store outlets is associated with higher prevalence of public safety problems, nuisance activities, and alcohol-related crime. In communities where empowerment and capacity are strong and supported, local citizens have made concerted efforts to address these problems and communities have experienced improvements in this area (reduced crime and the fear of crime). This partnership is an organized effort to inform, educate and engage a broad range of stakeholders to create historically and culturally competent, respectful, collaborative policy solutions to these problems.

This partnership is:

  • Convening community, civic, and academic partners and ongoing networking for coalition building.
  • Hosting consultations on key concerns, including calculating the local cost of alcohol-related public safety problems and nuisance activities.
  • Continuing to identify and engage key stakeholders from multiple sectors to address alcohol-related safety problems.
  • Beginning to identify and share data resources to measure the focus problem(s) and assess possible policy remedies.

Plans for 2013 include:

  • Designing and implementing trainings / information sessions on alcohol regulation in San Francisco.
  • Implementing pilot interventions  in focus neighborhoods to address alcohol-related safety/crime issues  to inform evidence-based regulation and enforcement solutions.
  • Supporting and engaging the business community in addressing alcohol-related safety/crime issues in their neighborhoods

Partners Include:

  • Bayview YMCA
  • Horizons Unlimited
  • Instituto Familiar de la Raza
  • Lower 24th St. Merchants Association
  • Mission Neighborhood Centers
  • Mission Neighborhood Health Center
  • National Council on Alcoholism - Bay Area
  • Renaissance Bayview
  • SF Police Department
  • SF Department of Public Health
  • SF Unified School District
  • St. Francis Hospital
  • UCSF Injury Center
  • Vietnamese Youth Development Center
  • Youth Leadership Institute

Please contact Paula Fleisher (paula.fleisher@ucsf.edu) with questions about this Partnership Working Group.

HUMS (Heavy Users of Multiple Safety Net Health Care Systems)

SFDPH and UCSF are partnering to identify heavy users of multiple safety net health care services.  These individuals rely heavily on multiple systems of public urgent/emergency care to meet complex health and social service needs.  A key goal of the partnership is to identify meaningful patterns in service use within the population of 2,222 multiple-system users.  This will help us better understand the problem and provide DPH with the evidence needed to develop population-based approaches for coordinating care to subgroups of these patients.

The partnership set out to track the neediest individuals in a merged data set of health records from 13 different DPH services, comprising 4 systems of urgent/emergent care:

  1. Emergency medical services or “EMS” (ambulance transport)
  2. The substance abuse system (including social and medical detoxification, sobering support)
  3. The mental health system (psych emergency, inpatient, crisis and diversion services) and
  4. The medical care system (ED, hospitalizations, and urgent care clinics). 

One of the strategies to address the goal is to pilot innovative approaches to improving care for HUMS patients.  UCSF investigators and the San Francisco Department of Public Health (SFDPH) propose to partner in a pilot feasibility study to test whether mobile phone technology can improve care coordination for Heavy Users of Multiple Systems (HUMS). Finding solutions must start by addressing the most elemental barrier to care:  the inability of providers to maintain contact with HUMS patients because they are homeless and socially disenfranchised. 

With funding from UCSF’s Resource Allocation Program, the team is conducting a pilot mobile phone intervention that will begin to develop strategies with the SFDPH that address the needs of HUMS patients in more effective ways.

Questions? Contact Paula Fleisher at paula.fleisher@ucsf.edu.

Hepatitis B

San Francisco Hepatitis B Quality Improvement Collaborative (QIC)
 is focused on improving the quality of care—from screening to specialty treatment—for patients at risk for and infected with chronic Hepatitis B.

  • San Francisco has a high prevalence of chronic Hepatitis B. One third of San Francisco residents are Asian, half of whom are born outside the US in countries with high rates of vertical transmission of Hepatitis B. 
  • The San Francisco Department of Public Health, Asian Week Foundation and other community groups have actively supported and promoted a SF Hep B Free Campagin to encourage the Asian community to be screened for Hepatitis B.
  • The screening campaign has uncovered major gaps in quality of care in San Francisco for managing patients who test positive for chronic Hepatitis B.
  • In partnership with the SF Hep B Free Campaign, CTSI and other partners have created a Hepatitis B Quality Improvement Collaborative to facilitate a cooperative, citywide effort in San Francisco among physician and health care organizations to systematically improve processes for Hepatitis B screening and clinical care.  All major medical groups in SF are participating in the collaborative, including Kaiser, Individual Practice Associations (IPAs), and safety net clinics.
  • Creating of a citywide registry of patients with Hepatitis B will be a key element for both improving quality of care and health outcomes for patients with Hepatitis B and enhancing clinical and comparative effectiveness research in Hepatitis B.

Partners Include:

  • AsianWeek Foundation

  • Brown and Toland Medical Group

  • Chinese Community Health Care Association
Chinese Hospital
Hill Physicians Medical Group
Kaiser Permanente

  • SF Community Clinic Consortium | Northeast Medical Services
SF Department of Public Health | Communicable Disease Control and Prevention

  • SF Department of Public Health | Community Health Network
SF Hep B Free Campaign
  • CTSI Community Engagement and Health Policy Program

  • UCSF Medical Center

  • UCSF School of Pharmacy 

Questions? Contact Paula Fleisher at paula.fleisher@ucsf.edu.