CHV Marks Success of Caring Wisely Initiative

Ralph Gonzales, MD, (left) joins Joshua Adler, MD from the UCSF Medical Center in recognizing the success of the Caring Wisely project teams.

The success of Caring Wisely, an innovative initiative spearheaded by UCSF’s Center for Healthcare Value (CHV) in collaboration with the UCSF Medical Center, was the focus of a November 12, 2013, event on the Parnassus campus.

The CHV is focused on advancing rational, science-driven, and clinician-tested healthcare solutions that reduce cost and improve quality, and Caring Wisely is a key effort under the Center’s Delivery Systems Initiative, one of three CHV focus areas.

“The ideas that launched the Caring Wisely Initiative came from front-line staff and care providers within the UCSF Medical Center, and in a relatively short time the teams involved have demonstrated a real return on investment,” said Ralph Gonzales, MD, MSPH, who leads the CHV’s Delivery Systems Initiative. “In one case, that translates to annual savings of over a million dollars.”

Through projects such as the first phase of Caring Wisely, the CHV is working in partnership with delivery system leaders from the UCSF Medical Center to inspire and support front-line proposals that lower health care costs. Caring Wisely 1.0 provides pilot funds as well as intervention design, implementation, and evaluation support through the Program in Implementation Science at UCSF’s Clinical and Translational Science Institute (CTSI).

Caring Wisely 2.0, which will include the next iteration of project funding opportunities at the UCSF Medical Center, as well as an expansion to include San Francisco General Hospital and Trauma Center, launches in early 2014, with support and commitment from the San Francisco Department of Public Health and the Metta Fund.

Among those in attendance at the showcase event was Clay Johnston, MD, PhD, interim director of the CHV and director of CTSI, which is administering the CHV.

Joshua Adler, MD, Chief Medical Officer of the UCSF Medical Center, was also on hand. He thanked the “trailblazers” and their teams, and highlighted the value of this unique collaboration with the CHV.

 Highlighted projects included:

  • Nebs No More After 24 (view poster): The project aims to decrease inhaled nebulizer usage in all hospitalized patients by at least 15%. This will be accomplished by expanding the current project beyond the 14M medicine patient pilot, improving patient education on proper MDI self-administration, and improving physician and nursing knowledge regarding the use of appropriate respiratory therapies. Project team: Chris Moriates, MD; Maria Novelero, MA, MPA; and various Respiratory Therapy, Nursing and UCSF Medical Center representatives and champions
  • Reduction of Red Blood Cell (RBC) Transfusions (view poster): The RBC Transfusions team includes senior officers and implementers from patient care, the UCSF Blood Bank, and management, in a vital collaboration. Together, they aim to reduce RBC transfusions by 5% for adult non-ICU patients over the course of 1 year by increasing adherence to national practice guidelines for more restrictive blood transfusion practices. Project team: Kathryn Curcione, RN, BSN, ONC, NE-BC; Molly Rankin, PA-C; Delene Johnson, MS, MT (ASCP), CM SBB; Traci Hoiting, RN, MS, NEA-BC; and Jeff Lam, RN, MSN
  • IV to PO (view poster): This project is spearheaded by the Department of Clinical Pharmacy, and aims to increase the rate and frequency of switching appropriate patients from IV to PO. Projected annual savings at scale = $1M. Project team: Allison Miller-Pollock, PharmD; Candy Tsourounis, PharmD; Elin Stengard, PharmD; Jason Phillips, PharmD; Catherine Au, PharmD; Heidemarie Windham, PharmD

The Caring Wisely project teams are supported in their intervention design, implementation and evaluation by an Implementation Science team that includes Margaret Handley, PhD, MPH; Sara Ackerman, PhD, MPH; Christy Boscardin, PhD; Priya Prasad, PhD candidate; Alvin Rajkomar, MD; and Aria Yow.

The ideas for Caring Wisely projects resulted from a call for proposals via UCSF Open Proposals. View all proposed ideas, as well as a related news story from

The Delivery Systems Initiative also supports the Action Research Program, which partners a multidisciplinary team of implementation scientists and medical students with a clinical practice to help the practice design and test new care delivery system strategies. Learn more.