The Southern California Clinical and Translational Science Institute (SC CTSI) at the Keck School of Medicine of USC and CHLA and their counterparts at the UCLA CTSI have joined forces with the Los Angeles County Department of Health Services (LA DHS) to not only expand the breadth of research into health care, but also to create new approaches to innovation by the scientists who study health and the professionals who deliver it.

The collaboration, the result of extensive groundwork and discussions by research leaders at USC, UCLA and LA DHS, seeks to improve the health of local residents by finding new ways to boost the effectiveness and the efficiency of the County's public health system. Investigators from academia and the county gathered at UCLA recently to kick off the collaboration.

The LA DHS, with an annual operating budget of $5 billion, is the second-largest public health system in the country and one of the most diverse, serving hundreds of thousands of patients.

"Changing health care is one of the most important economic challenges for America, as important as curing cancer," said Hal Yee, MD, PhD, DHS, Chief Medical Officer of the LA DHS. "This is a unique collaboration in a region that looks like the next century of America, economically and in many other ways.”

In concert with the DHS leadership, researchers from SC CTSI and UCLA CTSI will develop and test interventions in a number of priority research areas, including:

• Primary Care
• Specialty Care
• Perinatal Care
• Care Transitions/Post-Acute Care
• Complex Care Management - High Medical Risk
• Transition to Integrated Care - Post Incarceration
• Advanced Illness Planning and Care
• Antibiotic Stewardship
• High Cost Pharmaceuticals

"For those of us working in health research, the LA DHS is the best research partner imaginable to help develop truly transformative knowledge and practices," said Thomas A. Buchanan, MD, Director of the SC CTSI. "There are huge challenges and opportunities that can be achieved through research within a large, real-world system like the DHS."

A key challenge for the collaboration is finding ways to integrate the very different cultures of academia and public health, with their differing economic and operational requirements.

"The usual academic and county structures we have in place are good but not when we want to work together," said Steven M. Dubinett, MD, Director of the UCLA CTSI. "We wanted to create a system in which we conduct research without walls."

The huge technological and operational infrastructure of the LA DHS gives researchers the power to test and disseminate medical interventions and lifestyle changes that can significantly improve the lives and health of LA's residents, said Yee. Among the latest DHS investments in infrastructure are a $600 million electronic health records system, and tens of millions of dollars in other technology, including a cutting-edge web-based electronic consultations system (eConsult) that generates thousands of distance-medicine consults per month.

Building on Early Successes

The new collaboration follows the successes of a few earlier partnerships between scientists from USC and UCLA and the LA DHS.

About two years ago, for example, UCLA clinical researcher Arleen F. Brown, MD, PhD, a specialist in community-engaged research, began a research program with the DHS's Clemens Hong, MD, MPH, Medical Director, Community Health Research. They studied a program that hired community health workers to help seriously ill patients address health needs more effectively through primary care. As they fielded that study, said Brown, they brought in more partners from UCLA, USC and the DHS.

And while the community health worker project demonstrated important benefits, it also can serve as a model for evaluating research through the DHS, said Brown. "We're interviewing the staff and patients, to figure out not just whether we moved the quality metrics, but also what the patients' true experience of care was, what barriers community health workers still face, and what barriers staff in the clinic still face to delivering care to these complex patients."

The collaboration will also accelerate delivery of care to underserved populations.  "A central mandate of both of our CTSI's is to improve health care for the Southern California community, and particularly to address health disparities," added Buchanan. "This initiative will enable us to address community health issues effectively."