Health Services

The mission of the Health Services Research Program is to create a scientific basis for ensuring the translation of treatments of proven efficacy into routine clinical care to benefit persons with neurologic disease in everyday/actual practice. The program's ongoing research includes development of tools to measure the quality of care and analysis of barriers to translating evidence-based treatments into routine clinical care and improved health in populations with neurologic diseases. Applying these measurement tools and new knowledge about barriers, investigators work collaboratively with health care systems and communities to design and test novel and sustainable health care interventions for their ability to improve quality and outcomes of neurologic disease care. Such interventions often involve "re-engineering" health care delivery systems and engaging providers, community agencies, and patients in new models of collaborative care. This multidisciplinary research agenda includes scientists in the areas of health services research, health economics, biostatistics, anthropology, survey research, geriatrics, psychology, and organizational behavior. Collaborating with core full-time faculty in the department are faculty and scientists from the David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, the VA Center for the Study of Healthcare Innovation, Implementation and Policy, and RAND Corporation, a private, non-profit research institute focusing on research to inform public policy.

Ongoing and recent research studies in the program include:

Secondary stroke prevention: by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED) Trial is one of three research projects of the Los Angeles Stroke Prevention/Intervention Research Program in Health Disparities (SPIRP) - a multidisciplinary, collaborative research center funded by the National Institutes of Health (NIH) (U54NS081764). The SPIRP center in one of four national centers and is a partnership of Icahn School of Medicine, UCLA, four medical centers in the Los Angeles County safety net system, Healthy African American Families, and representatives from multiple community organizations serving low-income minority communities that span the Los Angeles basin. The SUCCEED Trial creates a strong community-based component with community health workers and mobile health technology to create a full-fledged Chronic Care Model intervention that is being tested relative to usual care in 500 patients with a recent stroke seen in the Los Angeles County safety net. Having a first stroke increases the chances of having another one, and this risk is greater among racial or ethnic minorities. This study is designed to look at how the risk of recurrent stroke can be lowered by on-the-ground community health workers who make home visits and use mobile health technology to teach participants how to do such things as measure their own blood pressure, read food labels, increase their physical activity and take their medications properly. This study aims to decrease the chances of having a repeat stroke among a diverse group of adults hospitalized for a stroke in one of four Los Angeles County public health care facilities by:

• Using a “team care” approach with nurse practitioners and community health workers to help people after a stroke to change their diet, increase their physical activity and control their risk factors.
• Evaluating in a randomized trial of 500 adults with a very recent stroke, whether this new approach helps control risk factors for stroke.
• Reporting back to the community, policy makers, and researchers about health benefits and program costs.

Improving Quality and Outcomes of Care for Parkinson's Disease, funded by the Veterans Health Administration through the Parkinson's Disease Research, Education, and Clinical Center at the Greater Los Angeles VA. Through a recent VA HSR&D award, researchers in the program have launched a one-year pilot study to develop the components of a multifaceted care management intervention for Parkinson's disease (PD). The products of the pilot study will enable a subsequent large-scale randomized trial of the intervention in the VA. This initiative continues a stream of earlier research (Barbara Vickrey, PI; Eric Cheng, co-PI) to development tools to measure the quality of care of patients with Parkinson's disease (PD). In these earlier studies, a national workgroup of neurologists was engaged in a systematic process to identify quality indicators for care processes relevant to PD, employing a modified Delphi method. This approach identified 29 quality indicators as having high validity and potential value for quality improvement interventions. We applied these to investigate determinants of variations in levels of care quality for PD, based on explicit medical record review. Findings among a sample of over 400 veterans with PD were that movement disorder specialist involvement was associated with higher adherence to care quality indicators than general neurologist involvement and non-neurologist involvement for treatment of wearing-off and for assessments of falls, depression, and hallucinations. There were few disparities by race/ethnicity except for assessment of depression. We also found that a generic patient-reported outcome measure was better able to detect change over time than either of two widely-used PD-targeted measures.

Costs of Care for Multiple Sclerosis, funded by the National Multiple Sclerosis Society, Eric Cheng (PI), Andrew Wilson (co-I). Multiple sclerosis (MS) is a complex neurological disorder that can cause a wide set of symptoms. The cost-of-illness of MS is high, related to diagnostic testing, acute and long-term care, and drug prices. Persons with MS are financially vulnerable to changes in insurance and drug coverage, especially in the era of high-deductible health plans. Through analysis of the Medical Expenditure Panel Survey, investigators are examining various indicators of out-of-pocket costs to better describe the economic burden of MS and to improve understanding of how public/insurance policies can alleviate or exacerbate the financial toxicity of MS.  

Implementing and Evaluating Teleneurology Clinics, funded by the VA Office of Academic Affiliations through the National Clinician Scholars Program, Andrew Wilson (PI). Teleneurology is a complex intervention that has the promise of improving access to providers. A multidisciplinary team has prototyped a teleneurology clinic to deliver high-quality polyneuropathy care to remote areas (the tele-PN clinic).  This study is evaluating both the implementation of and clinical outcomes for tele-PN pilot clinics.  Clinical outcomes of interest include appropriate laboratory screening, patient-reported outcomes in pain interference and mobility, and utilization of healthcare services.

Secondary stroke prevention: by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED) Trial
Cheng EM, Cunningham WE, Towfighi A, Sanossian N, Bryg RJ, Anderson TL, Barry F, Douglas SM, Hudson L, Ayala-Rivera M, Guterman JJ, Gross-Schulman S, Beanes S, Jones AS, Liu H, Vickrey BG. Efficacy of a Chronic Care-Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized Controlled Trial. Circ Cardiovasc Qual Outcomes. 2018 Jan;11(1):e003228. doi: 10.1161/CIRCOUTCOMES.116.003228. PubMed PMID: 29321134

Hill VA, Vickrey BG, Cheng EM, Valle NP, Ayala-Rivera M, Moreno L, Munoz C, Dombish H, Espinosa A, Wang D, Ochoa D, Chu A, Heymann R, Towfighi A. A Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Design of Healthy Eating and Lifestyle after Stroke (HEALS). J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2806-2813. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.058. Epub 2017 Aug 16. PubMed PMID: 28823491.

Towfighi A, Cheng EM, Ayala-Rivera M, McCreath H, Sanossian N, Dutta T, Mehta B, Bryg R, Rao N, Song S, Razmara A, Ramirez M, Sivers-Teixeira T, Tran J, Mojarro-Huang E, Montoya A, Corrales M, Martinez B, Willis P, Macias M, Ibrahim N, Wu S, Wacksman J, Haber H, Richards A, Barry F, Hill V, Mittman B, Cunningham W, Liu H, Ganz DA, Factor D, Vickrey BG. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). BMC Neurol. 2017 Feb 6;17(1):24. doi: 10.1186/s12883-017-0792-7. PubMed PMID: 28166784; PubMed Central PMCID: PMC5294765.

Cheng EM, Cunningham WE, Towfighi A, Sanossian N, Bryg RJ, Anderson TL, Guterman JJ, Gross-Schulman SG, Beanes S, Jones AS, Liu H, Ettner SL, Saver JL, Vickrey BG. Randomized, controlled trial of an intervention to enable stroke survivors throughout the Los Angeles County safety net to "stay with the guidelines". Circ Cardiovasc Qual Outcomes. 2011 Mar;4(2):229-34. doi: 10.1161/CIRCOUTCOMES.110.951012. PubMed PMID: 21406671; PubMed Central PMCID: PMC3065242.

Improving Quality and Outcomes of Care for Parkinson's Disease
Connor K, Cheng E, Siebens HC, Lee ML, Mittman BS, Ganz DA, Vickrey B. Study protocol of "CHAPS": a randomized controlled trial protocol of Care Coordination for Health Promotion and Activities in Parkinson's Disease to improve the quality of care for individuals with Parkinson's disease. BMC Neurol. 2015 Dec 15;15:258. doi: 10.1186/s12883-015-0506-y. PubMed PMID: 26670300; PubMed Central PMCID: PMC4681014.

Cheng EM, Siderowf AD, Swarztrauber K, Lee M, Vassar S, Jacob E, Eisa MS, Vickrey BG. Disparities of care in veterans with Parkinson's disease. Parkinsonism Relat Disord. 2008;14(1):8-14. Epub 2007 Aug 16. PubMed PMID: 17702625.

Cheng EM, Swarztrauber K, Siderowf AD, Eisa MS, Lee M, Vassar S, Jacob E, Vickrey BG. Association of specialist involvement and quality of care for Parkinson's disease. Mov Disord. 2007 Mar 15;22(4):515-22. PubMed PMID: 17260340.