20 th Annual Management of the Hospitalized Patient Hyatt Regency - - PDF document

20th Annual Management of the Hospitalized Patient Hyatt Regency Embarcadero San Francisco, California October 20-22, 2016

Conference Chair: Robert M. Wachter, MD Professor of Medicine and Chief of the Division of Hospital Medicine; Chair, Department of Medicine, University of California, San Francisco

20th Annual Management of the Hospitalized Patient

We’re thrilled that you’re joining us for the Management of the Hospitalized Patient CME course over October 20-22, 2016 here at the Hyatt Regency Embarcadero in San Francisco. Part of what makes this course so special is that you can access the syllabus material prior to the meeting, online at the following link: http://www.ucsfcme.com/2017/MDM17P01/info.html#CourseOutline Online, you’ll find all the presentations for the October 20-22, 2016 General Sessions and workshops that we’ve received to date. Through the years, many participants have told us that they prefer online materials to lugging around a huge paper syllabus book. The website will be up before and after the conference (we’ll add more and updated presentations as they become available). Again, no paper syllabus book will be distributed on site. If you wanted paper versions of some of the session materials, we encouraged you to print them out and bring them with you; alternatively, we will have several dedicated printers available on site for printing selected presentations.

Overview:

This course, chaired by Dr. Robert Wachter, covers the clinical issues most relevant to hospitalists and

• ther clinicians who care for inpatients. Taught by UCSF's top teachers and a stellar group
• f guest faculty, the course highlights recent advances and current controversies. To promote active learning,

the course uses a computerized audience response system, and features multiple workshops in a variety

• f disciplines to allow for small group discussions. The course includes broad content in critical care,

perioperative care, patient safety, and hospital neurology, cardiology, GI, hematology, oncology, nephrology, and infectious diseases. Back by popular demand, this year’s conference was preceded by the three day Hospitalist Mini-College (October 17-19, 2016). This course is presented by the UCSF Division of Hospital Medicine and is sponsored by the Office of Continuing Medical Education, University of California, San Francisco School of Medicine. It also serves as the West Coast regional meeting of the Society of Hospital Medicine.

Objectives:

An attendee completing the Management of the Hospitalized Patient course should be able to:

• Improve diagnosis of common inpatient clinical presentations;
• Perform an evidence-based work-up for common inpatient clinical presentations;
• Apply modern therapeutic approaches to common inpatient disorders;
• More effectively respond to patients’ questions in hospital medicine using the latest clinical literature.g the

latest clinical literature.

Accreditation:

The University of California, San Francisco School of Medicine (UCSF) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Physicians: UCSF designates this educational activity for a maximum of 19.00 AMA PRA Category 1 Credit(s)

• TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurses: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credit(s) TM credit issued by organizations accredited by the ACCME. Physician Assistants: AAPA accepts category 1 credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 Credit(s) TM from organizations accredited by the ACCME.

Pharmacists: The California Board of Pharmacy accepts continuing professional education those courses that meet the standard of relevance to pharmacy practice and have been approved for AMA PRA Category 1 Credit(s) TM. Geriatric Medicine: The approved credits shown above include 6.50 credits toward meeting the requirement under California Assembly Bill 1820, Geriatric Medicine. Pain Medicine: The approved credits shown above include 2.00 AMA PRA Category 1 Credit(s) TM towards meeting the requirement under California Assembly Bill 487, Pain Management and Care for the Terminally Ill. AAFP: This live activity, 19th ANNUAL MANAGEMENT OF THE HOSPITALIZED PATIENT, with a beginning date of 10/20/2016, has been reviewed and is acceptable for up to 18.75 Prescribed credit(s) by the American Academy of Family Physicians. This CME activity meets the requirements under California Assembly Bill 1195, continuing education and cultural and linguistic competency.

Exhibitors Aguirre Healthcare Baylor Scott &White Health Boehringer Ingelheim Pharmaceuticals, Inc. CEP America Dignity Health IPC Healthcare, Inc. Janssen Pharmaceuticals Lightning Bolt Mallinckrodt NovoNordisk Otsuka America Pharmaceuticals, Inc. Pfizer Society of Hospital Medicine Sanofi-Aventis Sound Physicians Sutter Health Wolterskluwer

Federal and State Law Regarding Linguistic Access and Services for Limited English Proficient Persons I. Purpose. This document is intended to satisfy the requirements set forth in California Business and Professions code 2190.1. California law requires physicians to obtain training in cultural and linguistic competency as part of their continuing medical education programs. This document and the attachments are intended to provide physicians with an overview of federal and state laws regarding linguistic access and services for limited English proficient (“LEP”) persons. Other federal and state laws not reviewed below also may govern the manner in which physicians and healthcare providers render services for disabled, hearing impaired or other protected categories II. Federal Law – Federal Civil Rights Act of 1964, Executive Order 13166, August 11, 2000, and Department of Health and Human Services (“HHS”) Regulations and LEP Guidance. The Federal Civil Rights Act of 1964, as amended, and HHS regulations require recipients of federal financial assistance (“Recipients”) to take reasonable steps to ensure that LEP persons have meaningful access to federally funded programs and

• services. Failure to provide LEP individuals with access to federally funded programs and services may constitute national
• rigin discrimination, which may be remedied by federal agency enforcement action. Recipients may include physicians,

hospitals, universities and academic medical centers who receive grants, training, equipment, surplus property and other assistance from the federal government. HHS recently issued revised guidance documents for Recipients to ensure that they understand their obligations to provide language assistance services to LEP persons. A copy of HHS’s summary document entitled “Guidance for Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons – Summary” is available at HHS’s website at: http://www.hhs.gov/ocr/lep/ . As noted above, Recipients generally must provide meaningful access to their programs and services for LEP persons. The rule, however, is a flexible one and HHS recognizes that “reasonable steps” may differ depending on the Recipient’s size and scope of services. HHS advised that Recipients, in designing an LEP program, should conduct an individualized assessment balancing four factors, including: (i) the number or proportion of LEP persons eligible to be served or likely to be encountered by the Recipient; (ii) the frequency with which LEP individuals come into contact with the Recipient’s program; (iii) the nature and importance of the program, activity or service provided by the Recipient to its beneficiaries; and (iv) the resources available to the Recipient and the costs of interpreting and translation services. Based on the Recipient’s analysis, the Recipient should then design an LEP plan based on five recommended steps, including: (i) identifying LEP individuals who may need assistance; (ii) identifying language assistance measures; (iii) training staff; (iv) providing notice to LEP persons; and (v) monitoring and updating the LEP plan. A Recipient’s LEP plan likely will include translating vital documents and providing either on-site interpreters or telephone interpreter services, or using shared interpreting services with other Recipients. Recipients may take other reasonable steps depending

• n the emergent or non-emergent needs of the LEP individual, such as hiring bilingual

staff who are competent in the skills required for medical translation, hiring staff interpreters, or contracting with outside public or private agencies that provide interpreter services. HHS’s guidance provides detailed examples of the mix of services that a Recipient should consider and implement. HHS’s guidance also establishes a “safe harbor” that Recipients may elect to follow when determining whether vital documents must be translated into other languages. Compliance with the safe harbor will be strong evidence that the Recipient has satisfied its written translation obligations. In addition to reviewing HHS guidance documents, Recipients may contact HHS’s Office for Civil Rights for technical assistance in establishing a reasonable LEP plan. III. California Law – Dymally-Alatorre Bilingual Services Act. The California legislature enacted the California’s Dymally-Alatorre Bilingual Services Act (Govt. Code 7290 et seq.) in

• rder to ensure that California residents would appropriately receive services from public agencies regardless of the person’s

English language skills. California Government Code section 7291 recites this legislative intent as follows: “The Legislature hereby finds and declares that the effective maintenance and development of a free and democratic society depends on the right and ability of its citizens and residents to communicate with their government and the right and ability

• f the government to communicate with them.

The Legislature further finds and declares that substantial numbers of persons who live, work and pay taxes in this state are unable, either because they do not speak or write English at all, or because their primary language is other than English, effectively to communicate with their government. The Legislature further finds and declares that state and local agency employees frequently are unable to communicate with persons requiring their services because of this language barrier. As

a consequence, substantial numbers of persons presently are being denied rights and benefits to which they would otherwise be entitled. It is the intention of the Legislature in enacting this chapter to provide for effective communication between all levels of government in this state and the people of this state who are precluded from utilizing public services because of language barriers.” The Act generally requires state and local public agencies to provide interpreter and written document translation services in a manner that will ensure that LEP individuals have access to important government services. Agencies may employ bilingual staff, and translate documents into additional languages representing the clientele served by the agency. Public agencies also must conduct a needs assessment survey every two years documenting the items listed in Government Code section 7299.4, and develop an implementation plan every year that documents compliance with the Act. You may access a copy of this law at the following url: http://www.spb.ca.gov/bilingual/dymallyact.htm Cultural Competency and CME January 2006 With the passage of Assembly Bill 1195, physicians licensed in California must incorporate cultural competency and linguistics into their continuing medical education program of study. The bill, which goes into effect on July 1, 2006, was designed to encourage physicians, surgeons, and CME providers to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. AB 1195 differs from both the pain and geriatric legislation by not requiring the completion of a set number of credits in a given time period. There are three principle ways that a CME provider may satisfy the requirement to offer educational activities under the new law. A provider may address both the cultural competency and the linguistic aspects or just one of

• them. Following are the key ways a CME program can include relevant content consistent with AB 1195.
• 1. To address cultural competency, defined as a set of integrated attitudes, knowledge, and skills that enables health care

professionals to care effectively for patients from diverse cultures, groups, and communities, a CME provider may offer specifically designed and focused activities. At a minimum such activities would include these four elements:

• A. Applying linguistic skills to communicate effectively with the target population
• B. Utilizing cultural information to establish therapeutic relationships
• C. Eliciting and incorporating pertinent cultural data in diagnosis and treatment
• D. Understanding and applying cultural and ethnic date to the process of clinical care

OR

• 2. To address linguistic competency, defined as the ability of a physician or surgeon to provide patients who do not speak

English or who have limited ability to speak English, direct communication in the patient’s primary language, a CME provider may incorporate translation/interpretation resources and/or strategies into materials for a CME activity. OR

• 3. A CME provider may incorporate a review and explanation of relevant federal and state laws and regulations regarding

linguistic access. The UC CME Consortium is working with UC’s legislative analyst to develop resources for inclusion in activity materials for the five CME programs within the UC system. Once the materials are available, they will be distributed to course chairs, program representatives, grand rounds coordinators, and other interested constituents. They will also be posted to our website. For answers to questions you may have about AB 1195, please contact the Office of CME at 415.476.4251

COURSE CHAIR Robert M. Wachter, MD Professor of Medicine; Chief of the Division of Hospital Medicine; Chair, Department of Medicine, University of California, San Francisco KEYNOTE SPEAKER Mark D. Smith, MD, MBA Founding CEO, California HealthCare Foundation; Clinical Professor of Medicine, UCSF; Visiting Professor, UC Berkeley School of Public Health GUEST FACULTY Scott A. Flanders, MD Professor and Director, Hospitalist Program; University of Michigan, Ann Arbor, MI Robert W. Lash, MD Professor of Medicine; Director, Clinical Foundations of Medicine; University of Michigan, Ann Arbor, MI Ronald Witteles, MD Associate Professor of Medicine, Division of Cardiovascular Medicine; Program Director, Internal Medicine Residency, Stanford University School of Medicine, Stanford, CA COURSE FACULTY (University of California, San Francisco, School of Medicine) Nima Afshar, MD Associate Professor of Medicine, San Francisco VA Medical Center Jennifer Babik, MD, PhD Assistant Professor of Medicine, Division of Infectious Diseases

• H. Quinny Cheng, MD

Professor of Medicine; Medical Director, Medicine Consultation Service and Neurosurgery Co-Management Service Gurpreet Dhaliwal, MD Professor of Medicine; Medicine Clerkship Site Director, San Francisco VA Medical Center Brett M. Elicker, MD Associate Professor of Radiology; Chief, Cardiac & Pulmonary Imaging Andrew Gross, M D Associate Professor of Medicine, Division of Rheumatology; Chief, Rheumatology Clinic Bilal Hameed, MD Assistant Professor of Medicine, Division of Gastroenterology Hepatology Section Gerald Hsu, MD, PhD Assistant Professor of Medicine, San Francisco VA Medical Center Trevor Prosch Jensen, MD Assistant Professor of Medicine, Division of Hospital Medicine

• S. Andrew Josephson, MD
• C. Castro-Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor and Senior

Executive Vice Chair, Department of Neurology

Dhruv Kazi, MD, MS Assistant Professor of Medicine, Zuckerberg San Francisco General Lorriana E. Leard, MD Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine; Associate Director Pulmonary and Critical Care Medicine Fellowship Andrew D. Leavitt, MD Professor of Medicine (Hematology) and of Laboratory Medicine; Medical Director, UCSF Adult Blood and Marrow Transplant Laboratory Bradley Monash, MD Assistant Professor of Medicine and Pediatrics; Associate Chair of Medicine Service Tracy Minichiello, MD Professor of Medicine; Chief, Anticoagulation and Thrombosis Service, San Francisco VA Medical Center Steven Z. Pantilat , MD Professor of Medicine, Alan M. Kates and John M. Burnard Endowed Chair in Palliative Care; Director, Palliative Care Leadership Center; Medical Director, Palliative Care Service Lekshmi Santhosh, MD Clinical Fellow, Pulmonary and Critical Care Medicine Bradley A. Sharpe, MD Professor of Medicine; Associate Chief, Division of Hospital Medicine; Associate Program Director Internal Medicine Residency Program Jonathan P. Terdiman, MD Professor of Medicine and of Surgery; Clinical Director, Colitis and Crohn’s Disease Center Director, Hereditary Gastrointestinal Cancer Prevention Program; Program Director, Gastroenterology Fellowship Training Program

Disclosures: The following faculty speakers, moderators, and planning committee members have disclosed they have no financial interest/arrangement or affiliation with any commercial companies who have provided products or services relating to their presentation(s) or commercial support for this continuing medical education activity:

Nima Afshar, MD Jennifer Babik, MD, PhD

• H. Quinny Cheng, MD

Kerry Cho, MD Gurpreet Dhaliwal, MD Vanja C. Douglas, MD Brett M. Elicker, MD Scott A. Flanders, MD Bilal Hameed, MD Gerald Hsu, MD, PhD Trevor Prosch Jensen, MD

• S. Andrew Josephson, MD

Dhruv Kazi, MD, MS Lorriana Leard, MD Andrew D. Leavitt, MD Tracy Minichiello, MD Bradley Monash, MD Steven Z. Pantilat, MD Lekshmi Santhosh, MD Bradley A. Sharpe, MD Jonathan P. Terdiman, MD

The following faculty speakers have disclosed a financial interest/arrangement or affiliation with a commercial company who has provided products or services relating to their presentation(s) or commercial support for this continuing medical education activity. All conflicts of interest have been resolved in accordance with the ACCME Standards for Commercial Support:

Bilal Hameed, MD Grant/Research Support Gilead Robert W. Lash, MD Consultant Express Scripts Robert M. Wachter, MD Advisor/Reviewer Patient Safe Solutions Early Sense SmartPatients Shareholder Amino.com Accuity Medical Management Twine Health Board Member CareWeb Ronald M. Witteles, MD Grant/Research Support Alnylam Pharmaceuticals Pfizer

This UCSF CME educational activity was planned and developed to: uphold academic standards to ensure balance, independence,

• bjectivity, and scientific rigor; adhere to requirements to protect health information under the Health Insurance Portability and

Accountability Act of 1996 (HIPAA); and, include a mechanism to inform learners when unapproved or unlabeled uses of therapeutic products or agents are discussed or referenced. This activity has been reviewed and approved by members of the UCSF CME Governing Board in accordance with UCSF CME accreditation policies. Office of CME staff, planners, reviewers, and all others in control of content have disclosed no relevant financial relationships.

ATIENT

SAVE THE DATE: The 2017 dates have been set for the following: October 16-October 18, 2017: Hospitalist Mini College (UCSF Parnassus Campus) October 19-October 21, 2017: Management of the Hospitalized Patient (Hyatt Regency Embarcadero)