Elimination of Race Based Reference Ranges

Nomination Highlights:

  • UC Davis Health has been an early leader in removing disparities and improving kidney care for all through the elimination of race-based reference ranges for estimated glomerular filtration rate (eGFR). Our approach to the change has served as a model for others. Race-based reference ranges have created concerns re: miscalculation of eGFR among African-American patients that can lead to differences of treatment, potentially including transplant eligibility, which can cause harm.
  • Medical students first brought this issue to light in Fall 2020 when students noted and questioned this long-standing reference range during teaching rounds, and drew attention to potential disparities in eligibility for renal transplantation and other treatments that such a reference range can create. These challenging and insightful questions from students prompted attending faculty member Rachael Lucatorto, M.D. to bring this issue to the attention of the Office of DEI and to the Department of Pathology and Laboratory Medicine and Internal Medicine's Division of Nephrology, who came together as a team to examine this issue.
  • UC Davis Health's multi-year multi-disciplinary team-based project provided data that recently culminated during the 2022-23 academic year. Not only were race-based reference ranges for eGFR lab test eliminated, a new better eGFR equation has been implemented that includes the newly introduced cystatin C test.
  • The work from our team has contributed to more objective, evidence based decision-making for patients with chronic kidney disease and has made UC Davis Health among the first to implement changes which align with the recommendations from the National Kidney Foundation (NKF) and American Society of Nephrology's Joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease.

Behavioral Escalation Support Team (BEST) – Psychiatric Nurse Practitioners Sharon Demeter and Jessica Vetter were recognized for developing and launching the BEST program.

BEST is a rapid response team that responds immediately to help support individuals experiencing a behavioral crisis in the hospital. The team is composed of a diverse group of clinical staff, including psychiatric nurse practitioners, lift team supervisors and mental health workers. The BEST team is grounded in the principles of recovery oriented, trauma informed, person centered care of the individual experiencing a temporary loss of behavioral control or an overwhelming emotional state.

Following a successful trial program from 2020 to 2021, UC Davis Health expanded BEST to increase access to this innovative care delivery model. To date, more than 120 discrete patients have been served by the BEST team. The comprehensive multidisciplinary team rapidly assesses the situation and facilitates any necessary clinical services to help address the patient’s needs (e.g., substance use navigators, social services support, rapid response, pharmacy or medical consultants) in a culturally sensitive and compassionate manner.

  • Tonya Fancher, M.D., M.P.H, and team members including Mustafa Shakir, Joshua Campista, Neha Mannikar, Omar Escobedo, and Brenden Tu, M.D., M.S..

In response to the COVID-19 pandemic, Tonya Fancher worked collaboratively with medical students, faculty, volunteer clinical faculty, undergraduates and staff to establish a protocol for a pilot clinic for the student-run clinics program that enabled the Shifa Clinic to re-open its doors and provide much needed in-person visits for underserved community members. The pilot clinic became a central hub for all the student-run clinics to refer patients. Physicians and students from the other clinics also volunteered at the pilot clinic, making it an effective collaborative effort to improve the health of the community during the pandemic.

SEED: Supporting Educational Excellence in Diversity Team (Education/Teaching)

  • Puja Chadha, M.D. (team leader)
  • Kupiri Ackerman-Barger, Ph.D., R.N.
  • Hana Anderson, Ph.D.
  • Joanna Arnold, Ph.D.
  • Alejandra Beristain-Barajas, M.D. Candidate 2021
  • Michael Donath, M.D.
  • Jeffrey Duong, Ph.D.
  • Ruthie Gordon, M.D.
  • Shea Hazarian
  • Rebecca Jorrin, M.S.
  • Esther Kang, M.D. Candidate 2021
  • Kevin Nguyen, M.D.
  • Swati Rao, M.D.
  • Erica Thomas, M.D.
  • Yoongi Tom, M.D.
  • Hendry Ton, M.D., M.S.

The SEED team lead exemplifies the spirit and the impact consistent with the intent of the Team Award for Inclusion Excellence in Education/Teaching. This content was developed as a joint effort across the UC Davis offices of Health Equity, Diversity and Inclusion, Office of Medical Education, and Faculty Development and employs the flipped classroom model to bring educators into a safe domain to develop and practice skills that are critical across the health system domains from the classroom to the clinic. SEED is active learning at its best and providing UC Davis Health educators with badly needed tools to engage with and be effective in an increasingly diverse environment. The sparkle of the program is its commitment to inclusive practice to recognize and solve problems and manage conflict. The impact of the program can’t be underestimated at a system level, but its demand from individual units is also an indicator of the importance and strengths of SEED.

Diversity and Inclusion Dialogue Series (Community Engagement)

  • Adrienne Lawson, Ed.D. (team leader)
  • Marian Brotzman
  • Jacqueline Dyson
  • Richard Falcon
  • Shawn Hadnot
  • Art Hernandez, R.N.
  • Khoban Kochai, M.P.H.
  • Mercedes Piedra, M.S.
  • Octavio Romero, Jr.
  • Annie Ngo Tat, R.N.
  • Hendry Ton, M.D., M.S.
  • Angela Velazquez Wallace

The Diversity and Inclusion Dialogue Series was established as a subcommittee of the Staff Advisory Committee for Equity, Diversity and Inclusion in 2015. Utilizing the Principles of Community as a framework, the Diversity and Inclusion Dialogues are intended to bring the UC Davis Health community (staff, faculty, students, patients, visitors and community members) a range of opportunities to engage in conversations around topics of diversity of inclusion in a safe and welcoming space.

UC Postbaccalaureate Program (Community Engagement)

  • José Morfín, M.D., F.A.S.N. (team leader)
  • Olivia Campa, M.D.
  • Arra Jane Concepcion, B.A.
  • Patricia González, M.A., Ed.D
  • Charlene Green, M.A., L.M.F.T.
  • Mary Rose Saint-Cyr, M.S.
  • Amy Whitcomb, M.S., M.F.A.

The UC Postbac Program has impacted the lives of many students from diverse backgrounds over the past 28 years, helping them overcome barriers to admission to medical school. The team’s commitment to diversity and inclusion is exemplified in the School of Medicine’s Postbac Program’s alumnae who have provided medical care to underserved communities throughout the United States.

Center for Reducing Health Disparities (CHRD) Team (Community Engagement)

The Center for Reducing Health Disparities (CHRD) team works at every level to advance health equity through community-partnered collaborations. Members of the CHRD team lead a five-year project to improve the Solano County Department of Health and Social Services systems to address the cultural and linguistic needs of immigrant communities. The team also leads the California Reducing Disparities Project (CRDP) program aimed at improving mental health of underserved communities and actively participates in developing community-defined evidence to improve health equalities for the communities they currently serve.

This team is actively involved in agencies and organizations that serve the LGBTQ, underserved Latino and Filipino communities to address utilization barriers in public health. The team also promotes dialogue and social justice through the Racial Healing Project, providing a safe space for communities to embrace the value of diversity and inclusion utilizing the Truth, Racial Healing, and Transformation Implementation Guide (Kellog Foundation). They actively partner with community based organizations such as Solano Pride, Rio Vista Care, and Fighting Back Partnership in Solano County to expand inclusive medical services and education needed to make the most vulnerable populations stronger, better served, and hopeful.

Office of Medical Education (OME) Team (Community Engagement)

The Office of Medical Education team works at every level recognizing, addressing, and impacting the reduction of health-care inequities. They use every element of the UC Davis Health to improve community health believing that quality health care is essentially a function of economic and social determinants. Then they develop systems such as using holistic admissions and pipeline programs to ensure that these disparities in society are addressed. Active members of the OME team, students are directed toward programs such as One Health, Student Run Clinics, community education, and then actively participate in every element of the community from coat and food drives to advocating for decreasing disparity by increasing diversity and inclusion.

Office of Medical Education students, staff, faculty and leadership are actively involved in agencies and organizations that serve the Underrepresentated in Medicine (URM) populations participating in outreach and pipeline programs, community service through Student Run Clinics, and fundraising efforts as well as giving through organizations. They actively promote expanding services to be inclusive of the excellent medical care and education needed to make the most vulnerable populations stronger, better served and hopeful. Also, OME never ceases to look for new opportunities to work in public policy forums and recruit the best and brightest individuals from all walks of life and backgrounds to serve on community committees moving the mission of UC Davis Health forward.

Women’s Careers in Biomedical Sciences (Research)

This team’s work has developed best practices, contributed to a doubling of the % of women faculty in the health sciences, and positioned our Women in Medicine and Health Sciences (WIMHS) program as an American Association of Medical Colleges (AAMC) national leader. This research team successfully obtained one of only 14 National Institutes of Health (NIH) RO1 grants on women’s careers in biomedical sciences, and one of only four grants from the ACE/Sloan Foundation. In the past six years they published eight original research manuscripts (plus two more submitted papers) in high visibility journals, including an ‘innovation’ description of WIMHS. 

On the health sciences campus the team has worked with multiple groups and units including the Council of Chairs, the Council of Managers, Departments, Clinical and Translational Science Center (CTSC), Building Interdisciplinary Research Careers in Women’s Health (BIRCWH), American Medical Women's Association (AMWA), and the UC Davis Health Mentoring Academy. They have engaged CBS and UC Davis School of Veterinary Medicine in research, as non-health science and health science comparator schools, respectively, and UC Davis ADVANCE and Center for Advancement of Multicultural Perspectives on Science (CAMPOS) programs. They serve as mentors/role models for undergraduate/graduate students and faculty including an 18-month WIMHS mentoring opportunity.

Smoking Cessation Team (Clinical Care)

Tobacco is the leading preventable cause of death and disability, and Sacramento has a higher smoking prevalence rate (18%) than the state. This multidisciplinary team of health professionals and staff has been key in improving how UC Davis Health identifies and assists current or passive smokers in the outpatient and inpatient setting. The signature accomplishment of this team, lead by Dr. Elisa Tong, is developing the state's first direct eReferral to the California Smokers' Helpline, which offers free evidence-based telephone counseling in multiple languages. This has been shared with the other 4 UC medical centers who are now live. Other accomplishments include initiating electronic medical record modifications that promote assistance with medications and counseling, a tobacco cessation counseling protocol for pharmacy students on the medicine ward teams, and comprehensive patient education materials. Developments initiated from this team have been a model for other UC medical centers to adopt systems change more rapidly

Promoting Inclusion, Cognitive Diversity and Health Equity through Faculty Development Team (Education)

Dr. Debra Bakerjian and Dr. Kupiri Ackerman-Barger have made an outstanding contribution to the Betty Irene Moore School of Nursing and the School of Medicine through a faculty development series titled, Promoting Inclusion, Cognitive Diversity and Health Equity through Faculty Development. These two faculty members designed, coordinated, implemented, and co-presented this faculty development series which provided faculty with in-depth learning opportunities to explore both personal and professional perspectives on important topics related to diversity and inclusion: micro-aggressions, unconscious bias, stereotype threat, privilege and inequity in education and health care.

Promoting Inclusion, Cognitive Diversity and Health Equity through Faculty Development was developed to provide learning activities to enhance the ability of a multidisciplinary group of healthcare educators to increase workforce diversity and promote health equity. The structure of the series included self-directed learning modules housed in a learning management system accompanied by quarterly face-to-face workshops over a ten month period of time. The series included an interprofessional cadre of experts, both internal and external, who were able to provide a wide range of content expertise as well as underscore the importance of interprofessional collaboration, respect and humility that are essential for bringing up the next generations of health care professionals. There were over 40 faculty multidisciplinary participants (including but not limited to fields of nursing, physician assistant, medicine, public health, psychology, sociology, and) who teach nurse practitioner, physician assistant, registered nurse and medical students.