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USC Gehr Family Center for HealthSystems Science and InnovationKeck Medicine of USCA prescient perspective piece by Michael Cousineau in TheConversation in March highlighted potential challenges for homelessindividuals during the COVID-19 pandemic.Gehr faculty member Susanne Hempel completed a reporton resource allocation during a pandemic for the Agency forHealthcare Research and Quality.The Gehr team was instrumental in helping KeckMedicine of USC respond to the COVID-19 pandemicby shifting to telecare.The Gehr Center’s Todd Schneberk helped the Keck School’sHuman Rights clinic achieve new heights in 2020.ANNUAL REPORT2020-2021
TABLECONTENTSGEHROFFAMILYCENTER FOR IMPLEMENTATION SCIENCETo Our Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Norbert Gehr and David Goldstein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Vision and Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Meet Our Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Gehr Community Education Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Educational Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Health Systems Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Evidence-Based Practice Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Research and Policy Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13By the Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15The USC Gehr Center for Health Systems Science and Innovation, February 2020
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONTo Our CommunityIt has been a year like none other, both for the world at large and for the Gehr Center!Our team has stepped up to the challenge, figuring out creative ways to contribute meaningfully tothe public health response to COVID-19 through research, advocacy and innovation; continuing toadvance our non-COVID-19 related work while working largely remotely; and finding creative ways toengage trainees in these efforts.As you will see in the coming pages, our team brought the Gehr Center to new heights in 2020. Hereare a few of my favorite Gehr accomplishments this year: Michael Cousineau directed a month-long course for third year Keck medical students onCOVID-19; Todd Schneberk and Jeniffer Kim co-led the Keck School of Medicine COVID-19 advocacy workgroup; Veronica Pagan initiated a remote colorectal cancer screening program, involving mailed coloncancer screening cards, to USC Health Plan members; Carol Peden wrote a report highlighting the rapid implementation of virtual care at Keck Medicineof USC in response to the pandemic — an initiative the Gehr team was instrumental in leading; Susanne Hempel led a review for the Agency for Healthcare Research and Quality on resourceallocation during a pandemic; Our team developed a COVID-19 patient self-assessment tool that has now been used by nearly600,000 people worldwide.We are ever-grateful to our benefactor, Mr. Norbert Gehr, and the Gehr Family Foundation,directed by Mr. David Lifschitz, whose support makes our work possible. We also keep our founder,David A. Goldstein, MD, close in our thoughts and continue to be guided by his vision. We alsothank Keck Medicine of USC, which continues to fund a significant portion of our work. Finally, a bigthanks to our administrative assistant, Drizelle Baluyot, who holds our team together!Michael Hochman, MD, MPHGehr Center Director3
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONNorbert GehrNorbert Gehr arrived in New York City from Brazil in July 1960 as a teenager, with the dreamof success and a few hundred dollars. He travelled to Southern California, where he took upresidency and attended Santa Ana College and UCLA. In 1965, at age 24, Mr. Gehr pursuedhis dream by using the modest proceeds from the sale of his car to start a small distributionbusiness, selling industrial supplies nationwide to contractors over the phone. Through hisdrive, determination, hard work and perseverance, Mr. Gehr grew his business. In 1975, Mr.Gehr established his own manufacturing facility, producing extension cords and other wire andcable products. Several years later, Mr. Gehr founded Gehr International and Gehr Development,which has become a diversified multinational holding company headquartered in Los Angeles,California. In 2016, through the Gehr Family Foundation that he established, Mr. Gehr made agenerous donation to Keck School of Medicine to establish the Gehr Family Center for HealthSystems Science & Innovation.David Goldstein, MDDavid Goldstein, MD moved from his home state of New York in 1975 to begin a nephrologyfellowship at LAC USC Medical Center. This was the start of a lifelong career at the Universityof Southern California (USC) that ultimately spanned five decades. During his historic career atUSC, Dr. Goldstein served as the founding Chief of the Division of General Internal Medicine; theVice Chair for Clinical Affairs within the Department of Medicine; the Co-Director of the PacificCenter for Health Policy and Ethics; and most recently, as the Director of Primary Care forKeck Medicine of USC. Dr. Goldstein’s impact on the Keck School of Medicine, the Departmentof Medicine, and the USC community at large was far-reaching, and was surpassed only bythe influence he had on the countless trainees and junior faculty members who were blessedto work with him during his tenure. Shortly before his retirement, and thanks to a generousdonation from Mr. Norbert Gehr, Dr. Goldstein founded the Gehr Family Center for HealthSystems Science and Innovation in 2016.Norbert Gehr4David Goldstein
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONVision And MissionVision:We advance healthcare delivery by building collaborative relationships across our campus andthe wider community. We promote high-quality, evidence-based and equitable care for allpatients in our health system, the local community, nationally, and internationally.MissionWe support multidisciplinary efforts to improve quality outcomes by accelerating the adoptionof high-value and equitable healthcare through science, advocacy and education:Delivery Science: We aim to facilitate implementation of evidence-based practices bybridging the gap between science and real-world healthcare delivery and evaluating theseefforts in real-world settings.Evidence Based Advocacy: We promote the translation of science into healthcare deliveryand policy reform by disseminating strategies for improving patient care.Education: We educate providers, policy makers and students in health systems science,and mentor future leaders. We also create a network of individuals who are interested inexchanging ideas about healthcare delivery.Learning Health System: We support continuous quality improvement and systeminnovation at Keck Medicine of USC by providing thought leadership, scholarly guidanceand technical support.Guiding Principles: Our interventions are evidence-based and aimed at improving the health of all populations,particularly vulnerable individuals, families and communities. Our innovations are sustainable in real-world settings. Efforts decrease disparities in the quality, accessibility and efficiency of care. Studies aim to maximize generalizability. Projects engage the Los Angeles community. Gehr faculty, affiliates and trainees are scholarly partners in researching and solving complexmedical cases and are policy advocates. Our work is additive to the global health databases; supporting knowledge, processes, andpolicies that will improve health globally.5
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONMeet Our TeamMichael Hochman, MD, MPHSonali Saluja, MD, MPHBarbara Turner, MDMichael Cousineau, DrPHRusha Modi, MD, MPHAlbert Farias, PhDCameron Kaplan, PhDSusanne Hempel, PhDTodd Schneberk, MDDirectorUSC Gehr Family Center for HealthSystems Science and InnovationKeck Medicine of USC6
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONMeet Our TeamCarol Peden, MD, MPHAlissa Maier, MPHVeronica Pagán, MA, MPHJeniffer Kim, PhD, MPHLourdes MontanoProgram and Grants AdministratorDrizelle BaluyotAdministrative AssistantUSC Gehr Family Center for HealthSystems Science and InnovationKeck Medicine of USCAneesa MotalaProgram Administrator7
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATION COMMUNITY EDUCATION GEHREVENTSKaty ButlerThe Dream Katyof a CommonButler LanguageThe Dream of a Common LanguageDavid Katz, MD, MPHDavid Katz,MD, MPHMaintainingPerspectiveThrougha Pandemic:PerspectiveThe Case forTotalMaintainingThroughHarm Minimizationa Pandemic:The Case for TotalHarm Minimization “As a layperson devoted to improving communication between themedicaland nonmedicalworlds,it wascommunicationmy great pleasureand honor“As a laypersondevoted toimprovingbetweenthetospeakandat theGehr Centeras partof theGoldsteinmedicalnonmedicalworlds,it wasmyDavidgreatA.pleasureandlecturehonorseries.I didnotCenterexpectaswasdeliveringthelecture andto speakWhatat theGehrpartthatof theDavid A.GoldsteinlecturesharingWhata wonderfulwithwasmythathostsand colleagueswouldlead toseries.I did notmealexpectdeliveringthe lectureandfruitfulcollaboration,a patient-facingsharingfurthera wonderfulmeal withincludingmy hostsco-writingand colleagueswould lead toarticleSTAT,collaboration,offering clinicallyvalid co-writingguidance ina nglanguagelay peoplethe chaoticearlydays ofinthecoronavirusarticle for epandemic.waspeoplean unexpectedblessing,windowinto thelanguage toIt layin the chaoticearlyanddaysa ofthe dedbeneficentpandemic. It wasan unexpectedblessing,andanda windowintoworkthe oftheGehr center.”Katy Butlercollaborative,innovative, -ethicallygrounded and beneficent work ofthe Gehr center.”- Katy ButlerJames Schultz, MD, MBANotLosingSchultz,Sight of HypertensionJamesMD, MBAHidingIn PlainSightWhile PivotingNot LosingSightof Hypertensionto COVID-19Hiding In PlainSight While Pivotingto COVID-19Nicole Lurie, MD, MSPHCOVID-19PreparednessandNicole Lurie,MD, MSPHResponse:ThenandNowCOVID-19 Preparedness andResponse: Then and Now GEHR ENDURINGMEDICALEDUCATIONMODULES CONTINUING Undiagnosed Hypertension:UndiagnosedHypertension:Hiding In PlainSightHiding2InHoursPlain SightHome BP Telemonitoring and Pharmacist on theHomeTelemonitoringand Pharmaciston theCare BPTeamto Improve HypertensionControl1 HourCare Team to ImproveHypertension Control2 Hours1 Hour“Being an Affiliate Member of the Gehr Center offers an invaluable opportunity for personal academic“Being an AffiliateMemberdiverseof the GehrCenter icadvancement members'perspectivescreateana richsoundingboard thatto bothadvancement members'diverseperspectivescreatea richsounding boardthat servesto bothamplify and sharpenyour work,andthe Gehr Teamoffersunparalleledopportunitiesto collaborateamplifyand sharpenyour work,andbutthesimilarGehr Teamoffersunparalleled opportunitiesto collaboratewithpartnersfrom disparatefieldsresearchinterests.”- José Luis González,MDwith partners from disparate fields but similar research interests.”- José Luis González, MD888
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONEducational ProgramsThe Gehr Student Innovators ProgramThis summer, the Gehr team sponsored and ran the fifth annual programfor health professional students. As part of the 6-week program, eachstudent develops a health systems science project under the mentorshipof a Gehr faculty member. Students also receive health systems sciencedidactics and learn about pathways for healthcare leadership. We had14 students participate (12 USC medical and graduate students, and twoundergraduate from the SCS Noonan Scholars program for high-achievingstudents from disadvantaged backgrounds). Though this year was entirelyvirtual, students still gave the program rave reviews!“The many didactic sessions on different topics regarding health systems science was invaluable and unique tothis program.” - Brenda Gutierrez, second year Keck medical student“I liked the combination of lectures and self-directed learning. It felt effective, and efficient, and I felt like Ilearned so much more than I anticipated even though very little of it felt like work.” - Kratika Mishra, second yearKeck medical studentThe Gehr-Schaeffer Health Policy Educational SeriesIn partnership with faculty from the USC Schaeffer Center,Gehr faculty developed a 20-hour health policy curriculumtaught longitudinally to Keck Medical Stu-dents during theirfirst three years of medical school. The curriculum aims toprovide students with health policy essentials for a careerin medicine. Gehr faculty member Sonali Saluja, MD, MPH,directs the series.“The Health Systems Science curriculum has provided my peers and me comprehensive insight into how macrosystem factors influence healthcare delivery and impact the patients we see. This timely insight given ongoingdebates on healthcare reform has inspired and facilitated research projects, translated into advocacy, and madeus better prepared to enter an evolving profession.”- Neal Nathan, third year Keck medical studentThe Keck Health Policy SelectiveGehr faculty collectively teach a 6-session selective course in advanced health policy for second yearKeck medical students with an interest in health policy.“The final project was very helpful and fun, it helped me think through implications of health policies for a topicrelevant to our current times!” - PPM student99
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATION SYSTEMS HEALTHINNOVATIONSince the merger of the Center for Health Systems Innovation (CHSI) and the Gehr Center, our team continues tobe involved with improving care delivery within the Keck Medicine of USC Health System — including KeckMedical Center, which is listed among the U.S. News and World Reports’ 2020—2021 Best Hospitals Honor Roll.Below are some ongoing partnered projects involving Keck Medicine of USC.USC Perioperative Brain Health InitiativeUSC Perioperative Brain Health InitiativeThis initiative aims to develop a multidisciplinary pathway forThis initiative aims to develop a multidisciplinary pathway for olderolder surgical patients at risk for perioperative neurocognitivesurgical patients at risk for perioperative neurocognitive disorders,disorders, while also increasing knowledge of this commonwhile also increasing knowledge of this common complication. Incomplication. In the last year, the initiative evolved tothe last year, the initiative evolved to utilize telehealth to screenutilize telehealth to screen and optimize patients at risk forand optimize patients at risk for cognitive dysfunction prior tocognitive dysfunction prior to surgery. Key members of oursurgery. Key members of our team contributed to a publicationteam contributed to a publication describing the initiative:describing the initiative: Beyond Cognitive Screening: EstablishingBeyond Cognitive Screening: Establishing an Interprofessionalan Interprofessional Perioperative Brain Health Initiative. Journal ofPerioperative Brain Health Initiative. Journal of the Americanthe American Geriatrics Society, 68(10), 2359–2364.Geriatrics Society, 68(10), uroConnect is a web-based platform to build a communityof providerswho share knowledgeand best practices,developKeckNeuroConnectis a web-basedplatformtoa build anetworkof primaryofandprovidersspecialty providersthat “share”in patientcommunitywho shareknowledgeand bestcare practices,and that facilitatethe transitionof patientsbetweenandKeck anddevelopa networkof primaryspecialtycommunityproviders.This pilot5 spokesitesprovidersthat “share”ininitiativepatient engagedcare andthat facilitatetheand ansition of patients between Keck and community providers.Neurology.Basedon the successof thepilot, thehealthhasThis pilotinitiativeengaged5 spokesitesandsystemdemonstratedapprovedthe expandedthisDepartmentplatform involvingadditional Basedfinancialviability useforoftheof Neurology.departmentsand spokeofsites.on the successthe pilot, the health system has approvedthe expanded use of this platform involving additionaldepartments and spoke sites.Colorectal Cancer ScreeningColorectal Cancer ScreeningThis initiative aims to improve colorectal cancer screening rates forUSC Health Plan members, comprised of employees and theirThis initiative aims to improve colorectal cancer screeningfamilies. The main focus this year was on our mailing pilot, whichrates for USC Health Plan members, comprised of employeesallowed eligible patients to test themselves at home, maintainingand their families. The main focus this year was on our mailingpatient safety and comfort during the COVID-19 pandemic. The firstpilot, which allowed eligible patients to test themselves atphase of the pilot resulted in a 33% return rate—better than thehome, maintaining patient safety and comfort during theliterature notes for mailing programs. USC Health Plan will expandCOVID-19 pandemic. The first phase of the pilot resulted in athe program to all eligible members in 2021.33% return rate—better than the literature notes for mailingprograms. USC Health Plan will expand the program to alleligible members in 2021.1010
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATION HEALTHSYSTEMSINNOVATIONHypertensionOur team partnered with Keck Medicine of USC toHypertensiondesign and implement a Hypertension Program for USCHealth PlanfreeofofUSCcharge.In a andpilot involvingOur team partneredwithmembers,Keck Medicineto l,implement a Hypertension Program for USC Health Plan members,a teamof involvingpharmacistsand occupationalfree of charge.In a pilot100 patientswith ssure goal.blood pressure control, a team of pharmacists andbloodoccupationaltherapists helped almost 60% achieve their blood pressure goal.Enhanced Recovery After Surgery (ERAS)Enhanced Recovery After Surgery (ERAS)EnhancedRecoveryAfter isSurgery(ERAS)to is a careEnhanced RecoveryAfterSurgery (ERAS)a care pathwaypathwayto enhancepatientfor bysurgery.enhance patientreadinessfor surgery.The readinessprogram is ledKeck TheprogramisledbyKeckfacultyfromspecialtiesfaculty from specialties such as Anesthesia. The Gehr team has such asGehrteamanalyticshas supportedthis initiativesupported Anesthesia.this initiative Thethroughqualityand projectthroughqualityanalyticsmanuscriptand projectmanagement.management.An ERASimplementationis currentlyAnERASimplementationmanuscriptis currentlyunderway.underway.IHI Leadership Alliance—OVIDThe GehrCenter team helped bring Keck Medicine ofIHI LeadershipAlliance—OVIDUSC into the Institute for Healthcare Improvement’sThe Gehr Centerteam helpedbring Keckof USCtheLeadershipAlliance.The MedicineKeck teamwasintoparticularlyInstitute active in the Office Visit is A Dinosaur (OVID) workgroup,Keck team whichwas particularlyin the toOfficeVisitis A DinosaurprovidedactiveguidanceKeckMedicineof USC as it(OVID) itioned from traditional in person visits to oftelevisitsUSC as it transitionedtraditionalin person visits to televisitsduring thefromCOVID-19pandemic.during the COVID-19 pandemic.1111
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONSOUTHERN CALIFORNIA EVIDENCE REVIEW CENTERIn the last year the Southern California Evidence Review Center, a Gehr Center partner led by SusanneHempel, PhD., (program manager Aneesa Motala) has led numerous review projects, including thoselisted here.EVALUATION OF PULMONARYNODULESCARE COORDINATION ACROSSHEALTHCARE SYSTEMSQUALITY INDICATORS FORHIGH NEED PATIENTRESOURCE ALLOCATIONAND PANDEMIC RESPONSETOPICAL TREATMENTSFOR ATOPIC DERMATITISDISPARITIES ANDBARRIERS FOR PEDIATRICCANCER SURVIVORSHIPCAREEXPERT PANEL HIGHNEED PATIENTSLANDSCAPE REVIEW OFGENE THERAPYDO WOMEN AND MENRESPOND DIFFERENTLY TOALCOHOL USE DISORDERTREATMENT?TOPIC BRIEF INFANTILEEPILEPSYEVIDENCE-BASED QUALITYIMPROVEMENTSAFETY OF VACCINESRADIATION THERAPY FORBRAIN METASTASESMore information on the SouthernCalifornia Evidence Review centercan be found here:12
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONRESEARCH AND POLICY WORKLeft: An analysis led by Cameron Kaplan found thatallowing “tobacco surcharges” was associated withlower health insurance enrollment among smokers,effectively reducing access to health care for a groupwith high needs.Right: Two medical students mentored by ToddSchneberk completed a study on the harms to asylumseekers from the Migrant Protection Protocols policy,which identified risks and threats to the health of thispopulation while remaining in Mexico.Left: Michael Cousineau facilitated a class on COVID19 for 186 Keck medical students. He coordinatedwith over 55 faculty and community representativesin putting together a 4 week class on the pandemicStudents organized projects and participated in virtualdiscussions. The class was well received by studentsand faculty alike.Right: Sonali Saluja and Cameron Kaplan receivedfunding from the WM Keck Foundation to studydisparities in Los Angeles County during the COVID-19pandemic. They conducted a survey of 2000 residentsof Los Angeles County at the end of 2020 to learn moreabout race and income based disparities in vaccinehesitancy, COVID-19 testing and access to care.Left: Albert Farias was a co-investigator for theProstate Cancer Comparative Outcomes of NewConceptual Paradigms and Treatment (PC CONCEPT)study, which aims to develop a national cohort of mendiagnosed with low and intermediate risk prostatecancer to compare the rate of adverse events andquality of life among four prostate cancer treatments.Right: Jeniffer Kim analyzed and submitted an academicarticle for the Keck Street Medicine project which isdoing great work for unsheltered homeless.“It has been a rewarding experience learning about the team’s efforts and sharing theirsuccess with the academic world. “1313
USC FAMILYGEHR FAMILYCENTERFORHEALTHHEALTH SYSTEMSSCIENCE& INNOVATIONUSC GEHRCENTERFORSYSTEMSSCIENCE& INNOVATIONRESEARCH AND POLICY WORKLeft: Carol Peden is a senior editor who worked on thefourth edition of the Royal College of Anaesthestists,Quality Improvement Compen-dium, which is freelydownloadable and used not only in the UK but aroundthe world.Right: Very soon after the pandemic began, MichaelHochman partnered with Akido Labs to develop anonline patient self-assessment tool to help triage patients before they arrived at the hospital. The tool hashad nearly 600,000 unique users from across the globeand is available in English and Spanish.Left: Susanne Hempel published a report for theAgency for Healthcare Research and Quality describingbest practices for allocating resources during a publichealth crisis.Right: Mental health care for USC students transitionedrapidly during the pandemic to telehealth visits. BarbaraTurner conducted a qualitative study with her summerfel-lowship student, providing unique insights into the challenges and opportunities of virtual mental health care.“This is the first transition to a populationhealth program at Keck and it will be a novelmulti-disciplinary collaboration on campus.”Left: The creation of a formal colorectal cancerscreening program at Keck has been a key focus forRusha Modi and Veronica Pagan this year. The projectincluded the acquisition of a new piece of equipmentto read Fecal I Test (FIT) kits which allowed Keck tolaunch a screening initiative of eligible USC Health Planmembers via mail, achieving a 33% return rate.Right: In September, Alissa Maier led a training for 86Community Health Workers (CHWs) and healthcareadministra-tors on integrating CHWs into care teamsto help identify those with elevated blood pressure,and to help patients make the necessary lifestylechanges to manage their chronic conditions.1414
USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATIONUSC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE & INNOVATION BY THE NUMBERS1515
USC Gehr Family Center for HealthSystems Science and InnovationKeck Medicine of USCUSC Gehr Family Center for Health Systems Science & Innovation2020 Zonal Avenue, IRD 318Los Angeles, CA 90033323-409-3823gehrcenter.usc.edu
Michael Cousineau directed a month-long course for third year Keck medical students on COVID-19; Todd Schneberk and Jeniffer Kim co-led the Keck School of Medicine COVID-19 advocacy work group; Veronica Pagan initiated a remote colorectal cancer screening program, involving mailed colon cancer screening cards, to USC Health Plan .
