Maria Raven, MD, MPH

Inspiration

Doctors often express frustration with the revolving door of medicine, and emergency department (ED) providers are at its center. We know that our patients need long-term supports to foster health, but the current structure of and areas of investment in our health and social care delivery system can make this difficult. I did my emergency medicine residency and a research fellowship in New York City at NYU Langone/Bellevue Hospital Center. It was clear to me that an ED visit can be an opportunity for interventions outside of only health care for patients. There, I oversaw one of six New York State Department of Health-funded Chronic Illness Demonstration Projects, which allowed me to explore institutional barriers to obtaining health care and other resources vulnerable patients need, and how to mitigate them. For example, we established data sharing agreements that allowed for information exchange between the public hospital system and multiple homeless services agencies, and our program staff followed patients across systems of care, from the ED or hospital to the shelter, street, or supportive housing unit. Identifying and lowering policy barriers is rewarding because it allows everyone in the system to function in a more coordinated manner, with the patient at the center.  

Impact

Since coming to UCSF in 2011, I have worked to investigate how frequent users of the health and social care system, many of whom have multiple unmet social needs, use health and community based services. I have also continued to develop, implement, and evaluate programs to address this population’s unmet needs. Because of some of this research, colleagues and I have been able to inform SFDPH policies related to care provision for the most frequent users in San Francisco city and county.  

Strategies

  • Publish in peer-reviewed journals: disseminate research findings, review existing literature, and write opinion pieces and editorials to help establish your expertise.
  • Based on the evidence we developed in the Whole Person Care pilot, we presented our findings and made recommendations to county public health and government leaders as physicians and researchers, to push forward policy changes.
  • Work with organizations focused on similar populations and partner on research: I worked for several years with the San Francisco Health Plan to develop and implement programs to care for their highest frequency members, and collaborated with the Health Plan on research.
  • Serve as advisory and specialty organization board members in order to advocate, affect policy and legislation, and disseminate data. I was on the Board for Collective Medical, and on the Board of Directors for the California chapter of the American College of Emergency Physicians (ACEP).
  • I am on the volunteer advisory board for collective medical and was on the BOD for CA chapter of the American college of emergency physicians (ACEP)
  • Lead efforts to implement change in the acute care system to address social needs (both EDIE program at UCSF; the Whole Person Care project; work with ACEP and SAEM as a leader in their sections/interest groups on Social EM).

Timeline

I am a practicing emergency medicine physician and health services researcher. I am also the Chief of Emergency Medicine at UCSF and a Vice Chair in the UCSF Department of Emergency Medicine. Prior to joining the UCSF faculty in 2011, I completed my residency and a research fellowship at NYU/Bellevue Hospital Center and oversaw one of six New York State Department of Health-funded Chronic Illness Demonstration Projects for the New York City Health and Hospitals Corporation and New York State Medicaid.

In addition to working clinically in the ED at UCSF, I speak locally, and nationally, about caring for complex populations, frequent emergency department users, and the link between homelessness and health. I have published and peer-reviewed extensively on these and other topics. I am co-PI for the San Francisco Whole Person Care Pilot evaluation, which focuses on improving care for chronically homeless high users of health and social care services. I lead the EDIE (emergency department information exchange) program in the UCSF ED. I am also the lead evaluator for a Santa Clara County Pay for Success program, providing permanent supportive housing for chronically homeless frequents users of the County health system and jail. I will be the co-editor of a forthcoming Social Emergency Medicine textbook and is currently working on multiple initiatives to improve care for individuals with substance use disorders in emergency departments. 

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