Program Development Award
This award celebrates the innovation and collaboration that are foundational to the success of UT Southwestern Medical Center. It recognizes a group of clinical faculty and staff who have partnered to create, develop, and sustain an innovative program that significantly advances our ability to improve patient care.
Cystic Fibrosis and Bronchiectasis Program
Extending Maternal Care After Pregnancy (eMCAP)
Cystic Fibrosis and Bronchiectasis Program
Raksha Jain, M.D.
Professor of Internal Medicine
Pulmonary and Critical Care Medicine
The Cystic Fibrosis and Bronchiectasis Program at UT Southwestern Medical Center is among the top cystic fibrosis centers in the country, providing comprehensive care for a complex disease and cutting-edge research that has led to a breakthrough drug.
Cystic fibrosis (CF), a lifelong condition caused by one or more genetic mutations, is often thought of as a lung disease, but CF causes multiple other problems as well, including liver disease, digestive system disease, repeated infections, diabetes, and osteoporosis.
The UT Southwestern Cystic Fibrosis and Bronchiectasis Program leads treatment on all these issues.
“We don’t just take care of patients’ lungs,” said Dr. Raksha Jain, Medical Director of the program. “We take care of their sinuses, their pancreatic and digestive problems, and their diabetes with help from our multidisciplinary CF team. We follow these patients for years and meet their families. We know where they go to school and whom they marry. We really grow to know and care about our patients’ lives tremendously.”
The UT Southwestern Cystic Fibrosis Program is accredited by the Cystic Fibrosis Foundation, which has rigorous requirements for care. It is the only program in Dallas to meet this standard.
One key aspect of the Cystic Fibrosis and Bronchiectasis Program is transitioning patients from pediatric to adult care. At one time, few people with cystic fibrosis lived beyond their teens. The prognosis for some with CF is no longer so dire and moving them smoothly from pediatric clinics to adult clinics is essential. The adult and pediatric CF care teams work closely together with a formal transition program to ensure the process is coordinated.
In a setting like the Adult Cystic Fibrosis clinic, it is impossible to separate clinical care from clinical research. Not only does a vibrant research program offer patients opportunities to participate in clinical trials, but such trials have led to breakthroughs in treatment for many people with CF.
Dr. Jain was co-Principal Investigator of an international clinical trial that led to such a breakthrough. This landmark research tested a pill combining three first-in-kind drugs on cystic fibrosis patients with a mutation in a particular segment of a gene. In the trials, the drug was found to significantly improve lung function, quality of life, and respiratory symptoms. The U.S. Food and Drug Administration approved elexacaftor/tezacaftor/ivacaftor (Trikafta) in 2019. With 90% of cystic fibrosis patients having a gene mutation that allows them to be eligible for this therapy, Trikafta is a significant development for people with CF. Dr. Jain was the senior and corresponding author on the resulting paper, which appeared in the New England Journal of Medicine in 2019 and is now a “Highly Cited Paper,” according to the Web of Science platform.
Another standout element of the UTSW Cystic Fibrosis and Bronchiectasis Program is its ongoing effort to improve quality, wrote a faculty nominator. “The clinic keeps a database and adds to the national registry to keep track of clinical metrics. A unique feature of the quality improvement initiative is a patient advisory committee that meets monthly to provide input.” The patient population at the clinic doubled between 2010 and 2017, and from 2017 to 2022, that number doubled again, as patients from outside the Dallas area sought to be a part of the nationally recognized program.
The CF clinic won UT Southwestern Team Excellence Awards twice and a Quality Care award in 2019. Nationally, the program won a Quality Improvement Care Award from the Cystic Fibrosis Foundation in 2018.
In their words: Our Cystic Fibrosis and Bronchiectasis team is honored to receive this recognition. We have an amazing group of multidisciplinary providers, including respiratory therapists, dietitians, and social workers, dedicated to caring for this population with a rare and often debilitating illness. We are proud to work hand in hand with our Pediatrics and Internal Medicine colleagues to provide care throughout the life span and ensure a smooth transition from pediatric to adult providers. We focus on quality improvement and collaborate with a patient and family advisory board to continuously reassess our processes and evolve to meet the needs of our patients. Research and therapeutic development are also central to our philosophy of care. We have participated in over 70 clinical trials for people with CF and remain at the forefront of critical interventions, which now include gene therapy, to help our patients live longer and healthier lives. This all translates to a holistic approach of caring for and treating CF and bronchiectasis, and it certainly takes a village of amazing people to provide this type of holistic care.
Extending Maternal Care After Pregnancy (eMCAP)
David B. Nelson, M.D.
Associate Professor of Obstetrics and Gynecology
Division Chief, Maternal-Fetal Medicine, UT Southwestern
Medical Director, Maternal-Fetal Medicine, Parkland Health
Maternal care tends to focus on keeping pregnant individuals and their infants safe up to and during delivery. But what about after a baby is born? More than 800 pregnant and postpartum patients die each year in the U.S. from pregnancy-related complications, and a disproportionate number are non-Hispanic Black individuals.
These grim statistics were addressed in 2022 by Vice President Kamala Harris in the White House Blueprint for Addressing the Maternal Health Crisis. It called for improved access to postpartum care, data collection systems, and an assessment of social determinants of health.
This wasn’t a call to action for UT Southwestern Medical Center and Parkland Health, though, as they were already leading the way with the innovative extending Maternal Care After Pregnancy (eMCAP) program, launched in October 2020.
Based on local initiatives identified in Dallas County’s 2019 Community Health Needs Assessment, the eMCAP program offers social services and patient care to postpartum patients with limited resources. It also targets gaps in screening and improves follow-up rates through virtual postpartum care, embedded community health workers, home blood pressure cuffs linked to a mobile unit, and standardized screening for mental health disorders and substance use disorders.
“The eMCAP program is novel and unlike any other postpartum care program in the United States,” said one person who nominated eMCAP for the Program Development Award.
More than 3,000 patients who would not have received postpartum care beyond six weeks after delivering babies at Parkland Memorial Hospital have enrolled in the one-year program. Potential patients complete a needs assessment. If they qualify, they are enrolled in Dallas Healthy Start, an eMCAP partner using community health workers to provide Medicaid access, well-baby care, and car seat distribution. Hope Supply Co., another eMCAP partner, provides diapers, wipes, and hygiene kits.
Enrollees who have acute or chronic medical conditions are visited in their homes by a nurse or seen at a mobile clinic staffed by an Advanced Practice Registered Nurse (APRN), social worker, and pharmacist.
Virtual provider visits are offered too; for the 15% who say they do not have access to Wi-Fi, audio-only visits are available.
Program data are collected and stored in a registry for analysis, and the results are impressive. Participation in follow-up visits for up to a year by patients with chronic hypertension and diabetes was significantly higher than matched controls, and 91% opted for virtual visits. Hemoglobin A1C levels were also significantly lower months later for enrollees with diabetes than for the control cases. Among participants who screened positive for anxiety and depression, 80% accepted therapeutic intervention. Of these patients, 68% received mental health counseling visits facilitated by eMCAP.
The program flexes to meet other needs too. For a patient with hearing deficits who worried that they would not hear their baby cry, the eMCAP team coordinated resources to supply hearing aids.
Post-program care is built in. After one year, enrollees who have medical comorbidities are referred for primary care to Parkland Health clinics in their communities.
A quantifiable success, the program has gained national attention. It received the Department of Health and Human Services Racial Equity in Postpartum Care Challenge Award in 2022. The program’s findings were presented in 2021 to Congress by eMCAP leader Dr. David B. Nelson, who testified before the U.S. House Committee on Oversight and Accountability. The program also received the 2022 John M. Eisenberg Local Level Innovation in Patient Safety and Quality Award from The Joint Commission and the National Quality Forum.
In March 2023, Dr. Nelson and Elaine Duryea, M.D., Associate Professor of Obstetrics and Gynecology, secured $18 million from the Patient-Centered Outcomes Research Institute to study the use of technology to improve access to maternal health care.
“The eMCAP program has established a postpartum care model to replace the typically fragmented, traditional care women receive after birth,” one nominator said.
In addition, a nominator said, the program has been presented to perinatal quality collaborative programs in other states to drive policy and practice change.
In their words: We are honored to have the extending Maternal Care After Pregnancy program recognized by our leadership and colleagues at UT Southwestern. The program is a partnership with Parkland Health to provide access to care for 12 months after birth for individuals living in areas with the highest social needs and limited access to physical clinic locations. We thank the many members of the organization and community who made this program successful. Ultimately, we believe this program serves as a demonstration project to advance health equity and reduce maternal morbidity and mortality.
