University of California, San Francisco

University of California, San Francisco Prepared: 08/20/2008

CURRICULUM VITAE

Name: Sei J. Lee, MD MAS

Position: Assistant Adjunct Professor of Medicine, Step 1 Associate Director, VA Quality Scholars Fellowship School of Medicine, Department of Medicine, Division of Geriatrics

Address: San Francisco VA Medical Center Building 1, Room 211A, Box 181G 4150 Clement Street San Francisco CA 94121 Voice: 221-4810 x4543 Fax: 750-6641 Email: [email protected]

EDUCATION:

1987-91 University of Chicago, Chicago, IL BA Chemistry 1991 University of Mississippi, Oxford, MS Teaching Cert Education 1994-95 University of California, Berkeley, CA Pre-Medicine 1995-99 University of Illinois, Rockford, IL MD Medicine, Honors 1999-00 University of California, SF, CA Intern Int Medicine, Primary Care 2000-02 University of California, SF, CA Resident Int Medicine, Primary Care 2004-06 San Francisco VA Med Ctr, SF, CA Fellow Healthcare Quality 2004-06 University of California, SF, CA MAS Clinical Research 2006-07 University of California, SF, CA Fellow Geriatrics

LICENSES, CERTIFICATION:

California Medical License: A73480 Exp 9/10 DEA Licensure: BL7205784 Exp 9/10 Internal Medicine, Board Certified: 216331 Exp 2012 Geriatric Medicine, Board Certified: 216331 Exp 2017

PRINCIPAL POSITIONS HELD:

1991-92 High School Chemistry and Physics Teacher, Clarksdale, MS 2002.4 Hospitalist Physician, Kaiser-South San Francisco 2007-present Assistant Adjunct Professor of Medicine, Step 1, UCSF

OTHER POSITION HELD CONCURRENTLY: 2007-present Associate Director, VA Quality Scholars, SFVAMC HONORS AND AWARDS:

1997 Alpha Omega Alpha 1999 King’s College (London) Scholarship 1999 Thomas Reeves Award (chosen by medical school peers as the person they would want caring for themselves or their family) 1999 Medical School Commencement Speaker

KEYWORDS/AREAS OF INTEREST:

Prognosis, mortality, risk adjustment, aging, geriatrics, functional status, quality measurement

CLINICAL ACTIVITIES:

Attending, SF VAMC Nursing Home: Care for a panel of frail geriatrics nursing home patients. (2-3 patients)

Attending, SF VAMC Medicine Wards: Help resident lead a ward team consisting of MS3, MS4, R1 and pharmacy students. Present didactic teaching on relevant clinical questions. (2wks)

Attending, SFGH ACE Unit: Advise in the appropriate care for frail, vulnerable older adults admitted to the Acute Care for Elders Unit, through education and participation in the multidisciplinary ACE rounds. Supervise and teach R1s rotating through during their Quality Improvement week. (2wks)

Attending, SFGH Medicine Wards: Help resident lead a ward team consisting of MS3, MS4, R1 and pharmacy students. Present didactic teaching on relevant clinical questions. (2wks)

PROFESSIONAL ORGANIZATIONS:

Memberships: 2002 – current Society of General Internal Medicine 2002 – current Society of Hospital Medicine, 2005 – current American Geriatrics Society 2005 – 2006 Society of Medical Decision Making

Service to Professional Organizations: 2006 Society of General Internal Medicine National Meeting Abstract Reviewer 2007 Society of General Internal Medicine CA Meeting Abstract Reviewer

Service to Professional Publications (Ad Hoc Reviewer): 2005 – current Journal of General Internal Medicine 2005 – current American Journal of Managed Care 2006 – current Journal of Hospital Medicine 2006 – current Journal of the American Geriatrics Soc 2007 – current Quality Management in Healthcare 2008 – current American Journal of Epidemiology

Invited Presentations: 2007 Society of General Internal Medicine, Toronto (workshop) 2006 Summer Institute, VA Quality Scholars, Fairlee, VT (Talk) 2005 Grand Rounds, Kaiser South San Francisco, South San Francisco, CA 2003 National Business Coalition on Health, Oak Brook, IL

UNIVERSITY AND PUBLIC SERVICE

Committees 2004 Healthcare Failure Methods Effects and Analysis (HFMEA) 2004 - 05 Root Cause Analysis (RCA) 2005 – current Bioethics Advisory Committee 2005 SF VAMC Nursing Home Hypoglycemia Task Force, Chair 2003 – 04 Special Care Committee, Kaiser South San Francisco

University Lectures 12/02 Primary Care Grand Rounds, “Medicare Reimbursement for Graduate Medical Education.”

Other Public Service 2/06 TV appearance: CBS Channel 5, CNN

TEACHING AND MENTORING

UCSF classes

Qtr Ac Yr Course # Teaching Contribution Units Class and Title Size F 2005-06 EPI 204 Section Leader (wrote questions, edited 3 15 textbook) W 2005-06 CP 124 Section Leader (graded article critiques) 2 25 Sum 2006 EPI 202 Section Leader (critiqued study protocols) 2 12

POSTDOCTORAL MENTEES:

Dates Name Level of Training Faculty Role Current Position 2007-09 Lee Jennings, MD PRIME Resident Research Supervision PRIME Resident 2007-09 Leslie Kernisan, MD VAQS Fellow Research Supervision, VAQS Fellow career mentoring 2008-09 Chrissy Kistler, MD VAQS Fellow Research supervision, VAQS Fellow career mentoring 2007-08 Lianne Wener, MD VAQS Fellow Career Mentoring Asst Clinical Prof, UCSF TEACHING AIDS

2000 UCSF Department of Medicine Housestaff Handbook, Section Editor

SUMMARY OF TEACHING/MENTORING HOURS:

2006-07: Formal class or course teaching hours: 16 hours Informal teaching hours: 32 hours Mentoring hours: 25 hours

2007-08: Formal class or course teaching hours: 30 hours Informal teaching hours: 250 hours Mentoring hours: 200 hours

2008-09: (anticipated) Formal class or course teaching hours: 25 hours Informal teaching hours: 200 hours Mentoring hours: 275 hours

RESEARCH AWARDS AND GRANTS

CURRENT

1) Geriatric Health Outcomes Research Scholars Award, Lee (PI) 7/08 – 6/10 Hartford Foundation and American Geriatrics Society $100,000/yr Foundation for Health in Aging

2) KL2, UCSF, Lee (PI) 9/09 – 9/13 $75,000 - $100,000/yr

1). VA SDR 03-090 Kennedy (PI), Lee (Consultant) 9/03 – 6/07 VA HSR&D $2500 MI+: Web-Enhanced Guideline Implementation for Post-MI CBOC Patients

2) R01 AG023626-03 Covinsky (PI) 9/1/04-8/30/08 NIH/NIA $127,500 direct yr1 Diseases/function/self-health in risk indices for elders $382,500 total directs 3 yrs Role: Co-Investigator 25% effort

3) R01 AG028481-01 Covinsky (PI) 9/1/07-10/1/10 NIH/NIA $201,139 directs yr 1 Depressive Symptoms, Aging, Disability and Health Outcomes $593,802 total directs 3 yrs Role: Co-Investigator 10% effort

4) R01 AG029233-01 Landefeld (PI) 9/1/06-8/31/09 NIH/NIA $164,000 total directs yr 1 Risk Indices for Disability Among Hospitalized Older Persons $483,000 total directs 3 yrs Role: Co-Investigator 5% effort

5) 2006-0108 Landefeld (PI) 1/07-12/11 The John A. Hartford Foundation, Inc. $150,000 total directs yr 1 Center for Excellence in Geriatrics $450,000 total directs 3 yrs Role: Junior Faculty 5% effort

PEER REVIEWED PUBLICATIONS

1) Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006 Feb 15;295(7):801-8.

2) Lee SJ, Newman TB. Conventional vs. atypical antipsychotic medications—Letter. N Engl J Med. 2006 Mar 2;354(9):972-4; author reply 972-4.

3) Lee SJ, Covinsky KE. Prognostic Index for 4-Year Mortality in Older Adults—Reply. JAMA. 2006 Aug 9; 296(6):648-649.

4) Lee SJ, Moody-Ayers SY, Landefeld CS, Walter LC, Lindquist K, Segal MR, Covinsky KE. The Relationship Between Self-Rated Health and Mortality in Black and White Americans. J Am Geriatr Soc. 2007 Oct;55(10):1624-9.

5) Lee SJ, Go AS, Lindquist K, Bertenthal DB, Covinsky KE. Chronic Conditions are Less Predictive of Mortality in the Oldest Old. Am J Public Health. 2008 Jul; 98(7): 1209-14. Epub 2008 May 29.

6) Lee SJ, Sudore RL, Williams BA, Lindquist K, Chen HL, Covinsky KE. Functional Limitations, Socioeconomic Status and All-Cause Mortality in Moderate Drinkers. J Am Geriatr Soc. In press.

7). Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR. Impact Of Age And Comorbidity On Colorectal Cancer Screening Among Older Veterans. Ann Intern Med. In press.

NON-PEER REVIEWED PUBLICATIONS

1) Mehrotra A, Lee SJ, Dudley RA. Hospital Performance Evaluation: What do we want, How do we get it, and How should we use it? Jun 2003. Accessed on 10/5/06. http://www.nbch.org/documents/litreview060603.pdf ABSTRACTS

1) Lee SJ, Dudley RA. Volume Mortality Relationships in Complex Surgical Procedures. Presented to the Pacific Business Group on Health, Mar 2001.

2) Lee SJ, Basaviah P. To Supplement or Not: That Is the Question. Presented at the Natl Assoc of Inpatient Physicians Conf, Atlanta, 3/01

3) Lee SJ, Christiansen R. Complementary Medicine in Northern Illinois: Attitudes of Patients and Health Providers. Presented at the American Public Health Conference, Chicago, 10/99.

4) Lee SJ, Salafsky B. Do Community-Oriented Medical Curricula Produce more Generalist Physicians? Presented at the Conference of the Network of Community- Oriented Health Education Institutions, Mexico City, 10/97.

RECENT PUBLICATIONS with CONTRIBUTIONS

1) Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006 Feb 15;295(7):801-8. - I conceptualized and designed the study, analyzed and interpreted the data, and drafted and edited the manuscript, including post-review revisions.

2) Lee SJ, Moody-Ayers SY, Landefeld CS, Walter LC, Lindquist K, Segal MR, Covinsky KE. The Relationship Between Self-Rated Health and Mortality in Black and White Americans. J Am Geriatr Soc. 2007 Oct;55(10):1624-9. - I conceptualized and designed the study, analyzed and interpreted the data, and drafted and edited the manuscript, including post-review revisions.

3) Lee SJ, Go AS, Lindquist K, Bertenthal DB, Covinsky KE. Chronic Conditions are Less Predictive of Mortality in the Oldest Old. Am J Public Health. 2008 Jul; 98(7): 1209-14. Epub 2008 May 29. - I conceptualized and designed the study, analyzed and interpreted the data, and drafted and edited the manuscript, including post-review revisions.

4) Lee SJ, Sudore RL, Williams BA, Lindquist K, Chen HL, Covinsky KE. Functional Limitations, Socioeconomic Status and All-Cause Mortality in Moderate Drinkers. J Am Geriatr Soc. Submitted. - I conceptualized and designed the study, analyzed and interpreted the data, and drafted and edited the manuscript, including post-review revisions. CURRENT RESEARCH ACTIVITIES

My research agenda is to continue to improve the accuracy of prognosis in the geriatric population and explore how prognostic information can improve clinical decisions and healthcare quality measures. My previous work has shown that the accuracy of prognostic indexes can be improved by incorporating functional measures to comorbidity and demographic measures. My funded KL2 project will test the hypothesis that incorporating other types of risk factors (such as race, socioeconomic status and biomarkers) can further improve the accuracy of prognostic indexes in the elderly. In order to explore the application of prognosis, I will continue to focus on interventions that pose immediate risks and burdens with delayed benefit. Examples of such interventions include cancer screening (immediate risk of complications, false positives and worry with delayed mortality benefit), intensive glycemic control (immediate risk of hypoglycemia with delayed benefit of decreased vascular complications), and intensive blood pressure control (immediate risk of hypotension and falls with delayed benefit of decreased vascular complications). For these interventions, I will explore whether clinicians are currently appropriately targeting these interventions to those patients with good prognosis and are thus most likely to survive to benefit. Furthermore, since many of these interventions are the subject of quality measures, I will explore whether refining these quality measures by only including subjects with good prognosis would improve the targeting of these interventions. A critical limitation to the dissemination of wide use of prognostic indexes has been the clinician time and effort required to determine prognosis. Thus, a major thrust of my work will be to facilitate the application of prognostic information in clinical practice by developing prognostic indexes using electronic data. Once validated, these indexes will enable the automatic provision of prognostic estimates, allowing us to test whether providing this information to clinicians at the point of care improves the targeting of interventions. Furthermore, these indexes will enable refinement of current quality measures so that only subjects with good prognosis and high likelihood of benefit are included. For example, current quality measures for colorectal cancer screening includes all subjects between specified age ranges as appropriate for screening. This has the effect of including younger, sicker subjects who are unlikely to benefit into the measure, while ignoring older, healthier subjects who are more likely to benefit. Application of a validated prognostic index would allow us to include subjects who are most likely benefit from screening, excluding sicker subjects regardless of age, and including healthier subjects regardless of age. I have proposed developing such an index within the VA incorporating diagnosis codes, pharmacy data and laboratory results, with the ultimate goal of testing whether these indexes can be used to improve VA quality measures. CURRENT TEACHING and MENTORING ACTIVITIES

Teaching Responsibilities Type Activity Setting # and type of trainees 07-08 08-09 09-10 (anticipated) Clinical Geriatrics clinic 3-6 Medical students, Clinic 250 Teaching precepting residents and fellows Didactic Geriatrics Journal Club, ~4 clincal/research Seminar 25 25 25 Teaching discussant fellows, division faculty Didactic Medical Student Seminar 15-20 medical students 5 Teaching Intersession: Lifecycle Clinical Medicine Ward Attending 5-10 students/ residents/ Hospital 200 200 Teaching (1 month) fellows Career Mentoring - Lianne Wener, MD - Adam Spira, PhD Mentoring Office 5 fellows and residents 100 100 100 - Leslie Kernisan, MD - Lee Jennings, MD - Chrissy Kistler, MD Research Mentoring Mentoring - Lee Jennings, MD Office 2 fellows and residents 100 100 100 - Leslie Kernisan, MD Medical Student Training Mentoring in Aging Research Office 1 medical student 75 75 (MSTAR) Total Teaching and Mentoring Activities per Year 480 500 500

Teaching/Mentoring Responsibilities 1) Associate Director of VA Quality Scholars Fellowship, 2007-present 2) Geriatrics Clinic Precepting, 2007-08 3) Attending Physician, Medical Ward Service, 2008- 4) Geriatrics Journal Club, Discussant, 2007-present 5) Medical Students Intersession: Lifecycle, Geriatrics, 2007-present SUMMARY of UNIVERSITY and PUBLIC SERVICE

University Committees 2004 Healthcare Failure Methods Effects and Analysis (HFMEA) 2004 - 05 Root Cause Analysis (RCA) 2005 – current Bioethics Advisory Committee 2005 SF VAMC Nursing Home Hypoglycemia Task Force, Chair

University Lectures 2002 Primary Care Grand Rounds, “Medicare Reimbursement for Graduate Medical Education.”

Service to Professional Organizations: 2006 Society of General Internal Medicine National Meeting Abstract Reviewer 2007 Society of General Internal Medicine CA Meeting Abstract Reviewer

Service to Professional Publications (Ad Hoc Reviewer): 2005 – current Journal of General Internal Medicine 2005 – current American Journal of Managed Care 2006 – current Journal of Hospital Medicine 2006 – current Journal of the American Geriatrics Soc 2007 – current Quality Management in Healthcare

Public Service Lectures: 2007 “Incorporating QI into Clinical Work” Society of General Internal Medicine, Toronto 2006 “Moving Messages Effectively” Summer Institute, VA Quality Scholars, Fairlee, VT 2005 “Bayesian Clinical Reasoning” Grand Rounds, Kaiser South San Francisco, CA 2003 “Measuring Hospital Performance” National Business Coalition on Health, Oak Brook, IL

Other Public Service 2006 TV appearance: CBS Channel 5, CNN 2006 Radio appearances: Over 20 local, national and international outlets