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New York City Health and Hospitals Corporation: Providing Health Care Quality and Value for New York City Residents Anne-Marie J. Audet, MD, MSc, FACP Senior Vice President for Quality New York City Health and Hospitals Corporation April 24 th 2008. HHC’s Role in NYC Healthcare Landscape.

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New York City Health and Hospitals Corporation: Providing Health Care Quality and Value for New York City Residents Anne-Marie J. Audet, MD, MSc, FACPSenior Vice President for QualityNew York City Health and Hospitals CorporationApril 24th 2008


Hhc s role in nyc healthcare landscape
HHC’s Role in NYC Healthcare Landscape

  • 1.3 million New Yorkers treated

    • 1 out of 6 New Yorkers; 400,000 uninsured

    • Very diverse patient population; over 100 languages spoken

    • 43% Hispanic, 35% African American, 6% Asian, 9% other minority

    • Socioeconomically diverse and socially complex patients

  • 220,000 discharges; 23,000 deliveries

  • 5 million outpatient visits (more than 2 million primary care)

  • 1 million ED visits; 30 percent of city’s trauma services

  • 41% of city’s mental health inpatient services; 27% of city’s chemical dependency inpatient capacity

  • 1 million skilled nursing facility patient days

  • 11 designated AIDS centers

  • Inpatient and specialty provider for correctional services

    HHC is one of over 100 urban safety net health systems

    nationwide providing comprehensive care in their communities.


Hhc at a glance
HHC at a Glance

Public Benefit Corporation Governing:

  • 7 regional networks serving 5 boroughs

    • 11 Acute Care Facilities (4,859 beds)

    • 4 Skilled Nursing Facilities (2,835 beds)

    • 6 Diagnostic and Treatment Centers

    • 88 Community Health clinics

  • A certified home health care agency

  • A managed care organization (300,000 enrollees)

  • Affiliations with all major NYC Medical Schools

  • 39,000 employees, 3,000MDs, 8,486 Nurses


Achieving value through quality and safety crossing the quality chasm
Achieving Value through Quality and Safety:Crossing the Quality Chasm

  • Leadership and Governance

  • Culture – Just, Safe, Transparent

  • Incentives

  • Reengineering care processes

    • Knowledge and skills – workforce support and development

    • Robust QA/PI infrastructure

    • Effective use of information technologies

    • Development of effective teams

    • Coordination of care across services, sites of care over time


Clinical strategic priorities
Clinical Strategic Priorities

  • Ensure care continuum for patients and the community

    • Staying Healthy – prevention

    • Getting better when sick – acute care

    • Living with disabilities and chronic conditions – chronic disease management

    • Coping with end of life

  • Ensure clinical quality (IOM Dimensions)

    • Access - timeliness

    • Effectiveness,

    • Safety

    • Patient-centeredness

    • Cultural competence

    • Efficiency

    • Equity




Strategies to improve safety quality and efficiency
Strategies to Improve Safety, Quality and Efficiency

  • Learning organization – Patient Safety Officer Training (CEO), Nurse Leadership Academy, culturally and linguistically appropriate services department

  • Team-based collaboratives – e.g. infections, diabetes, pressure ulcers, chronic disease model

  • Effective use of IT – EMR, CPOE, interoperability (smart card), telehealth, registries

  • Ambulatory care redesign – open access, cycle time, care management teams

  • Breakthrough Initiative – based on Toyota “Lean Thinking” – better allocate resources to patient care needs, bring services closer to patients


Bottom line impact on patient outcomes
Bottom Line: Impact on Patient Outcomes

Improved Performance in preventive, acute, chronic, and long

term care

  • Acute Care

    • In-hospital Mortality – Consistently lower than national

    • Hospital acquired infections – (see chart on VAP, CLIs)

    • CMS Hospital Care Indicators – HHC outperforms national performance

  • Long Term Care – 50% reduction in pressure ulcers, falls

  • Preventive care (see chart on smoking cessation)

  • Chronic disease (see chart for DM, asthma)







Impact on access to care
Impact on Access to Care

  • Ensuring patients get the care they need, when they need it

    • 50% reduction in “no show” rate

    • Reduction in wait time – 4-5 days

    • Cycle time < 60 minutes

    • Co-location of specialty care


Challenges
Challenges

  • Achieving and sustaining consistent performance throughout the system

  • Reliability – the right care for the right person at the right time, every time - hardwiring quality and safety

  • Coordination of care across services, sites of care, especially for patients with complex conditions


Policy implications
Policy Implications

  • Support for new Models of care

    • Patient-centered care: tailored to patients with complex set of clinical conditions; multi-disciplinary teams of MD, nurses, community based workers, case managers; models that go beyond the traditional one on one MD patient visit

  • Tools

    • Ensure that safety net health systems have the tools for performance improvement

      • Health Information Technologies – decision support

      • Technical assistance for performance improvement and redesign

  • Incentives

    • Ensure that quality reporting and payment policies capture care services for all patient populations – acute, preventive, chronic care

    • Break the cycle of supply driven healthcare - reward providers for improving public and patient health outcomes.


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