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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, 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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