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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 • 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 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 • 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 • 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 • 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 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 • 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 • 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 • 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.