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 Quality
New 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.