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

Transparency

Benchmarking: Collaboration and Competition

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)

Acute Care

Long Term Care

Preventive Care

Chronic Care Management

Chronic Care Management

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.