Winter 2016

QualityACollaborative Partnership Sponsored by the Greater Association and the United Hospital Fund IMPACT’s Progress at the Two-Year Mark

stablished in 2014 by Greater communication among the 18 , they train that person on the necessary New York Hospital Association 28 nursing homes, and five home care health-related tasks to be provided in (GNYHA) and United Hospital agencies participating, as well as between the home. Carol Levine, Director of E Fund (UHF), the IMPACT (Improve providers, patients, and caregivers. the Families and Health Care Project, Processes And Care Transitions) to The past year’s highlights include UHF, also offered insights on engaging Reduce Readmissions Collaborative recent caregiver-related legislation and and educating caregivers, highlighting continues efforts to help participants hospital-based programs for enhancing several caregiver resources that UHF has avoid hospital admissions and communication. developed as part of its Next Step in Care readmissions of nursing home residents program. and home care patients. IMPACT Engaging Patients and Caregivers In December, IMPACT participants identified improving communication In a caregiver-related presentation attended a robust session focusing on as essential in minimizing preventable held in October, Suzanne Mitchell, MD, hospital-based initiatives to improve readmissions and the associated costs, Assistant Professor of Palliative Care and care transitions. Susan Goldberg, RN, which can be significant given the new Family Medicine and co-researcher of MPA, Vice President, Organizational Affordable Care Act penalties. With that Project Re-Engineered Discharge (Project Performance at Maimonides Medical in mind, the collaborative has focused RED) at Boston University, stressed the Center, reported on the progress of on creating a strong foundation for better importance of understanding the patient a transfer center staffed by a nurse population. Dr. Mitchell noted that asking around the clock to triage calls for patients the right questions about clinical patient transfers from nursing homes and personal needs is critical, and that to the . Fran a “one-size-fits-all approach” does not Silverman, ACSW, LCSW-R, Director, Inside always work. Social Work, , In a November webinar addressing discussed her facility’s efforts to 2 Clinical Quality Fellowship Program care transistion needs, Lorraine Ryan, improve communication during care Evolves: An Interview with Rohit Senior Vice President, Legal, Regulatory, transitions, using “warm”—i.e., live— Bhalla, MD and Professional Affairs, GNYHA, communication handoffs between explained the key provisions of the clinicians in patient transfers between 3 GNYHA/UHF Clinical Quality Fellowship CARE (Caregiver Advise, Record, hospitals and nursing homes. The NYU Program Current Fellowship Classes and Enable) Act and shared a CARE Langone and Visiting Nurse Service of Act readiness assessment tool to assist New York team shared an update on the 4 Second Round of NYS Partnership hospitals in identifying gaps in current successful implementation of “teach- for Patients Advances Safety Goals practices. Enacted in 18 states, including back,” a method used to educate patients New York, the CARE Act requires that and caregivers to ensure that essential hospitals ask patients to identify a person information is clearly communicated and who can care for them at home and that continued on page 4 Clinical Quality Fellowship Program Evolves: An Interview with Rohit Bhalla, MD

aunched in 2009 by GNYHA them to look at their projects over Content-wise, the curriculum has and UHF, the Clinical Quality time in their home organization, which also expanded. Today, it addresses Fellowship Program has grown encourages them to build working such topics as the alignment of quality L in importance and relevance relationships with on-site clinicians and and health information technology, the with each graduating class. With final achieve sustainable successes. growing importance of standardized selections made for the class of 2016–17, It’s heartening to see senior leaders measurement, leadership techniques Quality Collaborative sat down with in hospitals continuing to offer support to use in the implementation of Rohit Bhalla, MD, MPH, Vice President for applicants, year after year. This tells quality improvement efforts, change- and Chief Quality Officer at Stamford me that they see a real benefit. management principles to achieve high Hospital and a key faculty member Another thing that makes the reliability in health care, and skill- of the fellowship program since its program work so well is the remarkable building activities for team-based care. inception, as well as its current chair, faculty. We have 12 quality improvement for his perspectives on how it continues experts from throughout the region who QC: Have you also seen changes in the to evolve to meet the changing needs of mentor the fellows and bring invaluable capstone quality improvement projects health care. knowledge to the table. that fellows lead as a key part of the program? Quality Collaborative: The application QC: Final selections have been made RB: With the field of quality field for those wanting to participate in for a new class—the program’s eighth. improvement expanding in scope, the program has never been stronger. With so much reform and other change many capstone projects in the last What makes it so appealing? occurring in health care, how has the few years have not been about only Dr. Rohit Bhalla: There’s no doubt, fellowship program evolved over time? bread-and-butter hospital safety positive word of mouth has been a big RB: The program has evolved on many concerns. They’ve addressed issues draw. The program also features some fronts. of timeliness, transitional care, and key differences from others out there—a Participant-wise, we started with quality improvement within ambulatory lot of our applicants have participated in physicians only. In recognition of the settings, too. I think these are all healthy other programs, interestingly, they come interdisciplinary nature of quality changes. to us for added training, skill building, improvement, we expanded the program I should underscore the importance and professional development in quality in the second year to include nurses, and of the capstone projects not just to improvement. both physicians and nurses have been the fellow’s training, but to the home With many of the other programs, participants ever since. organization as well. To the degree that participants have to leave the hospital We started with a focus almost the project makes meaningful change, where they work and be trained exclusively on acute care in hospitals. it’s a great benefit to the organization, at elsewhere for an extended period of time. Obviously, reform legislation has been a price that can’t be beat – free! We’re With ours, they get to continue clinical a huge force in health care over the past essentially giving clinicians skills to be work at their hospitals. Moreover, our eight years, which has driven changes internal management consultants, and program is practical, focusing ultimately at federal, state, and regional levels, and with the capstone the organization gets on helping the fellow build skills on we’ve adapted. Today, our fellows have an applied improvement effort from how to effectively plan and implement an interest in and learn about accountable someone who’s embedded there, knows quality improvement initiatives at his care, patient-centered medical homes, his or her way around, and can focus or her organization. And the work our and quality improvement within primary on the project at hand, as well as its participants do is longitudinal, allowing care settings. sustainability over time. n

2 GNYHA/UHF Clinical Quality Fellowship Program Current Fellowship Classes

hese fellows compose the seventh and eighth classes of the Clinical Quality Fellowship Program, which supports the training and professional development of early- and mid-career physicians and nurses with the specific purpose of helping them to lead and champion quality improvement and patient safety efforts within their hospitals. Including these classes, there have been T 152 participants in the program—123 physicians and 29 nurses—from more than 50 hospitals. Class of 2016–2017 §§ Denise May, NP, Winthrop University Hospital §§ Tracy Dowlat, RN, Brookdale University Hospital and §§ Umar Chouhdry, MD, MBA, WMCHealth, Bon Secours Medical Center Charity Health System, Good Samaritan Hospital Center §§ Kevin Slavin, MD, HackensackUMC (Suffern) §§ Natalie Bell, MSN, RN, ACNP-BC, OCN, Memorial Sloan Kettering Cancer Center §§ Theresa Madaline, MD, Montefiore Medical Center Class of 2015–2016 §§ Beth Kranitzky, MD, Mount Sinai Beth Israel §§ Maria Teresa Timoney, CNM, Bronx Lebanon Hospital §§ Trini Truong, MD, The Mount Sinai Hospital Center Health System §§ Natalie Wilson, MS, RN, The Mount Sinai Hospital §§ Lisa Tank, MD, FACP, HackensackUMC §§ Bernard Biviano, MD, Mount Sinai §§ Fouad Atallah, MD, Maimonides Medical Center §§ Kathy Navid, MD, Mount Sinai Queens §§ Chhavi Kumar, MD, Memorial Sloan Kettering Cancer §§ Francois Dufresne, MD, Mount Sinai St. Luke’s Center §§ Michael Redlener, MD, Mount Sinai St. Luke’s §§ Glenn Kashan, MD, Mount Sinai Beth Israel §§ Bernice Emmanuelli, RN, BSN, MD, Mount Sinai West §§ Robert Freeman, MSN, RN-BC, Mount Sinai Health §§ Matthew Lambiase, MSN, BSN, NYC Health + System Hospitals/Bellevue §§ Hyung (Harry) Cho, MD, The Mount Sinai Hospital §§ John McMenamy, MD, NYC Health + Hospitals/Bellevue §§ Amrita Gupte, MD, MPH, Mount Sinai Queens §§ Chinyere Anyaogu, MD, MPH, NYC Health + Hospitals/ §§ Jeffrey Rabrich, DO, FACEP, Mount Sinai West North Central Bronx §§ Barbara Gatton, MD, New York Methodist Hospital §§ Yvette Calderon, MD, MS, NYC Health + Hospitals/ §§ Daniel Crossman, MD, NYP/Lower Hospital North Central Bronx §§ John Babineau, MD, NYP/Morgan Stanley Children’s §§ Stephanie Muylaert, MD, NYP/Weill Cornell Medical Hospital Center §§ Roxana Lazarescu, MD, NYP/Queens §§ Ilseung Cho, MD, NYU Langone Medical Center §§ Jean Versace, RN, CCM, NYP/Queens §§ Prashant Sinha, MD, FACS, NYU Langone Medical §§ Kenneth Feldhamer, MD, , North Shore Center University Hospital §§ Diana Contreras, MD, MPH, NYU Lutheran §§ Yasir Al-qaqaa, MD, NYU Langone Medical Center §§ Sarah Kaplan, MSN, RN-BC, NYU Lutheran §§ Raghad Said, MD, NYU Langone Medical Center §§ David Hirschwerk, MD, Northwell Health, North Shore §§ Nada Abou-Fayssal, MD, NYU Lutheran University Hospital §§ Karen DeLorenzo, MSN, RN, CHCR, NYU Lutheran §§ Janine Liza Duran, RN, CEN, MS, APRN, SBH Health §§ Daniel Lombardi, DO, FACEP, SBH Health System System

3 Second Round of NYS Partnership IMPACT (continued) understood prior to discharge. Amanda for Patients Advances Safety Goals Ascher, MD, Chief Medical Officer of Bronx Partners for Healthy Communities, he second iteration of the NYS and reducing risk for mothers; a Delivery System Reform Incentive Partnership for Patients started §§ 25,351 avoided hospital readmissions Payment (DSRIP) Performing Provider in late September and is now within 30 days of discharge; and System, offered her perspective on T fully underway. Led again by §§ 1,279 fewer infections resulting from how IMPACT providers can strategize GNYHA and the Healthcare Association the use of central intravenous lines and leverage the benefits of their care of New York State, with support from which withdraw blood and provide transition activities to more broadly effect UHF, the NYS Partnership for Patients has patients with fluids and medication. improvement with the goals of improving enrolled more than 150 hospital sites in These results coincide with a recent interdisciplinary care coordination, this second round, which aims to reduce report issued by the Agency for Healthcare realignment of incentives, and addressing hospital-acquired conditions by 40 percent Research and Quality indicating that social determinants of health. and preventable readmissions by 20 the rate of hospital-acquired conditions percent. decreased by 17 percent from 2010 to Looking Ahead The partnership’s statewide 2014, averting approximately 2.1 million As the collaborative continues educational series provides hospitals inpatient adverse events cumulatively to plan and showcase its third-year with opportunities to learn about best during that timeframe. Aggregating activities, it will be shifting its focus to practices from local and national experts national data, the Department of Health problem areas, including conducting on a range of topics, with new areas in and Human Services has estimated that effective case reviews, implementing this round to include sepsis and septic 50,000 fewer patients died in hospitals and medication reconciliation, and effectively shock, Clostridium difficile, and delirium. approximately $12 billion in health care hardwiring the necessary changes to Other areas in which work is picking costs were saved as a result of a reduction ensure that these processes are carried up where it left off from the first round in hospital-acquired conditions from 2010 out reliably. Educational sessions and include catheter-associated urinary to 2013—much of the success attributed workshops focused on operationalizing tract infections, central line–associated to the national Partnership for Patients the New York State CARE Act and how bloodstream infections, surgical site initiatives. to collect appropriate process measures infections, adverse drug events (as well as In the second round just underway, will also be offered. n best practices for glycemic management), the NYS Partnership for Patients is pressure ulcers, patient falls, and venous providing hospitals with tools to help thromboembolism. Regional and hospital- build internal capacity for change and level educational sessions are held to improvement in specific service lines, or facilitate more targeted sharing around the patient safety hubs, including critical care, QualityCollaborative implementation of best practices. medical-surgical, obstetrics, operating Quality Collaborative is published three times a year, covering the efforts of the UHF/GNYHA partnership NYS Partnership for Patients is one of room, and emergency room departments. to improve hospital quality of care and patient safety.

17 such initiatives led by national, regional, Hospitals are embracing this approach as GNYHA is a trade association representing more than 160 member hospitals and health systems, in or state hospital associations and health a method to ensure that highly reliable, the metropolitan New York area and throughout the system organizations across the country, systemic quality improvement processes State, as well as New Jersey, Connecticut, and Rhode Island. continuing efforts undertaken in the first exist in each department, rather than United Hospital Fund (UHF) is an independent, round, which began in 2011. Improvements focusing on individual topic-specific nonprofit organization that works to build a more achieved from the first round of the NYS quality improvement projects. effective health care system for every New Yorker. Partnership for Patients included: For more information about the NYS §§ 1,832 fewer early elective deliveries, Partnership for Patients, visit giving babies a healthier start in life www.nyspfp.org. n

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