Health And Hospitals Corporation Research Articles

212. The Teen Health Improvement Program: A System-wide Initiative to Improve the Quality of Care for Adolescents Served by the Country's Largest Public Hospital System

The New York City Health and Hospitals Corporation (HHC) is the country's largest public hospital system, providing primary care services to nearly 50,000 adolescent patients annually. HHC started the Teen Health Improvement Program (THIP) in 2012 to improve population health outcomes among adolescent patients by ensuring access to high quality health care services. Most adolescent patients at HHC are seen in pediatric clinics by general pediatricians. Clinicians and staff in these settings may require support to better serve patients as they transition from childhood to adolescence to young adulthood.

Using a data-driven organizational improvement model to engage an interdisciplinary team in transforming a public women’s health clinic

Gouverneur Health is the largest diagnostic and treatment center in New York State, and part of the New Health and Hospitals Corporation (HHC), a public benefit corporation with $6.7 billion in annual revenues. HHC is the largest municipal healthcare system in the United States serving 1.4 million patients, including more than 475,000 uninsured city residents. 1 Within Gouverneur, the Women’s Health department is committed to providing high quality services that improve patients' health and wellbeing, yet patient experience, flow, clinic access and education are in need of process improvements. To e nhance patient experience and identify strategies replicable for other departments, an interdisciplinary 15-member team used an organizational improvement initiative known as a Breakthrough Value Stream Analysis (VSA) to analyze and improve a series of cli improvement model that HHC created in 2007 in collaboration with Simpler Consulting.

Mortality, ethnicity, and education in an occupational cohort

Purpose – The purpose of this paper is to investigate the relationship between occupational degree requirement and mortality between ethnic groups in a cohort of urban workers. Design/methodology/approach – The study included 118,606 health-insured full-time workers from the New York City Health and Hospitals Corporation (HHC). Mortality rates (MR) and mortality rate ratios (MRR) were calculated for major ethnic categories. Estimates were adjusted for age, sex, and occupational degree requirement. Findings – Prior to adjustment for degree requirement, mortality rates (MRs) by ethnic groups in the Health and Hospitals Corporation were in line with national estimates: highest for blacks, followed by whites, Hispanics, and Asian/Pacific Islander (APIs). After adjustment, the MR for blacks became comparable to whites (mortality rate ratio (MRR)=1.02). The low-Hispanic MR did not change; the Hispanic advantage persisted (MRR=0.66), as did the API advantage (MRR=0.50). Research limitations/implications – Higher education may not substantially change the MR for Hispanics, and it may only account for a portion of the survival advantage among APIs. The findings also suggest that without reducing the disparity in higher education attainment between blacks and whites, equality in other socioeconomic factors may not abolish the disparity in mortality between these groups. Originality/value – This study bypassed common limitations of ethnic mortality studies, with intrinsic parity for certain socio-economic status factors (full-time employment and health care access) across cohort members and consistent ethnic classification across time-points. This includes a cohort of API workers with complete self-identification of ethnicity, which has not been accomplished by previous investigations.

What proportion of patients need to be tested to realise test and treat goals? Trend analysis of patients screened for HIV within the New York City municipal health-care system

BackgroundNew York City Health and Hospitals Corporation (HHC) is the largest municipal health-care system in the USA, comprising 11 acute-care hospitals and six community clinics. Since 2005, HHC has made HIV testing routine, with the goal of reducing incidence and late-stage diagnosis. In this analysis we aimed to: identify proportional markers to signal that a facility's HIV screening efforts had reached stable, routine levels; and identify a marker that, if maintained, would suggest programme goals would be achieved. MethodsSince 2005, 17 HHC facilities have submitted monthly HIV testing reports. We analysed data from 2006–12 to identify patterns in newly diagnosed patients and to assess the rate of concurrent HIV/AIDS diagnoses. Time trends and associations between the reach of screening and screening outcomes were explored with scattergrams and lowess plots, and we used linear and piecewise-linear mixed effects regression models of these outcomes over time. A linear spline of calendar year with knots at 2008 was the fixed effect, with random intercepts at the facility level. To test the association of screening reach with yield of new HIV diagnoses, we estimated mixed effects piecewise linear models of new HIV diagnosis and concurrent HIV/AIDS diagnosis with a linear spline of screening reach with join points at 10% and 20% as fixed effects, and facility-level random intercepts. FindingsBetween 2006 and 2012, 7 381 847 patients aged 13 years and older were seen at 17 HHC facilities. 1 157 830 unique patients were tested, and 11 781 HIV-positive diagnoses were made, 4963 of them new. Rates of concurrent HIV/AIDS diagnosis for newly diagnosed patients went from 32·26% (190 of 589) in 2006, to 25·27% (94 of 372) in 2012. The proportion of age-eligible patients who were screened went from 9·41% (92 123 of 979 376) in 2006, to 18·03% (198 938 of 1 103 079) in 2012. Facility annual proportions ranged from 5·49% (5505 of 100 248) to 39·23% (3909 of 9964), with nine facilities annually screening 20% or more by 2012. In sites with higher proportions of age-eligible population screened, the proportion of tests leading to new HIV diagnoses declined in a curvilinear fashion. We found that when more than 20% are screened, the yield of new HIV diagnoses levels off at approximately 0·3%. The proportion of newly identified patients with a concurrent HIV/AIDS diagnosis declined almost linearly up to a screening proportion of 40%, at which point the predicted and observed rate of concurrent AIDS diagnosis is zero. InterpretationRoutine HIV screening within health-care systems should see a significant decline in undiagnosed HIV patients if they annually reach 20% of their age-eligible patient population. The goal of reaching patients early in their diagnosis and avoiding concurrent HIV/AIDS diagnoses would appear to be reached through routine screening when 40% of age-eligible patients are screened annually. Screening efforts must consider prevalence when interpreting results for other areas; the prevalence of HIV infection in New York City was 1·36% in 2012. The strength of these results related to concurrent HIV/AIDS rates are limited by the number of facilities reaching rates above 20%. FundingFunding for HIV testing expansion and evaluation was provided by continuing support from the New York City Council and through grants including from New York State Health Foundation and a Gilead Sciences FOCUS Award.

Meeting the needs of LGBT patients and families

Meeting the needs of LGBT patients and families

Reducing the Use of Seclusion and Restraint in Psychiatric Emergency and Adult Inpatient Services— Improving Patient-Centered Care

The reduction of seclusion and restraint (S/R) use has been given national priority by the US government, The Joint Commission, and patient advocacy groups. It is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention. The New York City Health and Hospitals Corporation (HHC) is the largest municipal health care system in the country, with 11 HHC facilities operating psychiatric emergency services and inpatient psychiatric services. HHC operates 1117 adult inpatient psychiatric beds with an average length of stay of 22.2 days that generated over 19,000 discharges in 2009. In 2009, there were over 36,000 psychiatric emergency services visits. HHC's Office of Behavioral Health provides strategic leadership, planning, and support for the operations and quality objectives of these services. In January 2007, the corporate office initiated the Seclusion and Restraint Reduction Initiative, with a sequenced, intensive series of interventions and strategies to help focus the behavioral health leadership and staff on the need for continued culture change toward a more patient-centered and safe system of psychiatric emergency and adult inpatient care. From 2007 to 2009, there was a substantial decline in HHC's overall rate of S/R incidents in inpatient units. The more substantial impact was in the reduced overall time spent in S/R; the reduced frequency of use of S/R; and the reduced likelihood of patient injury from S/R use.

69 Surveying the Impact of the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) on Hospital Based Dialysis Centers (HBDCS)

SURVEYING THE IMPACT OF THE END-STAGE RENAL DISEASE (ESRD) PROSPECTIVE PAYMENT SYSTEM (PPS) ON HOSPITAL BASED DIALYSIS CENTERS (HBDCS) George Coritsidis, Anjali Acharya, Ross Miller, Kelly Ko, Akhtar Ashfaq, Irene Agodoa; NYC Health and Hospitals Corporation (HHC), New York, NY, USA; Cerner Life Sciences, Beverly Hills, CA, USA; Amgen Inc, Thousand Oaks, CA, USA; The ESRD PPS will begin on January 1, 2011 and has the potential to impact HBDC financial stability, quality and patient access to care. This survey was designed to collect data related to HBDC’s perceptions of the PPS. Between Oct 2009 and Feb 2010, an online baseline questionnaire was sent to all HBDCs in the US (N=910) using the 2006 CMS provider file. Of the 910 HBDCs included in the CMS provider file, 669 were successfully contacted and 128 (19%) of facilities completed the survey. Respondents from dialysis centers affiliated with smaller hospitals (<200 beds) were more concerned that the new PPS may create financial risk (85.0% vs. 75.0%) compared to those affiliated with larger hospitals (≥200 beds). The figure provides an overview of HBDC perceptions around the consequences of the PPS.

Innovation in Our Nation's Public Hospitals: Three-Year Follow-Up Interview with Five CEOs and Medical Directors—Part 2

Tom Janisse, MD Summer 2011 - Volume 15 Number 3 This is Part 2 of a two-part conversation with leaders (Table 1) from four hospitals and systems who participated and attended the 2010 annual meeting of the National Association of Public Hospitals i

Business Process Improvement

The limitation of medical intern and resident work hours, known as the Bell 405 regulations, was initiated in New York State in 1989 with a modification to the state hospital code. The Bell 405 regulations were strengthened in 2000, and facilities would now be fined for noncompliance. Monitoring systems in place at that time were insufficient to provide an adequate level of review for the New York City Health and Hospitals Corporation (HHC) with more than 7,000 medical residents whose training is based at or who rotate through these public hospitals. A "simple to use," yet comprehensive, method of monitoring compliance needed to be developed to ensure that residents and interns complied with laws regulating working hours. The subsequent development of national accreditation standards increased the stakes for reliable scrutiny. HHC developed and implemented a Web-based Structured Query Language (SQL) application that facilitated easy access to work hour surveys captured through electronic time sheets. The time sheet data automatically entered a database that provided instant analysis of conformance to state law. The development of an electronic on-line application accessible from anywhere allowed HHC to efficiently identify nonconformance and pinpoint corrective action. Since the inception of the application and its expansion allowing access through the intranet, 26,000 individual time sheets have been submitted for evaluation. With the national movement regulating work hours, other hospitals still at the pencil and manual computation stage would greatly benefit by developing a similar application.

Ovarian cancer treatment in the New York City municipal hospital system

5569 Background: OC patients (pts) from minority groups/lower socioeconomic strata are reported to have poorer outcomes. New York City (NYC) Health and Hospitals Corporation (HHC) has 11 municipal hospitals. We evaluated surgical management of OC pts in HHC hospitals. Methods: The New York State SPARCS database of admissions was queried for OC pts in the years 2001 to 2006. Pts from HHC were compared to pts from all other NYC hospitals (other cohort). Pt demographics, procedure performed, emergent vs. scheduled admission, length of stay, and hospital charges were compared utilizing chi-square. A comorbidity index was applied to both cohorts. Surgeons were stratified by subspecialty training and OC case volume. Results: 6,010 admissions for OC were identified. 3,624 were major surgical procedures: 187 from the HHC cohort and 3,436 from the other cohort. Demographics for HHC vs other cohort, respectively: Caucasian 37 (20%) vs 2,224 (65%); African-American (AA): 64 (34%) vs 460 (13%); Asian 20 (11%) vs 181 (5%); other: 66 (35%) vs 286 (8%); unknown 0 vs. 286 (8%) (p&lt; 0.001). Payors for the HHC vs other cohort, respectively: Medicaid 108/187 (57%) vs 279/3,437 (8%); Medicare 22/187 (12%) vs 872/3,437 (25%); private insurance 38/187 (20%) vs 2,244/3,437 (65%); self-pay 18/187 (10%) vs 40/3,437 (1%) (p &lt; 0.001). Urgent admissions were 96/187 (51%) of HHC cohort vs 902/3,436 (26%) of other cohort (p &lt; 0.001). There were no differences in comorbidity rating or procedures performed. Subspecialty surgeons were documented for 59/187 (32%) of HHC cohort vs 1,839/3,437 (53%) of other cohort (p &lt; 0.001). The majority of surgeons performed less than two OC cases over the six year period, however surgeons with cases at HHC hospitals were more likely to be represented in the top 15% of total case volume (25% vs 14%, p &lt; 0.01) due to affiliations with academic centers. Conclusions: Pts in HHC cohort were more likely to be AA, have an urgent admission and less likely to have insurance or have a gynecologic oncologist as a surgeon. However there is evidence of centralized care for some in the HHC cohort. Despite the limitations associated with using a large database, clear differences were seen in the patterns of care between municipal and all other NYC OC pts. Studies to document outcomes and further optimize care within the HHC hospital system are ongoing. No significant financial relationships to disclose.

Engaging Patients and Family Members in Patient Safety?The Experience of the New York City Health and Hospitals Corporation

As one of its strategies to improve care, the New York City Health and Hospitals Corporation (HHC) has launched a number of initiatives to increase patient and family member involvement in the delivery of mental health services, including the hiring of peer counselors and the use of parent advocates. The effort to orient mental health services toward a more rehabilitative and recovery model has resulted in a significant change in the clinical culture. The article outlines patient and family member initiatives undertaken by the Corporation and offers some preliminary results that show the strong bond between increased patient and family member involvement and patient safety.

Something of value: The introduction of contingency management interventions into the New York City Health and Hospital Addiction Treatment Service

This paper explores the impact of the adoption of the contingency management approach by the Chemical Dependency Treatment Services of the New York City Health and Hospitals Corporation (HHC). The utilization of this approach grew out of an alliance between NIDA Clinical Trials Network-affiliated clinicians and researchers and a leadership team at the HHC. Interviews and dialogues with administrators, staff, and patients revealed a shared sense that the use of contingency management had: (1) increased patient motivation for treatment and recovery; (2) facilitated therapeutic progress and goal attainment; (3) improved the attitude and morale of many staff members and administrators; and (4) developed a more collegial and affirming relationship not only between patients and staff, but also among staff members.

Hospitals: N.Y. Appellate Court Denies Move to Privatize Public Hospital

The Court of Appeals of New York held, in Council of the City of New York u. Giuliani, slip op. 02634, 1999 WL 179257 (N.Y. Mar. 30, 1999), that New York City may not privatize a public city hospital without state statutory authorization. The court found invalid a sublease of a municipal hospital operated by a public benefit corporation to a private, for-profit entity. The court reasoned that the controlling statute prescribed the operation of a municipal hospital as a government function that must be fulfilled by the public benefit corporation as long as it exists, and nothing short of legislative action could put an end to the corporation's existence.In 1969, the New York State legislature enacted the Health and Hospitals Corporation Act (HHCA), establishing the New York City Health and Hospitals Corporation (HHC) as an attempt to improve the New York City public health system. Thirty years later, on a renewed perception that the public health system was once again lacking, the city administration approved a sublease of Coney Island Hospital from HHC to PHS New York, Inc. (PHS), a private, for-profit entity.

Managing the unmanageable: Public hospital systems

There are significant challenges to those who work in large public health care delivery systems: political imperatives; resource constraints; sometimes rigid personnel systems; and, the reality that everything occurs in a public forum. The fact that many nations are reviewing and, in some instances, restructuring their national health care systems, has added to the complexity and feeling of continual turbulence experienced by their managers. State run systems like that in the United Kingdom are introducing market forces to increase effectiveness and value for money; while market systems, like that in the United States, are increasing regulatory interventions to achieve the kind of cost control available to countries with large public systems which operate with global budgets. Public hospitals in the United States offer examples of public institutions operating in a highly competitive market environment. A decade of management changes undertaken to enhance the efficiency and effectiveness of the New York City Health and Hospitals Corporation (HHC), the largest public hospital system in the United States, is presented as a case study of public health services and public management in a market environment.

Community Boards in Search of Authority

T whom should publicly financed hospitals be responsible? In the case of city hospitals the principle of accountability to city residents and taxpayers is at least given lip service. Yet translating the principle of public accountability into practice is always fraught with conflicting alternatives and difficult choices. For example, which publics are to be served and which are to govern, it' any? What private influences are and should be involved in governing and receiving benefits? The New York City municipal hospitals began, over one hundred years ago, as charity institutions supported by public funds tor the direct benefit of the poor and the indirect benefit of the rich (who had the sick poor quarantined in the hospitals). New York City now has the largest municipal hospital system in the country. Nineteen municipal hospitals provide nearly onehalt' of the city's seven and one-half million residents with at least part of their medical care, and are the primary source of medical care for over a million and one-half persons, especially members of minority groups, the poor, the young, and the old. Until 1970 the city government exercised nominal control over the city hospitals, which were, at first, directly governed by physicians who volunteered their time, and later increasingly by persons connected with medical schools and teaching hospitals. Influence was also exercised by hospital administrators, by Blue Cross, by politicians, and by others. In 1970 the New York State Legislature established the Health and Hospitals Corporation (HHC) as a quasi-public benefit corporation, outside of the direct control of city hall. The new organizational scheme avoided some of the municipal bureaucratic regulations originally designed to insure public accountability, but more recently responsible for delays in the purchasing and construction of new facilities. The mayor and city council did retain influence in the Health and Hospitals Corporation through their power to appoint members to its board of directors and through the city's financial contributions to the corporation. While the establishment of the corporation reduced formal accountability, at least at the city-wide level, to the people of New York