The Emergency Department as the Front Door to Care in the Bronx
Bronx Community Health Network: ER Project
The Bronx Community Health Network (BCHN) is a nonprofit organization and federally qualified health center that sponsors fifteen community and school-based health centers in the Bronx. The health centers are owned and operated by Montefiore Medical Center and Acacia/Promesa Systems. At one site, Montefiore’s Weiler Hospital Emergency Department, BCHN funds a Patient Liaison who runs BCHN’s Emergency Department Diversion Program. The Patient Liaison works to prevent unnecessary readmission to the emergency department (ED) by connecting patients to primary care at BCHN health centers. The Capstone team conducted a program evaluation to determine the effectiveness of the ED Diversion program and to explore the drivers that continue to bring patients to the ED for non-emergent care and primary care. The team accomplished this by conducting a comprehensive literature review, interviewing key stakeholders, coordinating patient focus groups and analyzing secondary data.
Bronx Community Health Network: Strategic Plan
The Bronx Community Health Network (BCHN) is a federally qualified health center that sponsors fifteen community and school-based health centers. Since BCHN’s last strategic planning effort in 2007, the organization expanded their network of centers and adapted to significant changes in the health care environment. In response to these developments, BCHN commissioned the Capstone team to update its strategic plan to reflect the organization’s progress and evolving goals. The team conducted an in-depth literature review of health center regulations, the Affordable Care Act, and best practices in community-based medicine and outreach. The team also conducted a SWOT analysis with BCHN senior leadership and interviewed health center staff, government officials, policy experts, community-based organizations, and other key stakeholders. All research was synthesized into a final report of recommendations to help BCHN expand and strengthen their network partnerships, improve patient care, and advance the health of the Bronx community in the next five years.
Using Performance Measurement to Improve Sustainability
The Capstone team worked with Mercy Home for Children, a Brooklyn nonprofit serving the developmentally disabled, to enhance their ability to sustain current and obtain new program funding sources. The team first conducted individual interviews with organization program staff to determine current practices in performance measurement; identified current best practices and metrics through an extensive literature review; and created program logic models with indicators for comprehensive metrics. In addition, the team identified key recommendations to improve Mercy Home’s internal capacity to manage performance measurement of their current and future programs. A key recommendation included the investment and adoption of performance measurement software to create reports and dashboards specific to funders and stakeholders. These results will be used to aid Mercy Home in developing specific strategies to strengthen their approach to proving successful program performance history and impact.
Impact of a Medicaid Managed Care Model on Vulnerable Populations in NY State
New York Civil Liberties Union
The New York Civil Liberties Union (NYCLU) is one of the nation's leading defenders of civil liberties and civil rights. The NYCLU requested a Capstone team to help analyze and evaluate the New York State’s new model for the delivery of Medicaid services to persons with disabilities. The research began with an analysis of existing models in New York State for the delivery of services to vulnerable populations, systems and procedures of oversight and accountability regarding quality of care; identification of significant challenges and risks posed by New York State’s managed care initiatives through a series of interviews with stakeholders; and identification of best practices to promote favorable outcomes. These analyses provided a basis for recommendations to the NYCLU on policies and practices for delivering care to the focus populations, as well as oversight and accountability measures that promote favorable outcomes.
Evaluation and Strategic Planning
NYU-HHC Clinical and Translational Science Institute
The Clinical and Translational Science Institute (CTSI) was created as a joint five-year collaboration between New York University (NYU) and the Health and Hospitals Corporation (HHC) to “provide an integrated home for the advancement of collaborative translational science for the benefit of our patients, our community and the population at large.” The Capstone team's goal was to evaluate the effectiveness of the NYU-HHC CTSI in propelling translational research forward, with the ultimate goal of successful federal funding renewal from the NIH. The team evaluated the eight existing CTSI programs by first defining measures for success, followed by interviews with key program stakeholders, an analysis of existing data, and evaluation of other program-specific projects. The team synthesized these findings into a comprehensive summary report that will assist the CTSI in its efforts to further its mission to foster innovative research and discovery.
Physician Organization Concerns Regarding the 2010 Affordable Care Act
United States Centers for Medicare & Medicaid Services
Centers for Medicare & Medicaid Services (CMS), an agency within the United States Department of Health and Human Services, expressed interest in understanding the controversy among physician opinion and perception regarding the recently passed Patient Protection and Affordable Care Act of 2010 (ACA). CMS recruited the Capstone team to complete a thorough analysis of opinions from select physician organizations within CMS Region II. The team first conducted an online investigation of physician organization position statements and published quotes from organization officials, and also took part in CMS-led provider calls and educational sessions. The team then prepared a written analysis focused on research of key issues of the ACA and the correlating, dissenting, or lacking physician organization opinions. Finally, the team presented a concise document that outlined the top concerns of the physician organizations, as well as recommendations on physician organization education.