Mapping the Pediatric Patient Experience

Client
NYU Langone Medical Center
Faculty
Sarah Gurwitz
Team
Alexandra Berdebes, Steven Bondi, Zeeshan Haque, Tatiana Hryhorowych, Julie Kim

NYU Langone is an academic medical center located in New York City, and the Patient Experience department is dedicated to improving patient satisfaction, identifying unmet needs and values of patients and visitors, and identifying system issues that impact care and quality. Working throughout the entirety of the Medical Center, the Patient Experience department strives to improve performance related to these areas. Based on results of a 2014 survey, the Patient Experience department determined that the pediatric unit was an area that the Capstone team could analyze, map, and improve. With this department as a focus, the Capstone team analyzed previous survey data; interviewed staff, patients, and family members; performed site observations; and created a patient map that identifies stress points in the current state. The final deliverables included a comprehensive high-level map of the patient experience, as well as a final report outlining the project, the current state, and policies for improvement.

Hematology Oncology Palliative Care Delivery Models

Client
NYU Langone Medical Center
Faculty
Susan Abramowitz
Team
Bhakti Kanade, Stephanie Ma, Sharon Ramot, Stephanie Stadig, Harrison Wolnick

NYU Langone Medical Center (NYULMC) is a top-tier academic medical center located in New York City, and the hospital has been a member of the U.S. News and World Report hospital honor roll since 2012. NYU Langone Cancer Center is looking to improve its continuum of care between inpatient and outpatient cancer treatment. NYULMC engaged a Capstone team to design and determine the viability of a palliative care model for the Cancer Center that will reduce end-of-life spending, while simultaneously maintaining or improving the quality of care for hematology patients. The team investigated current industry trends surrounding cancer care through a literature review, analyzed internal and external industry data, and conducted interviews with administrative and clinical staff. Recommendations of various care models were presented to the client, including a gap and financial analysis to investigate the financial feasibility of implementation in the clinical setting.

Determine the Long-Term Financial Sustainability of the Emergency Department Care Management Program

Client
New York City Health and Hospitals Corporation
Faculty
Robert Criscuolo
Team
Zachary Kelchner, Sumit Kumar, Kai Tsyr Lee, Bernard Ortega, Emma Zheng

New York City’s integrated health care system, New York City Health and Hospitals (H+H) Corporation, serves approximately 1.4 million New Yorkers annually, 479,000 of whom are uninsured. In September 2014, H+H was awarded a three-year $17.9 million grant through the Center for Medicare & Medicaid Innovation (CMMI) to support the enhancement of H+H’s Emergency Department (ED) Care Management Program located in six of its 11 hospitals. Currently in the grant’s second year, H+H is required to develop a strategy for the program’s financial sustainability beyond grant funding. Initial plans include collaboration with MetroPlus, the wholly-owned subsidiary health plan of H+H, and Healthfirst. A Capstone team was engaged to provide recommendations concerning the long-term financial sustainability of H+H’s ED Management Program after the completion of the CMMI grant. The team assessed the program and developed a payment model to support the program beyond the grant funding expiration. Additionally, the team conducted a cost savings analysis utilizing insurance claims and hospital billing data to determine if the risk–based contracts can sustain the program. 

Incorporating Community Health Needs into Emergency Planning

Client
New York City Department of Health and Mental Hygiene, Office of Emergency Preparedness and Response
Faculty
John Donnellan
Team
Joshua Choe, Janice McFarlane, Rebecca Park, Anna Rosenblatt, Sasha Walek

The New York City Department of Health and Mental Hygiene (DOHMH) is one of the world’s oldest and largest public health agencies. The mission of the DOHMH Office of Emergency Preparedness and Response (OEPR) is to increase the preparedness of healthcare systems for public health emergencies in New York City. OEPR engaged a Capstone team to better incorporate community health needs into hazard vulnerability assessments (HVA). The team consulted with two types of healthcare coalitions, the Mount Sinai Network Coalition and the Staten Island Borough Coalition, to inform and develop a methodology for this process. The team performed a gap analysis by conducting an extensive literature review, qualitative interviews with emergency planning experts, and data analysis. The final report outlined recommendations for streamlining the HVA process in order to better integrate community needs assessments in emergency planning, preparedness, response, and recovery efforts.

Reducing Surgical Cancellations in the Department of Orthopedic Surgery

Client
Montefiore Medical Center
Faculty
Susan Abramowitz
Team
Deirdre Apicello, Estefania Blanco, Taruna Gupta, Garner Michael Smythe, Karen Wu

The Department of Orthopedic Surgery (DOS) at Montefiore Medical Center provides comprehensive care for all orthopedic and musculoskeletal conditions. The DOS consists of ten subspecialties and five surgical facilities, treating more than 130,000 patients across the New York City Metropolitan area in 2014. The DOS engaged a Capstone team to assess causes of surgical cancellations—a critical impediment to their care delivery model—and quantify the financial and resource implications of these cancellations, with the goal of developing a remediation plan. To achieve that objective, the team conducted stakeholder interviews, process walkthroughs, and a thorough analysis of financial and cancellation data. Based on the team’s findings and industry best practices identified in a literature review, the team outlined a series of process enhancements and a pilot intervention to target and mitigate preventable cancellations.

A Financial Model for High-Touch Community-Based Palliative Care

Client
Metropolitan Jewish Health System Institute for Innovation in Palliative Care
Faculty
Robert Criscuolo
Team
Dupe Ajayi, Kristyn Baccaglini, Nick Huober, Fitore Milla, Harshita Ravishankar, Eric Slotsve

A nonprofit organization dedicated to serving the needs of New Yorkers facing life-limiting illnesses, Metropolitan Jewish Health System (MJHS) Hospice and Palliative Care created a community-based palliative care program eight years ago. MJHS’s most challenging and important home care program is called the High-Touch Model, which offers home visits by members of an interdisciplinary team (physician or nurse practitioner, social worker, and chaplain, if needed), telephonic outreach by a nurse specialist in palliative care, and 24/7 access to on-call services. MJHS’s corporate commitment to in-home palliative care can only be sustained, however, if management develops clinical models that offer a clear value proposition to payers in the healthcare system. Through environmental scans, literature reviews, and an analysis of clinical and financial data, a Capstone team developed a financial model that can be flexed based on clinical acuity, patient census, and staffing type and levels, as well as a white paper outlining the model.

New York Dialysis Provider Coalition

Client
DaVita
Faculty
Robert Criscuolo
Team
Jonathan Kalish, Bohwoo Kim, Helen Omuya, Samantha Tran, Charlene Yomtobian

DaVita is one of the major dialysis care providers in the United States and has the largest dialysis chain organization in New York. In addition to providing dialysis care, DaVita takes an active role in educating patients and lobbying for policy reforms to improve dialysis healthcare. In New York, DaVita provides dialysis care to over 6,000 patients across 53 clinics and 12 hospital partners. Providers in the dialysis market encounter many challenges, including inadequate reimbursements, non-emergency patient transportation, and emergency Medicaid care. DaVita seeks to ascertain the potential benefits of a coalition of dialysis providers, specifically in terms of improving patient care and mitigating the challenges faced by providers. The Capstone team performed a cost/benefit analysis based on literature reviews, an environmental scan, and market surveys on the benefits of forming the coalition that involves other chain organizations and independent providers. The team presented recommendations to DaVita on the benefits of forming/joining a coalition and the cost/risk this would entail. They also weighed the cost/benefit of a coalition against the alternative of standing alone as a chain organization.

Evaluation of Howie the Harp Peer Specialist Training Program

Client
Community Access
Faculty
Sarah Gurwitz
Team
Baron Aboagye-Frimpong, Galeano Claudia, Dayana Herrera, Ivelisse Vazquez

Community Access is a nonprofit organization committed to helping individuals with mental health issues make the transition from shelters and institutions to independent living. The organization’s Howie the Harp Peer Specialist Training Program (HTH) helps individuals with serious mental illness and histories of homelessness and incarceration train to become peer specialists. As peer specialists, individuals use their experiences to assist others going through recovery. Given the changing healthcare landscape in New York, peer specialist training programs are in high demand. Community Access engaged a Capstone team to evaluate the HTH program. Specifically, the team created survey tools to measure the program’s effectiveness and its impact on HTH graduates and employers. The team also conducted a comparative analysis of similar peer programs around the country. Using the data collected through surveys, the comparative analysis, and a literature review, the Capstone team produced a detailed evaluation report and provided future recommendations for the program.

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