The NYU Langone Brooklyn Emergency Department (ED) seeks to mitigate the social determinants of health for at-risk populations by connecting patients with appropriate social resources at a Federally Qualified Health Center (FQHC). The client enlisted a Capstone team to help 1) develop a social determinant of health screener for physicians to administer during patient visits, and 2) evaluate the efficacy of a pilot screening of over 50 patients in the ED. Patients participating in the pilot who screen positive are connected to a variety of interventions via a referral system to the FQHC. The team observed the range of referrals—from food pantry bag distribution to health information pamphlet dissemination, from social work interventions to financial counseling consults—and collected data from follow-up tracking conducted by the ED and FQHC on patients who received referrals. In its final report, the team analyzes and visualizes relevant data and makes recommendations for full implementation of the triage screening and referral system.

There has been a consistent decline in the number of physicians pursuing the field of primary care. Because a wide variety of research highlights the importance of early intervention for health outcomes, a Capstone team investigated the relationship between primary care physicians (PCPs) and their effect on population health. The team conducted a comprehensive literature review analyzing the root causes of the declining number of PCPs, considering the involvement of social determinants of health, and examining anecdotal case studies. Based on its findings, the team assessed the degree to which over-utilization of specialists and emergency rooms interrelates with poorer patient health outcomes. The team’s recommendations included expanding access to telehealth, incentivizing PCPs to form quality relationships with patients, and implementing measures that allow various health institutions to track population health outcomes.

Bronx Community Health Network (BCHN) is a nonprofit, community-based organization and federally qualified health center (FQHC) with a mission to improve the health of individuals and families in the Bronx. BCHN has implemented evidence-based blood pressure control programs to improve its patients’ hypertension control and encourage self-management and healthy lifestyle goals. BCHN engaged a Capstone team to compile four years of data into a comprehensive report on the effectiveness of its blood pressure program at Bay Eden Senior Center. The team analyzed the data, conducted a literature review, and interviewed BCHN and Bay Eden staff members. Based on its findings, the team compiled a final report that includes comprehensive data analysis, outlines areas for improvement, and provides evidence-based recommendations to improve the existing screening program.

The Department of Orthopedic Surgery at the NYU Langone Orthopedic Hospital conducts thousands of procedures annually, ranging from adult reconstructive surgery to surgical oncology. The Department enlisted a Capstone team to assist in its aim to provide outstanding patient care and maximize financial performance, while adjusting to changes to the Centers for Medicare and Medicaid Services inpatient-only list. The team conducted on-site visits of various NYU Langone campuses and analyzed operating room utilization data and financial data. Using evidence-based guidelines and practices, the team identified procedures that can be moved from inpatient sites to ambulatory care sites to increase revenue and operating room utilization. In its final report, the team identifies high volume procedures that can be safely performed in outpatient settings where patients are discharged the same day as the procedure. In addition, the team considers the financial ramifications of moving procedures to outpatient settings, and the impact on quality and patient safety.

The US continues to face a nursing shortage that was first recognized in 1998, and widely exacerbated by the Covid-19 pandemic, which has driven nursing school graduates to shift careers and active nurses to retire earlier than expected. The team conducted a literature review outlining the factors that are most responsible for the current nursing shortage and reviewing the repercussions of the shortage. The team found that burnout, low pay, a lack of educational programs, an aging nursing population, and a growing advanced practice provider workforce all contribute to the low supply of nurses, and that an aging population, more chronic illness, and a need for more highly-trained nurses all contribute to the increased demand for nurses. Based on its findings, the team recommends the following measures: 1) addressing the shortage during the recruitment phase, 2) expanding access to, and advisement provided by, Bachelor of Nursing programs, and 3) offering financial incentives for entering the nursing profession. The team further recommends that efforts to retain existing nurses should include increasing the number of nurse residency and mentorship programs, improving nurse leadership, addressing burnout, and providing financial incentives to practicing nurses.

BJC HealthCare (BJC) is one of the largest nonprofit healthcare organizations in the US, with 15 hospitals located across Missouri and Illinois. As per the Patient Protection and Affordable Care Act of 2010, each BJC hospital is required to complete a Community Health Needs Assessment (CHNA) at least every 3 years. BJC engaged a Capstone team to provide recommendations to increase alignment in CHNA execution across the network and improve processes to better reflect the health needs of communities served by the organization. The team conducted an extensive landscape analysis of CHNA activities at healthcare organizations across the country and drew upon best practices regarding health needs data collection, community and patient engagement, participatory action research, and public health planning. In addition to making recommendations that were immediately implemented in the 2023 CHNA at one of the BJC hospitals, the team created an updated CHNA guidebook, along with a roadmap outlining steps for BJC to implement a system-wide approach for future CHNA cycles.

Mount Sinai Doctors Faculty Practice (MSDFP) is a multispecialty group of more than 2,000 physicians integrated within the Mount Sinai Health System. The current onboarding process can be unmanageable for administrators and confusing to doctors, and can lead to dissatisfaction and high turnover. MSDFP engaged a Capstone team to investigate and analyze the onboarding process for new physicians. The team analyzed current literature, constructed a process map from the physician’s perspective, and interviewed administrators from different hospital systems across the nation. The team produced a final report outlining best practices and recommendations to improve MSDFP’s onboarding processes for short-term and long-term success.

The Violence Prevention Initiative of the New York City Department of Health and Mental Hygiene (DOHMH) oversees NYC’s Hospital-Based Violence Interruption Programs (HVIPs). While HVIPs are an essential component of NYC’s public health-based violence prevention strategy, they are deeply underfunded and struggle with sustainability. DOHMH enlisted a Capstone team to identify ways to strengthen city-wide HVIPs with a special focus on sustainable financing. The team conducted an analysis of public datasets to explore violence at the national, state, and city levels and to better understand NYC rates of violence relative to other localities. The team completed further research and structured stakeholder interviews, and developed a database of national HVIPs. The final report includes an advocacy policy brief based on the team’s findings and sustainability recommendations, including ways to use Medicaid as a vehicle to reimburse NYC HVIPs.

Surgical technologies at the NYU Langone Orthopedic Hospital continue to evolve and expand, allowing surgeons to have better accuracy and spend less time in the operating room. Robotic-assisted total joint replacement surgery has shown additional benefits, such as faster recovery times and improved patient outcomes and satisfaction. Long-term, these technologies can be cost-saving for a hospital. The Capstone team was tasked with providing a financial analysis of the implementation of robotic technology for total joint and spine surgeries at three client sites: NYU Manhattan, NYU Brooklyn, and NYU Long Island. The team evaluated operating room volume data, reviewed current and upcoming orthopedic technologies, conducted a SWOT analysis, and researched market trends. The team’s final report outlines recommendations to guide technological implementation at NYU Langone hospitals.

Many healthcare organizations are working to improve their diversity efforts and outcomes, but ensuring that best practices are effective and sustainable has proven difficult. Many healthcare organizations have adopted DEI initiatives, but is this truly leading to a paradigm shift in diversity management? With an aging American demographic and an increasingly diverse population, it is crucial to prioritize culturally competent strategies in cultivating a more equitable system for both patients and practitioners. The team undertook a literature review that outlined the current state of diversity in healthcare in the following categories: care, educational opportunity, cultural competency, executive-level involvement, and best practices. The team recommended making efforts to increase accessibility to healthcare education in minority communities and honoring these communities through appropriate cultural competency.

In the ongoing COVID-19 pandemic, healthcare delivery in the US continues to be affected by patient demand and limited resource supply. Telehealth services are a way to mitigate the demand and supply issue and have become integral to present-day healthcare delivery. A team analyzed the evolving use of telehealth services and technology within three distinct stages of the pandemic. The team organized its literature review chronologically and thematically, describing how telehealth utilization shifted for three primary stakeholders—patients, providers, and payers—during the varying timeframes. The team synthesized current literature and concluded that further research is needed to better understand the stakeholders’ user experience and forecast the future utilization of telehealth services in the US beyond the pandemic.

The NYC Board of Correction (BOC) is a nine-person, non-judicial oversight board that regulates, monitors, and inspects NYC correctional facilities. During the COVID-19 pandemic, the BOC modified its oversight model to document the public health crisis in jails. Priorities included monitoring the system’s evolving response, facility adherence to agency plans, and general operations and compliance with BOC Minimum Standards. With over a year’s worth of data, the BOC engaged a Capstone team to create a comprehensive report on the impact of COVID-19 in jails. The team analyzed the data, conducted a literature review, and coded interviews held with incarcerated people. Based on its findings, the team compiled a final report that outlines areas for improvement and tangible recommendations to address existing gaps in the system.