New York-Presbyterian Hospital (NYP) has invested in numerous healthcare information technology systems (HIT) to manage the organization’s productivity. HIT systems manage health information across computerized systems and secure information exchange between consumers, providers, government, and insurers. Concerns exist that a breakdown has occurred between HIT system owners and nursing leadership system users, causing an inefficient utilization of HIT systems. Through interviews and surveys, the Capstone team gathered and analyzed feedback from both HIT system owners and nursing leadership HIT system users. The team also conducted a thorough literature review on implementation and management of HIT systems. Using that information, successful methods were identified and a strategic plan for streamlining productivity tools was developed. The team presented NYP with recommendations to improve productivity through optimization of various HIT systems.

From 2011 to 2013, the total uncompensated costs of charity care and bad debt for U.S. hospitals amounted to $37.2 billion each year, resulting in a net loss of $24.6 billion dollars each year. The Affordable Care Act (ACA), signed into law in 2010, would presumably lead to reductions in uncompensated costs by expanding health insurance coverage in the U.S. Increasing the number of Americans with insurance would consequently decrease the number of those unable to cover their medical expenses. Two mechanisms were included in the ACA to help achieve the expansion of health insurance coverage: the individual mandate to purchase insurance, and the expansion of Medicaid. Six states expanded Medicaid around 2010, while several others followed in 2014. This study confirms that early Medicaid expansion reduces hospital uncompensated costs considerably. In addition, the Capstone team estimated that a one percentage point increase in the insured population reduces uncompensated costs as a percentage of hospital operating expenses by 0.3 percentage points.

God’s Love We Deliver, a NYC-based, nonsectarian food and nutrition services nonprofit, is experiencing rapid growth. The organization is considering expanding existing services to new counties and new primary diagnoses, while looking to close gaps in current service areas. At the same time, state Medicaid policy has changed to offer reimbursements for food and nutrition services to certain populations, providing opportunities for further expansion. The Capstone team provided a quantitative estimate of God’s Love’s current gaps and potential growth from two perspectives: healthcare public financing reform and epidemiological trends. The team’s estimates provided a detailed synthesis of publicly available population data by disease category, county, and policy target populations, as well as forecasted growth for each. These numbers will enable God’s Love to leverage its expanded capacity and achieve greater effectiveness.

The Department of Orthopedic Surgery at Montefiore Medical Center has been providing comprehensive care of all orthopedic and musculoskeletal conditions for over 50 years. More than 128,000 patients visit the center annually for its expertise in orthopedics, as well as sports medicine and oncology. A Capstone team was requested to establish current market position for Montefiore’s sports medicine program and determine the business model required to become the dominant provider of sports medicine services in the South Bronx and lower Westchester market. The Capstone team identified internal and external stakeholders, conducted a thorough literature review, and carried out process and data analyses. Based on a SWOT analysis, the team provided a list of recommendations for a sustainable business model related to short-term and long-term opportunities.

The NYC Department of Health and Mental Hygiene (DOHMH) is one of the oldest departments of health in the U.S., employing more than 5,000 staff and supporting NYC’s diverse population of 8 million residents. DOHMH has established a comprehensive framework for identifying vulnerable populations; however, informing the public of factors that may increase their vulnerability to specific hazards remains a major challenge. The Capstone team developed an “At-Risk Self-Assessment” tool that allows residents to self-identify specific vulnerabilities and receive tailored feedback based on data that users input. In designing the tool, the team reviewed DOHMH vulnerability analyses, emergency preparedness surveys, and available preparedness content. The team also consulted NYU faculty with backgrounds in emergency preparedness to construct a self-assessment survey of personal risks (e.g., functional impairment) and an algorithm that provides a single, simple report with guidance on preparedness and hazard response.

The NYU Langone Faculty Group Practice (FGP) provides ambulatory care through more than 140 different practices. Due to practice acquisitions and recent technological upgrades, FGP has made patient experience a top priority. FGP requested that the Capstone team evaluate front-end office administrative processes (e.g., scheduling appointments, registration) to improve both consistency and efficiency across practices. The team performed several site visits to understand current workflows, analyze patient satisfaction surveys, and examine administrative metrics to identify opportunities for the improvement and standardization of best practices at FGP.

The Office of Patient Care Services (PCS) within the Department of Veterans Affairs receives an enormous number of high-priority, deadline-sensitive electronic correspondence from Congress, the White House, the media, and veterans. PCS receives 200-500 emails per day and must achieve rapid turnaround to process these requests. As a result, PCS is experiencing an overwhelming volume of incoming correspondence, unregulated workflow, and information overload. The Capstone team was tasked with analyzing their current process and level of performance. By conducting internal interviews and developing and evaluating questionnaires, the team collected information and provided recommendations to improve the overall process. Based on their findings, the Capstone team, while measuring for quality assurance, piloted their customized tracking mechanism to enhance the department’s response rate.

New York-Presbyterian (NYP) is one of the premier healthcare institutions in the United States. The hospital’s mission is to provide a full spectrum of medical interventions, from the prevention of disease and treatment of illness, to the promotion of wellness and the prospect of cure. NYP is committed to excellence in patient care, research, education, and community service. NYP enlisted the Capstone team to evaluate registered nurses’ time at the bedside. Specifically, the team investigated factors that can interrupt the time dedicated nurses spend with their patients. The Capstone team performed a qualitative and quantitative analysis of select inpatient units at four NYP campuses. After examining best practices in the field, the team made recommendations to improve nurses’ time spent at their patients’ bedsides; suggested practices aimed at prioritizing and organizing nurses’ work schedules; and suggested technological investments to deliver quality, patient-centered care with greater efficiency.

The Office of National Drug Control Policy (ONDCP) Reauthorization Act of 2006 reauthorized the ONDCP as the primary agency of U.S. federal drug control policy. The provisions of this act included a modification of the patient limits imposed on physicians who use buprenorphine therapy for opiate addiction, raising the cap from 30 to 100 patients per physician. Prescription opioid painkiller overdose rates quadrupled from 1999 to 2010, and prescription painkillers often serve as the gateway to other addictive substances. While advocates of buprenorphine point to its efficacy in safely reducing abuse of opioids including heroin, morphine, and prescription painkillers, other experts warn of the potential for misuse of the addiction treatment drug. This study investigated possible unintended consequences of the ONDCP Reauthorization Act of 2006 by estimating its impact on illicit drug use.

AdvantageCare Physicians (ACP) is a multi-specialty physician practice group delivering comprehensive, community-based care in convenient locations throughout the New York City metropolitan area. ACP is considering urgent care centers (UCCs) as a possible new service line, and requested a Capstone team to develop a comprehensive business plan. Development of the business plan included a literature review evaluating national trends, best practices and their impact on the New York City market, and preparing a heat map of local UCCs. The team also reviewed the scope of urgent care services currently offered at ACP and conducted patient surveys at key ACP locations. A thorough analysis was then performed to gain a better understanding of the potential for UCCs to improve access to healthcare and lower costs. Based on its findings, the team prepared a report advising recommendations for the implementation of a UCC.

CAMBA Gardens I is a supportive and affordable housing residence located on the campus of Kings County Hospital. It is comprised of 209 units, of which 146 units are occupied by formerly homeless individuals and their families. CAMBA Gardens is the first supportive housing residence in the nation to be co-located within a large public hospital. CAMBA Gardens II is currently under construction and will add an additional 293 supportive and residential units. The Capstone team was asked to evaluate the effects of health care utilization, residents’ behavior, and overall housing stability. The team interviewed staff at various levels of the organization to determine how CAMBA defined success. The team then designed and administered a survey to 70 supportive housing residents and completed two focus groups. The team’s findings and recommendations will help CAMBA design programming for the new units.

Jamaica Hospital Medical Center (JHMC) strives to provide accessible, cost-effective, high-quality health care. Recently, JHMC has implemented three pilot care-transition programs: 1) The Intensive Multidisciplinary Primary Care Team (IMPACT), 2) the Community-Based Care Team (CBCT), and 3) the Hospital Care Transitions Team (CTT). The programs have yielded cost savings for JHMC, and attention to best practices in care coordination has resulted in major improvements in patient care. In the face of diminishing government funds, JHMC requested a Capstone team to develop a cost-benefit analysis methodology to utilize as a demonstration tool to key stakeholders that the programs have positive financial outcomes and patient care improvements. After extensive research and analysis, the team delivered a literature review outlining successful methodologies implemented by other institutions and best practices for achieving accurate calculations, and a methodology to assess the costs and benefits for future care management programs and similar patient-centric initiatives.