Since its designation as a Children's Hospital by the National Association of Children's Hospitals and Related Institutions, Maimonides Infants & Children's Hospital (MICH) has continually worked to provide the highest levels of quality care in all pediatrics subspecial­ties. Serving over 750,000 children of diverse ethnic, cultural, and linguistic backgrounds in South Brooklyn, MICH identified the need to improve communi­cation between healthcare professionals, patients, and their families. Through inter­views, evidence­based research, and research from other children's hospitals, the Capstone team identified key commu­nication problems and compiled and ana­lyzedthisresearchtoproducerecommendations that MICH can use as it expands services, develops communication strategies, and creates mechanisms to evaluate and measure the organization's success in ful­filling its mission.

The Capstone team was engaged by New York ­Presbyterian (NYP) to develop a strat­egy to improve communication and collab­oration at Allen Hospital. There are approximately 5,000 nursing home beds and a substantial elderly population in the local community surrounding Allen Hospital, and NYP wants to better coordi­nate the care of the geriatric patient in the hospital with the providers in the commu­nity. The team performed a literature review on communication among providers and continuity of care; researched health care reform and Accountable Care Organizations; conducted interviews with nurses, doctors, clerks, and patients; and observed the emergency room at Allen Hospital. In addition, the team reviewed the social work process and assessed the hospital website to determine whether it could better connect patients and providers. As a final deliverable, the Capstone team improved the initial visit data processing system and built a frame­work for participating in community activi­ties and linkages between outside organizations and the hospital. The team's final recommendations build awareness of community resources and empower patients and providers to remain informed and connected.

The recently enacted Patient Protection and Affordable Care Act expands eligibility to Medicaid for millions of near­ poor indi­viduals. Given this expansion, policymak­ers need to understand the nature of the disparities that exist in the quality of care Medicaid beneficiaries receive as com­pared to their privately insured counter­parts. Previous research has demonstrated that as the percentage of Medicaid patients in a physician's practice increas­es, health services and the quality of care received by Medicare beneficiaries and the privately insured decrease. Yet, the literature offers very little information about the impact of a practice's proportion of Medicaid patients on the quality of care received by Medicaid patients themselves. The Capstone team analyzed how the proportion of Medicaid revenue received by a physician's practice influences the disparity in quality of care between Medicaid and privately insured patients. The study assessed whether disparities in the quality of care between Medicaid and privately insured patients occur within or between practices, and whether such disparities are themselves associated with the proportion of practice revenue from Medicaid.

Today's healthcare environment presents many challenges to nurse leaders, and effective leadership training for nurses is essential to successful transitions from the clinical to the managerial role. Addressing critical competencies and developing the required skills to manage staff and navigate the politics of a health­care institution are instrumental to this process. Along with curriculum content, the method of instruction is key for suc­cessful integration of the nurse into this new role. The Capstone team developed an evidence­based curriculum within a mentorship and project­oriented frame­work that will provide a cohesive starting point to bridge the gap between clinical practice and effective leadership. This cur­riculum will be implemented within the nurse's home institution and with partici­pation of senior leadership in order to reinforce newly acquired skills and the institution's culture.

Effective interdisciplinary communication is associated with reduced length of stay, improved patient safety, and increased employee satisfaction. However, communi­cation breakdowns are common in com­plex hospital settings and multiple com­munication structures often exist within the same organization. The Capstone team sought to evaluate current communication systems and make recommendations for improving interdisciplinary communication in hospital settings. After conducting site visits and staff interviews at Columbia and Cornell, the team identified highly functional interdisciplinary teams at both campuses. The team also evaluated best practices in interdisciplinary communication during site visits to other organizations. Based on characteristics of the highly functional teams, detailed interviews, site visits, and research from an extensive literature review on this topic, the Capstone team developed a pilot program for implementing an effective interdisciplinary communication structure on a hospital unit. Significant components of the pilot program include greater accountability, a focus on teamwork, and strong support from leadership.