Measures of distinction

Top performers in adult cardiac surgery

The Society of Thoracic Surgeons (STS) provides the public with information about mortality and morbidity for certain cardiac procedures. Data on cardiothoracic surgical outcomes provides patients and their families with critical information to help them make the most informed choices about their health care.

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating outcomes for the following five cardiothoracic surgery procedures: isolated coronary artery bypass graft (CABG), isolated aortic valve replacement (AVR), CABG + AVR, isolated mitral valve replacement/repair (MVRR) and CABG + MVRR. Star ratings derive from testing whether a provider’s score is significantly different from the overall STS national average in the five surgical categories. A three-star overall quality rating is the highest possible rating and represents the top 10 percent of those rated nationally.

In the most recent STS report, each Northwell Health cardiac surgery program earned three-star overall ratings (highest quality rating) as shown.

Percutaneous coronary intervention (PCI)

Northwell Health strives to continuously improve PCI performance by analyzing outcomes, creating meaningful quality improvement programs and publicly reporting its health care quality data. The standard by which Northwell Health cardiac catheterization patients are selected for PCI is the Journal of the American College of Cardiology (JACC) Guidelines for Appropriate Use. The most recent results from the National Cardiovascular Data Registry (NCDR®) CathPCI Registry® Outcomes are shown.

According to the most recent report on PCI from the New York State Department of Health (February 2020), Northwell Health hospitals compared favorably to US Registry patients for in-hospital/30-day observed and risk-adjusted mortality (all patients).

Transcatheter aortic valve replacement (TAVR)

Aortic stenosis (AS) is a narrowing of the aortic valve orifice in the heart which may lead patients to experience symptoms such as shortness of breath, fatigue, chest discomfort or fainting spells. Traditionally, patients with these symptoms were referred for surgical aortic valve replacement (SAVR), except for patients assessed to be at higher risk for complications and/or mortality. These patients can now undergo a much less invasive procedure through transcatheter aortic valve replacement (TAVR). The procedure is performed using a catheter that is advanced to the heart — most commonly through the femoral artery.

Four Northwell Health hospitals (Lenox Hill, Sandra Atlas Bass Heart Hospital at North Shore University Hospital, Southside Hospital and Staten Island University Hospital) perform TAVR procedures. More than 550 TAVRs were performed in 2019, with almost 2,900 procedures performed since program inception. The combined 30-Day TAVR mortality rates for the four Northwell Health programs are shown.

Northwell Health has one of the highest-volume TAVR programs in the nation. This is of critical importance to patients, as recent studies report superior outcomes in TAVR centers with the highest volumes.

Health Solutions

Advanced Illness – Independence at Home

The Northwell Health Advanced Illness Management program (House Calls) provides home-based primary care to homebound, frail, elderly individuals. With the majority of an aging population in the US desiring to remain in their own homes, home-based primary care programs foster care delivery whenever and wherever it is needed. Home-based primary care providers (PCPs) prevent unwanted and potentially unnecessary hospitalizations by diagnosing and treating conditions early in the course of illness, establishing goals of care and honoring patient preference for care and treatment. The Northwell House Calls program is one of the largest academic programs in the nation, serving 2,117 unique individuals in 2019.

House Calls utilizes the expertise of physicians, nurse practitioners, nurses, social workers and medical coordinators to provide home-based primary, urgent and emergent care in the home. Team members provide routine visits as well as acute visits for changes in condition. Working with the Northwell Health Clinical Call Center as well as its community paramedicine program, the House Calls program is able to provide a meaningful clinical response in the home 24 hours a day, seven days a week.

The House Calls program continues its national leadership in the Centers for Medicare and Medicaid Services (CMS) Independence at Home (IAH) demonstration project, a national investigation into the benefi ts of home-based medical care as shown.

In 2019, House Calls implemented an innovative telehealth model utilizing emergency medical technicians (EMTs) to facilitate video visits with a patient’s PCP, which has doubled the number of patients a PCP can serve in any given time period.

CMS Hospital Compare Star Ratings: 30-day Medicare readmission reduction

In 2016, CMS released the Overall Hospital Quality Star Ratings on its Hospital Compare website. This rating system classifies hospitals on a 1–5-star scale based on reported quality measures and was developed to increase quality of care and help patients, families and caregivers compare hospitals within their region. Hospital readmissions impact 22 percent of the overall star rating for Medicare patients over the age of 65 with certain disease conditions.

Since 2017, Northwell Health Solutions has provided transitional care management services to qualifying Medicare patients to reduce 30-day readmissions. These transitional services include engaging with patients and assisting in their transition back into the community through follow-up phone calls and home visits. Throughout this process, Health Solutions collaborates with the sites to improve care coordination for post-discharge needs and redesign ED processes to improve coordination with emergency department (ED) providers.

In 2019, Health Solutions enrolled a total of 3,620 patients in Conversa, an automated texting platform that provides diagnosis-specific conversations, as well as patient-focused education.

CMS Comprehensive Care for Joint Replacement (CJR) program

In partnership with the Orthopedic Service Line, Northwell Health Solutions provides transitional care management services for all patients enrolled in the CJR program at Northwell Health sites and contracted partners. The program involves engaging patients during their hospital stay and following them throughout their 90-day episode of care with home visits and follow-up phone calls. All patient needs are provided for, including urgent changes in clinical condition. This extension of services into the community, combined with regular hospital engagement and care redesign, has led to incremental improvements in 90-day readmission rates and home discharge rates since the start of the CJR model as shown.

Clinical outcomes have directly resulted in financial success in this value- based arrangement, establishing Northwell Health as a regional leader in program compliance and patient care navigation.

Institute for Nursing

Humanism and therapeutic communication

The Office of the Chief Nurse Executive and site nurse executives, in collaboration with Nursing Education and the Office of Patient and Customer Experience, developed curricula based on Dr. Jean Watson’s Theory of Human Caring to reintroduce humanism and interpersonal relationships to patient care. This partnership has led to the creation of a therapeutic communication framework and education program that has contributed to improvements in patient experience. The Institute for Nursing provided a four-hour “Expressions in Humanism” train-the-trainer program to interdisciplinary staff members in all care settings across the organization. Over 17,800 interprofessional staff attended the program in the first 10 months it was offered. Improvement in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey Nursing Communication Domain and subcategories is shown.

The performance domain “Response of Hospital Staff ” increased 12 percentile points based on the most recent results of the HCAHPS survey.