Reliable Care

Source: National Healthcare Safety Network (NHSN)
Krasnoff Quality Management (KQMI) Table of Measures
Data as of February 5, 2020

Antimicrobial stewardship in neonatal intensive care units (NICUs): Neonatal Service Line

Antibiotics are one of many therapies offered to infants in NICUs. However, many infants are given antibiotics during their NICU stay without a proven source of infection. Evidence shows that overuse may increase local antibiotic resistance and have negative side effects. In 2016, Cohen Children’s Medical Center (CCMC) joined the Choosing Antibiotics Wisely campaign in collaboration with the Vermont Oxford Network (VON) and the Centers for Disease Control and Prevention (CDC) to optimize antibiotic usage in the NICU and decrease antibiotic resistance. The aim was to reduce the antimicrobial utilization rate (AUR) in the NICU by 25 percent over a four-year period from baseline and share best practices across the entire service line.

To achieve this aim, CCMC established evidence-based guidelines for the diagnosis and treatment of neonatal urinary tract infections (UTI), pneumonia and necrotizing enterocolitis (NEC), encouraged timely ordering and discontinuation of antibiotics, and implemented a neonatal early sepsis calculator to identify low-risk infants and minimize unnecessary antibiotic exposure. Infectious disease physicians and preventionists were enlisted to interpret culture results and narrow antibiotic coverage as soon as possible. Parents were also encouraged to become members of the team through enhanced communication about the indications for antibiotics and appropriate duration of treatment. Reduction in antimicrobial usage in the NICU at CCMC is shown.

Best practices were shared with the Northwell Health Neonatal Service Line, which represents 12 hospitals with a collective mission to ensure that all infants in the NICUs, special care units and newborn nurseries receive the same evidence-based standards of care and achieve excellent outcomes.

Population health: Behavioral health programs

With one in five individuals experiencing a mental health concern in any given year, timely access to high-quality behavioral health remains a persistent challenge. The integration of behavioral health has clearly emerged as a best practice, both for expanding access to care as well as improving quality. Our strategy was to develop a population health framework for behavioral health in our large integrated health system serving many diverse populations. Augmenting traditional acute care and ambulatory services, this emerging continuum of integrated services includes:

  • Collaborative care management for depression and anxiety in primary care
  • TelePsychiatry medication consultations for adult and pediatric primary care
  • Reverse integration and comprehensive care management for the chronically mentally ill through the health home-model
  • Adult and pediatric crisis centers for reducing preventable ED utilization
  • Collaborative care management and school-based mental health for the pediatric population

These programs include:

Pediatric behavioral health urgent care

The prevalence of children and adolescents with mental health disorders and suicidality is increasing. While early diagnosis has improved through more screenings and education, there is still a shortage of pediatric mental health providers (particularly child and adolescent psychiatrists), resulting in limited access to timely ambulatory care. In the absence of this, concerns quickly escalate to an emergency department (ED) visit.

To address this growing gap in care, the Northwell Health Pediatric and Behavioral Health Service lines partnered to establish a pediatric behavioral health urgent care center at Cohen Children’s Medical Center (CCMC). This unique program helps support families in a crisis by providing them with immediate access to a mental health evaluation and a child psychiatrist who can provide crisis treatment in a pediatric ambulatory setting conducive to engagement.

Behavioral health urgent care also provides short-term crisis care, allowing children to receive immediate care at home instead of an inpatient psychiatric unit. As a result, inpatient psychiatric admissions decreased by approximately 15 percent. Repeat visits to the CCMC ED decreased by nearly 70 percent as shown.

Since inception in May 2017, the Behavioral Health Urgent Care Center at CCMC was utilized by 3,672 families. More than 90 percent of patients needing a referral were successfully linked with outpatient mental health providers.

Northwell Health Home

Quality performance

New York State (NYS) launched the Health Home Serving Adults (HHSA) in January 2011 and Health Home Serving Children (HHSC) in December 2016. Designated by the NYS Department of Health, Northwell Health operates one of 31 lead Health Homes responsible for providing vital care management service to high-risk Medicaid members in Nassau, Suffolk, Queens, Staten Island and Manhattan. In collaboration with several community-based organizations, members receive services designed to improve health care outcomes. Core services include care coordination, transitional care, disease management and linkage to social supports and health care resources. As of December 2019, Northwell Health Home (NWHH) had 6,828 enrolled members across 20 care management agencies (CMAs).

Each Northwell Health Home developed, built and implemented a health information technology platform, training infrastructure and billing and payment system, in addition to instituting enhanced policies and procedures. A quality management program, including a tiering system that measures performance and provides incentives for outcomes, was also developed. An audit in February 2019 ranked NWHH among the top performers across the state as shown.

Northwell Health Home quality performance was designated Tier 4 by the New York State Department of Health
(Tier 5 — highest performance)

NowPow: Managing social determinants of health referrals to community-based organizations

Based on recent research, approximately 80 percent of health care outcomes are attributed to social determinants of health (SDoH) — that means they depend on external factors outside of the clinical care provided by health care organizations. The ability to address patients’ SDoH and track their care has the potential to improve patient outcomes.

The goal of this initiative is to address patients’ SDoH needs by linking them to high-quality community resources through the NowPow electronic referral tracking platform. The platform combines clinical data with the community resource data to connect patients with appropriate resources. Examples include home and community-based service (HCBS) providers, entitlement enrollment, stress management programs, fitness classes, family planning, food banks, housing, employment and transportation. In addition, Northwell Health care providers can track the status of community referrals and close the loop on them with community-based organization (CBO) partners. The ultimate goal is to improve clinical outcomes such as reducing 30-day readmissions and inappropriate emergency department (ED) utilization.

The NowPow platform allows Health Home resource coordinators to develop curated CBO lists related to the SDoH needs of patients so they can self-refer. These lists can be texted, emailed or printed depending on patients’ preferences. The four most commonly identified social determinants of health are shown.

Improvements in breast cancer screening rates: Physician Partners Medicine Service Line

Screening examinations to prevent and treat disease are an important aspect to staying healthy. Aside from some forms of skin cancer, breast cancer is the most common cancer among American women, regardless of race or ethnicity. Early detection through screening reduces the risk of dying from breast cancer, can lead to a greater range of treatment options and lowers health care costs. Northwell Health follows national guidelines for assessing women ages 50-74 who had at least one mammogram to screen for breast cancer in the past two years.

Based on feedback from clinical and non-clinical teams, the Northwell Health Medicine Service Line instituted several new initiatives to improve breast cancer screening rates across 100 primary care practices, of which 59 are patient-centered medical homes (PCMH). These initiatives include standardized note templates to provide reminders about screening exams, a registry database and clinical snapshot of preventative screenings and vaccinations.

Breast screening rates have continuously improved and exceed the national benchmark across the Medicine Service Line Primary Care Practices as shown.