The Quality Institute: A Year of Progress

The Quality Institute at UHF focuses on three strategic building blocks of safe, effective health care:

1) Patient engagement, to better understand patients' priorities and concerns about accessing care and assessing its impact,

2) Quality measurement, to ensure that the multiplicity of measures provides meaningful information and data, and

3) Quality improvement, to build the capacity of providers to develop, test, and implement effective interventions.

As we embark on a new year of activity—research and policy analysis, partnerships and learning collaboratives, roundtables and symposia—we look back, in capsule descriptions of our work, at the progress we've made on each of these fronts.

Over the past year we focused on:

Identifying gaps in quality measures and information that matter to consumers when choosing a health care provider;
Better capturing patients' goals and desired outcomes of care through the use of patient-reported outcomes in primary care settings;
Building the quality improvement and leadership skills of physicians and nurses from a broad range of health care settings in the New York metropolitan area;
Contributing to a quality measurement strategy for New York State's primary care transformation program;
Developing and supporting quality improvement solutions for urgent public health threats such as antibiotic resistance.
Quality measures and information meaningful to patients
For patients who must make critical health care decisions, quality measures and information to help them choose a care provider are lacking, varying in rigor and accuracy, and/or difficult to access and understand. Despite the centrality of trust, communication, caring, and respect to how patients experience care, UHF's analysis of 500 quality measures and 32 websites reveals a dearth of information relevant to those concerns. Our findings indicate a need for:

Simplifying quality data;
Assisting consumers, patients, and families in navigating the information;
Integrating data from public and private sources;
Standardizing measure sets to explicitly guide consumer choice, and incentivizing their use;
Developing new partnerships and communication vehicles that put patients at the center of information gathering and dissemination.
Read UHF's new report on quality measurement priorities, measures that might be most useful to consumers, and strategies for moving forward.

Capturing patients' goals and desired outcomes of care
The use of “patient-reported outcomes,” or PROs, to elicit patients' goals, expectations, and desired outcomes is gaining traction in specialty settings. How can this kind of quality data—relevant to the symptoms and functional needs that bring patients in for care, and to patients' broader goals—be best used in primary care as well? UHF work is finding these measures particularly promising for safety-net primary care settings, where PROs can better detect behavioral health and social stressors by engaging patients directly. Success hinges on a curious and compassionate provider culture that consistently emphasizes attending to why the patient is seeking care. For effective implementation, teams also need to:

Carefully select the right PRO questionnaire;
Create coordinated workflows across multidisciplinary team members;
Emphasize documentation of patient goals and needs over time.
Learn about the Quality Institute's Patient Reported Outcomes in Primary Care–New York initiative to pilot the use of PROs in primary care in three New York City health systems.

Clinical quality improvement leaders
Clinicians skilled in both the techniques of quality improvement and the art of leadership are needed to realize the goal of uniformly high-quality, safe, effective care. They must lead multidisciplinary teams with a clear vision, well defined objectives, relevant data, and a practical workflow for formulating and testing interventions—but often practitioners lack formal training and professional learning opportunities in quality improvement. Now in its tenth year, UHF's Clinical Quality Fellowship Program, an intensive leadership development training in partnership with Greater New York Hospital Association (GNYHA), offers physician and nursing leaders in New York hospital and health systems:

Specialized training in clinical quality improvement;
Mentorship for capstone projects to develop and implement systematic quality improvement initiatives in fellows' home institutions;
Peer networking opportunities.
Meet the newest class of CQFP Fellows.

Primary care transformation
Incentivizing quality and value is a significant undertaking, especially in a state like New York. Yet purchasers, payers, and providers are coming together with a common vision for high-quality primary care. The multi-payer Advanced Primary Care (APC) Quality Scorecard, developed by the New York State Department of Health, is setting statewide goals for quality and arming practices with customized performance data for monitoring and improvement. In 2017, the State's release of the APC Core Measure Set fostered regional discussions among payers and providers to identify a subset of measures that can standardize and simplify the approach to measuring quality in emerging performance-based payment models. UHF has played an active role in this work:

Helping formulate, vet, and shape consensus on the core measures;
Partnering with the Department of Health to implement the measure set and a multi-payer scorecard of APC practice performance;
Curating a collection of evidence-based quality improvement resources and tools to help primary care practices assess and improve their performance.
Learn more about the APC Core Measure Set and UHF's related resources guide for primary care practices.

Addressing public health threats
Despite renewed emphasis, at both federal and local levels, on the dangers of antibiotic overuse and misuse, the public health threat of antibiotic resistance remains a critical challenge. Hospital inpatient settings are further ahead in developing antibiotic stewardship efforts to reduce the unnecessary and inappropriate use of these drugs, but more progress still needs to be made in outpatient settings and nursing homes. Quality Institute staff are:

Working with 35 outpatient clinics in New York City, through UHF's Outpatient Antibiotic Stewardship Initiative, to assess provider prescribing practices and help initiative participants drive practice change through formalized provider education, best-practice advisories and other clinical decision support tools, feedback on prescribing practices, and patient education on appropriate use of antibiotics;
Addressing the need for antibiotic stewardship in long-term care settings through a Nursing Home Antibiotic Stewardship Certification program, sponsored in partnership with GNYHA and the New York Society for Health System Pharmacists.
Learn more about the Quality Institute's Antibiotic Stewardship Initiatives, and be on the lookout for resources for developing antibiotic stewardship programs in outpatient settings.

We are grateful to our funders, whose support allows us to continue this critical work:

Charina Endowment Fund
The Engelberg Foundation
The Hearst Foundation
New York State Department of Health/Health Research Institute
New York State Health Foundation
United Hospital Fund

Feb. 14, 2018
Focus Area
Clinical-Community PartnershipsQuality and Efficiency
Quality Institute