United Hospital Fund (UHF) has announced seven grants, totaling $662,642, for projects to build a more effective health care system for every New Yorker.
The funded projects include an initiative to advance the use of patient-reported outcomes measures in the primary care setting; continuing support of the partnership between UHF and Greater New York Hospital Association to enhance the quality of care within health systems across the New York region; work to develop a risk screening tool to identify emergency department patients at high risk for future homelessness; pilot-testing a new framework for integrating behavioral health services in primary care in four medical practices in New York City; and developing guides to policies and practices that best engage and retain individuals involved in the criminal justice system in effective health care.
Details on the grants are included below.
Patient-Reported Outcomes in Primary Care Initiative ($149,322 over 18 months)
The Institute for Family Health ($49,978)
Montefiore Health System ($49,344)
Northwell Health ($50,000)
To advance the use of Patient-Reported Outcomes Measures as a vehicle for prioritizing the patient voice in the delivery of high-quality primary care in New York.
Research shows that patients' and physicians' perceptions of health outcomes differ, and that considering patients' views of their health status can lead to more effective interventions. Through this initiative, UHF's Quality Institute will facilitate a learning collaborative of primary care practices to test the feasibility and utility of integrating Patient-Reported Outcomes Measures (PROMs) into routine workflow. Practices will pilot-test standardized patient questionnaires, which elicit data from patients about their concerns, to inform care planning and monitor outcomes. The initiative will be led by a faculty of nationally recognized experts and the UHF Quality Institute team.
Greater New York Hospital Association ($130,000 over one year )
To continue the partnership of United Hospital Fund and Greater New York Hospital Association to enhance the quality of care within health systems across the New York region, with a focus on building clinical leadership through a fellowship program and promoting the appropriate use of antibiotics.
In 2005, UHF and the Greater New York Hospital Association (GNYHA) formed a partnership to improve the quality of care provided in hospitals in the greater New York region. Since then, UHF and GNYHA have implemented a series of successful quality improvement initiatives involving more than 100 hospitals. These initiatives have tackled topics including clinical quality leadership and education, antibiotic stewardship, preventing hospital-acquired infections, and reducing preventable admissions and readmissions. This grant will focus on the following activities:
Strengthening clinical leadership and education through the Clinical Quality Fellowship Program, which trains mid-career physicians and nurses to lead and champion quality improvement and patient safety efforts within their hospitals. By April 2017, nearly 150 fellows will have completed the program. With the support of this grant, an expanded class of fellows will be selected, and the curriculum and related educational events will focus more on coordination of care across settings, with added concentration on ambulatory care.
Tackling the critical issue of antibiotic resistance and misuse and overuse of antibiotics. Activities over the next year will include convening a symposium to highlight successful antibiotic stewardship program implementation in hospitals; administering a nursing home assessment tool to determine current antibiotic stewardship activities and barriers in nursing homes; developing and conducting an antibiotic stewardship program (ASP) certificate program for nursing home settings; and designing interventions to support long term care antibiotic stewardship implementation efforts.
Montefiore Medical Center ($188,320 over two years)
To pilot-test a new framework for integrating behavioral health care services in primary care in four primary care medical practices in New York City.
Depression and anxiety are common among patients seen in primary care settings and are risk factors for the development of chronic illnesses. Yet most primary care practices lack the ability to identify behavioral health conditions and provide evidence-based treatments. In 2015, UHF awarded a grant to Montefiore to develop a framework for integrating depression screening and management into primary care practices of different sizes and configurations. The project team, led by Dr. Henry Chung, will now pilot-test the framework in four primary care practices in New York City. (In parallel, through a grant from the New York State Health Foundation, the project team will also pilot-test the framework in four additional primary care practices in upstate New York.) The project team will provide technical assistance to support the use of the framework, identifying implementation challenges and fine-tuning the framework based on project learnings. A major focus of the project will be to ensure that practice changes are sustainable under a variety of value-based payment methods—and to provide insights to policymakers and payers on how to support and incentivize behavioral health integration more broadly.
New York University School of Medicine ($135,000 over two years)
To develop a homelessness risk screening tool for use in emergency departments (EDs), protocols for future ED-based homelessness prevention interventions, and a Social Determinants of Health (SDH) Registry that will link patient survey information with hospital utilization data.
Identifying who is most likely to become homeless is challenging, and the majority of at-risk people do not know how to access services. Emergency departments, which treat individuals experiencing health and life crises, may be optimal locations for screening for homelessness risk and connecting individuals and families to needed prevention services. The NYU team will conduct survey research and cross-system data analysis—matching patients' responses to surveys administered in the ED with Department of Homeless Services records— to develop the following: a first-of-its-kind homelessness risk screening tool to identify ED patients at significant risk for future homelessness; protocols for future ED-based homelessness prevention interventions; and a Social Determinants of Health Registry that will link survey research results with hospital utilization data to assess the effects of multiple social determinants on health care utlization over time.
Legal Action Center ($60,000 over one year)
To publish two guides to policies and practices that best engage and retain individuals involved in the criminal justice system in effective health care.
Individuals involved in the criminal justice system—including those in prisons and jails—are seven times more likely than the general population to experience mental illness, substance abuse disorders, and other chronic conditions. While treatment is available to them during incarceration, upon release these individuals are at high risk for disruptions in health insurance coverage and care, which can contribute to poor and costly outcomes, including increased drug use, recidivism, re-incarceration, or death.
The goal of this project is to produce two issue briefs that will provide guidance on policies and practices that best engage and retain these individuals in care—and to describe remaining issues and challenges. The first brief will examine New York's progress in securing Medicaid coverage for people who are incarcerated prior to their release, and a second brief will analyze progress and issues around linkage to health care services in New York. In this report, the project team will also analyze a pilot of criminal justice Medicaid Health Homes, for which it has served an advisory role.
About the United Hospital Fund: The United Hospital Fund is an independent, nonprofit organization working to build a more effective health care system for every New Yorker.