Quality of care in the Einstein-Montefiore Department of Medicine involves every aspect of a patient’s experience, from the first phone call or contact in the emergency room to the final follow-up appointment. Our physicians, nurses, and staff continually strive to ensure that each patient is treated with utmost respect and receives the best care possible.
With a strong commitment to continual quality improvement (QI), including dedicated leadership and initiatives throughout the network, Einstein-Montefiore and the Department of Medicine focus on a few common goals:
- to support growth, enable quality improvement, and capitalize on information technology
- to build greater faculty involvement in quality improvement activities
- to empower care providers on every level to practice quality improvement through training and education
- to focus on highly prevalent diseases and conditions, especially diabetes and congestive heart failure (CHF)
The QI Focus
Rather than merely focusing on fixing “special problems” or on correcting substandard performance, quality improvement takes a proactive, systematic, organization-wide approach to identify common causes and processes toward improving performance and overall quality of care.
Most QI approaches in medicine are derived from industrial practices used in manufacturing and aviation. These practices and their corresponding terms have continued to evolve.
The Quality Landscape
Various stakeholders are using their regulatory or financial leverage to improve quality (and value) in healthcare. These include, but are not limited to:
CMS pay-for-performance and patient-centered medical home efforts: If widespread, these initiatives will transform the payment structure for hospitals and primary care physicians.
"Never Events": CMS will not reimburse the hospital for additional costs incurred in caring for patients with certain hospital-acquired complications (e.g., decubiti ulcers).
National Patient Safety Goals: Established by the Joint Commission, these goals include deep vein thrombosis prophylaxis, prevention of central line infections, and timeouts for procedures (including bedside). Public reporting of process and outcome measures for certain "core" conditions ("core measures"): These conditions include pneumonia, congestive heart failure, and acute myocardial infarction (AMI). Quality measures for these conditions are publicly reported to CMS and publicly available. In addition, New York state has quality reporting efforts related to cardiac catheterization.
Peer review: In New York state, certain adverse events require the hospital to perform in-depth reviews to identify the causes of the error and create a corrective plan of action (”Root Cause Analysis”). This process is mandated by the New York Patient Occurrence and Tracking System (NYPORTS).
Target Areas
The Einstein-Montefiore Department of Medicine's commitment to quality improvement on every level involves the following targeted initiatives:
- Managing volume and growth: patient flow management, efficiency of admissions, discharge planning, antimicrobial stewardship
- Creating a new Associate Director of Quality position to coordinate and evaluate QI throughout the medical network
- Targeted growth in certain subspecialty services: hepatology and liver transplantation, nephrology and renal dialysis, hematology/oncology
- Leadership performance improvement through physician involvement, teaching hospitalists, housestaff, voluntary and staff attending physicians, physician assistants, and nurses
- Core conditions: chronic heart failure, diabetes, AIDS, cardiac care (e.g., door-to-balloon)
- Collaboration across the entire organization: the Department of Medicine partners with QI and clinical leaders across the Montefiore delivery system including the Montefiore Medical Group, the Care Management Organization, the Information Technology group (EHIT), and the Montefiore Medical Center Network Performance Group
- Information technology: clinical information systems (decision support tools, patient problem lists, PCP coverage information)
- Integration across the care continuum (inpatient to outpatient)
- Patient satisfaction: Press Ganey scores, physician practice and communication patterns
- Peer review
- Performance measurement: Network Performance Report, patient surveys, physician surveys
- Innovation and recognition: pay for performance (P4P) program, translational research, extramural funding, objective external recognition, research publications
- Staff satisfaction
- Community health
QI Leaders
Quality improvement is an organization-wide commitment, led by administrators, physicians-researchers, and nurses throughout Montefiore Medical Center's Moses, Weiler, and North divisions.