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.
Montefiore Medical Center, the University hospital of Albert Einstein College of Medicine, is nationally renowned for its groundbreaking social activism and emphasis on equity and accountability in providing quality medical care to all. 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)
Additionally, the Department's quality improvement efforts support one of Montefiore's five strategic goals, to develop a seamless delivery system with superior access, quality, safety and patient satisfaction.
The Einstein-Montefiore Department of Medicine's commitment to quality improvement on every level involves the following targeted initiatives:
- Creating an Associate Director of Quality position to coordinate and evaluate QI throughout the medical network
- Targeted QI to parallel growth in certain subspecialty services: hepatology and liver transplantation, nephrology and renal dialysis, hematology/oncology
- Leadership performance improvement with involvement of every Division in a Quality Work Group including 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), hospital-acquired infections through antimicrobial stewardship
- 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 Emerging Health Information Technology group (EHIT), and the Montefiore Medical Center Network Performance Group
- Managing volume and growth: patient flow management, efficiency of admissions, discharge planning
- Information technology: meaningful use of the electronic medical record, active population health management reports provided by the Montefiore Medical Group, clinical information systems (decision support tools, electronic documentation, PCP coverage information)
- Integration across the care continuum (inpatient to outpatient)
- Patient satisfaction: Use of Press Ganey scores and other patient experience data to improve patient experience, physician practice and teamwork/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
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:
Changes brought about by the Affordable Care Act including pay-for-performance for hospitals and implementation of Accountable Care Organizations and patient-centered medical homes. In addition, penalties for "excessive" readmission rates or hospital-acquired complications (so-called "never events" such as pressure ulcers, falls with injury, or catheter-acquired blood and urine infections). If widespread, these initiatives will transform the payment structure for hospitals and ambulatory physicians.
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).
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.
Quality improvement is an organization-wide commitment, led by administrators, physicians-researchers, and nurses throughout Montefiore Medical Center's Moses, Weiler, and North divisions.