Evaluating burnout during the COVID-19 pandemic among physicians in a large health system in New York

Abstract As the Age-Friendly Health System initiative moves across the US and around the world, not only do health system staff require education about the 4Ms, but older adults, caregivers, and families need education. Engaging and empowering the community about the 4Ms can improve communication, clarify and improve adherence to treatment plans, and improve patient satisfaction. Many methods for engaging the community in age-friendly care are currently in development. Initiated by Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Programs (GWEPs), Community Catalyst is leading the co-design of Age-Friendly Health System materials with older adults and caregivers. Testing these materials across the country in diverse populations of older adults and caregivers will yield open-source documents for local adaptation. Rush University Medical Center is testing a method for identifying, engaging, educating, and providing health services for family caregivers of older adults. This unique program integrates with the Age-Friendly Health System efforts in addressing all 4Ms for caregivers. The Bronx Health Corps (BHC) was created by the New York University Hartford Institute of Geriatric Nursing to educate older adults in the community about health and health behaviors. BHC developed a method for engaging and educating older adults that is replicable in other communities. Baylor College of Medicine adapted and tested the Patient Priorities Care model to educate primary care providers about how to engage older adults in conversations about What Matters to them. Central to the Age-Friendly movement, John A. Hartford Foundation leadership will discuss the implications of this important work.

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Promoting a Therapeutic Healing Environment: A Retrospective Examination of HCAHPS “Quiet at Night” Across a Large New York Health System

Journal of Patient Experience ◽

10.1177/23743735211056533 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110565

Author(s):

Agnes Barden ◽

Amy E Loeb ◽

Nicole Giammarinaro

Keyword(s):

New York ◽

Health System ◽

National Database ◽

Patient Centered ◽

Healing Environment ◽

Patient Feedback ◽

Leadership Accountability ◽

Percentile Rank ◽

The Press ◽

Adult Inpatient

Promoting respite and sleep impacts a patient's health and their inpatient experience. As New York State's largest health system, Northwell Health has been on a journey to create a healing and therapeutic healthcare environment. By establishing leadership accountability, leveraging patient feedback and adopting evidence-based interventions, system and individual adult inpatient hospital improvements have been noted. Between 2017 and 2020, Northwell's overall system HCAHPS “Quiet at Night” Top Box performance increased by 4.7, improving 30 percentile rank points when compared to the Press Ganey national database. This case study outlines Northwell's pragmatic patient-centered strategy and examines the unanticipated impact of limited visitation due to COVID-19 on this HCAHPS measure.

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Abstract P125: The First Year of Pre-Hospital Triage for Emergent Large Vessel Stroke Across a Large New York City Health System

Stroke ◽

10.1161/str.52.suppl_1.p125 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Brian D Kim ◽

Jacob Morey ◽

Naoum Fares Marayati ◽

Danielle Wheelwright ◽

Tara L Roche ◽

...

Keyword(s):

New York ◽

New York City ◽

Los Angeles ◽

Health System ◽

York City ◽

Large Vessel ◽

Access Time ◽

Hospital Arrival ◽

Arterial Access ◽

Triage Protocol

Introduction: On April 1 2019, New York City EMS began a triage protocol using a modified Los Angeles Motor Scale (S-LAMS for addition of speech) to identify potential endovascular thrombectomy (EVT) eligible patients in the field (S-LAMS 4-6 with last known well (LKW) <5 hours). These patients are routed to the nearest thrombectomy capable center, driving past potentially closer primary stroke centers. Methods: Patients brought by EMS to a large multicenter health system across NYC for the year following April 1, 2019 were extracted from a prospectively collected stroke database. S-LAMS triage positive (STP) patients were assessed for diagnostic accuracy and treatment times. They were compared with a cohort that underwent EVT during the same period, but triaged as S-LAMS triage negative (STN). Results: STP patients (N=145) were 56.6% women, mean age of 70, median baseline mRS of 0, S-LAMS score of 5, and arrival NIHSS of 13. Stroke was diagnosed in 110 (75.8%) patients, 32 intracerebral hemorrhage and 78 ischemic. Of the ischemic, 45 were large vessel occlusion stroke (ELVO) and 34 underwent EVT (PPV of 0.31 for ELVO). STN patients (N=65) with LKW of < 5 hours were brought by EMS and underwent EVT; 34 were brought directly to EVT capable centers, and 36 required transfer for EVT. Mean time to hospital arrival from EMS scene arrival was significantly longer for STP patients than STN patients (38 vs. 29 minutes, p<0.01). Mean ambulance travel time was significantly longer for STP patients than STN patients (10 vs. 7 minutes, p<0.01). Mean tPA administration time from EMS scene arrival was not significantly different between STP (N=41) and STN patients (N=40) (90 vs. 91 minutes, p=0.89). Mean arterial access time for EVT from EMS scene arrival was significantly shorter for STP patients than STN patients (137 vs. 200 minutes, p<0.01). Conclusions: Pre-hospital stroke triage using the streamlined S-LAMS scale is comparable with other pre-hospital scales in predictive value for ELVO. While pre-hospital evaluation and transport times are longer, they add minimal delay to the hospital arrival, do not affect tPA times, and improve times to EVT in a large, urban environment. Further analysis on effect of the triage protocol on patient outcomes is warranted.

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Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns

BMJ Open ◽

10.1136/bmjopen-2019-029340 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029340 ◽

Cited By ~ 3

Author(s):

Usnish B Majumdar ◽

Christophe Hunt ◽

Patrick Doupe ◽

Aaron J Baum ◽

David J Heller ◽

...

Keyword(s):

New York ◽

Health System ◽

Urban Health ◽

Low Income ◽

Chronic Conditions ◽

Cross Sectional Study ◽

Multiple Chronic Conditions ◽

Cross Sectional ◽

Study Population ◽

Mount Sinai

ObjectiveTo (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs.DesignRetrospective cross-sectional study.SettingMount Sinai Health System, set in all five boroughs of New York City, USA.Participants192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014.MethodsWe classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected.Results61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%.ConclusionsIn this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

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Unmet Social Needs and No-Show Visits in Primary Care in a US Northeastern Urban Health System, 2018–2019

American Journal of Public Health ◽

10.2105/ajph.2020.305717 ◽

2020 ◽

Vol 110 (S2) ◽

pp. S242-S250 ◽

Cited By ~ 2

Author(s):

Kevin P. Fiori ◽

Caroline G. Heller ◽

Colin D. Rehm ◽

Amanda Parsons ◽

Anna Flattau ◽

...

Keyword(s):

Primary Care ◽

New York ◽

Health System ◽

Urban Health ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Social Needs ◽

Positive Trend ◽

Missed Appointments ◽

Primary Care Practices

Objectives. To characterize the association between social needs prevalence and no-show proportion and variation in these associations among specific social needs. Methods. In this study, we used results from a 10-item social needs screener conducted across 19 primary care practices in a large urban health system in Bronx County, New York, between April 2018 and July 2019. We estimated the association between unmet needs and 2-year history of missed appointments from 41 637 patients by using negative binomial regression models. Results. The overall no-show appointment proportion was 26.6%. Adjusted models suggest that patients with 1 or more social needs had a significantly higher no-show proportion (31.5%) than those without any social needs (26.3%), representing an 19.8% increase (P < .001). We observed a positive trend (P < .001) between the number of reported social needs and the no-show proportion—26.3% for those with no needs, 30.0% for 1 need, 32.1% for 2 needs, and 33.8% for 3 or more needs. The strongest association was for those with health care transportation need as compared with those without (36.0% vs 26.9%). Conclusions. We found unmet social needs to have a significant association with missed primary care appointments with potential implications on cost, quality, and access for health systems.

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MAKING OLDER ADULT FALL PREVENTION PART OF ROUTINE CARE IN A LARGE HEALTH SYSTEM IN NEW YORK STATE

The Gerontologist ◽

10.1093/geront/gnv620.02 ◽

2015 ◽

Vol 55 (Suppl_2) ◽

pp. 320-320 ◽

Cited By ~ 3

Keyword(s):

New York ◽

Health System ◽

Older Adult ◽

Fall Prevention ◽

New York State ◽

Routine Care ◽

York State

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New York State Public Health System Response to Hurricane Sandy: An Analysis of Emergency Reports

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2015.142 ◽

2015 ◽

Vol 10 (3) ◽

pp. 308-313 ◽

Cited By ~ 1

Author(s):

Asante Shipp Hilts ◽

Stephanie Mack ◽

Millicent Eidson ◽

Trang Nguyen ◽

Guthrie S. Birkhead

Keyword(s):

Public Health ◽

New York ◽

Health System ◽

Key Words ◽

Public Health System ◽

New York State ◽

Hurricane Sandy ◽

System Response ◽

Emergency Operations ◽

York State

AbstractObjectiveAnalyzing Hurricane Sandy emergency reports to assess the New York State (NYS) public health system response will help inform and improve future disaster preparedness and response.MethodsQualitative analysis of NYS Department of Health (NYSDOH) and Nassau and Suffolk County local health department (LHD) emergency reports was conducted. Three after-action reports and 48 situation reports were reviewed, grouped by key words and sorted into 16 Public Health Preparedness Capabilities. Within each capability, key words were labeled as strengths, challenges, or recommendations.ResultsThe NYSDOH capability most cited as a strength was successful emergency operations coordination, eg, interagency conference calls (27.4% of 1681 strengths). The most cited challenge was environmental health protection, eg, mold and oil spills (28% of 706 challenges). The LHD capability most cited both as a strength (46.7% of 30 strengths) and as a challenge (32.5% of 123 challenges) was emergency operations coordination. Strengths were exemplified by sharing local resources and challenges by insufficient memorandums of understanding for coordination.ConclusionsPost-disaster emergency reports should be systematically reviewed to highlight both successes and areas for improvement. Future studies should prioritize collecting feedback from a wider spectrum of public health and service provider staff for planning of preparedness and response activities. (Disaster Med Public Health Preparedness. 2015;10:308–313)

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