Division of Health Care Quality and Patient Safety

Since 2008, the Department has forged a close relationship with the Mount Sinai Hospital to address issues of health care quality, patient safety and resource utilization.  As part of this collaboration, the Department, working with the hospital and the Institute for Family Health, was awarded a Community-Based Care Transitions Program demonstration project to avert readmissions of vulnerable Mount Sinai patients at high risk of re-hospitalization. We also provided analyses for hospital quality improvement projects that reduce surgical infections and sepsis, and that improve the quality and efficiency of hospital care with respect to glycemic control, ventilator-associated pneumonias, and falls. 

Dr. Greco has actively collaborated with the cardiothoracic surgery trial network (CTSN), a collaborative research alliance focused on improving cardiovascular disease outcomes, by supplementing new analyses and hypothesis-generating studies to the activity of the network.  The analysis of glycemic control in the ICUs of several academic centers, for example, has provided important insights into factors that modify the association of stress hyperglycemia and adverse hospital outcomes after cardiac surgery.  Such observations may eventually lead to the redesign and optimization of glycemic control strategies, by enabling a diversified approach that takes into account the different risk profiles of the patients.  In addition, Dr. Egorova has been analyzing hyperkalemia events and timing between the identification of hyperkalemia and the clinical response. Along with calling a lab technician to the hospital unit when hyperkalemia was found, the hospital has added a best practice alert in EPIC and later additional voice notification to nurses if there is no clinical response was within 1 hour. It was found that these additional methods reduced the time between hyperkalemia recognition and treatment.

The Department and the hospital also collaborate extensively on patient safety.  The Department’s web-based medical event reporting system (MERS) has been used by the hospital for several years.  The software was customized for MSMC along with a robust training program for faculty and staff, including the importance and analysis of near miss, no-harm, and patient harm events. Drs. Kaplan and Rabin, who are prominent in the national dialogue on patient safety, have served on committees of the AMA, AHRQ, the GE Patient Safety Organization, and the WHO. They also work within the ISMMS/RPI research affiliation on the effects of lighting on patient well-being and on staff performance, utilizing the Emergency Department’s Simulation, Teaching, and Research (STAR) Center.

The Department is involved in the restructuring of health care delivery at Mount Sinai, and provided analytical support for the implementation of the ACO and the "Bundled Payments for Care Improvement" initiatives of Medicare. 

The Department has a substantial quality of care research portfolio sponsored by AHRQ, NIH and foundations.  Dr. Howell has NIH-funding to examine quality of care delivered in New York City labor and delivery units and neonatal intensive care units.   She is using an innovative mixed methods approach to explore processes of care, unit characteristics, patient factors, and organizational factors that explain differences in hospital quality in the setting of maternal and child health.  As part of this research she has conducted surveys to better understand practice patterns, culture, and quality and safety practices across New York State hospitals.  In addition, she is leading a quality improvement research study aimed at improving postpartum care for high risk women.

Finally, the Department has conducted research on quality improvement for children.  In 2011, AHRQ awarded Dr. Kleinman (now at Case Western Reserve) a large grant to establish the Collaboration for Advancing Pediatric Quality Measures (CAPQuaM), a core center for the federal Pediatric Quality Measures Program mandated by the Children’s Health Insurance Program Reauthorization Act.  Quality measures of access to high-risk OB care, ED visits for asthma, temperature on admission to the NICU, general medication reconciliation, medication reconciliation in mental health, and follow-up after mental health hospitalizations have been developed.  This work led to another AHRQ award in 2015 to evaluate and improve medication reconciliation in pediatric mental health practices.