CAPSTONE: HCD 0901

The culminating course for participants in the Health Care Delivery Leadership program is the Capstone. Participants work on a project that directly addresses a strategic problem in their institution or carefully examine one of a host institution. Participants gain practical experience in planning and executing a project.

2019 Outstanding Capstone Award Recipient

Capstone Project Title: Applying the Strategic Concept of ‘Low-Hanging Fruit’ to Clinical Trials Recruitment in an Industry Setting

There is an opportunity to streamline the pre-screening/screening process for patients that may participate in clinical trials. Currently, the costs associated with screen failures is substantial because they screen fail late in the enrollment process. Screen failures happen in part due to inefficient test coordination, repeat testing, and wait times for tests. I believe that applying a “low-hanging fruit” methodology to the inclusion and exclusion criteria will result in an overall clinical trial enrollment increase and a savings in cost and time for all involved parties. This approach will be applicable in recruitment settings other than clinic, such as industry.

 Specific project goals:

1) Develop a robust checklist that factors in the following variables

- Order of I/E criteria

- Time of each procedure

- Cost of each procedure

- Lowest level provider that can complete the procedure

2) Apply the checklist to 23andMe’s clinical trial recruitment efforts

 
LEAN Process MAP:

2018 Outstanding Capstone Award Recipients

Optimization of the Inpatient Imaging Ordering Process

Problem:  While advances in technology have increased both application and diagnostic yield of imaging, there is considerable evidence that many imaging studies are requested in excess of clinical utility.  With healthcare spending still trending upward, and with imaging disproportionately represented in an older population which continues to enlarge, any reining in of unnecessary imaging will do its part to bend the cost curve.

Proposal:  Refine ordering practices to better align with imaging need.  The initial phase will include analysis across specialties & provider classes at Mount Sinai Hospital (1 year period ending April 30, 2018).  The data collected will represent diverse specialties (neuro, critical care, and rehab) and diverse clinician types (surgical, medical, critical care, pre-chronic care).  The patient population will include acute neurological patients (acute stroke, hemorrhage, tumor management), ICU patients in whom “daily” chest radiographs may be requested, and rehab patients in whom “baseline” imaging is obtained at admission.  Data will be obtained from GE Centricity RIS, GE Centricity RIS, and Premier.  The goal is to close 50% of the inpatient imaging utilization gap compared with peer group.  The proposed interventions include enhancing awareness among ordering providers regarding variability in utilization, obtaining clarity between attendings and residents regarding imaging goals in general, support the ordering process through availability of radiologists for pointed appropriateness question, development of more intelligent clinical decision support, review and examination of current order sets, and encourage family engagement by clinicians.  The long term goal is to extrapolate rules for broader engagement strategies to MSH-wide, MSQ, and MSHS.

Mount Sinai Medical Respite Program:  Internal Business Proposal

Problem:  This capstone project introduces an internal business proposal for the development of a medical respite center to combat many of the healthcare issues around homelessness.

Respite Centers can provide better care continuity,  improve care transition and coordination,  increase safe discharges, lower readmission rates, lower avoidable hospitalizations, decrease unnecessary ER visits and ultimately save hospitals and payers money while improving the health of the homeless. Homelessness interrupts care continuity, exacerbates illness and complicates the simplest of medical treatments. Homelessness affects healthcare organizations who must act as safety nets, providing non-reimbursable care.  This results in the unsafely discharge of homeless patients back to the streets.  Other healthcare organizations, such as nursing homes or assisted living often refuse to accept homeless individuals needing additional levels of care. The goal of a Medical Respite program is to break the homeless-hospital cycle by keeping homeless patients out of the hospitals and off the streets.

Proposal:  The medical respite center will act on its own business entity. The center will collaborate with hospitals for referrals and  will be staffed with nurses, social workers and physicians that will communicate regularly with the referring hospital system nurses, social workers and physicians. If a homeless patient is an inpatient, the doctor or care team member will contact the respite intake nurse to determine if the patient meets respite criteria.  Additionally, the respite intake nurse may come to the hospital for rounding and determine future patients that might be good candidates to refer to respite.

The typical respite patient would not be highly acute and would not require a high level of care.  The center would provide simple and complex wound care, IV antibiotics and maintenance, respiratory illness, oxygen needs, diabetics and medication management.  Classic medical respite services include medical care, medication management, case management (benefits acquisition, housing placement, health education, etc.), onsite or referral for mental health/substance use treatment, transportation, food service, in-kind (pastoral care, activities, laundry, haircuts, clothing).

The business model is predicated on high cost avoidance.  The center would operate as a care partner w/ Hospitals & Medicaid Managed Care Plans to significantly reduce hospital cost by actively shortening length of stay, reduce admissions and ER use. Contracting can include providing discounted rates for hospitals who supply the most volume, straight per-diem agreements, daily discounted rates for hospitals that pay for a blocked number of bed days, and capitated rates are also an option that can vary based on patient acuity and/or diagnosis.