- Written by kcho1
- Published: 08 Aug 2018
SBH pediatric infection disease specialist Dr. Tsoline Kojaoghlanian explains hand foot and mouth disease on News 12 the Bronx.
- Written by kcho1
- Published: 01 Aug 2018
Dr. Alyson Smith is interviewed by News 12 the Bronx on a new type of asthma therapy that has made a huge difference in the life of a 9-year-old Bronx girl.
- Written by kcho1
- Published: 16 Jul 2018
A pilot program in the Bronx that provides intensive care coordination services to patients with serious mental illness and unstable housing situations is having a positive effect in helping these people, many of whom in the past tended to fall through the cracks.
Led by Bronx Partners for Healthy Communities (BPHC), the DSRIP Performing Provider System headed by SBH Health System, the program uses “Critical Time Intervention” (CTI) to provide these patients with sustainable healthcare and community support systems.
CTI is a time-limited, evidence-based model that started in New York City in the mid-1980s. DSRIP is the state’s five-year Medicaid transformation initiative (now in year four) designed to reduce avoidable hospital admissions and re-admissions by 25% by building a provider system of community-based care that is coordinated, patient-focused and improves health outcomes.
Victor P. was homeless and in a state of mental decompensation when he met with a case manager at Mosaic Mental Health (one of the partner organizations in the BPHC provider system).
“I needed someone to advocate for me because I didn’t know how to say it,” says Victor.
Today, Victor’s mental health has stabilized and he is following his medication regimen. He sees both primary care and mental health providers regularly. He has a place to live and wants to go to school to become a patient navigator so he can help others like himself.
These patients have complex health conditions that are compounded by such circumstances as financial and housing instability, and an absence of family or social structures. The goal of the program is to help patients achieve long-term health improvements, become integrated back into the community, and reduce their stays in the hospital and other acute care settings.
Recent data shows the program is having an effect. The first group of 119 patients (from January – September 2017) realized a 62% reduction in the number of days spent in a hospital setting and a 57% reduction in the number of hospital admissions in the six months following the program’s start.
“Our initial goal was to reduce hospital utilization by 25%, so we are very excited by these promising results,” says Irene Kaufmann, BPHC Executive Director. BPHC has partnered with four community-based organizations (CBOs) on the CTI pilot: Coordinated Behavioral Care, Mosaic Mental Health, SCO Family of Services, and Visiting Nurse Service of New York.
Case managers work closely with patients – supported by an extensive network of providers including physicians, hospitals, specialists, therapists, housing services, food programs, and job training – to satisfy such goal areas as medical and behavioral health treatment, medication adherence, employment, housing, money management, and family intervention.
- Written by kcho1
- Published: 12 Jul 2018
Dr. Raghu Loganathan, Director of Critical Care Services at SBH Health System, discusses the need for clinicians to shift their perspective in order to increase organ donations. Dr. Loganathan and his ICU team are prominently mentioned in the NY Times article, New York Has World-Class Hospitals. Why Is It So Bad for People in Need of Transplants?.
- Written by Samira Pinu
- Published: 01 Jun 2018
Studies reveal that when left untreated, obstructed sleep apnea (OSA) can double the risk of a patient dying from cardiac disease. By Mediha Ibrahim, MD, Medical Director, SBH Center for Sleep Medicine
OSA has been linked to the risk of heart failure, hypertension, type 2 diabetes, elevated blood pressure, atrial fibrillation and stroke.
It’s been shown that there is nearly a 60 percent greater risk of developing heart failure in middle-aged men with severe sleep apnea and twice the increased risk of those with severe OSA suffering a stroke. As many as 4 in 10 of those with high blood pressure also have OSA. Studies have also shown that this risk is reduced to normal levels when those patients with sleep apnea are treated with PAP therapy.
Sleep apnea is defined as a common sleep-related breathing disorder characterized by regular episodes of reduced inspiratory airflow due to upper airway obstruction during sleep. OSA is associated with a significant increase in sympathetic activity during sleep, influencing heart rate and blood pressure.
It’s the connection between OSA, cardiac disease, and the benefit of the most common treatment for the sleep disorder (the use of the PAP therapy) in reducing it that makes it so important for primary care physicians and cardiologists to screen patients with cardiac disease for suspected OSA. According to the National Healthy Sleep Awareness Project, this begins by determining whether patients demonstrate any of these five warning signs and risk factors for OSA:
Snoring
Choking or gasping during sleep
Fatigue or daytime sleepiness
Obesity (with a BMI of 30 or higher)
High blood pressure
Since most patients may not necessarily be forthcoming about their sleep problems, believing it is normal to feel tired, doctors need to proactively raise the issue. As a means to this end, physicians should consider offering patients this five- question questionnaire provided by the National Sleep Foundation. If there is a concern that a patient has one or more of these risk factors, a sleep evaluation should be recommended to investigate whether there is a sleep disorder.
SLEEP STUDY
A sleep study, or polysomnogram, is a noninvasive, pain-free procedure that equires the patient staying overnight in a sleep center (although a home study is also possible). During the study, brain wave activity, eye movements, muscle tone, heart rhythm and breathing are monitored. Are they struggling to breathe? Have they stopped breathing at certain times? What is their oxygen status? All of this helps determine if the patient’s airway is being obstructed while asleep. The patient’s sleep position is also observed, as sleep apnea tends to be worse when the patient lays supine.
After recording a full night’s sleep, the technologist tabulates the data and presents it to a physician for interpretation. Should it be determined that the patient has sleep apnea, a titration study will be conducted to find the right amount of air pressure needed to prevent the patient’s upper airway from becoming blocked and eliminate breathing pauses in their sleep. As with the earlier polysomnogram, sensors are again attached to the patient’s body to monitor their sleep, as they are fitted with a nasal mask that is connected by a hose to a small electric unit. The fitting process is an important first step in the PAP titration. At certain intervals throughout the night, the technologist will remotely change the air pressure received through the mask. Pressure starts at a very low level and gradually increases as needed to eliminate any apneic events. The study is completed the next morning. Other treatments, if deemed necessary, may also be explored.
At-risk populations, those with a preponderance of cardiac comorbidities like hypertension, atrial fibrillation, diabetes, heart failure, hypertension, high BMI and stroke, such as found throughout the Bronx, are in particular need of OSA screening. As one cardiologist said, not screening for sleep apnea is akin to an auto mechanic fixing three tires on a car and never checking the fourth but simply hoping for the best.
For more information on the Center for Sleep Medicine at SBH call 718-960-3730
- Written by kcho1
- Published: 15 May 2018
Studies have long shown that unnecessary noise for a hospitalized patient is more than irritating – it can be damaging. In fact, back in the mid-19th century, no less a nursing legend than Florence Nightingale called it “the cruelest absence of care.” A much more recent study found that “the accumulation of noise, gossip and unwanted distraction adds up to stress, anxiety, and, in total, an unacceptable, unsatisfying and risk-laden health experience.”
With this in mind, SBH Health System has recently moved to reduce noise levels for inpatients. In the ICU, for example, which cares for many of the hospital’s most critical patients, it lowered the sounds for overhead pages, educated staff on the important of quiet, and dimmed the lights at night. In addition, the hospital is now piloting on one of its patient floors the use of “relaxation kits,” which include ear plugs and a night mask. In addition, a giant “ear” on the floor is storing data on the amount of sound occurring at different times of the day, and special “quiet hours” have been instituted at night. See this story by News 12 the Bronx.
- Written by kcho1
The idea of sharing the physician note with patients instinctively felt reckless. And yet, in 2017, SBH had begun to explore the possibility of using the Follow My Health Portal for patients to get access to their progress notes. Pat Belair, SBH’s senior vice president of Ambulatory Services and Strategy, was the first to propose the idea. She saw the possibility from the patients’ perspective – a project that could enhance the patient experience and impact patient safety.
But as I heard the proposal, my reaction was less than enthusiastic, even pessimistic. After all, my thinking went, the clinic note wasn’t meant for patients. It was a document intended to communicate clinical assessment and plans to other providers using technical medical terms, while fulfilling ever expanding regulatory and billing mandates. The note’s utility and readability, especially in the age of EMR, was raising questions even among clinicians. It seemed improbable that patients could use the note. But as I researched the topic, I was faced with growing evidence that patients also benefited from access to the note. Equipped with the latest research and best practices, the burgeoning patient safety movement known as “Open Notes” was looking for clinical partners to share notes with patients. And with SBH’s chief medical officer Dr. Eric Appelbaum’s agreement and encouragement, the decision was made to join the movement and analyze and report back its findings. My initial hesitation, however, wasn’t born just out of my own bias. A look at the development of the SOAP note (an acronym for subjective, objective, assessment, and plan) reveals the initial goals of medical documentation were focused on provider needs and not patient centered. Instead, the note served to standardize and refine the clinician’s thinking while also innovating in the field of medical education. Although the patient stood to benefit from the improvement of this standardization, the note wasn’t developed for the patient’s consumption.
Of course, the SOAP note was pioneered during another era in medicine. It was in the late 1960’s when Lawrence Weed, the dean of healthcare information technology, first introduced the problem-oriented medical record. American healthcare, in the intervening time, has transformed several times over. Today, the term “patient” can be substituted with “consumer.” The term “change” goes beyond mere semantics and signals the changing role of the patient in medical decision-making while hastening the endof paternalism. Furthering this trend, the publication of “To Err is Human,” the Institute of Medicine’s seminal work on medical errors, forced the healthcare industry into necessary introspection. The patient’s central role in their care could no longer be minimized. With digitization of health records that paved the way for patient portals, patients were now equipped with tools that could bolster their new central status. Put together, these trends advanced the notion that the physician note could be a resource for patients to further their care.
In the fall of 2017, SBH joined a collaborative of New York hospital systems to learn more about Open Notes and lessons learned on implementation. The first forum set out to address questions from each of the participating organizations. Wouldn’t patients be confused by the note with its complex medical terminology? What about non- English speakers? There were concerns about liability and possible malpractice implications. But the most pressing issue was how this would impact clinician workflow in an already challenging documentation environment. After all, the more time spent with an EMR meant less time for patients.
For the workflow concerns, a study surveying PCPs who had implemented Open Notes showed very few changes to the practice of medicine. In a one-year analysis on Open Notes, 140 PCPs from three geographically distinct regions were surveyed about the impact to the practice; few doctors reported longer visits (0 to 5 percent) or more time addressing patients’ questions outside of visits (0 to 8 percent). Three to 36 percent of doctors reported changing documentation content; and 0 to 21 percent reported taking more time writing notes. To further this point, the authors of the study reported some PCP’s questioned whether the project went live, noting that they saw no impact to the practice.
While the PCP experience was minimal, patients seemed to gain significant benefit. In the largest Open Notes study, 5,000 patients in three separate hospital systems were surveyed about the impact of reading the doctor’s note. In it, 85 percent of patients said Open Notes helped them feel more in control of their care. A remarkable 60 to 78 percent of those taking medications reported increased medication adherence. Only a minority of patients, from 1 to 8 percent, reported that the notes caused confusion, worry, or offense. The data demonstrated that benefits far outweighed the harm.
In another survey, 99 percent of patients valued access to notes. The top reasons listed included: remembering next steps, quicker access to results, greater confidence in clinicians, and the ability to share with care partners.
Based on this data, and a commitment to improving the patient experience, SBH will be one of the first New York sites to participate as an Open Notes healthcare system. Part of this project will be soliciting clinical input to guide implementation. A survey for physicians will establish baseline attitudes regarding the sharing of notes and perceived concerns. In addition, physician champions will represent each department and serve as sounding boards for the project. The following champions have agreed to lead the effort: Gerard Baltazar, D.O., George Manis, M.D., and Thomas Rechtschaffen, M.D., from the Department of Surgery; Tina Chee, M.D., from the Department of Medicine; Paula Amendola, D.O., from Family Practice; and Lisette Robledo, M.D., from Pediatrics. Working to gain the patient’s perspective on Open Notes will be Caroline Davis, Director of Patient Engagement and Community Outreach. Lastly, the IT department, led by Dr. Jitendra Barmecha, M.D., will provide the technical expertise and project management to facilitate all teams working together to meet the project’s goals.
- Written by kcho1
- Published: 17 Jan 2018
SBH Health System (St. Barnabas Hospital) is ranked as the #1 hospital for quality in primary care.
This is according to the latest ranking among the 41 institutions participating in the HealthFirst Quality Incentive Program. SBH has been an active participant in the HealthFirst Quality Incentive Program (HQIP) program since it began in 2012, and has demonstrated continued improvement in its performance.
Receiving a 4-star ranking, SBH was ranked as the #1 hospital for HealthFirst Medicaid patients, and among the top five hospitals for HealthFirst Medicare, when compared with all participating hospitals. This includes such large academic medical centers such as New York – Presbyterian, Montefiore, and the Mount Sinai Health System.
SBH was able to reach a collective score of 4.0 out of 5.0 for the 33 measures focused on access, preventive care, acute and chronic disease management, medication adherence and patient satisfaction, and achieved a 4 or 5 star rating on 21 measures. In meeting these metrics, as well as showing significant improvement on 11 additional measures compared to earlier performance levels, SBH not only continued to demonstrate a commitment to high-quality care, but also earned over $4.5 million in incentive payments related to the program for the year.
The HQIP program measures the quality of care provided to patients in HealthFirst Medicaid and Medicare-managed care programs, and covers roughly 30,000 patients who have been assigned to SBH-associated physicians and practices across the South/Central Bronx. Patients receive care across a variety of clinical service lines, including internal medicine, pediatrics, family medicine, dental, ob/gyn, and behavioral health departments, and the program utilizes standardized metrics that allow for comparison across the 40 HealthFirst-member hospitals and serves as a barometer of the care provided to patients within the program.
Through use of national standards as defined by both the National Committee on Quality Assurance (NCQA) and the New York State Department of Health Quality Assurance Reporting Requirements (QARR), care is measured across multiple domains, including timeliness of access, patient satisfaction, quality of clinical care, and ER and inpatient utilization. Special emphasis is placed on measures within the well-known Healthcare Effectiveness Data and Information Set (HEDIS) tool, which covers specific metrics related to screening and disease prevention; comprehensive care for chronic disease such as diabetes, hypertension, and asthma; medication adherence for chronic disease; and behavioral health care services for depression and other mental health issues.
“Accomplishments of this magnitude are unattainable without a strong, committed and accountable team,” said Dr. Raj Gurunathan, Director, Division of General Internal Medicine, Department of Medicine at SBH. “SBH has been successful in assembling a winning interdisciplinary team of physicians, nurses, patient care navigators, managers and front line staff, who have developed and implemented sustainable workflows and processes to support compliance with the measures.”
Added Irene Borgen, Vice President, Ambulatory Care Innovation and Transformation, “Through numerous efforts aimed at patient outreach and engagement; improvements in decision support for clinical providers through use of the Electronic Medical Records (EMR); and the leveraging of information technology resources, many in the SBH community have contributed to this incredible achievement and we look forward to future rankings with much anticipation.”