Description
Overview
The focus of this module was on quality care. For your final project, you will research a gap in access to quality, equity, or efficiency of healthcare, (including existing initiatives in place to address the gap and economic and regulatory factors that are currently in place to address the gap). To begin this project, you must first conduct some background research into the gap and the impacted population.
Prompt
In this milestone, you will identify and analyze an initiative that addresses the gap you chose as the topic for your final project. Explain what the initiative is, identify the goals of the initiative, describe the circumstances around its development, and identify sources of funding.
Tip: You have been introduced to the Institute for Healthcare Improvement (IHI) website in this course. It may be helpful to you as you conduct your research on an existing initiative.
Your milestone should address each of the following points in detail:
Explain an existing healthcare initiative that was put in place to address this gap in access.
Explain the specific goals of the existing initiative in place to address this gap in access.
Describe the circumstances around the development of the existing initiative. Consider when the initiative was developed and what factors were considered.
Describe the resources required to fund the existing initiative.
Explain why the existing initiative is not meeting its intended purpose and now requires improvement.
What to Submit
Your paper must be submitted as a 2- to 3-page Microsoft Word document with double spacing, 12-point Times New Roman font,
one-inch margins, and at least three sources cited in APA format.
Unformatted Attachment Preview
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The Montefiore Medical Center
Devonte Hayes
09/17/2023
Introduction
The Montefiore Medical Center, an esteemed medical academic institution located in New
York City, has successfully devised an improved care system tailored specifically for its
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economically disadvantaged patient population. To facilitate the implementation of integrated
care, this network of hospitals, community clinics, and school-based clinics employs advanced
chronic illnesses control strategies, offers access to exceptional hospital specialty care, and utilizes
focused care control and dependable health information technology. Montefiore Medical Center
has achieved financial sustainability while relying mostly on Medicaid and Medicare as its main
sources of revenue. The success of Montefiore can be linked to its healthcare delivery practices,
which encompass care management facilitating system-wide integration, efficient and effective
primary care delivery, and health systems that prioritize population health and local accountability.
The predominant demographic within Montefiore Medical Center’s population consists of
individuals who are visually impaired or hearing impaired, with a significant portion experiencing
varying degrees of hearing loss, including those who are hard of hearing. Furthermore, a significant
proportion of the patients have limited proficiency in the English language, either lacking fluency
altogether or possessing it as a secondary language. Montefiore, a non-profit organization, has
developed specialized procedures to effectively cater to the unique requirements of the vulnerable
populations it predominantly serves, namely low-income areas. The medical facility has recently
heightened its focus on addressing the needs of patients and the community, while also prioritizing
efforts to enhance performance (Chase,2010).
Patient Engagement Activities and Communication Strategies
The 500,000inhabitants of the Bronx and neighboring Westchester County are cared for by
Montefiore Medical Center. One of the poorest urban counties in the US is The Bronx, where 25%
of adults lack health insurance and poverty-related illnesses like obesity, hypertension,
cardiovascular disease, hepatitis C, asthma, and HIV are common. Around 1.4million people live
in The Bronx, and about 400,000 are children. A little more than half of the population identifies
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as Hispanic or Latino, and 36%of people identify as African American. A sizable portion of the
population is also undocumented. There are 21 community-based primary care clinics and four
hospitals at Montefiore. There are over 830,000 annual visitors to them, which are located all over
the Bronx. Additionally, Montefiore has 17 school-based clinics that see about 65,000 patients
annually and visit roughly 40 schools in total. These clinics offer medical, mental health, and dental
care.
A Human Communication Center has been determined at Montefiore Medical Center. The
facility offers its patients with translation services. The Montefiore Medical Center provides
translation services in150 different languages. Spanish, Chinese, Russian, French Creole, Korean,
Italian, Yiddish, Bengali, Polish, Arabic, French, Urdu, Greek, and Albanian are just a few of the
languages given for interpretation. The Montefiore Medical Center also provides a phone number
that non-English speakers can contact to request interpreting assistance.
For people who are hard of hearing or deaf, Montefiore also provides free sign language
interpreters. The services offered also include test messaging for hearing-impaired individuals,
phones with amplifiers, televisions with closed captions, and any other assistive devices a patient
might require. Patients can conveniently access the Non-Discrimination Notice of Montefiore by
navigating to the bottom section of the webpage. This notice also provides a customer service
contact for patients to call if they require the services available in the 15 different languages
mentioned. In addition to the aforementioned information, Montefiore also provides
communicards, which are pocket talkers designed to function as assistive listening devices for
individuals with hearing impairments. Patients can find around 2,500 fliers and pamphlets in both
English and Spanish at Montefiore’s outpatient locations. People can access information in 50
different languages digitally as well (Chase,2010).
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The New Associate Handbook at Montefiore Medical Center reminds all new employees
that meet all regulations pertaining to providing services to those who have hearing impairment or
have English as a second language. The employee handbook informs staff that they must provide
necessary aids and services to a person who does not speak E nglish or who is deaf. All around
Montefiore, including its outlying areas like its community centers, interpreters are available and
will be offered at no cost. It is needed to be done through an interpreter for healthcare provider to
prove that they have offered to translate for a patient.
Montefiore set out to achieve two goals: 1) to educate staff members who interact with
patients who might have concerns, and 2) to educate staff members who serve as information
sources in their communities. In this regard, Montefiore initiated a number of education and
awareness initiatives: Montefiore developed a presentation that was delivered live to all health
center organization-wide employees, and social workers, call center employees, and other agencies
upon need. The presentation was videotaped and made accessible as a webinar. The Montefiore
Hospital employees can also view this video online via the hospital’s intranet. The Montefiore
Medical Center staff has access to a free online action site with an information exchange, a
navigator, and an in-person assistance program. In addition, they have internal magazines that
feature articles on employee advancements, Inspired Medicine, and an internal social networking
platform called Yammer. In addition, Montefiore sought to certify its Medicaid and Financial Aid
specialists as Application Counselors, thereby gaining authorization from the State of New York
to assist patients with healthcare application processes.
There aren’t any communication gaps between Montefiore and the clients they serve.
Montefiore offers a translation services for more than 150 different languages communities. This
makes it possible for professionals to interact with patients and provide them with any information
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or training they might require. Along with ensuring patients have accessibility to any papers or
brochures that might be necessary for their medication, they also supply all literature that might
be required in these other communication languages.
Health promotion and disease prevention and management strategies
Implementing patient-centered homes is a significant way Montefiore addresses illness
prevention and health promotion. These residences serve as a resource for the community’s
primary and preventative healthcare. Montefiore thinks that by building these houses, they will be
able to offer more medical care to a population that has a greater need for care but less access to
it. Early evidence suggests they can improve quality, cut costs, and reduce disparities in patient
care. These medical homes aim to raise vulnerable populations’ access to basic care while also
reducing the number of visits to emergency rooms.
Primary Care
To ensure the provision of adequate medical care to their patients, the Family Health Center
has extended its operational hours, thereby offering clinic services on two evenings per week, in
addition to one Saturday each month. Efforts have been undertaken to increase the availability of
drop-in patient appointments. Due to Montefiore’s status as an academic institution, where a
significant portion of the medical practitioners operate on a part-time basis, concerns have arisen
over the potential challenges associated with maintaining continuity of treatment. This alone might
make it more difficult for Montefiore to gain the trust of the community it serves. African
Americans have always had a negative view of doctors, and 35% of people in the Bronx are black.
In the Bronx, Hispanics comprise more than 48% of the population. There is evidence indicating
that males within the Hispanic community exhibit lower rates of medical care utilization and are
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also less likely to establish a consistent source of primary healthcare. The primary objective of
medical homes is to provide individuals an opportunity to access healthcare services that would
otherwise be inaccessible to them.
Diabetes Care
Diabetes is three times more common in the Hispanic community than in white or nonHispanic groups and is twice as common in the African-American community. Montefiore is using
collaboration and tenderness to resolve the problem. About 12% of individuals in the Bronx have
records of diabetes, which Montefiore’s Diabetes Leadership Group has recorded together
clinicians and other care providers to improve. When Montefiore engages in community outreach
and uses community education methods with the community around diabetes, management, their
clinicians, and their employees are all involved. In 2009, Montefiore set measures for diabetes
management as a goal. Providing nutrition education to the community being served is one of the
main attempts to reduce diabetes. Since obesity and diabetes are related, Montefiore has tried to
address the dietary challenges faced by the Bronx’s underprivileged population, particularly those
who are obese. One method they use is by having staff members practice healthy cooking in the
clinic’s waiting area (Stoto et al., 2018).
Montefiore has produced materials to inform the public about diabetes. The materials are
available in a variety of languages and academic levels. Montefiore has made sure that it can speak
every language. They provide information in a total of 15 different languages. Additionally,
Montefiore has collaborated with neighborhood parks department to provide registration to those
with diabetes. Diabetes management includes exercise, but many low-income neighborhoods lack
amenities and are unsafe for strolling through on foot. This gives residents of those neighborhoods
the chance to exercise and manage both their diabetes and overall health. The availability of
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grocery stores, farmers’ markets, and healthy food options is another obstacle for low-income
neighborhoods.
Montefiore is addressing this problem by hosting a weekly farmers market on their
property. For a community that would often not have that option available to them, Montefiore is
delivering fresh fruit and vegetables to the Bronx in collaboration with other community
organizations. Additionally, they have a 5-person diabetes education team that supports patients
with disease management and education. Compared to other Medicaid patients, Montefiore’s
efforts have loweredA1c readings exceeding 9% to only 14%of individuals who gets care. A1c
levels of ≥ 9 were present in 45 percent of those getting Medicaid coverage, demonstrating the
success of Montefiore’s community-building efforts.
Asthma Care/Obesity
In order to keep asthma in the community under control, the Pediatric Department at
Montefiore has adopted an effective strategy. Beginning with the kids who were registered for
asthmatic cases, they discovered that when kids were released from the hospital, not only were
rescue inhalers prescribed, but also medications for maintenance. The Montefiore Children’s
Hospital’s readmission rate of children has decreased as a result of this. Along with the Bronx
Department of Education, Montefiore also works in the public schools there, offering these
students health care. Children receiving care from these school-based programs showed a 50%
decrease in the number of kids typically hospitalized for asthmatic episodes. Another important
aspect of this program is education.
The capacity to regulate asthma is impacted by poverty. Renting a home is not as highquality as buying a home in a suburb, which is one of the key contributing elements to controlling
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asthma in lower socioeconomic households. Asthma control may be less important to parents who
are focused on providing for their children’s fundamental necessities before anything else, such as
housing, food, and clothing. By visiting the schools and instructing the kids on how to care for
their asthma, Montefiore is assisting in reducing some of the burden for these families. Combating
childhood obesity is one of this program’s other objectives. In the Bronx, 40% of kids are
overweight. By switching from whole milk to low-fat milk, Montefiore and the NY School District
want to reduce the number of calories these kids consume while increasing their milk consumption.
Community Access
Patients at Montefiore frequently present with issues other than medical ones. Numerous
other issues for these people are a result of their socioeconomic situation. Visits to the emergency
room rank among the most expensive healthcare costs. The socioeconomically disadvantaged are
more likely than other groups to seek emergency care. In the Bronx, Montefiore is making an effort
to alter this tendency. According to Montefiore, the most frequent ER users are those with housing
problems, mental health conditions, and chemical dependency concerns. To guarantee that
“frequent fliers” receive better follow-up care after leaving the ER, Montefiore established a
Navigator program. The system aids emergency room staff in meeting the needs of ER patients,
including any social or clinical services they may require.
Additionally, staff developed a system that detects these high consumers upon arrival and
begins to schedule discharges. The employees will also help if they need a place to stay. Patients
who have been released must be contacted by residents 72 hours after their discharge. As a result,
the residents can better relate to their patients and comprehend their socioeconomic level. In
addition to their clinical expertise, residents are employed for their capacity to do social medicine
with patients.
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The fact that two-thirds of the staff at Montefiore are Bronx residents helps them better
understand the neighborhood and its residents’ needs. Compared to other Bronx ERs, Montefiore
has witnessed an increase in patients. As part of the aim to cut down on unnecessary ER visits,
Montefiore also offers care to people in need in shelters. After Montefiore assigns a social worker
to them, the social worker decides what kind of assistance the person requires. Every year, more
than 301,000 people visit Montefiore. Staff members say they are mindful of the requirements of
the population they offer care to, which contributes to some of this growth. Additionally,
Montefiore is working to ensure cardiac patients receive prompt and effective care in the ER.
Treating Hepatitis C
The Bronx has recorded highest incidences of Hepatitis-C in the nation, and is a widely
prevalent disease. Additionally, the most common cause of liver transplants is hepatitis C.
Montefiore established a Transplant Center of Excellence as a result. Since its opening in 2008,
the center has offered 29 adult and pediatric transplants to the Bronx neighborhood. 75 Bronx
transplant patients who needed treatment in the past had to travel. By allowing patients to continue
living in the Bronx and meeting any cultural demands that other hospitals might not be able to,
Montefiore assures that they are offering continuity of care to patients.
Financial incentives and quality improvement processes
Non-Discrimination Policy
Montefiore Medical Center adheres to all applicable Federal Civil Rights laws and
prohibits any kind of discrimination based on age, gender, race, color, religion, sex, national origin,
sexual orientation, and gender expression. Montefiore Medical Center adheres to a nondiscriminatory policy that prohibits any kind of discrimination on the grounds of race, color,
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religion, sex, national origin, disability, gender identity, speech, age, or appearance. The
Montefiore Medical Center offers a range of communication aids and services to assist those with
disabilities in effectively communicating. These include complimentary sign language
interpreters, written materials presented in big print, audio resources, cheap electronic forms, and
several other tools. Non-native speakers of the English language are provided with complimentary
translator services and access to information in many languages.
Because diversity and equality are two of our five core values that inform way and how
they help their patients, diversity and inclusion at Montefiore, develop a variety of perspectives,
insights, and approaches on how to do the best job possible. To continue to be a regional and
national leader in healthcare, Montefiore works hard to attract, hire, develop, mentor, and support
the best personnel. It is crucial that Montefiore locates and recruits talent from both conventional
and nontraditional applicant pools that represent various backgrounds, skill sets, and geographical
locations. This is crucial because patients at Montefiore experience more complex and new
healthcare issues than other population groups. Montefiore employs both LGBTQ people and
veterans of the military. When analyzing its employee benefits, Montefiore offers a comprehensive
wellness program for its personnel that includes staff discounts to gyms, smoking cessation, and
other services. They also have an incredible diversity and hiring plan for their workforce. However,
I did observe that the benefits packages for doctors, nurses, and house staff differ significantly,
which may indicate a discrepancy in how they treat their employees (Montefiore.rog; 2023).
Patient Care
Montefiore is dedicated to creating an active healthcare setting where care providers wish
to engage, patients desire to receive care, and other healthcare providers wish to model what
Montefiore delivers to its clients group through diversity and inclusion. Through the goals they
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have established for its patients and the community it serves, Montefiore thinks that it is doing
more for its patients. Additionally, they have a history of providing care to the LGBTQ community
in the Bronx in both hospital and community settings. Care providers at Montefiore are committed
to ensuring comfort and health of their patients and their family people. Interactions between
patients and clinicians—whether physicians, nurses, technologists, therapists, or volunteers—all
contribute to providing the best possible care.
Montefiore values its patients and considers their opinions when planning their care.
Patients are urged to actively participate in their treatment and assist their knowledge regarding
their sickness and illness management. Montefiore makes sure to offer a comfortable and friendly
environment for healing. Seven standards of care are followed by Montefiore when treating
patients:
•
Respect
•
Exceeding Expectations
•
Effective Communications
•
Courtesy
•
Sensitivity
•
Teamwork
•
Professionalism
Patient-Centered Care
The Montefiore Medical Center has been a healthcare delivery leader for over a century.
For their commitment to patient safety and care, Montefiore has won numerous accolades.
Doctors, nurses, and staff members consistently work to improve patient safety and care quality.
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Everyone, including patients, plays a part in ensuring the safety and caliber of the treatment that
is provided, according to Montefiore. Patients are encouraged to express their concerns and ask
inquiries. Patients are urged to voice their opinions on their treatment. They promote patient
education regarding their course of therapy and any potential medical care. Patients are urged to
inquire about drugs and their intended uses. All aspects of patient involvement in their care are
encouraged.
Patient Bill of Rights
Without regard to their ethnicity, religion, color, sex, nationality, sexual orientation, or
ability to pay for their care, individuals have the right to obtain treatment. 2) the setting in which
the treatment is given will be sterile and secure.3) seek immediate medical attention if required. 5)
Receive any information regarding the doctor who is treating them. 6) Have all pertinent
information about the personnel who are caring for them. 7) A nonsmoking area. 8) Receive
information about their diagnosis and course of treatment. 9) Receive all information pertaining to
treatment consent, including any risks and advantages. 10) Receive information on the choice of
designating a specific healthcare provider. 11) Offer the opportunity to decline medical care. 12)
The right to decline research program participation. 13) Your privacy will be safeguarded. 15)
Choosing a caregiver who will be knowledgeable about healthcare. 16) The right to a free review
of their medical records. They’ll receive an itemized bill (17).18) Possess the ability to examine all
regular hospital fees.19) the option to contest any fees. 20) Be able to voice complaints without
fear of retaliation regarding treatment they may have experienced. 21) Permit patients to have
visits during the hours that are permitted. 22) Make their own decisions on organ donation
(Montefiore.rog; 2023).
Financial Services
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Montefiore has remained at the forefront regarding patient financial aid programs. The
current Montefiore program, which includes an international component of data and counseling,
was revised in December 2015. These changes are a part of their shift to a single billing office and
their efforts to comply with 501R requirements. For how they charge patients, Montefiore has
established rules. Patients at Montefiore can use financial aid services to help them with the cost
of their medical expenses.
Montefiore is dedicated to assisting those without health insurance in obtaining the
necessary medical care. Montefiore has vowed to help patients whose medical expenditures are
out of control. Montefiore is aware that individuals in need of therapies or procedures could be
reluctant to get them due to the possibility of high costs. With the support of health care team at
Montefiore’s Patient Financial Services, Montefiore helps patients locate financial options,
including free or inexpensive insurance or government initiatives expressly developed to lower
healthcare expenses. If the patients lack health insurance, the facility financial services department
can support with registration for Medicaid, Child Health Plus, and the New York State Market
Place. If a patient’s insurance fails to cover the cost of care, Montefiore will work with them to
develop a reasonable payment plan. Additionally, Montefiore offers programs to help patients with
family planning and initiatives for women’s healthcare (Montefiore.rog; 2023)
Strategies for Helping to Reduce Costs
Montefiore Hospital modified its patient medication recommendations in 2000,
contributing to an 80% reduction in prescription mistakes. This is essential for patient care and
also lessens medication overuse and duplication. The computerized healthcare system from
Montefiore has also been put into place; it aids in monitoring and managing chronic illnesses like
diabetes. The Montefiore Medical Center has attained both monetary and organizational
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sustainability. This has been accomplished through implementing care management techniques
that allow for system-wide implementation, fusing established and novel basic care delivery
strategies, and emphasizing community health and local responsibility.
The IT group also developed a protected HIPAA-compliant, web-based communication
tool (branded MyMontefiore.com) to enhance messaging between patients and providers. Patients
can share information with their healthcare provider offices and email their healthcare provider to
communicate non-emergent matters, get private replies and lab results, make appointments, and
ask for prescription refills. The Children’s Hospital and the Moses and Weiler divisions fully
function with Montefiore’s inpatient EHR. The Montefiore administration has taken the lead in
initiatives to share data with other Bronx healthcare systems. Dr. Safyer served as the first chair of
the Bronx Regional Health Information Organization (RHIO), which was established in 2005 and
serves as the platform for an electronic data exchange on healthcare across the whole Bronx.
Allowing for a more comprehensive continuum of care and ensuring illness management is
controlled everywhere (Montefiore.rog; 2023).
The overuse of the emergency room is one issue facing the Montefiore healthcare system.
Although, they have increased the implementation of HIT, they have had issues utilizing the
system within the program, which is another cause for concern. By making follow-up calls to
patients, Montefiore is also lowering the number of readmissions to the hospital following
discharge, which helps to reduce expenditures. Early patient and chronic illness therapies have
also decreased hospitalizations. Moreover, the organization’s financial stability improved and
lowered costs.
Recommendations
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Given that Montefiore appears to be a leader in their industry, I’m wondering how many
suggestions I can provide them. Utilizing Valera Health, a mobile app and platform that helps an
integrated healthcare behavior model and encourages patient engagement by two-way
communication, appointment reminders, personalized learning materials, and automated selfassessment, Monte Fiore added a new patient care component in 2017. The platform notifies care
executives of transformations in a patient’s situation, indicating the requirement for clinical support
and assisting in improving care-planning. Anxiety and depression have decreased, according to
program data, and case managers have communicated with their patients three times as frequently
as usual. Five of the Bronx locations are currently accessible via the app. Extending this aspect of
patient care to its other sites is the only thing that needs to be added (Savage Hoggard et al., 2023).
Montefiore is a pioneer in its neighborhood when it comes to cultural sensitivity. They can
keep linked to the community and the individuals who know and understand it by hiring workers
from within the community. I wonder if this organization’s cultural competency is seriously weak.
Implementing some form of fitness program they run in the schools with kids is a potential strategy
to support population health that I have not seen Montefiore approach.
Although they have addressed diabetes through school programs and reduced milk to 2%,
exercise is crucial in lowering both. If these schools implemented an activity program that lowers
obesity, it would also aid in the fight against other illnesses like diabetes and asthma. By
implementing the program, you assist people in losing weight, which then regulates their diabetes
and lowers healthcare expenses by minimizing expenses for these conditions and the expenditures
of medication and possible hospitalizations.
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Reference
Chase, Deborah; (2010); Montefiore Medical Center: Integrated Care Delivery for Vulnerable
case_study_2010_oct_1448_chase_montefiore_med_ctr_case_study_v2.pdf
Montefiore.org
(2023)
Non-Discrimination
Policy
Retrieved
from:
Retrieved
from:
https://www.montefiore.org/discrimination-policy
Montefiore.org;
(2023)
Financial
Services;
https://www.montefiore.org/commitment-to-quality-care
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Montifiore.org;
(2023)
Non-Discrimination
Notice;
Retrieved
from:
https://www.montefiore.org/discrimination-policy
Patient’s bill of rights. Information for Patients – Patient’s Bill of Rights – Montefiore Medical
Center. (2023). https://www.montefiore.org/patients-bill-ofrights#:~:text=Receive%20treatment%20without%20discrimination%20as,care%20if%20y
ou%20need%20it.
Populations.
https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_
Savage Hoggard, C. L., Kaufman, A., Michener, J. L., & Phillips, R. L. (2023). Academic
medicine’s fourth mission: Building on community-oriented primary care to achieve
community-engaged health care. Academic Medicine, 98(2), 175–179.
https://doi.org/10.1097/acm.0000000000004991
Stoto, Michael A., Klaiman, T., & Davis, M. (2018). A community health needs assessment
environment scan. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3230259
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