180428 Successful strategies in managing chronic conditions in a large scale public organization through quality improvement process

Monday, October 27, 2008: 8:50 AM

Ramanathan Raju, MD, MBA, FACS , Division of Medical and Professional Affairs, NYC Health & Hospitals Corporation, New York, NY
Alan D. Aviles, Esq , President, NYC Health and Hospitals Corporation, New York, NY
Consuelo U. Dungca, EdD, RN , New York City Health and Hospitals Corporation, New York, NY
Juliet G. Gaengan, RN, MSA , NYC Health and Hospitals Corporation, New York, NY
Health/Hospitals Corporation is a public health corporation with 11 acute, 4 nursing homes, 6 diagnostic/treatment, a home/health and managed care agencies. HHC provides services to largely disadvantaged, indigent and multiethnic population with variety of chronic diseases and little attention to preventive care. Scientific- and evidence-based studies show that Quality Improvement (QI) processes have made significant impact on health promotion and chronic disease prevention.

The HHC Quality Assurance Committee (QAC) of the Board of Directors identified several chronic conditions such as, congestive heart failure, diabetes, depression and charged its Central Office and facilities to arrive at best practices. This required a corporate-wide collaboration with the goal of standardizing QI measurement methodologies and arriving at a corporate-wide best practice guidelines. The following measures were monitored:

Congestive Heart Failure: Diabetes:

left ventricular function assessment registry VS datawarehouse

discharge prescription for ACE/ARB A1c level monitoring

discharge patient instruction A1c good and bad control

smoking cessation counseling BP/Lipid control


Assessment using PHQ2 and PHQ9


Implementation of these measures resulted in improved systems, processes and outcomes of patients being screened and provided appropriate treatment.

CONCLUSION: A QI approach on management of chronic conditions entails high level of commitment from the Governing Body, Administration and “hands-on” staff. Prevention of chronic conditions will ultimately result not only in improved care but also improved health and cost.

Learning Objectives:
1. Identify QI indicators impacting health promotion and disease prevention of disadvantaged population. 2. describe QI monitoring process in implementing best practice guidelines.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As the Executive Vice Presisdent/Corporate Chief Medical Officer of NYC Health and Hospitals Corporation, I oversee the implementation and management of chronic conditions best practice guidelines in the 23 facilities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.