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New York City Health and Hospitals Corporation: Overcame Unsatisfactory Outcomes and Poor Compliance

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AMC Health’s clinical decision support tools helped HHC Nurses and patients lower HbA1c by 1.8%!

THE COMPANY:
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (NYC HHC)
NYC HHC is the country’s largest municipal integrated delivery system, a $5.4 billion public entity serving 1.3 million New Yorkers. It includes 11 hospitals, 6 large outpatient centers, four skilled nursing facilities, Medicaid Managed Care and Medicare Advantage plans, a certified home health agency and more than 80 community clinics.

THE CHALLENGE:
UNSATISFACTORY OUTCOMES AND POOR COMPLIANCE
A study by NYC HHC concluded that they were not reaching the goal of improving the care of patients with chronic disease: the system wanted to bring HbA1c below 7% for diabetic patients, reduce blood pressure among those who were also hypertensive, and reduce expensive and unnecessary hospital and ER use. One of the issues, the study discovered, was that too many patients believed that medication alone would control their diabetes and were not following dietary and activity guidelines.

THE STRATEGY:
REMOTE MONITORING WITH CARE COORDINATION
AMC Health and NYC HHC collaborated on the House Calls Telehealth Program. The program uses remote monitoring in patients’ homes to track blood glucose, weight, blood pressure and diabetes self-management parameters. Data is sent to AMC Health’s secure web portal, with clinical decision support tools that provide customized alerts for each patient, trending analytics and population-wide benchmarking. Clinicians use this platform as a de-facto electronic health record that can be accessed from anywhere.

THE SOLUTION:
DAILY BLOOD PRESSURE AND BLOOD GLUCOSE TELEMONITORING WITH COACHING AND EDUCATION BY NYC HHC NURSES
Physicians used telemonitoring data to adjust medication. ER use and hospital readmissions were dramatically reduced, and blood glucose and blood pressure controls were significantly improved. AMC Health’s clinical decision support tools helped HHC nurses and patients lower HbA1c by 1.8% The program has been used by nearly 700 patients, with dramatic results:

  • 81% had significant and sustained improvement in glycemic control, with HbA1c reduced an average of 1.8 percentage points.*
  • 66% of patients who also had hypertension had diastolic blood pressure reduced by 5 mmHg, representing a 21% reduced risk of cardiac events and a 15% reduced risk of stroke.
  • For members with at least 12 months of pre-telemonitoring and 12 months of telemonitoring data, ER use declined by 47%, and hospital admissions dropped 38%

 

*Journal of Managed Care Medicine (Vol 15, No.4), November 2012