2021 Quality And Outcomes Report - NYU Langone Health
2021Quality and Outcomes ReportDC-9/20/2022
Cover images:Illustration of the human bone structureGETTYIMAGES: SCIEPRO/SCIENCE PHOTO LIBRARY3D rendering illustration of the foot boneGETTYIMAGES3D rendering illustration of human body and skeletonContentsGETTYIMAGESKnee joints side view, MRIGETTYIMAGES: NICK VEASEY/SCIENCE PHOTO LIBRARY02PRESERVING QUALITY ANDOUTCOMES AS HEALTHSYSTEMS GROWHumanpelvisGETTYIMAGES: SEBASTIAN KAULITZKI/SCIENCE PHOTOLIBRARY09SURGICAL CASE VOLUME12RESEARCH REPORTS24INTEGRATEDQUALITY AND SAFETYINITIATIVES28PRESENTATIONSAND PUBLICATIONS30ABOUT US#423K 200 IN U.S. NEWS &WORLD REPORTORTHOPEDIC SURGERYPROCEDURES ANNUALLYORTHOPEDIC PHYSICIANEXPERTS ON FACULTYDC-9/20/2022
MESSAGE FROM OUR LEADERSHIPOn behalf of the faculty and staf of NYU Langone Orthopedics,we are pleased to present our 2021 Quality and Outcomes Report.Despite the ongoing COVID-19 pandemic, we have steadilyincreased our procedure volume while launching a range of newinitiatives to ensure that we continue to deliver healthcare of thehighest quality and value.Through our successful integration of multiple hospitals, we have led the way in demonstratinghow to advance high-quality and high-value care while greatly expanding our patient population.As our system has grown, so too have our eforts to develop infrastructure to ensure the systemwide integration of uniform quality and safety standards. At the same time, we have signifcantlyincreased our focus on diversity, equity, and inclusion to reduce health disparities and improverepresentation and have undertaken research projects focused on enhancing equity and reducingdisparities in health access, delivery, care, and outcomes.NYU Langone Orthopedics continues to blaze new trails in clinical research. Our surgeons areworld leaders in an innovative treatment for idiopathic adolescent scoliosis and in a pioneeringin-ofce needle arthroscopy for treating anterior ankle impingement. At our Center for OrthopedicInnovation, we’re developing methods that employ artifcial intelligence to improve risk stratifcationfor complex procedures such as total joint arthroplasty. Other research has supported the safetyand efectiveness of a new anesthesia option for high-risk hip fracture patients and of tranexamicacid in high-risk total joint arthroplasty patients. Our physician-researchers have demonstrated howto use video-based telemedicine to signifcantly improve satisfaction with outpatient proceduresand have provided important cultural data to aid expectation-setting and decision-making betweensurgical options after a traumatic hand injury.We are fortunate to be a part of a great university, and our department is continuing to leverage theentire breadth of talent throughout New York University’s portfolio of specialty schools. Throughpartnerships with the NYU Tandon School of Engineering, the NYU Wagner Graduate School ofPublic Service, and the NYU Stern School of Business, we are pursuing multiple projects focused onmusculoskeletal health and healing, diagnostic accuracy, and the economic impact of healthcarepolicy. Together, these exciting eforts have strengthened our commitment to quality as we continueto expand our reach.JOSEPH D. ZUCKERMAN, MDJOSEPH A. BOSCO III, MDWalter A.L. Thompson Professorof Orthopedic SurgeryProfessor, Orthopedic SurgeryChair, Department of OrthopedicSurgeryVice Chair for Clinical Afairs and Quality,NYU Langone Orthopedic HospitalSurgeon-in-Chief, NYU LangoneOrthopedic HospitalDC-9/20/2022
2NYU LANGONE HEALTHPreserving Qualityand Outcomesas Health SystemsGrowIn a roundtable discussion, NYU Langoneleaders in orthopedics describe how awell-integrated healthcare system hashelped them advance the shared goal ofhigher-quality care.Vinay K. Aggarwal, MD, andCordelia W. Carter, MDDC-9/20/2022
3NYU LANGONE ORTHOPEDICS 2021 QUALIT Y & OUTCOMESBecoming One Hospital System:The NYU Langone WayWell-planned growth and consolidation of health systems can drive greater efciencyand care coordination, but recent studies suggest that health system mergers acrossthe United States haven’t always lived up to the ideal of expanding high-quality patientcare. Nearly 25 years ago, NYU Langone Health brought a new approach to suchmergers, helping to establish a more consistent track record of success in the process.Te 1997 merger of NYU Langone with the Hospital for Joint Diseases, aided by afocused team efort, set the stage for decades of dynamic growth. NYU LangoneOrthopedics now includes more than 200 faculty who perform upward of 23,000procedures every year. Te department sponsors the largest orthopedic residencyprogram in the United States and has repeatedly earned a top-fve ranking in theannual U.S. News & World Report listing of “Best Hospitals” for Orthopedics.The 2021 U.S. News & WorldReport listing of “BestHospitals” for Orthopedicslauded NYU Langone’s“High Performing” hip andknee replacement services.Joseph D. Zuckerman, MD,Thomas R. Lyon, MD,Joseph A. Bosco III, MD, andJames D. Capozzi, MDJoseph D. Zuckerman, MD, inaugural chair of the combined department after the1997 merger, was tasked with fully integrating two residency programs and twofaculties providing orthopedic care at fve institutions. In 2016, Dr. Zuckermanprovided the same leadership, alongside Joseph A. Bosco III, MD (Vice Chair forClinical Afairs and Quality), and Thomas R. Lyon, MD (Vice Chair, Department ofOrthopedic Surgery at NYU Langone Hospital—Brooklyn), for a second fullintegration with Lutheran Hospital in Brooklyn. In 2019, when NYU Langone Healthmerged with Winthrop University Hospital to bring NYU Langone Hospital—LongIsland into the health system, Dr. Zuckerman and Dr. Bosco worked closely withJames D. Capozzi, MD (Chair, Department of Orthopedic Surgery at NYU LangoneHospital—Long Island), to apply the department’s proven approach for the third time.DC-9/20/2022
4NYU LANGONE HEALTHA Deliberate Focus on True System IntegrationDr. Lyon, Dr. Capozzi, and Dr. Bosco recently discussed howthey have collaborated in NYU Langone’s growing healthcaresystem to advance the shared goal of high-quality care. Onekey, Dr. Bosco said, has been understanding the criticaldiference between acquisition and integration. “Hospitalsystems are growing by acquiring and horizontally mergingwith other systems, but in order for patients to reap thebenefts, the entities must integrate,” he said. “Tat’s why wesee, nationally, that as hospital systems grow in size, theirquality doesn’t necessarily improve.” Instead, explainedDr. Bosco, NYU Langone has grown “deliberately andstrategically” and has spent the time needed to ensure a totalintegration of service lines.Part of the deliberate strategy has been recognizing the realworld diferences in facilities, personnel, patient populations,and even geography at the Manhattan, Brooklyn, and LongIsland sites. Te 11220 zip code that includes NYU LangoneHospital—Brooklyn, for example, has a far higher per-capitarate of Medicaid enrollees than the 10003 zip code that includesNYU Langone Orthopedic Hospital in Manhattan. “Trying toimpart one way of doing things on all three hospitals wouldnever work,” Dr. Capozzi said. “To achieve a successful systemintegration, we’ve been in constant communication and haveall learned from each other’s practices and hospitals, taking ourdiferences into account.” From the start, Dr. Lyon said, it wasclear that the three entities would fully integrate their qualitystandards, data, and systems. “We established the importantgoal of providing high-quality care regardless of location, andwe have created a metrics-driven system to help us achievethat,” he noted.Te attention to detail is paying of. In 2021, the LeapfrogHospital Safety Grade awarded “A” grades to all ofNYU Langone Health’s hospitals in Manhattan, Brooklyn, andLong Island—a unique honor among hospital systems in theNew York Metropolitan region. An obsessive focus on quality,Dr. Bosco said, is the hospital system’s “secret sauce.” Inparticular, a shared dashboard of metrics for nationallyaccepted quality indicators can show the collaborators wherethey are improving. “When you see your eforts come tofruition through better numbers and metrics, it just energizeseveryone to work even harder,” he said.In 2021, the Leapfrog HospitalSafety Grade awarded “A” gradesto all of NYU Langone Health’shospitals in Manhattan, Brooklyn,and Long Island—a unique honoramong hospital systems in theNew York Metropolitan region.Mehul R. Shah, MDDC-9/20/2022
5NYU LANGONE ORTHOPEDICS 2021 QUALIT Y & OUTCOMESTangible Results Trough Integrated Recordsand MetricsAs part of the “huge investment” in providing real-time data,Dr. Lyon said, NYU Langone fully integrated all electronicmedical records (EMR) through the Epic system. Tat meansproviders across the health system can look at the samenumbers on the same quality dashboard. “Te EMR systemwas probably the most important element to our hospital’ssuccessful integration, because if you can’t talk to each otheror look at metrics or share patient charts and data, you’re reallyat a disadvantage,” Dr. Capozzi added. “Our metrics keepimproving because we all have numbers to look at, and weknow where we need to focus.”NYU Langone’s readmission reduction initiative has similarlybenefted from data-sharing. In 2013, the health system wasone of the frst to volunteer for the Centers for Medicare &Medicaid Services (CMS) Bundled Payments for CareImprovement (BPCI) Initiative. For the total joint bundledpayment risk-sharing program, hospitals are fnanciallyresponsible for all care and readmissions up to 90 days afterdischarge, and CMS gives participating hospitals a list ofall 90-day readmissions. “Tat information allowed us toformulate improvement strategies that decreased ourreadmission rates by 70 percent,” Dr. Bosco said. On the LongIsland campus, Dr. Capozzi said that the metrics have helpedthe Department of Orthopedic Surgery signifcantly improve itsreadmission rate as well as its total joint length of stay andcomplication and mortality rates.In 2020, for example, providers noticed that hospital-acquiredconditions had ticked up over the previous six monthsacross all of NYU Langone’s sites. When they looked moreclosely, they found that venous thromboembolisms, or bloodclots, were driving the increase. “Why was that? Because ofCOVID-19,” Dr. Bosco said. “Today, everyone knows thatCOVID-19 causes a hypercoagulable state in patients, but noone knew that early in the pandemic.” Upon the discovery,the health system formulated a strategy and put new deepvein thrombosis (DVT) prophylactic protocols in place. “As aresult, we were able to address the increased DVT risk innear-real time and provide our patients with safer, higherquality care,” he said.Meredith A. Lazar-Antman, MDDC-9/20/2022
6NYU LANGONE HEALTHKenneth A. Egol, MDShared Commitment to ImprovingPatient ExperienceAmid the successes, NYU Langone Orthopedics has had toovercome several obstacles in improving the experience of ahighly diverse patient population. At the Brooklyn campus,Dr. Lyon said, providers have been challenged by an olderfacility and a larger proportion of patients admitted nonelectively through the emergency department. “Studies haveshown that these admissions are generally associated withlower patient satisfaction scores,” he said. “Nevertheless,signifcant investments and improvements in nursing carehave moved the needle upward on patient experience, and wewill continue to make it a priority moving forward.” A big infuxin nursing staf, for instance, improved the nurse-to-patientratios and helped NYU Langone Hospital—Brooklyn exceedquality standards. “We’ve seen major investments in nursingstaf, facilities, and information technology,” Dr. Lyon said.One overarching lesson, Dr. Bosco said, is that successfulmergers require complementary cultures. “Te saying is thatculture eats strategy for lunch,” he said. “We’ve all derivedbenefts because we started from the point of a commonculture and a vision of collaboration.” Te Department ofOrthopedic Surgery at NYU Langone Hospital—Long Island,he noted, runs an “outstanding fragility fracture service withunbelievable outcomes and detailed evidence-based carepathways. So we adopted those throughout our system.” Inthe same vein, the Department of Orthopedic Surgery atNYU Langone Hospital—Brooklyn runs an “incredibly efcientoperating room, and we learned a lot from integrating some oftheir practices across NYU Langone as well,” Dr. Bosco said.True integration, in other words, is a two-way street ofcollaborative learning and sharing that can foster mutualgrowth while enabling high-quality patient care.Older facilities on the Long Island campus have likewisepresented some obstacles for improving patient experience,but Dr. Capozzi said the site’s top-notch patient services haveprovided abundant opportunities to overcome the hurdles.“We have a phenomenal total joint program and a 98 percentfrst case on-time start rate in our operating rooms,” he said.To reduce the wait time for orthopedic appointments, thedepartment also started a walk-in, after-hours clinic everynight from 4 to 8 p.m.DC-9/20/2022
NYU LANGONE ORTHOPEDICS 2021 QUALITY & OUTCOMES7Toni M. McLaurin, MD (center), andorthopedic surgery residentsA Commitment to DiversityHelps Defne Quality CareAs the Department of Orthopedic Surgery has expanded tointegrate care across locations, an intentional focus on qualityand outcomes has dovetailed with a commitment to care thatrepresents everyone. Since the very frst Diversity Committeewas created in 2010, the department has worked to enhancediversity in order to reduce disparities and improve healthequity. Tat focus has been amplifed by the recent appointmentof Toni M. McLaurin, MD, as the inaugural director of Diversity,Equity, and Inclusion (DEI) for the department, and as chairof the newly expanded Committee on DEI.In the past year, the committee has strengthened DEIcommunication, convening discussions on DEI, microaggressions, and allyship; developing a website with resourcesand information emphasizing DEI in orthopedics; andlaunching a monthly newsletter in which committee membershighlight DEI issues. Among the 2021–2022 residency class,the largest in the country, more than one-third identify asfemale, and the department has the second-highest numberof Black residents in training.“We’ve made progress, but we still have a long way to go tobring individuals across races and genders into the profession,”notes Dr. McLaurin. “Moving forward, the committee willfurther our commitment to recruiting academically talentedand diverse faculty members, physicians in training, medicalstudents, and staf.”DC-9/20/2022
8NYU LANGONE HEALTHAn Infrastructure forContinued QualityImprovementAs the NYU Langone network has expanded, so too havededicated eforts to support continued prioritization of qualitystandards across the network’s sites. One such initiative,underway through the Center for Quality and Patient SafetyProgram and Infrastructure, is developing a system-widequality infrastructure to ensure uniform quality and safetystandards with coordination and communication among allNYU Langone Orthopedics care sites.Tis new system encompasses multiple sites, includingNYU Langone Orthopedic Hospital, NYU Langone Hospital—Brooklyn, and NYU Langone Hospital—Long Island, witheach subspecialty designating a physician lead to enhancequality initiatives at both a division and site level. Withinthe NYU Langone Orthopedic Center, an AmbulatoryQuality Committee was established to formulate, monitor,and create improvement strategies for musculoskeletal care.Te committee includes physician leaders, physicianassistants, and a practice manager, all under the guidance ofJoseph A. Bosco III, MD, director of quality and patient safetyat NYU Langone Orthopedic Hospital, and Gail S. Chorney,MD, clinical associate professor in the Department ofOrthopedic Surgery.Te committee emphasizes transparency around qualitydata for individual physicians, including benchmarks forcomparison with peers. All division chiefs and qualitydesignees have access to a dashboard, with data monitoringand monthly review to ensure accuracy. Physicians at eachsite review their own infection, readmission, venous thromboembolism events, and other outcomes data to confrmaccuracy and determine if cases were preventable. Regulardata outputs include a monthly Divisional Quality Scorecard,a quarterly Quality Dashboard Newsletter, a quarterlyDepartment Quality and Safety Report, monthly SnapshotGoals, and quarterly Patient Satisfaction Data distributed toall physicians.“Maintaining and enhancing a culture of quality demands acontinued, focused efort,” notes Dr. Bosco. “With these systemsin place, we have the infrastructure we need to support qualityoutcomes with data across our department and sites.”Gail S. Chorney, MDAccess to Statewide Datato Enable Health DisparitiesResearchTe Department of Orthopedic Surgery was recently grantedaccess to the New York Statewide Planning and ResearchCooperative System (SPARCS) database, which featuresde-identifed patient-level data on demographics, diagnoses,treatments, and services. It also includes information oncharges for each hospital inpatient stay and outpatient(ambulatory surgery, emergency department, and outpatientservices) visit, and each surgery and outpatient visit to ahospital extension clinic or diagnostic and treatment centerlicensed to provide ambulatory surgery services.Access to the rich data available through SPARCS will enablea range of research projects aimed at enhancing equity andreducing disparities in health access, delivery, care, andoutcomes across our growing network. Proposed initialprojects include a review of patient complications by race,region, and socioeconomic status for total joint arthroplasty(TJA), spine, and trauma; access to Centers of Excellence(Level 1 trauma centers or Magnet status) for orthopedicfractures by race across New York State hospitals; andpatient and institutional factors associated with the use oftechnology in TJA.DC-9/20/2022
9Surgical CaseVolumeJuan C. Rodriguez-Olaverri, MD, PhD (right)Research shows that high procedurevolume is associated with betterperformance for both institutions andindividual surgeons. NYU LangoneOrthopedics is committed to leveragingour high case volumes to achieve betteroutcomes for our patients.DC-9/20/2022
10NYU LANGONE HEALTHHigher Patient Volumes Yield Better OutcomesIn 2021, the department performed more than 23,000 orthopedic surgery procedures.Our annual case volume has grown steadily, with a 25 percent increase in totalprocedures over the last fve years.ORTHOPEDIC SURGERY PROCEDURE VOLUME (FY UPERSTORMSANDYAmbulatoryBROOKLYNINTEGRATIONLONG COVID-19PANDEMICPROCEDURE VOLUME BY DIVISION (FY 2021)Adult Reconstruction3,0963,792Foot and Ankle*1201,870Hand1034,085Orthopedic Oncology1587Pediatric Orthopedic171521Shoulder and Elbow154 651Spine1,797Sports Medicine3214,407Trauma and Fracture3217078340*Includes ulatoryDC-9/20/2022
11NYU LANGONE ORTHOPEDICS 2021 QUALIT Y & OUTCOMESPROCEDURE VOLUME BY LOCATION (FY 2021)INPATIENTAMBULATORY18%20%(LI)(LI)5% ng IslandNovel Scoliosis Treatment Draws Patient ReferralsAn innovative non-fusion technique to correct spinal curvature in patients treatedfor idiopathic adolescent scoliosis at NYU Langone preserves mobility and freedomof movement compared to traditional fusion techniques. Since joining NYU Langonein June 2020, Juan C. Rodriguez-Olaverri, MD, PhD, clinical associate professor inthe Department of Orthopedic Surgery, and a world-renowned scoliosis expert, hastreated more than 80 patients referred nationally and internationally for his vertebralbody tethering (VBT) technique. “With VBT, the spine can continue to move andbend, there’s better visual improvement to the spine, and patients have a smallerscar—all contributing to better outcomes and quality of life for these patients.”20Patients fromstateshave traveled to NYU Langone forthe VBT procedureDC-9/20/2022
12NYU LANGONE HEALTHResearchReportsClaudette M. Lajam, MDTo raise the quality of orthopedic care forall patients, our doctors conduct patientsafety and outcomes research. Here aresome highlights of recent eforts designedto identify the most efective strategiesfor treating orthopedic diseases, whileoptimizing quality, safety, and outcomes.DC-9/20/2022
13NYU LANGONE ORTHOPEDICS 2021 QUALIT Y & OUTCOMESA Safe New AnesthesiaOption for High-Risk HipFracture PatientsHip fracture fxation is associated with a high risk of perioperative morbidity and mortality, particularly in patients whohave multiple comorbidities, are frail, and have additionalinjuries. Most surgeons perform the fxation under general orspinal anesthesia; however, regional anesthesia with monitoredanesthesia care (MAC), which preserves spontaneousbreathing and airway refexes, has become increasingly popularin recent years. MAC is associated with rapid patient recoveryand fewer side efects such as urinary retention and nausea orvomiting. But studies have reached conficting conclusionsover which methods may help decrease postoperativemortality, adverse events, and hospital length of stay, and nostudies have ever assessed the use of purely local anestheticsoft-tissue infltration with MAC.Researchers at NYU Langone Health sought to fll theknowledge gap by examining the feasibility of using MAC andsoft-tissue infltration with local anesthesia (STILA) for patientsundergoing hip fracture fxation with short cephalomedullarynails (CMN). Teir retrospective study, published in theJournal of Orthopaedic Trauma, included 20 consecutiveOTA 13.A1-3 IT hip fracture patients treated with a short CMNand MAC-STILA protocol between October 1, 2019 andMarch 31, 2020. Te researchers matched the patient cohort1:1:1 with other hip fracture patients who had received eithergeneral or spinal anesthesia during their surgeries.Of the three patient cohorts, the researchers found that theMAC-STILA protocol was best able to maintain a normalintraoperative heart rate of 60 to 100 beats per minute.Additionally, the MAC-STILA patients reported consistentlylower pain scores (Visual Analog Scale score of 1) than eitherthe spinal or general anesthesia patients (VAS 1) in the frstthree hours after the surgery, after which the pain scoresequalized. Trough the frst 48 postoperative hours, patientswho underwent the MAC-STILA protocol required a somewhatlower dose of narcotics than those who received spinalanesthesia and an approximately fve-fold lower dose thanthe cohort who received general anesthesia.MAC-STILA PROTOCOL COMPARED TO TRADITIONAL ANESTHESIA METHODSMAC-STILA (MEAN, SD)SPINAL (MEAN, SD)GENERAL (MEAN, SD)P-VALUEWheels in to wheels out (minutes)99.1 26.4111.6 18.8111 21.90.154Minimum heart rate (BPM)67.3 9.968.3 13.559.3 8.90.023Maximum heart rate (BPM)99.7 13.9104.5 12.6112.9 18.70.027Mean length of stay (days)6.75 7.06.25 3.05.5 2.70.700VAS Pain Score 2 hours postop0.76 1.91.5 2.73.4 3.60.022VAS Pain Score 3 hours postop0.79 2.11.7 3.10.89 1.50.489VAS Pain Score 8 hours postop2.4 2.92.8 2.82.5 2.70.928Morphine equivalents 12 hours postop8.3 8.313.9 17.116.4 21.00.283Morphine equivalents 24 hours postop12.0 11.022.4 27.555.8 116.90.125Morphine equivalents 48 hours postop22.5 20.535.9 39.5116.0 249.30.118DC-9/20/2022
14NYU LANGONE HEALTHTe researchers found no meaningful diferences in intraoperative blood loss, procedural time, length of stay, minor ormajor complications, inpatient or 30-day mortality, 30-dayreadmissions, discharge location, postoperative ambulatorydistance, or inpatient cost among the patient cohorts. Giventheir fndings, they concluded that the MAC-STILA protocol isa safe and efective alternative to spinal or general anesthesiafor fxing intertrochanteric hip fractures with short CMNs. Forpatients who have severe medical comorbidities or contraindications to general or spinal anesthesia, MAC-STILA maybe preferable.Tranexamic Acid Is Safein Total Joint ArthroplastyPatients with CoronaryArtery DiseaseOrthopedic surgeons have increasingly used tranexamicacid (TXA) as a highly efective intervention for minimizingblood loss that can occur during total joint arthroplasty (TJA).Nonetheless, many surgeons have raised questions aboutwhether TXA might promote a prothrombotic event andincrease the risk for myocardial infarction and venousthromboembolism (VTE) among patients with a history ofcoronary artery disease (CAD) or coronary stents.To fnd out, an NYU Langone team conducted a retrospectiveanalysis of 26,808 patients who underwent total hip or kneearthroplasty between June 2011 and September 2019, all ofwhom received either topical or intravenous TXA. Teresearchers reviewed the patients’ charts to identify anyhistory of CAD or stents, and any myocardial infarction or VTE(either a pulmonary embolism or deep venous thrombosis)within 90 days of the arthroplasty operation.Sanjit R. Konda, MDNotably, their analysis in the Journal of Bone & Joint Surgeryfound no instance of postoperative myocardial infarctionsamong the at-risk patients. In addition, the researchersobserved no signifcant diference in the VTE rates of arthroplasty patients, regardless of their CAD history. Te same lackof diference held true when the researchers looked onlyVTE RATES IN PATIENTS RECEIVING TXAPATIENT GROUPNO. OF PATIENTSNO. OF VTEsRATEP-VALUEPatients with CAD undergoing THA42410.235%0.560Patients without CAD undergoing THA12,914550.426%—Patients with CAD undergoing TKA60420.331%0.073Patients without CAD undergoing TKA12,8661411.096%—Patients with CAD undergoing THA or TKA1,02830.291%0.086Patients with coronary stents undergoing THA or TKA28800.000%0.137Patients without CAD or coronary stentsundergoing THA or TKA25,7801960.760%—DC-9/20/2022
15NYU LANGONE ORTHOPEDICS 2021 QUALIT Y & OUTCOMESat total hip arthroplasty or total knee arthroplasty cases.Similarly, the analysis found no signifcant diference in VTErates based on the patients’ coronary stent history.Although both topical and intravenous administration of TXAduring TJA provides systemic levels considered therapeutic,surgeons often prefer topical application for at-risk patientsdue to concerns that higher levels of intravenous TXA couldtheoretically increase the risk of cardiac events. Little evidenceexists to support the superiority of one method over the other,however. Te NYU Langone Orthopedic team repeated itsanalysis of VTE rates in patients with a history of CAD, inpatients with a history of coronary stents, and in the subsetof patients who received either total knee or total hiparthroplasty. Again, they found no signifcant diferencesbased on the type of TXA administration, suggesting that thesystemic efect of intravenous TXA may not be as dangerousas previously thought.Overall, the results suggest that both topical and intravenousTXA are equally safe for all TJA patient populations, includingthose with a history of CAD or coronary stents, leading theresearchers to recommend intravenous TXA due to itspotential for easier implementation.Ran Schwarzkopf, MDDC-9/20/2022
16Day-of-Surgery Videoand Phone Calls IncreasePatients’ OutpatientSurgery SatisfactionPatient-centered metrics have been increasingly emphasizedin the U.S. healthcare system, with patient satisfaction nowaccounting for 25 percent of a hospital’s quality of care score.Telemedicine is generally associated with high patientsatisfaction in the feld of orthopedic surgery. In a newrandomized controlled trial published in the Journal of Bone &Joint Surgery, researchers at NYU Langone Health assessedwhether telemedicine in the form of day-of-surgery video orphone calls might likewise improve patient satisfaction afteroutpatient surgery.NYU LANGONE HEALTHTe trial enrolled 251 patients who underwent orthopedicsurgery between December 2018 and May 2019; every month,the trial randomly assigned three participating surgeons fromthe Department of Orthopedic Surgery’s Division of SportsMedicine to one of three communication methods. One surgeonhad no contact with patients after their same-day discharge,which had been the standard of care. A second surgeoncontacted patients by phone after their discharge, and a thirdcommunicated with patients via a video call.During an in-person ofce visit one week after surgery, theresearch coordinator assessed the patients’ satisfaction via theConsumer Assessment of Healthcare Providers and SystemsSurgical Care survey (S-CAHPS), which evaluates theirexperience before, during, and after a single episode ofoutpatient surgery. Te mean S-CAHPS top-box response ratewas greater in both the video group (0.86 0.14, p 0.001)and the phone group (0.84 0.17, p 0.001) than in theno-contact group (0.68 0.26).Eric J. Strauss, MD (right)DC-9/20/2022
17NYU LANGONE ORTHOPEDICS 2021 QUALIT Y & OUTCOMESDENSITY PLOT DEMONSTRATING DISTRIBUTION OF PATIENT SATISFACTION SCORESNo -CAHPS Top-Box Response RateThe dashed vertical lines represent group means.S-CAHPS Consumer Assessment of Healthcare Providers and Systems Surgical Care survey.Te patients also completed a separate nine-itemquestionnaire that measured their satisfaction with overallcare: 85.9% of patients in the video group gave the top-boxresponse, compared with 71.8% in the phone group and 60.7%in the no-contact group. Patients in the video group, in fact,
Orthopedic Surgery at NYU Langone Hospital—Brooklyn), for a second full integration with Lutheran Hospital in Brooklyn. In 2019, when NYU Langone Health merged with Winthrop University Hospital to bring NYU Langone Hospital—Long Island into the health system, Dr. Zuckerman and Dr. Bosco worked closely with
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Student Learning Outcomes . Purpose of Student Learning Outcomes . 1. Student learning outcomes communicate to students what they will be able to do after completing an activity, course, or program (course outcomes are specific and department/program outcomes are general). 2.
2 SPSS Statistics for better outcomes Contents 2 Introduction 3 Better outcomes for academia 4 Better outcomes for market research 5 Better outcomes for government 6 Better outcomes for healthcare 7 Better outcomes for retail 8 Conclusion Introduction IBM SPSS Statistics is a fast and powerful soluti
Report Dashboard, which provides the status of your PORs (Due, Overdue, Submitted, and Not Yet Due). Click the link under the PO Report Status column for the award to prepare or edit a saved report 2. The Project Outcomes Report Page will show you which Project Outcomes Report s are Due, Overdue, Submitted, and Not Yet Due. Your reports are .
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The Bubble Map is for describing using adjectives; Identifying the sensory, logical and emotional qualities of any topic or concept. Who Am I, My Story: My Qualities - Bubble Map name quality quality quality quality quality examples influences name quality quality quality quality quality 8 your name name 2
The next step is to record the outcomes. 2 Recording outcomes . At review, the practitioner discusses with the person whether and to what extent they have achieved the relevant outcomes. The review should include discussion of all outcomes, not just . personal plan) Ken is
Cortland AMP Lab is tasked with helping to collect data and to assist with ongoing development of outcomes-based content. . Standard Outcomes Percentage of Outcomes Addressed Standard 1 Outcomes 88% by content and assessment Standard 2 Outcomes 100% by content
