Background: The ACGME has developed competencies for systems-based practice and problem-based learning and improvement to encourage trainees to integrate quality and safety into their everyday practice. Furthermore, the AAMC has a call to action for US Medical schools and teaching hospitals to successfully align clinical and education missions in order to have quality improvement and [...]

Background: Healthcare in the U.S. is increasingly delivered by large health systems that include one or more hospitals and associated outpatient practices. It is unclear what role health systems play in driving or preventing overutilization of healthcare services in the U.S. We sought to learn what characteristics allow certain health systems to avoid low-value care [...]

Background: The US healthcare system is under increasing pressure to improve value and affordability. Acute care is responsible for a large proportion of overall health costs, but the complexities and pace in this environment have left an evidence gap in value-based care transformation. Novel improvement and evaluation strategies are thus needed more than ever to [...]

Background: Asking patients “what matters” to them is one of the 4 evidence-based elements of care developed by the Age-Friendly Health Systems initiative to improve the care of older adults, and the question “what matters most” has been extended to other settings. We conducted a study to assess the frequency and categories of responses to [...]

Background: The Lean-Kaizen approach of implementing patient-centered systems change by reducing waste and adding value has been widely used in health systems in the US to provide incremental process improvement. This approach to streamlining health care processes has been under-utilized in resource-poor regions of the world, even though the Lean-Kaizen approach was developed in under-resourced [...]

Background: Advanced Practice Professionals, APPs (Nurse Practitioners and Physician Assistants) often practice in variable, undefined capacities in teaching hospitals. APP roles are parallel to teaching faculty led teams, and function to accommodate clinical overflow and adjust to attending specific workflows. This impacts role satisfaction, professional advancement, and creates retention challenges. APPs’ inability to fit in [...]

Background: Health systems science (HSS) is a burgeoning field in medical education, a movement spearheaded by the American Medical Association (AMA). Proposed as the Third Pillar of Medical Education alongside the two existing Pillars of Basic and Clinical Sciences, this field focuses education on how health care is delivered and improved on every level of [...]

Background: Our Academic Medical Center, (AMC), located near the US-Mexico border, began receiving and treating patients with COVID-19 beginning in February of 2020. After activating incident command to increase surge capacity and developing protocols for treatment of patients with COVID-19, we developed adequate capacity for the most likely scenarios of pandemic progression. By April of [...]

Background: Neonatal abstinence syndrome (NAS) occurs when an infant is exposed to chemical substances in utero and consequently withdrawals from the substance(s) after birth. The long-term impact of NAS remains unclear due to confounding by other factors that impact infant health and development, but literature suggests that infants with NAS have motor and cognitive delays [...]

Background: Montefiore Health System (MHS) rapidly expanded from three hospitals in close proximity to eleven hospitals across hundreds of miles. The structure of the new health system follows a hub and spoke model with the concentration of specialty care located at the hub which is the Moses campus in Bronx, NY. In order to best [...]