Using a Systems Approach to Making Care Safer
"Healthcare is delivered through a complex set of interwoven systems, and there are many factors that can affect a patient’s outcome. Having a better understanding of those factors can help us to improve diagnosis, reduce readmissions, and make care safer."
Leora Horwitz, M.D., associate professor of population health and medicine and director of the Center for Healthcare Innovation and Delivery Science at New York University (NYU) Langone Health, is using a systems-based approach to evaluate clinical processes and information flow with an eye toward making them safer. Her goal is to improve clinical care and patient experience through thoughtful and deliberate healthcare redesign that incorporates principles from engineering, behavioral science, informatics, and implementation science.
As principal investigator in the AHRQ-funded Patient Imaging Quality and Safety Laboratory, or PIQS Lab, at NYU, Dr. Horwitz is leading a transdisciplinary team that is looking at ways to improve radiology services. The PIQS Lab brings together clinicians in NYU’s departments of population health, radiology, emergency medicine, medicine, urology, surgery, and oncology with operations, human factors, and management experts at NYU’s medical center and public policy and business schools.
The variety of backgrounds and roles represented on the NYU team enables a 360-degree view of radiology services to help make care as safe as possible for all patients. For example, in the outpatient setting, the team is focusing on redesigning the radiology ordering process to minimize inappropriate or unnecessary tests. For inpatient interventional radiology services (e.g., biopsies and drainages), the team is focusing on ways to improve teamwork, communication, and patient safety. Across the spectrum of care, the team is determining how to enhance the follow-up process for radiology test results so that patient outcomes can improve.
Examples of early work from the PIQS Lab include an automated scoring system that pulls together relevant information to categorize and communicate patient risk for pulmonary embolism, a dashboard that compares individual physician performance to that of their peers, standardized inter-team communication methods, and automated notifications of schedule changes. Further outcomes from this project are expected by the end of 2019.
Dr. Horwitz is also applying her experience in using systems-based research to get a better understanding of the underlying non-clinical factors that affect hospital readmissions—or unexpected return trips to the hospital. In another AHRQ-funded project, her team is analyzing data from more than 6 million hospital admissions of Medicare beneficiaries to identify common hospital characteristics such as facility size and type, as well as other factors that may contribute to avoidable readmissions.
Research from this project so far shows that Medicare patients in larger, urban, academic facilities have a higher risk of readmission than patients at smaller, suburban, community hospitals. The project, which ends in September 2019, builds on Dr. Horwitz’s previous research that developed a hospital-wide, all-condition readmission measure.
Dr. Horwitz is co-principal investigator of the AHRQ-funded training program that trains pre-doctoral and post-doctoral students in methods of healthcare redesign so that more researchers in the future will have these key skillsets.
In addition to leading AHRQ-funded research projects, Dr. Horwitz directs the Center for Medicare & Medicaid Innovation-funded Greater New York City Practice Transformation Network, which aims to transform ambulatory care for thousands of physicians across New York City. In 2018, she was elected as a member of the American Society for Clinical Investigation. She is also a member of the Society of General Internal Medicine, Society for Hospital Medicine, and the American College of Physicians. Dr. Horwitz was recently named a National Academy of Medicine Emerging Leader in Health and Medicine Scholar.
Principal Investigator: Leora Horwitz, M.D., Associate Professor of Population Health and Medicine and Director for Healthcare Innovation and Delivery Science
Institution: New York University (NYU) Langone Health
Grantee Since: 2014
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit http://www.ahrq.gov/training.