BINF G5000 - Defining, Evaluating and Improving Quality in Health Care

COURSE DESCRIPTION: There is an open question and debate about how best to measure and improve quality within healthcare. The broad context of how the healthcare system works and how quality is measured can help students understand where their informatics solutions can make the most impact.

The class is structured to feature many prominent guest speakers from around Columbia University Irving Medical Center and NewYork-Presbyterian leadership, as well as institutions like Geisinger, Cityblock Health, Brigham & Women’s Hospital, CVS-Aetna, Hackensack University Medical Center, and NYC Health + Hospitals. It will include both discussion and writing reflection/thought pieces. Through this class, students will develop a better understanding of healthcare, new publishing venues, as well as the operational and policy environment in which informatics work is being done.


Rimma Perotte, PhD

Teaching Assistant

RuiJun "Ray" Chen, MD

Class Schedule

Mondays, 10 am - 12 pm

Virtual (formerly PH 20-200)

Spring 2020

Course Requirements and Grading: Students will be expected to complete all reading assignments before the class for which they are assigned. Students will prepare short reports on each of the presentations. These must be submitted in CourseWorks before the following class. Each student will prepare a longer report outlining an approach to one of the interdisciplinary problems describe in the presentations. There will be no midterm or final exam. Grades will be based on class participation (30%), weekly short reports (30%), and final report (40%).

Short Reports: After the week’s presentation you should prepare a 1-2 page report based upon the presentation. While you may use the week’s readings as background, the report should focus on the problems and information presented in class. This report should include:
• A brief summary of the problem(s) described.
• Questions you had for the speaker.
• Ideas about how you might address the problem(s) presented from the perspective of your own discipline.
• Obstacles to addressing the problem(s)
• Suggestions you have for next steps if you were to follow up on these ideas, including resources you would need, other people who might be involved (either particular people or experts in particular areas).

Long Report: Project reports are proposals on how you would address one of the problems described in some presentation made during the course. Reports are 10 pages maximum (including bibliography), done in AMIA-style format. It may be a sub-problem mentioned by a speaker as part of a larger problem area. Actual experimental implementations will be welcome, but not mandatory. In the report, you should explain:
• the goal of the project
• the problem you intend to solve
• the research hypotheses tested (what question(s) did you want to answer?)
• relevant previous research on this topic
• the novel approaches you propose
• how your approach is related to solutions presented in this class earlier
• how you would measure the success of your proposed work
• proposed data, evaluation metrics, and experiments
• alternative methods or existing results for comparison

Schedule and Readings*
*Please note that the readings are subject to change. They will be finalized the Friday before the lecture.

01/27Welcome • How are hospitals rated on quality?Rimma Perotte, PhD
Director, Biomedical Informatics
Hackensack University Medical Center
• Chun and Bafford, History and Background of Quality Measurement
• Donabedian, Evaluating the quality of care
• McGlynn, The Quality of Health Care Delivered to Adults in the United States.
• Marjoua, Brief history of quality movement in US healthcare
• Austin et al. National Hospital rating systems share few common scores and may generate confusion instead of clarity. Health Affairs 2015.
02/03Population HealthDavid Silvestri, MD, MBA, MHS
Director, Care Transitions and Access

Chris Keeley
AVP, Ambulatory Care Operations

Kaushal Challa
COO, Ambulatory Care

NYC Health + Hospitals
• Background slides on NYC Health + Hospitals
• Bradley et al. Health and social services expenditures: associations with health outcomes
• Onie et al. Population Health: The Ghost Aim
• Woolf and Braverman. Where Health Disparities Begin: The Role of Economic Determinants – And Why Current Policies May Make Matters Worse
• Spencer et al. Measuring Social Determinants of Health among Medicaid Beneficiaries: Early State Lessons
• Human Services Organizations: Partnering for Better Community Health
02/10Quality Data Landscape

Process Improvement in Healthcare
Casey Cauthorn, MA
AVP, Advanced Analytics

Jamie Galorenzo, MS
Director, Value Institute
• Gonzalez et al, Using same hospital readmission data to estimate all-hospital readmission data
• Rising et al, Geography not Health System Affiliations, Determines Patients Revisits to an Emergency Department
• Nuckols, Economic Evaluation of QI Interventions Designed to Prevent Hospital Readmission

• Bohmer, The Hard Work of Healthcare Transformation
• Moraros, Lean Interventions in Healthcare, do they actually work?
• Schweikhart and Dembe, The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research
• Chassin, Improving The Quality of Health Care: What’s Taking So Long?
• Frelesleben, Revolutionary Impact?

• Gawande, What Big Medicine can Learn from the Cheesecake Factory
• Kophach-Konrad et al. Applying Systems Engineering Principles in Improving Health Care Delivery
02/17A Day in the life of…

RuiJun Chen, MD
Clinical Assistant Professor of Medicine
Weill Cornell Medical College

Rimma Perotte, PhD
Director, Biomedical Informatics
Hackensack University Medical Center
• Death by a Thousand Clicks
02/27Regulatory Compliance

Supply and standardizing a hospital
Amanda Ryan, PharmD
Director, Accreditation and Regulatory
NewYork-Presbyterian Hospital

Anand Joshi, MD, MBA
VP, Procurement and Strategic Sourcing
NewYork-Presbyterian Hospital
• Roberts et al. A History of the Joint Commission on Accreditation of Hospitals
• Patterson, Joint Commission on Accreditation of Healthcare Organizations
• Amazon poised to deliver disruption in medical supply industry
• J. R. Avansino, et al, “Standardization of operative equipment reduces cost,” J. Pediatr. Surg.,
• P. Brody, “the time is right for supply data synchronization,” Healthc. Financ. Manag.,
• D. A. Belkoski, “stop the supply chain insanity : retail as a model for hospitals,” Healthcare Financ. Manag.,
• K. Kawamoto et al., “Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes,” J. Am. Med. Informatics Assoc.,
• R. S. Kaplan, et al., “How to Solve the Cost Crisis in Health Care: Interaction.,” Harv. Bus. Rev.,
• B. L. Hall, D. A. Campbell, L. R. S. Phillips, and B. H. Hamilton, “Evaluating individual surgeons based on total hospital costs: Evidence for variation in both total costs and volatility of costs,” J. Am. Coll. Surg.,
• J. W. Allen and H. C. Polk, “A study of added costs of laparoscopic cholecystectomy based on surgery preference cards,” Am. Surg.
• T. Chu, R, et al., “The impact of surgeon choice on the cost of performing laparoscopic appendectomy,” Surg. Endosc. Other Interv. Tech.
• K. W. Park and C. Dickerson, “Can efficient supply management in the operating room save millions?,” Curr. Opin. Anaesthesiol
• D. G. Brauer et al., “Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: Implications for standardization and improved resource utilization,” Hpb
03/02Clinical Documentation

Marrying Practice and Quality
Matthew Oberhardt, PhD
Program Director, Research Science
NewYork-Presbyterian Hospital

Gregory Sugalski, MD
Vice Chair, Quality and Patient Safety
Hackensack University Medical Center
03/09Finance in Healthcare (Insurance Perspective)

Finance in Healthcare
Danny Dvinov
Director of Product Management
City Block Health

Claudia Rosen, MBA
VP, Financial Planning
• Atul Gawande, Finding Medicine’s Hotspots
• Steven Brill, Bitter Pill - Why Medical Bills Are Killing Us
• Steven Brill, What I learned from my 190,000 Surgery
03/23Patient ExperienceRick Evans, MA
Chief Experience Officer
NewYork-Presbyterian Hospital
• Hawkings, Patient Perceived Quality Using Twitter
• Kemp, Qualitative complaints and their relation to overall hospital rating using an H-CAHPS-derived instrument.
• Davidson et al, Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review
• Poole. Patient Experience Data and Bias – What Ratings Don’t Tell Us

Clinical Variability
Rimma Perotte, PhD
Director, Biomedical Informatics
Hackensack University Medical Center

Gregory Hruby, PhD
Program Director, Research Science
NewYork-Presbyterian Hospital
04/06Healthcare-Associated Infections

Measuring the Quality of Information Technology
Yoko Furuya, MD, MS
Director, Infection Control and
NewYork-Presbyterian Hospital

Sarah Rosetti, RN, PhD, FACMI,
Assistant Professor, Biomedical
Informatics and Nursing
Columbia University Medical Center
• Brilli, Preventable Harm Index
• Scott, The Direct Medical Costs ofHealthcare-Associated Infections in US Hospitals and theBenefits of Prevention. CDC 2009.
• Liu et al., Impact of State Reporting Laws on Central Line– Associated Bloodstream InfectionRates in U.S.
Adult Intensive Care Units, HSR 2017.
• Saint et al, Impact of State Reporting Laws on Central Line–Associated Bloodstream Infection Rates in U.S. Adult Intensive Care Units. NEJM 2016.
• Brilli, A Comprehensive Patient Safety Program Can Significantly Reduce Preventable Harm, Associated Costs, and Hospital Mortality
• Gawande, The Checklist, New Yorker . 2007.
• Saint et al. Implementing a National Program to Reduce Catheter . Associated Urinary Tract Infection: A Quality Improvement Collaboration of State Hospital Associations, Academic Medical Centers, Professional Societies, and Governmental Agencies. ICHE 2013. Provonost et al. An Intervention to Decrease Catheter- Related Bloodstream Infections in the ICU. NEJM 2006.
04/13Quality Metric Reporting

Healthcare Delivery Science
Deb Hollenberg, RN, MSN
Director, Analytics
NewYork-Presbyterian Hospital

Joseph Underwood, MD, MCHDS
Chair of Emergency Medicine
Hackensack University Medical Center
• Casalino et al, US Physician Practices Spend More Than $15.4 Billion Annually to . Report Quality . Measures
• Chassin et al, Using Measurement to Promote Quality
04/20Quality as Misuse, Overuse, and Underuse

Hojjat Salmasian, MD, PhD
Medical Director for Data Science and
Brigham and Women’s Hospital

Rimma Perotte, PhD
Director, Biomedical Informatics
Hackensack University Medical Center
04/27Culture of Safety

Value in Healthcare
Jason Adelman, MD, MS
Chief Patient Safety Officer
NewYork-Presbyterian Hospital

Jorge Luna, MA, MPhil
Lead Data Scientist
• Porter, What is Value in Healthcare?
• Bates et al, Big Data in Health Care: Using Analytics to Identify and Manage High-Risk and High-Cost Patients
• Huang et al, On mining clinical pathway patterns from medical behaviors
• Diehr, Methods for . Analyzing Health Care . Utilization and Costs
• Kawamoto et al, Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care . costs and outcomes
• Lee et al, Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality
• Normand et al. Statistical methods for profiling
05/04Future of Quality in Healthcare

David Vawdrey, PhD
Chief Data and Informatics Officer

Rimma Perotte, PhD
Director, Biomedical Informatics
Hackensack University Medical Center
• Doyle et al, Evaluating Measures of Healthcare Quality
• Chandra et al, Healthcare Exceptionalism? Performance and Allocation in the U.S. Healthcare Sector
• Meddings, Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives
• Berwick, Era 3 for Healthcare and Medicine
• Mullan, A Founder of Quality Assessment Encounters A Troubled System Firsthand

Academic Integrity: Columbia’s intellectual community relies on academic integrity and responsibility as the cornerstone of its work. Graduate students are expected to exhibit the highest level of personal and academic honesty as they engage in scholarly discourse and research. In practical terms, you must be responsible for the full and accurate attribution of the ideas of others in all of your research papers and projects; you must be honest when taking your examinations; you must always submit your own work and not that of another student, scholar, or internet source. Graduate students are responsible for knowing and correctly utilizing referencing and bibliographical guidelines. When in doubt, consult your professor. Citation and plagiarism-prevention resources can be found at the GSAS page on Academic Integrity and Responsible Conduct of Research ( Failure to observe these rules of conduct will have serious academic consequences, up to and including dismissal from the university. If a faculty member suspects a breach of academic honesty, appropriate investigative and disciplinary action will be taken following Dean’s Discipline procedures ( Copying or paraphrasing someone’s work (code included), or permitting your own work to be copied or paraphrased, even if only in part, is not allowed, and will result in an automatic grade of 0 for the entire assignment or exam in which the copying or paraphrasing was done. Your grade should reflect your own work. If you believe you are going to have trouble completing an assignment, please talk to the instructor or TA in advance of the due date.