Clinical Performance Clinical Performance

Clinical Performance

Clinical Performance

Mount Sinai PPS is actively working with partners to implement clinical initiatives to achieve key performance measures in our three clinical focus areas. These include: (1) Chronic Disease Management; (2) Access, Prevention, and Health promotion; and (3) Care Transitions, Coordination and Management.

MSPPS developed the following five clinical strategies to help guide these implementation activities. 

  1. Identifying, monitoring, and managing patients with diabetes, hypertension, cardiovascular disease, schizophrenia, bi-polar disorder, or are using an antipsychotic;
  2. Conducting treatment and referral/follow-up for patients who screen positive for acute depression episodes;
  3. Managing medication for patients who require depression treatment;
  4. Improving adult access to care; and
  5. Improving tobacco cessation programs for patients/clients who smoke.

Some clinical strategies fit across multiple clinical focus areas. We are working closely with partners to develop performance dashboards to track progress on performance measures across the board.

Read below for how each clinical strategy fits into each of the three clinical focus areas. Click on the blue buttons to read about our partners' implementation efforts. 

01

01 Chronic Disease Management

Chronic Disease Management

This clinical focus area aims to effectively improve and establish chronic disease management including depression, diabetes, cardiovascular disease, schizophrenia, and high blood pressure.

  • Establish/improve processes for identification, monitoring, and management for patients with diabetes/cardiovascular disease, hypertension, diabetes/cardiovascular disease with schizophrenia
  • Establish/improve the implementation of a treatment plan and referral/follow-up process for patients who screen positive for acute depression episodes
  • Establish/improve the implementation of a medication management plan for patients who require ongoing depression treatment

 

02

02 Access, Prevention, Health Promotion

Access, Prevention, Health Promotion

This clinical focus area aims to increase access to preventive care and health promotion.

  • Establish/improve a program that increases adult access to care
  • Establish/improve tobacco cessation programs for patients/clients who smoke

 

03

03 Care Transition, Coordination and Management

Care Transition, Coordination and Management

This clinical focus area aims to develop an integrated delivery system, develop transition services after hospitalization, and reduce hospital readmissions.

  • Establish/improve the implementation of a treatment plan and referral/follow-up process for patients who screen positive for acute depression episodes
  • Establish/improve the implementation of a medication management plan for patients who require ongoing depression treatment

 

 

For a list of the corresponding DSRIP measures that fall under each clinical  strategy, please click here to download the PDF overview. 

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