Mortality rates dip 33% after NYU Langone Hospital-Brooklyn merger

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In-hospital mortality rates dropped by 33% at a hospital serving one of the highest Medicaid populations in the country after its 2016 merger with NYU Langone Health, according to new research published in JAMA Network Open.

In-hospital mortality at NYU Langone Hospital-Brooklyn – formerly Lutheran Medical Center, in the southeast Brooklyn community of Sunset Park – declined from an average of 2.6% in the pre-merger period to 1.9% post-merger. 

The study also showed a 39% improvement on central line infections per 1,000 catheter days; a 33% improvement in catheter-associated urinary tract infections per 1,000 discharges; and a higher likelihood of patients recommending the hospital or giving it a top-tier ranking compared to figures before the merger.

WHAT'S THE IMPACT?

The current results stand in contrast to recent studies that found most mergers do not improve quality or safety – even when they involve high-quality acquirers. In these studies, overall mortality and readmission rates did not improve, and patient experiences worsened. And many mergers demonstrated a lack of integration in management, culture and data systems.

Yet researchers concluded that this was not the case with the NYU Langone experience. By honing in on quality improvements, the merger led to a significant shift in quality and safety metrics – a shift the hospital attributes to a comprehensive strategy and meaningful operational integration, rather than a focus strictly on financial outcomes.

Following the acquisition, leadership at NYU Langone Hospital-Brooklyn focused on five areas to achieve strategic integration: clinical leadership integration; information technology transition; local ownership and accountability of quality outcomes; system-level goals with real-time, actionable analytics through combined dashboards; and value-based, analytics-driven interventions.

Clinical leadership integration involved implementing a leadership governance structure more typical of academic systems, replacing physician leaders who had part-time hospital appointments with full-time, employed physicians and establishing new service lines, including reconstructive breast surgery, spine surgery, robotic surgery, advanced endoscopy and advanced bronchoscopy.

The information technology transition included the launch of a comprehensive electronic health record and cost-accounting system integrated through dashboards with real-time analytics of clinical and operational performance.

Meanwhile, leadership encouraged local ownership and accountability of quality outcomes by instituting quality committees and occurrence review committees to replace committees that involved part-time, voluntary clinical leaders; and setting post-merger meetings with employed, full-time clinical leadership that reviewed a broader number of cases and reinforced accountability.

System-level goals were established using real-time, actionable analytics through combined dashboards. This enabled monitoring mortality rates in near-real time and identifying opportunities for closer leadership review.

Projects were supported by information technology, including EHR-embedded decision support such as guideline-based blood transfusions. Additional projects targeted improvement opportunities such as hospital-acquired conditions.

THE LARGER TREND

Findings published in 2020 in the New England Journal of Medicine suggest that acquired hospitals actually saw a patient experience that was moderately worse, on average. What's more, 30-day mortality and readmission rates stayed largely the same at such facilities.

The only real improvement that was found among the majority of acquired entities was in the realm of clinical process, which improved modestly. But the improvement was so incremental that it couldn't be linked to the actual acquisition, and prices for commercially insured patients tended to be higher.

Patient satisfaction scores at acquired hospitals tended to be worse, on average. Such scores take into account what rating a patient would give a hospital, and how likely they would be to recommend it to someone else.

Acquiring entities that had lower patient satisfaction scores to begin with tended to see the steepest drops post-transaction, suggesting that organizations with already low scores could inspire a similar drop at their acquired facilities.

The findings mirror research published in February 2019 finding that mergers and acquisitions may negatively impact patient satisfaction and the perception of their care.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com