The New York City Clinical Data Research Network (NYC-CDRN), funded by the Patient-Centered Outcomes Research Institute (PCORI), brings together 22 organizations including seven independent health systems to enable patient-centered clinical research, support a national network, and facilitate learning healthcare systems. The NYC-CDRN includes a robust, collaborative governance and organizational infrastructure, which takes advantage of its participants’ experience, expertise, and history of collaboration. The technical design will employ an information model to document and manage the collection and transformation of clinical data, local institutional staging areas to transform and validate data, a centralized data processing facility to aggregate and share data, and use of common standards and tools. We strive to ensure that our project is patient-centered; nurtures collaboration among all stakeholders; develops scalable solutions facilitating growth and connections; chooses simple, elegant solutions wherever possible; and explores ways to streamline the administrative and regulatory approval process across sites.

Growing concern regarding costs of care and health outcomes in the United States has led to widespread calls to address the issue of health care spending. Today, providers across the country are working both to improve the quality and to reduce the cost of health care. These activities span multiple care delivery settings and include care standardization and redesign, shared decision making, palliative care, care coordination, readmission reduction, patient engagement, predictive modeling, and direct cost reduction. These efforts differ from those undertaken in the past because of the availability of information technology tools to collect and analyze data, and because of the emphasis on cost reduction in conjunction with quality improvement. Although the available literature reflects only a small fraction of the provider activities currently in progress, there is cause for hope for achieving a sustainable, innovative, and value-driven health care system.

Communities of poor, low-income immigrants with limited English proficiency and disproportionate health burdens pose unique challenges to health providers and policy makers. NewYork-Presbyterian Hospital developed the Regional Health Collaborative, a population-based health care model to improve the health of the residents of Washington Heights-Inwood. This area is a predominantly Hispanic community in New York City with high rates of asthma, diabetes, heart disease, and depression. NewYork-Presbyterian created an integrated network of patient-centered medical homes to form a "medical village" linked to other providers and community-based resources. The initiative set out to document the priority health needs of the community, target highprevalence conditions, improve cultural competence among providers, and introduce integrated information systems across care sites. The first six months of the program demonstrated a significant 9.2 percent decline in emergency department visits for ambulatory care-sensitive conditions and a 5.8 percent decrease in hospitalizations that was not statistically significant. This initiative offers a model for other urban academic medical centers to better serve populations facing social and cultural barriers to care.A population-based model of health and health care encompasses the ability to assess the health needs of a specific population; implement and evaluate interventions to improve that population's health; and provide care for individual patients in the context of the population's culture, health status, and health needs.1 NewYork-Presbyterian Hospital, in association with the Columbia University Medical Center, has developed a population-based, collaborative model of regional health planning and care coordination designed to measurably improve health and reduce disparities.This model, called the NewYork-Presbyterian Regional Health Collaborative, aligns services to meet the documented health needs of the local community by incorporating cultural competency, using information systems such as electronic health records and disease registries, and coordinating care across the continuum. The collaborative encompasses the entire neighborhood of Washington Heights-Inwood, in upper Manhattan, to help improve the health of the community by reducing health disparities at both the individual and population levels. The goal is to uniformly enhance and align the health care systems throughout the neighborhood to improve overall access and quality for the entire population.In 2008-recognizing that the residents in its community were experiencing gaps in care and unmet needs in the context of escalating health costs-NewYork-Presbyterian initiated a major review of the health care delivery model. The goal was to create a system of care modeled on the concept of population-based health. The hospital wanted the system to meet identified needs of the community; improve access to care; and coordinate care for each patient, wherever he or she received care.The hospital reviewed the ser...