Two UM BWMC Population Health Initiatives Honored for Innovation by Maryland Patient Safety Center

Circle of Honor awards recognize groundbreaking efforts to reduce sepsis readmissions and improve care transitions 

GLEN BURNIE, Md. (May 5, 2025) — Two population health initiatives at the University of Maryland Baltimore Washington Medical Center (UM BWMC) were recognized by the Maryland Patient Safety Center with Circle of Honor awards at the 2025 Minogue Award Ceremony.  

A member organization of the University of Maryland Medical System (UMMS), UM BWMC was one of only eight hospitals recognized for its commitment to high quality care at the annual awards program, a highly competitive initiative that drew more than 50 project submissions from health care organizations and hospitals across Maryland.  

“We are deeply committed to caring for our community—not only within our hospital walls, but also by building strong partnerships that expand access to care,” said Kathy McCollum, President and CEO of UM BWMC. “We are honored that two of our population-health initiatives have been recognized by the Maryland Patient Safety Center. This recognition reflects our mission and our continued dedication to meeting the healthcare needs of our community.” 

UM BWMC’s recognized programs feature innovative health care strategies that have significantly improved outcomes for patients recovering from sepsis in post-acute care settings and strengthened care transitions through UM BWMC’s community-focused initiative, From the Hospital to Home and Beyond - both working to reduce healthcare costs and lengths of stay. 

“As clinicians, we only interact with patients for a small part of their care journey,” said Jason Heavner, MD, Senior Vice President and Chief Medical Officer at UM BWMC. “Yet self-care and wellness - often offered outside of the hospital - greatly impact overall health. By making resources more accessible and affordable, and recognizing the unique needs of everyone, we can tailor care to fit their lifestyle rather than forcing them into a one-size-fits-all plan. We’re grateful to the Maryland Patient Safety Center for recognizing the importance of a preventive, population-health approach to care in improving health outcomes for the communities we serve.” 

The first award recognized the collaborative project between Adfinitas Health, Complete Care Severna Park, and UM BWMC: Reducing 30-Day Hospital Readmission Rates for Patients Recovering from Sepsis with the Sepsis-Recovery Pathway Collaborative Program in a Post-Acute Facility, which developed an evidence-based protocol aimed at reducing hospital readmissions for sepsis-recovering patients discharged to skilled nursing facilities (SNFs). 

Sepsis is one of the top 10 most preventable complications and a leading cause of readmissions in Maryland, according to the Maryland Patient Safety Center and Maryland Hospital Association. 

Traditionally, SNFs have lacked standardized, proactive protocols to support sepsis recovery, leading to reactive care and avoidable hospitalizations. This collaboration filled that gap with a structured, evidence-based clinical pathway designed specifically for the SNF environment. 

“This is truly a partnership for post-acute patients,” said Jennifer Bistrack, MPH, MS, RN, population health nurse and post-acute care program manager at UM BWMC. “In today’s regulatory environment, having collaboration at this level is monumental.” 

The pilot program, launched by Adfinitas partners at Complete Care Severna Park, monitored 34 newly admitted sepsis-recovering patients over 10 months. Only seven patients (20.6%) were readmitted, compared to a baseline rate of 29.2%, with early signs of decline detected in another seven patients, allowing interventions that prevented hospital transfers. 

“This initiative not only improves patient outcomes but also reduces healthcare utilization and costs,” Bistrack added. “It’s a model for how hospitals and post-acute partners can work together to deliver safer, more effective care.” 

During the awards ceremony, Stephanie Peditto, MHS President and CEO with the Maryland Patient Safety Center, emphasized the groundbreaking nature of the recognition, stating, “The UM BWMC-Afinitas-Complete Care award represents the first time a patient safety award has gone to a cross-organizational partnership.” 

Due to its success, the Sepsis-Recovery Pathway is being adopted as a standard protocol by a growing number of SNFs covered by Adfinitas in Maryland and Delaware. 

The second UM BWMC population health honored initiative, BW CARES: From the Hospital to Home and Beyond is a comprehensive program that addresses social barriers of health during and after a patient’s hospital stay. “There has always been a question by community members of where can I go for help,” said Cheryl Ruff, senior director of practice operations for primary care, pediatrics and population health at UM BWMC “Our program is designed to help break down barriers and increase access to care and services to better address the needs of the community.” 

Recognizing that true healing often continues beyond hospital walls, the UM BWMC population health team meets patients where they are - at the bedside, in clinics, and even in their homes - to deliver tailored, whole-person support. A critical innovation within the program is the travel team, a multidisciplinary group that includes a registered nurse, social worker, community health workers, pharmacist and referral coordinator. Together, they conduct in-person home visits for high-risk patients to address real-life challenges such as transportation access, food security, medication management, and housing safety. 

By addressing both clinical and non-clinical needs, they work together to prevent avoidable hospital readmissions and support long-term recovery. 

Early outcomes of the program have shown promising reductions in emergency department visits, hospital charges, and readmission rates - emphasizing the value of integrating social support into clinical care. 

The honored UM BWMC teams presented their projects at the 21st Annual Maryland Patient Safety Conference, themed “A New Era in Patient Safety,” recently at the Hilton Baltimore Inner Harbor. 

To learn more about UM BWMC’s outreach efforts, visit umbwmc.org. 

About the University of Maryland Baltimore Washington Medical Center

The University of Maryland Baltimore Washington Medical Center (UM BWMC) is a 307-bed medical center committed to improving the health outcomes of the communities it serves. A member organization of the University of Maryland Medical System (UMMS), UM BWMC is located in Glen Burnie (Anne Arundel County) and has more than 3,100 team members and 1,000 medical providers on staff. The medical group provides primary and specialty care services to individuals throughout the region. Together with community providers and faculty from the University of Maryland School of Medicine, UM BWMC offers a wide range of clinical programs including cancer, critical care, emergency, heart, lung, neurosciences, orthopedics, pediatric, primary care, vascular, and women’s health. For more information, visit umbwmc.org.

About the University of Maryland Medical System

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high-quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine and University of Maryland, Baltimore who educate the state’s future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. As one of the largest private employers in the state, the health system's more than 29,000 employees and 4,600 affiliated providers offer primary and specialty care at 11 hospitals, 5 standalone emergency rooms and more than 150 locations and through a network of UM Urgent Care locations. For more information, visit umms.org.