Quality of Care Report for Montgomery County Hospitals 2005
of
Care
Prepared by the
Greater Dayton Area Hospital Association (GDAHA) In partnership with
Ohio Hospital Association and
Applied Health Services May 2007
GDAHA member hospitals are working together to save lives. We are proud to present the inaugural Quality of Care Report for Montgomery County Hospitals. Although this report focuses on recent data, it provides an overview of years of work by hospitals in Montgomery County that serve adults. The purpose has been to improve patient care and patient outcomes in Greater Dayton Area Hospital Association (GDAHA) member hospitals. Through GDAHA, the Quality Council was formed to facilitate the timely dissemination of information about the quality of hospital services; provide a forum for review and discussion of hospital performance; develop priorities, benchmarks and timelines for improvement; and standardize processes of care. By standardizing care based on best practices and evidence-based medicine, patient care in the Miami Valley region is improved and lives are saved. This collaboration has gained the Miami Valley region national recognition in healthcare. As a winner of the prestigious 2002 Ernest A. Codman Award, the project has served as a model for the state. The Cincinnati, Columbus, and Cleveland regions now have similar groups addressing quality of care in the same manner. We should all be proud of the Quality Council, the collaboration that has taken place, the success on behalf of patients in the Miami Valley region, and the promising future in healthcare.
Greater Dayton Area Hospital Association
Quality of
Care
Quality of Care Report for Montgomery County Hospitals Table Of Contents: Executive Summary........................................................ii Overview of Quality of Care Initiative ........................1 n
Participating Hospitals.....................................2
n
Quality Council...............................................2
n
Steering Committee........................................3
Mortality Rates ..............................................................4 n
Acute Myocardial Infarction (AMI) or Heart Attack.....................................4
n
Chronic Obstructive Pulmonary Disease (COPD) . .........................................................5
n
Congestive Heart Failure.................................5
n
Coronary Artery Bypass Graft (CABG)...........................................................6
n
Gastrointestinal Hemorrhage..........................6
n
Pneumonia.....................................................7
n
Stroke.............................................................7
Length of Stay ............................................................... 8
GDAHA Quality of Care Team:
n
Laminectomy ................................................ 8
n
Major Joint Replacement .............................. 8
Process of Care .............................................................. 9 n
Kelly Brown, Director of Marketing & Communication
Acute Myocardial Infarction (Heart Attack).................................................9
n
Sandy Lehrter, Executive Assistant & Office Manager
Congestive Heart Failure...............................10
n
Pneumonia ................................................. 11
Bryan J. Bucklew, President & CEO
Beth Wolpert, Vice President of Health Initiatives Ohio Hospital Association Team: Mary Drake, M.A.O.M., Manager, Data Initiatives David Engler, Ph.D., Vice President, Data Services and Research & Educational Foundation Richard Snow, D.O., M.P.H., Principal, Applied Health Services Incorporated Virginia Swan, B.S., Data Analyst Rosalie Weakland, M.S.N., Director, Quality Improvement May 2007 The data compiled in this report was prepared by Ohio Hospital Association and Applied Health Services Incorporated.
Glossary.........................................................................11 Greater Dayton Area Hospital Association Team ......................... Back Cover
Executive Summary
ii The Quality Council and performance improvement project was nationally recognized as an Ernest A. Codman award winner by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2002.
n
The groundbreaking collaborative is comprised of competitive healthcare organizations working together to save lives.
n
Montgomery County hospitals demonstrated lower than expected mortality rates in five of seven areas.
n
The mortality rate for chronic obstructive pulmonary disease was almost 45% lower than predicted for Montgomery County for 2004-2005.
n
The mortality rate for congestive heart failure was almost 29% lower than expected for Montgomery County for 2004-2005.
n
The Miami Valley region has documented a dramatic improvement in the care of patients with congestive heart failure during 2005.
n
The Miami Valley region has been progressive in adopting a protocol of care for pneumonia.
n
Montgomery County hospitals demonstrated lower than expected
mortality rates in five of seven
Overview of Quality of Care Initiative 1 The Greater Dayton Area Hospital Association’s Quality Council was formed in August 2001. It is a unique and groundbreaking community collaborative designed to improve the quality of care for patients in the Miami Valley region. The Quality Council involves Montgomery County hospitals serving adults and the Tri-River Employers Healthcare Coalition, a local business coalition. It is comprised of the Greater Dayton Area Hospital Association’s President and Chief Executive Officer, the Chief Executive Officers of participating hospitals, medical directors from those hospitals, and Board members of the Tri-River Employers Healthcare Coalition. A Steering Committee, comprised of quality management professionals and medical directors from participating hospitals, helps guide the Quality Council. Additionally, local clinical experts examine processes and determine best practices for a variety of medical conditions or procedures. Participating hospitals include Good Samaritan Hospital, Grandview Medical Center, Kettering Medical Center, and Miami Valley Hospital. In 2002, the Dayton Heart Hospital joined the project as well. The hospitals actively engage their respective Boards of Trustees, medical staffs, and medical departments in analyzing and reviewing the data relating to quality care. Quality of care is measured in part through mortality or rate of death, length of stay, and process of care. These data elements are tracked and analyzed for a variety of procedures and conditions. Since the beginning of the project, the group wanted to assure data would be valid, reliable, actionable, risk-adjusted, representative of the patient population (with an appropriate mix of medical and surgical cases), and community-based to include measures of disease at the community level. The goal is to have data usable by a variety of audiences, including internal use by the hospitals.
areas.
The current set of procedures and conditions tracked includes coronary artery bypass graft (CABG), acute myocardial infarction (AMI) or heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), laminectomy, major joint replacement, gastrointestinal hemorrhage, and stroke.
Overview of Quality of Care Initiative (continued)
2 The conditions and procedures are risk-adjusted according to a methodology developed and accepted by the local clinical community. The risk adjustment allows data to be analyzed on a level playing field and assures quality results.
Quality of Care Initiative Participants
In 2002 the project was a winner of the prestigious Ernest A. Codman Award given by the Joint Commission on Accreditation of Healthcare Organizations Dayton Heart Hospital (JCAHO). The Greater Dayton Area Hospital Association (GDAHA), through the Quality Council, was recognized for excellence in the use of outcomes measurement. The model has been replicated across the state. This report demonstrates some of the success of the collaborative. It provides an overview of recent data including mortality rates for 2003 through 2005, length of stay results, and a summary of process of care measures for 2005. Comparisons with other regions of Ohio and with the State are provided. Hospital-specific summaries are included for the process of care regarding heart attack and congestive heart failure. With this report and those to follow, the Quality Council strives to disseminate information about the quality of hospital services in a timely manner, provide a forum for the review of hospital performance, identify opportunities for improvement, develop priorities and benchmarks for improvement, and standardize processes of care that define best medical practices. By analyzing quality measures, hospitals in Montgomery County are working together to improve patient care and save lives. Participating Hospitals
Dayton Heart Hospital
n
n
Good Samaritan Hospital
n
Grandview Medical Center
n
Kettering Medical Center
n
Miami Valley Hospital
Good Samaritan Hospital
Quality Council
Frank J. Perez, Quality Council Chair, President & Chief Executive Officer, Kettering Health Network Mary Boosalis, President & Chief Executive Officer, Miami Valley Hospital Thomas Breitenbach, President & Chief Executive Officer, Premier Health Partners Bryan J. Bucklew, President & Chief Executive Officer, Greater Dayton Area Hospital Association Roy Chew, Ph.D., President, Grandview Medical Center/Southview Hospital Fred Manchur, President, Kettering Medical Center James Pancoast, President & Chief Executive Officer, Good Samaritan Hospital Chad Patrick, President & Chief Executive Officer, Dayton Heart Hospital Gary Collier, M.D., Vice President of Medical Affairs/Chief Medical Officer, Miami Valley Hospital Mary Garman, R.N., M.S., Vice President of Clinical Operations/ Chief Operating Officer, Dayton Heart Hospital Thomas Hardy, D.O., Vice President of Medical Affairs, Grandview Medical Center Daniel Schoulties, M.D., Vice President of Medical Affairs/Chief Medical Officer, Good Samaritan Hospital Greg Wise, M.D., Vice President of Medical Affairs, Kettering Medical Center
3
Grandview Medical Center
Kettering Medical Center
Miami Valley Hospital
Quality Council (con’t.)
Steering Committee (con’t.)
Eileen Allen, Manager, U.S., Canada, & CLA Benefits, NCR Corporation
Mary Garman, Vice President of Clinical Operations/ Chief Operating Officer, Dayton Heart Hospital
Hugh Becker (Emeritus), Vice President of Investor Relations, Robbins & Myers (Retired) James Bell (Emeritus), Mead Corporation (Retired) Robert Clark, Vice President of Administration, Dayton Progress Jackie Harding, Director of Human Resources, Woolpert, Inc. Janet Jones, Director of Human Resources, Sinclair Community College Glenn McLellan, Executive Director, Tri-River Employers Healthcare Coalition Kathleen Molnar, Director of Compensation and Benefits, University of Dayton Sam Shalaby, Regional Director of Healthcare Initiatives, General Motors Amy Wiedeman, Director, Administrative Services Department, Montgomery County Steering Committee
Gary Collier, M.D., Vice President of Medical Affairs/Chief Medical Officer, Miami Valley Hospital Tim Collins, Vice President, Quality Improvement, Premier Health Partners Meribeth Derringer, Director, Clinical Quality, Miami Valley Hospital
Thomas Hardy, D.O., Vice President of Medical Affairs, Grandview Medical Center Dena Helsinger, Director, Center for Outcomes Research & Clinical Effectiveness and Quality Management, Good Samaritan Hospital Jeffrey Hoffman, M.D., Medical Director, Dayton Heart Hospital Stephen House, M.D., Director Clinical Management, Kettering Medical Center Jamie Hunter, Manager of Operational Quality, Miami Valley Hospital Daniel Schoulties, M.D., Vice President of Medical Affairs/Chief Medical Officer, Good Samaritan Hospital Lisa Seitz, Quality Improvement Coordinator, Grandview Medical Center Edward Syron, Director of Quality Improvement, Grandview Medical Center Troy Tyner, D.O., Medical Director of Quality, Grandview Medical Center Greg Wise, M.D., Vice President of Medical Affairs, Kettering Medical Center Liz Wise, Administrative Director of Clinical Quality, Kettering Medical Center
4 Mortality is the rate of death or fatal outcome. The Quality Council uses fatal outcomes as a benchmark for improvement, an indicator of care, and an opportunity for discussion to improve patient care.
Acute Myocardial Infarction (AMI) or Heart Attack Each year about 800,000 persons in the United States experience acute myocardial infarction (AMI) or heart attack, and about 213,000 of them die. At least one half of these persons die within one hour of the onset of symptoms and before reaching a hospital emergency department. Delays in seeking medical care play a significant role in patient outcome. Mortality Rate: 10.0% 9.69
9.0% 8.0% 7.08
6.99
7.86
7.14
6.90
6.66
5.84
5.0%
7.03
5.64
5.91
5.95
Cuyahoga County
6.0%
7.81 6.91
Montgomery County
7.0%
6.07 5.36
4.0%
2003
2004
The predicted risk-adjusted mortality rate for heart attack in Montgomery County for 2004-2005 was 6.99%. The risk-adjusted mortality rate for heart attack in Montgomery County for 2004-2005 was 5.88%.
This was almost 16% (15.88%) lower than predicted.
2005
State of Ohio
Hamilton County
Franklin County
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
Montgomery County
State of Ohio
0%
Hamilton County
1.0%
Franklin County
2.0%
Cuyahoga County
3.0% Montgomery County
Mortality Rates
5.88
5
Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is a term used for a group of respiratory diseases including chronic bronchitis and emphysema. Often caused by smoking tobacco, the condition is characterized by airflow obstruction and gets worse over time. The condition is a leading cause of disability and death in the United States and effects millions of people. Mortality Rate: 2.0% 1.81 1.61
1.5% 1.23
2003
0.93
0.75
2004
State of Ohio
Hamilton County
0.54 Franklin County
Cuyahoga County
0.49 Montgomery County
Hamilton County
Franklin County
Cuyahoga County
Montgomery County
State of Ohio
Hamilton County
Franklin County
0.87
0.76
0.60
0.65 Cuyahoga County
0%
1.03
0.92
Montgomery County
0.5%
0.98
1.12
1.0%
State of Ohio
1.34
1.23
2005
The predicted risk-adjusted mortality rate for for COPD in Montgomery County for 2004-2005 was .98%. The risk-adjusted mortality rate for COPD in Montgomery County for 2004-2005 was 0.54%.
This was almost 45% (44.90%) lower than predicted.
Congestive Heart Failure Congestive heart failure is a common medical condition that afflicts 4.8 million people in the United States. Common causes of heart failure are coronary artery disease, heart attack, and high blood pressure. Another condition that can lead to heart failure is diabetes. Heart failure means the heart is unable to fill or pump a sufficient amount of blood. Mortality Rate: 5.0%
5.02 4.64
4.0%
4.19 3.79
2003
2004
The predicted risk-adjusted mortality rate for congestive heart failure in Montgomery County for 2004-2005 was 3.29%. The risk-adjusted mortality rate for congestive heart failure in Montgomery County for 2004-2005 was 2.35%.
This was almost 29% (28.57%) lower than predicted.
2005
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
2.21 Montgomery County
State of Ohio
Hamilton County
Franklin County
0%
Cuyahoga County
1.0%
Montgomery County
2.0%
2.35
2.30
2.64
State of Ohio
2.49
3.21
2.80
2.80
Hamilton County
3.01
Franklin County
3.09
Cuyahoga County
3.01
Montgomery County
3.0%
3.29 3.43
6
Coronary Artery Bypass Graft (CABG) Coronary artery bypass graft (CABG) is a surgical procedure to improve function of the heart. Veins or arteries from elsewhere in the body are grafted to bypass narrowing arteries. Blood flow is rerouted through the new artery or vein around the diseased sections to increase blood flow. Mortality Rate: 3.0% 2.74
2.5%
2.58 1.79
2.15
1.40
2003
1.53 1.37
1.31
2004
Franklin County
0.79 Cuyahoga County
Montgomery County
State of Ohio
0.90 Hamilton County
Montgomery County
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
0%
Montgomery County
0.5%
1.49 1.34
1.15
Cuyahoga County
1.0%
1.19
1.50
State of Ohio
1.5%
Hamilton County
1.80
Franklin County
2.0%
2005
The predicted risk-adjusted mortality rate for for CABG in Montgomery County for 2004-2005 was 1.79%. The risk-adjusted mortality rate for CABG in Montgomery County for 2004-2005 was as predicted.
Gastrointestinal Hemorrhage Gastrointestinal hemorrhage or gastrointestinal bleeding describes loss of blood in the gastrointestinal tract. With a variety of causes including cancer, ulcers, and hemorrhoids and fissures, it has many symptoms and treatments.
Mortality Rate: 4.0% 3.76 3.36
3.17 2.92
2.52
2.81 2.33
2.26
2.44
2.48 2.02
2003
Montgomery County
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
Montgomery County
State of Ohio
Hamilton County
Franklin County
0%
Cuyahoga County
1.79 1.0%
2.42 2.10
2004
The predicted risk-adjusted mortality rate for gastrointestinal hemorrhage in Montgomery County for 2004-2005 was 2.52%. The risk-adjusted mortality rate for gastrointestinal hemorrhage in Montgomery County for 2004-2005 was as predicted.
Hamilton County
2.0%
2005
State of Ohio
2.49
Franklin County
2.78
Cuyahoga County
3.0%
Montgomery County
Mortality Rates
7
Pneumonia Pneumonia is an infection of the lungs and occurs about 4 million times each year in the United States. It is the sixth most common cause of death in the United States, and the incidence is heavily weighted toward the winter months. Mortality Rate: 9.0% 8.0% 7.0% 6.0%
6.20
5.76
5.65
5.0%
7.85
8.13
7.89 6.28
7.94
6.56 5.87
5.74
5.99
6.23 5.54
6.14
6.08 5.19
4.0%
2003
2004
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
Montgomery County
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
Montgomery County
State of Ohio
Hamilton County
0%
Franklin County
1.0%
Cuyahoga County
2.0%
Montgomery County
3.0%
2005
The predicted risk-adjusted mortality rate for for pneumonia in Montgomery County for 2004-2005 was 7.85%. The risk-adjusted mortality rate for pneumonia in Montgomery County for 2004-2005 was 5.99%
This was almost 24% (23.69%) lower than predicted.
Stroke Stroke occurs when the blood supply to the brain is cut off or greatly decreased. About 750,000 new strokes occur in the United States each year. It is the third most common cause of death, and getting immediate care is critically important.
Mortality Rate:
10.42
9.18 9.04
2004
The predicted risk-adjusted mortality rate for stroke in Montgomery County for 2004-2005 was 9.18%. The risk-adjusted mortality rate for stroke in Montgomery County for 2004-2005 was 7.91%.
This was almost 14% (13.83%) lower than predicted.
7.57
Hamilton County
6.83
Franklin County
Hamilton County
Franklin County
Cuyahoga County
State of Ohio
Hamilton County
Franklin County
2003
7.94
7.21
8.69 7.91
Cuyahoga County
7.89
7.11
Montgomery County
7.25
Montgomery County
9.00
State of Ohio
9.07
2005
State of Ohio
9.89
Cuyahoga County
2.0% 1.0% 0%
11.80
11.06
Montgomery County
12.0% 11.0% 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0%
8 Length of Stay measures the number of days a patient spends in the hospital. A shorter length of stay usually
indicates a better outcome for the patient. Through efficient and effective care a patient is able to return home earlier. Length of stay is used as a measure of care when patient death or mortality is unusual.
Laminectomy Laminectomy is a surgical procedure that relieves pressure on the spinal cord. The pressure can be caused by many factors including age, injuries, or tumors. By reducing pressure, many people are able to resume daily activities. Length of Stay in Days:
3
4.0
2
1
0
3.9
3.5 2.8
2.6
4.2
2.3
3.3
3.3
4.1
3.7
3.9 3.2
3.3
State of Ohio
4
Hamilton County
State of Ohio
5
Hamilton County
3.3
2.6
2003
2004
Franklin County
Cuyahoga County
Montgomery County
Franklin County
Cuyahoga County
Montgomery County
State of Ohio
Hamilton County
Franklin County
Cuyahoga County
Montgomery County
N/A
2005
The predicted risk-adjusted length of stay for laminectomy in Montgomery County for 2004-2005 was 3.3 days. The risk-adjusted length of stay for laminectomy in Montgomery County for 2004-2005 was 3.7 days. This was about 13% (12.69%) higher than predicted.
Major Joint Replacement Major joint replacement is a common and very often successful operation. Artificial surfaces replace painful worn or diseased joints to allow increased mobility.
2
1
0
3.9
3.9
3.9
4.0
4.3 3.8
3.8
3.9
State of Ohio
3.9
4.0
Hamilton County
3
3.8
4.3
State of Ohio
3.9
4.0
Hamilton County
4
Franklin County
State of Ohio
5
Hamilton County
Franklin County
Length of Stay in Days:
3.6
2003
2004
The predicted risk-adjusted length of stay for major joint replacement in Montgomery County for 2004-2005 was 4.0 days. The risk-adjusted length of stay for major joint replacement in Montgomery County for 2004-2005 was 3.8 days.
This was about 3% (3.28%) lower than predicted.
Franklin County
Cuyahoga County
Montgomery County
Cuyahoga County
Montgomery County
Cuyahoga County
N/A Montgomery County
Length of Stay
2005
3.8
Process of Care 9 The following pages address hospital performance measured by clinical guidelines or best practice rules. There are evidence-based clinical guidelines to be followed when patients meet specific criteria. The graphs below show the rate of eligible patients that received all indicated care. The percentage shows the rate that all of the indicators were met if a patient was eligible for that care.
Acute Myocardial Infarction (AMI) or Heart Attack Each year about 800,000 persons in the United States experience acute myocardial infarction (AMI) or heart attack, and about 213,000 of them die. At least one half of these persons die within one hour of the onset of symptoms and before reaching a hospital emergency department. Delays in seeking medical care play a significant role in patient outcome. The process of care indicators below represent the best practice of care once a patient arrives at a hospital or the recommended care for heart attack victims. Research has shown these treatments provide the best results. Indicators:
Aspirin at arrival n Aspirin prescribed at discharge n Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) for patients with left systolic ventricular dysfunction (LSVD) n Smoking cessation advice/counseling n
Beta blocker prescribed at discharge Beta blocker at arrival n Thrombolytic agent received n Percutaneous coronary intervention (PCI) received n n
The graph below displays the community performance and individual hospital performance for the indicators over the four quarters of 2005. It shows how often hospitals provide the recommended care to those patients eligible for at least one indicator. The percentage shows the rate that all of the indicators were met if a patient was eligible for that care. Percentage of Indicators Met in 2005:
Quarter 3
Franklin County
Hamilton County
Miami Valley Hospital
Kettering Medical Center
Grandview Medical Center
90.40
90.04
Quarter 4
Franklin County
80.33
Hamilton County
Kettering Medical Center
Grandview Medical Center
Good Samaritan Hospital
86.49 82.95 86.52 87.88 84.40
Dayton Heart Hospital
89.98
GDAHA
Hamilton County
Miami Valley Hospital
81.59
Franklin County
93.22 82.17
Kettering Medical Center
Grandview Medical Center
Good Samaritan Hospital
92.68 89.47 88.91 89.39
Quarter 2
Miami Valley Hospital
Quarter 1
Good Samaritan Hospital
90.28 90.23 88.55 86.22 87.06 83.33 81.82 79.93
Dayton Heart Hospital
Franklin County
Hamilton County
78.10
GDAHA
89.86
89.55
Miami Valley Hospital
84.43
Kettering Medical Center
Grandview Medical Center
Good Samaritan Hospital
Dayton Heart Hospital
GDAHA
79.41 76.74
Dayton Heart Hospital
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
94.19 85.83
GDAHA
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
10
Congestive Heart Failure Congestive heart failure is a common medical condition that afflicts 4.8 million people in the United States. The most common causes of heart failure are coronary artery disease, heart attack, and high blood pressure. Another condition that can lead to heart failure is diabetes. Heart failure means the heart is unable to fill or pump a sufficient amount of blood. The indicators below represent the processes of care that are most closely associated with care that should occur once the patient arrives at the hospital. Indicators:
Discharge instructions n Left ventricular systolic function assessment n ACEI and ARBs for certain patients at discharge
Smoking cessation advice/counseling Coumadin® at discharge n Beta blocker prescribed at discharge
n
n n
The graph below displays the community performance and individual hospital performance for the indicators over the four quarters of 2005. It shows how often hospitals provide the recommended care to those patients eligible for at least one indicator. The percentage shows the rate that all of the indicators were met if a patient was eligible for that care. Percentage of Indicators Met in 2005:
Franklin County
Hamilton County
Miami Valley Hospital
Kettering Medical Center
Good Samaritan Hospital
72.63
91.22
85.44
78.10 65.40
Quarter 4
Franklin County
Dayton Heart Hospital
GDAHA
Franklin County
Hamilton County
Miami Valley Hospital
Kettering Medical Center
Grandview Medical Center
Good Samaritan Hospital
64.26
87.06
Hamilton County
81.02 79.49
Miami Valley Hospital
81.37
76.47
Quarter 3
53.76
Kettering Medical Center
75.59
82.80 83.57
Grandview Medical Center
79.62 80.77
55.43
Quarter 2
Good Samaritan Hospital
Quarter 1
79.82 69.61
Grandview Medical Center
63.23
Dayton Heart Hospital
Miami Valley Hospital
Kettering Medical Center
Grandview Medical Center
Good Samaritan Hospital
Dayton Heart Hospital
39.45
82.39
76.67
53.24
GDAHA
61.64
69.85
Franklin County
63.83
78.08
Hamilton County
66.53
Dayton Heart Hospital
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
82.42
82.93
GDAHA
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
GDAHA
Process of Care
11
Pneumonia Pneumonia is an infection of the lungs and occurs about 4 million times each year in the United States. It is the sixth most common cause of death in the United States, and the incidence is heavily weighted toward the winter months. Management of pneumonia has remained controversial; however, the indicators below have been adopted in the Miami Valley region. Indicators:
Oxygenation assessment
n
Pneumococcal vaccination
n
Blood cultures performed within recommended guidelines
n
n n n
First dose of antibiotic following hospital arrival Initial antibiotic selection pneumonia patients Influenza vaccination
Adult smoking cessation advice/counseling
n
This is the most recent protocol to be adopted, and a four-quarter summary is not yet available. The protocol was implemented in December 2005 with a goal of 82% in two years. The national percentage is 50%.
Glossary of Terms ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme: group of medicines that are used primarily in
treatment of hypertension and congestive heart failure
ARBs (angiotensin receptor blockers): group of medicines
LVEF (left ventricular ejection fraction): fraction of blood
pumped out of the left ventricle with each heartbeat
LVSD (left ventricular systolic dysfunction): abnormal
used in hypertension (high blood pressure), diabetic nephropathy (kidney damage due to diabetes) and congestive heart failure
performance of the left ventricle or the muscular chamber of the heart, often occurs in the period following a heart attack and greatly increases patients’ risk for recurrent heart attacks, heart failure or other deadly events
Arrhythmia: irregular heart beat, faster or slower than normal
Mortality: rate of death
Atherosclerosis: “hardening” of the arteries, caused by the
Percutaneous Coronary Interventions (PCI): procedures
formation of multiple plaques within the arteries
Beta Blockers (sometimes written as ß-blockers): class
of drugs used for various indications, but particularly for the management of hypertension and cardiac arrhythmias
done for diagnosis or therapy which reach the heart through major blood vessels instead of having to open the chest Proton Pump Inhibitors (or “PPI”s): group of drugs whose
Cerebral Perfusion: net supply of blood flow to the brain
main action is pronounced and long lasting reduction of gastric acid production
Chronic: long-lasting and recurrent or characterized by
Spinal stenosis: medical condition where the spinal canal
long suffering
Graft: a surgical procedure to transplant tissue without
a blood supply
Laminectomy: surgical removal of part of a vertebra (back
bone), usually done to relieve pressure on a spinal nerve caused by a herniated disk or bony spur Left Ventricular Function Assessement: assessment of
how well the left ventricle is working
narrows and compresses the spinal cord and nerves, usually due to the natural process of spinal degeneration that occurs with aging Thrombolysis: breakdown of blood clots by pharmacological
means, sometimes referred to as clot busting
Thrombolytic: agent that facilitates the breakdown of
blood clots
GDAHA Leadership Team
GDAHA Staff
Board of Trustees
Bryan J. Bucklew
Thomas J. Boecker GDAHA Chair
Patricia Allbritton Jan Austin Bryan Beer Pat Bernitt
President & CEO Wilson Memorial Hospital www.wilsonhospital.com Mary Boosalis GDAHA Treasurer
Sandy Lehrter
President & CEO Miami Valley Hospital www.mvh.org
Jill Neitzel
Thomas Breitenbach
Lisa Rindler
President & CEO Premier Health Partners www.premierhealthpartners.com
Kelly Brown
Barrie Suhr Beth Wolpert
Roy Chew, Ph.D. GDAHA Vice-Chair
President Grandview Medical Center/ Southview Hospital www.kmcnetwork.org Susan Davis
CEO Kindred Hospital – Dayton www.khdayton.com Wayne Deschambeau
President & CEO Wayne Hospital www.waynehospital.com George Miller, Jr.
President & CEO Community Mercy Health Partners www.ehealthconnection.com/regions/ springfield Jim Ignelzi
CEO Twin Valley Behavioral Healthcare www.mh.state.oh.us David Kinsaul GDAHA Secretary
Brent Martin
CEO LifeCare Hospitals of Dayton www.lifecare-hospitals.com Doug McNeill
President & CEO Middletown Regional Health System www.middletownhospital.org David J. Meckstroth GDAHA Past-Chair
President & CEO Upper Valley Medical Center www.uvmc.com Col. Andrew R. Manteiro
Commander Wright-Patterson Medical Center/SGA wpmc1.wpafb.af.mil James R. Pancoast
President & CEO Good Samaritan Hospital www.goodsamdayton.org Chad Patrick
CEO Dayton Heart Hospital www.daytonhearthospital.com Frank J. Perez
President & CEO Kettering Health Network www.kmcnetwork.org Guy Richardson
Director Dayton Veteran’s Affairs Medical Center www.dayton.va.gov Michael R. Stephens
President & CEO Greene Memorial Hospital www.greenehealth.org
President & CEO The Children’s Medical Center of Dayton www.childrensdayton.org Fred Manchur 2 Riverplace Suite 400 Dayton, OH 45405-4936 Phone: 937.228.1000 Fax: 937.228.1035 www.gdaha.org
President Kettering Medical Center www.kmcnetwork.org ® 2007, Greater Dayton Area Hospital Association. All rights reserved. Printed in USA. 5/07 7.5K
