Some of the best hospital care available in the United States is right here in Delaware.
Christiana Care is the greater Philadelphia region’s only hospital to make this year’s Truven Health Analytics list of 100 Top Hospitals in the U.S. and is the only major teaching hospital in the nation to win the Everest Award consecutively in both 2015 and 2016. The Everest Award singles out health systems demonstrating the highest performance and fastest long-term improvement over five years, exceeding benchmarks for quality, safety and efficiency of hospital care.
“Earning these honors — particularly winning the Everest Award for two consecutive years — truly demonstrates the commitment of our extraordinary employees, leadership and volunteers to advancing The Christiana Care Way, our promise to the community we serve to be respectful, expert caring partners in their health,” said Janice E. Nevin, M.D., MPH, Christiana Care president and CEO.
The consistent, rapid gains in quality and safety recognized by a second consecutive Everest Award are the hallmark of a focused health care workforce that understands what patients and the community value.
“Everest is external validation that we continue to do the right work that allows us to provide excellent care for our patients,” said Kenneth Silverstein, M.D., MBA, chief clinical officer. “Our extraordinary people who care for our patients on a day-to-day basis, and those whose support makes high-quality care possible, are the strength behind this award. Being recognized for consistent excellence by such a reliable, independent, trusted marker as the Everest Award suggests we’re building the right system to be able to consistently provide the care our patients deserve.”
Focused on success
Key measurements of performance in health care quality and safety are the difference makers that earned Christiana Care’s inclusion as one of only 15 hospitals in the Major Teaching Hospital category in the 100 Top Hospitals list. They include lower-than-benchmark mortality and low 30-day readmission rates in key areas such as acute myocardial infarction (heart attack), heart failure, stroke, pneumonia, chronic obstructive pulmonary disease (COPD), and knee and hip replacement surgery.
Top 100 hospitals also score well on the Agency for Health Research and Quality’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for overall patient satisfaction.
“It’s not surprising to me that we’ve done well in COPD care,” said Virginia U. Collier, M.D., MACP, Hugh R. Sharp Jr. Chair of Medicine and physician leader of Christiana Care’s Acute Medicine service line. COPD has been an area of intense focus at Christiana Care over the past two years, as teams have examined every aspect of COPD care to identify opportunities to make it impactful and consistent for every patient. This includes enhanced support, education and connections to services in the community, based on the best evidence-based standards.
“When Christiana Care applies efforts in a focused way, the results are exceptional. These awards are validation of the focus we have on patient safety and quality throughout the health care system,” she said.
She also credits data-sharing among physicians and system leaders to help them continually assess how well the health system is doing and identify opportunities for improvement.
“We critically evaluate ourselves and drill deeply into the data to identify opportunities and apply our energies to developing solutions,” she said. “We are consistent in our approach to continuous improvement of safety and quality.”
Gerard J. Fulda, M.D., chair of Christiana Care’s Department of Surgery and physician leader of Surgical Services, said diligent work by his team has decreased complications, such as venous thromboembolism (blood clots) and infections following surgery, to levels well below rates of many other major teaching hospitals. Initiatives are also in place for experts to help those at higher risk for complications manage their care before and after surgery.
“Making sure patients are in the best possible shape going into an operation significantly helps to reduce the chance of complications after surgery,” Dr. Fulda said. He said the Everest Award’s validation of continued improvement assures patients and the community that when they come to Christiana Care, they will receive excellent, high-quality care from people who really care about their patients and their outcomes.
“That’s the kind of hospital I would want to have care for me,” he said.
When seconds count
Christiana Care’s stroke readmission and mortality rates, which are better than the national median of peer hospitals, were key metrics placing Christiana Care among this year’s 100 Top Hospitals and Everest award winners. According to Kert Anzilotti, M.D., MBA, chair of the Department of Radiology and physician leader for Neurosciences, “These Truven honors validate that the work we’re doing at Christiana Care is some of the best in the country.”
As one of the busiest stroke centers in the country, Christiana Care is the only hospital in Delaware offering intra-arterial treatment for acute stroke, in which specialists known as neurointerventionalists feed a catheter through an artery from the leg to the brain to mechanically remove an acute thrombosis, or clot, at the height of the stroke. The technique saves lives, preserves brain tissue and reduces complications.
The Christiana Hospital stroke program has been recognized as a Comprehensive Stroke Center, the most advanced level of expertise in stroke care, by national certifying organization The Joint Commission. Christiana Care is the only center to achieve this distinction within the region of Southeastern Pennsylvania, Eastern Maryland, Southern New Jersey and Delaware, outside of centers in urban Philadelphia and Baltimore.
Dr. Anzilotti points to the stroke program as a prime example of how the right people, the right technology and the right processes work together to create truly exemplary health care. That care includes the Lanny Edelsohn, M.D. Neuro Critical Care Unit, an 18- bed specialized intensive-care unit for patients critically ill from severe stroke, and the 24-bed Stroke Treatment and Recovery (STAR) unit, where patients prepare to leave the hospital and resume a healthy life. It also includes the highly accredited Center for Rehabilitation at Wilmington Hospital, where patients regain basic skills such as speech and walking that they lost due to stroke. These and other services and teams at Christiana Care work together to provide innovative, effective, affordable care that patients value.
“Sometimes we overlook what a great health system Christiana Care really is,” he said. “We are extremely lucky to have one of the best hospitals in the entire country right here in our own community.”
Care in the community
The best hospital care extends far beyond the hospital walls. For example, Christiana Care’s outpatient cardiac rehabilitation and secondary prevention program helps patients recovering from a heart attack regain their pre-diagnosis level of physical activity and provides coaching for a healthier lifestyle to prevent disease symptoms from returning.
Christiana Care ranks at the top in volume among leading health care systems, with only 20 hospitals in the U.S. having more admissions. We operate the only Level I trauma center for adults and children between Philadelphia and Baltimore, and our Level III neonatal intensive care unit makes us the only delivering hospital in Delaware offering this specialized care.
|Nationally, Christiana Care ranks:|
|21st in overall admissions.|
|32nd in births.|
|29th in number of surgical procedures.|
|21st in Emergency Department visits.|
“Cardiac rehabilitation is a very effective program that has great impact on improving the quality of life for patients and reducing the need to return to the hospital for disease-related complications,” said Timothy J. Gardner, M.D., medical director of Christiana Care’s Center for Heart & Vascular Health. Similarly, by coordinating care for patients with heart failure who are transitioning from the hospital to skilled nursing care, Christiana Care is helping to maintain very specific, focused treatment, resulting in lower readmission rates.
“This multifaceted approach is really making a difference and sending people home in the best possible condition,” Dr. Gardner said.
Community outreach is another key to Christiana Care’s success. For example, Christiana Care’s Community Health Outreach and Education Program, based in the Helen F. Graham Cancer Center & Research Institute, reaches out to the region’s African-American, Hispanic, Asian and Indian communities — on their terms and in their languages — to help educate people about their cancer risk and screen for detection at the earliest stages, when cancer is most treatable.
Delaware’s cancer mortality rate is dropping twice as fast as the national average, falling from highest to a predicted 17th in just a decade. Christiana Care’s efforts have been recognized as key to Delaware’s successful elimination of the racial disparity in colon cancer between African-Americans and whites — the first state to demonstrate that it’s possible to eliminate a health disparity statewide.
“The bottom line is that the quality of care we’re delivering is very high, and so is the impact we’re having on our community,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute.
The expertise of Christiana Care’s cancer team extends through a breathtaking array of innovative services and advanced research. The Graham Cancer Center includes the only high-risk family cancer registry and adult genetic counseling and gene testing program in the state. It includes the Center for Translational Cancer Research, the Gene Editing Institute and a clinical trial accrual rate that is six times higher than the national average. That means that more cancer patients at Christiana Care are enrolled in clinical trials, which gives them access to the newest, most advanced cancer treatments.
Using data in amazing new ways
The best health care is a partnership between the patient and the care team. A shining example of that partnership is Care Link, a new Christiana Care service that in many ways represents the future of health care. Unlike traditional care-management programs, Care Link integrates staff into primary care practices and is powered by information technology and “big data,” which taps into all available sources of an individual’s clinical data, including lab and radiology results, pharmaceutical use, hospital admissions and discharges, and emergency department notifications. It does so by leveraging the Delaware Health Information Network and Christiana Care’s own electronic health record. Claims data are included in the system to give Care Link a comprehensive clinical and financial view at both individual and population levels.
In addition, the information technology platform mines this data for subtle patterns that can predict patients who may be at high risk, which can then trigger the Care Link team to proactively reach out and help.
By identifying and solving problems that patients might experience after a surgery or an illness before those problems become serious enough to require a trip to the emergency department, Care Link is reducing readmission rates to the hospital. In its first year, Care Link supported more than 2,500 90-day bundled-payment Medicare patients. Fewer than 9 percent needed to be readmitted within 90 days of leaving the hospital, compared to 18 percent during the baseline period before Care Link management.
“Care Link allows us to provide personalized, highly coordinated care,” said Sharon Anderson, MS, BSN, RN, FACHE, chief population health officer and senior vice president, Quality & Patient Safety. “We are able to support our physicians in providing excellent care to their patients by addressing not only their clinical needs but behavioral and social determinants of health. At the same time, Care Link helps people navigate through all of their care needs, including follow-up appointments, tests and links to services in the community. This coordinated effort is helping us to improve health outcomes, to provide better patient experiences and to ensure the best use of resources.”
Transforming Care in the First State
Care Link’s team of nurses, case managers, social workers, pharmacists and physicians provide comprehensive care from pre-surgery through 90 days after hospital discharge as part of the Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement initiative. Care Link also cares for patients throughout Delaware supporting Christiana Care Quality Partners Accountable Care Organization (ACO). Bayhealth Medical Center, Nanticoke Health Services, Westside Family Healthcare and more than 150 primary care physicians also are partners in the ACO. As part of the Medicare Shared Savings Program, the ACO rewards groups that lower health care costs and meet performance standards on 33 measures of quality of care and clinical indicators. Launched in January, physicians in the ACO currently care for about 25,000 patients.
Partnering with those we serve
Partnership with patients, families and the community have propelled Christiana Care toward success. When Christiana Care launched its Patient and Family Advisory Council in 2011, it electrified the organization and created a new way of working that put the voices of real people from the community into the decision-making process at every level of the health system.
From advancing patient experience and systemwide goal-setting, to counsel on unit-based initiatives, service lines and clinical pathways, patient and family advisers help shape and drive the future of Christiana Care.
“In the past five years, we have transformed the way we work by bringing our patient and family advisers into every aspect of our organization,” said Shawn Smith, MBA, vice president, Patient Experience. “This collaborative process helps us design systems, both within our hospitals and throughout the continuum of care, that truly work for the people we serve. It helps us to achieve our goals of optimal health, exceptional experience and organizational vitality.”
Today, Christiana Care’s Patient and Family Advisory Council, made up of more than 180 former patients and family members, provides input and perspective toward the development of new ways to improve care. Advisers have helped Christiana Care in shaping new visitor policies, provided feedback on the design of hospital gowns, and even partnered with nurses and physicians in developing new processes of care.
“When you get to the top of Mt. Everest, you’d think there is nowhere to go, yet our rate of improvement is accelerating,” said Thomas L. Corrigan, MBA, CPA, Christiana Care’s executive vice president of health services operations and chief financial officer. “Everybody has the opportunity to impact our patients. There is a culture here where we’re always looking for opportunities to perform better. The Everest Award is confirmation that we’re doing things right.”
As the national conversation continues to focus on the rising cost of health care, Corrigan says that Christiana Care is ahead of the game, focused on delivering the best value to patients and to the community. He points to successful efforts to eliminate waste, such as Christiana Care’s reduction in unnecessary cardiac telemetry that saved $4.8 million in health care costs and served as a national model for other hospitals to follow. And he points to the responsible stewardship of resources that permeates throughout every department at Christiana Care, where detailed attention to the budgeting process helps to constrain the rise of health care costs. However, he’s quick to note that this culture of efficiency is driven, first and foremost, by what is needed in terms of clinical care.
“When you come to us, you are being cared for by a very high-performing organization as measured by an independent party,” Corrigan said. “Our patients can expect their clinical care to be as good as or better than anywhere else in the country. You’re getting great care here.
“We live here, too. Delaware is a small state, and in many ways that helps us to stay focused on the value we provide to the people we serve. The person we’re caring for in our Emergency Department today is someone we might run into at the grocery store this weekend. We’re part of our community, so we want to make sure that our neighbors have a great experience.”