The “Best Hospitals” ratings by U.S. News & World Report note the excellence of Christiana Care Health System, ranking it No. 1 in Delaware and No. 3 in the greater Philadelphia region, which is home to more than 90 hospitals.
The magazine’s 28th annual analysis of American hospitals also named Christiana Care as among the top 50 hospitals nationwide in three specialties: Nephrology, Diabetes & Endocrinology, and Gastroenterology & Gastrointestinal Surgery.
And among the nation’s estimated 5,000 hospitals, U.S. News rated Christiana Care as a high-performing hospital in four specialties: Geriatrics, Neurology & Neurosurgery, Orthopaedics, and Pulmonology.
Christiana Care also was one of only 48 hospitals – barely 1 percent of the more than 4,500 hospitals evaluated – that earned a top rating for their handling of nine surgical procedures and chronic conditions: aortic valve surgery, abdominal aortic aneurysm repair, heart bypass surgery, heart failure procedures, colon cancer surgery, hip replacement, knee replacement, lung cancer surgery and interventions to assist with chronic obstructive pulmonary disease (COPD).
“Our consistent Best Hospitals rating in U.S. News & World Report is a testament to the commitment of our extraordinary clinicians and staff to providing compassionate, high-quality care across our health system in The Christiana Care Way,” said Janice E. Nevin, M.D., MPH, Christiana Care president and CEO. “We are pleased to be recognized again for our efforts to help our patients and our communities achieve optimal health with the best in innovative and value-driven care.”
Christiana Care’s recent success has been bolstered by the creation of a service line structure within the organization, said LeRoi S. Hicks, M.D., MPH, FACP, the Hugh R. Sharp Jr. Chair of Medicine and physician leader of Christiana Care’s Acute Medicine Service Line. This new approach has brought together interdisciplinary teams who have collaborated effectively to develop clinical pathways that are improving patient outcomes.
“Organizationally we have redefined how we are delivering care with a goal to break down traditionally siloed areas,” said Dr. Hicks. “The very first demonstration of our effectiveness was to get leaders consistently working across departments to focus on the same targeted areas of improvement. These efforts are already showing positive results.”
The Acute Medicine Service Line, for example, has worked with other service lines to establish a lower GI bleed clinical pathway to optimize care delivery, as well as pathway for COPD with the Primary Care & Community Medicine Service Line that is reducing the rate of hospital readmissions for these patients.
Outstanding diabetes care
For decades, Christiana Care has embraced a team approach in Diabetes & Endocrinology, an area ranked 34th in the Best Hospitals ranking. A person with diabetes may routinely see a nurse practitioner, a dietitian, a certified diabetes educator and a physician.
“This is not a doctor-driven approach but a very collaborative one,” said James Lenhard, M.D., FACE, FACP, the medical director of Christiana Care Health System’s Diabetes & Metabolic Diseases Center, the Diabetes & Metabolic Research Center and Christiana Care’s Weight Management Center.
Even before the creation of the current service line structure at Christiana Care, which has helped clarify clinical pathways, the organization made a strong effort to optimize care delivery for diabetes and other conditions. More recently, clinicians within endocrinology have begun working interdepartmentally to improve care delivery around metabolic diseases. Also, because weight management is important in the control of diabetes, considerable attention has been given to counseling patients about their options.
“We work in partnership with bariatric surgeons, and every person gets the same level of care,” said Dr. Lenhard. “In the U.S. News methodology, bariatric surgery is included under endocrinology, so a significant element of our score comes from the strength of the bariatric surgery program.”
Dr. Lenhard says that patients at Christiana Care have also benefited from clinical trials to advance new treatment options. “To have access to cutting-edge technologies and medications even before they are widely available to the public is a benefit to people with diabetes and metabolic diseases,” he said.
He added that, as with other areas of care, “we have been assisted by systemwide improvements. An example would be patient safety and advances in technology, in terms of radiology and imaging, which have been important elements in our success.”
The Primary Care & Community Medicine Service Line, which cares for patients across all Christiana Care outpatient facilities and coordinates with the physician community both inside and outside Christiana Care, is focused on high-risk conditions such as diabetes. Omar A. Khan, M.D., MHS, FAAFP is the service line leader for Primary Care & Community Medicine and medical director for Community Health & the Eugene du Pont Preventive Medicine & Rehabilitation Institute.
“This recognition demonstrates the teamwork my colleagues display in support of our values — excellence and love — in serving our community,” said Dr. Khan, who also practices as part of the Department of Family & Community Medicine. “This work is partnered across all parts of our service line, especially in Primary Care, where we identify, diagnose and treat diabetes using point-of-care testing in the office and expert endocrinology support using our linked electronic medical record. Together, we as a service line serve the needs of patients with diabetes and indeed all conditions.”
A multidisciplinary approach to nephrology
Christiana Care’s nephrology care ranked 36th in the U.S. overall, and that is a tribute to a multidisciplinary approach that helps patients and clinicians be successful in managing a complex disease system, said Arun V. Malhotra, M.D., medical director of the hemodialysis unit at Wilmington Hospital.
In relation to the kidneys, patients often take several medications, and there may be a host of issues to address, such as anemia, high blood pressure and electrolyte abnormality.
“With end-stage kidney failure, patients don’t feel well and many times feel like skipping treatments,” said Dr. Malhotra. “So we have resources set up by Christiana Care to assist patients, and those have been key to making sure patients receive treatments they need without having to be hospitalized.”
For example, CareVio, Christiana Care’s technology-enhanced care management system managing 104,000 patients in Delaware and the surrounding area, identifies patients at a high risk of an adverse event so a clinical team can reach out to address issues before they become more serious medical problems.
“Technology is a big driver of our improvements in care, and our nephrologists are developing algorithms to manage different disease states and pathways,” he said.
Culture of collaboration and improvement
Christiana Care ranked 37th in the U.S. News rankings for Gastroenterology and GI Surgery. The achievement reflects the strong collaboration among physicians, surgeons and other providers to coordinate care around patients with gastrointestinal illnesses. It also reflects a culture of continuous improvement, as can be seen in the Endoscopy Performance and Value Improvement Team, a multidisciplinary team of providers who meet twice a month for case-based discussions around past procedures.
“We share perspectives on how we can improve future care for patients undergoing similar procedures and how we can improve the clinical experience for our caregivers,” said Nathan A. Merriman, M.D, MSCE, director of Endoscopy who also serves as section co-chief of Gastroenterology along with Jared Hossack, M.D., MBA.
A similar culture of collaboration and improvement in the Surgical Services team has produced notable successes. For example, to lower infection rates after colon surgery, clinicians developed best-practice protocols that have led to a significant drop in infections. To reduce the need for lengthy hospitalizations after surgery, Christiana Care surgeons now screen high-risk patients to see if lifestyle variables such as smoking, high glucose levels or excess weight can be improved upon prior to an operation.
“In many cases people can change aspects of their lives to reduce the likelihood of post-operative complications, which will improve their overall experience and lower costs,” said said Gerard Fulda, M.D. FACS, the chair of the Department of Surgery and physician leader for the Surgical Services Line. He believes a clear message about what patients can expect and what they can do to improve their outcomes is also driving success within the service line.
Dr. Merriman said there is a growing ethos within Christiana Care “fostering an environment that is patient-centric, provider-sensitive and system aware. This is an approach that inherently makes our health system better.”