| 2005 Oregon's Hospital Quality - Comment |
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| Intent and Use of Comments |
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Because the Oregon Hospital Quality Indicators are based on billing data, the results have limitations. There are many factors that determine health care outcomes that may not relate to hospital performance, but would influence the results presented here, for example, stage of illness, age, and other accompanying illnesses of conditions. Billing data does not provide every detail about a patient’s condition when he or she is admitted to the hospital, nor does it capture everything that occurs during the hospital stay.
The data analysis method attempts to adjust for some of these factors, But it is not possible to do so perfectly. For instance, when a patient has a Do Not Resuscitate (DNR) order in place, the hospital must honor that, and the data analysis software cannot differentiate between a death that occurs because a DNR was in place and one that occurs from some other cause.
Comments provided by the hospitals can more fully describe some of the factors involved in their results that may not be apparent otherwise. These comments also allow the hospitals to provide you with information about other quality initiatives with which they are involved as well as to link you to their internal quality websites.
Every hospital was afforded the opportunity to comment on their results, and we encourage you to read them.
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| Aortic Aneurysm (AAA) Repair |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is an abdominal aortic aneurysm repair?
An abdominal aortic aneurysm is an abnormal enlargement of the lower portion of the large artery that carries blood to the legs. This condition usually occurs in older people. Many of these patients have a history of high blood pressure. Because an aneurysm can rupture and cause serious and often fatal internal bleeding, this is a very serious condition. Surgeons can repair the aneurysm to prevent a rupture. Sometimes, however, the doctor will not discover the aneurysm until after it has ruptured. If the aneurysm ruptures, the patient will need emergency surgery.
An abdominal aortic aneurysm repair is a major surgical procedure. The surgeon removes the portion of the artery containing the aneurysm and replaces it with a synthetic tube. The surgery is risky because blood flow to the lower body must stop while the doctor repairs the aneurysm. There is also a chance of complications after surgery because these patients often come to the hospital with extensive blood vessel damage in the legs and other parts of the body.
OHSU expertise with abdominal aortic aneurysm repair
Patients who come to OHSU requiring an abdominal aortic aneurysm repair are often severely ill, have complex medical conditions and need emergency medical care. Patients and referring doctors choose OHSU because of its emergency medical and surgical expertise.
OHSU results
OHSU performed 43 operations in 2005. This number exceeds the 32 operations the state recommends as demonstrating experience with this type of surgery. Although low volumes makes generalizations difficult, OHSU’s 2.6% observed mortality, which has been adjusted for the severity of OHSU’s AAA patients, was significantly below the expected rate of 14.4%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Balloon Angioplasty (PTCA) |
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Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is balloon angioplasty?
Balloon angioplasty is a non-surgical procedure to open a blocked blood vessel. The doctor threads a thin tube (catheter) through a blood vessel into the heart. The catheter has an inflatable balloon at its tip. The balloon expands and opens an artery that has been blocked by the build up of fatty deposits on the walls of the artery. Sometimes the doctor will insert an expandable metal tube (known as a stent) to keep the artery open. Without this procedure, blood cannot flow through a blocked artery. The balloon relieves chest pain and helps prevent future heart attacks. If a patient is having an acute heart attack, cardiologists may have to perform this surgery as an emergency procedure, which is more risky. If the blockage immediately recurs, the patient may have to have a more complicated open-heart surgery to repair the blockage.
OHSU expertise with balloon angioplasty
OHSU’s expertise in cardiac care received an enormous boost at the end of 2005 with the recruitment of Dr. Sanjiv Kaul, one of the nation’s leading experts in the prevention, diagnosis and treatment of heart disease, as the new chairman of the department. Several of Dr. Kaul’s research and clinical care colleagues joined him in moving to OHSU.
OHSU Hospital is the first and only facility in Oregon, and one of only eight on the West Coast, to have received full accreditation as a Chest Pain Center by The Society of Chest Pain Centers (SCPC). The SCPC accredited OHSU in May 2006. The measures used to evaluate OHSU for accreditation focus on rapid diagnosis and treatment of heart attacks. One cause of heart attacks is a blocked artery. Every minute lost in making a diagnosis can mean irreparable damage to heart muscle. The advanced medical knowledge and training of OHSU's doctors, nurses and support personnel together with our state-of-the-art technology give us the tools to determine rapidly whether the pain indicates a heart attack and, when it does, to immediately begin whatever therapy is most appropriate. One of OHSU’s most successful quality improvement initiatives has focused on reducing the amount of time between the chest pain patient’s arrival in the Emergency Department to the time they enter the catheterization lab.
OHSU results
Most Oregon hospitals perform balloon angioplasty as a scheduled or elective surgery. Because other hospitals transfer their more serious cases to OHSU, we are often called upon to perform this procedure on an emergency basis for patients who may have multiple and/or complex medical conditions. In 2005, OHSU performed 131 angioplasties. This number is below the threshold most often used for measuring quality. OHSU’s risk-adjusted mortality rate of 1.7% is lower than the expected 5.5%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Carotid Endarterectomy (CEA) |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is a carotid endarterectomy?
A carotid endarterectomy (CEA) is a surgical procedure to repair a blockage in one of the major arteries that carries blood to the brain. A patient with this type of blockage has a high risk of having a serious stroke. Surgery to repair the blockage helps prevent a stroke. Doctors who are involved in this type of procedure have special training in interventional radiology, vascular surgery or vascular medicine.
OHSU expertise with carotid endarterectomy
OHSU has great expertise in vascular surgery and interventional radiology. Physicians from across Oregon refer patients who have blocked carotid arteries to OHSU to give them the benefit of this expertise.
Many patients may not require an open surgical procedure. At OHSU, specialists are able to perform a less-invasive procedure in which they insert a balloon catheter into the artery to open the blockage. The catheter is similar to the one doctors use to open a heart blockage. Some patients who have particularly difficult blockages, however, may require an open procedure. Both options are available at OHSU.
OHSU results
The measure reported in this Web site refers to patients who require an open surgical procedure. OHSU has had excellent results in both 2004 and 2005. During that two-year period, no patients who required this procedure died during the post-operative period. This is a 0% death rate.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Craniotomy |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is a craniotomy?
A craniotomy is an operation to open the skull so a surgeon can assess and repair damage to the brain. Bleeding, infection, trauma or cancer might be reasons for a surgeon to perform a craniotomy.
OHSU expertise with craniotomies
Patients who come to OHSU requiring a craniotomy are often severely ill, have complex medical conditions or have suffered a severe trauma. Many of these patients need emergency medical care. Patients and referring doctors choose OHSU because of its emergency medical, trauma, neurosurgical and oncology expertise.
OHSU results
OHSU performed 628 craniotomies in 2005. OHSU’s 5.3% risk-adjusted mortality rate is slightly higher than the expected rate of 5.1%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Esophageal Resection |
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Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is an esophageal resection?
An esophageal resection is very specialized surgery to remove a section of the esophagus, the tube that carries food and liquids from the mouth to the stomach.
OHSU expertise with esophageal resection
OHSU surgeons have the necessary skills to achieve outstanding outcomes for patients who
require surgery on their digestive systems. They have specific expertise in esophageal
resections.
OHSU results
In 2005 surgeons at OHSU operated on 31 patients who needed an esophageal resection (nearly double the number performed in 2004). That number represents 40% of all esophageal resections performed in Oregon. That number far exceeds the seven procedures the State recommends as demonstrating experience with this type of surgery. In 2005, none of the patients who had an esophageal resection at OHSU died during the post-operative period. This is a 0% death rate.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| GI Hemorrhage |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is a GI hemorrhage?
Bleeding in the gastrointestinal (digestive) track can occur in any part of the digestive track, including the stomach, esophagus, intestines, colon, etc. The cause could be ulcers, cancer, or a disease or injury to a vein or artery in that area of the body. Treatment may include either surgical or non-surgical procedures.
OHSU expertise with GI hemorrhage
The OHSU Digestive Health Center offers patients an interdisciplinary team approach to the prevention, detection and treatment of digestive disorders. Our teams blend clinical expertise with research advances to achieve the best possible care and outcomes. Our gastric disorders program specializes in gastrointestinal bleeding and other benign and malignant diseases of the stomach.
OHSU results
OHSU treated 141 patients with GI bleeding. OHSU’s risk-adjusted mortality rate of 1.3% is considerably lower than the expected rate of 5.1% and also lower than the state average of 2.5%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Heart Bypass Surgery (CABG) |
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Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is coronary artery bypass graft surgery?
In coronary artery bypass graft surgery, the surgeon removes a section of a patient’s blood vessel from another part of the body and makes a bypass so blood can travel around a blockage in an artery to the heart. The surgery relieves symptoms, such as anginal chest pain, and prevents future heart attacks.
This surgery may be risky because the surgeon must stop the heart while creating the bypass. Risk increases if a patient who needs this type of surgery also has other serious diseases such as high blood pressure, diabetes mellitus and blood vessel blockages in the brain and other parts of the body. If the patient is suffering an acute heart attack, the surgeon must perform this type of surgery as an emergency procedure, which is even riskier.
OHSU expertise with coronary artery bypass graft surgery
Patients and referring providers throughout Oregon recognize OHSU’s expertise in cardiac surgery. Patients who come to OHSU because they are having an acute heart attack or their condition is deteriorating and may soon have a heart attack are often severely ill. Therefore, while most hospitals in Oregon perform this type of surgery on a scheduled or elective basis, OHSU often performs it on an emergency basis.
OHSU results
OHSU performed 61 CABG procedures during 2005 with a risk-adjusted mortality rate below the expected rate (risk-adjusted observed rate 3.2% vs. expected rate of 3.6%). OHSU performs many of these heart surgeries for both pediatric and adult patients.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Heart Attack (AMI) |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is a heart attack?
A heart attack occurs when a blockage develops in one of the arteries that supply blood to the heart. The blockage prevents blood flow and causes damage to the heart. When the damage is severe, the heart has to work harder to pump blood. In severe cases, the heart stops pumping and the patient may die. Skilled medical care immediately after a heart attack can reduce the risk of death. This data only includes patients who have not been transferred from another hospital. In the case of OHSU, this would not include any of the complex patients who were transferred to OHSU because of the severity or complexity of the patient’s condition.
OHSU expertise with acute myocardial infarctions (heart attacks)
OHSU Hospital is the first and only facility in Oregon, and one of only eight on the West Coast, to have received full accreditation as a Chest Pain Center by The Society of Chest Pain Centers (SCPC). The SCPC accredited OHSU in May 2006. The measures used to evaluate OHSU for accreditation focus on rapid diagnosis and treatment of heart attacks. One cause of heart attacks is a blocked artery. Every minute lost in making a diagnosis can mean irreparable damage to heart muscle. The advanced medical knowledge and training of OHSU's doctors, nurses and support personnel together with our state-of-the-art technology give us the tools to determine rapidly whether the pain indicates a heart attack and, when it does, to immediately begin whatever therapy is most appropriate. One of OHSU’s most successful quality improvement initiatives has focused on reducing the amount of time between the chest pain patient’s arrival in the Emergency Department to the time they enter the catheterization lab.
OHSU results
Of OHSU’s heart attack patients, 94 were not transferred from another hospital. OHSU’s risk-adjusted mortality rate for these patients was 10.4%, which is lower than the expected rate of 12.7%. OHSU had a total of 125 heart attack patients, including patients who were transferred to OHSU from other hospitals. The risk-adjusted mortality rate for this larger group was 9.1%, which is lower than the relevant expected rate of 11.5%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Heart Failure (CHF) |
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| Cascade Healthcare Community (St. Charles Bend MC and St. Charles Redmond MC) |
The Mission of Cascade Healthcare Community is "To improve the health of those we serve in a spirit of love and compassion." An important component of this Mission is having care processes that are patient-centered, including those for end-of-life care. Patients communicate their end-of-life care preferences through various means, including an advance directive, Physician's Orders for Life-Sustaining Treatment (POLST), and "Comfort Measures" instructions (care undertaken with the primary goal of keeping a person comfortable, rather than prolonging life).
Currently, the hospital mortality data used by state and national regulatory agencies (and reflected in this Oregon Hospital Inpatient Quality Indicators report) do not provide a mechanism for hospitals to indicate which patients have specific preferences for the extent of care to be provided to them at the end-of-life. Cascade Healthcare Community believes this is an important factor to include in a statistical model that aims to predict a patient's likelihood of dying in the hospital. We believe our hospital's performance would be more favorable if mortality rates were adjusted for this factor.
Some communities may have a higher proportion of patients with these specific end-of-life documents, particularly those with strong comfort care programs and public awareness. This may cause variation among hospitals in the proportion of patients who arrive at the hospital with specific end-of-life care preferences. Cascade Healthcare Community's Comfort Care Program has been recognized nationally by the the Joint Commission on Accreditation of Healthcare Organizations as a model for end-of-life care.
Cascade Healthcare Community routinely conducts internal reviews to ensure the care we provide is excellent and delivered in a manner that respects patient and family wishes. In our 2005 review of patient deaths from congestive heart failure and from pneumonia, we found the vast majority of these patients were receiving comfort measures only and/or there was an active do-not-resuscitate ("DNR") order reflecting patient wishes. We believe future hospital datasets should capture such important factors so that comparisons of hospital quality are as accurate and as fair as possible.
Comments last updated: August 25, 2006
After extensive review of the Congestive Heart Failure mortalities, it should be noted that the 3 patient deaths out of 32 cases were patients who had “Do Not Resuscitate” (DNR) requests. Also, their average age was 75.6 years and all of these patients had contributing chronic diseases. Two (2) of them also presented to the hospital with acute myocardial infarction (heart attack), which contributed to their deaths. In all cases care and comfort measures were carried out.
It should be noted that the extraction and reporting of the quality data does not take into account many factors that can alter results, including DNR status, co-morbidities, area demographics, etc.
Comments last updated: August 21, 2006
| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is heart failure?
Heart failure is a condition in which damage to the heart muscle prevents the heart from pumping enough blood to meet the body’s needs. Heart failure causes fluid to build up in the lungs and in other parts of the body. This condition can affect the lungs, kidneys and other important body organs. Patients who have severe heart failure may require placement of mechanical pumps to stay alive. Ultimately, these patients may require a heart transplant. Doctors will carefully evaluate patients who have heart failure to understand the causes of the heart problem. They will use various medications to improve the condition.
OHSU expertise with heart failure
OHSU has a highly skilled team of cardiac specialists who have routinely been recognized for their level of expertise. OHSU has one of two heart transplant programs in Oregon. The team has a high level of success in treating patients with heart failure.
OHSU results
Patients admitted to OHSU Hospital for heart failure in 2005 had a risk-adjusted mortality rate of 4.6 %, which is similar to the expected rate of 4.5% for this group of patients.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
Peace Harbor Hospital is committed to improving the quality and safety of patient care. We are also committed to the concept of transparency. We are convinced that if the public is aware of the efforts we are making to improve their experience and outcomes they will feel good about choosing us for their health care needs.
The year of 2005 saw a significant improvement in the mortality rate of patients admitted to our hospital for the diagnosis of Congestive Heart Failure. Rates have been adjusted for age, sex and risk of death. Statistics include “Comfort Care Only” patients. We believe this is a result of our response to JCAHO Core Measures requirements and our efforts to improve the care we provide to our Congestive Heart Failure patients.
Peace Harbor Hospital looks forward to riding the wave of Health Care Improvement, and welcomes the opportunity to share the results of our work with the public.(pdf)
Comments last updated: August 23, 2006
| Samaritan North Lincoln Hospital |
For small hospitals, the use of statistics based on percentage can be misleading (appear high) when the total number of patients in the category is small.
These two diagnoses (Congestive Heart Failure and Pneumonia) are routinely monitored for adherence to standard, evidence-based criteria on a regular basis, but were retrospectively reviewed again in detail by hospital clinical personnel, the goal being to find opportunities where care could have been improved and death averted.
All were found to have been affected by some or all of the following factors:
- An Advanced Directive was in place that refused the use of resuscitation or extreme treatment measures.
- Families requested that aggressive treatment be discontinued in favor of comfort measures only.
- The patients were already High Risk, suffering from additional disease processes or underlying conditions that either contributed to the severity of the event or influenced the choice of or effectiveness of treatment.
For additional information about Samaritan North Lincoln Hospital or other Samaritan Health Services facilities, see our website atwww.samhealth.org.
Comments last updated: August 24, 2006
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| Hip Fracture |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is hip fracture surgery?
A hip fracture is an acute condition in which the large thighbone breaks, often the result of a fall. Hip fractures usually require immediate surgery to repair the broken bone with metal hardware. Hip fracture patients are often elderly, so the condition of the patient and the severity of the patient’s other medical conditions affect the risk associated with hip fracture surgery.
OHSU expertise with hip fracture
Orthopaedic surgeons perform hip fracture surgery. Many doctors refer patients to OHSU because of the level of expertise in caring for patients with more complex medical needs.
OHSU results
Patients admitted to OHSU for hip fracture in 2005 tended to have more severe underlying diseases when compared to patients with hip fractures who were admitted to other Oregon hospitals. After adjusting for the complexity of the underlying diseases, OHSU’s 2.3% risk-adjusted mortality rate following hip fracture was lower than the average of Oregon hospitals (2.6%) and half the expected rate of 4.8% for these complex patients.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Pancreatic Resection |
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be transferred to a hospital that is closer to their homes and can continue their care.
What is pancreatic resection?
A pancreatic resection is a demanding and very specialized surgery to remove part of the pancreas. The pancreas is located near the stomach. It is a vital part of the digestive system.
OHSU expertise with pancreatic resection
OHSU surgeons have the necessary skills to achieve outstanding outcomes for patients who require surgery on their digestive systems. OHSU surgeons and clinical teams at OHSU have specific expertise in pancreatic resections.
OHSU results
In 2005 surgeons at OHSU operated on 38 patients who needed pancreatic resections. This was more than twice the number performed in 2004 and represents 43% of all pancreatic resections performed in Oregon. That number far exceeds the 11 procedures the State recommends as demonstrating experience with this type of surgery.
In 2005 OHSU’s risk-adjusted mortality rate of 2.9% was significantly lower than the expected rate of 9.1%, and better than Oregon’s average mortality rate of 8.1% and the national mortality rate of 7.7%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
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| Pneumonia |
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| Cascade Healthcare Community (St. Charles Bend MC and St. Charles Redmond MC) |
The Mission of Cascade Healthcare Community is "To improve the health of those we serve in a spirit of love and compassion." An important component of this Mission is having care processes that are patient-centered, including those for end-of-life care. Patients communicate their end-of-life care preferences through various means, including an advance directive, Physician's Orders for Life-Sustaining Treatment (POLST), and "Comfort Measures" instructions (care undertaken with the primary goal of keeping a person comfortable, rather than prolonging life).
Currently, the hospital mortality data used by state and national regulatory agencies (and reflected in this Oregon Hospital Inpatient Quality Indicators report) do not provide a mechanism for hospitals to indicate which patients have specific preferences for the extent of care to be provided to them at the end-of-life. Cascade Healthcare Community believes this is an important factor to include in a statistical model that aims to predict a patient's likelihood of dying in the hospital. We believe our hospital's performance would be more favorable if mortality rates were adjusted for this factor.
Some communities may have a higher proportion of patients with these specific end-of-life documents, particularly those with strong comfort care programs and public awareness. This may cause variation among hospitals in the proportion of patients who arrive at the hospital with specific end-of-life care preferences. Cascade Healthcare Community's Comfort Care Program has been recognized nationally by the the Joint Commission on Accreditation of Healthcare Organizations as a model for end-of-life care.
Cascade Healthcare Community routinely conducts internal reviews to ensure the care we provide is excellent and delivered in a manner that respects patient and family wishes. In our 2005 review of patient deaths from congestive heart failure and from pneumonia, we found the vast majority of these patients were receiving comfort measures only and/or there was an active do-not-resuscitate ("DNR") order reflecting patient wishes. We believe future hospital datasets should capture such important factors so that comparisons of hospital quality are as accurate and as fair as possible.
Comments last updated: August 25, 2006
After extensive review of the records of our 2 Pneumonia mortalities it should be noted that both of the 2 deaths out of 45 cases were patients who had “Do Not Resuscitate” (DNR) requests. Their average age was 89.5 years. Both these patients also had several other chronic, debilitating diseases which contributed to their death. Each of these patients were given their requested care and comfort.
It should also be noted that the extraction and reporting of the quality data does not take into account many factors that can alter results, including DNR status, co-morbidities, area demographics, etc.
Comments last updated: August 29, 2006
| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be tranferred to a hospital that is closer to their homes and can continue their care.
What is pneumonia?
Pneumonia is a severe infection of the lung tissue that causes breathing problems. The infection sometimes enters the bloodstream. When this happens, the infection spreads throughout the body and the patient goes into shock. Doctors treat patients with pneumonia by carefully selecting antibiotic medications and using special equipment to help the patient breathe.
OHSU expertise with pneumonia
OHSU specialists are highly skilled in treating pneumonia.
OHSU results
In 2005 patients admitted to OHSU Hospital for pneumonia had a lower risk-adjusted mortality rate (5.6%) than the average mortality rate of patients admitted to other Oregon hospitals (6.7%) or the expected rate of 8.1%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
Peace Harbor Hospital is committed to improving the quality and safety of patient care. We are also committed to the concept of transparency. We are convinced that if the public is aware of the efforts we are making to improve their experience and outcomes they will feel good about choosing us for their health care needs.
The year of 2005 saw a significant improvement in the mortality rate of patients admitted to our hospital for the diagnosis of pneumonia. Rates have been adjusted for age, sex and risk of death. Statistics include “Comfort Care Only” patients. We believe this is a result of our response to JCAHO Core Measures requirements and our efforts to improve the care we provide to our pneumonia patients.
Peace Harbor Hospital looks forward to riding the wave of Health Care Improvement, and welcomes the opportunity to share the results of our work with the public.(pdf)
Comments last updated: August 23, 2006
| Samaritan North Lincoln Hospital |
For small hospitals, the use of statistics based on percentage can be misleading (appear high) when the total number of patients in the category is small.
These two diagnoses (Congestive Heart Failure and Pneumonia) are routinely monitored for adherence to standard, evidence-based criteria on a regular basis, but were retrospectively reviewed again in detail by hospital clinical personnel, the goal being to find opportunities where care could have been improved and death averted.
All were found to have been affected by some or all of the following factors:
- An Advanced Directive was in place that refused the use of resuscitation or extreme treatment measures.
- Families requested that aggressive treatment be discontinued in favor of comfort measures only.
- The patients were already High Risk, suffering from additional disease processes or underlying conditions that either contributed to the severity of the event or influenced the choice of or effectiveness of treatment.
For additional information about Samaritan North Lincoln Hospital or other Samaritan Health Services facilities, see our website atwww.samhealth.org.
Comments Last updated: August 24,2006
Silverton Hospital’s mission is to improve the health of our community. One quality aspect of the life process is a dignified death. We have performed a review of all patients that died of pneumonia in our facility in 2005. All of these patients had advanced directives, particularly ‘do-not-resuscitate’ orders, as part of their plan of care.
Our commitment to dignified end-of-life care includes meeting patient and family needs when treatment is no longer desired or advantageous to the patient. Our physician and nursing staff are proud of the care we offer to patients who choose to not seek more aggressive treatment due to advanced age or other co-existing illnesses.
Oregon can be proud of progress in addressing advanced directives and patient determination of care at end-of-life. Since there is not a uniform national standard to address patient advanced directives, published mortality statistics do not accurately reflect the wishes of patients who choose ‘comfort care’ as an option.
Silverton Hospital supports continued national efforts to determine indicators of quality that are more meaningful than mortality statistics when a patient’s determination of their own care can not be factored into the equation.
Comments last updated: August 23, 2006
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| Kaiser Sunnyside Medical Center |
Kaiser Sunnyside Medical Center is committed to the safety of our patients. Our physicians continuously and carefully review hospital mortality reports and other clinical quality information. They do so to learn where quality efforts are improving care and to pinpoint areas where we might improve further. In the most recent state mortality report, risk-adjusted mortality rates at Kaiser Sunnyside were comparable to the statewide average. This means that for all 12 clinical conditions or surgeries, there was no statistical difference in risk-adjusted mortality between Oregon hospitals and Kaiser Sunnyside.
Comments last updated: August 29, 2006
Oregon Health & Science University is Oregon’s only academic medical center. OHSU is a respected regional resource because of the knowledge, expertise and leading-edge medical technology that is available at OHSU Hospital, Doernbecher Children’s Hospital, and their numerous clinics and specialized centers. Doctors from throughout Oregon refer patients to OHSU when the necessary level of care or expertise is not available closer to home. Because OHSU is one of two designated Level 1 trauma centers in Oregon, OHSU accepts many patients who are critically ill or injured. OHSU only transfers patients who no longer require its unique services and can be tranferred to a hospital that is closer to their homes and can continue their care.
What is a stroke?
A stroke occurs when an artery that supplies blood to the brain becomes blocked or ruptures and brain cells (known as neurons) die. A stroke is an acute medical problem. Symptoms may include paralysis, and difficulty with speech, vision, hearing and/or touch. Sometimes these symptoms are permanent and sometimes they partially improve with time.
OHSU expertise with stroke
OHSU operates the Oregon Stroke Center and has made a special commitment to improving the outcomes of patients who have had strokes. Many Oregon hospitals transfer their serious stroke patients to OHSU because of this level of expertise. Therefore, OHSU’s stroke patients tend to be more severely ill or have more complicated overall medical conditions than patients who are admitted to other Oregon hospitals.
OHSU results
In 2005 OHSU provided care to 6% of all stroke patients in Oregon. After adjusting for the severity of their overall medical conditions, OHSU’s stroke patients had a lower mortality rate (10.3%) than the 11.4% mortality rate for stroke patients admitted to other Oregon hospitals in 2005 or the expected mortality rate of 17.0%.
More OHSU comparative information
OHSU provides the public additional comparative information online at www.OHSUhealth.com/quality_service.
Samaritan Pacific Communities Hospital
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For small hospitals, the use of statistics based on percentage can be misleading when the total number of patients in the category is small. Regarding the statistics describing the Stroke Mortality Rate, the total number of stroke patients treated over the entire year 2005 was 33. All 7 mortality cases were retrospectively reviewed in detail by hospital clinical personnel, the goal being to find opportunities where care could have been improved.
Of the 7 cases, all were found to have received appropriate care, adhering to the standards put forth by the American Heart Association (AHA) Stroke Council.
In addition, neurological consults were obtained, either from specialized Stroke Centers located in Portland or from neurology specialists based in referral hospitals.
In all 7 cases, the following factors were found to be present that influenced the outcomes for these patients.
- The patients arrived at the Emergency Department after having been found unresponsive and were deemed to have had an “Unsurvivable Event” as characterized by diagnostic criteria and/or neurologic consultation.
- An Advanced Directive was in place that refused the use of resuscitation or extreme treatment measures.
- Families requested that aggressive treatment be discontinued in favor of comfort measures only.
- The patient suffered from additional disease processes or underlying conditions that either contributed to the severity of the event or influenced the choice of treatment.
Other Inpatient Quality Indicators:
Similar factors were found to have influenced the other mortality rate data sets in this report.
For additional information about Samaritan Pacific Communities Hospital or other Samaritan Health Services facilities, see our website atwww.samhealth.org.
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