Participating Hospitals & Publicly Released COAP Data

Transcription

1 Participating Hospitals & Publicly Released COAP Data Welcome to the hospital outcomes section of the Clinical Outcomes Assessment Program (COAP) web site where you can find detailed information on the performance of Washington State hospitals in the area of cardiac care. What you will learn on this site is that all Washington State hospitals are doing a very good job in cardiac care, and our state is out-performing the national average in many areas. We hope that this site will be used by hospitals for their internal quality improvement initiatives; and by heart patients and their loved ones as information to discuss with their doctor. COAP is a truly unique and ground-breaking collaborative. This physician-led quality improvement activity is aimed at improving the quality of care for patients with heart disease who are treated in Washington hospitals. Through COAP, hospitals have been working together since 1997 to share and learn from comparative cardiac care performance information and they have steadily improved. There have been significant improvements in many areas, and Washington State hospitals have much to be proud of! We are very fortunate to live in a state where we can be assured that every hospital is dedicated to making sure that you are getting the best possible care by participating in quality improvement efforts such as COAP. To keep the momentum going, and to work for even greater improvement, we are now making COAP data publicly available for several key clinical measures. In Washington State, there are 33 hospitals that perform Percutaneous Coronary Interventions (PCI), 18 of which also perform Coronary Artery Bypass Graft (CABG) and Valve surgeries. Hospitals have voluntarily agreed to make information about their performance available publicly. The few that are not disclosing data at this time may have chosen not to for a variety of reasons, which can be discussed with your physician or surgeon. Data from CABG & Valve surgeries and PCI are included on this site. COAP measures are all outcomes measures, meaning that they measure the end result of the treatment how patients fared. In the following table, you will see whether your hospital performed better, not as good as, or within the range of the state average for each of the measures. You will also see comparisons to the statewide average. It is very important to note that there are many reasons why one hospital s results might look different from another s and that while a hospital may not be currently performing within the range of the state average, they may still be significantly better than the national average. We encourage you to discuss this information with your physician or surgeon. The data reported is from the 2012 annual risk-adjusted clinical reports. It highlights outcomes from 2012 for PCI and CABG surgery. Because of the relatively small number of valve surgeries performed, valve surgery outcomes are reported as 3-year averages for To see the list of hospitals participating in COAP, their hospital-identified clinical outcomes information and details about each of the measures for Percutaneous Coronary Interventions (PCI), Coronary Artery Bypass Graft Surgery (CABG) and Valve Surgeries, Procedure Type Click here: PCI CABG Valve Surgeries If you are interested in information on select general surgical procedures, visit the Surgical Care & Outcomes Assessment Program (SCOAP) website: Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

2 CABG & PCI Procedure Volume by Hospital Washington State, 2012 CABG Volume 2012 PCI Volume 2012 (Ordered by PCI volume) Providence Sacred Heart, Spokane Swedish Health Services - Cherry Hill Seattle ProvidenceRegional Medical Center Everett Providence St. Peter, Olympia PeaceHealth St. Joseph, Bellingham St. Joseph, Tacoma Kadlec, Richland Multicare Tacoma General Harrison, Bremerton Overlake, Bellevue Virginia Mason, Seattle Evergreen, Kirkland Deaconess Rockwood Health, Spokane PeaceHealth Southwest, Vancouver Yakima Regional Central WA, Wenatchee Skagit Valley, Mt. Vernon Valley, Kent Multicare Good Samaritan, Puyallup University of WA, Seattle Northwest, Seattle Swedish Health Services, Edmonds St. Francis, Federal Way Highline, Burien Multicare Auburn Regional Yakima Valley Capital, Olympia PeaceHealth St. John, Longview Swedish Health Services, Issaquah Harborview, Seattle Walla Walla St. Anthony, Gig Harbor

3 Percutaneous Coronary Intervention (PCI) Procedure Volume by Hospital Washington State, 2012 Providence Sacred Heart, Spokane Swedish Health Services - Cherry Hill Seattle ProvidenceRegional Medical Center Everett Providence St. Peter, Olympia PeaceHealth St. Joseph, Bellingham St. Joseph, Tacoma Kadlec, Richland Multicare Tacoma General Harrison, Bremerton Overlake, Bellevue Virginia Mason, Seattle Evergreen, Kirkland Deaconess Rockwood Health, Spokane PeaceHealth Southwest, Vancouver Yakima Regional Central WA, Wenatchee Skagit Valley, Mt. Vernon Valley, Kent Multicare Good Samaritan, Puyallup University of WA, Seattle Northwest, Seattle Swedish Health Services, Edmonds St. Francis, Federal Way Highline, Burien Multicare Auburn Regional Yakima Valley Capital, Olympia PeaceHealth St. John, Longview Swedish Health Services, Issaquah Harborview, Seattle Walla Walla St. Anthony, Gig Harbor PCI Volume

4 Percutaneous Coronary Intervention (PCI) Outcomes Metrics Key: click on each individual link below for a detailed explanation of what is measured and why Risk-Adjusted Mortality - PCI 2012 State Average = 1.9% Median Door to Balloon Time PCI State Average = 59 Minutes; Benchmark = 41.5 minutes Symbols Key: Hospital results for 2012 are within the range of the statewide average for that metric Hospital results for 2012 are statistically better than the risk adjusted statewide average for that metric and/or have contributed to setting the benchmark for this measure Hospital results for 2012 are statistically not as good as the statewide average for that metric No data available for this hospital or no procedures done for this time period xxx Hospital is not currently releasing their data Mortality 2013 Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June 2013 PCI Metrics Door to Balloon Time Black = Hospitals currently in full compliance with COAP s quality standards; Blue = hospitals currently in partial compliance with COAP s quality standards; Red = Hospitals currently out of compliance with COAP s quality standards Multicare Auburnl Medical Center, Auburn Capital Medical Center, Olympia Central Washington Hospital, Wenatchee Deaconess Hospital Rockwood Health, Spokane Evergreen Hospital Medical Center, Kirkland Multicare Good Samaritan Hospital, Puyallup Harborview Medical Center, Seattle Harrison Medical Center, Bremerton Highline Medical Center, Burien Kadlec Medical Center, Richland Madigan Army Medical Center, Fort Lewis Northwest Hospital & Medical Center, Seattle Overlake Hospital Medical Center, Bellevue PeaceHealth Southwest Medical Center, Vancouver PeaceHealth St. John, Longview PeaceHealth St. Joseph Hospital, Bellingham Providence Regional Medical Center, Everett Providence Sacred Heart Medical Center, Spokane Providence St. Peter Hospital, Olympia Skagit Valley Hospital, Mt. Vernon St. Anthony Hospital, Gig Harbor St. Francis Hospital, Federal Way St. Joseph Medical Center, Tacoma Swedish Health Services, Cherry Hill, Seattle Swedish Health Services, Edmonds Swedish Health Services, Issaquah Tacoma General Hospital, Tacoma University of Washington Medical Center, Seattle Valley Medical Center, Renton Veteran s Affairs Medical Center, Seattle xxx xxx Virginia Mason Medical Center, Seattle Yakima Regional Medical & Heart Center, Yakima Yakima Valley Memorial Hospital, Yakima Walla Walla Hospital, Walla Walla 4

5 PCI Risk-Adjusted Mortality Rate 33 hospitals in Washington State perform percutaneous coronary interventions, or PCI. PCI is a method of restoring blood flow to the heart muscle by reopening clogged arteries. Mortality rate is the percentage of patients who died before being discharged from the hospital following PCI for both elective and emergent procedures. All surgical procedures involve some risk. Additionally, all patients have their own particular risk factors such as previous medical and family history, current state of overall health, how long they have had their coronary disease, how long it has taken between onset of symptoms to treatment in an acute situation, and many others. Mortality rates for a hospital can be impacted by many things. For example, if a hospital does a low volume of this particular type of surgery, even one unavoidable death can make a significant impact on their mortality rate. Results for this measure refer to the percentage of patients in Washington State that died during or following percutaneous coronary intervention (PCI). The average rate of death for PCI procedures is very low and has remained so over the past several years. Overall, hospitals in Washington State are doing a very good job in keeping their mortality rates low. Individual hospital results for 2012 range from a low of 0.0% to a high of 4.1%. TRENDS: Percutaneous Coronary Intervention (PCI) Outcomes 5% PCI Risk-Adjusted Mortality 4% 3% 2% 1% 0% Ask your physician about mortality rates for percutaneous coronary interventions at your hospital and specific risks associated with your particular case. Encourage them to examine their COAP report regarding mortality rates so they know you care! 2013 Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

6 Median Door to Balloon Time for ST-Elevation Myocardial Infarction (STEMI) Washington State Hospitals, 2012 Percutaneous Coronary Intervention (PCI) is a method of restoring blood flow to the heart muscle by reopening clogged arteries. This is often done by inflating a tiny balloon at the site of the blockage, and sometimes putting in a small metal device called a stent to hold the artery open. Experts agree that when a patient is having an acute heart attack, the quicker this happens, the better. The longer blood does not flow to the heart muscle during a heart attack, the more likely there could be damage to that muscle. Door-to-Balloon Time is a measurement of the time between when a patient having an acute heart attack comes through the door of the emergency room and when the balloon is first inflated in the clogged artery and blood flow is restored. The American Heart Association and the American College of Cardiology along with many other national agencies recommend that this time interval be no more than 90 minutes. Results for this measure refer to the median door-to-balloon time for all Washington hospitals that perform PCI. The statewide median has decreased from 95 minutes in 2004 to 59 minutes in 2012, which is truly outstanding! Individual hospital results for Washington State in 2012 range from a low of 41 minutes to a high of 84 minutes indicating that all Washington hospitals have exceeded the goal of median door to balloon times < 90 minutes. Two hospitals in Washington have significantly lower door-to-balloon times than the state average, and as such have set what we call a best practice benchmark for all hospitals to try to achieve. The statewide trends over the past several years are shown below, and the top performing individual hospitals are highlighted on the following graph. 6

7 Median Door to Balloon Time for ST-Elevation Myocardial Infarction (STEMI) Washington State, Median Door to Balloon Time 90 Time in Minutes

8 Median Door to Balloon Time for ST-Elevation Myocardial Infarction (STEMI) Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The average for all of WA State is indicated by the blue line. 90 PCI 2012: WA Best Practice Benchmark = 41.5 Minutes; Statewide Average Median Time = 59 Minutes Lower is better Median Number of Minutes from Door to Balloon Capital Medical Center Swedish Health Services Edmonds PeaceHealth Southwest Medical Center St. Francis Hospital Harborview Medical Center Yakima Valley Memorial Hospital Multicare Good Samaritan Hospital Deaconess Hospital Rockwood Health Central WA Hospital Valley Medical Center Highline Medical Center Multicare Auburn Medical Center Providence Regional Medical Center Yakima Regional Medical Center University of WA Medical Center Skagit Valley Hospital Evergreen Healthcare Swedish Health Services Issaquah PeaceHealth - St. Joseph Medical Center Northwest Hospital St. Joseph Medical Center Providence Sacred Heart Medical Center Overlake Hospital Medical Center Harrison Medical Center Multicare Tacoma General Hospital Providence St. Peter Medical Center Walla Walla General Hospital Kadlec Medical Center PeaceHealth - St. John Medical Center Virginia Mason Medical Center Swedish Health Services Cherry Hill 8

9 % ST-Elevation Myocardial Infarction (STEMI) Cases with a Door to Balloon Time <90 Minutes Washington State Hospitals, 2012 Given that quicker is better when it comes to the amount of time from door-to-balloon, the more individual patients that are able to receive this quick care is also better. The goal is to have a door-to-balloon time of 90 minutes for all non-transferred patients having an ST elevated myocardial infarction and having primary percutaneous coronary intervention (PCI). Results for this measure refer to the % of eligible patients at a particular hospital that have a door-to-balloon time of less than 90 minutes. The average for all hospitals in Washington State is 95%. Individual hospital results for Washington State in 2012 range from a low of 66.7% of eligible patients meeting this goal to a high of 100% of eligible patients. Four hospitals in Washington have a significantly higher percentage than the state average, and as such have set what we call a best practice benchmark for all hospitals to try to achieve. These top performing hospitals are highlighted on the following graph. 9

10 % ST-Elevation Myocardial Infarction (STEMI) Cases with a Door to Balloon Time <90 Minutes Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The average for all of WA State is indicated by the blue line. 100% PCI 2012: WA Best Practice Benchmark = 100%; Statewide Average Median Time = 95% 90% Higher is better % of Cases with a Door to Balloon Time Less Than 90 Minutes 80% 70% 60% 50% 40% 30% 20% 10% 0% PeaceHealth - St. John Medical Center Swedish Health Services Cherry Hill Walla Walla General Hospital Yakima Valley Memorial Hospital Evergreen Healthcare Northwest Hospital Yakima Regional Medical Center Central WA Hospital Multicare Auburn Medical Center Multicare Good Samaritan Hospital Virginia Mason Medical Center Harrison Medical Center St. Joseph Medical Center Overlake Hospital Medical Center Providence Regional Medical Center Everett Multicare Tacoma General Hospital Providence Sacred Heart Medical Center PeaceHealth Southwest Medical Center University of WA Medical Center Kadlec Medical Center Swedish Health Services Edmonds Highline Medical Center Swedish Health Services Issaquah PeaceHealth - St. Joseph Medical Center St. Francis Hospital Valley Medical Center Deaconess Hospital Rockwood Health Providence St. Peter Medical Center Harborview Medical Center 10 Skagit Valley Hospital Capital Medical Center

11 Appropriate Use Measures for Percutaneous Coronary Intervention (PCI) PCI is a critical tool in the management of coronary disease. For patients experiencing an acute MI (myocardial infarction or heart attack ), PCI is known to reduce mortality and recurrent MI. In patients with stable coronary artery disease, PCI offers significant symptom relief in appropriately selected patients. PCI is considered appropriate when the expected benefits, in terms of survival or health outcomes (reduction of symptoms, improvement in the quality of life, etc), exceed the expected negative consequences of the procedure. COAP, along with other national organizations, has begun using a complex process based on widely agreed upon criteria, to evaluate the appropriateness of each PCI procedure done in the state of Washington. The majority of PCI s are done for acute reasons and in Washington State as well as nationally, this is almost always (99% of the time) the most appropriate form of treatment. For the non-acute, or elective procedures however, PCI is not always the best option for treatment at that time. In this case, those procedures would be classified as inappropriate. There is wide variation among hospitals as to the frequency that this occurs. Reducing the incidence of those inappropriate procedures is a goal that Washington hospitals have set, and COAP is helping them work on this. Certain information must be available in order to evaluate whether a procedure can be classified as appropriate and it should be collected for every patient and every procedure. Again, there is wide variation among hospitals as to whether all of that information is routinely collected and/or documented. Put simply, if the data used to evaluate the appropriateness of the procedure is missing, the appropriateness of the procedure can t be measured. One of the ways that COAP is helping hospitals to work on the goal of reducing inappropriate procedures is to help them reduce the amount of insufficient information. The following graph represents the percentage of non-acute or elective PCI procedures that were not able to be classified or in other words, did not have enough information documented in order to be evaluated. All PCI centers in Washington are represented on this graph. Hospitals are ranked here in order of their performance for In this instance, the lower the better. The comparison with 2011 and 2010 is provided so that you can see whether that hospital is improving. If the orange line (2012) is shorter than the green line (2011) and/or blue line (2010), the hospital has made improvements in the collection and documentation of the data needed to determine whether a non-acute PCI procedure was appropriate. The current statewide average for insufficient information on non-acute procedures is 45%. The Washington State Best Practice Benchmark, which is set by the best performing hospitals which collectively make up >= 10% of the total volume in the state, is currently 20% however the overall goal is that insufficient information will occur less than 10% of the time WA State Benchmark = 20% Insufficient Information for Non Acute Procedures Highline Multicare Good Samaritan Kadlec Multicare Tacoma General University of Washington Skagit Valley PeaceHealth Southwest Swedish-Edmonds Multicare Auburn Valley Prov Sacred Heart Prov Everett Harrison St Joseph -Tacoma Swedish-Cherry Hill PeaceHealth St Joseph Deaconess Virginia Mason St Francis Prov St Peter Yakima Regional Overlake Northwest Central Washington Capital Evergreen PeaceHealth St.John Yakima Valley Harborview St. Anthony Swedish-Issaquah Walla Walla Statewide No Non-Acute Procedures % 20% 40% 60% 80% 100% % Non-Acute Procedures NOT CLASSIFIED Due to Insufficient Information Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

12 Coronary Artery Bypass Graft (CABG) Procedure Volume by Hospital Washington State, 2012 CABG Volume 2012 St. Joseph, Tacoma Providence Sacred Heart, Spokane ProvidenceRegional Medical Center Everett Kadlec, Richland Swedish Health Services - Cherry Hill Seattle Multicare Tacoma General Providence St. Peter, Olympia Virginia Mason, Seattle PeaceHealth Southwest, Vancouver Harrison, Bremerton Yakima Regional Overlake, Bellevue Central WA, Wenatchee University of WA, Seattle Deaconess Rockwood Health, Spokane PeaceHealth St. Joseph, Bellingham Northwest, Seattle

13 Coronary Artery Bypass Graft (CABG) Surgery Outcomes Metrics Key: click on each individual link below for a detailed explanation of what is measured and why Mortality - CABG Surgery 2012 State Average = 2.0% Renal Failure CABG Surgery 2012 State Average = 2.0%; Benchmark = 0% Stroke CABG Surgery 2012 State Average = 1.3%; Benchmark = 0% Arterial Graft Use CABG Surgery 2012 State Average = 99.9%; Benchmark = 100% Deep Sternal Wound Infection CABG Surgery 2012 State Average = 0.2%; Benchmark = 0% Blood Use CABG Surgery 2012 State Average = 25.1%; Benchmark = 13.9% Symbols Key: CABG Metrics Hospital results for 2012 are within the range of the statewide average for that metric Hospital results for 2012 are statistically better than the risk adjusted Statewide average for that metric and/or have contributed to setting the benchmark for this measure Hospital results for 2012 are statistically not as good as the statewide average for that metric No data available for this hospital or no procedures done for this time period xxx Hospital is not currently releasing their data Black = Hospitals in full compliance with COAP s quality standards; Blue = hospitals in partial compliance with COAP s quality standards; Red = Hospitals out of compliance with COAP s quality standards Central Washington Hospital, Wenatchee Deaconess Hospital Rockwood Health, Spokane Harrison Medical Center, Bremerton Kadlec Medical Center, Richland Madigan Army Medical Center, Fort Lewis Northwest Hospital & Medical Center, Seattle Overlake Hospital Medical Center, Bellevue Providence Regional Medical Center, Everett Providence Sacred Heart Medical Center, Spokane Providence St. Peter Hospital, Olympia PeaceHealth St. Joseph Hospital, Bellingham PeaceHealth Southwest Washington Medical Center, Vancouver St. Joseph Medical Center, Tacoma Swedish Health Services, Cherry Hill, Seattle Tacoma General Hospital, Tacoma University of Washington Medical Center, Seattle Veteran s Affairs Medical Center, Seattle xxx xxx xxx xxx xxx xxx Virginia Mason Medical Center, Seattle Yakima Regional Medical & Heart Center, Yakima Mortality Renal Failure Stroke Arterial Graft Use Wound Infection Blood Use 2013 Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

14 Coronary Artery Bypass Graft (CABG) Surgery Outcomes CABG Risk-Adjusted Mortality Rate Mortality rate is the percentage of patients who died before being discharged from the hospital following Coronary Artery Bypass Graft Surgery (CABG) for both elective and emergent procedures. All surgical procedures involve some risk. Additionally, all patients have their own particular risk factors such as previous medical and family history, current state of overall health, how long they have had their coronary disease, how long it has taken between onset of symptoms to treatment in an acute situation, and many others. Mortality rates for a hospital can be impacted by many things. For example, if a hospital does a low volume of this particular type of surgery, even one unavoidable death can make a significant impact on their mortality rate. Results for this measure refer to the percentage of patients in Washington State that died during or following coronary artery bypass graft (CABG) surgery before being discharged from the hospital. The statewide riskadjusted average has remained fairly stable over the past several years. Overall, hospitals in Washington State are doing a very good job in keeping their mortality rates low, and are consistent with the national averages. Individual hospital results for Washington State in 2012 range from a low of 0.0% to a high of 4.4%. When adjusted for high risk cases, all Washington hospitals fall within the statewide average for TRENDS: 5% CABG Risk-Adjusted Mortality 4% 3% 2% 1% 0% Ask your surgeon about mortality rates for coronary artery bypass surgery at your hospital and specific risks associated with your particular case. Encourage them to examine their COAP report regarding mortality rates so they know you care! 2013 Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

15 Renal Insufficiency After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 One significant complication that can occur following coronary artery bypass graft (CABG) surgery is renal (kidney) insufficiency or failure. Results for this measure refer to the percentage of patients in Washington State that experience renal failure following CABG surgery. Overall this is a rare complication, with the average among hospitals in Washington State being 2.0% in 2012 and hospitals are continually working to keep the rate of this complication extremely low. Individual hospital results for Washington State in 2012 range from a low of 0% of patients experiencing renal insufficiency following their CABG surgery to a high of 2.7%. Four hospitals in Washington have a significantly lower rate of renal failure following CABG than the state average and as such have set what we call a best practice benchmark for all hospitals to try to achieve. These top performing hospitals are highlighted on the following graph. 15

16 Renal Insufficiency After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The overall average for all of WA State is indicated by the blue line. Lower is better % patients experiencing renal insufficiency following CABG surgery 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Virginia Mason, Seattle Multicare Tacoma General Overlake, Bellevue Northwest, Seattle CABG Only 2012: WA Best Practice Benchmark = 0%; Statewide Average = 2.0% PeaceHealth Southwest, Vancouver Yakima Regional Swedish, Cherry Hill Seattle Univ. of WA, Seattle St. Joseph, Tacoma Central WA, Wenatchee Prov. Regional, Everett PeaceHealth St. Joseph, Bellingham Prov. St. Peter, Olympia Prov. Sacred Heart, Spokane Kadlec, Richland Harrison, Bremerton 16 Deaconess Rockwood, Spokane

17 Arterial Graft Use in Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 Coronary Artery Bypass Grafting (CABG) is a technique used to treat coronary artery disease. CABG is usually recommended for patients with disease of the left main coronary artery, or those who have blockages in several major coronary arteries, especially when the left ventricle (the part of the heart that pumps oxygenated blood to the rest of the body) is not working efficiently. CABG is also used for patients with chest pain that cannot be controlled by medication alone. Over the years, the best results have been found using the Left Internal Mammary Artery (LIMA), an artery within the chest wall. This artery is similar in size to the coronary arteries. It is more durable and usually stays open longer. Surgeons are finding that by using LIMA or other arterial grafts, they can decrease the patient's risk of needing repeat surgery and improve long-term survival rates. Many studies suggest that arterial grafting requires less need for transfusions, less time spent in the hospital, and lower rates of recurring chest pain and heart attacks; however certain patients, such as those undergoing emergency surgery and those who have had previous heart procedures, may not be eligible for this procedure. Washington's own COAP information supports these findings. Over the past several years that this has been a quality metric for COAP participants, the use of LIMA has increased and this year there is far less variability among hospitals than ever before. On average, 99.9% of potentially eligible patients in Washington received arterial grafts in Only three hospitals in the state had less than 100%, and the rate at each of those was still >99%. This is clearly a quality measure that has met its goal of meeting the best practice benchmark across the state! 17

18 Arterial Graft Use in Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The average for all of WA State is indicated by the blue line. CABG Only 2012: WA Best Practice Benchmark = 100%; Statewide Average = 99.9% Higher is better % patients receiving an internal mammary artery graft during CABG surgery 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Central WA, Wenatchee Deaconess Rockwood, Spokane Harrison, Bremerton Kadlec, Richland Northwest, Seattle Overlake, Bellevue PeaceHealth St. Joseph, Bellingham Prov. Regional, Everett Prov. Sacred Heart, Spokane Prov. St. Peter, Olympia St. Joseph, Tacoma Swedish, Cherry Hill Seattle Virginia Mason, Seattle Yakima Regional Multicare Tacoma General 18 PeaceHealth Southwest, Vancouver Univ. of WA, Seattle

19 Blood Transfusions During/After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 In the past, blood transfusions were given almost routinely during and after heart surgery. Because blood transfusions are not without risk, and blood products (red blood cells and other parts of the blood) are often in short supply, costly, and may not always be necessary, doctors and researchers are taking a closer look at routine transfusions. Beginning in 1988, health care groups have created guidelines that recommend the least number of blood transfusions possible during surgery. Despite these recommendations, the use of blood products, including red blood cells and platelets, continues to vary considerably between hospitals, both nationally and in Washington. On average, 25% of patients at hospitals in Washington state will receive a blood transfusion as part of their bypass surgery. Some hospitals use less and others use more blood for routine care. Washington s doctors have been working closely with COAP to better understand practice patterns for blood transfusion. While nearly all agree that fewer transfusions are preferred, not all agree on exactly when to give them. With help from COAP, surgeons and hospitals are working together to develop consistent approaches to blood transfusions. The goal is not to eliminate blood use, it is to work toward having a system in place that makes effective use of this resource while minimizing avoidable risks. Individual hospital results for Washington State in 2012 range from a low of 10.4% of patients receiving blood transfusions to a high of 60.3%. Two hospitals in Washington have significantly lower blood use than the state average, and as such, have set what we call a best practice benchmark for all hospitals to try to achieve. These top performing hospitals are highlighted on the following graph. 19

20 Blood Transfusions During/After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The overall average for all of WA State is indicated by the blue line Lower is better % patients who received a blood transfusion during or after CABG surgery 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CABG Only 2012: WA Best Practice Benchmark = 13.9%; Statewide Average = 25.1% Prov. Regional, Everett PeaceHealth Southwest, Vancouver Prov. Sacred Heart, Spokane Prov. St. Peter, Olympia Kadlec, Richland PeaceHealth St. Joseph, Bellingham St. Joseph, Tacoma Virginia Mason, Seattle Swedish, Cherry Hill Seattle Yakima Regional Central WA, Wenatchee Multicare Tacoma General Northwest, Seattle Harrison, Bremerton Overlake, Bellevue Univ. of WA, Seattle 20 Deaconess Rockwood, Spokane

21 Return to OR for Bleeding Complications After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 Bleeding complications that are of such significance that they require a return to the operating room can occur following coronary artery bypass graft (CABG) surgery. While it is relatively rare, it can puts a patient at greater risk for additional complications and also increases the cost of the hospital stay. Results for this measure refer to the percentage of patients in Washington State that are taken back to the operating room (OR) for bleeding complications following CABG surgery. The average among hospitals in Washington State was 1.4% in 2012 and hospitals are continually working to keep the rate of this complication extremely low. Individual hospital results for Washington State in 2012 range from a low of 0% of patients needing to return to the OR for bleeding following their CABG surgery to a high of 4.1%. Five hospitals in Washington have a significantly lower rate of this complication following CABG than the state average and as such have set what we call a best practice benchmark for all hospitals to try to achieve. These top performing hospitals are highlighted on the following graph. 21

22 Return to OR for Bleeding Complications After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The average for all of WA State is indicated by the blue line. 10% CABG 2012: WA Best Practice Benchmark = 0.0%; Statewide Average = 1.4% Lower is better Return to Operating Room Following CABG Surgery 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Central WA, Wenatchee Northwest, Seattle Overlake, Bellevue PeaceHealth Southwest, Vancouver PeaceHealth St. Joseph, Bellingham Swedish, Cherry Hill Seattle Virginia Mason, Seattle Prov. Sacred Heart, Spokane Univ. of WA, Seattle Kadlec, Richland Prov. Regional, Everett St. Joseph, Tacoma Multicare Tacoma General Harrison, Bremerton Deaconess Rockwood, Spokane Yakima Regional 22 Prov. St. Peter, Olympia

23 Deep Sternal Wound Infection After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 One significant complication that can occur following coronary artery bypass graft is an infection of the surgical site which goes deep into the sternal bone. This complication is very infrequent, but the consequences can be very serious. It increases the chance of death or other significant complications, the length of stay in the hospital and the cost. Results for this measure refer to the percentage of patients in Washington State that experienced a deep sternal wound infection following their coronary artery bypass graft (CABG) surgery. Among hospitals statewide, the average is 0.2%. These results are risk adjusted, which means that patients who had a particularly high risk of developing an infection were accounted for in the calculations. Individual hospital results for Washington State in 2012 range from a low of 0.0% of patients experiencing a deep sternal wound infection (DSWI), to a high of 0.4%. While even the highest rate in the state is less than one half of one percent, there are 13 hospitals in Washington that had no incidences of DSWI and as such have set what we call a best practice benchmark for all hospitals to try to achieve. These top performing hospitals are highlighted on the following graph. 23

24 Deep Sternal Wound Infection After Coronary Artery Bypass Graft (CABG) Surgery Washington State Hospitals, 2012 The best performing hospitals in WA for this particular measure, that represent >= 10% of total volume in the state, are indicated in green. The average of these best performers is known as the Best Practice Benchmark for WA and is indicated by the horizontal green line. The overall average for all of WA State is indicated by the blue line. CABG Only 2012 : WA Best Practice Benchmark = 0%; Statewide Average = 0.2% Lower is better % of patients who developed a DSWI after CABG surgery 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Central WA, Wenatchee Deaconess Rockwood, Spokane Harrison, Bremerton Multicare Tacoma General Northwest, Seattle Overlake, Bellevue PeaceHealth Southwest, Vancouver PeaceHealth St. Joseph, Bellingham St. Joseph, Tacoma Swedish, Cherry Hill Seattle Univ. of WA, Seattle Virginia Mason, Seattle Yakima Regional Kadlec, Richland Prov. Regional, Everett Prov. St. Peter, Olympia 24 Prov. Sacred Heart, Spokane

25 Aortic Valve Replacement (AVR) Surgery 3-Year Outcomes Metrics Key: click on each individual link below for a detailed explanation of what is measured and why Mortality - AVR Surgery 3 Year Average = 2.0% Renal Failure AVR Surgery 3 Year Average = 3.2% Stroke AVR Surgery 3 Year Average = 1.9% Deep Sternal Wound Infection AVR Surgery 3 Year Average = 0.2% Blood Use AVR Surgery 3 Year Average = 30.3%, Benchmark = 12.3% Symbols Key: AVR Metrics Hospital results for 2012 are within the range of the statewide average for that metric Hospital results for 2012 are statistically better than the risk adjusted Statewide average for that metric and/or have contributed to setting the benchmark for this measure Hospital results for 2012 are statistically not as good as the statewide average for that metric No data available for this hospital or no procedures done for this time period xxx Hospital is not currently releasing their data Black = Hospitals in full compliance with COAP s quality standards; Blue = hospitals in partial compliance with COAP s quality standards; Red = Hospitals out of compliance with COAP s quality standards Central Washington Hospital, Wenatchee Deaconess Hospital Rockwood Health, Spokane Harrison Medical Center, Bremerton Kadlec Medical Center, Richland Madigan Army Medical Center, Fort Lewis Northwest Hospital & Medical Center, Seattle Overlake Hospital Medical Center, Bellevue Providence Regional Medical Center, Everett Providence Sacred Heart Medical Center, Spokane Providence St. Peter Hospital, Olympia PeaceHealth St. Joseph Hospital, Bellingham PeaceHealth Southwest Washington Medical Center, Vancouver St. Joseph Medical Center, Tacoma Swedish Health Services, Cherry Hill, Seattle Tacoma General Hospital, Tacoma University of Washington Medical Center, Seattle Veteran s Affairs Medical Center, Seattle xxx xxx xxx xxx xxx Virginia Mason Medical Center, Seattle Yakima Regional Medical & Heart Center, Yakima Mortality Renal Failure Stroke Wound Infection Blood Use 2013 Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

26 CABG + Aortic Valve Replacement (AVR) Surgery 3-Year Outcomes Metrics Key: click on each individual link below for a detailed explanation of what is measured and why Mortality CABG + AVR Surgery 3 Year Average = 3.5% Renal Failure CABG + AVR Surgery 3 Year Average = 4.7% Stroke CABG + AVR Surgery 3 Year Average =2.2% Arterial Graft Use CABG + AVR Surgery 3 Year Average = 67.1% Benchmark = 85.6% Deep Sternal Wound Infection CABG + AVR Surgery 3 Year Average = 0.5% Blood Use CABG + AVR Surgery 3 Year Average = 47.5% Benchmark = 32.2% Symbols Key: CABG + AVR Metrics Hospital results for 2012 are within the range of the statewide average for that metric Hospital results for 2012 are statistically better than the risk adjusted Statewide average for that metric and/or have contributed to setting the benchmark for this measure Hospital results for 2012 are statistically not as good as the statewide average for that metric No data available for this hospital or no procedures done for this time period xxx Hospital is not currently releasing their data Black = Hospitals in full compliance with COAP s quality standards; Blue = hospitals in partial compliance with COAP s quality standards; Red = Hospitals out of compliance with COAP s quality standards Central Washington Hospital, Wenatchee Deaconess Hospital Rockwood Health, Spokane Harrison Medical Center, Bremerton Kadlec Medical Center, Richland Madigan Army Medical Center, Fort Lewis Northwest Hospital & Medical Center, Seattle Overlake Hospital Medical Center, Bellevue Providence Regional Medical Center, Everett Providence Sacred Heart Medical Center, Spokane Providence St. Peter Hospital, Olympia PeaceHealth St. Joseph Hospital, Bellingham PeaceHealth Southwest Washington Medical Center, Vancouver St. Joseph Medical Center, Tacoma Swedish Health Services, Cherry Hill, Seattle Tacoma General Hospital, Tacoma University of Washington Medical Center, Seattle Veteran s Affairs Medical Center, Seattle xxx xxx xxx xxx xxx xxx Virginia Mason Medical Center, Seattle Yakima Regional Medical & Heart Center, Yakima Mortality Renal Failure Stroke Arterial Graft Use Wound Infection Blood Use 2013 Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

27 Mitral Valve Repair or Replacement (MVRR) Surgery 3-Year Outcomes Metrics Key: click on each individual link below for a detailed explanation of what is measured and why Mortality - MVRR Surgery 3 Year Average = 2.6% Renal Failure MVRR Surgery 3 Year Average = 3.5% Stroke MVRR Surgery 3 Year Average = 0.9% Deep Sternal Wound Infection MVRR Surgery 3 Year Average = 0.1% Blood Use MVRR Surgery 3 Year Average = 28.5% Benchmark = 7.5% Symbols Key: MVRR Metrics Hospital results for 2012 are within the range of the statewide average for that metric Hospital results for 2012 are statistically better than the risk adjusted Statewide average for that metric and/or have contributed to setting the benchmark for this measure Hospital results for 2012 are statistically not as good as the statewide average for that metric No data available for this hospital or no procedures done for this time period xxx Hospital is not currently releasing their data Black = Hospitals in full compliance with COAP s quality standards; Blue = hospitals in partial compliance with COAP s quality standards; Red = Hospitals out of compliance with COAP s quality standards Central Washington Hospital, Wenatchee* Deaconess Hospital Rockwood Health, Spokane* Harrison Medical Center, Bremerton* Kadlec Medical Center, Richland Madigan Army Medical Center, Fort Lewis Northwest Hospital & Medical Center, Seattle Overlake Hospital Medical Center, Bellevue Providence Regional Medical Center, Everett Providence Sacred Heart Medical Center, Spokane Providence St. Peter Hospital, Olympia PeaceHealth St. Joseph Hospital, Bellingham PeaceHealth Southwest Washington Medical Center, Vancouver* St. Joseph Medical Center, Tacoma Swedish Health Services, Cherry Hill, Seattle Tacoma General Hospital, Tacoma University of Washington Medical Center, Seattle Veteran s Affairs Medical Center, Seattle xxx xxx xxx xxx xxx Virginia Mason Medical Center, Seattle Yakima Regional Medical & Heart Center, Yakima * Mortality Renal Failure Stroke Wound Infection Blood Use * <20 procedures for 3-year period Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June

28 CABG + Mitral Valve Repair or Replacement (MVRR) Surgery 3-Year Outcomes Metrics Key: click on each individual link below for a detailed explanation of what is measured and why Mortality CABG + MVRR Surgery 3 Year Average = 6.7% Renal Failure CABG + MVRR Surgery 3 Year Average = 11.5% Stroke CABG + MVRR Surgery 3 Year Average = 2.5% Arterial Graft Use CABG + MVRR Surgery 3 Year Average = 75.7% Benchmark = 93.1% Deep Sternal Wound Infection CABG + MVRR Surgery 3 Year Average = 0.6% Blood Use CABG + MVRR Surgery 3 Year Average = 46.7% Benchmark = 21.6% Symbols Key: CABG + MVRR Metrics Hospital results for 2012 are within the range of the statewide average for that metric Hospital results for 2012 are statistically better than the risk adjusted Statewide average for that metric and/or have contributed to setting the benchmark for this measure Hospital results for 2012 are statistically not as good as the statewide average for that metric No data available for this hospital or no procedures done for this time period xxx Hospital is not currently releasing their data Black = Hospitals in full compliance with COAP s quality standards; Blue = hospitals in partial compliance with COAP s quality standards; Red = Hospitals out of compliance with COAP s quality standards Central Washington Hospital, Wenatchee* Deaconess Hospital Rockwood Health, Spokane* Harrison Medical Center, Bremerton* Kadlec Medical Center, Richland* Madigan Army Medical Center, Fort Lewis Northwest Hospital & Medical Center, Seattle* Overlake Hospital Medical Center, Bellevue* Providence Regional Medical Center, Everett Providence Sacred Heart Medical Center, Spokane Providence St. Peter Hospital, Olympia PeaceHealth St. Joseph Hospital, Bellingham* PeaceHealth Southwest Washington Medical Center, Vancouver* St. Joseph Medical Center, Tacoma Swedish Health Services, Cherry Hill, Seattle Tacoma General Hospital, Tacoma* University of Washington Medical Center, Seattle* Veteran s Affairs Medical Center, Seattle xxx xxx xxx xxx xxx xxx Virginia Mason Medical Center, Seattle * Yakima Regional Medical & Heart Center, Yakima * Mortality Renal Failure Stroke Arterial Graft Use Wound Infection Blood Use * <20 procedures for 3-year period Foundation for Health Care Quality Clinical Outcomes Assessment Program Updated June