Heart & Vascular Institute & 2013 Outcomes
Measuring Outcomes Promotes Quality Improvement
Measuring and understanding outcomes of medical treatments promotes quality improvement. Cleveland Clinic has created a series of Outcomes books similar to this one for its clinical institutes. Designed for a physician audience, the Outcomes books contain a summary of many of our surgical and medical treatments, with data on patient volumes and outcomes and a review of new technologies and innovations. The Outcomes books are not a comprehensive analysis of all treatments provided at Cleveland Clinic, and omission of a particular treatment does not necessarily mean we do not offer that treatment. When there are no recognized clinical outcome measures for a specific treatment, we may report process measures associated with improved outcomes. When process measures are unavailable, we may report volume measures; a relationship has been demonstrated between volume and improved outcomes for many treatments, particularly those involving surgical and procedural techniques. In addition to these institute-based books of clinical outcomes, Cleveland Clinic supports transparent public reporting of healthcare quality data. The following reports are available to the public: Joint Commission Performance Measurement Initiative (qualitycheck.org) Centers for Medicare and Medicaid Services (CMS) Hospital Compare (hospitalcompare.hhs.gov), and Physician Compare (medicare.gov/physiciancompare) Ohio Department of Health (ohiohospitalcompare.ohio.gov) Cleveland Clinic Quality Performance Report (clevelandclinic.org/qpr) Our commitment to transparent reporting of accurate, timely information about patient care reflects Cleveland Clinic s culture of continuous improvement and may help referring physicians make informed decisions. We hope you find these data valuable, and we invite your feedback. Please send your comments and questions via email to: OutcomesBooksFeedback@ccf.org or scan here. To view all our Outcomes books, please visit Cleveland Clinic s Quality and Patient Safety Institute website at clevelandclinic.org/outcomes.
Dear Colleague: Welcome to this 2013 Cleveland Clinic Outcomes book. Every year, we publish Outcomes books for 14 clinical institutes with multiple specialty services. These publications are unique in healthcare. Each one provides a summary overview of medical or surgical trends, innovations, and clinical data for a particular specialty over the past year. We are pleased to make this information available. Cleveland Clinic uses data to manage outcomes across the full continuum of care. Our unique organizational structure contributes to our success. Patient services at Cleveland Clinic are delivered through institutes, and each institute is based around a single disease or organ system. Institutes combine medical and surgical services, along with research and education, under unified leadership. Institutes define quality benchmarks for their specialty services, and report on longitudinal progress. All Cleveland Clinic Outcomes books are available in print and online. Additional data are available through our online Quality Performance Report (clevelandclinic. org/qpr). The site offers process measure, outcome measure, and patient experience data in advance of national and state public reporting sites. Our practice of releasing annual outcomes reports has received favorable notice from colleagues and healthcare observers. We appreciate your interest and hope you find this information useful and informative. Sincerely, Delos M. Cosgrove, MD CEO and President
what s inside Chairman Letter 4 Introduction 5 Institute Overview 6 Quality and Outcomes Measures Surgical Overview 8 Ischemic Heart Disease Interventional Treatment 13 Surgical Treatment 15 AMI 20 Cardiac Rhythm Disorders 21 Valve Disease 28 Aortic Disease 38 Hypertrophic Obstructive Cardiomyopathy 48 Congenital Heart Disease 50 Pericardial Disease 53 Heart Failure and Transplant 55 Lung and Heart-Lung Transplant 58 Peripheral Vascular Disease 60 Cerebrovascular Disease 66 Thoracic Surgery 67 Preventive Cardiology and Rehabilitation 76 Surgical Quality Improvement 84 Patient Experience Heart & Vascular Institute 86 Cleveland Clinic Implementing Value-Based Care 88 Innovations 94 Contact Information 100 About Cleveland Clinic 102 Resources 104 Institute Resources 106 Prefer an e-version? Visit clevelandclinic.org/outcomesonline, and we ll remove you from the hard-copy mailing list and email you when next year s books are online.
Chairman Letter The Sydell and Arnold Miller Family Heart & Vascular Institute has shared patient outcomes with the public since 1998. Our mission is to offer transparent data to provide a clear picture of the work we do to help guide the healthcare decisions of our patients and also to help us understand how we are doing so we can create new challenges and goals for ourselves. The importance of outcomes is becoming even more significant as we travel into an era of value-based healthcare. Our focus is not only on volume, but also on the quality of care we provide and access to that care. The Miller Family Heart & Vascular Institute has consistently been the leader in volume, quality outcomes, and access to the highest quality cardiovascular care. This combination is a powerful one that we are proud of, but we are always striving to improve. As we continue to work toward developing and implementing innovative methods and strategies to treat our patients, we are also working toward innovative solutions to ensuring access to affordable, quality care. We welcome your feedback, questions and ideas for collaboration. Please contact me via email at OutcomesBooksFeedback@ccf.org and reference the Heart & Vascular Institute book in your message. Sincerely, Bruce W. Lytle, MD Chairman, Miller Family Heart & Vascular Institute 4 Outcomes 2013
Introduction Cleveland Clinic is the nation s leader in cardiovascular care and is home to many of the world s best heart, vascular and thoracic specialists. They work with referring physicians to coordinate care and achieve the best possible outcomes and experience for every patient. The Sydell and Arnold Miller Family Heart & Vascular Institute is located at Cleveland Clinic s main campus. A total of 189 staff physicians, 121 residents and fellows, and 1,400 nurses are dedicated to the care of patients with cardiovascular, thoracic and vascular disease. The comprehensive care they provide includes collaboration with 54 vascular surgery and cardiovascular intensive care anesthesiologists and 3,000 Cleveland Clinic staff physicians in 120 medical and surgical specialties and subspecialties. Sydell and Arnold Miller Family Heart & Vascular Institute 5
Institute Overview Heart & Vascular Institute Overview 2013 Patient Visits 448,229 Admissions 13,767 Beds 422 Coronary Intensive Care 24 Heart Failure Intensive Care 10 Cardiac, Vascular and Thoracic Surgery Intensive Care 76 Private Patient Rooms 283 Same-Day Recovery 29 Surgical Procedures Cardiac Surgery Cardiac Surgeries 4405 Valve Surgeries 2852 Coronary Artery Bypass Grafting (Isolated and Concomitant) 1296 Surgeries for Septal Myectomy 205 Congenital Heart Surgeries (Adult and Pediatric) 306 Robotically Assisted Cardiac Surgeries 167 Transplant Surgery Heart Transplants 44 Lung Transplants 98 Thoracic Surgery General Thoracic Surgeries 1555 Esophageal Surgeries 293 Vascular Surgery Vascular Surgeries (Open and Endovascular) 3291 Bypass Surgeries 228 Arteriovenous Access Surgeries 416 The data reported in the Institute Overview reflect volumes at Cleveland Clinic s main campus only. Data in other areas of the book may reflect volumes for main campus and other Cleveland-area Cleveland Clinic hospitals. For a complete list of Cleveland Clinic hospitals, visit clevelandclinic.org. 6 Outcomes 2013
Aortic Surgery Open Ascending Aorta and Aortic Arch Repairs 676 Open Descending Aorta and Thoracoabdominal Repairs 113 Open Abdominal Aortic Aneurysm Repairs 101 Endovascular Descending Aorta and Thoracoabdominal Repairs 250 Endovascular Abdominal Aortic Aneurysm Repairs 79 Cardiovascular Medicine Procedures Interventional Cardiology Diagnostic Cardiac Catheterizations 7463 Interventional Cardiac Procedures 1594 Percutaneous Aortic Valvuloplasties 223 Percutaneous Mitral Valvuloplasties 7 Percutaneous Atrial Septal Defect and Patent Foramen Ovale Closures 52 Vascular Intervention Interventional Carotid Procedures 344 Interventional Vascular Procedures 1043 Patients from 75 countries came to Cleveland Clinic for their cardiovascular care in 2013. In 2013, patients traveled from all 50 states to Cleveland Clinic for their cardiovascular care. Electrophysiology Electrophysiology Ablations 1427 Ablations for Atrial Fibrillation 811 Device Implants 1445 Leads Extracted 334 Diagnostic and Cardiac Imaging Echocardiograms 74,552 Cardiac Computed Tomography (CT) Scans 7836 Cardiac Magnetic Resonance Imaging (MRI) Scans 5989 Nuclear Cardiology Tests Tc-Myoview-Rest 4275 Tc-Myoview-Stress 4222 Rubidium Heart (PET) 681 FDG Heart (PET) 494 MUGA 105 N-13 Ammonia Heart 109 Stress Tests 6636 Sydell and Arnold Miller Family Heart & Vascular Institute 7