Outcomes - Cleveland Clinic

Transcription

Endocrinology & Metabolism Institute
2011
Outcomes
To promote quality improvement, Cleveland Clinic has created a series of
Outcomes books similar to this one for many of its institutes. Designed for a
physician audience, the Outcomes books contain a summary of our surgical and
medical trends and approaches, data on patient volumes and outcomes, and a
review of new technologies and innovations.
Although we are unable to report all outcomes for all treatments provided at
Cleveland Clinic — omission of outcomes for a particular treatment does not
necessarily mean we do not offer that treatment — our goal is to increase
outcomes reporting each year. When outcomes for a specific treatment are
unavailable, we often report process measures associated with improved
outcomes. When process measures are unavailable, we may report volume
measures; a volume/outcome relationship has been demonstrated for many
treatments, particularly those involving surgical techniques.
In addition to our internal efforts to measure clinical quality, Cleveland Clinic
supports transparent public reporting of healthcare quality data and participates
in the following public reporting initiatives:
• Joint Commission Performance Measurement Initiative (qualitycheck.org)
• Centers for Medicare & Medicaid Services (CMS) Hospital Compare
(hospitalcompare.hhs.gov)
• Ohio Department of Health (ohiohospitalcompare.ohio.gov)
• Cleveland Clinic Quality Performance Report (clevelandclinic.org/QPR)
Our commitment to providing accurate, timely information about patient care also
will help patients and referring physicians make informed healthcare decisions.
We hope you find these data valuable, and we invite your feedback. Please send
comments and suggestions to us at [email protected]. To view
all our Outcomes books, please visit Cleveland Clinic’s Quality and Patient Safety
website at clevelandclinic.org/outcomes.
Dear Colleague:
Welcome to Cleveland Clinic’s 2011 Outcomes
books. They include data on clinical outcomes,
patient volumes, innovations and publications.
Cleveland Clinic pioneered the collection and
annual publication of outcomes data. This initiative
has become part of the national discussion on
lowering costs and improving the quality of
healthcare.
Cleveland Clinic uses data to manage outcomes
across the full continuum of care. Clinical services
are delivered through patient-centered institutes,
each based around a single disease or organ
system. Institutes combine medical and surgical
services, along with research and education, under
unified leadership. Each institute defines quality
benchmarks for its specialty services and reports
longitudinal progress.
Cleveland Clinic Outcomes books are available
in print and online. Additional data is available
through our online Quality Performance Report
(clevelandclinic.org/QPR). The site offers data in
advance of national and state public reporting sites
in key areas, including heart attack, heart failure,
stroke and infection prevention.
We hope you will find this information useful.
Sincerely,
Delos M. Cosgrove, MD
CEO and President
what’s inside
Chairman’s Letter
04
Institute Overview
06
Quality and Outcomes Measures
Adrenal
12
Diabetes
16
Liver 18
Obesity
20
Thyroid and Parathyroid
30
Surgical Quality Improvement
34
Patient Experience
36
Innovations40
Selected Publications
42
Staff Listing
50
Contact Information
52
Institute Locations
54
Improving Quality, Safety and the Patient Experience
56
About Cleveland Clinic
61
Resources
63
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Chairman’s Letter
Dear Colleague:
On behalf of Cleveland Clinic’s Endocrinology & Metabolism
Institute, I am pleased to share our 2011 Quality Outcomes
book. Quality, patient safety, patient experience and employee
engagement remain top priorities for us.
This past year our institute saw both growth and innovation.
In year two of our Diabetes Center’s operation, we educated
more than 1,000 patients and conducted numerous research
studies. Our main campus diabetes educators spearheaded
the standardization of diabetes education across Cleveland
Clinic. Diabetic educators across our health system worked
together to develop one common curriculum.
We also began to offer bariatric surgeon consults in the
Diabetes Center in 2011. Obese patients are counseled about
the options for and timing of weight-loss surgery to control
type 2 diabetes.
In 2011, we established an Endocrine Calcium Clinic to streamline the evaluation and treatment of patients with
mineral abnormalities, bone loss, unexplained fractures and similar disorders. Bone density scans (DEXA) for osteoporosis,
an on-site laboratory and an infusion center for bisphosphonates and other therapies are available.
In our Bariatric & Metabolic Institute’s Medical Weight Management Program, we began offering shared medical
appointments for patients on the protein-sparing modified fast protocol. We also offered exercise coaching to enhance
patients’ commitment to maintaining and improving fitness.
Research continues to be an important part of what we do every day in our institute. It keeps us and all who practice in
our field on the cutting edge of treatment for obesity, liver/adrenal tumors, thyroid cancer, pituitary disorders and diabetes.
This past year, for example, our Bariatric & Metabolic Institute launched the NIH-funded STAMPEDE II trial to compare
laparoscopic Roux-en-Y surgery with medical management options. The results of STAMPEDE I, which concluded
recruitment in 2010, were published in the New England Journal of Medicine and were presented at the 2012 American
College of Cardiology meeting.
4
Outcomes 2011
Meanwhile, our endocrinologists and surgeons now offer care at 12 community locations,
including a new Family Health and Surgery Center in Twinsburg, Ohio, the Ashtabula County
Medical Center and Cleveland Clinic Florida in Weston. This helps to ensure patient access to
high-quality endocrinologic and metabolic care across Northeast Ohio and in Florida.
The Endocrinology & Metabolism Institute continues to take on all of the clinical challenges
that chronic disease management has to offer. We invite you, our colleagues, to review in
detail the programs, projects and outcomes summarized in this text. We hope you find this
booklet informative and applicable to your practice. We truly want to collaborate and develop
a relationship with all providers for a healthier community.
James B. Young, MD
Chairman, Endocrinology & Metabolism Institute
Professor of Medicine and Executive Dean, Cleveland Clinic Lerner College of Medicine
The George M. and Linda H. Kaufman Chair in Cardiovascular Medicine
5
Institute Overview
Institute Overview
Cleveland Clinic’s Endocrinology & Metabolism
Institute is committed to providing the highest
quality healthcare for patients with diabetes,
endocrine and metabolic disorders, and obesity.
Our staff is dedicated to exploring ways to improve
the care of these patients and to teaching the
best methods for treating them. Our diabetes and
endocrinology services are ranked fifth in the nation
by U.S.News & World Report.
Our institute’s caregivers work together to provide
the finest care in the country. Thirty staff physicians,
18 fellows, and more than 80 nurses, medical
assistants, diabetes educators, secretaries, patient
service representatives, coders, administrators and
managers work in our:
•
•
•
•
6
Department of Endocrinology,
Diabetes and Metabolism
Diabetes Center
Center for Endocrine Surgery
Bariatric & Metabolic Institute
Outcomes 2011
Department of Endocrinology, Diabetes and Metabolism
Endocrinology
Total Patient Visits
New Patient Visits
Total Fine Needle Aspirations
Diabetes Center
New Patient Visits
Education Visits
2009
2010
2011
23,103
1,006
456
27,465
1,435
489
38,293
1,709
708
2009
2010
2011
n/a
n/a
n/a
1,015
330
109
5,835
828
1,048
Diabetes Center
Cleveland Clinic's Diabetes Center continues to optimize care
for patients with Type 1 and Type 2 diabetes. The center’s
caregivers are dedicated to diabetes care and include:
•
•
•
•
•
•
Physicians
Nurses and medical assistants
Certified nurse practitioners
Diabetes educators
Registered dietitians
Surgeons, including a bariatric surgeon who offers
consults to obese patients on the advisability and
timing of weight-loss surgery for diabetes control
Research studies on many new tools for managing diabetes
are ongoing. Our inpatient multidisciplinary team contributes
to the Diabetic Care Committee, addressing quality initiatives
and the unique needs of diabetic patients throughout the
hospital — from assessing patient knowledge of insulin
pumps to optimal delivery of steroids.
Our Diabetes Education Task Force has
successfully implemented a single diabetes
education system across the entire Cleveland
Clinic system to ensure that patients with
diabetes receive the same teaching at the
location of their choice. Diabetes education
now focuses on seven themes of care:
•
•
•
•
•
•
•
Healthy eating
Being active
Glucose monitoring
Taking medication
Problem-solving
Reducing risk
Healthy coping
The Task Force also implemented a new single
telephone number that will enable our patients
to make one call to schedule their diabetes
education classes at the most convenient
location and time.
7
Institute Overview
Calcium Clinic
The Calcium Clinic based in our Department of Diabetes, Endocrinology
and Metabolism streamlines the evaluation and treatment of mineral
abnormalities, bone loss, unexplained fractures and similar conditions.
The clinic benefits patients with:
•
•
•
•
Common problems such as hypocalcemia,
vitamin D deficiency, hyperparathyroidism,
osteopenia, primary osteoporosis, renal stones and
abnormal DEXA results
Bone disorders such as Paget’s disease, secondary
osteoporosis and other rare diseases
Complex underlying problems that increase the risk
of metabolic abnormalities, such as inflammatory
bowel disease, cancer and renal failure
Metabolic abnormalities that occur after bariatric
surgery and organ transplantation
The Endocrinology & Metabolism Institute conducts many other
disease-specific clinics for Type 1 and Type 2 diabetes, pituitary
disorders, thyroid/parathyroid disorders, post-pancreas-transplant
diabetes, and post-pancreas-transplant care, and liver/adrenal tumor
care. We also offer a preventive cardiology clinic and a transition clinic
for adolescents ready to move on to adult endocrine care.
8
Outcomes 2011
Center for Endocrine Surgery
Endocrine Surgery
2009
2010
2011
3,934
4,271
4,770
Endocrine Surgery
588
680
865
Total Fine Needle Aspirations
302
337
373
Our endocrine surgery service has the most extensive experience
in the world in the surgical care of thyroid, parathyroid, adrenal,
endocrine and pancreas disorders. Advanced minimally invasive
technology is often utilized:
•
•
•
We perform robotic adrenalectomies, thyroidectomies
and parathyroidectomies.
We are one of the busiest centers in the country
for laparoscopic radiofrequency thermal ablation of
neuroendocrine tumors that metastasize to the liver.
We offer a laparoscopic liver resection program.
Our endocrine surgery team’s thyroid and parathyroid surgery
case volume has more than quadrupled in the past 10 years.
Patients are increasingly referred for complex conditions such
as reoperative problems, advanced cancers and hereditary
endocrine syndromes.
9
Institute Overview
2009
2010
2011
18,570
21,277
22,140
329
451
411
Laparoscopic Sleeve Gastrectomy Surgery
63
81
91
Laparoscopic Adjustable Gastric Band Surgery
67
55
44
Other Bariatric Surgery
102
105
98
Total Bariatric Cases
561
692
644
Total Patient Visits (Bariatric and General)
Gastric Bypass Surgery
In this institute, our ultimate goal is to manage all degrees of obesity and its comorbidities. For patients with
severe obesity, we offer various minimally invasive approaches to bariatric surgery. A large team of caregivers
participates in patient care, teaching and research.
Ours is one of the few U.S. bariatric centers recognized as a Center of Excellence by both the American Society
for Metabolic & Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). This designation is
awarded only after independent program review and demonstration of the highest-quality patient management
and outcomes.
Our state-of-the-art bariatric care facility includes an inpatient bariatric unit, an adjacent outpatient clinic, an
endoscopy suite, patient waiting and conference rooms, and physician and support staff offices — all on one
floor for patients’ convenience.
10
Outcomes 2011
Basic and Clinical Research
The Metabolic Translational Research Center — formed in partnership
with Cleveland Clinic’s Lerner Research Institute in 2010 — is based
in the Endocrinology & Metabolism Institute. The center is designed to
develop, promote, facilitate and support:
• Interdisciplinary basic and clinical translational research in
obesity, endocrinology and metabolism
• Education and training in conducting endocrine and metabolic
disease research for medical students, graduate students,
residents, fellows and junior staff
Institute staff members are active not only in translational and basic
research, but also in clinical research. On average, we actively enroll
patients in about 20 trials at any given time. Our trials are sponsored
by both government and industry.
Subspecialty Education
Cleveland Clinic Endocrinology & Metabolism Institute continuing
education courses continue to be in demand. They include:
• Thyroid Expo: A Multidisciplinary Symposium on Thyroid
Diseases and Thyroid Cancer
• Update on the Management of Adrenal Diseases and Lesions
• Update on Minimally Invasive Solid Organ Surgery
• Obesity Summit: Science and Practice of Obesity Management
• Annual Diabetes Day: Controversies in Diabetes for
Healthcare Professionals
• Endocrinology, Metabolism and Diabetes Annual Board
Review Course
• Contemporary Issues in Pituitary Disease: Case-based
Management Update
• Advanced Practice Nursing Endocrine Review Day
(First Annual Meeting in 2011)
11
Surgical
AdrenalOverview
Adrenalectomy Cases Mean Length of Stay
Adrenalectomy Cases Requiring Intensive Care
2009 − 2011
2009 − 2011
Days
Percent
5
30
4
25
20
3
15
2
10
1
0
5
Cleveland Clinic
N=
USNews Top 10 Teaching Hospitals
97
876
3,040
0
Cleveland Clinic
N=
97
876
3,040
Adrenalectomy Mortality
2009 − 2011
Over three years, on average, Cleveland Clinic’s
mortality rate and percentage of cases requiring
ICU stay were lower, and observed length of stay
was shorter than both teaching and U.S.News
Top 10 hospitals.
Percent
0.4
0.3
Source: University HealthSystem Consortium (UHC)
Performance Accelerator Suite Program
0.2
0.1
0
0
Cleveland Clinic
N=
12
97
876
3,040
Outcomes 2011
Adrenalectomy Cases (Tumors > 5 cm)
Mean Operative Time by Surgical Approach
2000 − 2011
Minutes
200
190
180
170
160
150
140
N=
Laparoscopic
Robotic
38
24
Robotic adrenalectomy operative times were shorter than the
laparoscopic approach.
Adrenalectomy Cases (Tumors > 5 cm)
Mean Length of Stay
2000 − 2011
Days
3.0
2.5
2.0
1.5
1.0
0.5
0
N=
Laparoscopic
Robotic
38
24
The length of stay for robotic adrenalectomy was shorter than average and
there were no complications compared to the laparoscopic surgical approach.
13
Surgical
AdrenalOverview
All Robotic Cases
(Year Initiated)
Adrenal 74
(2008)
Thyroid 21
(2009)
Liver 15
(2008)
Parathyroid 7
(2010)
Surgery for Large (≥ 5 cm) Adrenal Tumors
Demographic and Clinical Parameters by Surgery Approach
2000 – 2011
Parameters
Laparoscopic
Robotic
(N = 38)
(N = 24)
Age
52.5 ± 2.3
52.4 ± 2.9
0.987
Body Mass Index
30.2 ± 0.9
27.1 ± 0.8
0.029
20 / 18
14 / 10
0.642
6.2 ± 0.3
6.5 ± 0.4
0.661
(5 – 15)
(5 – 10.2)
10 (27%)
7 (29%)
0.932
187.2 ± 8.3
159.4 ± 13.4
0.043
(range)
(85 – 290)
(64 – 357)
Hospital Stay (days)
1.9 ± 0.1
1.4 ± 0.2
0.009
4
1
0.043
3.7%
0%
N/A
Gender (female / male)
Tumor Size (cm)
(range)
Previous Abdominal Surgery
Operative Time (minutes)
Conversion to Open Surgery
30-day Morbidity
14
P value
Outcomes 2011
Posterior Retroperitoneal (PR) Adrenalectomy
Demographic, Clinical and Perioperative Parameters for Robotic
and Laparoscopic PR Approaches
2009 – 2011
Parameters
Robotic
(N = 31)
Laparoscopic
(N = 31)
P value
Age
52.5 ± 2.3
53.2 ± 2.0
0.374
Body Mass Index
27.5 ± 0.7
30.3 ± 0.8
0.076
21 / 10
17 / 14
0.220
3.1 ± 0.2
3.0 ± 0.2
0.477
163.2 ± 10.1
165.7 ± 9.5
0.428
Median Length of Stay (days)
1
1
0.411
Pain Score on Post-op Day 1
2.5 ± 0.3
4.2 ± 0.4
0.008
Gender (female / male)
Tumor Size (cm)
Operative Time (minutes)
Posterior Retroperitoneal Adrenalectomy Pain Assessment and Surgical Approach
2009 − 2011
*Rating
Robotic posterior retroperitoneal (PR)
adrenalectomy is a relatively new surgical
technique utilized by Cleveland Clinic
surgeons since 2009 that has resulted
in slightly shorter operative times and
significantly less immediate postoperative
pain (P = 0.008) compared with the
laparoscopic PR surgical approach.
5
4
3
2
1
0
N=
Laparoscopic
Robotic
31
31
*Rating is based on Visual Analog Scale.
15
Diabetes
Diabetes Center and Main Campus Endocrinology
Outpatient Visits for Diabetes Mellitus
2010 − 2011
Visits
600
Education
Established
New
500
400
300
200
100
0
*S O N D J F M A M J
2010
J A S O N D
2011
*In September 2010, the Diabetes Center was
established, and education visits have seen a steady
increase in volume.
Diabetes Center and Main Campus Endocrinology
New Diabetes Visits by Diagnosis (N = 1,203)
2010 − 2011
Patients
1,000
800
600
400
200
0
16
Type 2
Type 1
Pre-Diabetes
Outcomes 2011
New Patients' Change in Hemoglobin A1c Over Time
2010 − 2011
Percentage Points
2
1
0
-1
-2
-3
-4
-5
-6
Baseline A1c All Patients <6.5 6.5 – 8.0 8.1 – 10.0
461
127
160
111
N=
>10.0
63
Data were collected on new patients seen in Endocrinology and the Diabetes
Center, which opened in September 2010. Changes in hemoglobin A1c
values from baseline to last visit were compared (mean +/- SD).
Insulin Pump and Current HbA1c Values (N = 207)
2011
Percent
60
50
40
30
20
10
0
<7
7–9
HbA1c
>9
Data were collected on adult patients who were using an insulin pump to manage their
Type 1 diabetes mellitus. Mean HbA1c was 8.5% (+/-SD 1.9%) (range 4.6 – 15.7%).
The most recently collected HbA1c value was evaluated. Mean duration of insulin pump
usage was 5.5 years (+/- SD 5.1 years), ranging from one to 20 years.
17
Liver
Radiofrequency Ablation of Neuroendocrine Tumors
From 2000 to 2010, Cleveland Clinic endocrine
surgeons treated 68 patients with neuroendocrine
liver metastases with radiofrequency ablation
(RFA) as a first line of treatment. RFA was
commonly used as an initial treatment compared
with other modalities such as liver resection or
embolization. Patients undergoing RFA had up to
15 discrete lesions.
Demographics and Clinical Information (N = 68)
2000 − 2010
Age
56.9 ± 1.5
Gender
Female
Male
27 (40%)
41 (60%)
Tumor Type
Carcinoid
Pancreatic Islet Cell
Medullary Thyroid
44 (65%)
15 (22%)
9 (13%)
Dominant Metastasis Size (cm)
3.6 ± 0.2
Number of Metastases
6.7 ± 0.5
Extrahepatic Disease
23 (34%)
Symptomatic
37 (54%)
Liver Metastasis
Synchronous
Metachronous
25 (41%)
36 (59%)
Chromogranin A (ng/ml)*
Primary Tumor
Resected
Nonresected
Unknown
RFA
Laparoscopic
Open
278 ± 129
53 (78%)
8 (12%)
7 (10%)
67 (98.5%)
1 (1.5%)
Resection
Wedge
Segmentectomy
Bisegmentectomy
Hemihepatectomy
8 (30%)
3 (11%)
6 (22%)
10 (37%)
Embolization
Chemoembolization
Radioembolization
Both
16 (57%)
10 (36%)
2 (7%)
*Normal range for chromogranin A: 6 – 39 ng/ml
18
Outcomes 2011
Periprocedural Outcomes, Survival and Pattern of Recurrence (N = 68)
2000 − 2010
Residual Liver Tumor
24 (35%)
Symptom Relief
29 (78%)
Duration of Symptom Relief (months)
19.8 ± 4.3
Complication
Length of Stay (days)*
7 (10%)
1.0 ± 0.5
Follow-up (months)
22
Overall Survival (months)
73
Progression-Free Survival (months)
10.5
Local Liver Recurrence**
22%
New Liver Lesion
63%
New Extrahepatic Lesion
43%
*Median
**Local recurrence is per patient, not per lesion.
19
Obesity
Obesity/Metabolism
Bariatric Cases by Type
2006 − 2011
In 2011, Cleveland Clinic Bariatric &
Metabolic Institute marked its seventh
anniversary and continued to be accredited
as a designated Bariatric Surgery Center
of Excellence by the American Society
for Metabolic & Bariatric Surgery and
the American College of Surgeons. This
designation is awarded to programs that
meet high-quality standards and perform a
minimum of 125 procedures annually.
Cases
Banded Plication
Other
Gastric Plication
Revisions
Sleeve
Band
Bypass
800
600
400
200
0
2006
N= 326
2007
2008
2009
2010
2011
409
589
561
692
644
Laparoscopic Roux-en-Y gastric bypass continues to be the
predominant procedure at Cleveland Clinic. Due to patient
preference, laparoscopic adjustable gastric banding has
declined over the past two years.
Bypass
20
Sleeve
Band
Gastric Plication
Banded Plication
Outcomes 2011
Comorbidities at Baseline for Bariatric Surgery
2009 − 2011
Percent
50
Cleveland Clinic (N = 1,726)
*ACS Bariatric Comparison (N = 65,381)
40
30
20
10
0
OSA
Diabetes MusculoHx
Mellitus skeletal Smoking
Disease
Hx
DVT Tx
Hx
PCI
Hx
MI
Steroids/
Hx
Immuno- Cardiac
suppression Surgery
Oxygen
Dependent
Renal
Insuff./
Dialysis
OSA = Obstructive Sleep Apnea
Hx DVT Tx = Deep Vein Thrombosis Treatment
Hx PCI = History of Percutaneous Coronary Intervention
Hx MI = History of Myocardial Infarction
For all comorbidities except smoking, Cleveland Clinic bariatric surgery patients were higher-risk at baseline compared
with the American College of Surgeons Bariatric Surgery Database.
*As a Level 1A accredited American College of Surgeons (ACS) Bariatric Center, Cleveland Clinic participates in the
ACS Bariatric Surgery Database, a national program that objectively measures and reports risk-adjusted surgical
outcomes for 100 percent of bariatric surgery cases at participating facilities. Hospitals with the Level 1A certification
are recognized for high-volume practices and management of the most challenging and complex patients.
21
Obesity
Laparoscopic Roux-en-Y Length of Stay
2009 − 2011
Laparoscopic Gastric Banding Length of Stay
2009 − 2011
Days
Days
Cleveland Clinic
American College of Surgeons
5
5
4
4
3
3
2
2
1
1
0
N=
*ACS =
2009
2010
2011
353
8,555
446
11,006
391
11,191
0
N=
*ACS =
Cleveland Clinic
2009
2010
2011
85
7,182
51
7,936
43
5,602
Cleveland Clinic Source: Surgical Review Corporation:
Bariatric Outcomes Longitudinal Database
*ACS = American College of Surgeons Bariatric
Surgery Database
Cleveland Clinic bariatric patients have higher-risk
baseline demographics and comorbidities.
22
Outcomes 2011
Laparoscopic Sleeve Gastrectomy Length of Stay
2009 − 2011
Days
5
4
Cleveland Clinic
3
2
1
0
N=
*ACS =
2009
2010
2011
52
4
65
1,434
79
4,669
Cleveland Clinic Source: Surgical Review Corporation:
Bariatric Outcomes Longitudinal Database
Surgery Database
Cleveland Clinic bariatric patients have higher-risk
baseline demographics and comorbidities.
23
Obesity
Cleveland Clinic bariatric surgery patients were higher risk at baseline compared with
patients in the American College of Surgeons Bariatric Surgery Database.
Bariatric Surgery Complications (30 Days, Non-risk Adjusted)
Laparoscopic Roux-en-Y (N = 1,186)
2009 − 2011
Percent
2.0
Cleveland Clinic
1.5
1.0
0.5
0
Bleeding
Intestinal
Obstruction
Anastomotic
Leak
Wound
Infection/
Evisceration
Pulmonary
Embolism
Deep
Vein
Thrombosis
*ACS = American College of Surgeons Bariatric Surgery Database
24
Outcomes 2011
Bariatric Surgery Complications (30 Days, Non-risk Adjusted)
Laparoscopic Adjustable Gastric Band (N = 154)
2009 − 2011
Percent
1.00
Cleveland Clinic
0.75
0.50
0.25
0
0
Wound
Infection/
Evisceration
0
Band Port,
Tubing or
Band Problem
0
Band
Slippage/
Prolapse
American College of Surgeons Bariatric Surgery Database comparisons showed that
complications of laparoscopic gastric banding were low.
25
Obesity
Unplanned ICU Admissions within 30 Days of Bariatric Surgery
(Non-risk Adjusted)
2009 − 2011
Percent
10
Cleveland Clinic
ACS Bariatric Comparison
8
6
4
2
0
Laparoscopic
Roux-en-Y
N=
*ACS =
1,221
31,132
Laparoscopic
Adjustable
Gastric Band
162
20,805
Despite the relatively high-risk patient population, 5 percent or less
of bariatric procedures required postoperative ICU stays.
26
Outcomes 2011
30-Day Bariatric Surgery (Non-risk Adjusted)
Percent Mortality
2009 – 2011
Cleveland Clinic
(# Cases; % All Operations)
*ACS Comparison
(# Cases; % All Operations)
All Operations
0.3% (1,725; 100%)
0.1% (61,735; 100%)
Laparoscopic Roux-en-Y
0.4% (1,221; 70.8%)
0.1% (30,033; 48.6%)
Laparoscopic Gastric Banding
0.6% (162; 9.4%)
0.0% (19,274; 31.2%)
Laparoscopic Sleeve Gastrectomy
0.0% (124; 7.2%)
0.1% (5,816; 9.4%)
Other Bariatric Procedures
0.0% (217; 12.6%)
0.2% (6,667; 10.8%)
*American College of Surgeons Bariatric Surgery Database
27
Obesity
Mean Percent Weight Loss Toward Ideal Body Mass
Index (Non-risk Adjusted): 3-Year Follow-up
2008 − 2011
Percent
Cleveland Clinic
80
60
Percent
40
20
N=
ACS =
Most Common Reasons for Not Reaching Bariatric
Surgery After 15 Months (N = 129)
2011
40
0
The Bariatric & Metabolic Institute’s Behavioral Health
team examined why patients who begin the pre-operative
bariatric surgery evaluation fail to complete surgery or drop
out of bariatric programs.
30
All Cases
Lap Roux-en Y
Lap Band
120
2,216
67
995
27
1,030
20
10
Weight Loss Formula: (baseline BMI – follow-up BMI)
/ (baseline BMI – ideal BMI(25)) x 100
Surgery Database
0
Withdrawal for Unknown Cause after Clearing Psychology
Insurance Denial
Outstanding Psychological or Medical Requirements
Surgery Scheduled then Patient Cancelled
Switched to Non-Surgical Weight Management
Moved Out of Area
Death While Waiting for Surgery
Out of 518 patients evaluated, 129 did not receive surgery
after 15 months. Patients with outstanding program
requirements (either medical or psychological were more
likely to be involved in outpatient behavioral health
programs, or taking psychotropic medication(s) or to have
current or past alcohol abuse/dependence than patients who
had not undergone surgery for other reasons.
28
Outcomes 2011
Concerns have been raised about an increased incidence of substance
abuse post-bariatric surgery. Alcohol use after surgery may be particularly
problematic due to changes in patients' pharmacokinetics in relation to
alcohol, leading to greater intoxication.
Cleveland Clinic Bariatric & Metabolic Institute has created the Substance
Risk Reduction Group, a unique relapse prevention group for at-risk
bariatric surgery candidates. The session includes education about the
health effects of alcohol and other substances on outcomes, as well as
ways to develop alternative coping strategies and identify warning signs
of relapse and resources for treatment.
Effect of a Single-Session Group Intervention on Knowledge Test
Scores to Reduce Risk from Alcohol and Substances (N = 37)
2011
Percent
100
80
60
40
20
0
Pre-Test
Post-Test
Knowledge about Alcohol and Weight Loss Surgery
After the intervention, patients showed a significant increase in knowledge
(P < .0001) regarding the negative effects of substance abuse after surgery
and reported significantly healthier coping strategies (P < .0001). Patients
also reported a lower intention of using alcohol post-surgery (P < .01).
29
Thyroidectomy Mean Length of Stay
Thyroidectomy Cases Requiring ICU Stay
2009 − 2011
2009 − 2011
Days
Percent
2.0
8
7
1.5
6
5
4
3
2
1
0
1.0
0.5
0
Cleveland Clinic
N=
504
2,368
9,157
Cleveland Clinic
N=
504
2,368
9,157
Thyroidectomy Mortality
2009 − 2011
mortality and percentage of cases requiring ICU
stay were lower, and observed length of stay
Top 10 hospitals.
Percent
0.12
0.10
0.08
0.06
0.04
0.02
0
0
Cleveland Clinic
N=
30
504
2,368
9,157
Outcomes 2011
Robotic-Assisted Transaxillary Thyroidectomy
2010
2011
Number of Patients
11
10
Age Range (years)
31 – 66
23 – 75
Gender (female %)
100
100
BMI Range (kg/m2)
19.9 – 23.7
19.6 – 31.6
Nodule Size Range (mm)
10.2 – 31.9
9.0 – 39.0
Left Hemithyroidectomy
3
0
Right Hemithyroidectomy
2
2
Total Thyroidectomy
6
8
Benign
6
4
Carcinoma
5
6
241.0 ± 61.8
140.6 ± 7.9
1
0
Operation Performed
Post-operative Histology
Operation Time (minutes)
Complications
Transient Hypocalcemia
31
Parathyroidectomy Mean Length of Stay
Parathyroidectomy ICU Cases
2009 − 2011
2009 − 2011
Days
Percent
4
8
3
6
2
4
1
2
0
0
Cleveland Clinic
N=
389
816
3,201
0
Cleveland Clinic
N=
389
816
3,201
Parathyroidectomy Mortality
2009 − 2011
mortality and percentage of cases requiring ICU
stay were lower, and observed length of stay
Top 10 hospitals.
Percent
0.20
0.15
0.10
0.05
0
0
Cleveland Clinic
N=
32
389
0
816
3,201
Outcomes 2011
Cure Rate After Reoperation for Hyperparathyroidism
(N = 176)
2000 − 2009
Percent
100
80
Unsuccessful
Successful
60
40
20
0
From 2000 to 2009, 203 patients with hyperparathyroidism were
evaluated for reoperative neck surgery. Of these 203, 176 patients
met criteria for reoperative parathyroid exploration. The information
provided by localization studies and clinical history was applied
in the stratification of patients by disease status and reoperative
approach.The cure rate after reoperation was 96 percent.
33
Surgical Quality Improvement
National Surgical Quality Improvement Program
The American College of Surgeons’ National Surgical Quality Improvement
Program (NSQIP) objectively measures and reports risk-adjusted surgical
outcomes based on a defined sampling and abstraction methodology.
The outcome data below reflect Cleveland Clinic's surgical cases between
July 1, 2010, and June 30, 2011.
Overall Multispecialty 30-Day Mortality (N = 4,643)
July 2010 – June 2011
Percent
4
3
2
1
0
Observed
Expected
Overall multispecialty mortality was lower than expected; the
difference was statistically significant.
34
Outcomes 2011
Surgical Care Improvement Program (SCIP) — Appropriateness of Care
This composite metric, based on 10 hospital surgical quality process measures developed by the Center
for Medicare and Medicaid Services (CMS), shows the percentage of patients who received all of the
recommended care for which they were eligible.
Surgical Appropriateness of Care
2010 – 2011
Percent
100
92.3
80
84.8
96.0
Cleveland Clinic, 2010 (N = 1,501)
Cleveland Clinic, 2011 (N = 1,501)
UHC Top Decile, 2011*
60
40
20
0
* Data source: University HealthSystem Consortium (UHC) Clinical Database
https://www.uhc.edu
Cleveland Clinic has set a target of UHC’s 90th percentile, and results are
trending positively.
35
Patient Experience
Cleveland Clinic is dedicated to delivering excellent clinical
outcomes and the best possible experience for our patients and
their families. Patient feedback is critical in driving priorities and
assessing results. Based on this feedback, Cleveland Clinic's Office
of Patient Experience implements training programs to improve
service and communication as well as educational initiatives to help
patients understand what to expect when they are in our care.
Outpatient – Endocrinology & Metabolism Institute
Overall Rating of Outpatient Care and Services During Outpatient Visit
2010 – 2011
Percent
100
2010 (N = 567)
2011 (N = 1,143)
80
60
40
20
0
Very Good
Good
Fair
Poor
Very Poor
Source: Press Ganey, a national hospital survey vendor
36
Outcomes 2011
Rating of Outpatient Care Provider
2010 – 2011
Percent
100
2010 (N = 567)
2011 (N = 1,143)
80
60
40
20
0
Very Good
Good
Fair
Poor
Very Poor
Likelihood of Recommending Outpatient Care Provider
2010 – 2011
Percent
100
2010 (N = 567)
2011 (N = 1,143)
80
60
40
20
0
Very Good
Good
Fair
Poor
Very Poor
37
Patient Experience
Inpatient — Endocrinology & Metabolism Institute
The Centers for Medicare and Medicaid Services (CMS) requires U.S. hospitals that treat Medicare patients
to participate in the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
survey, a standardized tool that measures patients’ perspectives of hospital care. Results collected for public
reporting are available at hospitalcompare.hhs.gov.
HCAHPS Overall Assessment
2010 – 2011
Percent
100
80
2010 (N = 401)
2011 (N = 158)
70%
75%
78%
80%
60
40
20
0
Rate Hospital
Would Recommend
% 9 or 10
(0 – 10 scale)
% “definitely yes”
38
Outcomes 2011
HCAHPS Domains of Care
2010 – 2011
Percent
100
2010 (N = 401)
2011 (N = 158)
80
60
40
20
0
Discharge
Doctor
Information Given Communication
% yes
Nurse
Communication
Pain
Management
Room
New Medications Responsiveness
Clean
Communication
to Needs
% always
(Options: always, usually, sometimes, never)
Quiet at
Night
39
Innovations
Robotic Transaxillary Single-Incision
Total Thyroidectomy
In 2009, one of the first robotic thyroidectomies in
the U.S. was performed by surgeon Eren Berber,
MD, who leads the endocrine robotic surgery
program. In 2011, his team took this innovation
to the next level by performing robotic total
thyroidectomies through a single axillary incision
(underarm surgery). Currently, Cleveland Clinic's
Endocrine Surgery Department is the only program
in Ohio offering robotic thyroid surgery.
Robotic Transaxillary Parathyroidectomy
Cleveland Clinic doctors have performed more
than 115 robotic endocrine surgery cases since
2008. Additionally, our doctors performed one of
the first robotic transaxillary parathyroidectomies
in the world. Compared with the standard
parathyroidectomy approach, transaxillary robotic
surgery not only offers technical precision but leaves
the patient without a neck scar.
40
Outcomes 2011
Best Practice Alert: BMI > 30
The Best Practice Alert (BPA) was created to detect patients
who were at high risk for increased obesity and obesity-related
diseases. Within the EPIC electronic medical record, the BPA
fires at a body mass index of 30 or higher and will fire every six
months if the patient's excess weight has not been addressed.
Through the alert, the provider can find a menu of programs
to suggest to the patient, including those that fall under
Preventive Cardiology, the Wellness Institute and the Bariatric
& Metabolic Institute. The BPA will also serve as a tool to
stimulate discussion regarding obesity between the patient and
the provider.
Preventing Avoidable Readmissions:
Bariatric Rehydration Clinic
The quality team within the Bariatric & Metabolic Institute
identified patients' lack of adherence to self-hydration following
bariatric surgery to be a strong contributing factor to multiple
hospital readmissions within 30 days of surgery.
Downloadable Resources for Relaxation
and Coping
The Bariatric Behavioral Health Team has long
used relaxation CDs to aid patients in preparing
for surgery and for the development of alternative
coping skills. In 2011, the team expanded and
updated these resources to include a variety
of empirically validated relaxation techniques.
Diaphragmatic breathing, progressive muscle
relaxation and guided imagery, as well as
strategies to improve mindfulness during eating,
imagery, affirmations for healing and instructions
on behavioral change are some of the techniques
used. These programs will be made available as
MP4 files in 2012 on the Bariatric & Metabolic
Institute’s website so patients can easily
download files of interest at no charge.
A rehydration clinic was developed using the existing space and
staff of the endoscopy suite. A specific patient care algorithm
was developed to identify and treat patients with symptoms of
dehydration. These patients may be discovered either during
routine follow-up appointments, as a result of phone inquiries
or during triage by the nurse on call. The process directs the
patient to receive physician-directed IV fluids as an outpatient
treatment, avoiding potential readmissions in most cases. Since
the inception of the rehydration clinic in 2011, 32 patients
were treated. Out of the 32 patients who received treatment,
91 percent (29) were discharged and sent home, avoiding
hospital readmissions.
41
Abdelmalak B, Zimmerman R, Foss J. Reply [Diagnosing
preoperative hyperglycemia in non-diabetic patients:
a challenge and an opportunity]. Can J Anaesth. 2011
Jun;58(6):583.
Akyildiz HY, Morris-Stiff G, Aucejo F, Fung J, Berber E.
Techniques of radiofrequency-assisted precoagulation
in laparoscopic liver resection. Surg Endosc. 2011
Apr;25(4):1143-1147.
staff authored more than
90 publications
in 2011. For a complete list go to
clevelandclinic.org/outcomes.
Albashir S, Olansky L, Sasidhar M. Progressive muscle
weakness: More there than meets the eye. Cleve Clin J
Med. 2011 Jun;78(6):385-391.
Anderson C, Teo K, Gao P, Arima H, Dans A, Unger T,
Commerford P, Dyal L, Schumacher H, Pogue J, Paolasso E,
Holwerda N, Chazova I, Binbrek A, Young J, Yusuf S.
Renin-angiotensin system blockade and cognitive function
in patients at high risk of cardiovascular disease: analysis of
data from the ONTARGET and TRANSCEND studies. Lancet
Neurol. 2011 Jan;10(1):43-53.
Appachi S, Kelly KR, Schauer PR, Kirwan JP, Hazen S,
Gupta M, Kashyap SR. Reduced cardiovascular risk
following bariatric surgeries is related to a partial recovery
from "adiposopathy." Obes Surg. 2011 Dec;21(12):
1928-1936.
Ashton K, Heinberg L, Windover A, Merrell J. Positive
response to binge eating intervention enhances
postoperative weight loss. Surg Obes Relat Dis. 2011
May-Jun;7(3):315-320.
42
Outcomes 2011
Baliga RR, Young JB. Early detection and monitoring of
vulnerable myocardium in patients receiving chemotherapy:
is it time to change tracks? Heart Fail Clin. 2011
Jul;7(3):xiii-xxix.
Baliga RR, Young JB. Editorial: Sudden death in heart
failure: An ounce of prediction is worth a pound of
prevention. Heart Fail Clin. 2011 Apr;7(2):xiii-xviii.
Baliga RR, Young JB. Clinical trials to "real-world" heart
failure: applying risk stratification to deliver personalized
care. Heart Fail Clin. 2011 Oct;7(4):xi-xiv.
Baliga RR, Young JB. Editorial: Depression in heart failure
is double trouble: warding off the blues requires early
screening. Heart Fail Clin. 2011 Jan;7(1):xiii-xvii.
Berber E, Siperstein A. Re: Robot-assisted posterior
retroperitoneoscopic adrenalectomy (From: Ludwig AT,
Wagner KR, Lowry PS, et al. J Endourol 2010;24:
1307-1314). J Endourol. 2011 Mar;25(3):541-542.
Berber E, Siperstein A. Robotic transaxillary total
thyroidectomy using a unilateral approach. Surg Laparosc
Endosc Percutan Tech. 2011 Jun;21(3):207-210.
Berisha SZ, Serre D, Schauer P, Kashyap SR, Smith JD.
Changes in whole blood gene expression in obese subjects
with type 2 diabetes following bariatric surgery: a pilot
study. PLoS ONE. 2011;6(3):e16729.
Brethauer S. ASMBS position statement on preoperative
supervised weight loss requirements. Surg Obes Relat Dis.
2011 May-Jun;7(3):257-260.
Brethauer S. American Society for Metabolic and Bariatric
Surgery position statement on global bariatric healthcare.
Surg Obes Relat Dis. 2011 Nov-Dec;7(6):669-671.
Brethauer SA, Harris JL, Kroh M, Schauer PR.
Laparoscopic gastric plication for treatment of severe
obesity. Surg Obes Relat Dis. 2011 Jan-Feb;7(1):15-22.
Brethauer SA, Heneghan HM, Eldar S, Gatmaitan P,
Huang H, Kashyap S, Gornik HL, Kirwan JP, Schauer PR.
Early effects of gastric bypass on endothelial function,
inflammation, and cardiovascular risk in obese patients
[Erratum in: Surg Endosc 2011 Aug;25(8):2660]. Surg
Endosc. 2011 Aug;25(8):2650-2659.
Brethauer SA. Sleeve gastrectomy. Surg Clin North Am.
2011 Dec;91(6):1265-1279.
Cheng V, Kashyap SR. Weight considerations in
pharmacotherapy for type 2 diabetes. J Obes.
2011;2011:984245-984245.
Cheng V, Doshi KB, Falcone T, Faiman C.
Hyperandrogenism in a postmenopausal woman: diagnostic
and therapeutic challenges. Endocr Pract. 2011
Mar-Apr;17(2):e21-e25.
Daud S, Hamrahian AH, Weil RJ, Hamaty M, Prayson RA,
Olansky L. Acromegaly with negative pituitary MRI and
no evidence of ectopic source: the role of transphenoidal
pituitary exploration? Pituitary. 2011 Dec;14(4):414-417.
Eldar S, Heneghan HM, Brethauer S, Schauer PR. A focus
on surgical preoperative evaluation of the bariatric patient Cleveland Clinic protocol and review of the literature.
Surgeon. 2011 Oct;9(5):273-277.
Eldar S, Heneghan HM, Brethauer SA, Schauer PR.
Bariatric surgery for treatment of obesity. Int J Obes (Lond).
2011 Sep;35 Suppl 3:S16-S21.
43
Franz RW, Hinze SS, Knapp ED, Jenkins JJ. Oral
prostaglandin E1 in combination with sodium bicarbonate
and normal saline in the prevention of contrast-induced
nephropathy: A pilot study. Int J Angiol. 2011 Dec;20(4):
229-233.
Harvey A, Bohacek L, Neumann D, Mihaljevic T, Berber E.
Robotic thoracoscopic mediastinal parathyroidectomy for
persistent hyperparathyroidism: case report and review of
the literature. Surg Laparosc Endosc Percutan Tech. 2011
Feb;21(1):e24-e27.
Ginsberg GG, Chand B, Cote GA, Dallal RM,
Edmundowicz SA, Nguyen NT, Pryor A, Thompson CC.
A pathway to endoscopic bariatric therapies: ASGE/ASMBS
task force on endoscopic bariatric therapy. Surg Obes Relat
Dis. 2011 Nov-Dec;7(6):672-682.
Hatipoglu BA, Kennedy L. Postradiation therapy
hypopituitarism. Expert Rev Endocrinol Metab. 2011
Mar;6(2):187-194.
Ginsberg GG, Chand B, Cote GA, Dallal RM,
Edmundowicz SA, Nguyen NT, Pryor A, Thompson CC.
A pathway to endoscopic bariatric therapies: ASGE/ASMBS
task force on endoscopic bariatric therapy. Gastrointest
Endosc. 2011 Nov;74(5):943-953.
Gould J, Ellsmere J, Fanelli R, Hutter M, Jones S, Pratt J,
Schauer P, Schirmer B, Schwaitzberg S, Jones DB. Panel
report: Best practices for the surgical treatment of obesity.
Surg Endosc. 2011 Jun;25(6):1730-1740.
Greenlee C, Burmeister LA, Butler RS, Edinboro CH,
Morrison SM, Milas M. Current safety practices relating to
I-131 administration for diseases of the thyroid: a survey
of physicians and allied practitioners. Thyroid. 2011
Feb;21(2):151-160.
Grover V, Hamrahian AH, Prayson RA, Weil RJ. Rathke's
cleft cyst presenting as bilateral abducens nerve palsy.
Pituitary. 2011 Dec;14(4):395-399.
Hamaty M. Insulin treatment for type 2 diabetes:
When to start, which to use. Cleve Clin J Med. 2011
May;78(5):332-342.
44
Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR,
Young JB. Effect of bariatric surgery on cardiovascular risk
profile. Am J Cardiol. 2011 Nov 15;108(10):1499-1507.
Horwitz SM, Heinberg LJ, Storfer-Isser A, Barnes DH,
Smith M, Kapur R, Findling R, Currier G, Wilcox HC,
Wilkens K. Teaching physicians to assess suicidal youth
presenting to the emergency department. Pediatr Emerg
Care. 2011 Jul;27(7):601-605.
Huang H, Kasumov T, Gatmaitan P, Heneghan HM,
Kashyap SR, Schauer PR, Brethauer SA, Kirwan JP. Gastric
bypass surgery reduces plasma ceramide subspecies and
improves insulin sensitivity in severely obese patients.
Obesity (Silver Spring). 2011 Nov;19(11):2235-2240.
Jarrar AM, Milas M, Mitchell J, Laguardia L, O'Malley M,
Berber E, Siperstein A, Burke C, Church JM. Screening
for thyroid cancer in patients with familial adenomatous
polyposis. Ann Surg. 2011 Mar;253(3):515-521.
Karabulut K, Akyildiz HY, Lance C, Aucejo F, McLennan G,
Agcaoglu O, Siperstein A, Berber E. Multimodality
treatment of neuroendocrine liver metastases. Surgery.
2011 Aug;150(2):316-325.
Outcomes 2011
Karabulut K, Berber E. Robotik endokrin cerrahi [Robotic
endocrine surgery] [Turkish]. Ulusal Cerrahi Dergisi.
2011;27(1):1-5.
Kashyap SR, Louis ES, Kirwan JP. Weight loss as a cure
for type 2 diabetes? Fact or fantasy. Expert Rev Endocrinol
Metab. 2011 Jul 1;6(4):557-561.
Katznelson L, Atkinson JLD, Cook DM, Ezzat SZ,
Hamrahian AH, Miller KK. American Association of Clinical
Endocrinologists Medical Guidelines for Clinical Practice for
the Diagnosis and Treatment of Acromegaly — 2011 update:
executive summary. Endocr Pract. 2011 Jul-Aug;17(4):
636-646.
Kennedy DJ, Kashyap SR. Pathogenic role of scavenger
receptor CD36, metabolic syndrome and diabetes. Metab
Syndr Relat Disord. 2011 Aug;9(4):239-245.
Kirklin JK, Naftel DC, Kormos RL, Stevenson LW,
Pagani FD, Miller MA, Ulisney KL, Baldwin JT, Young JB.
Third INTERMACS Annual Report: The evolution of
destination therapy in the United States. J Heart Lung
Transplant. 2011 Feb;30(2):115-123.
Knafo R, Haythornthwaite JA, Heinberg L, Wigley FM,
Thombs BD. The association of body image dissatisfaction
and pain with reduced sexual function in women with
systemic sclerosis. Rheumatology (Oxford). 2011
Jun;50(6):1125-1130.
Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P,
Kaouk J, Chalikonda S. First human surgery with a
novel single-port robotic system: cholecystectomy using
the da Vinci Single-Site platform. Surg Endosc. 2011
Nov;25(11):3566-3573.
45
Lamy A, Wang X, Gao P, Tong W, Gafni A, Dans A,
Avezum A, Ferreira R, Young J, Yusuf S, Teo K. The cost
implications of the use of telmisartan or ramipril in patients
at high risk for vascular events: the ONTARGET study. J
Med Econ. 2011;14(6):792-797.
Lansang MC, Hustak LK. Glucocorticoid-induced diabetes
and adrenal suppression: How to detect and manage them.
Cleve Clin J Med. 2011 Nov;78(11):748-756.
Lott DG, Russell JO, Khariwala SS, Dan O, Strome M.
Ten-month laryngeal allograft survival with use of pulsed
everolimus and anti-alphabeta T-cell receptor antibody
immunosuppression. Ann Otol Rhinol Laryngol. 2011
Feb;120(2):131-136.
Makin V, Hatipoglu B, Hamrahian AH, Arrossi AV, Knott PD,
Lee JH, Sade B. Spontaneous cerebrospinal fluid rhinorrhea
as the initial presentation of growth hormone-secreting
pituitary adenoma. Am J Otolaryngol. 2011 Sep-Oct;32(5):
433-437.
Maudlin S, Hatipoglu B. Is there a lack of communication
between endocrinologists and psychiatrists regarding
metabolic screening of second-generation antipsychotic
users? Psychiatr Ann. 2011 Jul;41(7):350.
McQuade C, Skugor M, Brennan DM, Hoar B, Stevenson C,
Hoogwerf BJ. Hypothyroidism and moderate subclinical
hypothyroidism are associated with increased all-cause
mortality independent of coronary heart disease risk factors:
A PreCIS database study. Thyroid. 2011 Aug;21(8):
837-843.
Milas Z, Shin J, Milas M. New guidelines for the
management of thyroid nodules and differentiated thyroid
cancer. Minerva Endocrinol. 2011 Mar;36(1):53-70.
46
Outcomes 2011
Mitchell J, Siperstein A, Milas M, Berber E. Laparoscopic
resection of abdominal paragangliomas. Surg Laparosc
Endosc Percutan Tech. 2011 Feb;21(1):e48-e53.
Mulligan GB, Eray E, Faiman C, Gupta M, Pineyro MM,
Makdissi A, Suh JH, Masaryk TJ, Prayson R, Weil RJ,
Hamrahian AH. Reduction of false-negative results in
inferior petrosal sinus sampling with simultaneous prolactin
and corticotropin measurement. Endocr Pract. 2011 JanFeb;17(1):33-40.
Newey CR, Sarwal A, Uchin J, Mulligan G. Necrotic
skin lesions after hemodialysis. Cleve Clin J Med. 2011
Oct;78(10):646-648.
Ngeow J, Mester J, Rybicki LA, Ni Y, Milas M, Eng C.
Incidence and clinical characteristics of thyroid cancer
in prospective series of individuals with Cowden and
Cowden-like syndrome characterized by germline PTEN,
SDH, or KLLN alterations. J Clin Endocrinol Metab. 2011
Dec;96(12):E2063-E2071.
Olansky L, Reasner C, Seck TL, Williams-Herman DE,
Chen M, Terranella L, Mehta A, Kaufman KD, Goldstein BJ.
A treatment strategy implementing combination therapy
with sitagliptin and metformin results in superior glycaemic
control versus metformin monotherapy due to a low rate
of addition of antihyperglycaemic agents. Diabetes Obes
Metab. 2011 Sep;13(9):841-849.
Pantalone KM, Faiman C, Olansky L. Use of insulin
detemir and insulin glargine during pregnancy: Are the data
convincing? Endocr Pract. 2011 Sep 1;17(5):830.
Pantalone KM, Faiman C, Olansky L. Insulin glargine use
during pregnancy. Endocr Pract. 2011 May-Jun;17(3):
448-455.
Pantalone KM, Agarwal S, Faiman C. Glargine vs. NPH
insulin therapy in pregnancies complicated by diabetes:
An observational cohort study-Comment on Negrato et al.
Diabetes Res Clin Pract. 2011 Jul;93(1):e9-e10.
Pantalone KM, Kattan MW, Wells BJ, Zimmerman RS.
Response to comment on: Pantalone et al. The risk of
overall mortality in patients with type 2 diabetes receiving
glipizide, glyburide, or glimepiride monotherapy:
A retrospective analysis. Diabetes Care 2010;33:12241229. Diabetes Care. 2011 Aug;34(8):e139.
Reasner C, Olansky L, Seck TL, Williams-Herman DE,
Chen M, Terranella L, Johnson-Levonas AO, Kaufman KD,
Goldstein BJ. The effect of initial therapy with the
fixed-dose combination of sitagliptin and metformin
compared with metformin monotherapy in patients with
type 2 diabetes mellitus. Diabetes Obes Metab. 2011
Jul;13(7):644-652.
Rhoads GG, Dain MP, Zhang Q, Kennedy L. Two-year
glycaemic control and healthcare expenditures following
initiation of insulin glargine versus neutral protamine
Hagedorn insulin in type 2 diabetes. Diabetes Obes Metab.
2011 Aug;13(8):711-717.
Sanchez J, Perera E, Jan de Beur S, Ding C, Dang A,
Berkovitz GD, Levine MA. Madelung-like deformity in
pseudohypoparathyroidism type 1b. J Clin Endocrinol
Metab. 2011 Sep;96(9):E1507-E1511.
Schauer PR, Rubino F. International Diabetes Federation
position statement on bariatric surgery for type 2 diabetes:
implications for patients, physicians, and surgeons. Surg
Obes Relat Dis. 2011 Jul-Aug;7(4):448-451.
47
Shin JJ, Milas M, Mitchell J, Berber E, Ross L,
Siperstein A. Impact of localization studies and clinical
scenario in patients with hyperparathyroidism being
evaluated for reoperative neck surgery. Arch Surg. 2011
Dec;146(12):1397-1403.
Sisson TA, Freitas J, McDougall IR, Dauer LT, Hurley JR,
Brierley JD, Edinboro CH, Rosenthal D, Thomas MJ,
Wexler JA, Asamoah E, Avram AM, Milas M, Greenlee C.
Radiation safety in the treatment of patients with thyroid
diseases by radioiodine (131)i: practice recommendations
of the American Thyroid Association. Thyroid. 2011
Apr;21(4):335-346.
Smith BR, Schauer P, Nguyen NT. Surgical approaches to
the treatment of obesity: bariatric surgery. Med Clin North
Am. 2011 Sep;95(5):1009-1030.
Subbarayan S, Kipnes M. Sitagliptin: a review. Expert Opin
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Sun G, Kashyap SR. Cancer risk in type 2 diabetes
mellitus: metabolic links and therapeutic considerations.
J Nutr Metab. 2011;2011:708183.
Tamimi TI, Elgouhari HM, Alkhouri N, Yerian LM, Berk MP,
Lopez R, Schauer PR, Zein NN, Feldstein AE. An apoptosis
panel for nonalcoholic steatohepatitis diagnosis. J Hepatol.
2011 Jun;54(6):1224-1229.
Tan MH, Mester J, Peterson C, Yang Y, Chen JL, Rybicki LA,
Milas K, Pederson H, Remzi B, Orloff MS, Eng C. A clinical
scoring system for selection of patients for PTEN mutation
testing is proposed on the basis of a prospective study of
3042 probands. Am J Hum Genet. 2011 Jan 7;88(1):
42-56.
48
Tariq N, Chand B. Presurgical evaluation and postoperative
care for the bariatric patient. Gastrointest Endosc Clin N
Am. 2011 Apr;21(2):229-240.
Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP,
Navaneethan SD. Metabolic syndrome and kidney disease:
A systematic review and meta-analysis. Clin J Am Soc
Nephrol. 2011 Oct;6(10):2364-2373.
Tritos NA, Greenspan SL, King D, Hamrahian A, Cook DM,
Jonsson PJ, Wajnrajch MP, Koltowska-Haggstrom M,
Biller BMK. Unreplaced sex steroid deficiency, corticotropin
deficiency, and lower IGF-I are associated with lower bone
mineral density in adults with growth hormone deficiency:
A KIMS database analysis. J Clin Endocrinol Metab. 2011
May;96(5):1516-1523.
Wallace LB, Parikh RT, Ross LV, Mazzaglia PJ, Foley C,
Shin JJ, Mitchell JC, Berber E, Siperstein AE, Milas M.
The phenotype of primary hyperparathyroidism with normal
parathyroid hormone levels: How low can parathyroid
hormone go? Surgery. 2011 Dec;150(6):1102-1112.
Wallace LB, Berber E. Percutaneous and video assisted
ablation of endocrine tumors: liver, adrenal, and thyroid.
Surg Laparosc Endosc Percutan Tech. 2011 Aug;21(4):
255-259.
Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS,
Dugar B, Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y,
Schauer P, Smith JD, Allayee H, Tang WHW, DiDonato JA,
Lusis AJ, Hazen SL. Gut flora metabolism of
phosphatidylcholine promotes cardiovascular disease.
Nature. 2011 Apr 7;472(7341):57-63.
Outcomes 2011
Yimcharoen P, Heneghan HM, Singh M, Brethauer S,
Schauer P, Rogula T, Kroh M, Chand B. Endoscopic findings
and outcomes of revisional procedures for patients with
weight recidivism after gastric bypass. Surg Endosc. 2011
Oct;25(10):3345-3352.
Yimcharoen P, Heneghan HM, Tariq N, Brethauer SA,
Kroh M, Chand B. Endoscopic stent management of leaks
and anastomotic strictures after foregut surgery. Surg Obes
Relat Dis. 2011 Sep-Oct;7(5):628-636.
Young JB. A better process for new medical devices. Issues
Sci Technol. 2011 Summer;27(4):10-12.
Zeiger MA, Siegelman SS, Hamrahian AH. Medical and
surgical evaluation and treatment of adrenal incidentalomas.
J Clin Endocrinol Metab. 2011 Jul;96(7):2004-2015.
49
Staff Listing
Chairman
James Young, MD
Department of Endocrinology, Diabetes and Metabolism
Laurence (Ned) Kennedy, MD
Chairman
Director of Clinical Research
Amir Hamrahian, MD
Robert Zimmerman, MD
Vice Chairman
Director, Cleveland Clinic Diabetes Center
Patient Experience Officer
Kresmira (Mira) Milas, MD
Sanjit Bindra, MD
Kevin Borst, DO
Krupa Doshi, MD
Quality Improvement Officer
Christian Nasr, MD
Philip Schauer, MD
Chairman
Revital Gorodeski-Baskin, MD
Marwan Hamaty, MD
Amir Hamrahian, MD
Betul Hatipoglu, MD
Suman Jana, MD
Kathleen Ashton, PhD
Sangeeta Kashyap, MD
Stacy Brethauer, MD
Department Quality Improvement Officer
Leila Khan, MD
Derrick Cetin, DO
Bipan Chand, MD
Karen Cooper, DO
Leslie Heinberg, PhD
Matthew Kroh, MD
M. Cecilia Lansang, MD, MPH
Melissa Li-Ng, MD
Vinni Makin, MD
Adi Mehta, MD
Guy Mulligan, MD
Julie Merrell, PhD
Christian Nasr, MD
Co-Director, Thyroid Center
Tomasz Rogula, MD, PhD
Leann Olansky, MD
Amy Windover, PhD
Richard Shewbridge, MD
David Shewmon, MD
Mario Skugor, MD
Mariam Stevens, MD
50
Outcomes 2011
Department of Endocrine Surgery
Allan Siperstein, MD
Chairman
Bariatric and Endocrine Surgical Anesthesia Section
Karen Steckner, MD
Section Head
Eren Berber, MD
Director, Robotic Endocrine Surgery
Charanjit Bahniwal, MD
Kresimira (Mira) Milas, MD
Jamie Mitchell, MD
Joyce J. Shin, MD
Consultant Staff, Department of Endocrinology,
Diabetes and Metabolism
Charles Faiman, MD
Angelo Licata, MD, PhD
Tracy Dovich, MD
Alexandru Gottlieb, MD
Maria Inton-Santos, MD
Samuel Irefin, MD
Paul Kempen, MD
Surgical Intensive Care Unit
Marc Popovich, MD
Unit Director
Program Director, Critical Care Fellowship
S. Sethu K. Reddy, MD
Demetrios Bourdakos, MD
Center for Pediatric Endocrinology
Douglas G. Rogers, MD
Center Head
Onur Demirci, MD
Shahpour Esfandiari, MD
Faith Factora, MD
Anzar Haider, MD
Samuel Irefin, MD
Michelle Schweiger, DO
Ali Jahan, MD
Piyush Mathur, MD
Douglas Naylor Jr., MD
Nadeen Rahman, MD
Nicholas Russo, MD
Some physicians may practice in multiple locations.
For a detailed list including staff photos, please visit
clevelandclinic.org/staff.
51
Contact Information
General Patient Referral
24/7 hospital transfers or physician consults
800.553.5056
Endocrinology, Diabetes and Metabolism
Appointments/Referrals
216.444.6568 or 800.223.2273, ext. 46568
Endocrine Surgery Appointments/Referrals
216.444.6568 or 800.223.2273, ext. 46568
Bariatric Surgery Appointments/Referrals
216.445.2224 or 800.223.2273, ext. 52224
On the Web at clevelandclinic.org/endo
and clevelandclinic.org/bariatric
Additional Contact Information
General Information
216.444.2200
Hospital Patient Information
216.444.2000
General Patient Appointments
216.444.2273 or 800.223.2273
Request for Medical Records
216.445.2547 or 800.223.2273, ext. 52547
52
Outcomes 2011
Referring Physician Center and Hotline
Cleveland Clinic’s Referring Physician Center has
established a 24/7 hotline — 855.REFER.123
(855.733.3712) — to streamline access to our array of
medical services. Contact the Referring Physician Hotline
for information on our clinical specialties and services, to
schedule and confirm patient appointments, for assistance
in resolving service-related issues, and to connect with
Cleveland Clinic specialists.
Medical Concierge
For complimentary assistance for out-of-state patients
and families
800.223.2273, ext. 55580, or email
[email protected]
Global Patient Services
Complimentary assistance for international patients
and families
001.216.444.8184 or visit clevelandclinic.org/gps
Cleveland Clinic Florida
Toll-free 866.293.7866
For address corrections or changes, please call
800.890.2467
53
Institute Locations
Cleveland Clinic Main Campus
Independence Family Health Center
Endocrinology, Diabetes and Metabolism/F20
Crown Centre II
Endocrine Surgery/F20
5001 Rockside Road
Bariatrics/M61
Independence, OH 44131
9500 Euclid Ave.
216.986.4000
Cleveland, OH 44195
216.444.6568 or 800.223.2273, ext. 46568
Lakewood Hospital Professional Building
14601 Detroit Road
Diabetes Center
Lakewood, OH 44107
10685 Carnegie Ave./X20
216.529.5300
Cleveland, OH 44106
216.444.6568 or 800.223.2273, ext. 46568
Lorain Family Health and Surgery Center
5700 Cooper Foster Park Road
Ashtabula County Medical Center
Lorain, OH 44053
2420 Lake Ave.
440.204.7400
Ashtabula, OH 44004
440.997.2262
Medina Hospital Professional Building
4087 Medina Road, Suite 400
Beachwood Family Health and Surgery Center
Medina, OH 44256
26900 Cedar Road
330.725.3713
Beachwood, OH 44122
216.839.3000
Solon Family Health Center
29800 Bainbridge Road
Cleveland Clinic Florida
Solon, OH 44139
2950 Cleveland Clinic Blvd.
440.519.6800
Weston, FL 33331
877.463.2010
54
Outcomes 2011
South Pointe Charles Miner Medical Building
Twinsburg Family Health and Surgery Center
20600 Harvard Road
8701 Darrow Road
Warrensville Heights, OH 44122
Twinsburg, OH 44087
216.295.1010
330.888.4000
Stephanie Tubbs Jones Health Center
Willoughby Hills Family Health Center
13944 Euclid Ave.
2570 SOM Center Road
East Cleveland, OH 44112
Willoughby Hills, OH 44094
216.767.4242
440.943.2500
Strongsville Family Health and Surgery Center
Wooster Family Health Center
16761 SouthPark Center
1740 Cleveland Road
Strongsville, OH 44136
Wooster, OH 44691
440.878.2500
330.287.4500
55
Overview
Cleveland Clinic uses a scorecard approach to measure quality, safety and patient experience. In addition, realtime dashboard data are leveraged to drive performance improvement. Although not an exact match to publicly
reported data, more timely internal data provide transparency for leaders at all levels of the organization to
support improved care in their clinical locations. The following are examples of Cleveland Clinic’s 2011 focus
areas and main campus results.
Appropriateness of Care
Mortality
2010 – 2011
2010 – 2011
Percent of Patients
100
O/E Ratio
1.0
98
0.8
96
0.6
94
92
Cleveland Clinic performance
Cleveland Clinic target
90
88
86
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
Cleveland Clinic’s goal is for all patients to receive all
the recommended care for which they are eligible. An
aggregated “all or nothing” measurement approach to
monitoring multiple publicly reported process-of-care
measures for heart failure, acute myocardial infarction,
pneumonia and surgical patients is trending positively.
56
0.4
Cleveland Clinic*
UHC academic medical
center 50th percentile*
0.2
0.0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
*Source: Performance Accelerator Suite Program maintained
by the University HealthSystem Consortium (UHC)
https://www.uhc.edu/
Cleveland Clinic’s observed/expected (O/E) mortality
ratio outperformed the University HealthSystem
Consortium (UHC) academic medical center 50th
percentile throughout 2011.
Outcomes 2011
Patient Safety Indicators (PSIs)
Central Line-Associated Bloodstream Infections — ICUs
2011
2010 – 2011
Number of PSIs*
200
Rate per 1,000 Line Days
4
150
3
100
2
50
1
0
Jan
Mar
May
July
Sep
Nov
* PSI 3 Stage III/IV Pressure Ulcers, PSI 6 Iatrogenic Pneumothorax,
PSI 7 CLABSI, PSI 8 Post-Op Hip Fracture, PSI 9 Post-Op Hemorrhage/
Hematoma, PSI 11 Post-Op Respiratory Failure, PSI 12 Post-Op PE or
DVT, PSI 13 Post-Op Sepsis, PSI 14 Post-Op Wound Dehiscence, PSI
15 Accidental Puncture/Laceration
Cleveland Clinic focused on reducing the
incidence of 10 Agency for Healthcare
Research and Quality PSIs. Cleveland Clinic
achieved a reduction of more than 60
percent in the total number of these PSIs in
2011 through a combination of clinical and
documentation improvement activities.
0
Q1
Q2
Q3
2010
Q4
Cleveland Clinic performance
Cleveland Clinic target
Q1
Q2
Q3
Q4
2011
Cleveland Clinic established a 2011 target
ICU surveillance rate of 1.33 central lineassociated bloodstream infections (CLABSIs)
per 1,000 central line days, with the goal of
reducing our rate by an additional 50 percent
over the 2010 results. This 2011 target was
met by the end of the year.
57
Hospital-Acquired Pressure Ulcers — ICUs
Patient Falls — Stepdown Units
2010 – 2011
2010 – 2011
Pressure Ulcer Prevalence (%)
14
Fall Rate per 1,000 Patient Days
4.0
12
3.5
3.0
10
2.5
8
2.0
6
1.5
4
Cleveland Clinic ICUs
Benchmark: NDNQI* ICUs
2
0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
Hospital-acquired pressure ulcers in Cleveland
Clinic ICU patients were below the national
average in 2010 and 2011.
Cleveland Clinic Stepdown Units
Benchmark: NDNQI* Stepdown Units
1.0
0.5
0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
*The National Database of Nursing Quality Indicators® (NDNQI®) is owned
by the American Nurses Association. The database collects and evaluates unitspecific nurse-sensitive data from hospitals domestically and globally with over
1800 hospitals participating. The comparison data represented here are based
on a third of all hospitals in the U.S. participating. © 2012 American Nurses
Association, All Rights Reserved. https://www.nursingquality.org/
Falls in Cleveland Clinic stepdown unit patients were
below the national average for most of 2010 and 2011.
In 2011, Cleveland Clinic supplemented proactive fallsreduction strategies with after-event huddles to evaluate
causality and develop prevention strategies.
58
Outcomes 2011
Critical Response Outcomes
Medical Emergency Team Event Volume*
2009 – 2011
Events
3,000
2,500
2,000
1,500
1,000
500
0
2009
2010
2011
*Excluding events originating in ORs and ICUs
Percent of Medical Emergency Team Events Resulting in ICU Transfer
2009 – 2011
Percent
40
30
20
10
0
2009
2010
2011
Medical Emergency Teams (METs) bring critical care experience to patients across the hospital and
provide early intervention that can prevent unplanned transfers to ICUs. As adult MET activations
increased from 2009 through 2011, post-event adult ICU transfers decreased.
59
Patient Experience — Cleveland Clinic
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the standard national
tool for measuring patients’ perspectives of hospital care. Results are available at hospitalcompare.hhs.gov.
HCAHPS Rate and Recommend Hospital
2010 – 2011
Percent (Best Response)
100
80
60
40
20
0
Rate Hospital
% 9 or 10
(0 – 10 scale)
Would Recommend Hospital
% “definitely yes”
Cleveland Clinic 2010*
Cleveland Clinic 2011*
*Source: Press Ganey, a national hospital survey vendor
HCAHPS Hospital Domain Scores
National Average 7/1/2010 – 6/30/2011
2010 – 2011
Source: hospitalcompare.hhs.gov.
Percent (Best Response)
100
80
60
40
20
0
Nurse
Communication
Responsiveness
to Needs
Doctor
Communication
Room
Quiet at
Clean
Night
% always
(Options: always, usually, sometimes, never)
Pain
Management
New Medications
Discharge
Communication Information Given
% yes
“Patients First” is the guiding principle of Cleveland Clinic, which was among the first major academic medical centers to make
improving the patient experience a strategic goal. The Office of Patient Experience collaborates with physician and nursing
leadership to establish best practices and implement standardized protocols that ensure delivery of patient-centered care.
Campus-wide HCAHPS survey results are trending favorably in every domain.
60
Outcomes 2011
Overview
Cleveland Clinic is a nonprofit multispecialty academic medical center
that integrates clinical and hospital care with research and education.
Across the health system, 2,800 Cleveland Clinic physicians and scientists
practice in 120 medical specialties and subspecialties, annually recording
more than 4.6 million physician visits and nearly 188,000 surgeries.
Patients come for treatment from every state and from more than 125
countries annually.
Cleveland Clinic’s main campus, with 50 buildings on 180 acres in
Cleveland, Ohio, includes a 1,400-bed hospital, outpatient clinic, specialty
institutes, and supporting labs and facilities. The hospital currently has the
highest CMS case-mix index in America. Cleveland Clinic also operates 18
family health centers, eight community hospitals, one affiliate hospital, a
rehabilitation hospital for children, Cleveland Clinic Florida, Cleveland Clinic
Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada,
and Sheikh Khalifa Medical City. Cleveland Clinic Abu Dhabi (United Arab
Emirates), a multispecialty care hospital and clinic, is scheduled to open
in 2013. With 41,000 employees, Cleveland Clinic is the second largest
employer in Ohio and is responsible for an estimated $9 billion of economic
activity every year.
The Cleveland Clinic Model
Cleveland Clinic was founded in 1921 by four physicians who had served
in World War I and hoped to replicate the organizational efficiency of
military medicine. The organization has grown through the years by
adhering to the model set forth by the founders. All Cleveland Clinic staff
physicians receive a straight salary with no bonuses or other financial
incentives. The hospital and physicians share a financial interest in
controlling costs, and profits are reinvested in research and education.
In 2007, Cleveland Clinic restructured its practice, bundling all clinical
specialties into integrated practice units called institutes. An institute
combines all the specialties surrounding a specific organ or disease system
under a single roof. Each institute has a single leader and focuses the
energies of multiple professionals on the patient. Institutes are improving
the patient experience at Cleveland Clinic.
61
Cleveland Clinic Lerner Research Institute
At the Lerner Research Institute, hundreds of principal
investigators, project scientists, research associates
and postdoctoral fellows are involved in laboratorybased, translational and clinical research. Total research
expenditures from external and internal sources exceeded
$240 million in 2010. Research programs include
cardiovascular, cancer, neuralgic, musculoskeletal, allergic
and immunologic, eye, metabolic, and infectious diseases.
Cleveland Clinic Lerner College of Medicine
Celebrating its 10th anniversary in 2012, the Lerner College
of Medicine of Case Western Reserve University is known
for its small class size, unique curriculum and full-tuition
scholarships for all students. The program graduated 31
students as physician investigators in 2011.
Graduate Medical Education
In 2011, nearly 1,800 residents and fellows trained at
Cleveland Clinic and Cleveland Clinic Florida, the most
ever hosted by Cleveland Clinic and part of a continuing
upward trend.
U.S.News & World Report Ranking
Cleveland Clinic is consistently ranked among the top
hospitals in America by U.S.News & World Report, and our
heart and heart surgery program has been ranked No. 1
since 1995.
For more information about Cleveland Clinic, please visit
clevelandclinic.org.
62
Outcomes 2011
Resources
Referring Physician Center and Hotline
Cleveland Clinic’s Referring Physician Center has
established a 24/7 hotline – 855.REFER.123
(855.733.3712) – to streamline access to our array of
medical services. Contact the Referring Physician Hotline
for information on our clinical specialties and services, to
schedule and confirm patient appointments, for assistance
in resolving service-related issues, and to connect with
Cleveland Clinic specialists.
Remote Consults
Online medical second opinions from Cleveland Clinic’s
MyConsult are particularly valuable for patients who wish
to avoid the time and expense of travel. Cleveland Clinic
offers online medical second opinions for more than 1,000
life-threatening and life-altering diagnoses. For more
information, visit clevelandclinic.org/myconsult, email
[email protected] or call 800.223.2273,
ext. 43223.
Request Medical Records
216.444.2640 or 800.223.2273, ext. 42640
Track Your Patient’s Care Online
DrConnect offers referring physicians secure access to their
patients’ treatment progress while at Cleveland Clinic. To
establish a DrConnect account, visit clevelandclinic.org/
drconnect or email [email protected].
Medical Records Online
Cleveland Clinic continues to expand and improve electronic
medical records (EMRs) to provide faster, more efficient
and accurate care by sharing patient data through a
highly secure network. Patients using MyChart can renew
prescriptions and review test results and medications from
their personal computers. MyChart provides a link to Microsoft
HealthVault, a free online service that helps patients securely
gather and store health information. It connects to Cleveland
Clinic’s social media and Internet site, currently the most
visited hospital website in America. For more information,
visit clevelandclinic.org/mychart.
Critical Care Transport Worldwide
Cleveland Clinic’s critical care transport team and fleet of
mobile ICU vehicles, helicopters and fixed-wing aircraft serve
critically ill and highly complex patients across the globe.
To arrange a transfer for STEMI (ST elevated myocardial
infarction), acute stroke, ICH (intracerebral hemorrhage), SAH
(subarachnoid hemorrhage) or aortic syndrome, call toll-free
877.379.CODE (2633).
For all other critical care transfers, call 216.444.8302 or
800.553.5056.
CME Opportunities: Live and Online
Cleveland Clinic’s Center for Continuing Education operates
one of the largest and most successful CME programs
in the country. The Center’s website (ccfcme.com) is an
educational resource for healthcare providers and the public.
Available 24/7, it houses programs that cover topics in 30
areas – if not from A to Z, at least from Allergy to Wellness
– with a worldwide reach. Among other resources, the
website contains a virtual textbook of medicine (Disease
Management Project) and myCME, a system for physicians
to manage their CME portfolios. Live courses, however,
remain the backbone of the Center’s CME operation. Most
live courses are held in Cleveland, but outreach plans are
under way. In 2011, the Center offered 15 simultaneous
courses at Arab Health, a major world healthcare forum.
63
This project would not have been possible without the
commitment and expertise of a team led by Christian Nasr, MD,
and Ronald R. Gambino, RN, MPA.
© The Cleveland Clinic Foundation 2012
9500 Euclid Avenue, Cleveland, OH 44195
ClevelandClinic.org

Outcomes - Cleveland Clinic

Transcription

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