Outcomes 2008 - Cleveland Clinic · 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

Digestive Disease Institute

2008Outcomes

65312_CCFBCH_ACG 1 6/23/09 10:47:54 AM

2

Institute Overview

65312_CCFBCH_ACG 2 6/23/09 10:47:57 AM

Digestive Disease Institute 1

Surgical OverviewTo 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 volume 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 mean we necessarily do not offer that treatment — our goal is to increase

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:

(www.qualitycheck.org)

(www.hospitalcompare.hhs.gov)

Our commitment to providing accurate, timely information about patient care will also help patients and referring physicians make informed healthcare decisions.

quality/outcomes.

65312_CCFBCH_ACG 1 6/23/09 10:47:59 AM

Outcomes 20082

Dear Colleague,

On behalf of Cleveland Clinic, I am pleased to present our 2008 Outcomes books. The primary purpose of our annual Outcomes book initiative is to promote quality improvement at Cleveland Clinic, thereby optimizing the care we provide to our

accountability, transparency and results.

requiring hospitals to report more and more quality and patient safety data. We view our Outcomes books as voluntary supplements to the required public reporting and an opportunity to share selected innovations with colleagues across the country.

Designed for the physician reader, each book in the annual series focuses on care provided by one of our patient-centered

content informative.

65312_CCFBCH_ACG 2 6/23/09 10:48:01 AM


what’s inside

Institute Overview 05

Quality and Outcomes Measures

Anorectal Disease 06

Esophageal Cancer 28

Nursing Quality 29

Contact Information 50

Cleveland Clinic Overview 52

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4

Chairman’s Letter

Outcomes 2008

Thank you for your interest in the Cleveland Clinic Digestive Disease Institute (DDI) 2008 Outcomes. This is the seventh year that we have shared our clinical outcomes and advanced technology with referring physicians, alumni, potential patients and other individuals interested in digestive diseases around the country.

includes the liver transplant team, nutrition therapy, nutrition support, intestinal rehabilitation and transplant nutrition, and upper gastrointestinal surgery – along with the former Digestive Disease Center’s departments of colorectal surgery and gastroenterology and hepatology.

reorganization as this close-knit team of healthcare providers draws on each

across the nation and from around the world. The institute is the largest national referral center for repairing failed pelvic pouches and houses

and treatment of digestive diseases, which you can read about in the pages that follow. It was also the year that

who I have mentored for many years here at Cleveland Clinic, will carry on the department’s reputation of both quality and compassion.

Digestive Disease Outcomes useful both as a reference as well as a testimony to our commitment to continuously raise the standards of our patient-centered care.

Chairman, Digestive Disease Institute

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Institute Overview

and hepatology, colorectal surgery, hepato-pancreato-biliary and transplant surgery, and nutrition within one unique, fully integrated model of care – aimed at optimizing the

treatments performed in the most effective and patient-friendly way, including shorter waits for appointments and more seamless interaction with all of our specialists. In addition, our institute model enhances opportunities for cutting-edge research and physician education.

U.S.News & World Report’s

2008 Statistics

Admissions 5,398

Patient Days 39,033

Average Length of Stay 7.2

Total Visits 100,954

Surgical Cases 5,092

Endoscopic Cases 33,269

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Outcomes 20086

Surgical Overview

6

Anorectal Disease

Diseases We Treat

•AnalCancer

•Polyps

•Abscess

•Fistula

•Fissure

•Hemorrhoids

•PruritisAni

•Bowen’sDisease

•Paget’sDisease

•AnalIntraepithelialNeoplasia

Techniques We Use

•CombinedModalityTherapyfor AnalCancer

•TransanalExcisionandTEM

•FistulaPlug

•AdvancementFlaps

•SetonInsertion

•Episioproctomy

•Sphincterotomy

•BotoxInjection

•Stapled,Doppler-Guided,and ConventionalHemorrhoidectomy

•High-ResolutionAnoscopy

Hemorrhoids

ClevelandClinic’sDigestiveDiseaseInstituteofferspatientsallavailabletechniquestotreathemorrhoids—frombandingtohemorrhoidalarterialligationtostapleandconventionalsurgicaltechniquesproventoprovidegoodoutcomes.

Procedure Volumes and Percent Recurrence (1 year) for Treatment of Hemorrhoids 2008

VolumeVolume Recurrence (%)

00

200200

HemorrhoidalBanding

100100

150150

5050

Hemorrhoidalarterial ligation

Treatment

Stapledhemorrhoidectomy

Excisionalhemorrhoidectomy

0

4

1

2

3


Procedure Volumes and Percent Recurrence (1 year) for Treatment of Anal and Rectovaginal Fistula 2008

Procedure Volumes and Percent Recurrence (1 year) for Treatment of Anal Fissures 2008

Anal Fistula and Rectovaginal Fistula

operative techniques that are determined by the etiology and precise anatomy of

plug and other cutting edge treatments in

the result of failed prior attempts at cures,

In many cases, despite the challenges of

Anal Fissures

60 percent when treated conservatively. Cleveland Clinic’s Digestive Disease Institute offers minimally invasive and traditional surgical options to increase healing rates in patients whose

treatment or have failed therapy at other institutions. Careful patient selection and a focus on changing bowel habits can decrease the chances of recurrence.


00

8080

Fistulotomy

4040

6060

2020

FistulectomyComplex

Treatment

Anal andRectovaginal

RectovaginalFistula Complex

0

60

15

30

45


00

8080

Fissurectomy

4040

6060

2020

Botox injection

Treatment

Lateral internalsphincterotomy

0

16

4

8

12

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8

Constipation, Rectal Prolapse, Fecal Incontinence

Constipation

patients and their physicians. In 2008, we performed nearly 60 surgical procedures to treat the different causes of severe constipation. The two most commonly performed procedures,

specialized surgical procedure that preserves the colon and is used in select cases of severe constipation.

Constipation Patients with Symptom Improvements as a Result of Surgery (N = 60) 2008

Constipation - Comparison of Pre- and Post Op Patients following ACE Procedure (N = 9) 2008

Percent ImprovementPercent Improvement

00

8080

4040

6060

2020

Abdominal Colectomy IRA

Surgical Procedure

Stoma

Occurrences per WeekOccurrences per Week

00

88

44

66

22

BowelMovements

Laxatives RetrogradeEnemas

FecalIncontinence(Episodes)

Abdominal Pain(Episodes)

Pre-OpPost-Op

Outcomes 2008

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Rectal Prolapse

In 2007 through 2008, we performed 31 surgical procedures for rectal prolapse including 14 perineal procedures and 17 abdominal procedures. A laparoscopic approach was used for the majority of the abdominal procedures. More than 80 percent of patients experienced symptomatic improvement. At one year follow-up, 100 percent and 86 percent of patients who underwent abdominal and perineal procedures respectively were free of recurrent prolapse.

Fecal Incontinence

Overlapping sphincteroplasty was used to treat fecal incontinence in 61 patients in 2007 and 2008. More than 80 percent of patients improved control following sphincteroplasty. Quality of life related to control of bowel movements also was markedly improved after sphincteroplasty. (Charts below)

FIQL: Fecal Incontinence Quality of Life - Improvement noted in all domains

FIQL: Comparison Between Pre- and Post-Sphincteroplasty (N = 61) 2007 – 2008

SF-12: Comparison Between Pre- and Post-Sphincteroplasty (N = 61) 2007 – 2008

PercentPercent

00

100100

4040

8080

2020

Lifestyle Score Coping/Behavior Depression Embarrassment

FIQL scales

ImprovedWorseSame

PercentPercent

00

8080

4040

6060

2020

SF-12 scores

ImprovedWorseSame

9Digestive Disease Institute

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Outcomes 2008

Colon and Rectal Cancer

Cleveland Clinic’s Digestive Disease Institute is a leader in both prevention and treatment of colon and rectal polyps and cancer. Using a multidisciplinary approach Digestive Disease Institute provides world-class care through patient screening, education, detection, and treatment.

A recent study from the Institute provided information that could lead to an

in 2006 at Cleveland Clinic. Detecting at least one adenoma was considered a positive colonoscopy. Colonoscopies performed in the morning had a higher rate of adenoma detection than those performed in the afternoon. The adenoma detection

group (p = 0.008). This study accounted for variability in bowel preparation and

p = 0.006]. This information has led to further studies as to why this phenomenon was observed and how the detection rate may be improved.

Effect of Time of Colonoscopy on Adenoma Detection Rate (N = 3,619)

Percent RatePercent Rate

Adenoma DetectionAdenoma Detection1010

3030

2020

2525

1515

MorningAfternoon

10

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Treating colon and rectal cancer is often a multimodal approach with surgery as the cornerstone of care. The Cleveland Clinic’s Digestive Disease Institute treats one of the highest volumes of colorectal cancer patients in the country. Institute surgeons

5-Year Survival Curves (Kaplan-Meier) for Colon Cancer by Stage

Proportion DFS Survival

Months from Surgery

0

0.6

0.8

0.4

0.2

1.0

0 10 20 40 5030 60

79.7%, Stage 2, N = 98260.5%, Stage 3, N = 823

92.7%, Stage 1, N = 694

6.3%, Stage 4, N = 572

11

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12 Outcomes 2008


Rectal Cancer

Colostomy avoidance is one goal of rectal cancer surgery. Digestive Disease Institute colorectal surgeons were able to avoid a permanent colostomy in 67 percent, despite the complex presentation of many of our rectal cancer patients.

Types of Surgery Performed for Rectal Cancer:

Procedures (%) 2001 2002 2003 2004 2005 2006 2007 2008

Sphincter saving procedure 52 66 66 64 58 67 66 57

Resection and Colostomy 23 25 20 22 28 25 22 33

Local excision/treatment 14 8 12 12 9 9 12 8

Other Treatments 1 1 2 2 5 0 0 2

5-Year Survival Curves (Kaplan-Meier) for Rectal Cancer by Stage


Months from Surgery

0

0.6

0.8

0.4

0.2

1.0

0 10 20 40 5030 60

70.6%, Stage 2, N = 64455.5%, Stage 3, N = 881

83.4%, Stage 1, N = 1,176

8.5%, Stage 4, N = 390


Rectal Cancer Recurrence Rates

Optimal surgery combined with proper use of chemotherapy and radiation resulted in low rates of local recurrence for rectal cancer patients. In 2008, the local recurrence rate for rectal cancer was less than 1 percent, 3 percent and 4 percent for upper, middle, and low rectal cancers respectively.

Laparoscopic Surgery in the Treatment of Colorectal Cancer

Laparoscopic surgery for colorectal cancer was shown to result in cancer-related outcomes similar to those of traditional open surgery. Advantages of the laparoscopic approach include decreased hospital stay, decreased pain and more rapid recovery. In 2008, approximately 50 percent of colorectal cancer operations were performed by laparoscopic approach.

Recal Cancer Recurrence Rate 2008PercentPercent

00

44

22

33

11

Upper Third Middle Third Lower Third

Rectal Cancer

Comparison on Median Length of Stay for Colorectal Cancer – Laparoscopic vs. Open

Open Surgery N Median LOS

Partial Colectomy 89 6

Anterior Resection 83 7

Total 172 7

Laparoscopic Surgery

Partial Colectomy 127 4

Anterior Resection 15 5

Total 142 5

LOS: Length of stay after surgery

14 Outcomes 2008


Colorectal Cancer in the Elderly

often have associated medical comorbidities that affect their ability to tolerate surgery

rectal cancer, stage-for-stage.

5-Year Disease-Free Survival for Stage I-III Colon Cancer by Age


Months from Surgery

0

0.6

0.8

0.4

0.2

1.0

0 10 20 40 5030 60

>75, N = 861

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Jagelman Registries

Center is composed of physicians, researchers and nurses from several institutes including the

to provide outstanding clinical care, education to caregivers, patients and families, and to research hereditary colorectal cancer.

Jagelman Registry Numbers

4% Juvenile Polyposis (34)4% Juvenile Polyposis (34)

3% Peutz-Jehgers (27)3% Peutz-Jehgers (27)

2% Hyperplastic Polyposis (17)2% Hyperplastic Polyposis (17)2% MYH-associated Polyposis (13)2% MYH-associated Polyposis (13)

89% Familial Adenoma Polyposis (754)89% Familial Adenoma Polyposis (754)

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Outcomes 2008


No Chemoprevention (CP) Chemoprevention (CP)

Proportion Without Cancer or Proctectomy

Years since IRA

0

0.6

0.8

0.4

0.2

1.0

0 6 12 24 30 3618 42

CP

p <0.0001

No CP

Effect of Chemoprevention on Familial Adenoma Polyposis

A 2008 Digestive Disease Institute study evaluated the effect of chemoprevention on the rate of rectal cancer and proctectomy in 290 patients with familial adenomatous

receiving chemoprevention were less likely to undergo proctectomy, develop rectal cancer, or die from their disease.

16

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Diverticular Disease

surgery. A further cohort is referred for reconstructive surgery, having had an emergency procedure performed elsewhere.

Complications of Primary Resection and Anastomosis vs. Hartmann Reversal Procedure

associated with a higher prevalence of surgical or medical complications compared with primary resection and anastomosis.

postoperative period. Our results add emphasis to importance of timely and appropriate surgery for sigmoid diverticulitis so a

Diverticular Operations - Volumes and Length of Stay 2008

N Median Length of Stay

Primary Resection / Anastomosis n (%) Hartmann Reveral n (%) P-value

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Outcomes 200818

In 2008, we continued our tradition of providing the highest level of care to patients with Crohn’s disease, ulcerative colitis

Variable Abdominal Repeat Pouch Primary IPAA Group P-value Surgery Group

Patients Who Underwent Repeat Pouch Surgery to Salvage a Failed Pouch and Avoid Permanent Ileostomy.

IPAA: ileal pouch-anal anastomosis CGQL:

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Ileoanal Pouch for Crohn’s Disease Patients

Diagnosis of Crohn’s Disease (CD) in Patients with Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis. (N = 204)

Intentional

Incidental

Delayed

Post-Operative Outcomes in Patients with Intentional or Incidental Pouch with Crohn’s Disease Versus Delayed Diagnosis of Crohn’s Disease.

Outcome Overall Intentional or Delayed CD P-value Incidental diagnosis CD Pouch

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Outcomes 200820

Inflammatory Bowel Disease

Infliximab (Remicade) Use Increased Frequency of Complications in Patients with Both Crohn’s Disease and Ulcerative Colitis

A recent study performed by Digestive Disease Institute colorectal surgeons suggests that the surgical approach to ulcerative colitis may require modifications in ulcerative colitis patients treated with infliximab.

Infliximab Non-Infliximab P-value

Sepsis 10 (22%) 1 (2%) 0.016

Leak 8 (17%) 1 (2%) 0.023

Overall early postoperative complication 16 (35%) 7 (15%) 0.027

Pouchitis 18 (39%) 7 (15%) 0.037

Stricture 5 (11%) 9 (20%) 0.39

SBO 3 (6.5%) 6 (13.0%) 0.45

Overall late postoperative complication 24 (52%) 17 (37%) 0.23

The increased incidence of septic complications in ulcerative colitis patients treated with infliximab has resulted in increased use of three stage pouch procedures in this patient population with the aim of decreased post-operative complications.

Inflammatory Bowel Disease Complications and Functional Results After Ileoanal Pouch Formation in Obese Patients 1983 – 2007

Ileoanal pouch formation (IPAA) can be technically challenging in obese patients, and there is little data evaluating results after the procedure in these patients. We compared outcomes for patients with a body mass index (BMI) 30 or more undergoing IPAA when compared with those for patients with BMI less than 30.

RESULTS:

Obese Not obese P-value

N 345 1671

Pelvic Sepsis 6.7% 5.3% NS

Pouch Failure 6% 4.5% NS

Wound Infection 19% 8.1% P<.05

Anastomotic Leak 10% 5% p<.05

Long-term outcome including QOL and function after 15 years was comparable between groups. CONCLUSIONS: Although technically demanding, IPAA can be undertaken in obese patients with acceptable morbidity. Good long-term functional results and QOL that is comparable to nonobese patients may be anticipated.


Short and Long-Term Morbidity of Ileal Pouch Anal Anastomosis (IPAA) Surgery

We recently reported outcomes for all patients who underwent primary

patients who underwent the procedure at a different center before being

Early (30-day) Post-Operative Complications of IPAA (N = 3,080)

Surgical Technique for IPAA (N = 3,080)

21

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Outcomes 200822

Total Morbidity for Crohn’s Disease (N = 2,212)

Year Volume 30 Day 30 Day Abdominal Obstruction Anast. Mortality (%) Readmission (%) Abscess (%) or Ileus (%) Leak (%)

Ileal Pouch Failure Model

score as calculated by the Weibull survival

probabilities are shown (orange circles).

Pr (pouch failure)

CCF-IPF score

0

0.6

0.8

0.4

0.2

1.0

0 10.5 1.5 2 3.5 4 4.5 5.5 652.5 3 6.5

10-years5-years

15-years

3-years1-year

65312_CCFBCH_ACG 22 6/23/09 10:49:00 AM


IncontinenceRare or No Incontinence

Bowel Movements: Frequency

and about one to two times at night. These results were much better than prior to surgery.

PercentagePercentage

00

100100

5050

7575

2525

BL

Time Post Surgery

1 yr 5 yrs 15 yrs

23

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Outcomes 200824

Cleveland Clinic Quality of Life Score

00

1212

66

99

33

BL

Time Post Surgery

1 yr 5 yrs 15 yrs

Mean QOL ScoreMean QOL Score

Continent Ileostomy

Continent ileostomy is an option in patients in whom an ileal pouch surgery is not possible or in whom the initial and subsequent repeat ileoanal pouch surgery failed and the patient is reluctant to accept a permanent ileostomy. Continent ileostomy, or Kock pouch, is constructed by three loops of small bowel and a one-way valve, which allows patients to avoid wearing an outer appliance. One has to cannulate the Kock pouch three or four times a day to empty itself. Cleveland Clinic

Complications # of Patients %

Koch Pouch Status # of Patients %

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Liver Disease

Liver Transplantation

the liver transplant program we have maintained graft and patient survival above the national average.

Liver Transplant Volume

00

160160

8080

120120

4040

2004

Year

2005 2006 2007 2008

PatientsPatients

25

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Outcomes 2008

Liver Disease

Liver Transplant Graft Survival (Includes Liver/Heart, Liver/Kidney Liver/Lung and Liver/Pancreas) 2004 – 2008

Survival Analysis: Patient survival for 587 primary liver, liver/heart, liver/kidney, liver/lung and liver/pancreas transplants 2004-2008

Survival Analysis: Liver graft survival for 587 primary liver, liver/heart, liver/kidney, liver/lung and liver/pancreas transplants 2004-2008

Percent Survival

Months

0

60

80

40

20

100

0 6 18 2412

All Patients

Liver Transplant Patient Survival (Includes Liver/Heart, Liver/Kidney Liver/Lung and Liver/Pancreas) 2004 – 2008

Percent Survival

Months

0

60

80

40

20

100

0 6 18 2412

All Patients

26


Intestinal Rehabilitation and Transplant Program

the Country. 2008 was a very productive year for the Intestinal

Intestinal Transplant in Ohio.

reconstructive surgery or transplantation.

A lesser percentage of referred patients were readmitted with

lesser percentage of referred patients were discharged from the

27

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Outcomes 200828

Esophageal Cancer

Early Esophageal Cancer in High-Risk Patients

measured by histologic response rate and cancer-free survival at Cleveland Clinic’s Digestive Disease Institute between

patients with complete response had recurrence of dysplasia or cancer in the gastric cardia.

year follow-up.

Probability of Cancer Free Survival

Proportion Cancer Free

September 2005 – September 2008

MonthsPost-CSA

N at Risk

0

0.6

0.8

0.4

0.2

1.0

0 3 6 12 189 24

31 31 27 22 1422 10

Upper and LowerConfidence Intervals

Cancer-free Survival

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Nursing Quality

Inpatient Nursing Risk Assessment Improvement

Results of 2008 WOSCN Survey: All Peers

100

90

602005 2006 2007 2008

80

70

Percent

Assess Skin on AdmitBraden on AdmitDaily Braden DoneWOSCN position

Peer Evaluation Averages

0 1 2 3 4 5 6 7 8 9 10

Nurse: MD Collaboration

Overall Quality of Patient Care

Support of Bedside Nurse

Overall Quality of Skin Care

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Outcomes 200830

Surgical Quality Improvement

Hospital Compare: Surgical Care Improvement Project (SCIP)

SCIP - Prophylactic Antibiotic Received within 1 Hour Prior to Surgical Incision (N = 902)

data showing how consistently they provide recommended care to adult patients, irrespective of payer. (These results also

0 20

* Source: www.hospitalcompare.hhs.gov, discharges July 2007- June 2008

40 60 80 100

Percent of Patients

NationalAverage*

ClevelandClinic

86

95

65312_CCFBCH_ACG 30 6/23/09 10:49:31 AM


SCIP - Prophylactic Antibiotic Discontinued within 24 Hours After Surgery End Time (N = 813)

SCIP - Prophylactic Antibiotic Selection for Surgical Patients (N = 937)

0 20


40 60 80 100

Percent of Patients

NationalAverage*

ClevelandClinic

84

82

0 20


40 60 80 100

Percent of Patients

NationalAverage*

ClevelandClinic

92

95

65312_CCFBCH_ACG 31 6/23/09 10:49:31 AM

Outcomes 200832


SCIP - Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered (N = 677)

SCIP - Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours Prior to Surgery to 24 Hours After Surgery (N = 677)

0 20


40 60 80 100

Percent of Patients

NationalAverage*

ClevelandClinic

84

96

0 20


40 60 80 100

Percent of Patients

NationalAverage*

ClevelandClinic

81

95

65312_CCFBCH_ACG 32 6/23/09 10:49:31 AM


SCIP - Surgery Patients with Appropriate Hair Removal (N = 1,386)

0 20

* Source: www.hospitalcompare.hhs.gov, discharges January - June 2008

40 60 80 100

Percent of Patients

NationalAverage*

ClevelandClinic

95

94

65312_CCFBCH_ACG 33 6/23/09 10:49:32 AM

Outcomes 200834


National Surgical Quality Improvement Project - Colorectal Surgery (N = 261)

morbidity outcomes and length-of-stay data are reported. Cleveland Clinic’s most

30-DayMortality

30-DayMorbidity

0

10

20

30

40

*Length of stay for patients without complications

Length of Stay*(N = 186)

Surgical SiteInfection

Percent

ExpectedObserved

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Leapfrog Survey - Pancreatic Resection

One bar = willing to report data Two bars = some progress Three bars = substantial progress

mistakes and improve the quality and affordability of

pancreatic resection rating appears above.

http://www.leapfroggroup.org/

65312_CCFBCH_ACG 35 6/23/09 10:49:32 AM

Outcomes 200836

Cleveland Clinic has placed a renewed emphasis on improving the patient

that patients seek more than solely a successful clinical outcome, the mission

the well-being of our patients, families and employees in a way that elevates Cleveland Clinic’s reputation as one of the world’s best hospitals.

institutes to research and implement innovative patient- and family-based programs that support this mission.

Outpatient – Digestive Diseases Institute

100

80

0

60

40

20

Percent

Excellent Very Good Good Fair Poor

Source: Quality Data Management, a national hospital survey vendor

2008 (N = 2,591)2007 (N = 2,403)

Overall Rating of Outpatient Care and Services

Patient Experience

65312_CCFBCH_ACG 36 6/23/09 10:49:33 AM


Recommend Outpatient Provider

100

80

0

60

40

20

Percent

Excellent Very Good Good Fair Poor


2008 (N = 2,591)2007 (N = 2,403)

100

80

0

60

40

20

Percent

ExtremelyLikely


Very Likely SomewhatLikely

SomewhatUnlikely

VeryUnlikely

2008 (N = 2,591)2007 (N = 2,403)

Rating of Outpatient Provider

65312_CCFBCH_ACG 37 6/23/09 10:49:33 AM

Outcomes 200838

100

80

0

6061% 61%

40

20

Percent

Rate Hospital Would Recommend

% respondentschoosing 9 or 10

% respondents choosing'definitely yes'

Source: Quality Data Management and Press Ganey, national hospital survey vendors

For comparison purposes, 2007 and Q1 2008 HCAHPS scores have been adjusted to account for a survey mode administration change as recommended by CMS.

2008 total survey respondents = 1,0812007 total survey respondents = 787

73% 73%

HCAHPS Overall Assessment

Inpatient – Digestive Diseases Institute

reporting are available at www.hospitalcompare.hhs.gov.

Patient Experience

65312_CCFBCH_ACG 38 6/23/09 10:49:33 AM


100

80

0

60

40

20

Percent

DischargeInformation

Doctor Communication

Nurse Communication

PainManagement

RoomClean

CommunicationNew Medications

Responsivenessto Needs

Quiet atNight

Respondents choosing 'always' or 'yes'

Source: Quality Data Management and Press Ganey, national hospital survey vendors

For comparison purposes, 2007 and Q1 2008 HCAHPS scores have been adjusted to account for a survey mode administration change as recommended by CMS.

2008 total survey respondents = 1,0812007 total survey respondents = 781

HCAHPS Domains of Care

65312_CCFBCH_ACG 39 6/23/09 10:49:34 AM

Outcomes 200840

Innovations

Endoscopic Cryospray Ablation

less than one minute thaw time between applications.

same vicinity treated by endoscopic mucosectomy or argon plasma coagulation.

crycopharyngeal location (one stricture requiring temporary naso-enteric tube feeding and dilations, one stricture treated

palliation gastrostomy or pharyngolaryngectomy. Two patients averted radiation therapy. One patient died of metastatic disease after a clinical response of the esophageal lesion and improvement in dysphagia. One patient with a crycopharyngeal

65312_CCFBCH_ACG 40 6/23/09 10:49:34 AM


Pre-procedure

During procedure Post-procedure

Example of patient with invasive squamous cell cancer at the cricopharyngeus facing laryngectomy as an alternative to cryotherapy. By treating this early cancer with cryotherapy, the patient maintains ability to speak and swallow.

Minimally Invasive/Robotic Liver and Pancreas Surgery Program

Minimally invasive techniques have been proven to benefit patients by decreasing length of hospital stay and time required to return to full activities. The surgical robot has allowed surgeons at DDI to expand minimally invasive surgery to the areas of liver and pancreas.

The surgical robot incorporates 3D visualization with articulating instrumentation to give surgeons the dexterity of conventional open surgery while maintaining the benefits of the minimally invasive approach.

41

Outcomes 2008

Selected Publications

Digestive Disease Institute staff authored more than

www.clevelandclinic.org/quality/outcomes.

200 Publicationsbowel disease genetics. Curr Opin Gastroenterol. 2008

associated with adverse postoperative outcomes in Crohn’s patients. J Gastrointest Surg

technology to promote gastrointestinal outcomes research: a case for electronic health records. Am J Gastroenterol. 2008

report of a rare indication for liver transplantation. Liver Transpl

measurements improve the management of portosystemic shunts during liver transplantation. Liver Transpl. 2008

colitis are attenuated in the absence of signal transducer Am J Pathol. 2008

42

65312_CCFBCH_ACG 42 6/23/09 10:49:37 AM


and morbidity in patients with chronic intestinal failure including those who are referred for small bowel transplantation. Transplantation. 2008

polyposis. Clin Gastroenterol Hepatol

and distal splenorenal shunt. J Hepatol

J Endourol. 2008

of fatty liver and disease progression to steatohepatitis: implications for treatment. Am J Gastroenterol

ed. Current Surgical Therapy

staging system separates patients with intra-abdominal, familial adenomatous polyposis-associated desmoid disease by behavior and prognosis. Dis Colon Rectum

sword has two edges. Dis Colon Rectum

43

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Outcomes 200844


what have we learned? A collection of perspectives and panel discussion. Cleve Clin J Med

between donor-recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl. 2008

cost. Dis Colon Rectum

for screening and surveillance of esophageal varices in patients with portal hypertension. Hepatology. 2008

colon and rectal surgery. Clin Colon Rectal Surg. 2008

techniques. Endoscopy

Endoscopy. 2008

Impact of orthotopic liver transplant for primary sclerosing cholangitis on chronic antibiotic refractory pouchitis. Clin Gastroenterol Hepatol

for serrated colorectal cancer, selectively represses beta-catenin-dependent transcription. Oncogene. 2008 Oct

Colorectal Dis

of metabolic syndrome in the setting of recurrent hepatitis C after liver transplantation. Liver Transpl. 2008

On-treatment prediction of response to peginterferon/ribavirin therapy. Liver Transpl

of metabolic syndrome in the setting of recurrent hepatitis C after liver transplantation. Liver Transpl. 2008

liver transplantation. J Hepatobiliary Pancreat Surg.

Female Urology

lymphoproliferative disorders after liver transplantation in relation to age and duration of follow-up. Liver Transpl. 2008

65312_CCFBCH_ACG 44 6/23/09 10:49:46 AM


manner. Transplantation

Colon Rectal Surg

Kelley DE. Estimates of hepatic glyceroneogenesis in type 2 diabetes mellitus in humans. Metabolism. 2008

Dis Colon Rectum

results after ileoanal pouch formation in obese patients. J Gastrointest Surg

case in an unusual location. Tech Coloproctol. 2008

Nat Clin Pract Gastroenterol Hepatol

ulcerative colitis: a randomized placebo-controlled trial. Gastroenterology

Hepatology

patterns of use and effects on liver function. Am J Gastroenterol

Incidental reduction in the size of liver hemangioma following J Hepatol. 2008

pathology. Dis Colon Rectum

Med Clin North Am. 2008

of clinical outcomes in primary biliary cirrhosis by Hepatology. 2008

ileal pouch-anal anastomosis and Crohn’s disease: pouch retention and implications of delayed diagnosis. Ann Surg.

with living liver donation. Transplant Rev (Orlando).

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Outcomes 200846


Neurogastroenterol Motil

with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum. 2008

after ileal pouch surgery for ulcerative colitis. Endoscopy.

the early postoperative period with noninvasive indocyanine green elimination following orthotopic liver transplantation. Liver Transpl

methylationalterations in endoscopic retrograde cholangiopancreatography brush samples of patients with suspected pancreaticobiliary disease. Clin Gastroenterol Hepatol

spontaneous bacterial peritonitis. Gastroenterology. 2008

cholangiopancreatography and pancreatic function test in suspected chronic pancreatitis and negative cross-sectional imaging. Clin Gastroenterol Hepatol. 2008

Adv Exp Med Biol

of meperidine and midazolam during endoscopy. Clin Gastroenterol Hepatol

is portal hyperperfusion, not arterial siphon. Liver Transpl.

Will it ever yield grafts for two adults? Liver Transpl. 2008

laparoscopy in colorectal surgery. Colorectal Dis. 2008

disease: progress in basic and clinical science. Curr Opin Gastroenterol

all responsible. Dis Colon Rectum

associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol

65312_CCFBCH_ACG 46 6/23/09 10:49:47 AM


pouch failure in patients with different phenotypes of Crohn’s disease of the pouch. . 2008

pouches. J Clin Gastroenterol

anastomosis. Clin Gastroenterol Hepatol. 2008

laparoscopic versus open ileocolic resection for Crohn’s disease: follow-up of a prospective randomized trial. Surgery

transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy. World J Gastroenterol

and endoscopic retrograde pancreatography for the prediction Dig Dis Sci. 2008

secretin-stimulated endoscopic and Dreiling tube pancreatic function testing in patients evaluated for chronic pancreatitis. Gastrointest Endosc

of a steroid-free regimen with thymoglobulin induction in pancreas-kidney transplantation. Transplant Proc. 2008

mucosa in cirrhosis and portal hypertension. World J Gastroenterol

aspiration for suspected pancreatic cystic neoplasms. JOP.

of suspected pancreatic cystic neoplasms based on cyst size. Surgery

Best Pract Res Clin Gastroenterol

65312_CCFBCH_ACG 47 6/23/09 10:49:48 AM

Outcomes 20084848

Staff Listing

Institute Chairman

Department of Colorectal Surgery

Chairman

Department of Gastroenterology and Hepatology

Chairman

Colon Cancer

Endoscopy Section

Section Head

Section Head

Swallowing Center

Section Head

Nutrition

Outcomes Section

Clinical Hepatology Section

Section Head

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Gastroenterology Regional Practice

Department of Hepato-pancreato-biliary and Transplant Surgery

Chairman

Program and Surgical Director, Liver Transplantation

Surgical Director, Intestinal Transplantation

Vice Chairman, Department of Hepato-pancreato-biliary and Transplant Surgery

Digestive Disease Institute Anesthesiology

Section Head

General and Liver Transplantation Anesthesiology Section

Section Head

Allen Keebler, DO

clevelandclinic.org/staff.

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Outcomes 20085050

Contact Information

General Patient Referral

Colorectal Surgery Appointments/Referrals

Gastroenterology & Hepatology Appointments/Referrals

Additional Contact Information

General Information

Hospital Patient Information

Patient Appointments

Medical Concierge for Out-of-State Patients

Complimentary assistance for out-of-state patients and families

[email protected]

Global Patient Services / International Center

Complimentary assistance for international patients and families

clevelandclinic.org/gps

Cleveland Clinic in Florida

For address corrections or changes, please call

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Institute Locations

Main Campus/A30

9500 Euclid Ave.

Beachwood Family Health and Surgery Center

Hillcrest Hospital Atrium

Elyria Chestnut Commons Family Health Center

Independence Family Health Center

Crown Center II

Solon Family Health Center

Strongsville Family Health and Surgery Center

Westlake Family Health Center

Willoughby Hills Family Health Center

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Outcomes 20085252

Cleveland Clinic Overview

bundling all clinical specialties into integrated practice units called institutes. An institute combines all the

under a single roof. Each institute has a single leadership and focuses the energies of multiple professionals onto the

point-of-care service, institutes will improve the patient

outpatient clinic, specialty institutes and supporting labs

Cleveland Clinic Abu Dhabi (United Arab Emirates), a multispecialty care hospital and clinic, is scheduled to

associates and postdoctoral fellows are involved in laboratory-based, translational and clinical research. Total

federal agencies, non-federal societies and associations, endowment funds and other sources. In an effort to bring research from bench to bedside, Cleveland Clinic

at any given time.

offers all students full tuition scholarships. The program will

Cleveland Clinic is consistently ranked among the top hospitals in America by U.S.News & World Report, and our

clevelandclinic.org.

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Resources for Physicians

Cleveland Clinic Secure Online Services

Cleveland Clinic uses state-of-the-art digital information systems to offer secure online services such as online medical second opinions, medical record access, patient treatment progress for referring physicians (see below), and imaging interpretations by our subspecialty trained radiologists. For more information, please visit eclevelandclinic.org.

MyChart This secure online tool connects patients to their own health information from the privacy of their home any time, day or night. Some features include renewing prescriptions, reviewing test results and viewing medications, all online. For the convenience of physicians and patients across the country, MyChart now offers a secure connection to GoogleTM Health. Google Health users can securely share personal health information with Cleveland Clinic, and record and share the details of their Cleveland Clinic treatment with the physicians and healthcare providers of their choice. To establish a MyChart account, visit clevelandclinic.org/mychart.

DrConnect Whether you are referring from near or far, DrConnect streamlines communication from Cleveland Clinic physicians to your office. This complimentary online tool offers secure access to your patient’s treatment progress at Cleveland Clinic. With one-click convenience, you can track your patient’s care using the secure DrConnect website. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

MyConsult Online Medical Second Opinion This secure online service provides specialist consultations from our Cleveland Clinic experts and remote medical second opinions for more than 1,000 life-threatening and life-altering diagnoses. MyConsult is particularly valuable for people who wish to avoid the time and expense of travel. For more information, visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext 43223.

Critical Care Transport: Anywhere in the world

Cleveland Clinic’s critical care transport team serves critically ill and highly complex patients across the globe. The transport fleet comprises mobile ICU vehicles, helicopters and fixed-wing aircraft. The transport teams are staffed by physicians, critical care nurse practitioners, critical care nurses, paramedics and ancillary staff, and are customized to meet the needs of the patient. Critical care transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.279.CODE (2633). For all other transfers, call 216.444.8302 or 800.553.5056.

CME Opportunities: Live and Online

Cleveland Clinic’s Center for Continuing Education’s website, clevelandclinicmeded.com, offers hundreds of convenient, complimentary learning opportunities, from webcasts and podcasts to a host of medical publications including the Disease Management Project Online Medical Textbook, with more than 150 chapters. The site also offers a schedule of live CME courses, including international summits that focus on key areas of translational research. Many live CME courses are hosted in Cleveland, an economical option for business travel. Physicians can manage their CME credits by using the myCME Web Portal. Available 24/7, the site offers CME opportunities to medical professionals across the globe.

staffed beds, an education institute and a research institute.

clevelandclinic.org.

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Documents

Outcomes 2008 - Cleveland Clinic · 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