Barlow Respiratory Hospital Outcomes Book 2019

Outcomes 2019

In this issue: OUTCOMES | NATIONAL COMPARISONS

MASTER PLAN The multi-phased plan to ReBuild Barlow Respiratory Hospital has begun.

Significant progress has already been made on a required seismic retrofit of Barlow’s historic hospital building on the main campus in Los Angeles. The hospital has provided uninterrupted patient care throughout this first phase of construction to protect the historic 1927 hospital building.

The project will soon segue to the next phase—construction entirely within the walls of an adjoining, existing hospital building. This will create a completely new, higher-capacity hospital at a fraction of the cost of building from the ground up.

This will significantly expand services on our Los Angeles campus and builds upon our legacy and our promise to serve patients and families for generations.

DEAR COLLEAGUE, Barlow Respiratory Hospital is proud to present our annual Outcomes book.

This publication highlights our unique role in the continuum of adult acute respiratory care. We are the only not-for-profit long-term acute care hospital in California. We serve chronically critically ill and medically complex patients referred to us by esteemed medical professionals at the finest hospitals in California. Our commitment to provide the highest quality care for our patients is illustrated by the outcomes we report.

At Barlow Respiratory Hospital we provide exceptional patient care by combining our strengths in clinical expertise and research, most notably our published TIPS© weaning protocol. Serving nearly 1,000 patients annually, Barlow Respiratory Hospital’s unsurpassed experience and national recognition attracts patients from all over southern California and surrounding states for weaning from prolonged mechanical ventilation and care of complex respiratory conditions.

Clinical outcomes are broadly agreed, measurable changes in health or quality of life that result from our care. Measuring a defined set of comprehensive health outcomes is a dynamic process, allowing us to make decisions about how to best care for our patients. For any medical condition, no single outcome captures the details or the nuanced results of the care our patients receive. For ventilatordependent patients, to regain the ability to breathe on their own is the most important outcome. For family members, the gift of having more time with a loved one is precious beyond measure.

A path forward exists in developing new and better ways of addressing the science, structures (organizational and team factors), and processes (elements of care) that improve outcomes important to patients and families. Our commitment to value and transparent reporting of accurate, timely information about patient care reflects our Barlow Respiratory Hospital culture of continuous improvement and is designed to help referring physicians, patients, and families make informed decisions.

We hope you find this information valuable. We welcome your feedback, questions, and ideas for collaboration. Please contact us at info@barlowhospital.org Sincerely,

A M I T M O H A N , P H D, FAC H E , FAC M P E PRESIDENT & CHIEF EXECUTIVE OFFICER

1 BARLOW OUTCOMES BOOK 2019

DAV I D R . N E L S O N , M D MEDICAL DIRECTOR

BARLOW OUTCOMES BOOK 2019

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WHO WE ARE: MISSION: To make a positive difference in the lives of individuals with chronic critical illnesses and complex respiratory conditions in post-acute settings.

VISION: To be the best in the care of individuals with complex respiratory conditions in the post-acute setting.

VALUES: Continuous Improvement – to deliver best outcomes Collaboration – to improve patient care Efficiency – in clinical services delivery Respect – for patients, families and co-workers

2 BARLOW OUTCOMES BOOK 2019

We were founded in 1902 by Dr. Walter Jarvis Barlow as the premier sanatorium for the treatment of tuberculosis. We transitioned to a full-service respiratory hospital in the late 1960’s and assumed our current mission in the 1980’s as a

ORGANIZATIONAL OVERVIEW:

regional specialty hospital for weaning chronically critically ill patients from mechanical ventilation.

At Barlow Respiratory Hospital, patients with complex respiratory conditions benefit from the expertise of a multidisciplinary medical team of clinicians who specialize in pulmonary medicine, critical care medicine, and internal medicine and who work in close collaboration with

Barlow Respiratory Hospital is among the nation’s leading

physicians in a variety of medical practice specialties. This

long-term acute care hospitals serving the chronically

partnership promotes communication and coordination of

critically ill. We are the destination of choice for weaning

care, informs treatment decisions and supports patient-

patients from prolonged mechanical ventilation.

centered goal setting.

Patients are referred to Barlow from nearly 100 hospital

Barlow Respiratory Hospital serves as a clinical training

intensive care units (ICUs) in the Los Angeles metropolitan

site for respiratory therapy, nursing, physical, occupational,

area and Southern California. With nearly 300 physicians

speech therapy, pharmacy, and clinical nutrition allied

on our medical staff and multiple locations in Los Angeles

health professionals. Educating medical professionals of

County, our expertise is accessible to patients and families

the future to care for the chronically critically ill is a vital role

throughout the region.

Barlow plays in our community, and one in which we take great pride.

In 2018, Barlow Respiratory Hospital was recertified and awarded the Gold Seal of Approval® for Disease Specific

ONE TEAM ONE GOAL – BEST OUTCOME

Certification for Respiratory Failure, the only one on the West

Barlow Respiratory Hospital is committed to providing the

Coast and among a select few hospitals nationwide to attain

highest quality post-acute intensive care for chronically

this elite certification. Barlow also holds the designation

critically ill and medically complex patients. We serve Los

as the only West Coast Passy-Muir Center of Excellence,

Angeles County with award-winning expertise from three

recognized for treating patients with tracheostomies, on and

convenient locations that allow patients and families the

off the ventilator.

comfort of access to their home communities.

1 BARLOW OUTCOMES BOOK 2019

BARLOW OUTCOMES BOOK 2019

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ESTABLISHED EXPERTISE – VOLUME MATTERS

Barlow Respiratory Hospital admits and treats more than twice the national percentage of mechanically ventilated patients discharged from long-term care hospitals.

(Data Source: Medicare Payment Advisory Commission (MedPAC), March 2019)

2018

Barlow Respiratory Hospital is a high-volume regional weaning center. In a true value-based system, volume matters. Volume of a condition treated is positively correlated with the outcome for that condition. Clinicians who treat a high volume of patients with the same condition become expert in treating those conditions. For over three decades, Barlow Respiratory Hospital has focused on serving chronically critically ill patients with complex respiratory conditions.

Total Patients 917 Ventilator Weaning Program 294 Weaning Success Rate 62%

2009-2018

Total Patients Ventilator Weaning Program Weaning Success Rate

1988-2018

Total Patients Approximately 21,000 Ventilator Weaning Program 6,602 Weaning Success Rate 52%

2 BARLOW OUTCOMES BOOK 2019

8,086 2,930 56%

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VENTILATOR WEANING PROGRAM More than 50% weaned each year 54%

55%

2016

2017

2018

50%

n=297

n=268

n=275

n=347

n=305

n=294

TIME TO WEAN (MEDIAN DAYS) More than half of patients who wean do so within the first two weeks of admission.

62%

2015

Weaned is defined as patient being free of invasive mechanical ventilation at least one full calendar day prior to day of discharge.

55%

58%

2014

Barlow Respiratory Hospital consistently liberates over half of all chronically critically ill patients admitted for weaning from mechanical ventilation.

61%

2013

WEANING SUCCESS RATE

47% decrease in time to wean

19

13

12

12

11

10

2013

2014

2015

2016

2017

2018

Time to wean is tallied from day of admission through last day of ventilator support.

n=297

n=268

n=275

n=347

n=305

n=294

Days to Wean

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6 Year Median

12 DAYS

58% 54%

55%

19 13

2018

10

2017

11

2016

12

2015

12

n=297

n=268

n=275

n=347

n=305

n=294

Weaned

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62%

2014

Barlow Respiratory Hospital has consistently weaned more than 50% of patients each year for the last six years while decreasing the number of days to wean.

61% 55%

2013

PERFORMANCE OVER TIME

Median Days to Wean

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NATIONAL COMPARISONS NATIONAL COMPARISON: INVASIVE MECHANICAL VENTILATION ADMISSIONS Barlow Respiratory Hospital admits and treats nearly twice the percentage of mechanically ventilated patients compared to a national LTCH database.

(Source: National LTCH database (7/1/2018-6/30/2019))

NATIONAL COMPARISON: VENTILATOR WEAN RATE Barlow Respiratory Hospital’s wean rate was 16 percentage points higher compared to that of a national LTCH database.

42.6%

More Ventilator Admissions

23.8%

Barlow Respiratory Hospital

66.7%

National

More Weaned

50.5%

Weaning success, inclusion and exclusion criteria are as defined by Centers for Medicare and Medicaid Services (CMS) in the Long-term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set - Version 4.00.

(Source: National LTCH database (7/1/2018-6/30/2019))

Barlow Respiratory Hospital 6 BARLOW OUTCOMES BOOK 2019

National

CASE MIX INDEX (CMI) CMI of a hospital reflects diversity, clinical complexity, and the needs for resources in the population of all the patients in the hospital.

A higher CMI indicates a more complex and resource-intensive patient population.

(Source: National LTCH database (7/1/2018-6/30/2019))

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1.35

More Complex

1.19

Barlow Respiratory Hospital

National

BARLOW OUTCOMES BOOK 2019

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CONTINUOUS IMPROVEMENT We are driven to achieve superior value in the eyes of our stakeholders. We take pride in our work.

We believe that excellence in our delivery of patient care and services distinguishes us from others.

We focus on personal and professional development to promote a culture of safety and provide a systematic, coordinated and continuous approach for creating and maintaining focus on reliable processes and best clinical outcomes.

Changes in Skin Integrity: Pressure Ulcer/Injury Percent of patients with pressure ulcers/injuries that are new or worsened (Stages 2, 3, or 4) 25%

The overall direction of the data is lower (lower is better)

20%

15%

UCL 10%

CL 5%

NOV – 15 DEC – 15 JAN – 16 FEB – 16 MAR – 16 APR – 16 MAY – 16 JUN – 16 JUL – 16 AUG – 16 SEP – 16 OCT – 16 NOV – 16 DEC – 16 JAN – 17 FEB – 17 MAR – 17 APR – 17 MAY – 17 JUN – 17 JUL – 17 AUG – 17 SEP – 17 OCT – 17 NOV – 17 DEC – 17 JAN – 18 FEB – 18 MAR – 18 APR – 18 MAY – 18 JUN – 18 JUL – 18 AUG – 18 SEP – 18 OCT – 18 NOV – 18 DEC – 18

0%

*Measure includes patients with unstageable and deep tissue pressure injuries beginning July 2018

35.0

C. Difficile Rate per 10,000 Patient Days

The overall direction of the data is lower (lower is better)

UCL

30.0 25.0 20.0

CL

15.0 10.0

LCL

5.0

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Q4 18

Q3 18

Q2 18

Q1 18

Q4 17

Q3 17

Q2 17

Q1 17

Q4 16

Q3 16

Q2 16

Q1 16

Q4 15

Q3 15

Q2 15

Q1 15

Q4 14

Q3 14

0.0

CAUTI Rate per 1,000 Urinary Catheter Days

The overall direction of the data is lower (lower is better)

7.0 6.0

UCL

5.0 4.0 3.0

CL

2.0 1.0

CLABSI Rate per 1,000 Central Line Days

Q4 18

Q3 18

Q2 18

Q1 18

Q4 17

Q3 17

Q2 17

Q1 17

Q4 16

Q3 16

Q2 16

Q1 16

Q4 15

Q3 15

Q2 15

Q1 15

Q4 14

Q3 14

Q2 14

Q1 14

Q4 13

Q3 13

Q2 13

Q1 13

0.0

Below average rate of infection last two calendar years

7.00 6.00 5.00 4.00

UCL

3.00 2.00

CL

1.00

9 BARLOW OUTCOMES BOOK 2019

Q4 18

Q3 18

Q2 18

Q1 18

Q4 17

Q3 17

Q2 17

Q1 17

Q4 16

Q3 16

Q2 16

Q1 16

Q4 15

Q3 15

Q2 15

Q1 15

Q4 14

Q3 14

Q2 14

Q1 14

Q4 13

Q3 13

Q2 13

Q1 13

0.00

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Experience of Care Better patient care experiences are associated with higher levels of adherence to treatment processes, better clinical outcomes, and better patient safety. Barlow Respiratory Hospital is committed to providing care that is respectful of and responsive to individual patient preferences, needs and values.

98% Patient and Family Experience of Care Overall satisfaction with the experience of care at Barlow Respiratory Hospital was ranked in the top tier by over 95% of patients and families.

(Source: Patient and Family Satisfaction with Care Inpatient Survey Report 1/1/2018 – 12/31/2018)

Likelihood of Recommending Barlow

2% Very Satisfied/ Satisfied

96%

The likelihood of recommending Barlow was ranked at the top of the scale by over 95% of patients and families.

4%

(Source: Patient and Family Satisfaction with Care Inpatient Survey Report 1/1/2018 – 12/31/2018)

Highly Likely

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Other Responses

Other Responses

CENTER FOR OUTCOMES & VALUE Barlow Respiratory Hospital maintains the largest longitudinal dataset in the nation with reported outcomes of chronically critically ill patients admitted to an LTCH for weaning from prolonged mechanical ventilation. The Ventilation Outcomes Dataset (VOD), a performance improvement dataset, includes data on more than 6,600 patients over 30 consecutive years. The advantage of our rich longitudinal dataset is that we can measure change. The dataset allows us to analyze the impact of various processes, protocols, and policies on improvement in patient outcomes.

Barlow leads LTCHs in outcomes reporting with over 90 publications – book chapters, peer-reviewed journal articles, editorials and abstracts – and numerous national and international conference presentations.

By reporting its outcomes, Barlow Respiratory Hospital serves as a valuable resource for patients who become ventilator-dependent and have weaning and rehabilitative potential, the chronically critically ill, those with chronic lung and medically complex disease processes, their families, and the medical community entrusted with their care.

BARLOW RESPIRATORY HOSPITAL GROUP & HOSPITAL BOARD OF DIRECTORS Michael D. Berger CHAIR Diane Naegele VICE CHAIR Jason Zayon, CPA SECRETARY/TREASURER Amit Mohan, PhD, FACHE, FACMPE PRESIDENT David R. Nelson, MD MEDICAL DIRECTOR Bradford M. Bolger Earl E. Gales, Jr. Eric Kleerup, MD Richard F. Seiden John Van Dyke, MD Daniel Weinstein

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With a legacy of care and expertise, Barlow Respiratory Hospital welcomes patients from all over California, the West Coast and beyond.

If you have a patient who requires the experience and expert care only Barlow can offer, contact us today. With locations in Los Angeles, Van Nuys, and Whittier we are accessible to patients’ home communities.

Admissions and Referrals Info Line: 213-202-6878 Toll Free: 833-4-BARLOW www.barlowhospital.org

LOS ANGELES

VAN NUYS

WHITTIER

2000 Stadium Way

15107 Vanowen St.

12401 E. Washington Blvd.

Los Angeles, CA 90026

Van Nuys, CA 91405

Whittier, CA 90602