Barlow Respiratory Hospital Outcomes Book 2019

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,

AMIT MOHAN , PHD, FACHE, FACMPE PRESIDENT & CHIEF EXECUTIVE OFFICER

DAVID R. NELSON , MD MEDICAL DIRECTOR

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

ORGANIZATIONAL OVERVIEW:

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

Barlow Respiratory Hospital is among the nation’s leading long-term acute care hospitals serving the chronically critically ill. We are the destination of choice for weaning patients from prolonged mechanical ventilation.

Patients are referred to Barlow from nearly 100 hospital intensive care units (ICUs) in the Los Angeles metropolitan area and Southern California. With nearly 300 physicians on our medical staff and multiple locations in Los Angeles County, our expertise is accessible to patients and families throughout the region.

In 2018, Barlow Respiratory Hospital was recertified and awarded the Gold Seal of Approval® for Disease Specific Certification for Respiratory Failure, the only one on the West Coast and among a select few hospitals nationwide to attain this elite certification. Barlow also holds the designation as the only West Coast Passy-Muir Center of Excellence, recognized for treating patients with tracheostomies, on and off the ventilator.

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 physicians in a variety of medical practice specialties. This partnership promotes communication and coordination of care, informs treatment decisions and supports patientcentered goal setting.

Barlow Respiratory Hospital serves as a clinical training site for respiratory therapy, nursing, physical, occupational, speech therapy, pharmacy, and clinical nutrition allied health professionals. Educating medical professionals of the future to care for the chronically critically ill is a vital role Barlow plays in our community, and one in which we take great pride.

ONE TEAM ONE GOAL – BEST OUTCOME

Barlow Respiratory Hospital is committed to providing the highest quality post-acute intensive care for chronically critically ill and medically complex patients. We serve Los Angeles County with award-winning expertise from three convenient locations that allow patients and families the comfort of access to their home communities.

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

2009-2018

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.

1988-2018

VENTILATOR WEANING PROGRAM

WEANING SUCCESS RATE

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

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

TIME TO WEAN (MEDIAN DAYS) 2013 2014 2015 2016 2017 2018

decrease in time

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

PERFORMANCE OVER TIME

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.

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.

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))

42.6%

More Ventilator Admissions

23.8%

66.7%

More Weaned

50.5%

Barlow Respiratory Hospital

Barlow Respiratory Hospital

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))

1.35

More Complex

1.19

Barlow Respiratory Hospital

National

CONTINUOUS IMPROVEMENT

Changes in Skin Integrity: Pressure Ulcer/Injury

Percent of patients with pressure ulcers/injuries that are new or worsened (Stages 2, 3, or 4)

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

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. *Measure includes patients with unstageable and deep tissue

C. Difficile Rate per 10,000 Patient Days

CAUTI Rate per 1,000 Urinary Catheter Days

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

CLABSI Rate per 1,000 Central Line Days

Below average rate of infection last two calendar years

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)

Very Satisfied/ Satisfied

2% Other Responses

96%

Likelihood of Recommending Barlow

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

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

Highly Likely

4% 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

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 2000 Stadium Way

Los Angeles, CA 90026

VAN NUYS 15107 Vanowen St. Van Nuys, CA 91405

WHITTIER 12401 E. Washington Blvd. Whittier, CA 90602