Outcomes 2020
In this issue: OUTCOMES | NATIONAL COMPARISONS
Master Plan The multi-phased plan to ReBuild Barlow Respiratory Hospital has begun. A required seismic retrofit of Barlow’s historic hospital building on the main campus in Los Angeles is complete. The hospital has provided uninterrupted patient care throughout this first phase of construction to protect the historic 1927 hospital building.
Construction has begun on the next phase. An adjoining hospital building will be renovated entirely within existing walls and will result in a completely new, higher-capacity hospital at a fraction of the cost of building from the ground up. This new state-of-the-art hospital building 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. Faced with the stark realities of global pandemic and racial inequities, we share our outcomes with you from a world perspective that was unfathomable just a few short months ago. Yet we believe this moment may provide an opportunity to reflect on ways to evolve and be a larger part of change beyond the walls of our hospitals. This publication highlights our unique role in the continuum of adult acute respiratory care. We remain the only not-for-profit long-term acute care hospital in California. We continue our history of care for 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. What are the benefits of measuring outcomes? We all want to improve our health care. All aspects of this, from the improved health of an individual to improved hospital experience, can be measured. Constant review of our clinical outcomes establishes standards that drive all aspects of our care. Measuring change using outcome measures is one way to monitor the clinical impact and effectiveness of our services. Our commitment to value and transparent reporting of accurate, timely information about patient care reflects Barlow Respiratory Hospital’s culture of continuous improvement and is designed to help referring physicians, patients, and families make informed decisions. The safety of our patients and their families, and our staff, are our highest priorities. We thank our patients and families for their understanding. We also thank our staff for their uninterrupted dedication to service. Both were impacted by strategic decisions made during this time of unprecedented challenge. Our path forward compels us to stay present and connected as we endeavor to fight for a fairer society for future generations. We can and must make a difference, whether we demonstrate this on a personal level in how we treat one another, or on a professional level in addressing health inequities. We can bring about change. 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 MO H A N, P H D, FAC H E , FACM P E P R ES I DE NT & C H I E F E XEC U T I VE OF F IC ER
1
BARLOW OUTCOMES BOOK 2020
DAVID R. N ELSON , M D M ED IC A L D IREC TOR
BARLOW OUTCOMES BOOK 2020
1
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 2020
Organizational Overview
Barlow Respiratory Hospital was founded in 1902 by Dr. Walter Jarvis Barlow as the premier sanatorium for the treatment of tuberculosis. In the late 1960’s we transitioned to become a full-service respiratory hospital. To meet greater need in our community, in the 1980’s we assumed our current mission to serve as a regional
Barlow Respiratory Hospital is among the nation’s leading
specialty hospital for weaning chronically critically ill
long-term acute care hospitals (LTAC/LTCH) serving the
patients from mechanical ventilation.
chronically critically ill. We are the destination of choice for weaning patients from prolonged mechanical ventilation.
At Barlow Respiratory Hospital, patients with complex respiratory conditions benefit from the expertise of a
Patients are referred to Barlow from nearly 100 hospital
multidisciplinary medical team of clinicians who specialize
intensive care units (ICUs) in the Los Angeles metropolitan
in pulmonary medicine, critical care medicine, and internal
area and Southern California. With nearly 300 physicians
medicine and who work in close collaboration with
on our medical staff and multiple locations in Los Angeles
physicians in a variety of medical practice specialties. This
County, our expertise is accessible to patients and families
partnership promotes communication and coordination of
throughout the region.
care, informs treatment decisions and supports patientcentered goal setting.
Barlow Respiratory Hospital was the first hospital on the West Coast to be awarded the Gold Seal of Approval® for
Barlow Respiratory Hospital serves as a clinical training
Disease Specific Certification for Respiratory Failure and
site for respiratory therapy, nursing, physical, occupational
remains among a select few hospitals nationwide to attain
and speech therapy, pharmacy, clinical nutrition and allied
this elite certification. Barlow also holds the designation
health professionals. Educating medical professionals of
as the only West Coast Passy-Muir Center of Excellence,
the future to care for the chronically critically ill is a vital role
recognized for treating patients with tracheostomies, on and
Barlow plays in our community, and one in which we take
off the ventilator.
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.
1
BARLOW OUTCOMES BOOK 2020
BARLOW OUTCOMES BOOK 2020
1
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 Committee (MedPAC), March 2020
2019
2
Barlow Respiratory Hospital is a high-volume regional weaning center. Outcome from trauma, surgery, and a variety of other medical conditions has been shown to be positively affected by providing treatment at facilities experiencing a high volume of patients with those conditions. Outcome is influenced by patient volume, with better outcome occurring in high-volume centers. For over four decades, Barlow Respiratory Hospital has focused on serving mechanically ventilated chronically critically ill patients with medically complex conditions. Recognized nationally and internationally for its published outcomes and TIPSŠ weaning protocol, and well-established expertise, Barlow Respiratory Hospital remains a leader among long-term acute care hospitals.
Total Patients 951 Ventilator Weaning Program 318 Weaning Success Rate 58%
2010-2019
Total Patients Ventilator Weaning Program Weaning Success Rate
1988-2019
Total Patients Approximately 22,000 Ventilator Weaning Program 6,912 Weaning Success Rate 53%
BARLOW OUTCOMES BOOK 2020
8,372 2,931 56%
3
BARLOW OUTCOMES BOOK 2020
Ventilator Weaning Program More than 50% weaned each year 62%
61%
58% 54%
58%
55%
50%
WEANING SUCCESS RATE
2015
2016
2017
2018
2019
Weaned is deďŹ ned as patient being free of invasive mechanical ventilation at least one full calendar day prior to day of discharge.
2014
Barlow Respiratory Hospital consistently liberates over half of all chronically critically ill patients admitted for weaning from mechanical ventilation.
N=268
N=275
N=347
N=305
N=294
N=318
TIME TO WEAN (MEDIAN DAYS) More than half of patients who wean do so within the first two weeks of admission.
23% decrease in time to wean 13 12
12 11 10
10
2014
2015
2016
2017
2018
2019
Time to wean is tallied from day of admission through last day of ventilator support.
n=164
n=147
n=200
n=168
n=182
n=184
Days to Wean
4
BARLOW OUTCOMES BOOK 2020
6 Year Median
11 DAYS
58% 54%
BARLOW OUTCOMES BOOK 2020
10
2019
10
N=268
N=275
N=347
N=305
N=294
N=318
Weaned
5
11
2018
12
2017
12
2016
13
58%
55%
2015
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.
62%
61%
2014
PERFORMANCE OVER TIME
Median Days to Wean
BARLOW OUTCOMES BOOK 2020V
5
National Comparisons NATIONAL COMPARISON: VENTILATOR WEAN RATE Barlow Respiratory Hospital’s ventilator liberation rate is 33% higher compared to the Pacific Region in a national LTCH database.
60.4% More Weaned
40.3%
Weaning success, inclusion and exclusion criteria 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. Data Source: National LTCH database (1/1/2019 – 12/31/2019)
Barlow Respiratory Hospital
NATIONAL COMPARISON: INVASIVE MECHANICAL VENTILATION ADMISSIONS Barlow Respiratory Hospital admits and treats a higher percentage of mechanically ventilated patients compared to the Pacific Region in a national LTCH database.
43%
Pacific Region
More Ventilator Admissions
26.8%
Data Source: National LTCH database (1/1/2019 – 12/31/2019)
Barlow Respiratory Hospital 6
BARLOW OUTCOMES BOOK 2020
Pacific Region
NATIONAL COMPARISON: VENTILATOR WEANING ADMISSIONS Barlow Respiratory Hospital admits and treats a higher percentage of patients for weaning from mechanical ventilation compared to the Pacific Region in a national LTCH database. Data Source: National LTCH Database (1/1/2019 – 12/31/2019)
NATIONAL COMPARISON: HAPI (HOSPITAL ACQUIRED PRESSURE INJURIES) Barlow Respiratory Hospital has a 42% lower incidence of hospitalacquired pressure injuries compared to the Pacific Region in a national LTCH database. Data Source: National LTCH Database (1/1/2019 – 12/31/2019)
31.1%
More Weaning Admissions
21.5%
Barlow Respiratory Hospital
Lower is Better
Pacific Region
3.31%
1.93%
Barlow Respiratory Hospital
Pacific Region
BARLOW OUTCOMES BOOK 2020
7
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. Data Source: National LTCH Database (1/1/2019 – 12/31/2019)
1.354
More Complex
1.264
Barlow Respiratory Hospital
Pacific Region
BARLOW OUTCOMES BOOK 2020
9
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, 4, and Unstageable) The overall direction of the data is lower (lower is better)
18% 16% 14% 12%
UCL
10% 8% 6% 4%
CL
2%
NOV-15 DEC-15 JAN-16 FEB-16 MAR-16 APR-16 MAY-16 JUN-16 JUL-16 AUG016 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 JAN-19 FEB-19 MAR-19 APR-19 MAY-19 JUN-19 JUL-19 AUG-19 SEPT-19 OCT-19 NOV-19 DEC-19
0%
C. DIFFICILE RATE PER 10,000 PATIENT DAYS
The overall direction of the data is lower (lower is better)
35.0
UCL
30.0 25.0 20.0
CL
15.0 10.0 5.0
LCL
10
BARLOW OUTCOMES BOOK 2020
Q4 19
Q3 19
Q2 19
Q1 19
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
0.0
CAUTI RATE PER 1,000 URINARY CATHETER DAYS
The overall direction of the data is lower (lower is better)
7.0
UCL
6.0 5.0 4.0 3.0
CL
2.0 1.0
CLABSI RATE PER 1,000 CENTRAL LINE DAYS
Q4 19
Q3 19
Q2 19
Q1 19
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
0.0
Below average rate of infection last two calendar years
7.0 6.0 5.0
UCL
4.0 3.0 2.0
CL
1.0
Q2 19
Q1 19
Q4 19
Q3 19
Q2 18
Q1 18
Q3 18
Q2 18
Q1 17
Q4 17
Q3 17
Q2 17
Q1 16
Q3 16
Q2 16
Q1 16
Q4 15
Q3 15
Q2 15
Q1 15
0.0
BARLOW OUTCOMES BOOK 2020
11
BARLOW OUTCOMES BOOK 2020
12
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. Established in 1988, the Ventilation Outcomes Dataset (VOD), a performance improvement dataset, includes data on over 7,000 patients over 32 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.
FIRST IN OUTCOMES REPORTING Barlow leads LTCHs in outcomes reporting with over 90 publications – book chapters, peer-reviewed journal articles, editorials and abstracts – and hundreds of national and international conference presentations. Using the ability of the web to track the impact of our work, the data show that other medical authors have cited, or referenced, Barlow publications nearly 1,000 times. Our rich history of outcomes research and publication in chronic critical illness and post-acute weaning spans three decades, beginning in the early 1990’s. First Published Weaning Outcomes. Barlow was the first to publish outcomes of weaning patients from prolonged mechanical ventilation at an LTCH, introducing the concept of a regional weaning center to the pulmonary and critical care community. First Published Weaning Protocol. Barlow Respiratory Hospital was the first to develop and publish an evidencebased protocol for weaning ventilator-dependent chronically critically ill patients in the post-ICU setting. Our TherapistImplemented Patient-Specific “TIPS©” protocol has long been the standard of care at Barlow, and is recognized nationwide and abroad, serving as a “best practice” model for weaning patients from prolonged mechanical ventilation. First Multicenter Study. Barlow Respiratory Hospital served as the leader and primary research site for the first published multicenter study, reporting characteristics and weaning outcomes of patients admitted to 23 LTCHs nationwide.
LEGACY OF LEADERSHIP A leader establishes themselves and gains respect by sharing knowledge. Building on our position at the forefront of LTCH reporting, Barlow has played an active and vital role in shaping healthcare decisions and establishing national benchmarks for LTCH quality measures. By reporting its outcomes, Barlow Respiratory Hospital serves as a valuable resource for patients who become ventilatordependent 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 OUTCOMES BOOK 2020
13
Experience of Care Better patient care and family 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. Overall, how would you rate your satisfaction with your experience at Barlow?
99% PATIENT AND FAMILY EXPERIENCE OF CARE Overall satisfaction with the experience of care at Barlow Respiratory Hospital was ranked in the top tier by nearly 100% of patients and families. There were over 400 responses.
1%
Data Source: Patient and Family Experience of Care Inpatient Survey Report (1/1/2019 – 12/31/2019)
Very Satisfied/ Satisfied
LIKELIHOOD OF RECOMMENDING BARLOW
Other Responses
96%
The likelihood of recommending Barlow was ranked at the top of the scale by over 95% of patients and families. There were over 400 responses.
4%
Data Source: Patient and Family Satisfaction with Care Inpatient Survey Report (1/1/2019 – 12/31/2019)
Highly Likely
14
BARLOW OUTCOMES BOOK 2020
Other Responses
Barlow Group and 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
BARLOW OUTCOMES BOOK 2020
15
With a legacy of care and expertise, Barlow Respiratory Hospital admits and treats 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