YEAR IN REVIEW
We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value.
Christiana Care Health System, headquartered in Wilmington, Delaware, is one of the country’s largest health care providers, ranking 22nd in the nation for hospital admissions. We are a major teaching hospital and recognized as a regional center for excellence in cardiology, cancer and women’s health services. We operate Delaware’s only Level I trauma center, the only center of its kind between Philadelphia and Baltimore, and a Level 3 neonatal intensive care unit, the only delivering hospital in the state to offer this level of care for newborns. A not-for-profit, nonsectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, a home health care service, preventive medicine, rehabilitation services, a network of primary care physicians and an extensive range of outpatient services.
2 THE CENTER FOR HEART & VASCULAR HEALTH 10 THE HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE 18 IN OUR COMMUNITY 28 RESEARCH & EDUCATION 40 SYSTEM STATISTICS 44 RECOGNITION
A MESSAGE TO OUR NEIGHBORS:
Living The Christiana Care Way At Christiana Care Health System, we embrace our responsibility as a leader in caring for our neighbors in an era of sweeping transformation in health care. To guide us, we created The Christiana Care Way, a simple yet powerful statement of our commitment to meet the challenge of caring for all our neighbors, all of the time, under every circumstance.
“When we live The Christiana Care Way, we create the experience for our patients that we would want for ourselves and our loved ones. This approach enables us to serve patients with expertise, caring and innovation — to fuse science and humanity — which is the very core of medicine.”
Robert J. Laskowski, M.D., MBA President and Chief Executive Officer
Here are those words: We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value. As a not-for-profit health system, our mission is one of service. But we can’t do this on our own. We believe that the key to providing truly exceptional care is to partner with our patients and their families, who tell us they want the very best care. We understand that the way to help our neighbors to get well and to stay that way requires that we take the time to learn who they are, what they want and what they need. Everything we do is centered around our patients and the people who love them. My colleagues and I are privileged to serve every patient and every family member who comes to us seeking help.
YEAR IN REVIEW
The Christiana Care Way: We take seriously our responsibility to be experts at what we do. Every one of our patients deserves the best care, and we work tirelessly to stay at the forefront of our profession.
A NEW BEGINNING Michael K. Banbury, M.D., (left) and James Hopkins, M.D., (right) meet with Dorothy Loose and her daughter.
THE CENTER FOR HEART & VASCULAR HEALTH
Intervention with Heart AT 93, DOROTHY LOOSE ENJOYED LIFE. BUT HEART PROBLEMS SLOWED HER DOWN. EXPERT CARE AT THE CENTER FOR HEART & VASCULAR HEALTH RESTORED HER QUALITY OF LIFE, WITHOUT THE RISKS OF MAJOR SURGERY.
orothy Loose has five children, 18 grandchildren, 25 great grandchildren and five great-great-grandchildren — and only one heart. At 93, her heart wasn’t pumping as much blood as it should because of age-related aortic stenosis, a narrowing of the valve that allows blood to flow from the major artery of the heart. She also suffered from chronic obstructive pulmonary disease (COPD), a lung condition that makes it hard to breathe. Simple chores like making the bed or washing dishes were exhausting.
“It was hard to do the things I enjoy, like go out with friends,” she recalled. “I didn’t feel like cooking any more.” For the expert care she needed, she turned to the Center for Heart & Vascular Health at Christiana Care. Her doctor, James Hopkins, M.D., an interventional cardiologist, suggested Transcatheter Aortic Valve Replacement (TAVR), a less traumatic, potentially life-saving alternative for patients with agerelated aortic stenosis. Christiana Care is among an elite group of institutions offering the skill and technology required for TAVR.
YEAR IN REVIEW
“It’s an alternative for patients like Mrs. Loose who are
not candidates for open-heart surgery because of other health problems, such as COPD or severe diabetes,” Dr. Hopkins said. Her daughter, Dorothy Mundy, went with her to appointments at the Center for Heart & Vascular Health. Her granddaughter, Michelle Wheeler, is a nurse manager there. The younger Dorothy was impressed by the doctor’s expertise, as well as his compassion. “There have been times when doctors at other hospitals have talked to me, not my mother,” she said. “Dr. Hopkins was focused completely on her, answering every question and treating her with kindness and respect.” He explained that the valve is made of cow tissue and polyester on a steel-mesh frame. To place the device, a physician compresses it into a pencil-width catheter and threads it from a small incision in the leg through the femoral artery to the site of the diseased aortic valve. There, the doctor deploys the new valve, which starts working immediately. “It sounded good to me,” the elder Dorothy said. “I said, ‘let’s go for it.’” “While it’s not appropriate for use in all patients who can’t undergo open-heart surgery, TAVR is expected to offer a lifeline to increasing numbers of patients as the population ages, and the number of people with health problems that rule out surgery increases,” said Michael K. Banbury, M.D., the W. Samuel
Carpenter III Distinguished Chair of Cardiovascular Surgery at Christiana Care. Dr. Banbury and Dr. Hopkins worked as a team to install the valve. The procedure puts less stress on the body than open-heart surgery, and patients recover more quickly. After a day in the hospital, the nonagenarian returned to her home in Wilmington. “They treated me like a queen and did everything under the sun that they could possibly do for me,” she recalled. “The nurses were so positive and cheerful. They actually had me laughing.” On Aug. 19, Mrs. Loose celebrated her 94th birthday. “I can breathe much better and I’m out with my friends, thanks to the good people at Christiana Care,” she said.
Christiana Care is among an elite group of hospitals with the skill and technology to perform Transcatheter Aortic Valve Replacement.
T H E C E N T E R F O R H E A R T & VA S C U L A R H E A LT H
A nationally recognized cardiovascular program The Center for Heart & Vascular Health has earned a national reputation for expert care and leading-edge technology, with a top rating of three stars for open-heart surgery from the Society of Thoracic Surgeons for four consecutive years. It is the only center in the region to integrate services under one roof, offering value and convenience for patients. Services include cardiac surgery, vascular surgery, vascular interventional radiology, cardiology and interventional nephrology. Christiana Care ranks seventh in the nation for the volume of stroke cases and among the top for advanced treatment of arrhythmia. We partner with patients to achieve optimum heart and vascular health, through the prevention of heart disease, planned care, emergency care, rehabilitation
awards JOINT COMMISSION ADVANCED CERTIFICATION
for Left Ventricular Assist Device Program for treatment of patients with advanced heart failure. SOCIETY OF THORACIC SURGEONS’ 3-STAR RATING, the gold standard of surgical programs attained by fewer than 15 percent of heart programs in the U.S. AMERICAN COLLEGE OF
and ongoing support.
CARDIOLOGY FOUNDATION’S ACTION REGISTRY-GWTG GOLD PERFORMANCE ACHIEVEMENT AWARD,
earned by only 32 hospitals in the nation, for success in carrying out a higher standard of care for heart attack patients. AMERICAN HEART ASSOCIATION GET WITH THE GUIDELINES HEART FAILURE GOLD PLUS AWARD for exceptional care of patients with heart failure.
GET WITH THE GUIDELINES —
OPEN-HEART CASES: 598
ACHIEVEMENT AWARD for
STROKE GOLD PLUS QUALITY
VENTRICULAR ASSIST DEVICE CASES: 5 TRANSCATHETER AORTIC VALVE REPLACEMENT CASES: 13 CARDIAC-CATHETERIZATION CASES: 4,514 ELECTROPHYSIOLOGY CASES: 1,598 VASCULAR SURGERY CASES: 1,331 VASCULAR INTERVENTION CASES:
CARDIOVASCULAR NON-INVASIVE STUDIES: 23,359
implementing a higher standard of care for stroke patients. TARGET: STROKE HONOR ROLL, the only hospital in Delaware and one of only a few in the Philadelphia region named to the list by the American Heart Association/American Stroke Association.
VASCULAR ULTRASOUND STUDIES: 24,860 CARDIAC REHABILITATION MONITORED VISITS: 16,853
YEAR IN REVIEW
SHORT STAY UNIT
New Short Stay Unit fast-tracks cardiac patients
LVAD offers advanced technology for heart failure
An innovative 10-bed Cardiology Short Stay Unit fasttracks cardiac patients who come to the Emergency Department so they can receive specialized expert treatment from doctors and nurses. Patients at Christiana Hospital who require emergency cardiac care — but do not necessarily need to be admitted — go to the CSSU for noninvasive cardiac tests. ED patients also benefit from this new process because having more beds available means timelier care. A review of case studies by The Advisory Board Company, a Washington, DCheadquartered health care consulting firm, found that CSSUs also reduce unnecessary hospital admissions.
Christiana Care’s Left Ventricular Assist Device (LVAD) Program offers a lifeline for patients with advanced heart failure. It is one of only 124 programs in the United States to earn the Joint Commission’s Gold Seal of Approval and the only health system in Delaware to offer the service. The pioneering program’s funding comes, in part, from the Crystal Trust, established in 1947 by Irenee du Pont to support organizations that serve people in Delaware. Implanted during open-heart surgery, the batterypowered left ventricular assist device replaces the pumping action of the heart. The latest devices are smaller and more durable and they improve quality of life for patients in many ways. Patients with advanced heart failure often have reached their maximum doses of medications and may have undergone coronary bypass or valve operations. The LVAD can represent a bridge to a heart transplant, a bridge to recovery or a destination therapy if a transplant is not an option.
CARDIOLOGY SHORT STAY UNIT
Bridging the Divides to improve heart health
Christiana Care spearheads Million Hearts Delaware Christiana Care is leading Million Hearts Delaware, a public-private statewide effort that is part of a national campaign to prevent 1 million heart attacks and strokes by 2017. The public awareness initiative focuses on blood pressure control and waist circumference, key measures to reducing heart attacks and strokes. The goal is to identify people with those risk factors and connect them with health care providers.
Christiana Care’s Bridging the Divides program seeks to close the gaps in care for patients who have had ischemic heart disease, including heart attacks. A $10 million grant from the Center for Medicare & Medicaid Innovation (CMMI) funds a model that uses information technology to identify patients who experience complications in the hospital and are at greater risk of readmission. A comprehensive care team will engage those patients when they leave the hospital to make certain they get the extra care they need to manage their symptoms to avoid unnecessary, costly readmissions while remaining in the comfort of their homes. Historically, patients with heart and vascular disease have received fairly standardized care in order to achieve optimal results. Bridging the Divides aims to determine whether concentrating certain resources on patients who need them most will ultimately prove to be a more efficient and effective approach. The program was one of only 107 projects selected by CMMI out of more than 3,000 proposals.
T H E C E N T E R F O R H E A R T & VA S C U L A R H E A LT H
STATE’S ONLY NEURO CRITICAL CARE UNIT OPENS THANKS TO DONORS
CRITICAL SUPPORT (from left) Lanny Edelsohn, M.D., Christiana Care Trustee and wife Micki Edelsohn, also a Trustee; Patricia Cochran and her husband John Cochran, a Christiana Care Board member; and Carroll M. Carpenter, chair of Trustees, on the new Neuro Critical Care Unit named in honor of Dr. Edelsohn.
THE NEW NEURO CRITICAL CARE UNIT (NCCU) at Christiana Hospital provides expert care that is critical to giving patients with serious neurovascular illnesses and injuries the greatest chance of survival. The stateof-the-science unit is named for Lanny Edelsohn, M.D., an esteemed neurologist and philanthropist who served as chief, Section of Neurology, from 1987 to 2010. The unit was funded by $1.3 million in contributions from donors, most of whom are Christiana Care Trustees. With the latest in technology, five expert neuro critical care specialists, eight neuro critical care midlevel providers and a staff of nurses trained to care for critically ill neurology patients, the 18-bed NCCU is the only unit of its kind in Delaware and is solely devoted to patients with immediate life-threatening
problems affecting the brain, spinal cord or peripheral nerves. The new NCCU expects to treat as many as 650 acute stroke patients every year. “The generosity of the donors makes it possible for these very ill patients to receive expert care from fellowshiptrained neuro critical care physicians, and benefit from our advanced technology,” said Valerie E. Dechant, M.D., medical director. “For some patients, it could be the gift of life.”
The NCCU is home to cutting-edge Continuous Electroencephalogram (cEEG) technology for more advanced neuromonitoring that is fundamental in helping to prevent irreversible neurological damage, severe disability or death. This innovative technology also will improve the evaluation and treatment of seizure disorders for the many patients who rely on Christiana Care for high-quality treatment that is close to home.
YEAR IN REVIEW
New cardiac PET scans offer multiple advantages
A milestone in zero central-line-associated infections
Christiana Care’s Section of Nuclear Medicine and Cardiovascular Laboratory now offers stress myocardial perfusion Positron Emission Tomography (PET) scans, a technology that produces high-quality images that will make it easier to diagnose coronary artery disease. The program initially focuses on patients who are obese or have other conditions that make it difficult to achieve accurate results with traditional stress tests. Cardiac PET scans offer significant advantages over a traditional stress myocardial perfusion scan using Single Photon Emission Computed Tomography (SPECT). They can be completed in about an hour, compared to three to four hours for SPECT studies. In addition, patients and the monitoring medical staff receive less radiation exposure.
The staff of the Cardiovascular Critical Care Complex marked a milestone in the continual battle against centralline-associated blood stream infections or CLABSIs — an entire year without a single infection. The Centers for Disease Control and Prevention estimates that 41,000 CLABSIs occur in U.S. hospitals each year. These serious infections prolong hospital stays and increase the risk of mortality.
Clinic places stroke patients in extended care continuum after discharge Patients who have suffered strokes receive ongoing care and education after they leave the hospital through Christiana Care’s new Stroke Prevention and Recovery Center. The center also promotes ongoing care for stroke patients through their primary doctors, with specialists consulting on stroke cases with primary care providers in the community. A visit includes a review of hospital records and tests, an evaluation of how well the patient is recovering, medication review and screening for depression, which frequently follows a stroke. Patients and their families receive education on making healthy lifestyle choices, as well as recognizing the signs of a subsequent stroke.
Christiana Care joins national Outpatient Cardiac Registry The Cardiac Rehabilitation Department at the Center for Heart & Vascular Health is now part of the American Association of Cardiovascular and Pulmonary Registry, the only program in the state to participate. The first nationwide registry of its kind, the AACVPR Outpatient Cardiac Rehabilitation Registry tracks patient outcomes and program performance in meeting evidence-based guidelines for secondary prevention of heart and vascular disease. It provides cardiac rehabilitation programs with national outcomes data for benchmarking and demonstrates the positive impact of cardiac rehabilitation. Last year, Christiana Care monitored almost 17,000 cardiac rehabilitation visits.
TIMOTHY J. GARDNER, M.D.
WILLIAM S. WEINTRAUB, M.D.
AHA honors Timothy Gardner, M.D., and William Weintraub, M.D. In recognition of more than 25 years of distinguished service, Timothy J. Gardner, M.D., medical director of the Center for Heart & Vascular Health, received the American Heart Association 2013 Gold Heart Award, the AHA’s highest honor. Dr. Gardner, an internationally known surgeon and leader in cardiovascular medicine, is a past president of the AHA. William S. Weintraub, M.D., the John H. Ammon Chair of Cardiology and director of the Christiana Care Center for Outcomes Research, received the Science Advocate of the Year Award from the AHA/American Stroke Association. The award recognizes a medical professional who is actively engaged in communicating with lawmakers on behalf of the Association’s heart and stroke issues and encouraging other experts to get involved. Dr. Weintraub, an internationally distinguished cardiologist and expert in outcomes research, is president of the AHA’s Great Rivers Affiliate board of directors.
T H E C E N T E R F O R H E A R T & VA S C U L A R H E A LT H
CARDIAC PET SCANNING
OUTPATIENT CARDIAC REHABILITATION
STROKE CLINIC EXTENDED CARE
INTERVENTIONAL CARDIOLOGY YEAR IN REVIEW
THE HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE
takes Teamwork TONY DALE WAS DUE FOR A COLONOSCOPY. BUT HE NEEDED HELP IN FINDING THE RIGHT TIME AND PLACE. A CANCER SCREENING NURSE NAVIGATOR MADE IT EASY FOR HIM TO GET THE TEST. THAT STRATEGY IS SAVING LIVES AND HAS ELIMINATED DISPARITIES FOR AFRICAN-AMERICANS IN DELAWARE.
n Tony Dale’s 50th birthday, he received a postcard from Lt. Gov. Matt Denn reminding him to schedule a colonoscopy, the most effective method of screening for colorectal cancer. “I had a couple friends who passed away from cancer because they waited too long to get help,” Tony said. “So I called the number for Christiana Care on the card and asked about the test.” That phone call likely saved his life.
At the other end of the line was Charlene Marinelli, BSN, OCN, the cancer screening nurse navigator at the Helen F. Graham Cancer Center & Research Institute. It’s Marinelli’s job to guide patients through the system, coordinating tests, appointments and paperwork. Creating innovative ways to eliminate barriers to care is an important part of The Christiana Care Way. “Location, physician, day of the week, insurance,” she said. “It takes a bit of finagling to figure it all out.”
FIGHTING CANCER Nurse navigator Charlene Marinelli, BSN, OCN, guides Tony Dale through the process of colon cancer screening.
The Christiana Care Way: We have the opportunity to design and implement approaches of care that are not only excellent, but that focus on the specific needs of our community.
YEAR IN REVIEW
Tony wanted his test at Wilmington Hospital, only a
few blocks from his home. He asked for a physician who would make an appointment to meet with him before the test so he could ask questions about the procedure. “And he needed to have his colonoscopy on a Friday, so we matched him with a physician who has hours then,” Marinelli recalled. Tony had his colonoscopy. During the procedure, the doctor removed seven polyps that could have become cancerous down the road. Tony is receiving follow-up care to make sure he stays healthy. “Going for the test was a life-saving decision,” he said. “I am so grateful to Charlene and Christiana Care for making sure my colonoscopy was stress-free. There was no going here, no going there. It was totally smooth.” Making sure everyone has access to screenings that can identify cancer in its earliest, most treatable stage requires teamwork. Christiana Care partners with Delaware’s other hospitals, providers and state government to reach out to underserved people in the African-American community, who statistically are at greater risk for dying of colorectal cancer. Everyone shares a common goal: saving lives. In 2004, the percentage of African-Americans in Delaware diagnosed when they were already in the later stages of colorectal cancer was 79 percent. By recruiting patients for testing and coordinating their care, Delaware became the first state in the U.S. to eliminate a key disparity between African-American and white patients in colorectal cancer diagnoses. By 2009, the percentage of African-American patients diagnosed in later stages had declined to 45 percent, the same percentage as white patients. Those impressive results were published in the April 2013 issue of the Journal of Clinical Oncology, “Eliminating Racial Disparities in Colorectal Cancer in
the Real World: It Took a Village,” by Stephen Grubbs, M.D., an oncologist at the Graham Cancer Center, and Nora Katurakes, RN, MSN, OCN, Christiana Care’s manager of Community Outreach and Education. “We demonstrated what can happen when the state’s entire health care community mobilizes toward a common goal,” Dr. Grubbs said. At the Graham Cancer Center, all patients have access to the same high-quality care. If patients don’t have insurance, Marinelli connects them with the state’s Screening for Life program, which provides free colonoscopies. If patients can’t afford the preparations they need to take before the test, she applies for free medications. “Everyone who needs a colonoscopy gets one,” she said. As for Tony, he shared the news about his colonoscopy with a friend who was about to turn 50. “My buddy went home that night and the postcard was in his mailbox,” he said. “I told him to call Charlene right away.”
A LIFE-SAVING BIRTHDAY CARD Recruiting patients for testing and coordinating their care made Delaware the first state in the U.S. to eliminate disparity in colorectal cancer diagnoses for African-Americans.
T H E H E L E N F. G R A H A M C A N C E R C E N T E R & R E S E A R C H I N S T I T U T E
Ten years of saving lives through expert, effective cancer treatment and outreach For a decade, the Helen F. Graham Cancer Center & Research Institute led the way in the state’s dramatically declining cancer rates and deaths from cancer through a multi-pronged effort combining evidence-based medicine, research and community outreach.
PATIENT VISITS IN 2013:
In the 1990s, Delaware had the second highest cancer mortality in the nation. In the most recent report by the state Department of Health and Social Services, Cancer Incidence and Mortality in Delaware, 2005-2009, the state ranked 14th. The previous year’s report, evaluating 2003-2007, ranked Delaware 12th in cancer deaths. The state outpaced the national average in reducing deaths from a number of cancers, including ovary, larynx, colon, cervix, esophagus, stomach and Hodgkin’s lymphoma. Thanks to the improvement in early detection, the breast cancer death rate for all Delaware women fell 29 percent, more than 50 percent greater than the national decline. Of women over age 40, 81.4 percent have had a mammogram within the past two years, the second highest rate in the United States. Delaware is the first state to end a racial disparity for colorectal screening. In 2010, the screening rate for African-Americans was 74.9 percent, slightly higher than the 74 percent rate for whites. Delaware’s colorectal incidence rate declined 22.6 percent, outpacing the U.S. average of 16.6 percent.
2013 statistics PATIENT VISITS:
NEWLY DIAGNOSED AND/OR NEWLY TREATED: 3,124
PATIENTS ENROLLED IN CLINICAL TRIALS: 652
YEAR IN REVIEW
Graham Cancer Center earns reaccreditation with commendation
Building a national model for psychosocial cancer programs
The Graham Cancer Center has earned accreditation with commendation from the Commission on Cancer of the American College of Surgeons, an honor for only those facilities that exceed standard requirements. To earn voluntary accreditation, a cancer program must meet or exceed 34 Commission on Cancer quality-care standards, undergo evaluation every three years and maintain levels of excellence in the delivery of comprehensive patientcentered care. The cancer program at Christiana Care consistently earned Commission on Cancer accreditation since 1951.
As a National Cancer Institute selected Community Cancer Center Program (NCCCP), the Graham Cancer Center is working with other centers across the nation to build effective psychosocial programs for cancer survivors. The goal is to change the culture of thinking about mental health and how to best communicate with cancer survivors to get them the help they need. Scott D. Siegel, Ph.D., a health psychologist, led the NCCCP Survivorship & Palliative Care Subcommittee working group to develop a Cancer Psychosocial Care Matrix. Theresa Gillis, M.D., medical director of Oncology Pain and Symptom Management and Rehabilitation Services, is a co-author on its paper published online in the journal Psycho-Oncology 2013. National practice guidelines emphasize the importance of providing distress screening for survivors, improving communication between providers and patients, and offering interventions or referrals for mental health and social services.
ASCO trial award for Radiation Oncologists P.A. Radiation Oncologists P.A. at the Graham Cancer Center is one of only seven community oncology research programs in the country to receive a Clinical Trials Participation Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO). The award recognizes Radiation Oncologists for its work improving cancer care through its high-quality clinical trials program. In 2012, 24 percent of patients participated in clinical trials at the Graham Cancer Center, far above the national average of 4 percent.
RADIATION ONCOLOGISTS P.A.
Breast Imaging Center of Excellence The Breast Center received designation as a Breast Imaging Center of Excellence from the American College of Radiology, earning a Gold Seal of Accreditation in mammography, stereotactic breast biopsy and breast ultrasound, including ultrasound-guided breast biopsy. Itâ€™s the only center in the region to offer dedicated breast MRI testing and the first in Delaware to offer tomosynthesis, the latest in breast cancer screening and diagnostic technology. Tomosynthesis uses 3D technology to capture images of the breast at multiple angles. The individual images are then reconstructed into extremely thin, high-resolution slices, which can be displayed individually or as a set. Tomosynthesis eliminates the challenges associated with detecting cancer in overlapping structures in the breast, which is the primary drawback of conventional 2D analog and digital mammography. The technology also makes it easier to see lesions and localize structures in the breast.
T H E H E L E N F. G R A H A M C A N C E R C E N T E R & R E S E A R C H I N S T I T U T E
Nicholas Petrelli, M.D., in Society of Surgical Oncology’s Great Debates Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute, participated in the Society of Surgical Oncology’s “Great Debates” series during the 66th SSO Annual Cancer Symposium on March 9 in National Harbor, Md. Intended to provoke lively and educational discussions about treatment strategies, the Great Debates are a highlight of the symposium. Only past presidents of the society can participate. Dr. Petrelli and Mitchell C. Posner, M.D., chief of surgical oncology at the University of Chicago, received the topic “Surgery Alone Versus Surgery Plus Chemotherapy for Resectable Colorectal Liver Metastases.” Dr. Petrelli argued in favor of surgery alone; Dr. Posner argued in favor of both surgery and chemotherapy.
SOCIETY OF SURGICAL ONCOLOGY GREAT DEBATES
BREAST IMAGING CENTER OF EXCELLENCE
“The real crux of the matter here is surgical resection and avoiding the toxicity and the cost of these agents, which have absolutely no impact on overall survival as shown by prospective randomized trials,” Dr. Petrelli asserted. “Randomized trials are the gold standard in oncology.”
Reaching out to the community with free skin cancer screenings Since 1990, Christiana Care and the Academy of Dermatology have offered free screenings for skin cancer through the Melanoma Monday campaign to diagnose cancer early, when the disease is highly curable. Patients also learn ways to prevent skin cancer. This year, 185 people received screenings at the event, held May 22–23 at the Graham Cancer Center. The center’s outreach team also follows up with people who need additional care after screening to ensure they get the help they need.
SKIN CANCER SCREENINGS
PSYCHOSOCIAL CANCER PROGRAM YEAR IN REVIEW
First allied health residency program in medical physics
Graham Cancer Center tops in national cancer care survey
The Department of Radiation Oncology at the Graham Cancer Center is offering its first residency program in medical physics. The program is in collaboration with the Thomas Jefferson University Radiation Oncology Department Division of Medical Physics at the Kimmel Cancer Center in Philadelphia. As a branch campus of Jefferson Medical College and an independent academic medical center, Christiana Care supports 13 residency programs. The new medical physics residency at the Graham Cancer Center is the first for allied health professionals. Medical physicists collaborate with radiation oncologists to help plan and supervise the delivery of complex radiation treatments for cancer patients.
The Graham Cancer Center scored highest in patient experience for the quality of cancer care among six U.S. centers in a July survey reported by the Mayo Clinic and the American Institutes for Research. In the prototype Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for Cancer Care, Christiana Care had the highest score for overall care with 88 percent of patients giving a 9 or 10 rating to their cancer care team on a scale of 1 to 10. Christiana Care’s average score of 9.5 was significantly higher than the average for all six centers.
Pioneering clinical immersion program for students In a first-of-its-kind program in the United States, cancer specialists at the Graham Cancer Center are closing the gap between the real world and the classroom for tomorrow’s biomedical engineers. The goal of the fourweek immersion session for University of Delaware students was to challenge future biomedical engineers to explore solutions to problems in today’s operating rooms. In January 2013, 11 students took the course, offered in partnership with clinicians and professionals at Christiana Care, Nemours/Alfred I. duPont Hospital for Children and the Infant Behavior Laboratory at UD’s Early Learning Center. MEDICAL PHYSICS RESIDENCY PROGRAM
American Psychological Association Healthy Workplace Award For creating a healthy, high-performing work environment, the Care Management Department at the Graham Cancer Center received the American Psychological Association’s 2013 Psychologically Healthy Workplace Award. One of only four employers in North America to receive the award, Christiana Care won in the not-for-profit category. The department previously won the Delaware Psychological Association’s state-level Psychologically Healthy Workplace Award, qualifying for the APA nomination. Christiana Care is only the fourth hospital system ever to win the national award. The APA also recognized the Graham Cancer Center department as a Best Practices honoree for promoting employee growth and development through such practices as an annual employee retreat, wellness website and flexible scheduling.
T H E H E L E N F. G R A H A M C A N C E R C E N T E R & R E S E A R C H I N S T I T U T E
YOU’VE GOT A ‘FRIEND’ AT THE GRAHAM CANCER CENTER IT’S AMAZING WHAT CAN BE ACCOMPLISHED when friends work together. For 10 years, the Friends of the Helen F. Graham Cancer Center & Research Institute has worked to raise both money and awareness in the treatment and prevention of cancer. Showing neighbors we care is part of The Christiana Care Way. “We are all touched by cancer, either directly or indirectly, and we need to work together to beat it,” said Penny Saridakis, Friends co-chair. The group of 60-plus volunteers works in cooperation with the clinical staff of the Graham Cancer Center to help fund programs that enhance the patient care experience, support cancer research and provide public education on the prevention, early detection and treatment of cancer. So far, the Friends have raised more than $2 million and hope to raise more. The group sprang from the vision of its founder, Carroll M. Carpenter, chair of Christiana Care Health System’s Trustees. She believes that philanthropic efforts, working in concert with the clinical staff, can move hospital initiatives forward and benefit patients. Her passion, guidance, leadership and friendship are a guiding light for the group.
FRIENDS UNITED Co-chairs of the Friends of the Helen F. Graham Cancer Center & Research Institute (from left) Amanda Friz, Karen Kimmel Legum, Anne Martelli, Diane du Pont, Penny Saridakis, Elisa Morris and Maureen Rhodes. Early on, the group raised money to help buy a CyberKnife, a robotic radiosurgery system that is noninvasive and delivers beams of highdose radiation to tumors with extreme accuracy. The group also funded radiation therapies. In recent years, the majority of funds have gone to the Center for Translational Cancer Research at the Graham Cancer Center, where researchers are exploring innovative and effective ways to treat cancer.
The group has also supported the special needs fund, which helps patients with medication, transportation to and from appointments, supplies, nutrition counseling and massage therapy. Educating neighbors on ways to stay healthy is a priority, too. In May 2012, the Friends sponsored a free wellness seminar on whole foods featuring Christina Pirello, a celebrity chef and cancer survivor. “The Friends have been invaluable to the cancer program,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director. “Without their support many of our programs and technologies would not have been possible. Their generous philanthropic efforts help our patients to receive cutting-edge, highquality care.”
YEAR IN REVIEW
The Christiana Care Way: We are committed to treating every patient as a partner. It takes a partnership — both sides working together to be truly successful.
OFFICE VISIT WITHOUT THE OFFICE Tracy Pearson, MSW, MSM, senior social worker for the Medical Home Without Walls program, visits with patient Danny Wise — on his front steps — where he is seen for his care.
IN OUR COMMUNITY
Lifeline to Wellness A
FOR PATIENTS WITHOUT HEALTH INSURANCE, THE EMERGENCY DEPARTMENT OF THE HOSPITAL IS OFTEN THEIR ONLY REFUGE WHEN THEY GET SICK. MEDICAL HOME WITHOUT WALLS GIVES DANNY WISE AND OTHER PATIENTS THE EXTRA HELP THEY NEED TO STAY WELL AT HOME.
or Danny Wise, the road to wellness was choked with obstacles: joblessness, stress and financial burdens and then a series of debilitating strokes. But he didn’t have to walk that road alone. A team at Christiana Care’s Medical Home Without Walls reached out to partner with Danny, offering expert, compassionate care and guidance every step of the way. Medical Home Without Walls is an innovative program designed to help “super users,” the fewer than 10 percent of patients who account for more than 20 percent of visits to the hospital. Many of these
patients have no family, no friends and no advocates. Some live on the streets. “When they get sick, they see the local Emergency Department as their only refuge,” said Diane Bohner, M.D., the program’s medical director. Medical Home Without Walls identifies patients who need extra help through electronic medical records and partners them with a primary care doctor, an advanced practice nurse and a social worker who coordinate their medical care – and far more. If the patient is hungry, they will connect her to a food bank or a kitchen serving hot meals. If she needs a safe place to sleep, the team will reach out to a shelter.
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As a result of that special boost, patients are
able to avoid hospitalizations and visits to the ED. They also learn to be active partners in taking responsibility for their health. Their quality of life improves. The health system benefits from reduced costs. Everybody wins. That’s The Christiana Care Way. The health system is committed to forging strong partnerships with neighbors and their communities, reaching people where they live. That translates to training Latinas to talk to their friends and relatives about breast health. Grandmothers get free flu shots at the local senior center. Inner-city teens learn to prepare heart-healthy meals they can make at home. When the team contacted Danny, he was frustrated, confused and struggling to make ends meet. He was only 48 and wondering if he would stay healthy enough to enjoy his golden years. The team at Medical Home Without Walls offered him a lifeline to wellness and self-sufficiency. “I had stopped taking my blood pressure medication after I lost my job,” he said. “I wound up in the hospital for three months.” To help keep Danny out of the hospital, Dana Cortese, an advanced practice nurse, visited him at his home in Wilmington to check his blood pressure and make sure he was taking his medications properly. She went with him to doctor’s appointments. Each time they got together was an opportunity to educate Danny about his health, empowering him to become an active partner in his care. His lengthy hospital stay produced a mountain of medical bills. Tracy Pearson, MSW, MSM, the team social worker, connected Danny with information from various health care providers so he could get help with his bills through charity-care programs. “I highlighted the names and gave him the list,” she said. “But it was up to him to make the calls – and he did.”
PROUD GRADUATE Danny Wise was the first graduate of the Medical Homes Without Walls program. He continues to stay healthy and has not needed hospitalization since working with the team.
She helped Danny to apply for Medicaid, too, ensuring his access to the medications and care that will keep him healthy at home. “On a scale of 1 to 10, they are a 10, always caring and ready to help,” Danny said. “Without their help, it would have been very hard to figure out my medications.” The team also connects patients with other partners in the community. That might include a free prescription program at a supermarket or a referral to an agency that helps people who don’t have adequate medical coverage. Medical Home Without Walls launched in late 2012 and has enrolled more than 50 patients in New Castle County who don’t have insurance. As part of their training, Christiana Care team members shadowed nurses and social workers who work with patients in a successful program in Camden, N.J., that has reduced super users’ visits to the ED by 56 percent. Danny is the first graduate of the program. He has not been hospitalized or treated in the ED since he started working with the team. He is now taking responsibility for his own health. And if he ever needs help, Danny can reach out to his partners at Christiana Care.
IN OUR COMMUNIT Y
Partners with our neighbors Every day, dedicated professionals throughout Christiana Care show their exceptional commitment through innovative programs, initiatives and partnerships – all part of The Christiana Care Way. Christiana Care exists to care for our neighbors in the community – to be partners in their health. The generous support of our partners in business, government and the community helps us expand and enhance the expert care we provide to all community members, regardless of their ability to pay. In fiscal year 2013, Christiana Care provided our neighbors with $27.3 million in charity care. We also educate our neighbors about healthy behaviors and make it easier for people to get the tests and care they need through such effective initiatives as the Patient-Centered Medical Home, Medical Home Without Walls and the Helen F. Graham Cancer Center & Research Institute’s Community Health Outreach and Education Program.
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WILMINGTON HOSPITAL TRANSFORMATION: A MILESTONE FOR NEIGHBORS IN THE CITY
New south tower is named in honor of Carol A. Ammon.
THE COMPLETION OF the first phase of the $210-million transformation of Wilmington Hospital is a giant step forward in Christiana Care’s commitment to provide high-quality care in the heart of the city. It’s also a shining example of generosity, of caring people devoted to helping their neighbors. In all, benefactors donated $35 million to the initiative, which will grow Wilmington Hospital to a 1 million-square-foot, technologically advanced center. They include Carol A. Ammon, whose gift is the largest individual donation in Christiana Care history. The hospital’s new, nine-story tower is named for Ammon, who has served as a Christiana Care trustee since 1998. Gifts to the Wilmington Hospital Transformation Project also include 10 donations of $1 million or more and 40 gifts of $100,000 or more. Those efforts are “a philanthropic investment that will benefit our community today and for generations to come,” said Lear Pfeiffer, who co-chaired the campaign with her husband Gary, who chairs the Board at Christiana Care.
INVESTING IN WILMINGTON Lear and Gary Pfeiffer led the fundraising efforts that made Wilmington Hospital the most advanced care facility in the city.
The Wilmington campus, founded 125 years ago as a homeopathic hospital, provides expert, compassionate care for a diverse population. The transformation, which will be completed in 2014, dramatically enhances services for patients and families. An upgraded, state-of-the-science Emergency Department, which doubled in size, opened in June. A new welcoming main lobby entry is repositioned on Jefferson Street and provides an enclosed walkway to the parking garage. In addition to the 286,000-square-foot Ammon Tower, Wilmington Hospital also will offer: • A new surgical suite, with 13 operating rooms and four procedure rooms. • Capacity for 120 private patient rooms. • A new intensive care unit. • An upgraded, 30-bed unit for the Center for Advanced Joint Replacement. • A 51,000-square-foot, state-of-the-art medical office building, allowing more physicians to practice on-site. • A tranquil atrium and healing garden.
IN OUR COMMUNIT Y
Middletown Emergency Department offers expert care, 24/7 Christiana Care’s first stand-alone Emergency Department provides patients in southern New Castle County with accessible, quality care for emergencies. The $34-million, 36,500-square-foot facility off state Route 299 near Brick Mill Road opened on April 16 and provides emergency medical services 24 hours a day, seven days a week. “This facility is an example of The Christiana Care Way — how we use innovation and creativity to provide care that our neighbors truly value,” said Robert Laskowski, M.D., president and CEO of Christiana Care. “The residents of this growing area no longer have to leave their community to receive high-quality emergency services.” Christiana Care expects to treat about 1,250 patients a month at the ED, including walk-in patients and those brought by ambulance. The center focuses on serious, but not life-threatening emergencies. The ED is a unique model, designed using LEAN efficiency principles originally developed in manufacturing to create value for customers.
One-stop care for patients coming to Concord
Starting in January 2014, Christiana Care’s high-quality outpatient services will be more convenient than ever when the Concord Health Center opens on Route 202 in Concord Township, Pa. Patients can expect primary care doctors and specialists with convenient office hours; lab work, imaging and cardiovascular testing; rehabilitation services, and compassionate cancer care.
Christiana Care expects to treat about 1,250 patients a month at the Middletown ED.
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Patient-Centered Medical Home a model of effective, affordable care
Partnering with patients in the Health Insurance Marketplace At a time of sweeping health care reform, Christiana Care is leading the way in Delaware, where 90,000 people without insurance are shopping for affordable health benefits through a new virtual exchange called the Health Insurance Marketplace. To help uninsured people navigate the new virtual Health Insurance Marketplace, Christiana Care has hired nine specially trained marketplace guides, who began working Oct. 1. Christiana Care is the only hospital health system in the region that has been awarded a state contract to hire marketplace guides. “For the first time many adults and children will have access to primary care and medical homes, getting the care they need, when they need it,” said Robert J. Laskowski, M.D., president and CEO. Trained as health educators, the guides help patients enroll in the marketplace and educate them on how best to manage their health care needs. They serve patients at six Christiana Care locations and also visit local community centers, health fairs and churches. “Helping our most vulnerable patients get health insurance is part of our partnership with our community,” said Janice Nevin, M.D., chief medical officer.
At the Wilmington Health Center, patients find a PatientCentered Medical Home (PCMH), where primary care has been transformed into what patients want it to be. The model creates value for our neighbors by coordinating their care with a team that includes a clinical pharmacist and social workers, in addition to doctors and nurses. If patients need extra help, team members reach out to them to make certain they receive care. In July, the Internal Medicine Faculty Practice achieved recognition from the National Committee for Quality Assurance as a Level 2 PCMH. That means the Wilmington Health Center’s three primary care practices – Internal Medicine, Adult Medicine and Pediatrics – comprise the first certified multi-site PCMH in Delaware.
Better care, better health, lower costs, starting with employees During this time of dynamic changes in health care, Christiana Care Health System is committed to finding a better way to deliver high-quality, accessible care in ways that people value. The goal is better care, better health and lower costs. As the state’s leader in health care, that dedication to excellence is reflected in how Christiana Care provides care for the system’s more than 10,000 employees and their dependents. A new concept, Christiana Care Quality Partners, is a clinically integrated network that brings together hospitals, doctors and other health care providers to deliver services focused on quality, performance, efficiency and value to the patient. Employees and their dependents benefit from care that is more convenient. The model also helps patients who need extra help to get that care in order to be as healthy as possible.
“Helping our most vulnerable patients get health insurance is part of our partnership with our community.” JANICE NEVIN, M.D., CHIEF MEDICAL OFFICER
IN OUR COMMUNIT Y
Oral and Facial Surgery Center a first in Delaware
Project Engage is a lifeline for patients with substance abuse issues
The Oral and Facial Surgery Center, a recently constructed, state-of-the-art, hospital-based practice for the Christiana Care Oral and Maxillofacial Surgery faculty, offers a broad scope of oral and maxillofacial surgery services at Wilmington Hospital. The practice enhances Christiana Careâ€™s stature as an academic teaching hospital with a fully accredited Oral and Maxillofacial Surgery residency program that is unique in Delaware. Upper-level residents train with full-time faculty, further enhancing their education. The faculty practice provides many services, including basic tooth extractions, wisdom teeth removal and dental implant placement, surgical correction of congenital deformities, facial fracture repair, orthognathic surgery, sleep apnea surgery, temporomandibular joint surgery, removal of pathological lesions, facial reconstruction, bone grafting and cosmetic procedures.
Project Engage is a nationally recognized program that saves lives and money by engaging people with substance abuse problems at the bedside in the hospital or Emergency Department and then connecting them with resources in the community that can put them on the path to wellness. Engagement specialists embedded at Christiana and Wilmington hospitals counsel patients and encourage them to go directly into treatment when they leave the hospital. The goal is to remove barriers to care by arranging for placement in programs, as well as such basic needs as food, clothing, shelter, transportation and primary medical care that will keep patients healthy and out of the hospital. About 1,000 patients were engaged from 2008-2012; 30 percent continued with treatment.
Dental care for special-needs children and adults The Roxana Cannon Arsht Surgicenter now offers services for patients with developmental and physical disabilities who need general anesthesia for dental work. The center provides a safe, fully equipped setting for both dentists and patients, who often had to wait for extended periods of time for access to an operating room. Launched in December 2012, the program provides timely, expert care for patients with conditions such as autism and cerebral palsy who could not be treated in a standard dental office.
Home-based care helps patients with depression Elderly patients with depression and anxiety are much less likely to require hospitalization or to engage in disruptive behavior when they receive home-based behavioral health care, thanks to a pioneering program by the Christiana Care Visiting Nurse Association. That is because a trained psychiatric nurse can see things in the home that arenâ€™t apparent in the physicianâ€™s office or a brief hospital stay. Did the patient get dressed today? Is she eating properly? By identifying problems and intervening sooner, visiting nurses help to keep patients from cycling in and out of the Emergency Department. They also educate patients and loved ones about medications and serve as a trusted resource for families.
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BEST FED BEGINNINGS
VIVE TU VIDA COMMUNITY EVENT
WOMEN'S HEALTH COMMUNITY EVENT
PEDIATRIC ORAL SURGERY
IN OUR COMMUNIT Y
Best Fed Beginnings supports breastfeeding moms
Interpreters ensure language is not a barrier to care
New moms are giving their babies the best possible start in life with breastfeeding support from Christiana Care and the Best Fed Beginnings program. Christiana Hospital is one of 89 hospitals taking part in the 22-month learning collaborative, sponsored by the National Initiative for Children’s Healthcare Quality. It focuses on improving maternity care and increasing the number of hospitals that achieve the organization’s Baby Friendly designation. The steps to reach the Baby Friendly goal include staff education, instruction and support for pregnant women and new moms, and rooming-in, placing babies in mothers’ rooms, rather than a nursery, for at least the first 23 hours. Rooming-in allows moms to learn their babies’ sleeping and feeding rhythms.
In any given month, patients coming to Christiana Care speak at least 30 different languages. That’s why Christiana Care provides qualified staff interpreters in Spanish and American Sign Language, as well as a telephonic interpreting service that provides interpreters for dozens of languages. Interpreters are dispatched regularly to the Emergency Department, the Helen F. Graham Cancer Center & Research Institute, Maternity and many other areas of the hospitals to make certain patients understand their care so that they can be active partners in their care.
Excellence in Women’s Health The U.S. Department of Health & Human Services recognized Christiana Care as the region’s only National Community Center of Excellence in Women’s Health. Christiana Care achieved this honor by: • Improving the health and well-being of women through partnerships with community-based organizations. • Providing integrated, coordinated care with strong links to existing community programs. • Offering comprehensive care in a way that reduces fragmentation and recognizes the complexity of women’s lives. • Conducting community-based research to guide the development of new models of patient-centered, evidence-based care.
Inpatient hospice care in a family-like setting Patients with serious illnesses and their families can receive compassionate care through Seasons Hospice & Palliative Care, an inpatient unit at Christiana Hospital. The unit features 12 private rooms and wheelchair-accessible bathrooms, and a homelike day room with a refrigerator, microwave and café tables for a family dining atmosphere. Families can stay with their loved ones 24 hours a day.
Health coaches are an Rx for patients who lack insurance Caring for neighbors regardless of their ability to pay is part of The Christiana Care Way. Christiana Care’s Health Coach Program helps patients who don’t have insurance to get the medications they need to control or prevent serious illnesses. The health coach helps patients to fill out applications to various drug makers requesting free medications. The coach also documents the patients’ inability to pay. In most cases, medications are delivered directly to the patients’ homes. Patients receive free drugs for up to one year before they need to reapply to the program.
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RESEARCH & EDUCATION
THE FUSION OF
Medicine and Humanity DETERMINED TO HELP PATIENTS IN DIRE NEED, ROBERT WITT, M.D., TOOK AN UNUSUAL ROUTE, FROM BEDSIDE TO BENCH. HIS ALLY IN HIS QUEST TO DEVELOP AN ARTIFICIAL SALIVARY GLAND IS ARKADI KUHLMANN, BANKER, PHILANTHROPIST AND PATIENT.
hristiana Care’s groundbreaking research in developing an artificial salivary gland sprang from the passion of a doctor dedicated to alleviating the suffering of his patients and an entrepreneur who shared his vision. That fusion of medicine and humanity was sparked by Robert Witt, M.D., director of the Head & Neck Multidisciplinary Clinic at the Helen F. Graham
Cancer Center & Research Institute, and Arkadi Kuhlmann, then CEO of ING Direct Bank, who grew a tissue engineering startup into an internationally recognized powerhouse of innovation. The two men first met at Lower Brandywine Presbyterian in Greenville. Their relationship deepened in 2006 when Kuhlmann was diagnosed with thyroid cancer and Dr. Witt performed his surgery.
BENCHSIDE ALLIES Robert Witt, M.D., and Arkadi Kuhlmann in the lab at the Graham Cancer Center.
The Christiana Care Way:
We must make the best use of the tools of science and research, and challenge ourselves to continually ask questions and strive for perfection.
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“I see patients every day who remind me that we need to get this done.” R O B E R T W I T T, M . D . CONTINUED
Kuhlmann’s treatment was successful, and he made a full
recovery. As doctor and patient got to know one another better, the banker was struck by Dr. Witt’s compassion for the people entrusted to his care. “He is constantly curious about how to treat his patients better,” he said. Dr. Witt was searching for a way to help patients whose salivary glands no longer function because of radiation treatment for cancers of the upper respiratory system and neck. The radiation knocks out the cancer but the side effects are devastating. Radiation dramatically reduces saliva production and patients lose their sense of taste. They can’t swallow properly and develop severe dental problems, and painful, permanent dry mouth. “They exist on the planet but don’t have the quality of life they should have to be complete,” he said. “Current medicines are not adequate, and the way forward is to develop an artificial tissue engineered salivary gland.” Finding innovative ways to help people lead the lives they want to live is The Christiana Care Way. The doctor was willing to donate his time to the project. But the majority of his training focused on the bedside, not bench research. “I’m a surgeon, not a formally trained scientist,” Dr. Witt said. “I could not get a research grant from government or a foundation.” But the banker believed in his doctor. Kuhlmann, who is also a Christiana Care Board member, and his wife Synthia made a private initial donation of $20,000. The seed money soon began to bear fruit. “It meant that we could hire a graduate student and buy supplies,” Dr. Witt said. “We were on our way.” He asked Cindy Farach-Carson, Ph.D., an extracellular matrix biologist at the Center for Translational Cancer Research at the Graham Cancer Center, to help him find a graduate student with the skills and dedication required to take on the project. Swati Pradhan Bhatt, Ph.D., was the perfect match. Seven years later, Dr. Bhatt is director of Tissue Engineering at the center.
“She has the knowledge and the drive to perform the experiments that fail and fail and fail – and then succeed,” he said. Kuhlmann invited Dr. Witt to come to the bank’s headquarters in Wilmington and share his project with employees. “Dr. Witt’s enthusiasm got them excited and ING Direct decided to give money, too,” Kuhlmann recalled. In all, the Kuhlmanns and ING Direct have donated more than $400,000 over the years. The results that sprang from their generosity were so impressive that the National Institutes of Health awarded a $2.5 million grant to fund the project over four years. Besides Dr. Witt, other principal investigators on the project include Xinqiao Jia, Ph.D., a materials engineer at the University of Delaware, and Dr. Farach-Carson, who is now at Rice University in Houston. The team has grown to more than 15 people. Dr. Farach-Carson’s team at Rice University, NIH scientists, and Dr. Witt’s University of Delaware team, including graduate students, members of the Materials Engineering Department and Randy Duncan, Ph.D, chairman of the department of Biological Sciences, consult via teleconference each week. Dr. Witt’s wife, Carol Landefeld, a veterinarian, brainstorms with the team. Dr. Witt’s dream of helping patients to reclaim their quality of life could become reality in five to 10 years. “I see patients every day who remind me that we need to get this done,” he said.
RESEARCHER SWATI PRADHAN BHATT, PH.D. CHRISTIANACARE.ORG
R E S E A R C H & E D U C AT I O N
BANKER’S SEED MONEY BLOSSOMS INTO MAJOR GRANT BEFORE HE WAS A PHILANTHROPIST, Arkadi Kuhlmann was a banker. Making a charitable gift to develop an artificial salivary gland appealed to both his instincts as an entrepreneur and his empathy for cancer patients. After all, Kuhlmann himself was successfully treated at the Graham Cancer Center. He believed that the Graham Cancer Center could become a leader in tissue engineering, the science of creating functioning organs in the lab. And he believed in his doctor, Robert Witt, M.D., who dreamed of helping cancer patients whose salivary glands were disabled by radiation treatment. “Who would have ever invested in a surgeon completely untested in the scientific realm?” Dr. Witt asked. “Only someone who truly understood the value that this work would bring to humanity.” Kuhlmann’s initial investment of $20,000 ultimately led to the team’s earning a $2.5 million grant from the National Institutes of Health, an exceptionally competitive and prestigious award. Clearly, it was money well spent.
“The seed support that individuals can provide is very important in laying the groundwork that can lead to large grants.” ARKADI KUHLMANN
“The seed support that individuals can provide is very important in laying the groundwork that can lead to large grants,” he said. Kuhlmann began saving when he was a boy and manages his own money. When he first banked on the salivary gland project in 2007, he was CEO of ING Direct, which since has been acquired by another financial institution. He is now launching a new bank. Throughout the years, he has remained committed to Dr. Witt’s research and has continued to make charitable gifts.
“I am a sounding board and a reader of the articles that have been published about this work in journals,” Kuhlmann said. “My wife Synthia and I follow his progress closely.” Creating innovative and affordable systems of care that our neighbors value is The Christiana Care Way. The banker is pleased by the efficient way Christiana Care manages donations. “Every penny is accounted for,” he said. “They are very judicious in the way they spend money so they achieve the maximum impact. As a banker, I like that a lot.”
MICROSCOPIC IMAGES Investigating a salivary spheroid may unlock the key finding a successful treatment.
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Innovative research and education Christiana Care’s robust partnerships in clinical, translational and outcomes research focus on speeding new ideas, technologies and treatments to improve our neighbors’ health. That fusion of science and humanity keeps clinicians at the top of their specialties and attracts the brightest and the best to serve as faculty and mentors in our fully accredited graduate medical educational programs and undergraduate student rotations. Finding innovative ways to enhance education and propel research is part of The Christiana Care Way.
At a glance: The number of studies in each research area at Christiana Care
BONE MARROW TRANSPLANT
40 200 6
SURGICAL CRITICAL CARE/TRAUMA
OTHER RESEARCH (NON-CATEGORIZED)
total number of studies 884
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Highlights of Research and Education from 2013
ACT a model for collaborative learning ACT, or Achieving Competency Today, is an exceptional experiential learning course that focuses on small groups of Christiana Care employees from multiple disciplines who explore such topics as patient safety and the economics of health care. Classmates collaborate on a project, with everyone playing an equal role. In addition to serving as an incubator for projects, ACT nurtures respect among colleagues.
Emergency Medicine clot-busting ultrasound device A clinical trial at Christiana Care will help to determine whether stroke patients do better when they receive treatment with an ultrasound device worn on their heads, in addition to infusions of traditional medications that dissolve clots. The device, called ClotBustER, is unique in that it requires no advanced training in ultrasound to place it. That would benefit patients in remote or rural settings who might not have access to a physician who specializes in ultrasound. CLOT BUSTING TECHNOLOGY TRIAL
Delaware Health Sciences Alliance takes a global view Christiana Care and its partners in the Delaware Health Sciences Alliance focused on the challenges of creating sustainable improvements in public health worldwide at DHSA’s second Global Health Symposium, held in February at Thomas Jefferson University in Philadelphia. Christiana Care now offers a global health curriculum, two global health residency tracks, requisite resident experiences in community preventive medicine and grant-funded work in global health research. In addition to Christiana Care and Jefferson, DHSA partners include the University of Delaware and Nemours.
We’re tops in training For the second year in a row, Christiana Care Health System ranks in the top half among the Top 125 organizations named by Minneapolis-based Training magazine. The publication for training, human resources and business management professionals ranks the top 125 training organizations in the country. That recognition reflects Christiana Care’s commitment to building a culture of learning and personal development, said Rosa ColonKolacko, Ph.D., MBA, senior vice president, System Learning, executive director, Learning Institute, and chief diversity officer. YEAR IN REVIEW
in preventing secondary swelling. In early studies, patients with moderate head injuries who received progesterone had less disability than patients who received a placebo.
Free diabetes meds and supplies removes barriers for patients
Clinical study tests progesterone therapy for brain trauma The prognosis for patients who have suffered traumatic brain injuries has not improved for more than 50 years. But this could change dramatically if the results of a clinical trial prove effective. Typically, head trauma patients suffer from the initial injury and secondary swelling after the injury, which can cause brain damage and contribute to long-term disability. Christiana Care is participating in an international trial to study the effectiveness of the hormone progesterone
Making medications easier to obtain means patients are more likely to take their meds and manage chronic diseases, concluded a study by Christiana Care clinical research scholars published in the Feb. 13 issue of Population Health Management. The study, â€œPatient-Centered Outcomes of a Value-Based Insurance Design Program for Patients with Diabetes,â€? analyzed the economic and patient-perceived benefits of eliminating co-payments for medications and supplies. It compared patient self-reports from before and one year after the start of a value-based insurance program for Christiana Care employees that eliminated co-payments for diabetes-related meds and supplies. Nearly 90 percent of the study participants felt eliminating co-payments helped them to better manage their diabetes.
Center for Translational Cancer Research a team effort in fight against cancer
TALENs research promotes personalized cancer treatments
The Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute is a dynamic, comprehensive cancer program that highlights prevention, treatment and laboratory research. The team includes the University of Delaware, Nemours/Alfred I. duPont Hospital for Children, Delaware State University and the Delaware Biotechnology Institute, who share Christiana Careâ€™s vision of finding innovative and effective ways of treating cancer. Translational research is a means of transferring the latest discoveries in the lab into new clinical interventions for cancer diagnosis, treatment, prognosis or prevention, directly benefitting our patients. In addition to state-ofthe-art laboratory space, the center includes the Familial Cancer Registry and tissue-procurement program focused on high-risk patients.
The Center for Translational Cancer Research at the Graham Cancer Center is among fewer than 20 institutions producing proteins that play a key role in manipulating genetic material in order to develop personalized treatments for cancers and other genetic diseases. Transcription Activator-Like Effector Nucleases or TALENs work by zeroing in on a specific region of the genome, where they can precisely cut DNA and insert or delete a gene. Think of TALENs as scissors that can tailor genetic sequences. The potential of this technology lies in its capacity to precisely repeat the genetic profile of a tumor, extracted from the patient, in cells that can be used in the laboratory for screening the effectiveness of anti-cancer drugs, said Eric Kmiec, Ph.D., director of the Genome Customization Core, a research group at the CTCR.
R E S E A R C H & E D U C AT I O N
Landmark breast cancer study The Graham Cancer Center is among an elite group of institutions that provided tumor samples for groundbreaking research hailed as the largest, most comprehensive breast cancer genomic study ever. The results that are emerging from this study are redefining our understanding of breast cancer and other cancers, and signal a transformation in future treatments that will benefit a wide range of patients. Recent discoveries identify four genetically different subtypes of breast cancer and, within those, the genetic drivers of many different types of cancer. Researchers analyzed data from 825 breast tumor samples as part of The Cancer Genome Atlas. They identified at least 40 genetic alterations that could be targeted with anti-cancer drugs, many of which are being developed or are already being used to treat other cancers with the same mutations. The Graham Cancer Center is teaching best practices for participation in The Cancer Genome Atlas Project to researchers from major university cancer-research programs, including Stanford University School of Medicine, Emory University’s Winship Cancer Institute, Nigeria’s Institute of Human Virology and six other institutions. Training focuses on the multidisciplinary approach to screening, collecting, preparing, storing and shipping potential tissue samples for the National Cancer Institutesponsored genetics research.
Clinical trials investigate ways to help cancer patients quit smoking Christiana Care’s Community Clinical Oncology Program (CCOP) is working to find ways to help cancer patients quit smoking through two National Cancer Institute (NCI) trials at the Graham Cancer Center. Smoking reduces the effectiveness of cancer treatment and places patients at risk for second malignancies and other tobaccorelated diseases. One trial is a randomized, placebo-controlled study of Memantine, a drug currently treating Alzheimer’s disease, to treat cancer survivors who are six months post-treatment and are still smoking. The second trial is evaluating the feasibility of a Quitline-based intervention using motivational counseling and nicotine replacement therapy in patients undergoing or recently completing therapy for their primary cancers.
The National Cancer Institute awarded $2.8 million to the Graham Cancer Center to expand cancer research. YEAR IN REVIEW
Womenâ€™s and Childrenâ€™s Research
A key role in reducing infant mortality
Pioneering research in fetal growth
Once among the highest in the nation, the infant mortality rate in Delaware is declining. In the five-year span from 2005-2009, the rate declined 10.7 percent, more than twice the national average of 4.3 percent. That improvement is due, in part, to an innovative Christiana Care initiative to prevent premature labor by providing the hormone progesterone to obstetric providers. Christiana Care also offers high-quality preconception and prenatal care through its Healthy Beginnings program, serving women who are at-risk because of chronic health conditions, high stress levels and crime in their communities.
Christiana Care is the lead institution in a groundbreaking study of adrenal gland growth as a marker for preterm birth. Adrenal glands produce hormones and are at their largest just before birth. Researchers are trying to determine if measuring the size of the gland will help doctors predict which babies are at risk of being born prematurely. Data gathered in a separate study of women of all ethnicities between the ages of 18 and 40 will help to establish a national standard for fetal growth that will help physicians to better determine when to intervene if they suspect the fetus is not developing normally. Christiana Care was the first health system in the U.S. to enroll expectant mothers in the program and is one of only six institutions to earn a $1.136 million grant from the National Institutes of Health.
Research focuses on sleep during pregnancy Christiana Care is taking the lead in understanding how sleep during pregnancy impacts a babyâ€™s development. A study of 3,600 pregnant women will help to determine if maternal obesity is linked to poor quality of sleep and whether poor sleep quality contributes to such complications as preeclampsia, restricted fetal growth and stillbirth. Investigators also will study the impact of apnea, or brief interruptions in breathing during sleep, on fetal health.
R E S E A R C H & E D U C AT I O N
Women’s and Children’s Research
OB/GYN study targets CMV virus A national research program led by Christiana Care’s Department of Obstetrics and Gynecology will determine if pregnant women who contract a virus that can be harmful to the fetus can reduce the risk of passing it to their babies by taking antibodies for the virus. Cytomegalovirus (CMV), a virus that spreads like a cold, infects only about 1 percent of pregnant women. But if it’s the first time the mother has been infected there’s a 40 percent chance the baby will be infected, which can result in hearing loss, learning difficulties and, rarely, death. Nationwide, researchers expect to screen 160,000 pregnant women for the virus, including 4,800 at Christiana Care. “The ability to participate in such complex trials is a testament to how far the research infrastructure at Christiana Care has developed,” said Matthew Hoffman, M.D., MPH, the principal investigator.
Studying the link between moms, kids and obesity Childhood obesity is a growing concern in the U.S. and Delaware, where 32 percent of children are overweight or obese. A team led by Deborah Ehrenthal, M.D., director of Health Services Research for Women and Children, is studying the mother-child pair, working to understand ways to identify children at greatest risk for obesity and how modifying factors early, such as encouraging moms to breastfeed exclusively instead of giving babies food, might protect a child from becoming obese. Using growth measures from electronic health records, research shows that children of mothers who were obese before their pregnancies are significantly more likely to become obese as early as age 4. In addition, the child’s rate of weight gain in the first six months of life is strongly related to risk of obesity.
Saving mothers’ lives around the globe Research by Richard Derman, M.D., the Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology, is saving lives of women around the world by reducing postpartum bleeding, the most common cause of maternal death. Women in developing countries, who often do not deliver babies in hospitals, typically do not have access to oxytocin, an injectable medication that requires refrigeration. His research concludes that orally administered misoprostol, a prostaglandin that stimulates uterine contractions, is an inexpensive alternative to oxytocin that is effective, safe and has a long shelf life. Dr. Derman has written extensively on the topic, most recently in the November 2012 edition of The Journal of the Royal Society of Medicine in Britain. Dr. Derman is a principal investigator of the Global Research Network for Women’s and Children’s Health, funded by the National Institutes of Health.
YEAR IN REVIEW
Heart and Vascular Research
New anti-clotting drug more effective, study shows Christiana Care is a key player in a landmark clinical study of an experimental drug shown to be significantly more effective at preventing blood clots during coronary stenting procedures compared to the anti-clotting agent now typically used. Given intravenously, the new anticlotting drug cangrelor reduced the odds of complications from stenting procedures — primarily blood clots, but also heart attacks and strokes — by 22 percent when compared with the routinely used anti-platelet drug clopidogrel, known by the brand name Plavix, according to the CHAMPION PHOENIX study published March 10 in the New England Journal of Medicine.
Landmark study on cost-effectiveness in coronary care Coronary artery bypass grafting (CABG) can be more cost-effective over a person’s lifetime than percutaneous coronary intervention (PCI), according to findings by Christiana Care’s Centers for Outcomes Research (CCOR), presented at the November 2012 American Heart Association Scientific Sessions in Los Angeles. CCOR is the analytic center for economic outcomes on ASCERT, a large observational study published earlier in the New England Journal of Medicine. It found that long-term mortality in high-risk patients is lower after bypass surgery than after PCI. The new study adjusted lifetime costs per patient undergoing CABG at about $50,000. Using data from multiple sources, the authors developed an incremental cost-effectiveness ratio expressed as cost per “quality life year gained.”
Investigators found that for a period of less than one year, CABG was more costly and less effective than PCI. But patients undergoing CABG gained an average of 0.18 life-years relative to PCI. Considering a common threshold for cost, based on adjusted life year gained, at $50,000, CABG often will be a cost-effective strategy.
Clinical trial explores gene replacement to slow heart failure Christiana Care is part of an elite group conducting a groundbreaking clinical trial to learn if gene-replacement therapy can dramatically slow the progression of heart failure. If successful, genetically targeted therapy would be a major advance in the treatment of heart failure, said Mitchell Saltzberg, M.D., medical director of the Heart Failure Program and principal investigator for the study at Christiana Care. The “Calcium Up-Regulation by Percutaneous Administration of Gene Therapy In Cardiac Disease” or CUPID Phase 2b Trial is the largest study of its kind and the first-ever cardiac genetic trial in Delaware. Heart failure exacts a staggering toll in both human suffering and health care costs and is the leading cause of hospitalization in patients over age 65. In the trial, genetic material is stripped from a virus to remove any possibility of infection. Then, new DNA material is inserted into the virus, and the virus is injected directly into the arteries that feed blood to the heart. The virus attaches to the heartmuscle cells and injects the DNA material, and this DNA turns on a protein that controls the way heart-muscle cells handle calcium. Calcium controls contractions of the heart; the goal is to make contractions stronger. Cardiac catheterization delivers the treatment, called Mydicar, directly to the heart.
R E S E A R C H & E D U C AT I O N
The Value Institute: innovative care, maximizing impact In just 18 months, the Value Institute, led by Executive Director Timothy J. Gardner, M.D., and Associate Director Eric V. Jackson, Jr., M.D., MBA, has begun changing the research culture at Christiana Care, creating the potential for profound improvements in care, not just for our neighbors, but for the entire country.
Focusing on value as a fundamental strategy, the Value Institute applies scientific principles and rigor to projects with the goals of identifying treatments, interventions and processes to achieve better, more cost-effective health outcomes. Three pre-existing centers of excellence form the foundation of the Value Institute. The Center for Outcomes Research contributes an academically sophisticated and nationally known team of clinical outcomes researchers, biostatisticians and data analysts. The Center for Quality and Patient Safety works to create a safe culture, achieve high reliability and leverage technology. The Center for Operational Excellence provides expertise in rapid cycle improvement and Lean Six Sigma to improve the efficiency of care delivery. And the newly formed Center for Health Care Delivery Science creates and analyzes system-based processes of care that our patients value. The Value Institute works with departments and individual providers to develop research programs, promote the value of publication, institute grant planning and integrate related efforts so that research can play a continual and growing role in answering important clinical questions. The Value Institute comprises of a team with
diverse expertise – medicine, public health, sociology, law, economics and mathematics – providing a unique range of perspectives, all working together to develop the best models of evidence-based care for our patients.
VA L U E S Y M P O S I U M E X P L O R E S THE TRIPLE AIM Creating innovative, effective, affordable systems of care that our neighbors value is The Christiana Care Way. Achieving that goal in an era of sweeping change was the focus of the keynote address at Christiana Care’s Second Annual Value Symposium on May 9 by Don Berwick, M.D., former administrator of the Centers for Medicare and Medicaid Services and founding CEO and president emeritus of the Institute for Healthcare Improvement. Dr. Berwick spoke on “Transforming Health Care in America: Making the Triple Aim a Reality.” The Triple Aim is Dr. Berwick’s brainchild and is defined as delivering health care that improves the individual patient experience, improves the health of populations and reduces the per capita costs of care for populations.
SECOND ANNUAL VALUE SYMPOSIUM Robert J. Laskowski, M.D., MBA, Christiana Care president and CEO, leads a panel discussion, featuring (from left) Don Berwick, M.D., Bettina Riveros, JD; Stephen J. Kushner D.O.; former Delaware Gov. Pierre S. “Pete” duPont IV; and Timothy J. Gardner, M.D.
YEAR IN REVIEW
Our primary mission is to serve Christiana Care is a not-for-profit health system that provides expert, respectful care for neighbors in our hospitals, emergency departments, and outpatient centers. As a national leader in health care and the state’s largest private employer, neighbors trust Christiana Care to provide advanced care and treatment.
Christiana Care’s facilities and volume at a glance:
DELAWARE & THE REGION 14 SCHOOL-BASED HEALTH CENTERS
CHRISTIANA CAMPUS CHRISTIANA HOSPITAL (907 BEDS) CENTER FOR HEART & VASCULAR HEALTH IN THE BANK OF AMERICA PAVILION HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE AND CENTER FOR TRANSLATIONAL CANCER RESEARCH CHRISTIANA CARE BREAST CENTER CHRISTIANA SURGICENTER
HOME HEALTH & COMMUNITY SERVICES — VISITING NURSE ASSOCIATION
WILMINGTON HOSPITAL (241 BEDS)
ALZHEIMER’S AND DEMENTIA DAY PROGRAMS
WILMINGTON HOSPITAL HEALTH CENTER
EUGENE DU PONT PREVENTIVE MEDICINE & REHABILITATION
CENTER FOR ADVANCED
CENTER FOR REHABILITATION
ROXANA CANNON ARSHT
18 PRIMARY CARE CENTERS
(2 IN NEW JERSEY)
SWANK MEMORY CARE CENTER
9 CHRISTIANA CARE REHABILITATION SERVICES LOCATIONS
FIRST STATE SCHOOL
15 CHRISTIANA CARE IMAGING SERVICES LOCATIONS
Christiana Care ranks among the leaders by volume in several categories, according to the American Hospital Association’s latest survey of more than 6,000 U.S. hospitals.
In the United States
On the East Coast
SYSTEM STATISTICS FISCAL YEAR 2013
EMERGENCY DEPARTMENT VISITS
[ WILMINGTON ]
AVERAGE INPATIENT STAY (NO. OF DAYS)
[ C H R ISTIA N A ]
[ M ID D L E T OW N ]
10,572 1,487 273
MEDICAL & DENTAL STAFF
MEDICAL & DENTAL RESIDENTS AND FELLOWS
NURSES AND PATIENT CARE TECHNICIANS
YEAR IN REVIEW
CHRISTIANA CARE HOME HEALTH
SCHOOL-BASED HEALTH CENTERS: CHRISTIANA CARE STAFFS
AND COMMUNITY SERVICES
14 SCHOOL-BASED HEALTH CENTERS IN DELAWARE
DAY PROGRAM VISITS
PRIMARY CARE PHYSICIAN OFFICE VISITS
WILMINGTON HOSPITAL HEALTH CENTER VISITS
CHRISTIANA CARE REHABILITATION SERVICES VISITS
CENTER FOR ADVANCED JOINT REPLACEMENT
TOTAL KNEE AND HIP REPLACEMENTS
CENTER FOR REHABILITATION
638 REHABILITATION PATIENTS
S Y S T E M S TAT I S T I C S
CHRISTIANA CARE’S FINANICAL IMPACT ON THE REGION
MILLION PAID IN TAXES
TO THE STATE OF DELAWARE
ON AVERAGE THE AMOUNT
RETURNED TO DELAWARE’S ECONOMY BY EMPLOYEES
TOTAL PATIENT REVENUE (BILLIONS OF DOLLARS)
1,161 VOLUNTEERS GAVE 87,364 HOURS WHICH TRANSLATES TO $2 MILLION DOLLARS OF MAN HOURS
CHARITY CARE (MILLIONS OF DOLLARS)
*ADJUSTED ** ESTIMATED
CHRISTIANA CARE HEALTH SYSTEM OPERATING DOLLAR
.28 THERAPEUTIC & DIAGNOSTIC SERVICES
.16 EMPLOYEE BENEFITS .08 MEDICAL EDUCATION & SOCIAL SERVICES .07 SUPPORT SERVICES .01 OTHER AFFILIATES
.01 INSURANCE & OTHER .23 NURSING SERVICES
.03 ADMINISTRATION .06 DEPRECIATION & INTEREST .07 FACILITIES & SERVICES
COST COMPARISON OF AVERAGE PATIENT STAY
SOURCE: COTH AUTUMN 2012 DATABOOK YEAR IN REVIEW
Giving our personal best to serve our neighbors At Christiana Care, our greatest reward is serving our neighbors as respectful, expert caring partners in their health. We are committed to patients, our community and our employees who give their best every day. Christiana Care has earned recognition as a national leader in health care with our dedication to providing high-quality care in innovative, effective and affordable ways that patients value.
awards U.S. NEWS & WORLD REPORT BEST HOSPITAL
AMERICAN COLLEGE OF SURGEONS
ranking in the specialty of Gynecology.
National Surgical Quality Improvement Program recognition for achieving exemplary outcomes for surgical patient care.
JOINT COMMISSION continued Gold Seal of
Approval for recertification as a Primary Stroke Center and for the hip, knee and heart failure programs. AMERICAN NURSING CREDENTIALING CENTER MAGNET designation.
Human Rights Campaign Foundation recognition as a LEADER IN LGBT HEALTHCARE EQUALITY for equitable,
inclusive care for lesbian, gay, bisexual and transgender patients and their families.
CIO 100 AWARD, Computerworld Honors Laureate winner
(second year for both) and INFORMATIONWEEK500 listing (third year) for eSignout software program that enables safe and confidential sharing of necessary information about patients as they change caregivers during a hospital stay. TRUVEN HEALTH ANALYTICS 100 TOP HOSPITALS in the major teaching hospital
category. NURSING DEGREES.COM top hospital ranking in the
score of “A” (third consecutive time).
guide “10 Nursing Internships Offering Exceptional Training Opportunities.”
GOLD LEVEL BEACON AWARD FOR
NICHE (Nurses Improving Care for Healthsystem Elders)
THE LEAPFROG GROUP hospital safety
EXCELLENCE to the Cardiovascular Critical
Care Complex from the American Association of Critical Care Nurses. TRAINING MAGAZINE TOP 125 company for training and learning development.
program exemplar status for outstanding elder care. MOREHEAD APEX WORKPLACE OF DISTINCTION
(Christiana Care Visiting Nurse Association) for patient care, patient safety, employee safety and diversity support and commitment to the community.
US NEWS BEST HOSPITAL RANKING – GYNECOLOGY
MAGNET DESIGNATION FOR NURSING
LEAPFROG GROUP FOR HOSPITAL SAFETY
INFORMATIONWEEK 500 LISTING FOR ESIGNOUT
P.O. Box 1668 Wilmington, Delaware 19899-1668 800-693-CARE (2273)
Christiana Care is a private, not-for-profit regional health care system that relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about our mission, please visit christianacare.org/donors.