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neurology Outcomes 2012


Table of Contents 4 // Total Inpatient and Outpatient Visits, UCH Neurosciences 4 // Spinal Surgery Volumes 4 // Neurosurgery Volumes* 5-10 // Stroke Outcomes 5 // IV rt-PA Arrive by 2 Hour, Treat

11 // Brain & CNS (Excluding

by 3 Hour

Benign Brain) 5–Year Survival

5 // Early Antithrombotics

11 // Brain (Including Benign Brain)

6 // VTE Prophylaxis 6 // Antithrombotics 7 // Anticoag for AFib/Aflutter 7 // LDL 100 or ND – Statin 8 // Stroke Education 8 // Rehabilitation Considered 9 // Cerebrovascular/Ischemic Stroke – Mortality Index 9 // Cerebrovascular/Intracerebral Hemorrhage – Mortality Index 10 // Cerebrovascular/Other Volume 10 // Other Neurology & Neurosurgery Volume

5–Year Survival 12 // Brain (GBM Only) 5–Year Survival 12 // Epilepsy Volume 13 // Movement Disorder Volume 13 // Neuromuscular Volume 14 // MS Volume 14 // Neuro-Oncology Volume 15 // UCH Insider Article


University of Colorado Hospital

is the leading academic medical center in the nation. University of Colorado Hospital (UCH) is recognized as the highest-performing academic hospital in the United States for delivering quality health care by the University HealthSystem Consortium for two years in a row, and is ranked as the best hospital in the Denver metro area and one of the best in the country by U.S. News & World Report. UCH is best known as an innovator in patient care and often is one of the first hospitals to bring new medicine to the patient’s bedside. The hospital’s physicians are affiliated with the University of Colorado School of Medicine, part of the University of Colorado system. Based at the expansive Anschutz Medical Campus in Aurora, Colo., UCH is where patient care, research and education converge to establish the future of health care delivery.

The University of Colorado Hospital Difference… The University of Colorado Hospital Department of Neurosciences is one of the nation’s leading neurosciences programs and is comprised of some of the country’s top neurologists, neurosurgeons, neurointerventional radiologists, neurocritical care specialists, neurohospitalists, NPs, PAs, researchers, social workers, counselors, dieticians and other caregivers. With a multidisciplinary team that subspecializes in and treats a broad spectrum of neurological conditions, the neurosciences division is a contributing reason why the University of Colorado Hospital was recently named the top performing academic hospital in the nation by the University HealthSystem Consortium, again. For more information, please visit us at uch.edu.

3


OUTCOMES data

Based on the July 1 - June 30 fiscal year

Neurosciences Service Line

FYInpatient 2008 - FY 2012 Trend Over Time Total and Outpatient Visits, UCH Neurosciences Outpatient Visits, Inpt Admissions & Days Inpatient Admissions Inpatient Days Outpatient Visits

31217

29317 25681 22303

19806

2008

spinal  surgery Volumes

2008 469

2009

2009 563

2010 537

2011 613

KEY

Inpatient Admissions Epilepsy neurosurgery  volumes 2008 2009Trend Over2010 2011 FY 2008 - FY 2012 Time Outpatient & Days 190 Visits, Inpt 474Admissions951 1010

1857

1725

1664

1522

1325

10473

9717

9465

8629

7641

2010

2011

2012 883 Inpatient Days

2012

Outpatient Visits

2012 Inpatient Admissions Inpatient Days 1002Visits Outpatient

4218 3709

3344

3063

2922

Spinal Surgery Volumes Title

Neurosurgery Volumes* *excludes Title spinal surgeries.

Series1 1500

1306

1422

1293

883

2008

563

350

294

270

256

2009 613

2010

951 2011

Series1 1360 1010 359

1002

2012

537

469 474

190

2008

UCH  Confidential

4

2009

2010

2011

2012

2008

1/2/13

2009

2010

2011

2012

Page  6  of  10


Based on the calendar year

79.10%

81.1%

82.7%

79.00%

2012

National

97.20%

97.2%

97.2%

97.4%

97.10%

98.6% 96.60%

100.0%

National

97.4%

Colorado

83.4%

100.0%

Colorado

97.2%

96.40%

96.9%

96.7%

84.3%

100.0% 77.00%

83.6%

91.3% 74.20%

Academic Hospitals

98.7% 96.2%

96.1%

96.5%

96.10%

100.0%

UCH

2011

93.3%

95.1%

2010

Academic Hospitals

Early Antithrombotics Early Antithrombotics

96.6%

79.7%

2009

National

100.0%

UCH

Colorado

96.1%

2008

KEY

79.4%

92.9% 64.3%

75.9%

85.7% 71.4%

62.8%

60.80%

66.2%

69.2%

Percent of Patients

2007

Percent of Patients

Academic Hospitals

82.2%

IV rt-PA Arrive by 2 Hour, Treat by 3 Hour

IV rt-PA Arrive by 2 Hour, Treat by 3 Hour UCH

2007

KEY

2008

UCH

2009

Academic Hospitals

2010

Colorado

2011

2012

National

5


OUTCOMES data

Based on the calendar year

DVT/VTE Prophylaxis

87.9%

93.90%

94.9%

99.4% 93.20%

94.1%

95.4%

98.6% 91.80%

94.3%

Academic Hospitals

Colorado

2012

National

2008

UCH

2009

Academic Hospitals

2010

2011

Colorado

2012

National

97.80%

98.9%

97.8%

98.2%

97.90%

98.3%

97.40%

98.1%

97.8%

100.0%

National

100.0%

Colorado

97.60%

97.8%

96.9%

96.9%

97.3%

99.2%

100.0%

Academic Hospitals

2011

94.80%

94.3%

95.4%

96.9%

Percent of Patients

6

2010

100.0%

UCH

UCH

KEY

95.7%

2009

Antithrombotics AT Discharge Antithrombotics

2007

National

99.2%

2008

97.4%

2007

KEY

Colorado

92.60%

94.6%

92.0%

94.0%

100.0%

Academic Hospitals

95.6%

100.0% 88.20%

91.4%

97.1% 90.9%

Percent of Patients

UCH

92.7%

DV/VTE Prophylaxis


Based on the calendar year

Anticoag for AFib/Aflutter

2008

UCH

2009

2010

2011

Colorado

National

Academic Hospitals

96.0%

93.30%

95.0%

100.0% 90.4%

93.30%

95.5%

93.40%

92.9%

95.7%

100.0%

National

100.0%

Colorado

93.40%

94.2%

95.4%

93.0%

95.1% 89.30%

94.7%

94.8% 90.9%

Percent of Patients

2007

KEY

Academic Hospitals

100.0%

UCH

100.0%

100.0%

Anticoag for Afib/Aflutter

2012

LDL 100 or ND – Statin

KEY

2008

UCH

2009

Academic Hospitals

2010

Colorado

2011

91.60%

89.8%

93.2%

100.0%

89.70%

86.8%

91.9%

97.4%

88.60%

National

86.4%

91.2%

Colorado

95.7%

87.70%

73.4%

64.0%

76.3%

82.8%

67.30%

60.7%

69.7%

Percent of Patients

70.6%

2007

86.9%

Academic Hospitals

100.0%

UCH

89.3%

LDL 100 or ND Statin

2012

National

7


OUTCOMES data

Based on the calendar year

14.9%

88.80%

87.5%

93.5%

80.70%

83.4%

70.7%

69.2%

75.20%

76.5%

64.1%

68.2%

8.30%

8.4%

0.0%

43.0%

64.4%

67.8%

66.3%

Percent of Patients

89.2%

National

85.40%

Colorado

76.5%

Academic Hospitals

99.2%

UCH

87.4%

Stroke Education Stroke Education

2007

2008

KEY

2009

UCH

2010

Academic Hospitals

2011

Colorado

2012

National

Rehabilitation Considered

73.7%

2007

KEY

8

2008

UCH

2009

Academic Hospitals

2010

Colorado

2012

National

97.10%

96.7%

100.0%

2011

97.5%

96.80%

95.8%

97.6%

99.3%

96.60%

97.5%

National

95.8%

Colorado

99.4%

96.40%

97.0%

95.3%

Academic Hospitals

98.7%

94.2%

88.9%

UCH

94.9%

89.3%

73.60%

74.6%

Percent of Patients

91.1%

Rehabilitation Considered


Based on the July 1 - June 30 fiscal year

Ischemic Stroke – Mortality Index Lower is better (compared to national averages from UHC Reporting Hospitals) UCH UCH

Title

Title

0.85

0.93

.08 LOWER than UHC Reporting Hospitals 0.8

0.77

KEY Mortality Index 2012

UCH UHC Reporting Hospitals

Mortality Index 2012

hemorrhagic stroke – Mortality Index

UCH

Lower is better (compared to national averages from UHC Reporting Hospitals) UCH

Title

0.85

ndex 2012

0.93

.13 LOWER than UHC Reporting Hospitals 0.8

KEY

UCH UHC Reporting Hospitals

Mortality Index 2012

9


OUTCOMES data

Based on the July 1 - June 30 fiscal year

Cerebrovascular / OtherVolume Cerebrovascular/Other FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days Inpatient Admissions Inpatient Days Outpatient Visits

777

740

702

560 471 357

387

352

309

Cerebrovascular / Other FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days 75 Inpatient Admissions Inpatient Days Outpatient Visits

65 2008

740

79

777

109

87 702

2009

560

2010

2011

2012 471

Neurology & Neurosurgery / Other 357 - FY 2012 Trend Over Time FY 2008 309 Outpatient Visits, Inpt Admissions & Days

KEY

75

65

6016

5764 2008

OtherNeurology Neurology & Neurosurgery Volume & Neurosurgery / Other FY 2008 - FY 2012 Trend Over2215 Time 1686Visits, Inpt Admissions & Days Outpatient Inpatient Admissions 404 Inpatient Days Outpatient Visits

365 2008

5764

1686

2008

UCH  Confidential

10

Outpatient Visits 7137

87

8512

109

2010

2011

2012

2432

2594

2746 8512

476

2009 6016

2010

2215

2432

6436

2010

Inpatient Admissions

1/2/13

7137

Inpatient Days

512

2011

2012

2594

2746

512

476

453 2009

KEY

6436

453

404

365

Inpatient Days

79

2009

532

387

352

Inpatient Admissions

Inpatient Admissions Inpatient Days Outpatient Visits

532

2011

2012

Outpatient Visits

Page  10  of  10


Based on the calendar year

Brain & CNS (Excluding Benign Brain) 5–Year Survival Brain & CNS (excluding Benign Brain) 5 Year Survival 72% UCH

60%

58%

Brain & CNS (excluding Benign Brain) 51% 5 Year Survival 44% 72%

48% 38%

44%

Year 1

Year 2

51%

UCH

48% 38%

Year 3

KEY

47% 36%

60%

58%

State

State 35% 47%

36%

35%

Year 4

Year 5

UCH Colorado

Observed on2patients diagnosed between 2003 – 2005. Year 1survival data based Year Year 3 Year 4

Year 5

Brain (including Benign Brain) 5 Year Survival 72%

Brain (Including Benign Brain) 5–Year Survival 60% 59% Brain (including Benign Brain) 50% 48% 5 Year Survival 72% 60%

33%

UCH 24%

49%

42%

40% 27%

State

National

47% 40%

27%

52%

48%

49%

42%

33%

59% 50%

52%

UCH

39% State National 22%

47% 39%

Year 1

Year 2

Year 3

24% Year 4

22% Year 5

Year 1

Year 2

Year 3

Year 4

Year 5

KEY

UCH Colorado

Observed survival data based on patients diagnosed between 2003 – 2005.

11


OUTCOMES data

Based on the calendar year

Brain (GBM Only) 5–Year Survival Brain - GBM Only 5 Year Survival 49%

UCH

State

36% 26%

Neurosciences Service Line FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions14% & Days

12%

Inpatient Admissions Inpatient Days Outpatient Visits

Year 1

11%

7%

11% 5%

29317

31217

4%

25681

Year 2

22303

Year 3

Year 4

Year 5

19806

KEY

UCH Colorado

7641

2008

2009

1857

1725

1664

1522

1325

10473

9717

94652003 – 2005. Observed survival data based on8629 patients diagnosed between

2010

2011

2012

Epilepsy Volume Epilepsy FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days

Inpatient Admissions Inpatient Days Outpatient Visits

4218 3709

3063

2922

1500

1306

2008

2009

KEY

1422

1293

Inpatient Admissions

2010

2011

Inpatient Days

1360

359

350

294

270

256

12

3344

2012

Outpatient Visits


Based on the July 1 - June 30 fiscal year

Movement Disorder Volume Movement Disorders FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days

Inpatient Admissions Inpatient Days Outpatient Visits

2543

2785

2824

2785

2824

2353

2095

Movement Disorders FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days

Inpatient Admissions Inpatient Days Outpatient Visits

2543 41

90

2095

77

2008

107

2353 70

2009

KEY

41

3382

77

2008

107

75

2010

Neuromuscular FY 2008 - FY 2012 Trend Over Time Admissions Inpatient Outpatient Visits, Inpt Admissions & Days 90

92

3072

70

2009

Inpatient Admissions Inpatient Days Days Inpatient Outpatient Visits

3206

92

69

2008

52

202

69

295

3072 58

173

3524 76

2011

175

46

2010

58

2009

KEY

Outpatient Visits 147

3054

2012

3206

2009

2008

UCH  Confidential

295

2012

3524

3382 202

75

147

Inpatient Admissions Inpatient Days Outpatient Visits

FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days

52

76

2011

2010

Neuromuscular Volume Neuromuscular

173

175

1/2/13

50

2011

46

2010

Inpatient Admissions

181

Inpatient Days

181 2011

167

3054

2012

50

167 2012

Outpatient Visits

Page  7  of  10

13


OUTCOMES data

Based on the July 1 - June 30 fiscal year

MS VolumeMS/Neuroimmunology

FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days Inpatient Admissions Inpatient Days Outpatient Visits

8575

7847 6318

3846 2548 MS/Neuroimmunology FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days 28

183 Inpatient Admissions 48 2008

Inpatient Days Outpatient Visits

279

52

2009

293 2010

Neuro-Oncology FY 2008 - FY 2012 Trend Over Time 3846 Inpatient Admissions Outpatient Visits, Inpt Admissions & Days

KEY

2548 Admissions Inpatient Inpatient Days Outpatient Visits 28

183

2310

48

2008

Neuro-Oncology Volume 1275

279

2008

2310

52

2008

UCH  Confidential

14

52

274

Outpatient Visits 3325

128 1928 2011

52

2704

2010

274

344

2011

3086

368

2010

Inpatient Admissions

1/2/13

2012

1928

1749

1782

344

2011

Inpatient Days

3086

1782 2012

3325

368

8575

2012

2928

2009

KEY

30

374

374

337

259

293 1749 2010

1491

1275

Inpatient Days

7847

2928

2009 1491

2009

128 2011

6318

2704

Neuro-Oncology FY 2008 - FY 2012 Trend Over Time Outpatient Visits, Inpt Admissions & Days 337 259 Inpatient Admissions Inpatient Days Outpatient Visits

30

2012

Outpatient Visits

Page  8  of  10


ICU to Thank UCH Providers To say Rick Hamilton’s visit last week to the Neuro Intensive Care To Hamilton’s visit lastHospital week towas the different Neuro Intensive Unitsay at Rick University of Colorado than theCare one Unit at University of Colorado Hospital was different than the one he made last fall would be quite an understatement. he made last fall would be quite an understatement. The last time the Illinois man had seen the unit and many of the The last time Illinois there man had seenhim the July unit and many the providers whothe gathered to greet 12, he wasofonly providers who gathered there to greet him July 12, he was only hours removed from a brush with serious disability – if not death hours removed from ahebrush with while serious – if not – caused by a stroke suffered ondisability a Halloween Daydeath flight –from caused by a stroke he suffered while on a Halloween Day flight St. Louis to Salt Lake City. from St. Louis to Salt Lake City.

Volume 6 | Issue 2 | Through July 31, 2012

Record-setting treatment

UCH Insider Article

Stroke Victim Returns to Neuro ICU to Thank UCH Providers

Hamilton speaks with neurohospitalist Matt West, MD, center, who was aHamilton member of the team treated him. Matt Hospitalist Cumbler, speaks with that neurohospitalist West, Ethan MD, center, whoMD, was stands far right. a member of the team that treated him. Hospitalist Ethan Cumbler, MD, stands far right.

To say Rick Hamilton’s visit last week to the Neuro Intensive Care Unit at University of Colorado Hospital was different than the one he made last fall would be quite an understatement. Rick Hamilton (center, left), who suffered a stroke aboard an airplane

last applauds UCH providers visit many toan theairplane Neuro TheRick lastHalloween, time the(center, Illinoisleft), man had seen the unitaaboard and of the Hamilton who suffered aduring stroke ICU last week. applauds UCH providers during a visit to the Neuro last Halloween, providers who gathered there to greet him July 12, he was only ICU last week. hours an removed from landing a brush at with serious disability –Airport, if not death After emergency Denver International After an emergency landing attoDenver International Airport, –paramedics caused by rushed a strokeHamilton he suffered while on a Halloween Day flight UCH, where a team of providers paramedics Hamilton to Department, UCH, where aassessed team of providers from St. Louis Salt Lake City. admitted himrushed totothe Emergency him, admitted him to the Emergency Department, assessed obtained and interpreted a CT image and administered him, clot-busting obtained andin interpreted CT image and administered clot-busting medication a record 18aminutes. medication in a record 18 minutes. After some additional tense moments and a four-day Neuro ICU After some additional andwith a four-day Neuroeffects ICU stay, Hamilton walked tense out ofmoments the hospital no residual stay, Hamilton walked out of the hospital with no residual effects from the stroke (Insider, Nov. 30, 2011). from the stroke (Insider, Nov. 30, 2011). “It’s rewarding to walk back through this journey and see the “It’s rewarding to walk thistold journey and see thein people who played thisback role,”through Hamilton the small crowd people who played this role,” Hamilton told the small crowd in the Neuro ICU. the Neuro ICU.

Hamilton and West with ( from left) interventional radiologist David Kumpe and Neuro Medical Director Neumann, MD. Hamilton speaks withICU neurohospitalist MattRobert West, MD, center,David who was Hamilton and West with ( from left) interventional radiologist aKumpe memberand of the teamICU that Medical treated him. Hospitalist Cumbler, Neuro Director Robert Ethan Neumann, MD.MD, stands far right. Among those on hand to speak to Hamilton was interventional

Among those on hand to speak to Hamilton interventional radiologist David Kumpe, MD, who threadedwas a catheter through radiologist David Kumpe, a catheter through Hamilton’s femoral artery MD, to thewho clotthreaded in the right middle cerebral Hamilton’s femoral artery to the clot in the right middle cerebral artery that caused the stroke. Kumpe delivered a second dose of artery caused the stroke. (tPA), Kumpe delivered a second tissue that plasminogen activator this one directly to thedose clot,of which dissolved.

Continued

Rick Hamilton (center, left), who suffered a stroke aboard an airplane Continued Subscribe: Insiderduring is delivered viaNeuro email every other Wednesday. To subscribe: uch-publications@uch.edu last Halloween, applauds UCHThe providers a visitfree to the Comment: your feedback, of stories we’ve missed.spoke To Kumpe of the uch-insiderfeedback@uch.edu good that came out of Hamilton’s ordeal. Subscribe:We Thewant Insider is input, delivered free vianotices email every other Wednesday. To comment: subscribe: uch-publications@uch.edu ICU last week. Comment: We want your input, feedback, notices of stories we’ve missed. To uch-insiderfeedback@uch.edu Referring tocomment: the hospital’s record-setting response to the case,

After an emergency landing at Denver International Airport, paramedics rushed Hamilton to UCH, where a team of providers admitted him to the Emergency Department, assessed him, obtained and interpreted a CT image and administered clot-busting medication in a record 18 minutes. After some additional tense moments and a four-day Neuro ICU stay, Hamilton walked out of the hospital with no residual effects from the stroke (Insider, Nov. 30, 2011). “It’s rewarding to walk back through this journey and see the people who played this role,” Hamilton told the small crowd in the Neuro ICU.

Kumpe said, “Little has been said about the effect that you had on us. You set a benchmark for us.” An avid golfer, Hamilton said he’s not quite back to playing 18 holes, but only because of a sore shoulder. HeHamilton was happy come his own power to sayDavid thanks and to West withback ( fromunder left) interventional radiologist Kumpe and Neuro ICU Medical Director Robert Neumann, MD. to those he met under far different circumstances. Among those on hand towho speak to Hamilton was interventional “Thank you to the people allowed me to do this,” Hamilton said. radiologist David Kumpe, MD, who threaded a catheter through For more onfemoral Hamilton’s visittotothe UCH, storymiddle aired on 9News. Hamilton’s artery clotwatch in thetheright cerebral artery that caused the stroke. Kumpe delivered a second dose of Continued

Subscribe: The Insider is delivered free via email every other Wednesday. To subscribe: uch-publications@uch.edu Comment: We want your input, feedback, notices of stories we’ve missed. To comment: uch-insiderfeedback@uch.edu

15



Neurology Outcomes 2012