100034 MOUNT SINAI MEDICAL CENTER
Transcript of 100034 MOUNT SINAI MEDICAL CENTER
100034 MOUNT SINAI MEDICAL CENTER
4300 ALTON RD Miami Beach, FL 33140-2948
Overall Hospital Performance State Wide
Total Hospitalizations: 26,978 2,765,069
* Total Adult Hospitalizations: 18,674 2,255,089
* Total Pediatric Hospitalizations: 2 32,562
Risk Adjusted Average Length of Stay: 4.7 days 4.6 days
* 15-day Overall Readmission Rate: 7.17 % (Higher than Expected) 6.11 %
*Time period for readmission data.
Performance by Medical Condition or Procedure
Adults
Bones and Joints Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Back Problems 153 4.6 3.6 4.9 22,987 46,065
State Wide 18,879 3.8 27,726 65,060
Disc Surgery 139 5.7 5.0 5.4 55,620 85,561
State Wide 7,834 4.7 60,205 129,074
Femur Fracture Surgical Repair 126 7.5 6.0 7.0 57,291 93,658
State Wide 19,606 5.5 66,993 138,754
Fracture of Pelvis or Dislocation of Hip 41 6.0 3.8 6.1 24,951 50,092
State Wide 3,492 3.8 22,370 51,178
Hip Replacement 164 4.3 3.3 4.0 53,642 72,659
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State Wide 42,438 3.0 64,252 124,523
Knee Replacement 291 3.1 2.2 3.3 49,438 57,445
State Wide 38,778 2.4 64,098 126,684
Leg Amputation 24 13.6 11.9 12.4 77,064 174,934
State Wide 4,895 10.9 68,115 169,410
Shoulder, Upper Arm & Forearm Procedures 87 3.3 2.7 3.3 43,972 61,702
State Wide 17,567 2.7 72,175 139,684
Spinal Fusion 211 5.5 4.3 5.2 71,017 150,444
State Wide 27,782 4.0 108,241 227,915
Tibia / Fibula Fracture Repair 39 7.1 4.6 8.1 53,508 82,159
State Wide 11,944 5.3 68,634 149,260
Brain and Nervous System Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Craniotomy (brain surgery) 108 15.7 9.9 14.0 137,129 277,815
State Wide 10,435 8.9 98,846 259,650
Stroke 383 5.7 5.2 5.2 39,061 90,063
State Wide 43,670 4.7 37,432 98,172
Transient Cerebral Ischemia 96 2.4 2.2 2.4 31,523 47,510
State Wide 10,005 2.2 30,527 66,048
Cancer Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Acute Leukemia 23 11.4 14.1 11.3 30,697 111,769
State Wide 1,801 13.9 42,948 266,814
Bone Marrow Transplant 0 0.0 0.0 0.0
State Wide 1,057 22.9 230,901 590,446
Brain Cancer 35 4.3 5.3 4.2 19,192 50,249
State Wide 3,644 5.2 27,487 78,511
Chemotherapy 21 7.1 5.8 7.3 23,284 91,344
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Florida Agency For Health Care Administration
State Wide 6,229 6.0 28,404 91,329
Digestive System Cancer 102 5.0 5.6 4.9 13,876 57,567
State Wide 5,594 5.5 31,160 87,017
Female Reproductive Cancer 14 5.9 6.1 4.5 14,498 61,187
State Wide 1,417 4.7 25,322 72,386
Kidney / Ureter Removal 115 3.6 5.0 3.3 44,947 67,040
State Wide 3,220 4.6 64,867 143,635
Leukemia / Lymphoma, Non-Surgical 95 5.9 7.1 5.5 29,124 83,380
State Wide 6,350 6.5 30,239 106,107
Leukemia / Lymphoma, Surgical 33 8.0 10.1 8.1 58,931 121,581
State Wide 2,563 10.2 57,972 188,195
Liver / Pancreatic Cancer 53 4.8 5.3 4.4 26,739 70,548
State Wide 4,890 4.9 31,127 84,697
Lung Cancer 93 4.1 5.4 4.2 15,448 69,621
State Wide 7,096 5.6 34,132 95,197
Mastectomy 57 2.5 2.2 2.7 63,238 98,680
State Wide 1,392 2.4 65,022 168,438
Diabetes/ Endocrinology/ Metabolism Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Diabetes 125 3.3 3.4 3.1 18,206 37,480
State Wide 28,759 3.2 20,010 49,154
General Medical Information Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Acute Pancreatitis 132 3.5 3.8 3.3 21,432 41,449
State Wide 19,870 3.6 23,566 54,570
Cellulitis 242 3.2 3.6 3.4 16,445 33,720
State Wide 36,608 3.7 18,968 46,684
Convulsions (Seizures) 83 2.9 3.3 3.1 20,495 40,874
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State Wide 19,536 3.4 25,157 62,652
Diverticulosis / Diverticulitis 207 3.5 3.5 3.4 23,111 40,914
State Wide 22,119 3.4 23,136 52,663
Gastrointestinal Hemorrhage 249 3.7 3.8 3.6 26,972 49,749
State Wide 36,578 3.7 28,944 68,101
Hypovolemia (Low Blood Volume) 114 3.7 3.7 3.5 23,176 44,226
State Wide 10,648 3.4 20,554 51,095
Inflammatory Bowel Disease 67 4.3 3.6 4.5 24,863 45,644
State Wide 7,148 3.8 24,544 57,218
Migraine & Other Headaches 61 3.0 2.3 3.2 24,917 48,041
State Wide 5,421 2.4 25,736 58,043
Non-Bacterial Gastroenteritis, Nausea & Vomiting 124 3.0 3.0 2.8 22,598 39,057
State Wide 21,130 2.8 23,513 51,421
Renal Failure 280 4.2 4.4 4.1 23,049 49,057
State Wide 47,119 4.3 22,274 61,279
Septicemia (blood poisoning) 923 6.6 6.1 6.4 32,397 83,937
State Wide 134,198 6.0 34,725 98,265
Sickle Cell Disease 31 3.8 4.7 3.8 20,629 40,505
State Wide 8,837 4.7 19,729 48,173
Syncope (fainting) 110 2.6 2.4 2.8 20,152 42,470
State Wide 15,701 2.6 25,701 58,999
Urinary Stones 101 1.9 2.0 1.9 27,307 37,346
State Wide 8,335 2.0 24,768 57,624
Urinary Tract Infection 331 3.7 3.7 3.6 22,111 40,766
State Wide 44,084 3.6 22,385 51,664
Heart and Circulatory System Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Angina Pectoris & Coronary Atherosclerosis 207 2.0 2.0 2.0 17,349 34,250
State Wide 12,352 2.0 20,441 47,111
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Angioplasty 860 4.5 4.0 4.2 79,462 131,003
State Wide 50,941 3.7 91,677 199,729
Cardiac Catheterization 392 5.0 4.2 4.8 42,302 79,036
State Wide 30,137 4.0 47,728 102,578
Cardiac Defibrillator & Heart Assist Anomaly 86 9.1 7.5 10.0 131,891 250,498
State Wide 6,071 8.2 190,156 392,955
Cardiac Pacemaker Implant 106 5.2 4.1 5.2 58,724 88,729
State Wide 8,913 4.2 73,059 139,478
Cardiac Valve Procedures without Cardiac Catheterization 157 9.0 8.9 9.0 128,348 199,226
State Wide 4,408 8.9 183,737 374,338
Chest Pain 123 1.8 1.6 1.9 16,051 30,527
State Wide 11,587 1.6 21,494 45,258
Coronary Bypass Surgery 170 9.1 9.1 9.8 120,603 187,919
State Wide 14,286 9.8 180,133 399,850
Heart Attack 259 3.7 3.4 3.9 33,040 60,560
State Wide 23,058 3.6 33,481 82,390
Heart Failure 681 4.9 4.7 4.9 27,695 56,147
State Wide 84,902 4.7 25,795 65,637
High Blood Pressure 216 3.1 2.8 2.9 22,217 46,795
State Wide 16,772 2.6 22,601 51,373
Irregular Heartbeat 343 3.2 3.0 3.1 21,317 43,762
State Wide 46,238 2.9 19,411 47,642
Major Thoracic & Abdominal Vascular Procedures 67 8.0 8.0 8.3 92,336 178,034
State Wide 3,661 8.3 106,168 276,193
Peripheral Vascular Disease (PVD) 160 4.0 3.7 4.2 21,416 48,673
State Wide 15,547 3.9 21,865 62,070
Pulmonary Edema & Respiratory Failure 96 4.2 5.0 4.1 7,253 65,210
State Wide 29,700 4.9 30,652 84,428
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Lungs Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Asthma 99 4.0 3.1 4.1 22,485 40,059
State Wide 9,376 3.2 22,178 50,587
Chronic Obstructive Pulmonary Disease, COPD 283 4.2 4.0 4.2 24,355 50,444
State Wide 45,830 4.0 24,507 57,744
Lung and Chest Procedures 429 5.2 6.0 6.9 59,535 98,095
State Wide 11,532 7.9 72,034 183,672
Pneumonia 359 4.6 4.3 4.6 24,039 57,609
State Wide 44,807 4.3 25,491 63,472
Pneumonitis, Aspiration 146 6.8 6.2 7.2 28,893 76,881
State Wide 17,060 6.6 34,766 97,161
Surgery Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Appendectomy 172 2.4 2.5 2.5 39,307 53,750
State Wide 9,406 2.6 45,959 94,912
Arteriovenostomy (renal dialysis) 9 10.6 8.1 10.4 88,498 127,012
State Wide 708 7.9 67,045 156,226
Gall Bladder Removal 5 2.8 5.4 3.4 30,048 63,211
State Wide 1,207 6.6 72,096 174,112
Heart and/or Lung Transplant 0 0.0 0.0 0.0
State Wide 413 38.8 572,046 1,254,911
Hernia Repair 43 5.0 4.2 5.3 38,738 78,247
State Wide 5,591 4.4 55,782 126,084
Inguinal, Femoral & Umbilical Hernia Procedures 27 3.3 3.1 3.7 38,816 58,834
State Wide 2,692 3.5 47,126 108,943
Kidney/Pancreas Transplant 0 0.0 0.0 0.0
State Wide 1,488 7.0 191,621 321,639
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Laparoscopic Gall Bladder Removal 267 3.5 3.5 3.7 44,680 69,413
State Wide 22,876 3.6 54,018 116,733
Liver Transplant 0 0.0 0.0 0.0
State Wide 607 20.6 293,633 697,816
Major Small & Large Bowel Procedures 218 7.8 7.6 8.2 61,558 127,395
State Wide 25,054 8.0 76,013 185,964
Major Stomach, Esophageal & Duodenal Procedures 99 4.6 5.4 6.5 47,483 98,161
State Wide 5,354 7.6 72,554 189,740
Minor Small & Large Bowel Procedures 38 5.6 5.2 6.3 40,631 77,665
State Wide 5,887 5.9 43,824 116,391
Obesity Procedures 39 2.0 1.6 2.1 42,315 49,318
State Wide 10,998 1.7 50,762 118,386
Peritoneal Adhesiolysis 19 7.1 8.0 7.1 57,377 109,799
State Wide 2,188 7.9 60,752 150,623
Radical Prostatectomy 54 1.5 1.8 1.6 34,366 41,342
State Wide 2,068 2.0 71,741 115,590
Thyroid, Parathyroid & Thyroglossal Procedures 26 3.0 3.0 2.7 43,110 65,619
State Wide 1,654 2.6 59,948 106,004
Transurethral Prostatectomy 22 3.5 3.8 3.3 31,941 54,514
State Wide 1,834 3.6 38,134 87,152
Urethral & Transurethral Procedures 68 3.4 3.4 3.1 35,206 55,147
State Wide 7,298 3.1 41,954 89,846
Women's Health / Deliveries Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Cesarean Section Delivery 923 3.2 3.1 3.4 21,288 27,495
State Wide 78,785 3.3 26,107 49,148
Hysterectomies and Other Uterine & Adnexa Procedures 51 2.5 2.2 3.1 29,320 46,249
State Wide 13,900 2.7 43,887 96,861
Vaginal Delivery 1,607 2.5 2.4 2.5 15,877 25,489
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State Wide 125,102 2.4 13,853 27,497
Deliveries and Newborns
Newborns Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Baby with Complications 1,491 4.1 4.7 6.9 4,255 9,525
State Wide 79,283 7.8 4,716 30,858
Normal Baby 1,159 2.0 2.1 2.0 4,064 5,034
State Wide 138,977 2.1 3,051 5,795
Pediatrics
Pediatrics Average Length of Stay (days) Charges
Condition or Procedure Hospitalizations Obs Exp Risk Adj Low High
Appendectomy - Ages 1-17 years 4 0.8 1.7 0.8 29,992 36,909
State Wide 5,070 1.7 24,654 41,434
Asthma - Ages 2-17 years 1 1.0 1.8 1.1
State Wide 15,526 2.0 8,012 18,018
Brain Surgery - Ages 0-17 years 0 0.0 0.0 0.0
State Wide 3,463 7.5 44,463 141,052
Bronchiolitis and RSV Pneumonia - Ages 0-4 years 0 0.0 0.0 0.0
State Wide 16,539 2.8 7,624 18,936
Cancer Care - Ages 0-17 years 8 6.8 3.0 12.8 34,823 39,507
State Wide 8,678 5.6 17,168 60,198
Cellulitis - Ages 0-17 years 2 2.5 2.5 2.7 12,954 12,954
State Wide 12,076 2.7 7,842 19,221
Convulsions (Seizures) - Ages 0-4 years 0 0.0 0.0 0.0
State Wide 6,596 2.8 9,894 26,734
Convulsions (Seizures) - Ages 5-17 years 0 0.0 0.0 0.0
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State Wide 7,185 2.4 10,334 28,563
Diabetes - Ages 6-17 years 0 0.0 0.0 0.0
State Wide 2,392 2.3 10,496 23,858
Fever and Infectious Illness - Ages 0-17 years 2 1.5 2.0 1.8 16,981 16,981
State Wide 22,646 2.3 7,671 16,822
Gastroenteritis - Ages 3 months - 4 years 0 0.0 0.0 0.0
State Wide 5,781 2.1 6,379 13,383
Gastroenteritis - Ages 5-17 years 0 0.0 0.0 0.0
State Wide 3,600 2.0 7,432 18,229
Pneumonia, Other - Ages 2-17 years 1 5.0 2.8 5.2
State Wide 12,890 2.9 10,333 24,530
Sickle Cell Disease - Ages 1-17 years 0 0.0 0.0 0.0
State Wide 5,228 3.8 9,849 25,412
Spinal Fusion - Ages 5-17 years 0 0.0 0.0 0.0
State Wide 2,552 5.5 148,887 293,154
Urinary Tract Infections - Ages 3 months to 17 years 0 0.0 0.0 0.0
State Wide 5,113 3.1 9,375 20,379
Viral Meningitis - Ages 0-17 years 0 0.0 0.0 0.0
State Wide 1,361 2.7 10,076 20,113
AHRQ Pediatric Quality Measures
Quality Measure Lower
Confidence
Upper
Confidence
Numerator Denominator Observed Volume Observed Rate Risk Adj Rate Expected Rate Interval Interval
Accidental Puncture or Laceration As Expected 1 5,030 5,030 0.02% 0.03% %0.04 0.00 % %0.13
State Wide 117 589,632 589,632 0.02% 0.02% 0.01% 0.03%
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Florida Agency For Health Care Administration
Pediatric Heart Surgery Mortality 0 0 0 0.00%
Not Rated
0.00% %0.00 0.00 % %0.00
State Wide 95 3,540 3,540 2.68% 3.08% 2.40% 3.75%
Pediatric Heart Surgery Volume 0 0 0 0.00%
Not Rated
0.00% %0.00 0.00 % %0.00
State Wide 3,851 0 0 0.00% 0.00% 0.00% 0.00%
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AHRQ Mortality Rates
Mortality for Inpatient Procedures
Quality Indicator Denominator Numerator Observed Rate Risk Adjusted Rate
Lower
Conf
Interval
Upper
Conf
Interval
Abdominal Aortic Aneurysm Repair Mortality Rate 36 1 2.78 % 2.11% As Expected 0.00% 7.90 %
State Wide 2,869 113 3.94 % 2.43 %
Carotid Endarterectomy Mortality Rate 39 0 0.00 % 0.00% As Expected 0.00% 2.24 %
State Wide 7,170 22 0.31 % 0.24 %
Coronary Artery Bypass Graft Mortality Rate 235 4 1.70 % 0.49% As Expected 0.00 % 1.61 %
State Wide 15,134 413 2.73 % 0.83 %
Craniotomy Mortality Rate (Surgical opening of the
skull)
State Wide
189
10,840
7
603
3.70 %
5.56 %
7.06% As Expected
10.74 %
2.29 % 11.83 %
Esophageal Resection Mortality Rate (Surgical
Removal of the Throat)
State Wide
5
382
0
27
0.00 %
7.07 %
0.00% Not Rated
2.29 %
0.00 % 11.01 %
Hip Replacement Mortality Rate 113 0 0.00 % 0.00% As Expected 0.00% 0.42 %
State Wide 23,592 18 0.08 % 0.03 %
Pancreatic Resection Mortality Rate (Surgical
Removal of the Pancreas)
State Wide
9
621
0
22
0.00 %
3.54 %
0.00% As Expected
1.39 %
0.00% 7.33 %
Percutaneous Transluminal Coronary Angioplasty
Mortality Rate
State Wide
711
38,441
12
971
1.69 %
2.53 %
1.11%
1.80%
Lower than
Expected
0.42 % 1.80 %
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Florida Agency For Health Care Administration
Mortality for Inpatient Conditions
Quality Indicator Denominator Numerator Observed Rate Risk Adjusted Rate
Lower
Conf
Interval
Upper
Conf
Interval
Acute Myocardial Infarction Mortality Rate (Heart
Attack)
State Wide
581
43,815
27
2,146
4.65 %
4.90 %
3.77% As Expected
4.04 %
1.94% 5.60 %
Acute Myocardial Infarction Mortality Rate (Heart
Attack), Without Transfer Cases
State Wide
480
40,301
24
1,955
5.00 %
4.85 %
4.26% As Expected
4.21 %
2.13% 6.39 %
Acute Stroke Mortality Rate 315 19 6.03 % 6.93% As Expected 3.39% 10.47 %
State Wide 44,151 2,728 6.18 % 7.15 %
Congestive Heart Failure (CHF) Mortality Rate 693 30 4.33 % 2.84% As Expected 1.75% 3.92 %
State Wide 78,661 1,940 2.47 % 1.78 %
Gastrointestinal (GI) Hemorrhage Mortality Rate 368 5 1.36 % 1.17% As Expected 0.00 % 2.61 %
State Wide 41,223 702 1.70 % 1.49 %
Hip Fracture Mortality Rate 171 3 1.75 % 1.42% As Expected 0.00% 3.68 %
State Wide 21,956 378 1.72 % 1.39 %
Pneumonia Mortality Rate 451 19 4.21 % 2.82% As Expected 1.35% 4.29 %
State Wide 56,654 1,536 2.71 % 2.04 %
Complication/Infection Rates
* AHRQ Patient Safety Indicators
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Patient Safety Indicator
latrogenic pneumothorax
State Wide
Denominator
17,299
1,974,190
Numerator
10
506
Observed Rate
0.06 %
%0.03
Risk Adjusted Rate
0.13 % Higher than
Expected
0.06 %
Lower
Conf
Interval
0.08 %
Upper
Conf
Interval 0.18 %
Postoperative hip fracture
State Wide
3,860
285,566
0
13
0.00
0.00
%
%
0.00 %
0.00 %
As Expected 0.00 % 0.04 %
Postoperative pulmonary embolism or deep vein
thrombosis
State Wide
5,686
523,956
27
2,540
0.47
0.48
%
%
0.32 %
0.39 %
As Expected 0.11 % 0.53 %
Pressure ulcer (bed or pressure sore)
State Wide
7,495
606,061
11
466
0.15
0.08
%
%
0.47 %
0.24 %
As Expected 0.00 % 1.01 %
* Methodology utilizes Present on Admission (POA)
Readmissions by Medical Condition or Procedure
Adults
Bones and Joints
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Back Problems
State Wide
8
841
115
15,581
6.96 %
5.40 %
5.41% 6.94% As Expected
Disc Surgery
State Wide
5
380
100
6,752
5.00 %
5.63 %
6.00% 4.69% As Expected
Femur Fracture Surgical Repair
State Wide
6
849
96
17,232
6.25 %
4.93 %
5.53% 5.57% As Expected
Fracture of Pelvis or Dislocation of Hip
State Wide
1
120
30
3,092
3.33 %
3.88 %
3.30% 3.92% As Expected
Hip Replacement 2 134 1.49 % 3.14% 1.42% As Expected
State Wide 1,150 38,479 2.99 %
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Florida Agency For Health Care Administration
Knee Replacement
State Wide
1
804
219
37,743
0.46 %
2.13 %
1.64% 0.59% As Expected
Leg Amputation
State Wide
4
377
23
4,415
17.39 %
8.54 %
11.06% 13.43% As Expected
Shoulder, Upper Arm & Forearm Procedures
State Wide
3
404
78
15,378
3.85 %
2.63 %
2.34% 4.32% As Expected
Spinal Fusion
State Wide
3
1,101
121
24,895
2.48 %
4.42 %
4.24% 2.58% As Expected
Tibia / Fibula Fracture Repair
State Wide
1
367
30
10,183
3.33 %
3.60 %
3.78% 3.18% As Expected
Brain and Nervous System
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Craniotomy (brain surgery)
State Wide
4
408
37
5,584
10.81 %
7.31 %
8.01% 9.87% As Expected
Stroke
State Wide
15
1,863
233
34,124
6.44 %
5.46 %
6.06% 5.80% As Expected
Transient Cerebral Ischemia
State Wide
1
334
76
8,859
1.32 %
3.77 %
3.68% 1.35% As Expected
Cancer
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Digestive System Cancer
State Wide
0
43
22
1,388
0.00 %
3.10 %
2.79% 0.00% As Expected
Female Reproductive Cancer
State Wide
1
14
2
477
50.00 %
2.94 %
2.21% 66.49% Not Rated
Kidney / Ureter Removal 6 63 9.52 % 5.00% 10.61% As Expected
State Wide 132 2,371 5.57 %
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Leukemia / Lymphoma, Non-Surgical
State Wide
0
19
7
830
0.00 %
2.29 %
1.58% 0.00% As Expected
Leukemia / Lymphoma, Surgical
State Wide
1
13
7
520
14.29 %
2.50 %
2.39% 14.94% Higher than Expected
Liver / Pancreatic Cancer
State Wide
2
57
9
1,203
22.22 %
4.74 %
5.28% 19.92% Higher than Expected
Lung Cancer
State Wide
0
78
11
2,156
0.00 %
3.62 %
2.94% 0.00% As Expected
Mastectomy
State Wide
1
36
32
1,013
3.13 %
3.55 %
3.14% 3.54% As Expected
Diabetes/ Endocrinology/ Metabolism
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Diabetes
State Wide
7
1,691
63
21,351
11.11 %
7.92 %
8.41% 10.46% As Expected
General Medical Information
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Acute Pancreatitis
State Wide
5
1,196
78
15,518
6.41 %
7.71 %
8.76% 5.64% As Expected
Cellulitis
State Wide
7
1,544
180
29,161
3.89 %
5.29 %
4.82% 4.27% As Expected
Convulsions (Seizures)
State Wide
8
851
40
14,108
20.00 %
6.03 %
6.55% 18.43% Higher than Expected
Diverticulosis / Diverticulitis
State Wide
10
1,004
161
19,302
6.21 %
5.20 %
5.24% 6.17% As Expected
Gastrointestinal Hemorrhage 6 157 3.82 % 7.52% 3.73% As Expected
State Wide 2,006 27,329 7.34 %
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Hypovolemia (Low Blood Volume)
State Wide
1
483
69
7,449
1.45 %
6.48 %
7.44% 1.26% As Expected
Inflammatory Bowel Disease
State Wide
4
450
38
5,693
10.53 %
7.90 %
7.15% 11.64 % As Expected
Migraine & Other Headaches
State Wide
1
185
43
4,360
2.33 %
4.24 %
4.10% 2.41% As Expected
Non-Bacterial Gastroenteritis, Nausea & Vomiting
State Wide
4
903
90
16,768
4.44 %
5.39 %
5.45% 4.40% As Expected
Renal Failure
State Wide
21
2,848
195
34,458
10.77 %
8.27 %
9.16% 9.72% As Expected
Septicemia (blood poisoning)
State Wide
39
6,576
480
90,013
8.13 %
7.31 %
7.95% 7.46% As Expected
Sickle Cell Disease
State Wide
2
976
15
5,840
13.33 %
16.71 %
14.04% 15.87% As Expected
Syncope (fainting)
State Wide
3
539
68
12,592
4.41 %
4.28 %
4.25% 4.45% As Expected
Urinary Stones
State Wide
3
227
73
6,975
4.11 %
3.25 %
2.81% 4.76% As Expected
Urinary Tract Infection
State Wide
12
2,064
223
35,981
5.38 %
5.74 %
5.79% 5.33% As Expected
Heart and Circulatory System
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Angina Pectoris & Coronary Atherosclerosis
State Wide
15
694
131
9,624
11.45 %
7.21 %
7.39% 11.17 % As Expected
Angioplasty
State Wide
51
3,009
642
43,770
7.94 %
6.87 %
7.07% 7.73% As Expected
Cardiac Catheterization 9 267 3.37 % 5.41% 3.40% As Expected
State Wide 1,379 25,273 5.46 %
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Cardiac Defibrillator & Heart Assist Anomaly
State Wide
8
456
60
4,822
13.33 %
9.46 %
8.60% 14.66% As Expected
Cardiac Pacemaker Implant
State Wide
5
458
74
8,107
6.76 %
5.65 %
5.26% 7.25% As Expected
Cardiac Valve Procedures without Cardiac
Catheterization
State Wide
10
324
116
3,815
8.62 %
8.49 %
7.33% 9.99% As Expected
Chest Pain
State Wide
6
424
68
9,396
8.82 %
4.51 %
5.03% 7.91% As Expected
Coronary Bypass Surgery
State Wide
6
1,016
120
12,460
5.00 %
8.15 %
7.00% 5.83% As Expected
Heart Attack
State Wide
16
1,273
148
15,689
10.81 %
8.11 %
7.72% 11.36 % As Expected
Heart Failure
State Wide
49
6,612
441
60,902
11.11 %
10.86 %
10.49% 11.50 % As Expected
High Blood Pressure
State Wide
7
727
146
13,811
4.79 %
5.26 %
5.60% 4.51% As Expected
Irregular Heartbeat
State Wide
26
2,483
241
38,426
10.79 %
6.46 %
7.18% 9.71% Higher than Expected
Major Thoracic & Abdominal Vascular Procedures
State Wide
6
318
51
2,885
11.76 %
11.02 %
10.35% 12.53% As Expected
Peripheral Vascular Disease (PVD)
State Wide
9
613
87
10,857
10.34 %
5.65 %
5.34% 10.93% Higher than Expected
Pulmonary Edema & Respiratory Failure
State Wide
3
1,872
28
19,918
10.71 %
9.40 %
11.00% 9.16% As Expected
Lungs
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Asthma 1 79 1.27 % 5.06% 1.37% As Expected
State Wide 438 8,008 5.47 %
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Florida Agency For Health Care Administration
Chronic Obstructive Pulmonary Disease, COPD 14 198 7.07 % 8.90% 6.81 % As Expected
State Wide 3,199 37,294 8.58 %
Lung and Chest Procedures 15 184 8.15 % 5.27% 10.74 % As Expected
State Wide 553 7,964 6.94 %
Pneumonia 13 203 6.40 % 6.55% 6.29 % As Expected
State Wide 2,187 33,983 6.44 %
Pneumonitis, Aspiration 6 96 6.25 % 8.58% 6.08 % As Expected
State Wide 925 11,076 8.35 %
Surgery
Condition or Procedure
Readmissions /
Numerator
Population at
Risk /
Denominator
Observed
Readmission
Rate
Expected
Readmission
Rate
Risk Adjusted
Readmission
Rate
Appendectomy
State Wide
6
296
97
7,871
6.19 %
3.76 %
3.15% 7.38% As Expected
Arteriovenostomy (renal dialysis)
State Wide
0
64
6
632
0.00 %
10.13 %
8.53% 0.00% As Expected
Gall Bladder Removal
State Wide
0
90
5
1,090
0.00 %
8.26 %
6.76% 0.00% Not Rated
Hernia Repair
State Wide
3
352
51
4,999
5.88 %
7.04 %
7.41% 5.59% As Expected
Inguinal, Femoral & Umbilical Hernia Procedures
State Wide
1
95
19
2,340
5.26 %
4.06 %
3.71% 5.76% As Expected
Laparoscopic Gall Bladder Removal
State Wide
3
942
173
20,374
1.73 %
4.62 %
4.20% 1.91% As Expected
Major Small & Large Bowel Procedures
State Wide
11
1,684
110
19,318
10.00 %
8.72 %
7.74% 11.27 % As Expected
Major Stomach, Esophageal & Duodenal
Procedures
State Wide
4
369
69
4,122
5.80 %
8.95 %
7.87% 6.59% As Expected
Minor Small & Large Bowel Procedures 2 28 7.14 % 8.68% 7.29% As Expected
State Wide 437 4,935 8.86 %
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Florida Agency For Health Care Administration
Obesity Procedures 2 44 4.55 % 2.00% 5.61% As Expected
State Wide 244 9,876 2.47 %
Peritoneal Adhesiolysis 4 11 36.36 % 7.70% 40.88% Higher than Expected
State Wide 164 1,894 8.66 %
Radical Prostatectomy 0 25 0.00 % 2.56% 0.00% As Expected
State Wide 41 1,447 2.83 %
Thyroid, Parathyroid & Thyroglossal Procedures 0 17 0.00 % 3.27% 0.00% As Expected
State Wide 46 1,198 3.84 %
Transurethral Prostatectomy 1 18 5.56 % 7.08% 5.11 % As Expected
State Wide 104 1,596 6.52 %
Urethral & Transurethral Procedures 5 44 11.36 % 5.43% 11.93 % As Expected
State Wide 362 6,347 5.70 %
Women's Health / Deliveries Population at Observed Expected
Risk Adjusted
Readmission
Readmissions / Risk / Readmission Readmission Rate
Condition or Procedure Numerator Denominator Rate Rate
Hysterectomies and Other Uterine & Adnexa 2 40 5.00 % 3.04% 5.66% As Expected
Procedures
State Wide 407 11,826 3.44 %
Pediatrics
Pediatrics Population at Observed Expected
Risk Adjusted
Readmission
Readmissions / Risk / Readmission Readmission Rate
Condition or Procedure Numerator Denominator Rate Rate
Appendectomy - Ages 1-17 years 0 1 0.00 % 2.01% 0.00% Not Rated
State Wide 61 2,914 2.09 %
Asthma - Ages 2-17 years 0 1 0.00 % 1.20% 0.00% Not Rated
State Wide 159 9,865 1.61 %
Pneumonia, Other - Ages 2-17 years 0 1 0.00 % 1.79% 0.00% Not Rated
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State Wide 153 7,449 2.05 %
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Florida Agency For Health Care Administration
Cases by Physician
Total hip replacement
LicNo
ME46349
Name
Amaya Wilfredo P
ME62590 Lavernia Carlos J
ME104875 Saenz CesarL
ME66812 Umlas Marc E
Cases
5
2
11
27
Total knee replacement
LicNo
ME46349
Name
Amaya Wilfredo P
ME62590 Lavernia Carlos J
ME104875 Saenz CesarL
Cases
51
8
91
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Florida Agency For Health Care Administration
20ME66812 Umlas Marc E
Page 22 of 22
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Florida Agency For Health Care Administration