Neurosciences Outcomes 2014 - University of Colorado Hospital

2014 OUTCOMESNEUROSCIENCES

TABLE OF CONTENTS

4 // Brain Tumor Data

6 // Cerebrovascular and Stroke Data

8 // Epilepsy Data

9 // Cognitive Disorder Data

10 // Movement Disorder Data

12 // Multiple Sclerosis Data

13 // Neurocritical Data

14 // Neuromuscular Data

15 // Neuro-Ophthalmology Data

16 // Spine Data

UNIVERSITY OF COLORADO HOSPITAL IS ONE OF THE LEADING ACADEMIC MEDICAL CENTERS IN THE NATION.

Advancing medicine and achieving excellence in complex clinical care requires outstanding

teamwork and collaboration of clinicians, researchers, staff and leaders. At the University

of Colorado Hospital we are privileged to have such a team, all focused on the needs of the

patient and engaged in excellence. University of Colorado Hospital is the largest provider

of comprehensive neurological and neurosurgical care in the region. We lead the state in

the amount and quality of care provided to patients with epilepsy, movement disorders,

neuroimmunology/multiple sclerosis, neuro-oncology, behavioral neurology/dementia, neuro-

ophthalmology and neuro-critical care. In 2013, we provided over 41,000 outpatient visits,

and our neurosciences units accounted for 3,215 admissions, 1,971 major Neurosurgical and

Spine procedures, and 16,068 patient days.

4 * Leading neuroscience hospitals is an aggregate of top ranked hospitals from sources such as US News & World Report, Becker’s 100 Great Hospitals, and NeuStrategy Centers of Excellence.

30 DAY READMISSION RATES - RELATED CAUSE

8.1%

7.5%

7.6%

6.8%

7.3%

7.0%

5.8%

5.5%

6.0%

Source: UHC Clinical Data Base/Resource Manager™. Chicago, IL: UHC; 2012. https://www.uhc.edu. Accessed 7/30/2014.

University of Colorado Hospital comparably-sized academic medical centers

leading neuroscience hospitals*

2011 2012 2013

30 DAY READMISSION RATES - ALL CAUSE

5.5%




2011 2012 2013

12.6%12.3%

14.0%13.8%

14.4%

12.9%

11.1%

8.7%

12.0%

BRAIN TUMOR DATA

3,287

2,928

3,045

3,224

BRAIN TUMOR OUTPATIENT VISITS

2010 2011 2012 2013

Source: UCH Finance Source: CU Department of Neurosurgery

98

106 103

165

GAMMA KNIFE PROCEDURES

2010 2011 2012 2013

BRIAN TUMOR COMPLICATION RATES

5.9%

6.2%

4.5%

6.4%

6.7%

6.3%

6.1%

5.5%

5.9%




2011 2012 2013

.72

.951.01

.86

1.08

.86

.81

.35

.79

BRAIN TUMOR MORTALITY INDEX




2011 2012 2013

Mortality Index is the ratio of observed to expected mortality based on a risk adjustment algorithm. An index score of 1 indicates observed and expected mortality are equal. Values below 1 are desirable.

3,224 OP VISITS 94% OF PITUITARY TUMOR PATIENTS HAVE A 5-YEAR SURVIVAL RATE

47% MALIGNANT BRAIN & CNS PATIENTS HAVE A 5-YEAR SURVIVAL RATE (25% NATL)

PIONEERING RESEARCH ON TUMOR VACCINE

NEUSTRATEGY CENTER OF EXCELLENCE CRANIAL TUMOR

5* Leading neuroscience hospitals is an aggregate of top ranked hospitals from sources such as US News & World Report, Becker’s 100 Great Hospitals, and NeuStrategy Centers of Excellence.

BRAIN TUMOR (GBM ONLY) 5 YEAR SURVIVAL100%

10%

6048362412

MONTHS SINCE DIAGNOSIS

SU

RV

IVA

L R

AT

E

University of Colorado Hospital (n=93) Colorado (n=473)

4%

Source: UCH: Hospital Tumor Registry COLORADO: Colorado Central Cancer Registry

BRAIN (INCLUDING BENIGN) 5 YEAR SURVIVAL

38%

49%


6048362412



100%

SU

RV

IVA

L R

AT

E

PITUITARY GLAND 5 YEAR SURVIVAL

88%

94%

6048362412



100%

SU

RV

IVA

L R

AT

E


Source: UCH Hospital Tumor Registry

MEDIAN SURVIVAL FOR GBM (MONTHS)

2

4

6

8

10

12

14

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

SU

RV

IVA

L R

AT

E

BRAIN TUMOR DIAGNOSIS DISTRIBUTION

Meningiomas, pituitary tumors, gliomas and nerve sheath tumors comprise about 90% of neuro-oncology diagnoses seen at UCH in the past two years.

*Annualized based on 6 months of data Source: UCH Hospital Tumor Registry

Neoplasms, NOS

NeuroepitheliomatousNeoplasms

Blood Vessel Tumors

Germ Cell Tumors

Lymphomas

Miscellaneous Tumors

Nerve Sheath Tumors

Gliomas

Pituitary Tumors

Meningiomas

2012 2013*

28%

24%

28%

14%

30%

26%

21%

11%

BRAIN TUMOR PROCEDURES

*Excludes stereotactic radiosurgery and gamma knife procedures. source: UCH Hospital Tumor Registry

146

175

180

157

2010 2011 2012 2013

LONG TERM SURVIVAL FOR GBM(% of patients living at least 3 years after diagnosis)

5%

10%

15%

20%

25%

Source: UCH Hospital Tumor Registry

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010


97.1%

89.7%89.3%86.6%

IV RT-PA ARRIVE BY 2 HOURS,TREAT BY 3 HOURS

Be

tte

r O

utc

om

es

2007 2008 2009 2010 2011 2012 2013

University of Colorado HospitalAcademic Hospitals Colorado National

source: Get With The Guidelines® reports run on 8/4/2014 and 8/8/2014

7.0%

9.4%

8.0%

6.3%

7.2%

6.6%6.6%

6.7%6.9%

COMPLICATIONRATES-ISCHEMICSTROKE




2011 2012 2013

32.1%

35.3%

26.6%

21.5%21.2%

20.6%

13.9%14.4% 14.6%

COMPLICATION RATES – HEMORRHAGIC STROKE




2011 2012 2013

0

2

4

6

8

>10109876543210-1-2-3-4-5-6-7-8-9<-10

NIHSS SCORE IMPROVEMENT (N=57)

BETTER OUTCOMES

SCORE IMPROVEMENT

NU

MB

ER

OF

PA

TIE

NT

S P

ER

SC

OR

E C

HA

NG

E

WORSE OUTCOMES

Source: UCH Stroke Council

2.3%

2.6%

2.7%

2.83%2.7%

3.1%

2.8%2.63%

30 DAY READMISSION RATES - RELATED CAUSE - HEMORRHAGIC STROKE

1.9%




2011 2012 2013

2.1%

3.2%

0%

2.98%

2.71%

3.1%

2.7%

3.0%

30 DAY READMISSION RATES - RELATED CAUSE - ISCHEMIC STROKE




2011 2012 2013

CEREBROVASCULAR & STROKE DATA

This Get With The Guidelines® Aggregate Data report was generated using the Quintiles PMT® system. Copy or distribution of the Get With The Guidelines® Aggregate Data is prohibited without the prior written consent of the American Heart Association and Quintiles.


1.06

0.930.88

1.01

MORTALITY INDEX - ISCHEMIC STROKE

0.87 0.86




2011 2012 2013

1.05

1.111.04

1.09

MORTALITY INDEX - HEMORRHAGIC STROKE

0.82

0.91

0.88

0.99




2011 2012 2013

0.98

1.01

6.7%

6.0%

7.5%

8.2%8.7%

8.0%

9.3% 9.2%

8.3%

30 DAY READMISSION RATES - ALL CAUSE - HEMORRHAGIC STROKE




2011 2012 2013

9.2%

6.4%

7.7%

5.2%

8.8%8.6%

8.2%

9.1%8.6%

30 DAY READMISSION RATES - ALL CAUSE - ISCHEMIC STROKE




2011 2012 2013

97% OF PATIENTS THAT ARRIVE BY 2 HOURS ARE TREATED WITHIN 3 HOURS OF SYMPTOM ONSET

1.9% RELATED CAUSE READMISSION RATE FOR HEMORRHAGIC STROKE,

0% FOR ISCHEMIC STROKE

JC COMPREHENSIVE STROKE CENTER

NEUSTRATEGY CENTER OF EXCELLENCE NEUROVASCULAR/STROKE

AMERICAN HEART ASSOCIATION TARGET STROKE GOLD PLUS 2011, 2012, 2013, 2014


4,218

3,709

4,480

source: UCH Finance

EPILEPSY OUTPATIENT VISITS

2011 2012 2013

343

325303

source: CU Department of Neurology

EMU ADMISSIONS

2011 2012 2013

3.2%

1.4%

1.3% 1.3%

1.9%

2.5%

1.6%1.4%

1.5%1.6%

EPILEPSY COMPLICATION RATES


similar epilepsy centers leading neuroscience hospitals*

2011 2012 2013


.99.93

.88

.81

.94

.91.87

.71

.89

1.621.75

.54

EPILEPSY MORTALITY INDEX



2011 2012 2013


8.5%

8.4% 8.3% 8.1%

8.4%

8.5%

8.2%

8.1%

8.4%

6.3%

5.3%

7.6%




2011 2012 2013


5.3%

5.0%

4.9%5.0%

5.1%5.1%5.0%

5.2%

2.4

4.5%

3.4%




2011 2012 2013


EPILEPSY DATA



514602

2,144

source: Epic query

COGNITIVE DISORDER OUTPATIENT VISITS

2011 2012 2013

COGNITIVE DISORDER DATA

LEVEL 4 EPILEPSY CENTER 4,480 OUTPATIENT VISITS

SURGICAL PATIENTS ACHIEVED A 98% REDUCTION IN SEIZURES

64% OF PATIENTS WITH SURGICAL INTERVENTION ARE SEIZURE FREE



20.7%

10.7%

10.5%

6.5%

11.5%

10.3%

24.5%

9.8%

9.6%




2011 2012 2013

10.3%

6.5%

4.4%

5.0%4.6%

3.6%

14.3%

4.9%

4.2%





2011 2012 2013

.78

.71

0 0 0

.7

.65

1.61

.78

MOVEMENT DISORDER MORTALITY INDEX




2011 2012 2013

3.2%

3.2%

2.2%

2.1%

3.4%

6.1%

2.6%

2.0%

2.1%

MOVEMENT DISORDER COMPLICATION RATES




2011 2012 2013

2,785

2,353

2,824

3,073

MOVEMENT DISORDER OUTPATIENT VISITS

Source: UCH Finance

2010 2011 2012 2013

47

53

61

91

DBS PROCEDURES(excluding Battery implants/explants)

Source: DBS database

2010 2011 2012 2013

MOVEMENT DISORDER DATA


PDQ-39 SUMMARY INDEX SCORE(N=39)

20

40

60

80

100

• 30

• 21


PRE-OP POST-OP

86%

75%

ACTIVITIES SPECIFIC BALANCE CONFIDENCE High and Moderate Range (N=28)

Be

tte

r O

utc

om

es

PRE-OP POST-OP


MOVEMENT DISORDERS The average PDQ-39 Summary Index score decreased significantly by 9 points (p=0.008) after DBS implant mean post-operative duration of 10 months. 82% of patients showed improvement while 18% remained stable or had increasing symptoms after DBS. Lower scores reflect better health and fewer symptoms.

Balance confidence is an important indicator of functional mobility and independence in people with Parkinson’s Disease. The Activities-specific Balance Confidence (ABC) Scale measures balance confidence in progressively more challenging yet common scenarios ranging from walking around inside the home to shopping at the mall to navigating an icy sidewalk. Prior to DBS implant, 75% (21 of 28) patients rated themselves as highly or moderately confident on the ABC scale. After DBS that number rose to 86% (24 of 28), indicating that 3 patients increased from very little confidence to either moderate or high confidence.

MOST ACTIVE SURGICAL PROGRAM FOR DBS IN THE ROCKY MOUNTAIN REGION WITH 601

LEAD PLACEMENTS PERFORMED

OVER 3,000 PATIENT VISITS

NEUSTRATEGY CENTER OF EXCELLENCE NEUROSCIENCE

82% OF PATIENTS EXPERIENCE IMPROVEMENT IN PDQ-39 SCORES POST IMPLANTATION


6.4%

7.3%

7.2% 6.7%

8.9%

3.2%

5.7%

7.4%

8.1%





2011 2012 2013

4.0%

5.0%

4.4%

6.7%

5.1%

3.2%

3.8%

4.4%





2011 2012 2013

.51.51

1.27

.41

.58

MS MORTALITY INDEX




2011 2012 2013

0 0 0

1.7%

.5%

.2%

.9%

.7%

.8%

.9%

MS COMPLICATION RATES




2011 2012 2013

0% 0%

7,847

8,575

9,241

MS OUTPATIENT VISITS

2011 2012 2013

Source: UCH Finance

MULTIPLE SCLEROSIS DATA


9,241 OUTPATIENT VISITS

40 ACTIVE CLINICAL AND

LABORATORY TRIALS

LARGEST BRAIN TISSUE BANK

IN THE COUNTRY


NEUROCRITICAL CARE

3,375

3,206

3,538

5,630

NEUROCRITICAL CARE PATIENT DAYS

2010 2011 2012 2013

Source: UCH Finance

NHSN (CDC) Benchmark Rate

1.35%

2013

University of Colorado Hospital Neurocritical Rate

CATHETER-ASSOCIATED URINARY TRACT INFECTIONS


5.00%

NHSN (CDC) Benchmark Rate

2013

University of Colorado Hospital Neurocritical Rate

1.10%

1.41%

CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS


NEUROCRITICAL CARE DATA

Central line-associated bloodstream infections (CLABSI) typically cause prolonged hospital stay, increased cost and risk of mortality. CLABSI rates are expressed as the number of infections per 1000 central-line days. In 2013, the Neurocritical Intensive Care Unit at UCH hovered near the national benchmark provided by the National Healthcare Safety Network (NHSN).

Complications caused by catheter-associated urinary tract infection (CAUTI) cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality. CAUTI rates are expressed as the number of infections per 1000 urinary catheter days. In 2013, the Neurocritical Intensive Care Unit at UCH was well below the benchmark provided by the National Healthcare Safety Network (NHSN).

CAUTI RATE OF 1.35/1,000 DAYS, SIGNIFICANTLY LOWER THAN THE NATIONAL BENCHMARK

BEACON AWARD, GOLD LEVEL

1ST NEUROCRITICAL CARE UNIT IN COLORADO 616 PATIENTS ADMITTED IN 2013

HIRED THE FIRST NEUORINTENSIVIST IN THE ROCKY MOUNTAIN REGION


NEUROMUSCULAR

3,073

4,014

7,292

NEUROMUSCULAR OUTPATIENT VISITS

source: Epic query

2011 2012 2013

3.77%

2.86%

0%0%

3.14%

2.8%

6.1%

2.44%

2.8%

NEUROMUSCULAR COMPLICATION RATES




2011 2012 2013

1.89

1.71

3.49

0 0

1.21

1.17

1.17

1.1

NEUROMUSCULAR MORTALITY INDEX




2011 2012 2013

16.9%

12.8%

9.1%

12.5%

15.2%

13.5%

14.9%

13.7%

13.8%





2011 2012 2013

8.1%

7.5%

5.8%

5.5%

6.0%

7.0%

7.3%

6.8%

7.6%





2011 2012 2013

IMPROVEMENT IN PHQ-9 SCORES (N=35)

0

5

10

15

20

25

30

25

First Assessment LAST Assessment

Minimal Mild Moderate Moderate-Severe

Severe Depression not Suggested

(N=35)

Patients whose PHQ-9 scores initially suggested possible depressive disorder showed significant improvement. Sixty-six percent of patients’ (n=23) moved out of the “Depression Suggested” category. Six patients had continued symptoms but moved from higher to lower severity levels with an average score decrease of 5 points. Six patients remained stable or worsened with an average score increase of 2 points.

NEUROMUSCULAR DATA


1,769

1,736

1,896

NEURO-OPHTHALMOLOGY OUTPATIENT VISITS

source: Epic query

2011 2012 2013

NEURO-OPHTHALMOLOGY DATA

1,896 OUTPATIENT VISITS

PIONEERING TESTS OF VISION

THROUGH 3D SIMULATION

PIONEERING METHODOLOGY FOR

EARLY DETECTION OF ALZHEIMER’S


13,075

11,112

13,691

15,069

SPINE OUTPATIENT VISITS

2010 2011 2012 2013

Source: UCH Finance

2,1852,113

2,520

2,675

SPINE OUTPATIENT PROCEDURES(EMG, Injection, Kyphoplasty, RFA)

2010 2011 2012 2013

source: Spine Administration and IR database

3.2%

2.5%

2.3%

2.6%

3.7%

3.9%

2.4%2.3%

2.1%

2.6%2.7%

2.9%

SPINE COMPLICATION RATES


comparable spine hospitals leading neuroscience hospitals*


2011 2012 2013

24.9

27.5

44.5

23.422

PRE AND POST OPERATIVE ODI SCORE

Pre Opn=105

3 MonthsPost Op

n=64

6 MonthsPost Op

n=65

1 YearPost Op

n=50

2 YearsPost Op

n=55

source: HCOL CU Spine Study

6.6

5.3

5

4.4

3.22.92.8

PRE AND POST OPERATIVE SYMPTOM SEVERITY

PRE-OP n=113 1 YEAR POST-OP n=73

Leg PainBack Pain Weak Legs Numb Legs


PRE AND POST OPERATIVE SYMPTOM SEVERITY

PRE-OP n=23 1 YEAR POST-OP n=16

Arm PainNeck Pain Weak Arms Numb Arms

6

5.3

4.7

3.9

2.8

1.10.90.8


SPINE DATA

The Oswestry Disability Index (ODI) is the ‘gold standard’ of low back functional outcome measures. Patients who had surgery at UCH between October 2011 and December 2013 showed an average ODI score reduction of 20 points after surgery; well above the minimum clinically important difference of 15 points.

Patients were asked to rate the severity of their pain, weakness, and numbness both pre-operatively and at one year post-operatively. Using a 0-10 visual analog scale where 0 means no symptom occurrence, post-operative scores improved dramatically.


1.05

.79

.42

.65

.81

.55

.46

.59

SPINE MORTALITY INDEX




2011 2012 2013

0% 0%0%

5.6%5.7%5.64%

5.59%

5.9%

5.0%

6.2%

5.9%

5.7% 5.8%

4.5%





2011 2012 2013

3.3%

3.23%3.17%

3.3%

2.7%

3.7%

3.3%

3.4%

3.1%





2011 2012 2013

61.1%

30.3%

33.3%

32%

18.8%

PRE AND POST OPERATIVE WORK LIMITATIONS


Pre-Opn=54

3 MonthsPost-Op

n=27

6 MonthsPost-Op

n=33

1 YearPost-Op

n=25

2 YearsPost-Op

n=32

8.6%

42.9%

52.7%

10.9%

PRE AND POST OPERATIVE LEVEL OF DISABILITY

minimal disability severe disability


Pre Opn=105

3 MonthsPost Op

n=64

6 MonthsPost Op

n=65

1 YearPost Op

n=50

2 YearsPost Op

n=55

Mortality Index is the ratio of observed to expected mortality based on a risk adjustment algorithm. An index score of 1 indicates observed and expected mortality are equal. Values below 1 are desirable. Since the Spine service at UCH had no mortalities over the past three years, the mortality index is zero.

Prior to surgery, 61% of surveyed patients who were employed had been placed on limited or light duties due to their spine conditions. Two years after surgery, 81% of respondents were free of work restrictions.

Based on ODI interpretation ranges, the largest percentage of patients rated themselves as severely disabled prior to surgery. Post-operatively, the majority improved to minimally disabled, the best possible category on the ODI. (Not all interpretation ranges are shown on graph.)

15,069 OP VISITS 0% MORTALITY RATE

TRUE INTEGRATION OF NEUROSURGERY,

ORTHOPEDIC SURGERY AND PM&R

81% POST SURGICAL PATIENTS REPORT BEING

FREE OF WORK RESTRICTIONS

NEUSTRATEGY CENTER OF EXCELLENCE SPINE

Neurosciences Outcomes 2014 - University of Colorado Hospital

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