2012 Year in Review by ChristianaCare

T H E C H R I S T I A NA CA R E WAY

Expert

| Respectful

Partners in your health

2012 YEAR IN REVIEW

| Caring

In this report

34 The Center for Heart & Vascular Health 114 Research at The Center for Heart & Vascular Health 134 The Helen F. Graham Cancer Center 174 Research at The Helen F. Graham Cancer Center 214 Community Care 314 Education and Research 394 Philanthropic Support 424 Achieving Excellence: Awards & Appointments 474 Service Statistics

Christiana Care oﬀers a wide range of health care services in Delaware and surrounding communities, at a glance: O N T H E C H R I S T I A NA H O S P I TA L CA M P U S Christiana Hospital (907 beds) Center for Heart & Vascular Health in the Bank of America Pavilion Helen F. Graham Cancer Center and Center for Translational Cancer Research Christiana Care Breast Center Christiana Surgicenter O N T H E W I L M I N G TO N CA M P U S Wilmington Hospital (241 beds) Wilmington Hospital Health Center Center for Advanced Joint Replacement Center for Rehabilitation Roxana Cannon Arsht Surgicenter Swank Memory Care Center First State School D E L AWA R E A N D T H E C O M M U N I T Y 14 school-based health centers Home Health & Community Services—Visiting Nurse Association 2 Alzheimer’s day programs Eugene du Pont Preventive Medicine & Rehabilitation Institute 18 primary care centers (2 in New Jersey) 9 Christiana Care Physical erapy PLUS sites 15 Christiana Care imaging services locations

T H E C H R I ST I A N A CA R E WAY 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.

Dear Neighbors, In all that we do, Christiana Care Health System strives to serve everyone as respectful, expert and caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value. This is The Christiana Care Way, and it is our promise to all neighbors who trust us to care for them. Embedded in this promise is a commitment to transform how we deliver that care, to make it more meaningful for patients and families. As you read our 2012 Year in Review, it is clear that our commitment to patient and family centered care is the foundation of our national reputation for excellence. This report highlights many of Christiana Care’s accomplishments and community partnerships, as well the honors bestowed on the dedicated and talented people who work in the health system. Our neighbors rely on us to deliver their babies and provide care for them throughout every stage of life, regardless of their ability to pay. We are steadfast in our commitment to provide the very best, from heart care to cancer research, to prevention to the latest technology. Most important, we are increasing the value of care for our patients because we work with them and not merely for them. This is a testament to the power of The Christiana Care Way.

Robert J. Laskowski, M.D., MBA PRESIDENT AND CHIEF ExECUTIVE OFFICER

As a private not-for-proﬁt regional health care system, we rely in part on the generosity of individuals, corporations and foundations to fulﬁll our mission to serve. To learn more about how you can help, visit www.christianacare.org/donors.

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Showing we care in 2 million ways Christiana Care Health System is one of the largest health care providers in the nation, delivering medical care in more than 2 million encounters with patients last year. Despite our large size and advanced technology, we strive to make each encounter a personal experience. Our patients are our neighbors, as well as our partners in patient and family centered care, from routine screenings to complex surgeries to cutting-edge clinical trials. The Christiana Care Way is the foundation of all we do, working diligently with patients to meet their needs, as the patients perceive them. In Delaware and the surrounding area, people trust Christiana Care to care for them when they are sick, promote ways to keep them well and provide the highest quality regardless of their ability to pay.

ACCORDING TO THE AMERICAN HOSPITAL ASSOCIATION’S LATEST SURVEY OF MORE THAN 6,000 U.S. HOSPITALS, CHRISTIANA CARE RANKS AMONG THE LEADERS BY VOLUME IN SEVERAL CATEGORIES.

Christiana Care

IN THE U.S.:

ON THE EAST COAST:

ADMISSIONS 21

ADMISSIONS 11

BIRTHS 33

BIRTHS 15

EMERGENCY VISITS 25

EMERGENCY VISITS 12

TOTAL SURGERIES 24

TOTAL SURGERIES 12

T H E C H R I ST I A N A CA R E WAY

e Center for Heart & Vascular Health oﬀers expert care in a nationally recognized program

FACTS & FIGURES OPEN-HEART CASES 588 VENTRICULAR ASSIST DEVICE CASES 3 TRANSAORITC VALVE REPLACEMENT CASES 9 CARDIAC CATHETERIZATION CASES 4,790 ELECTROPHYSIOLOGY CASES

1,666 VASCULAR SURGERY CASES

1,504 VASCULAR INTERVENTION CASES

4,426 CARDIOVASCULAR NON INVASIVE STUDIES 21,606 VASCULAR ULTRASOUND STUDIES

30,837 CARDIAC REHABILITATION MONITORED VISITS 17,876

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The Center for Heart & Vascular Health

Christiana Care’s Center for Heart & Vascular Health is the only center in the region to integrate services under one roof, including cardiac surgery, vascular surgery, vascular interventional radiology, cardiology and interventional nephrology.

AC H I E V E M E N T S

L E A D E R S I N CA R D I OVA S C U L A R CA R E Our prestigious cardiovascular program has earned a national reputation, with a three-star rating for open-heart surgery from the Society of Thoracic Surgeons. Christiana Care ranks in the top 2 percent in the United States for advanced heart arrhythmia capabilities and is sixth in volume for stroke cases. We partner with our patients to achieve optimal heart and vascular health, through the prevention of heart disease, planned care, emergency care, rehabilitation and ongoing support.

Once again, Gold Seal of Approval as a Primary Stroke Center Christiana Care has earned continued Gold Seal of Approval for recertiﬁcation as a Primary Stroke Center by the Joint Commission, the leading accreditor of health care organizations in America. The national agency recognized Christiana Care on the basis of an on-site evaluation and demonstration of compliance with nationally developed standards for stroke care. This is Christiana Care’s second time achieving the honor.

“Providing patients with exceptional stroke care requires quick and eﬃcient treatment because time lost is brain loss.” — ANTHONY E. MUNSON, M.D.

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Christiana Care is a high-volume stroke center, ranking number 6 in the nation for the number of people it treats. According to the latest Medicare data, Christiana Care treated 1,090 people in 2009. “This award of distinction validates all the hard work by our stroke and vascular care team in implementing processes to help us consistently deliver quality care,” says Anthony E. Munson, M.D., medical director, Stroke Program. “Providing patients with exceptional stroke care requires quick and eﬃcient treatment because time lost is brain loss.”

The award also notes the early recognition of stroke by paramedics in the community who notify the Emergency Department to prepare the Stroke Alert Team for a patient’s arrival.

Gold Plus in stroke care from Get With The Guidelines Christiana Care’s Center for Heart & Vascular Health has received the American Heart Association–American Stroke Association’s Get With The Guidelines–Stroke Gold Plus Quality Achievement Award. The award recognizes commitment and success in implementing excellent care, according to evidence-based guidelines, for patients who have had strokes. Christiana Care achieved scores of 85 percent or higher for adherence to Stroke Quality Achievement indicators for two or more consecutive 12-month intervals and achieved compliance scores of 75 percent or higher for six of 10 Stroke Quality Measures, which include aggressive use of medications aimed at reducing death and disability rates and improving the lives of patients who have had strokes.

“The Get With The Guidelines–Stroke Gold Plus Quality Achievement Award demonstrates Christiana Care’s commitment to being one of the top hospitals in the country for providing aggressive, proven stroke care,” says Timothy J. Gardner, M.D., medical director of the Center for Heart & Vascular Health and past national president of the American Heart Association.

American Heart Association gold quality achievement in heart failure care For the third consecutive year, Christiana Care’s Center for Heart & Vascular Health has received the American Heart Association’s Get With The Guidelines– Heart Failure Gold Quality Achievement Award. The honor signiﬁes that for at least 24 months Christiana Care has met an ambitious goal of treating patients with heart failure at a level of 85 percent compliance with core standard levels of care outline by the American Heart Association–American College of Cardiology secondary prevention guidelines for patients with heart failure. Under this initiative, patients with heart failure work with a multidisciplinary team to improve their outcomes and reduce readmissions to the hospital. Patients also receive counseling on smoking cessation, healthy eating and managing depression and anxiety. When needed, patients receive referrals for follow-up home care. “Patients are getting the right care they need when they need it, resulting in improved survival,” says Mitchell Saltzberg, M.D., medical director, Heart Failure Program.

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The Center for Heart & Vascular Health AC H I E V E M E N T S

A lifeline for patients with end-stage heart failure The Center for Heart & Vascular Health is the ﬁrst center in Delaware to offer the latest generation of left ventricular assist devices (LVADs), the most advanced technology for patients with end-stage heart failure short of a transplant. During surgery, an LVAD is attached to the patient’s heart and aorta, and the pump is placed in the patient’s chest. A battery-powered controlling device connects the pipe through a driveline, which exits through the patient’s abdomen. The patient wears the controller on an external belt. The Crystal Trust provided funding to make this technology available at the Center for Heart & Vascular Health.

The Center for Heart & Vascular Health is the first in the state of Delaware to offer left ventricular assist devices to patients.

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Highest-quality ranking from Society of Thoracic Surgeons For the third consecutive year, the Center for Heart & Vascular Health has been awarded three stars—the highest designation for hospitals—from the Society of Thoracic Surgeons (STS). Fewer than 15 percent of heart programs in the United States achieve this status, widely considered the gold standard by which to evaluate surgical programs. STS data show that Christiana Care performs more than twice as many heart procedures than the national average.

“Our higher surgical volumes, combined with increasingly complex and challenging conditions in patients being operated on here, account for our national leadership among heart programs,” says Timothy Gardner, M.D., medical director of the Center for Heart & Vascular Health and past national president of the American Heart Association.

Heart valve replacement without open-heart surgery Christiana Care is among a select group of hospitals implanting the ﬁrst heart valve replacement approved by the U.S. Food and Drug Administration that does not require open-heart surgery.

The Sapien Transcatheter Heart Valve is a new option for patients with severe aortic stenosis for whom surgery is too risky. As a top U.S. health system for cardiac care, Christiana Care has the patient volume, medical expertise, equipment and facilities required to implant the device. The procedure offers a less-traumatic and potentially life-saving alternative for patients with age-related aortic stenosis, a narrowing of the valve that allows blood to ﬂow from the major artery of the heart. Because there is less stress on the body with the procedure than in open-heart surgery, patients recover more quickly.

STAR unit steps up level of stroke care A new unit at Christiana Hospital offers highly specialized “stepdown” nursing care for patients requiring more frequent monitoring, such as those who have had a stroke and those who have had neurointerventional procedures. “Christiana Care treats more than 1,000 stroke patients a year, sixth highest among U.S. health systems,” says Anthony E. Munson, M.D., medical director, Stroke Program. “We believe the 6C stepdown unit is a signiﬁcant step forward in enhancing the quality of care.” The stepdown unit is part of the Stroke Treatment and Rehabilitation (STAR) Unit. The unit provides care for patients with stroke and nontraumatic hemorrhages, as well as interventional procedures, such as carotid stents or coiling, a minimally invasive endovascular procedure performed to treat a cerebral aneurysm.

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The Center for Heart & Vascular Health AC H I E V E M E N T S

Keeping a watchful eye on patients with heart failure through telemonitoring Patients with heart failure can stay at home and still get an extra layer of care through the Christiana Care Visiting Nurse Association telemonitoring program. In the program, nurses from the association work closely with patients to electronically monitor such vital signs as weight, blood pressure and oxygen levels in the blood so that patients can make adjustments as soon as their numbers indicate a problem. Nurses also help patients to maintain heart-healthy diets and establish personal goals. In addition, monitored patients are signiﬁcantly less likely to require readmission to the hospital than those who are not monitored.

Navigating arrhythmia through stereotaxis The Gerret and Tatiana Copeland Arrhythmia Center at the Center for Heart & Vascular Health is the only center in Delaware to offer stereotaxis

Christiana Care

remote navigation, technology with the capability to perform a new type of ablation, a corrective procedure that cures atrial fibrillation in up to 80 percent of patients who have it. Atrial fibrillation affects more than 2 million Americans and is difficult to treat. Stereotaxis remote navigation creates real-time, three-dimensional pictures that allow a cardiologist to diagnose and regulate the heart’s rhythm. What makes stereotaxis technology so revolutionary are magnetic fields that allow physicians direct control of the tip of soft catheters. These extremely flexible and easily manipulated catheters allow physicians to work through patients’ veins more quickly and effectively.

Grant targets heart health of African-American teens and women Thanks to a grant of more than $152,000 from the AstraZeneca HealthCare Foundation, Christiana Care’s Cardiovascular Outreach Prevention Program is better serving underserved, low-income African-American teens and adult women. The program

engages teens to increase both their knowledge and their conﬁdence in their ability to make healthy lifestyle changes, as well as to teach them skills to improve the heart health of their mother or another important adult female in their lives.

Cardiology appointments and tests within 24 hours The Center for Heart & Vascular Health is making ﬁrst-rate cardiology care more convenient and accessible for patients. At the Christiana Care Cardiology Consultants Same Day Clinic at Christiana Hospital, patients who have cardiovascular issues that require speedy attention can make appointments within 24 hours of their call. Most are scheduled the same day. Same-day cardiac diagnostic testing also is available. Christiana Care Cardiology Consultants also provide care at the Smyrna Health & Wellness Center. Cardiologists work with primary care physicians to coordinate primary and cardiac care, provide a direct link to advanced heart support through the Center for Heart & Vascular Health, and provide pacemaker and deﬁbrillator management.

Our cardiologists work with primary care physicians to coordinate care for their patients, providing a direct link to advanced heart support.

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The Center for Heart & Vascular Health AC H I E V E M E N T S

William Weintraub, M.D.

Dr. Weintraub attends White House briefing on “Million Hearts” campaign William S. Weintraub, M.D., the John H. Ammon Chair of Cardiology at Christiana Care and president-elect of the American Heart Association Great Rivers Affiliate, was one of 70 experts invited to the White House in February for a briefing on cardiovascular health as part of American Heart Month. Dr. Weintraub, also the director of the Christiana Care Center for Outcomes Research, participated in a workshop on the “Million Hearts” campaign, a national initiative to prevent 1 million heart attacks and strokes over the next five years. The initiative brings together communities, health systems, nonprofits, federal agencies and private-sector partners from across the nation to fight heart disease and stroke.

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Successful treatment for chronic deep vein thrombosis Patients with post-thrombotic syndrome are getting relief from pain and an improved quality of life through treatment with minimally invasive interventional radiology techniques. “Many people suffering from postthrombotic syndrome once heard that no treatment options were available to treat their clots and help to relieve their symptoms, but that is no longer true,” says Mark J. Garcia, M.D., chief of Vascular Interventional Radiology at Christiana Care’s Center for Heart & Vascular Health. About half the people who have deep vein thrombosis develop post-thrombotic syndrome, characterized by leg pain, swelling, fatigue and skin changes. In a three-year study, more than 100 patients with the condition received minimally invasive treatments to relieve blockages and restore blood ﬂow, with 93 percent reporting signiﬁcant improvement, Dr. Garcia announced at the 2011 annual meeting of the Society of Interventional Radiology in San Francisco.

A pioneer in stent system for peripheral artery disease Christiana Care is one of the first health care systems in the United States to take part in a unique international medical trial involving a stent system developed in Japan for treating peripheral artery disease, which restricts blood flow to extremities. Named OSPREY—for Occlusive/Stenotic Peripheral artery REvascularization studY—the initiative focuses on a flexible stent system for use in the superficial femoral artery, a long, curvy artery in the thigh. Traditional stents typically are not flexible enough to fit in that artery. Patients have reported immediate and significant reduction in cramping, pain and leg fatigue.

Research at the Center for Heart & Vascular Health

Dr. Weintraub, ASCERT study in national spotlight

Among the elite in clinical heart failure research centers

Older patients with clogged heart arteries have less risk of dying over time if they undergo bypass operations instead of angioplasty and stent placement, according to a study led by William S. Weintraub, M.D., John H. Ammon Chair of Cardiology at Christiana Care and director of the Christiana Care Center for Outcomes Research.

Christiana Care is teaming with two major Philadelphia health systems to form a new National Institutes of Health Heart Failure Clinical Research Center.

In a bypass, physicians move healthy vessels from other parts of the body to detour around clogged arteries. In angioplasty, a tiny balloon pushed through a vessel is inﬂated to ﬂatten the clog and a stent is placed to hold the artery open.

The seven-year project focuses on small to intermediate randomized clinical trials devoted to improving outcomes for patients with heart failure. Christiana Care’s Heart Failure Program will provide scientiﬁc leadership and team with Thomas Jefferson University and Temple University to pool data from patients as one of nine regional centers collaborating as a national network.

Researchers compared these approaches using records on 190,000 patients with two or three blockages in the largest study ever of this issue, titled “Survival After PCI or CABG in Older Patients With Stable Multivessel Coronary Disease: Results From the ACCF-STS Database Collaboration on the Comparative Effectiveness of Revascularization Strategies,” or ASCERT. Death rates were about equal one year after either treatment. But after four years, nearly 21 percent of the patients who underwent angioplasty had died, compared with 16 percent of patients who underwent bypass surgery. Results were discussed in March at an American College of Cardiology conference in Chicago and published in the New England Journal of Medicine.

The principal investigator is William Weintraub, M.D., the John H. Ammon Chair of Cardiology and CCOR director. The American College of Cardiology, in partnership with the Society of Thoracic Surgeons, received the grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Dr. Weintraub authors JAMA study William S. Weintraub, M.D., the John H. Ammon Chair of Cardiology at Christiana Care, is an author of a study in published in the October 5, 2011, issue of JAMA (formerly known as the Journal of the American Medical Association) showing that older, lowerrisk patients undergoing elective percutaneous coronary intervention can be safely discharged from the hospital on the same day that they undergo the procedure. Among selected patients eligible for Medicare, same-day discharge is still uncommon, but investigators observed nearly equivalent rates of hospitalization and mortality at two days and at 30 days when compared with patients who stayed overnight.

Study compares effectiveness of cardiac procedures The Christiana Care Center for Outcomes Research (CCOR) shares in a $4.026 million grant in a pioneering study that compares the effectiveness of catheter-based and surgery-based cardiac procedures. The research compares data from more than 10 million patients and will help physicians to improve care for people with coronary artery disease.

The study evaluated the prevalence and outcomes of same-day discharge among 107,018 patients age 65 years or older undergoing elective percutaneous coronary intervention in the United States. Data were collected from the American College of Cardiology CathPCI Registry (November 2004 to December 2008), which includes Christiana Care’s Center for Heart & Vascular Health, and were linked with Medicare Part A claims.

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T H E C H R I ST I A N A CA R E WAY

e Helen F. Graham Cancer Center is transforming cancer care

FACTS & FIGURES PATIENT VISITS 196,706 NEWLY DIAGONSED AND/OR NEWLY TREATED PATIENTS

3,100 RADIOLOGY ONCOLOGY VISITS

2,057 ExTERNAL BEAM TREATMENTS

31,584 PATIENTS ENROLLED IN CLINICAL TRIALS 748

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The Helen F. Graham Cancer Center

One of the most technologically advanced and largest cancer programs on the East Coast, the Helen F. Graham Cancer Center recorded more than 195,000 visits last year from patients who beneﬁt from a unique model of care that includes a patient-navigation system and quick access to a world-class team of cancer specialists.

AC H I E V E M E N T S

A NAT I O NA L M O D E L F O R CA R E The Helen F. Graham Cancer Center is one of the original National Cancer Institute Community Cancer Center Program sites selected in the United States and is a national model for other health systems to follow, with a patient accrual rate into clinical trials that is six times the national average. Our passion for delivering the highest-quality care is reﬂected in advanced medical technology, an on-site laboratory that allows researchers and oncologists to collaborate in developing unique treatments for individual patients, and a comprehensive slate of services to make diagnosis and treatment as convenient and comfortable as possible.

Leading the way in reducing cancer and saving lives in Delaware The Helen F. Graham Cancer Center is leading the way in the state’s dramatically declining cancer rate and in deaths from cancer, through evidence-based medicine, research and community outreach.

“Cancer deaths per capita are falling faster in Delaware than anywhere else in the country.” — NICHOLAS J. PETRELLI, M.D.

Delaware was formerly ﬁrst in the nation in both rates of cancer incidence and mortality. The cancer death rate in Delaware dropped 18 percent from 1993-1997 to 2003-2007, according to the report “Cancer Incidence and Mortality in Delaware, 2003-2007.” Delaware’s progress outpaces the U.S. rate of a 12.1 percent drop during the same 10-year period. Between 1993-1997 and 2003-2007, Delaware’s all-site cancer mortality rate for males decreased 22.4 percent, compared with a decrease in the U.S. rate of 15.7 percent. During the same period, Delaware’s all-site cancer mortality rate for females decreased 15.2 percent, compared with a decrease in the national rate of 10.9 percent. The most impressive results have been in colorectal cancer. The Delaware Cancer Consortium, formed in 2001 to advise the governor and lawmakers on ways to reduce cancer rates, prioritized screening for colorectal cancer through colonoscopies and sigmoidoscopies. CONTINUED 2 0 1 2 Ye a r i n Revie w

The Helen F. Graham Cancer Center AC H I E V E M E N T S This initiative has decreased both the incidence and death rate from colorectal cancer and has eliminated ethnic disparities through outreach and education efforts. “Cancer deaths per capita are falling faster in Delaware than anywhere else in the country,” says Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center. “That is due, in part, to effective screening programs that are diagnosing more cancers at an earlier, more curable stage.” Dr. Petrelli also credits the work of Community Health Outreach and Education Program navigators, a team dedicated to helping Delawareans learn more about what causes cancer and the risk factors involved.

Nicholas J. Petrelli, M.D., medical director of the Helen F. Graham Cancer Center, greeting cancer survivor Regina Marini.

Additionally, Delaware is a leader in laws and policies that save lives and money by funding screenings for breast, cervical and colorectal cancer, as well as offering tobacco prevention initiatives, according to the American Cancer Society. Last year, the adult smoking rate dropped to 17.8 percent, the lowest in state history. PATIENT VISITS TO THE HELEN F. GRAHAM CA NC E R C E NTE R FROM 2003 TO 2011 200,000 thousand

196,706 >

100,000

60,112 >

American Cancer Society Hometown Heroes The American Cancer Society honored its Hometown Heroes, local advocates and volunteers who have helped the organization save more lives from cancer. Honorees are Bill Bowser, Esq., recognized for his work with the Delaware Cancer Consortium; Nora Katurakes, RN, for community outreach and her impact on the community; and Stephen Grubbs, M.D., for work with the Delaware Cancer Consortium. Congressman John Carney was also honored. Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, presented the award. Hometown Heroes honorees Bill Bowser, Esq., Stephen Grubbs, M.D., Nora Katurakes, RN, OCN, and Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, who presented the award.

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Christiana Care’s Bone Marrow Transplant Program Team

Leading-edge technology in mammography The Christiana Care Breast Center at the Helen F. Graham Cancer Center is the ﬁrst center in Delaware to offer breast tomosynthesis, a 3-D screening and diagnostic technology that acquires images of a breast at multiple angles during a short scan. The individual images are then reconstructed into a series of thin, high-resolution slices, which can be displayed individually or in a series. Tomosynthesis virtually eliminates detection challenges associated with overlapping structures in the breast, which is the primary drawback of conventional mammography. In addition, tomosynthesis makes it easier to view lesions and margins, as well as localized structures in the breast. This enhanced accuracy means fewer patients need further testing. The technology also greatly increases cancer detection. In an analysis presented at the 2011 conference of the Radiological Society of North America, tomosynthesis resulted in a relative increase of 47 percent in detecting cancer, compared with two-dimensional mammography alone.

Bone marrow program receives accreditation It’s a fact. Christiana Care’s Bone Marrow Transplant Program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT). That underscores the high level of training, education and experience among the physicians and staff members at the Helen F. Graham Cancer Center, says Frank Beardell, M.D., director of the Bone Marrow Transplant Program. In addition, the National Marrow Donor Program recognized Christiana Care as a national performance leader in the collection of bone marrow for 2011, for excellence in meeting service and quality indicators for donor care, product integrity, data submission and overall service.

Advanced four-dimensional program offers more accurate radiation treatment The Helen F. Graham Cancer Center is one of only a handful of institutions in the United States to install RayStation, four-dimensional software for radiotherapy treatment planning that provides more accurate radiation treatments for patients with cancer. The fourth dimension is time, meaning that the software uses special adaptive techniques to adjust for anatomical changes that can occur in both tumors and surrounding normal tissues over time during the course of treatment, allowing far greater control in targeting the tumor while sparing normal tissue.

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The Helen F. Graham Cancer Center AC H I E V E M E N T S Jennifer Sims-Mourtada, Ph.D., and Firas Mourtada M.S.E., Ph.D., D. ABR

Christiana Care and Wistar Institute forge historic partnership The partnership between the Helen F. Graham Cancer Center and the Wistar Institute leverages the strengths of both institutions to beneﬁt patients in Delaware and the surrounding region with the very latest in cancer research. The Graham Cancer Center and the Wistar Institute, an international leader in biomedical research, are collaborating on translational cancer research with the goal of bringing the latest discoveries in research to patients in the community. The partnership combines Wistar’s strengths in basic biomedical research with the Graham Cancer Center’s exceptional cancer treatment and patient care. The goal is to “translate” or advance research discoveries made in Wistar’s labs into early-phase (phase I and II) clinical trials with patients at the Graham Cancer Center. Areas of initial research in the partnership focus on colon cancer stem cells, targeted treatments for melanoma and novel approaches for molecular proﬁling, and treatment of advanced and metastatic disease. Lung cancer is the most common cause of cancer-related deaths. Currently, there is no clinically effective way to screen for lung cancer at an early stage. Recently, Louise C. Showe, Ph.D., a Wistar professor, showed that it is possible to detect early-stage non-small cell lung cancer by examining changes in gene activity in white blood cells. By partnering with the Helen F. Graham Cancer Center and Temple University, she aims to streamline blood collection and analysis to develop a commercially viable test.

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Husband-and-wife scientists join Helen F. Graham Cancer Center

Trail-blazing Community Cancer Center

Jennifer Sims-Mourtada, Ph.D., is the Helen F. Graham Cancer Center senior clinical scientist for the Center for Translational Cancer Research, continuing her pioneering investigation into why some cancers are resistant to treatment and her work in developing the imaging tools to target them for destruction. She is former director of Molecular Research and Development at RadioMedix, Inc. in Houston.

The Helen F. Graham Cancer Center is a pioneer in speeding research and raising the quality of care for underserved patients in the groundbreaking National Cancer Institute Community Cancer Centers Program.

Her husband, Firas Mourtada M.S.E., Ph.D., D. ABR, is the new chief of Clinical Physics in Radiation Oncology. Previously, he was an associate professor at the University of Texas MD Anderson Cancer Center.

One of the original 16 of only 21 cancer centers in the United States chosen for the program, the Graham Cancer Center is a leader in enhanced quality of care for patients and advances in cancer research. As a result, more patients have access to innovative treatments in clinical trials. The ultimate vision is a dynamic national network of community cancer centers engaged in research that will provide the latest evidence-based treatment for patients of all ethnic and economic backgrounds.

Research at the Helen F. Graham Cancer Center

At a rate of 24 percent, Christiana Care’s Helen F. Graham Cancer Center has one of the highest patient accrual rates into cancer clinical trials in the United States, far above the national average of 4 percent.

In cancer control trials, we are number 1 Christiana Care’s Community Clinical Oncology Program is one of the nation’s top enrollers in cancer clinical trials in the newly formed Alliance for Clinical Trials in Oncology. Christiana Care is ranked number 1 in cancer control trials that seek to prevent cancer or control its incidence, and Christian Care ranks sixth in enrolling patients in treatment trials. Combined, the Christiana Care program ranks third of 210 participating organizations.

Christiana Care leads colorectal cancer trial The Helen F. Graham Cancer Center is leading a national clinical trial to determine if Crestor, the cholesterol-lowering drug rosuvastatin, can prevent new tumors from forming after colon cancer surgery. Bruce Boman, M.D, Ph.D., director of Cancer Genetics & Stem Cell Biology at the Helen F. Graham Cancer Center, is the national principal investigator of the study. The study seeks to determine if Crestor can stop the growth of tumor cells by blocking some of the enzymes that affect cell growth. The trial will also determine if Crestor can keep new tumors from forming after surgery to remove a patient’s initial colon cancer. Named “P-5: Statin Polyp Prevention Trial in Patients with Resected Colon Cancer,” the study is conducted under the National Cancer Institute by a network of cancer research professionals, the National Surgical Adjuvant Breast and Bowel Project. It takes place at more than 200 medical centers throughout North America.

Helen F. Graham Cancer Center researchers tapped to lead Alliance for Clinical Trials in Oncology Christiana Care Medical Oncologist Stephen S. Grubbs, M.D., and Cancer Research Director Kandie Dempsey, MS, RN, were named to leadership roles with the newly formed Alliance for Clinical Trials in Oncology. Additional physician investigators from the Helen F. Graham Cancer Center will serve on Alliance committees. The Alliance merges three National Cancer Institute funded research cooperative groups: Cancer and Leukemia Group B (CALGB), North Central Cancer Treatment Group (NCCTC), and the American College of Surgeons Oncology Group (ACOSOG).

Bruce Boman, M.D, Ph.D., in the lab 2 0 1 2 Ye a r i n Revie w

Research at the Helen F. Graham Cancer Center

$2.5 million funds research in artificial salivary glands A research team at the Helen F. Graham Cancer Center and the Center for Translational Cancer Research plays a key role in a prestigious National Institutes of Health research project grant of $2.5 million to continue groundbreaking work into the creation of artiﬁcial salivary glands. “The purpose of our project is to relieve the debilitating lack of saliva in a patient who has undergone radiation treatments for throat cancer,” says Robert Witt, M.D., chief of the Multidisciplinary Head and Neck Oncology Clinic at Graham Cancer Center and the clinician-scientist principal investigator in the four-year initiative. “These patients have lost the ability to swallow properly and enjoy food and liquids. They suffer from a lack of taste and are prone to many dental problems.” Already, the team has discovered a laboratory technique for isolating salivary acinar cells in culture. Acinar cells are the basic building blocks of salivary glands. Researchers then stimulate the cultured cells with neurotransmitters that support their ability to make water and enzymes. Encasing the cells in an absorbable matrix of hyaluronic acid allows them to grow toward each other and differentiate into structures that are necessary for producing saliva. Ultimately, physicians will reimplant the patients’ own cells back into their damaged salivary glands when radiation is complete. Magnified view of salivary spheroid growing hyaluronic-based hydrogel.

Robert Witt, M.D., and Swati Pradhan Bhatt, Ph.D., research artificial salivary glands. 18

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Clinical studies target breast and lung cancers Two clinical trials in the treatment of breast cancer at the Helen F. Graham Cancer Center are showing great promise in keeping the disease from spreading. In one trial, the drug trastuzumab is linked with an antibody called pertuzumab to create a dual blockade against breast cancer. In another trial, trastuzumab and a toxin, maytansine, form a compound that targets and poisons cancer cells while sparing healthy cells. Patients with widespread lung cancer that no longer responds to ﬁrst-line therapy can beneﬁt from a combination of erlotinib and the chemical ARQ-197, which targets two different pathways for tumor growth. Spheroids of salivary gland cells releasing the enzyme alpha-amylase in a red stain to show their functionality.

Studies advance therapies to treat melanoma Patients at the Helen F. Graham Cancer Center are helping scientists crack the code for treating drug-resistant melanoma, the deadliest of skin cancers, by donating tumor samples for study at the Wistar Institute’s Melanoma Research Center in Philadelphia, home to the world’s largest melanoma cell collection. “We are providing tumor samples mostly from patients with advanced disease, an area where more melanoma research is needed,” explains Michael Guarino, M.D., director of Pharmaceutical Clinical Trials. “What is essentially surgical waste potentially could lead scientists to important new discoveries, and we are in on this right at the ground level.”

Student researchers are stars at health sciences symposium In a separate collaboration, Dr. Guarino anticipates a new clinical trial for diﬃcult-to-treat melanoma will open for patients at the Graham Cancer Center as a member of Academic and Community Cancer Research Group United, a clinical research group of some 60 centers in North America.

$1 million funds research for lung cancer test Clinicians at the Helen F. Graham Cancer Center have joined scientists at the Wistar Institute and Temple University to develop the world’s ﬁrst practical blood test for lung cancer. A $1 million grant to fund the project for two years comes from Pennsylvania’s Commonwealth Universal Research Enhancement Program.

Three students at Christiana Care’s Center for Translational Cancer Research are award winners at the Delaware Health Sciences Alliance annual research symposium for their work at the Helen F. Graham Cancer Center. Swati Pradhan Bhatt, Ph.D., and Vignesh Viswanathan, M.Sc., tied for ﬁrst place for their posters. Dr. Bhatt is working on developing an artiﬁcial salivary gland. Viswanathan’s research focuses on colon cancer. Seema Bhatlekar, M.Sc., placed second for her poster on the role of genetics in the regulation of stem cell populations in normal and malignant colon tissue.

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Research at the Helen F. Graham Cancer Center

A team effort in the fight against cancer

Advancing toward better tests for cancer genes

The Center for Translational Cancer Research at the Helen F. Graham Cancer Center is a dynamic, comprehensive cancer program that highlights prevention, treatment and laboratory research. A collaborative effort, the center team includes the University of Delaware, Nemours/Alfred I. duPont Hospital for Children, and the Delaware Biotechnology Institute, all of which share a common vision for making great strides in cancer research and treatment.

People who are at higher genetic risk for colon cancer and other cancers could gain essential information as a result of a study at the Center for Translational Cancer Research at the Helen F. Graham Cancer Center. The study focuses on MSH2 and MLH1 genes, commonly known as mismatch repair genes. Four of ﬁve people with these genes develop cancer.

National Cancer Institute funding advances research The Helen F. Graham Cancer Center is the recipient of $2.8 million from the National Cancer Institute to expand cancer research. The money is funding community outreach programs, initiatives aimed at reducing health care disparities, and efforts to leverage information technology to beneﬁt patient safety and enhance survivorship and palliative care. The award also promotes genetic counseling, breast cancer research and smoking-cessation programs for cancer survivors.

The National Cancer Institute awarded $2.8 million dollars to the Graham Cancer Center to expand cancer research.

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The goal is to develop a cheaper, faster blood test to identify individuals who are at risk. Researchers are examining blood samples from patients in the Graham Cancer Center’s Familial Cancer Risk Assessment Program.

Cancer Genome Atlas charts genetics The Helen F. Graham Cancer Center collects and stores human tissue samples to help scientists learn more about the growth and development of cancer

through a $4.6 million, four-year role in the Cancer Genome Atlas Project. The massive, federally funded project aims to speed up scientiﬁc insight into the molecular basis of cancer so physicians can ultimately diagnose diseases and treat patients on the basis of their genetic proﬁles.

Gene therapy a historic first in Delaware The Helen F. Graham Cancer Center is one of only 11 sites nationwide and the ﬁrst East Coast center selected to participate in an early-phase study focusing on using genetically engineered cells from the patient’s own blood to create a personalized melanoma vaccine. A specially designed pill controls the vaccine’s anti-tumor action. The trial is open for patients with stage 3 or 4 melanoma whose cancer has not responded well to chemotherapy or other treatments and who have tumors accessible for biopsy.

T H E C H R I ST I A N A CA R E WAY

Community Care provides education, outreach and charity care to our neighbors

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Community Care AC H I E V E M E N T S

In ﬁscal year 2012, Christiana Care provided the community with approximately $28.1 million in charity care.

A TRADITION OF GIVING Christiana Care exists to take care of our neighbors in our community. Our ability to deliver on this promise is embodied in the extraordinary talent and dedication of our physicians, surgeons, nurses, health care professionals, community outreach coordinators and administrative staff members. Our growing national reputation enables us to attract some of the best health care specialists in the country. The generous support of our partners in business, government and the community helps us expand and enhance the care we provide to all community members, regardless of their ability to pay. In ﬁscal year 2012, Christiana Care provided the community with approximately $28.1 million in charity care. Each year, our Wilmington Hospital Health Center alone provides primary and specialty medical care for more than 74,000 patient visits. The Helen F. Graham Cancer Center’s Community Health Outreach and Education Program is dedicated to helping Delawareans learn more about what causes cancer. We also provide information about healthy behaviors and make it easier for people to get the tests and the care that they need. Every day, professionals throughout Christiana Care demonstrate their exceptional commitment through innovative programs, initiatives and partnerships. The new Christiana Care Value Institute represents the next level in patient-focused care, balancing safety, quality and cost to beneﬁt both patients and the community.

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P E D I AT R I C CA R E

S E N I O R CA R E

25 years of miracle babies

Christiana Care participates in home care program for seniors

Parents can count on the expertise of the Christiana Care Neonatal Transport Team, which has been saving newborns for 25 years by providing advanced care where the baby is born or by transporting the baby to a hospital that offers a more advanced level of care. Established by Christiana Care and the State of Delaware, the team’s special ambulance is an intensive care unit on wheels, equipped with the latest technologies, including mobile ventilators, incubators, monitors, intravenous infusion pumps and a mobile cooling blanket to help stabilize the condition of a baby who is sick. To date, the team has transported more than 7,000 infants.

A lifesaving link in a pediatric emergency care network Each year, more than 15,000 patients age 15 and younger seek treatment at Christiana Care’s Emergency Department facilities at Christiana and Wilmington hospitals. Now, through a new network, the hospital emergency departments will be able to save the lives of even more children. Overall death rates through the Delaware Trauma System—a network of the Delaware Division of Public Health— have been cut by 40 percent, thanks to the efforts of emergency department health care staff at those hospitals. Delaware recently launched the Pediatric Emergency Care Facility Recognition Program and became only the ﬁfth state to create a standard of care that includes equipment, protocols, staﬃng and continuing education.

Christiana Care is one of only 16 health care providers nationwide selected to participate in a new home care program for chronically ill seniors. Called the Independence at Home Demonstration Project, the three-year program from the Centers for Medicare & Medicaid Services tests whether delivering primary care services in the home can lead to better health outcomes and reduce costs for patients living with multiple chronic illnesses. Christiana Care was selected from a pool of more than 130 applicants representing hundreds of health care providers interested in the delivery of this new model of care.

Visiting Nurse Association behavioral health program improves quality of life for seniors Elderly patients with depression and anxiety are much less likely to require hospitalization or engage in disruptive behavior when they receive home-based behavioral health care, according to the outcomes of a pioneering program by the Christiana Care Visiting Nurse Association.

as a trusted resource for patients and their loved ones. The nurse ensures that a patient is taking his or her medication properly. On the basis of observations, the nurse also will contact the patient’s physician to suggest a change in a prescription or its dosage. After a year in the program, patients’ outcomes signiﬁcantly improve. Of the patients who had been experiencing anxiety in 2011, none required admission to the hospital for behavioral issues, 17 percent had decreased anxiety and 78 percent were emotionally stable.

Improving mobility, memory and function of seniors The Acute Care for the Elderly Unit at Christiana Hospital has launched TAPE (Tailored Activities Program for the Elderly), an initiative whose goal is to improve patients’ mobility and function, maintain and improve memory and attention, and decrease behavioral symptoms associated with dementia. Activities include an All About Me poster, life history, crafts, a walking and mobility program, and games, including bingo and Wii electronic activities.

That is, in part, because a trained psychiatric nurse sees things in the home that aren’t immediately apparent in the physician’s oﬃce or during a brief hospital stay. By identifying problems and intervening sooner, the nurse can help patients can avoid readmission to the hospital or visits to the Emergency Department. The nurse is trained in cognitive behavioral therapy and serves

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Community Care AC H I E V E M E N T S PAT I E N T S F I R S T

Care centers on the patient and the family The Christiana Care Way addresses the needs of patients and their loved ones. “Patient- and family-centered care is an approach to the planning, delivery and evaluation of health care that is grounded in mutually beneﬁcial partnerships among health care providers, patients and families,” says Janice Nevin, M.D., chief medical oﬃcer. Core concepts include sharing information and empowering families to be partners in care. These principles are behind initiatives in Wilmington and Christiana hospitals, including: • AIDET (“acknowledge, introduce, duration, explanation and thank you,”) a communication tool that ensures that patients and visitors feel welcome and at ease, and that promotes open communication among families and hospital staff members • Bedside shift reporting, which eases patient anxiety and engages the patient and family in decision making • Hourly rounding, a practice that helps nurses and support staff members better anticipate and meet patient needs • Patient whiteboards, a shared communication tool that invites everyone involved in the patient’s care to communicate openly.

In-patient hospice care Christiana Hospital is serving patients nearing the end of their lives and their families with a new in-patient hospice unit. Operated by Seasons Hospice & Palliative Care, the unit features 12 private rooms with wheelchair-accessible bathrooms, plus a family dayroom and dining area in a home-like setting where families can stay with their loved one 24 hours a day. 24

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Medical Home without Walls reaches ‘super users’ Christiana Care is launching an initiative to reach “super users” of the acute care system, a group of patients who comprise less than 10 percent of all patients but account for more than 20 percent of all visits. The Medical Home without Walls program is modeled on a successful program in Camden, N.J., that reduced health care costs by 56 percent by dramatically decreasing the need for emergency care. A dedicated multidisciplinary team identiﬁes super users and works with the individual to connect them with a medical home, coordinate their clinical care and address their psychological and social needs. In its initial stage, the program will focus on patients who do not have health insurance.

Value Institute symposium highlights the patient The medical profession must refocus attention on the patient to deliver quality care at greater value. That message came through loud and clear at the Christiana Care Value Institute’s inaugural symposium, “Value: Medicine’s New Frontier,” held April 30. The Value Institute’s inaugural symposium speakers

More than 200 health care experts from top institutions in the nation discussed how returning to the basics of medicine— listening to the patient, better use of resources and a greater emphasis on quality and safety—can transform patient care and deliver far greater value. Christiana Care established the Value Institute in 2012 to study and design solutions to the questions of value in the real-world settings of health care delivery. The institute aims to implement strategies to achieve better health outcomes at lower costs.

Christiana Care welcomes patient and family advisers Volunteer advisers are helping hospital staff members gain insights and make suggestions on how to better care for patients and their families. More than 40 advisers are serving in various areas, among them the Neonatal Intensive Care Unit at Christiana Hospital, the Helen F. Graham Cancer Center, and the Center for Rehabilitation and the Intensive Care Unit at Wilmington Hospital. “This is an opportunity for us to advance our goal to better work with patients rather than for patients and their families,” says Diane Bohner, M.D., medical director of Patient and Family Centered Care and Resource Management.

WO M E N ’ S H E A LT H

Excellence in Women’s Health Christiana Care has been recognized by the U.S. Department of Health & Human Services as the region’s only National Community Center of Excellence in Women’s Health. The designation of excellence is based on • Improving the health and well-being of women through partnership 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 Additionally, Christiana Care provides excellent clinical and preventive services, training for health care professionals, and public outreach and education, as well as research into women’s health.

Expectant mothers get flu vaccine To protect mothers and their babies from influenza, Christiana Care’s Delaware Center for Maternal & Fetal Medicine is administering the flu vaccine to pregnant patients. Even healthy women with low-risk pregnancies can develop serious complications after contracting the flu. Last year, only 49 percent of mothersto-be in the United States received vaccination, according to the Centers for Disease Control and Prevention. Among local patients, 80 percent of women offered the vaccine chose to receive it.

Healthy Beginnings is 5 years old and growing More than 4,000 expectant moms have participated in Christiana Care’s Healthy Beginnings since the program was born ﬁve years ago. Healthy Beginnings was established to address Delaware’s high infant mortality rate among women at risk for problem pregnancies. In 2011, nearly 1,000 women were enrolled in the program. Healthy Beginnings’ holistic approach to prenatal care addresses housing, relationships and other issues, in addition to health. Women receive care from a team that includes obstetricians and nurses, a registered dietician, a clinical social worker and a perinatal educator.

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Community Care AC H I E V E M E N T S DIVERSITY AND INCLUSION

Reaching out to the Chinese community Reaching Delaware’s population of Chinese immigrants is not an easy task because they are spread out in various communities instead of clustered in neighborhoods. So xiangfen “Fen” Gu, an outreach and education worker, goes directly to the people, visiting Chinese restaurants. Many restaurateurs and their workers are not insured. Most do not speak English. Gu, who is bilingual, educates Chinese people about free screenings and other resources available through the Helen F. Graham Cancer Center. She also focuses on houses of worship and other places people gather. At the New Castle Chinese Evangelical Church, 48 women received information about breast cancer screening during 2012. One Friday each month, members of the outreach team visit the New Castle Farmers Market, where there a number of Asian vendors. On March 10, a health fair reached more than 65 people at the Chinese American Community Center in Hockessin.

Christiana Care reaches out to Hispanic neighbors By providing free tests and bilingual education in a community setting, Christiana Care and partners are working together to remove barriers to care in the Hispanic community. Through Christiana Care, Latinas are learning about breast health and cancer screenings, essential information they can share as “promotoras”—promoters of health education—to Delaware’s rapidly growing Hispanic community. At the Vive tu Vida—“Get Up, Get Moving”—

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event in Kennett Square, Christiana Care partnered with La Comunidad Hispana, a social service agency, to promote exercise and heart health. “Latinas Fuertes Y Saludables”—“Latinas: Strong and Healthy”—is an annual breast health and life-aﬃrming event for Hispanic women, who are empowered with education about healthy living and encouraged to share their knowledge with others. Our bilingual outreach staff and community partners make these programs a success.

We’re diverse—and inclusive At Christiana Care’s Center for Diversity, Cultural Competency and Communications, interpreters and dual handset phones empower patients and health care providers to access interpreters in more than 150 languages, 24 hours a day. Most documents are available in Spanish. And there is a Spanish-language version of the Christiana Care website at http://es.christianacare.org. The Diversity & Inclusion Council addresses the needs of an increasingly diverse population of patients and staff members. Christiana Care has been recognized as a

“Leader in LGBT Healthcare Equality” in the Healthcare Equality Index 2012 report, an annual survey conducted by the Human Rights Campaign Foundation.

Project SEARCH earns community partner award from Goodwill Christiana Care is the recipient of the 2011 Community Partner of the Year Award from Goodwill of Delaware and Delaware County. The award recognizes Christiana Care’s leadership in partnership with Goodwill, the Red Clay Consolidated School District and the Delaware Departments of Labor and Education to be the inaugural employer in the state to host Project SEARCH. This innovative, nine-month school-to-work program enables students with intellectual disabilities to obtain real-life work experiences, combined with training in employability and independent living skills to make successful transitions from school to productive adult life. Gov. Jack Markell visited the Project SEARCH classroom at Christiana Hospital in March, where he praised the unique collaboration of government, business, education and the community.

O U T R E AC H

Christiana Care enhances partnership with Westside Family Healthcare Christiana Care is partnering with Westside Family Healthcare in a transformational initiative that will provide an innovative model for both communitybased primary care and physician training.

hospital treatment programs for drug use, alcohol abuse or mental health issues. Patients with addictions are frequently admitted to hospitals, and their care is expensive. Project Engage is designed to intervene earlier and to help patients overcome obstacles to recovery, such as housing, insurance and transportation. In the ﬁrst six months after discharge, readmissions for 30 patients decreased 48 percent, an estimated savings of $6,000 per patient in health care costs.

Under the new initiative, two family medicine faculty members will split time between Christiana Care and Westside for combined academic–clinical roles. Resource manual focuses on These positions and the higher level of domestic violence collaboration they enable will expand Christiana Care’s ability to provide Health care professionals now have family medicine services and training at a manual that provides them with Westside and help residents gain insights information to help them with the and experience in providing care in screening and treatment of patients traditionally underserved communities. involved in domestic violence. The initiative is The Domestic Violence consistent with Resource Manual for Healthcare reforms under Our collaboration Professionals, designed by the the Affordable with Westside Family Domestic Violence Coordinating Care Act. The Healthcare will Council, in partnership with partnership also expand our care Christiana Care and the Medical provides a trainin traditionally Society of Delaware, educates ing ground for underserved providers on the signs of domesnurse practitioncommunities. tic violence, the unique medical ers and physician and mental health needs of assistants to help victims, and the resources meet the primary available to patients. care needs of patients.

An engaging approach to addiction outreach Project Engage takes a dynamic, fresh approach to treating addiction through on-site peer-to-peer engagement specialists at Christiana and Wilmington hospitals who counsel patients while they are still in the hospital, when studies say efforts are more successful. A social worker also links patients to after-

Christiana Care number 1 in tri-state region in organ donations Of the 130 hospitals in the tri-state region served by the Gift of Life Donor Program, Christiana Care ranks ﬁrst in the number of families that have chosen to donate organs. In 2011, 45 donors and their families gave 141 patients the lifesaving gift of a heart, lung, liver, pancreas or kidney.

Another 94 donated bone, skin, cornea and heart-valve tissue beneﬁting 6,000 patients, a record level of participation from the communities Christiana Care serves. The success of the program stems from Christiana Care’s strong support of the donation and transplantation process, and the collaboration of Christiana Care’s critical care teams and Gift of Life staff members.

TECHNOLOGY

Meaningful use of electronic health record energizes safe, efficient, high-quality care On the great frontier of health care reform, Christiana Care is making strides with Meaningful Use, a powerful initiative that harnesses the electronic health record system to give providers the information they need to deliver the best possible care. Christiana Care has completed stage 1 of the extensive certiﬁcation process, well before the January 1, 2013, deadline to receive the government’s full incentive. The measure will provide $18.3 million in stimulus money for Medicare and Medicaid payments to the health system and 150 medical providers who are able to demonstrate meaningful use of health technology. The initiative is part of the Health Information Technology for Economic and Clinical Health Act. Already in place are computerized provider order entry and electronic medication administration record. Electronic procedures enhance patient safety and make the system more eﬃcient by reducing duplications and errors. The goal is to have the entire health care system ordering, delivering and verifying tests and medications electronically. 2 0 1 2 Ye a r i n Revie w

Community Care AC H I E V E M E N T S E M E R G E N C Y D E PA RT M E N T

Emergency care faster and more efficient Christiana Care is moving more patients through the Emergency Department (ED) while reducing length of stay, thanks to multiple ongoing eﬃciency initiatives using a Lean process approach.

diagnosis and treatment before patients are released from the ED or admitted to the hospital. In Super Track, patients with minor injuries and ailments receive care in a separate process from the regular emergency stream to provide rapid treatment.

The results: Christiana Hospital treated 118,704 patients in the ED in 2011, an increase of more than 19,000 from 2005, SPEED, the Synchronized Provider without adding rooms Evaluation and Eﬃcient to the ED. Length Disposition program, of stay for patients The SPEED program teams an emergency discharged from the medicine physician, a synchronizes hospital was reduced resident and a physician patient care in from 3.83 hours in assistant with three to the emergency 2005 to 3.72 hours in four nurses to synchronize department with 2011. At Wilmington care from assessment a medical team Hospital, a newly through treatment and from assessment implemented SPEED disposition. Physicians through treatment process reduced average receive test results faster, and disposition. length of stay by facilitating a timely 25 percent.

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Emergency Department aims to reduce secondary fragility fractures Various units within Christiana Care are coordinating a pilot program to ensure that patients coming to the ED with fragility fractures caused by osteoporosis know what type of injury they have, why a fragility fracture is important and how to reduce the risk of future fractures. The pilot project will address the issue by following up with both patient and primary care provider. Currently, the follow-up rate for fragility fractures in the United States is only around 20 percent. Understanding fractures is important because patients who have broken a wrist are three to four times more likely to fracture a hip or sustain another break.

E X PA N S I O N

ENVIRONMENT

Growing environmentally by ‘Greening the OR’ Studies estimate that 20 to 30 percent of the total waste generated by a hospital comes from its operating rooms.

Wilmington Hospital expansion building healthy community

Middletown emergency center under construction

Christiana Care is expanding and renovating its Wilmington Hospital campus—a $210 million investment that helps us continue building a healthy community for our neighbors in the city and will add nearly 600 jobs.

Patients in lower New Castle County and northern Kent County will have greater access to emergency care when Christiana Care’s new Middletown Freestanding Emergency Department is complete. Currently, patients living in the area can face an average drive of 25 minutes to hospital EDs.

Wilmington Hospital will grow by 337,000 square feet, creating a 1-million-square-foot, state-of-the-art medical center. The project will be complete in 2014. The hospital remains fully operational during construction.

Expanding services in Delaware County, Pennsylvania Christiana Care will begin offering health care services in Delaware County, Pennsylvania, starting late in 2013. At the 72,000square-foot multidisciplinary medical oﬃce complex on Route 202 in Concord Township, patients will be able to receive care from primary and specialty care practices as well as cancer care, imaging and laboratory services and outpatient rehabilitation.

The 36,500-square-foot facility, located at Route 299 and Brick Mill Road, will include 18 treatment bays and eight observation-unit beds and will be staffed by board-certiﬁed physicians and specially trained nurses 24 hours a day, seven days a week. The center also will feature imaging and laboratory facilities, as well as a pharmacy and space for respiratory therapy and support.

Christiana Care’s new Middletown Freestanding Emergency Department is expected to serve more than 86,000 residents each year.

The emergency department is expected to serve more than 86,000 residents each year. The opening of the new facility will create about 90 permanent positions when construction is complete in early 2013.

Christiana Care is one of only 116 hospitals in the world that have signed on to the Greening the OR Initiative of Practice Greenhealth, a national organization promoting efficiency through environmental sustainability. In that spirit, staffers are looking to reduce, reuse and recycle waste from Christiana Care’s operating rooms. Greening the OR provides direction on how to reduce and prevent waste, buy environmentally friendly products, and modify working spaces and systems to use less and recycle more. Operating rooms recycle cardboard, plastics, irrigation bottles, paper and blue wrap, which fills ten 40-gallon bins twice per shift, five days a week, thus diverting it from landfills.

Garbage out, compost in Wilmington Hospital serves more than 600 meals each day, which makes for lots of leftovers. Twice weekly, Food and Nutrition staff members ﬁll eight special receptacles, each holding 96 pounds of leftover food and food by-products: peels, rinds, coffee grounds, eggshells and table scraps. What makes the receptacles special is that the contents are composted to transform them into natural fertilizers for local gardens, including several gardens at Christiana Hospital. A vendor picks up the food scraps and adds worms and pests to catalyze decomposition. In just a few weeks, the mixture becomes natural fertilizer for farms and gardens. 2 0 1 2 Ye a r i n Revie w

T H E C H R I ST I A N A CA R E WAY

Education and research lead to scientific discovery and clinical excellence

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Education and Research

Christiana Care is one of the largest community-based teaching hospitals conducting research in the United States.

A DVA N C I N G M E D I CA L CA R E Christiana Care’s commitment to exploring the science of medicine keeps clinicians at the top of their specialty and attracts the brightest and the best to serve as faculty and mentors in our fully accredited graduate medical education programs and undergraduate student rotations, where tomorrow’s health providers learn state-of-the-science medical care. Robust partnerships in clinical, translational and outcomes research boost the health system’s national reputation and speed new ideas, technologies and treatments to communities challenged by today’s most pressing health concerns. The following includes a sample of the education and research programs from the past year at Christiana Care. See the research sections on the Center for Heart & Vascular Health and the Helen F. Graham Cancer Center for an overview of studies in those areas.

AC H I E V E M E N T S

Four physicians join academy of distinguished educators Several Christiana Care physicians are now members of the Jefferson Academy of Distinguished Educators, a service organization dedicated to promoting faculty teaching and excellence, recognizing and rewarding excellence in teaching, making contributions to the educational mission, promoting scholarship in medical education and fostering a community of scholars. The four physicians are Matthew Burday, D.O.; Virginia Collier, M.D., the Hugh R. Sharp, Jr. Chair of Medicine; Moses Hochman, M.D.; and Michael Rosenthal, M.D., chair of the Department of Family & Community Medicine.

17 complete first Certificate in Healthcare Leadership program Seventeen managers completed Christiana Care’s first Certificate in Healthcare Leadership joint program with the University of Delaware. The program is an important element in the commitment of the Christiana Care Learning Institute Center for Transforming Leadership to develop the next generation of top Christiana Care leaders. In addition to completing classwork, the managers worked in teams on a capstone project. In a final lesson, the teams presented their findings and recommendations and discussed the leadership lessons they learned.

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Education and Research AC H I E V E M E N T S E D U CAT I O N

Simulation training center moves up to Level I Christiana Care’s Virtual Education and Simulation Training Center has attained Level I accreditation as a Comprehensive Education Institute through the American College of Surgeons (ACS). The simulation training center first received ACS accreditation at Level II—basic accreditation for simulation—in 2009. As a Level I site, the center has moved beyond being able to train a small number of physicians and staff members. Now, more than 3,500 employees from all departments receive training, gaining crucial experience dealing with simulated high-risk conditions so they can provide the best care when those situations do arise. First responders, including police officers and firefighters, also obtain highly realistic training at the center. The center includes a trauma bay, intensive care unit, operating room and patient rooms. The simulated patients are highfidelity manikins that breathe, speak, blink their eyes and respond to stimuli like real adults and children.

Training magazine ranks Christiana Care among top organizations As a training institution, Christiana Care ranks 60th among the top 125 organizations, according to Minneapolisbased Training professional development magazine. The recognition reﬂects Christiana Care’s commitment to learning and development. In 2011, the systemwide Learning and Education Council designed the Christiana Care Learning Institute and launched a three-year strategic plan to integrate all common learning processes and support services into one easily accessible system. This virtual institute helps coordinate E D U CAT I O N the thousands of hours of continuing education and community, wellness and patient education Christiana Care offers that reaches thousands of people each year. The institute focuses on educator development, innovation, continuous professional education, diversity and inclusion, transforming leadership, employee development and patient education.

Christiana Care wins prestigious innovation grant Christiana Care has been awarded $10 million from the Center for Medicare & Medicaid Innovation to design a new care model that will harness pioneering information technology to transcend the gaps that currently exist within health care to provide more coordinated care and greater value for patients. Christiana Care’s proposal is tailored to use existing hospital and oﬃce information systems to trigger alerts speciﬁcally for patients who need extra care during hospitalization and upon discharge to their homes. The alerts will help a team of nurses and other health care professionals respond quickly and effectively to the patients, enabling them to recuperate in their homes and safeguarding them from symptoms that can result in readmission. The proposal—known as the Bridging the Divides model—was one of only 107 projects picked for the innovation grants from more than 3,000 applicants nationwide.

Christiana Care’s Virtual Education and Simulation Training Center

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Medical student class of 2014 joins Jefferson branch campus Christiana Care is participating in Jefferson Medical College’s Delaware Branch Campus program, underscoring the transformative role the health system plays in medical education. This achievement speciﬁcally spotlights our core competency in providing clinical education to third- and fourth-year medical students. Christiana Care has a long-standing relationship with Jefferson Medical College in providing ﬁrst-rate medical education to students from the college, one of the top medical schools in the country.

ACT a model for collaborative learning

Global Health Symposium advances curriculum

An exceptional experiential learning course at Christiana Care is one of the original top six performing sites funded by a prestigious Robert Wood Johnson Foundation grant in 2004. Known as ACT, or Achieving Competency Today, the 12-week course focuses on small groups of employees from multiple disciplines who explore such topics as patient safety and health care economics. Participants collaborate on a project, with everyone playing an equal role. In addition to serving as an incubator for projects, ACT nurtures respect among colleagues. So far, 304 employees have completed the course.

In 2012 Christiana Care hosted the ﬁrst Global Health Symposium of the Delaware Health Sciences Alliance, which examined the challenges and importance of creating sustainable improvements in public health worldwide. The symposium is part of a new effort to provide a global-health curriculum at Christiana Care.

nurses, physicians, researchers and other professionals from disciplines as varied as anthropology, public health, psychology and library science. What unites them is a common interest in improving lives by eliminating health inequities around the world.

The symposium attracted about 60 attendees from all four of the alliance partners—Thomas Jefferson University, Nemours, the University of Delaware and Christiana Care—including medical and undergraduate students, residents,

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Education and Research AC H I E V E M E N T S N U M B E R O F C L I N I CA L

RESEARCH

& P H A R M AC E U T I CA L

Center for Outcomes Research weighs care and cost to find best treatment

RESEARCH STUDIES

DEPARTMENT

No. of STUDIES

Anesthesia

Bone Marrow Transplant

Cardiology

Community Outcomes

Critical Care

Diabetes

Education

Emergency Medicine

Family Medicine

Genetics

Genetics-Oncology

GYN Oncology

Hematology

Infectious Disease

Internal Medicine

Maternal/Fetal Medicine

Neonatology

Nephrology/Renal Transplant

Neurology/Neurosurgery

Nursing

Nutrition

OB/GYN

Oncology

205

Orthopedics

Outcomes

Pathology

Pediatrics

Performance Improvement

Pharmaceutical Oncology

Pharmacy

Psychiatry

Pulmonary/Respiratory Care

Radiation Oncology

Radiology/Interventional Radiology

Radiology/Cardiology

Surgery

Surgical Critical Care/Trauma

Women’s Health

Other Research (non categorized) (non categorized)

7 84 84

TOTAL

The Christiana Care Center for Outcomes Research (CCOR) is a research center with a dual focus on epidemiological research and analysis of outcomes in all fields of medicine. In addition, it is a data-coordinating center for a number of large and small clinical trials in cardiovascular diagnostics and therapeutics. The center features specific expertise in evaluating of quality of life, economic effectiveness, and cost-effectiveness and takes a multidisciplinary approach to research. CCOR is one of only a handful of groups involved in the science of evaluating the consequences of health care delivery by comparing the results of one type of therapy or treatment with another type of treatment. CCOR’s mission is to promote and conduct research aimed at improving patient care, informing health care policy, or both. CCOR is directed by William Weintraub, M.D., who says that Delaware’s compact, diverse population makes the state ideal for studies that can benefit patients throughout the United States.

Cancer and cardiovascular research expand Research into the diagnosis and treatment of cardiovascular disease is expanding in scope through a $17.4 million, ﬁve-year federal grant. In all, the grant supports 15 projects, including cancer biomarkers and stem cell research, as well as the role of kidney function in the link between obesity and heart disease. The National Institutes of Health awarded the grant to the Delaware IDeA

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Network of Biomedical Research, which includes Christiana Care, the Delaware Biotechnology Institute at the University of Delaware, Nemours/Alfred I. duPont Hospital for Children, Delaware State University, Delaware Technical Community College and Wesley College. Investigators at Christiana Care were awarded one of the two-year pilot grants to study the cardiovascular risk factors of women after a pregnancy complicated by hypertension. The 6 to 8 percent of women whose pregnancy is complicated by hypertension will have a fourfold to ﬁvefold higher risk of developing hypertension and a twofold to threefold risk of cardiovascular mortality later in life. Pregnancy appears to unmask such vulnerability years before it might otherwise be detectable. This study will enable investigators to develop strategies for early prevention of heart disease in women.

Christiana Care joins ICU infection study The Surgical Critical Care Complex at Christiana Hospital is one of just 22 intensive care units nationwide chosen to participate in only the second multicenter, randomized trial in infection control in the country. The Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Joint Commission, and a research team including Yale and the University of Maryland lead and fund the study nationwide. The Beneﬁts of Universal Glove and Gowning study aims to determine whether using gowns and gloves for all patient contacts (instead of only for patients in contact isolation for known resistant bacteria) decreases acquisition of the resistant bacteria and health care– associated infections.

Dr. Drees researches infection control practices

of platelet transfusion for traumatic intracranial hemorrhage.

Marci Drees, M.D., MS, hospital epidemiologist and medical director of infection prevention at Christiana Care Health System, is the ﬁrst recipient of a new research award from the Society for Healthcare Epidemiology of America (SHEA).

The National Trauma Institute approved the grant to start enrolling patients in June after a two-year application process involving Christiana Care and the U.S. Department of Defense, a major supporter of the pilot research project.

The $20,000 inaugural grant, called the SHEA Epi Project Award, seeks to advance research in health care epidemiology through the SHEA Research Network. The network is a consortium of nearly 200 hospitals collaborating on multicenter research projects that identify gaps in the health care epidemiology science base.

Joining forces in a collaboration vision The Delaware Health Sciences Alliance enables partner organizations to collaborate and conduct cutting-edge biomedical research, to improve the health of Delawareans through access to

health care professionals and to educate the next generation of providers. The alliance focuses on establishing innovative collaborations among experts in medical education and practice, health economics and policy, population sciences, public health, and biomedical sciences and engineering. The alliance includes Christiana Care, Nemours/ Alfred I. duPont Hospital for Children, Thomas Jefferson University and the University of Delaware. Two pilot grants have been awarded to principal investigators at Christiana Care: one to study the maternal determinants of childhood obesity and the second to study medication adherence among patients with hypertension.

Dr. Drees’ research focuses on deﬁning variability of infection control practices for multidrug-resistant Gram-negative organisms. These organisms, which include Pseudomonas, Klebsiella and Acinetobacter species, are increasingly reported worldwide and can result in infections that cannot be treated with currently available antibiotics.

Study focuses on traumatic cranial bleeding among patients receiving antiplatelet therapy Will blood platelet transfusions help stop brain bleeding and fend off neurological damage caused by traumatic head injury in patients taking aspirin or clopidogrel (Plavix)? Christiana Care’s Level-I trauma center team received a grant to study outcomes for trauma patients receiving antiplatelet therapy, which includes an ever-increasing number of people prescribed aspirin and clopidogrel to prevent strokes and heart attacks. This is the ﬁrst randomized, controlled trial

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Education and Research AC H I E V E M E N T S RESEARCH

Obesity and cancer screenings explored in Journal of Obesity

Nursing specialty certification soars The number of nurses at Christiana Care certified in a specialty has increased an impressive 147 percent in only three years, from 552 nurses, or 17 percent of the staff, in 2009 to 1,363 nurses, or 42 percent, in 2012. At the Roxana Cannon Arsht Surgicenter, 83 percent of nurses are certified. Christiana Care’s commitment to excellence in nursing also is reflected in having achieved Magnet status from the American Nurses Credentialing Center, joining an elite group of hospitals and health care systems to achieve the honor.

The relationship between obesity and cancer screening is more complicated than previously thought, according to a recent study led by Christiana Care’s Department of Family & Community Medicine.

An article published in the Journal of Obesity by lead author Heather Bittner Fagan, M.D., FAAFP, MPH, director of Health Services The number of Research, Department nurses certified in of Family & Community a speciality has Medicine, noted that the increased an study found that this impressive 147% relationship depends in just three years. on the type of cancer screening test used. The study found that obesity is associated with

higher rates of prostate cancer screening among all races as well as lower rates of cervical cancer screening predominantly in white women. The data on breast and colon cancer screening were contradictory, suggesting the possibility of other determinants such as race, sex, ethnicity and access to care. Original analysis was also conducted examining the role of race, sex and ethnicity in moderating the relationship between obesity and colorectal cancer screening and showed that weight status does not contribute to disparities in colorectal cancer screening in race/ethnicity and gender subgroups.

Examining childhood bullying and teen suicide Bullying, once dismissed as a normal part of growing up, is now recognized as far more dangerous and consequential than once believed. High-proﬁle incidents, including school shootings and suicides, have sparked a national conversation about bullying, placing it topmost in the minds of parents, educators and health care professionals. Preventing adolescent suicide is the life work of Christiana Care’s Gregory D. Cooper, BSN, RN, a crisis interventionalist at Wilmington Hospital. He is the lead author of “Examining Childhood Bullying and Adolescent Suicide: Implications for School Nurses,” published in the March issue of the Journal of School Nursing.

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On the basis of the entirety of the ﬁndings, the investigators recommended several outcomes that should be tracked, at Christiana Care and at other institutions nationwide, to ensure that there are no adverse consequences to this broad intervention.

Nationally recognized for quality improvement strategies in neonatology Christiana Care’s neonatology research team highlighted its leading-edge care and quality initiatives among 11 studies presented last spring at the Pediatric Academic Societies annual meeting. RESEARCH IN WOMEN’S & C H I L D R E N ’ S H E A LT H

Study aims to prevent preterm births Christiana Care received a $400,000 grant from the Thrasher Research Fund to conduct a deﬁnitive study of the effectiveness of an antibiotic known as oral clindamycin to prevent preterm births in women with genital tract infections linked to preterm delivery. Christiana Care received the award in partnership with Jawaharlal Nehru Medical College of KLE University in Karnataka, India. The study will examine whether a 5-day dose of 300 mg oral clindamycin for women who are 13 to 20 weeks pregnant will prevent 30 percent of preterm deliveries at minimum. The research will be conducted in South India, an area that accounts for the greatest number of global newborn deaths, 27 percent of which are caused by preterm births. The study will be the ﬁrst to test whether oral clindamycin prevents preterm births in a community-based setting in a developing country, where most of the world’s annual 3.1 million newborn deaths

occur. The study results will have broadbased applications to the United States and Europe—as well as at Christiana Hospital—where the incidence of preterm births is also high and increasing.

Christiana Care data used to study effectiveness of the ‘39-week rule’ Because outcomes for babies are best when they are born full term, there is a national effort to reduce the number of elective deliveries before 39 weeks. Adherence to this “39-week rule” is now a quality measure being tracked by hospitals across the country. Investigators at Christiana Care used ﬁve years of data from our electronic medical records to study the effectiveness of this rule at improving outcomes for babies. In an article published in the November 2011 issue of Obstetrics & Gynecology, they reported signiﬁcant improvements in the timing of elective deliveries and an associated reduction in admission of term newborns to the Neonatal Intensive Care Unit.

Stephen Pearlman, M.D., director of the Neonatal Fellowship Program, and his multidisciplinary team successfully instituted a bundle of interventions that markedly reduced hypothermia among infants admitted to the Neonatal Intensive Care Unit and lowered the potential for serious negative outcomes. Director of Neonatal Research David Paul, M.D., presented a report on a rapid-cycle process-improvement effort driven by bedside nurses to reduce serious levels of intravenous inﬁltrates and associated tissue damage among infants in the Neonatal Intensive Care Unit. Antibiotic therapy for hospital-acquired pneumonia was the subject of a health care utilization study led by Dr. Paul and Kelly Gray, RN. This subproject is part of a ﬁve-year collaboration, funded by the National Institutes of Health, with Columbia University, Cornell University and The Children’s Hospital of Philadelphia that showed that despite similar diagnosis rates and choices of antibiotic coverage, duration of antibiotic therapy varied greatly, suggesting the need for a more standardized, evidence-based approach.

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Education and Research AC H I E V E M E N T S RESEARCH IN WOMEN’S & C H I L D R E N ’ S H E A LT H

Research shows episiotomy not often needed in childbirth Christiana Care is taking a leading role in developing national guidelines for the obstetrical practice of episiotomy, which is a surgical incision to enlarge the vaginal opening during childbirth, to aid delivery and prevent tissue damage. Under current guidelines in obstetrics, episiotomy is a routine practice. The National Quality Forum endorsed Christiana Care’s petition to consider the incidence of episiotomy as a performance

measure in evaluating the quality of perinatal services, taking the standard of low episiotomy rates a step closer to adoption by the Joint Commission, the independent, not-for-proﬁt organization that accredits and certiﬁes health care systems. Episiotomy was routine for decades and was a standard part of training for most obstetricians practicing today. In theory, the procedure prevented more serious vaginal tears and reduced the patient’s risk of incontinence. But over time, evidence didn’t support that theory. In fact, data show that episiotomy increases the risk of serious lacerations and can contribute to stool incontinence.

A key role in reducing infant mortality Once among the highest in the nation, the infant mortality rate in Delaware has been declining steadily and is now 8.3 deaths for every 1,000 live births. That improvement is due in part to initiatives by Christiana Care, which has been making available the hormone progesterone, which is effective in preventing premature labor, to obstetric providers since 2007. Christiana Care also offers preconception and prenatal care through its Healthy Beginnings program, serving women who are at risk for chronic health conditions, have high stress levels and live in high-crime areas.

Pioneering research in fetal growth Christiana Care is a leader in groundbreaking research in fetal growth in a study of women between ages 18 and 40 of all ethnicities. The data that researchers gather will help to establish a national standard for fetal growth that will help physicians to better determine when to intervene because of suspected abnormal fetal growth.

Improving breastfeeding rates through nationwide collaborative Christiana Care is among 90 U.S. hospitals participating in Best Fed Beginnings, a first-of-its-kind national, 22-month collaborative effort to significantly improve breastfeeding rates in states where they are lowest. Breastfeeding has health benefits. For infants, it decreases the incidence and severity of many infectious diseases, reduces mortality, supports neural development and decreases the risk of becoming obese later in childhood. For mothers, it decreased the risk of breast and ovarian cancers, diabetes, rheumatoid arthritis and cardiovascular disease. Still, half of all babies born in the United States receive formula within their first week, and only 31 percent of babies are breastfeeding at nine months of age.

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Christiana Care was the ﬁrst health system in the United States to enroll expectant mothers in the program and is one of only six institutions in the country selected for a $1.136 million grant from the National Institutes of Health. The health system’s large, diverse patient population and track record in research in obstetrics and gynecology make Christiana Care an ideal match for the project.

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Philanthropic support helps us fulfill our mission

The power of giving can start at an early age and have a profound impact on the care we provide to our community.

From left brothers Dean, Sander and Harry Saridakis donated money they earned to help cancer patients in need. 2 0 1 2 Ye a r i n Revie w

Philanthropic Support AC H I E V E M E N T S

C H A R I TA B L E G I F T S S U P P O R T C H R I S T I A NA CA R E ’ S M I S S I O N O F E XC E P T I O NA L PAT I E N T A N D FA M I LY C E N T E R E D CA R E A N D S E RV I C E Philanthropy is the noble and powerful embodiment of a distinctive spirit that has engaged generations of Americans in the shared privilege of serving people and communities. Harnessing our passion to improve the human condition enriches lives across our region who turn to Christiana Care in times of great need for the highest quality medical care.

The ﬁrst annual report for Christiana Care in 1889 is replete with pages of itemized gifts given from community-minded citizens who knew the profound impact philanthropy can make in health care. In the decades since then, our community has supported Christiana Care with generous contributions to support high-tech diagnostic and treatment equipment, transformational community outreach and recruitment of the most qualiﬁed clinical leaders. The friends of Christiana Care, including the board, trustees, grateful patients, foundations and corporations, have been incredibly generous, particularly over the past decade. Their gifts helped fund the opening of the Helen F. Graham Cancer Center and the bold expansion of Christiana Hospital, including the Center for Heart & Vascular Health. Our donors are now generously supporting the expansion of Wilmington Hospital, the second largest transformational project in our history scheduled for completion in 2014.

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Our focus shifts to supporting the programs and people that are the heart and soul of our buildings— and that benefit all in our region. In 2012, giving from Christiana Care supporters included such heart-felt efforts as: The ﬁrst patient to receive a left ventricular assist device at Christiana Care did so thanks in large part to the generosity of the Crystal Trust, which provided major funding for this advanced technology at the Center for Heart & Vascular Health. Alicia and Brandon Lewandowski, founders of the non-proﬁt organization Kids Kickin’ Cancer, presented a check for $49,000 to the Center for Translational Cancer Research at the Helen F. Graham Cancer Center. The Lewandowskis, sister and brother, founded Kids Kickin’ Cancer as teens in 2007 in memory of their father, Michael Lewandowski, who died of cancer in 2006.

Verizon Delaware presented a gift of $15,000 to support Christiana Care’s Forensic Nurse Examiner program through continuing education to enhance their expertise. Since 1997, Christiana Care nurse examiners have provided compassionate, comprehensive care for victims of sexual assault, domestic violence, child or elder abuse and neglect and other violent crimes. The AstraZeneca HealthCare Foundation awarded a grant of more than $152,000 to Christiana Care’s Cardiovascular Outreach Prevention Program, which focuses on underserved, low-income African-American teens and

adult females. The strategy is to empower teens with the knowledge and conﬁdence to make healthy lifestyle changes, and to improve the heart health of their mothers or other important women in their lives.

The Battle for the Cure volleyball event, sponsored by athletes from Archmere Academy in Claymont and St. Elizabeth’s High School in Wilmington, brought in $10,400 to beneﬁt the Helen F. Graham Cancer Center. Total fundraising for the Graham Cancer Center since the event started in 2007 now totals $48,437.

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T H E C H R I ST I A N A CA R E WAY

Awards, honors and appointments reflect our commitment to service G I V I N G O U R P E R S O NA L B E S T Christiana Care’s many recognitions and honors are the sum total of individual efforts of people in the health system giving their best, every day, to provide the best in patient care. Christiana Care excels on many levels, as a quality health care provider, a caring voice in the community and a great place to work.

AWA R D S & R E C O G N I T I O N

Best Hospital ranking from U.S. News & World Report Christiana Care has been ranked one of the nation’s best hospitals by U.S. News & World Report. In its annual Best Hospital edition, the publication places Christiana Care’s Department of Medicine among the top 50 in the specialty of gastroenterology. Christiana Care is the only adult acute-care hospital in Delaware to make the list. U.S. News & World Report ranks Christiana Care number 4 of the 93 hospitals in the Philadelphia metropolitan area and “high-performing” in 11 specialties.

Christiana Care achieves Magnet status for nursing Christiana Care has been awarded Magnet recognition for the period 2010-2014 for excellence in nursing by the American Nurses Credentialing Center, joining an elite group of hospitals to achieve the highest level of recognition for sustained excellence in nursing care. Christiana Care is the only hospital in Delaware to achieve Magnet status; only 6 percent of U.S. hospitals have earned the honor.

Achieving grade of A for patient safety Beacon Award for Critical Care Excellence Christiana Care is the recipient of the Silver Beacon Award for Critical Care Excellence from the American Association of Critical-Care Nurses, the largest specialty nursing organization in the world.

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Christiana Care received a grade of “A” for patient safety in a ﬁrst-ever report card on safety in the nation’s hospitals from the Leapfrog Group, an independent, national, not-for-proﬁt organization of employer purchasers of health care and the nation’s leading experts on patient safety.

Joint Commission awards seal of approval Christiana Care has earned continued Gold Seal of Approval for recertiﬁcation as a Primary Stroke Center by the Joint Commission.

InformationWeek and Computerworld recognize Insight Christiana Care has been named to InformationWeek magazine’s 2012 InformationWeek 500 list for the second consecutive year. Calling the health system one of the nation’s most innovative users of technology, the magazine spotlights Christiana Care’s Insight program. The tablet-based self-evaluation tool enables patients to report the severity of their symptoms and how they affect quality of life. Insight also won top ﬁve honors in the health category from Computerworld magazine earlier this year after the publication named the innovative tool a Laureate Award winner from among 500 nominations.

Leading the way in health care equality Christiana Care has been recognized as a Leader in LGBT Healthcare Equality in the Healthcare Equality Index 2012 report, an annual survey conducted by the Human Rights Campaign Foundation, the educational arm of the country’s largest lesbian, gay, bisexual, transgender (LGBT) organization. Christiana Care earned top marks for its commitment to equitable, inclusive care for LGBT patients and their families, who can face challenges in accessing adequate health care.

Tops in training and staff development Christiana Care ranks among the top 125 companies in the nation in employer-sponsored training and development programs, according to Training magazine.

Christiana Care earns top workplace employer Christiana Care has been recognized as one of the top places to work in Delaware and in the nation, according to Workplace Dynamics, Inc., a human resources consulting company. For the competition, surveyors evaluated Christiana Care on the basis of employee responses to 24 different questions on topics about leadership, productivity,

communications, career opportunities, working conditions, management, pay and beneﬁts. Christiana Care employees were especially positive about compensation and beneﬁts, the direction of the company and innovation.

Center for Rehabilitation receives accreditation Christiana Care’s Center for Rehabilitation at Wilmington Hospital has achieved certiﬁcation from the Commission on Accreditation of Rehabilitation Facilities for its brain injury, amputation and stroke programs and for comprehensive adult inpatient care. The certiﬁcation is for the three-year period of June 2012 through June 2015.

Wound Care Center earns distinction Christian Care’s Wound Care and Hyperbaric Medicine Center earned a Center of Distinction Award from Diversiﬁed Clinical Services (now known as Healogics) by delivering outstanding results for 12 consecutive months.

Practice Greenhealth awards sustainability Christiana Care received Partner for Change with Distinction awards for reducing its environmental footprint and producing substantial waste savings from Practice Greenhealth, the nation’s leading membership association devoted to environmentally responsible health care.

Consumer Choice Award winner For the 17th year in a row, Christiana Care was named the top health care provider of choice in Delaware by the National Research Corporation. Winning hospitals possess the best doctors, nurses and reputation and provide the best overall quality of care.

CIO magazine honors information technology innovation Christiana Care has been named a recipient of a 2012 CIO 100 Award from IDG Network’s CIO magazine for a twopart breakthrough communication management and workﬂow solution, changing the way care is coordinated in one of the busiest emergency departments in the nation. 2 0 1 2 Ye a r i n Revie w

Achieving Excellence APPOINTMENTS

Dr. Laskowski named chair-elect of AAMC Council of Teaching Hospitals and Health Systems Christiana Care President and CEO Robert J. Laskowski, M.D., MBA, is chair-elect of the Council of Teaching Hospitals and Health Systems of the Association of American Medical Colleges. In this role, Dr. Laskowski also serves on the association’s board of directors. He is a member of the Health Management Academy Chief Executive Oﬃcers Forum and the American Medical Association Section on Medical Schools. He also serves on the board of directors of the United Way of Delaware, the Delaware State Chamber of Commerce, and Wilmington HOPE Commission and chairs the board of the Delaware Public Policy Institute. He is a member of the Economic Advisory Council of the Federal Reserve Bank of Philadelphia.

Dr. Nevin serves United Way Janice E. Nevin, M.D., MPH, chief medical oﬃcer for Christiana Care, serves as a campaign cabinet member of the United Way of Delaware. She is a member of the Delaware Health Care Commission and a member of the board of the Delaware Community Foundation.

Dr. Gardner directs Value Institute Timothy J. Gardner, M.D., medical director of Christiana Care’s Center for Heart & Vascular Health and past national president of the American Heart Association, has been named director of Christiana Care’s Value Institute. He is also chair of the Steering Committee for the Cardiothoracic Surgery Clinical Research Network of the National Heart, Lung, and Blood Institute of the National Institutes of Health.

Dr. Petrelli provides leadership in cancer care Nicholas J. Petrelli, M,D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, is a member of the National Cancer Institute Gastrointestinal Steering Committee that oversees and approves clinical trials in the United States for gastrointestinal cancers. Dr. Petrelli has been named a member of the Medical Advisory Board of Fight Colorectal Cancer, the leading colorectal cancer advocacy organization in Washington, DC.

Dr. Collier elected master of the American College of Physicians Dr. Weintraub serves as American Heart Association aﬃliate president William S. Weintraub, M.D., the John H. Ammon Chair of Cardiology and director of the Christiana Care Center for Outcomes Research, is serving as president-elect of the board of directors of the American Heart Association Great Rivers Aﬃliate.

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Virginia U. Collier, M.D., MACP, the Hugh R. Sharp, Jr. Chair of the Department of Medicine, joins a select group of internists elected to mastership of the American College of Physicians. She is the fourth master ever elected from the state of Delaware.

Dr. Galinat serves on Board of the Eastern Orthopaedic Association Brian Galinat, M.D., chairman of the Department of Orthopedic Surgery, was elected to the Board of the Eastern Orthopaedic Association. He is an active member of the American Orthopaedic Association and serves on the Coding, Coverage, and Reimbursement Committee of the American Academy of Orthopaedic Surgeons. He is the American Academy of Orthopaedic Surgeons alternate to the Resource-Based Relative Value Scale Update Committee of the American Medical Association.

Dr. Ehrenthal earns MPH, wins Capstone Award Deborah Ehrenthal, M.D., FACP, director of Health Services Research for Women and Children and medical director of Women’s Health Programs in the Department of Obstetrics and Gynecology, earned her master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health. She won a Capstone Award for Outstanding Achievement for her research on the inﬂuence of maternal factors on early childhood obesity. She was also inducted into the Johns Hopkins chapter of Delta Omega Alpha, a national honor society that encourages excellence in research, scholarship and practice among graduate students in public health.

Dr. Scantlebury appointed to NIH Council Velma Scantlebury, M.D., associate chief of Transplant Surgery, was appointed to the National Institutes of Health Advisory Council for Allergy, Immunology and Transplantation and will serve until 2014. She has been a member of the American Society of Transplant Surgeons and has served nationally as a member of the Advisory Committee on Transplantation to the Secretary of Health and served as chair of the committee until 2012.

Dr. Grubbs elected to board of oncology society Medical oncologist Stephen S. Grubbs, M.D., was elected to a three-year term on the board of directors of the American Society of Clinical Oncology. He was also named to a leadership role with the newly formed Alliance for Clinical Trials in Oncology.

Dr. Rizzo chairs lung association board Albert A. Rizzo, M.D., chief of the Section of Pulmonary and Critical Care Medicine, is the national volunteer chair of the board of directors of the American Lung Association.

Lynn Jones appointed to Joint Commission Advisory Council Lynn C. Jones, FACHE, president of Christiana Care’s Visiting Nurse Association, has been appointed to the Joint Commission’s Home Care Advisory Council. He is also in his second year of a two-year term as board chair of the Visiting Nurse Associations of America. He has been on that board for seven years and was previously chair of its Public Policy Council. He is chair-elect of the American Hospital Association Post-Acute Governing Council. This year he completed his term as regent for Delaware for the American College of Healthcare Executives.

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Achieving Excellence APPOINTMENTS

Dr. Dickson-Witmer vice chair of cancer commission task force Diana Dickson-Witmer, M.D., medical director of the Christiana Care Breast Center at the Helen F. Graham Cancer Center, served as vice chair of the Standards Revision Task Force for the Commission on Cancer of the American College of Surgeons. This task force, with input from 50 national organizations, developed the commission’s new standards for cancer centers throughout the country. She is a member of the Education Program Committee of the American Society of Breast Disease and of the Education Committee of the American Society of Breast Surgeons. She is also a member of the Alliance for Clinical Trials in Oncology, serving on both the Prevention Committee and the Cancer Care Standards Development Committee.

Dr. Meara receives educator award Daniel J. Meara, M.D., D.M.D., chair of the Department of Oral and Maxillofacial Surgery and Hospital Dentistry, received the Faculty Educator Development Award from the American Association of Oral and Maxillofacial Surgeons and Oral and Maxillofacial Surgery Foundation.

Maureen Seckel serves on national board Maureen Seckel, RN, a clinical nurse specialist in medical pulmonary critical care, is serving a three-year term as a director on the board of the American Association of Critical-Care Nurses through June 30, 2013. She served a one-year term as secretary in 2011-2012.

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Donna Casey appointed to nursing advisory board Donna Casey, RN, director of Nursing for Cardiovascular/ Critical Care and co-chair of the Ethics Committee, was appointed to the Center for Ethics and Human Rights Advisory Board of the American Nurses Association for the two-year period 2012-2014. The board recommends policy about issues of concern in ethics and human rights to the association’s board of directors.

Bonnie Osgood elected to nursing congress Bonnie S. Osgood, MSN, RN, nurse manager of 4 Medical at Wilmington Hospital, was elected to serve on the American Nurses Association Congress on Nursing Practice and Economics. The congress focuses on establishing nursing’s approach to emerging trends within the socioeconomic, political and practice spheres of the health care industry by identifying issues and recommending policy alternatives to the board of directors.

Patricia Lincoln, RN, receives AIDS educator award Patricia Lincoln, RN, received the HIV Educator Distinguished Service Award from the Association of Nurses in AIDS Care. The honor recognizes an outstanding association member who, through education about HIV and AIDS, has had a great impact on the lives of those they have instructed, including patients, clients, families, health care providers, community groups and the general public.

T H E C H R I ST I A N A CA R E WAY

A not-for-profit health care system providing value to our community

S E RV I C E S TAT I S T I C S A DM IS S IONS

OUTPATIE NT V IS ITS

2012

*adjusted

E M E RGE NC Y DE PA RTM E NT V IS ITS

2012

WILMINGTON HOSPITAL

CHRISTIANA HOSPITAL

TOTAL VISITS

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Service Statistics

C H R I S T I A NA CA R E ’ S I M PAC T O N D E L AWA R E Christiana Care employees paid more than $25.9 million in taxes to the State of Delaware. On average, a Christiana Care employee returns more than $100,000 to Delaware’s economy every year.

BIRTHS

2012

AV E RAGE INPATIE NT S TAY (NO. OF DAYS)

2012

RADIOLOGY PROC E DURE S

2012

S URGICA L PROC E DURE S

2012

WILMINGTON HOS PITA L HE A LTH C E NTE R V IS ITS

2012

1,198 Christiana Care volunteers gave a total of 94,294 hours of service this year. That translates into more than $2 million dollars.

PHYS ICA L THE RA PY PL US V IS ITS

2012

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C HRIS TIA NA CA RE HOM E HE A LTH AND C OM M UNITY S E RV IC E S

PRIMA RY CA RE PHYS IC IA N OF F IC E V IS ITS

HOME HEALTH CARE VISITS 286,770 HIGH SCHOOL WELLNESS CENTERS AND ALZHEIMER’S DAY PROGRAM VISITS 5,320* *Visiting Nurse Association no longer staffs High School Wellness Centers

C E NTE R F OR A DVA NC E D JOINT RE PLACEMENT A ND C E NTE R F OR RE HA BIL ITATION 2012 TOTAL KNEE AND HIP REPLACEMENTS 2,287 REHABILITATION PATIENTS 656 TOTAL PATIE NT RE V E NUE (BILLIONS OF DOLLARS) PE RS ONNE L S TATIS TIC S CHRISTIANA CARE EMPLOYEES 10,582 MEDICAL-DENTAL STAFF 1,454 MEDICAL & DENTAL RESIDENTS & FELLOWS 262 RNs, LPNs AND PATIENT CARE TECHNICIANS 3,699

W HE RE C HRIS TIA NA CA RE HE A LTH SERVICES’ OPE RATING DOL L A R GOE S

2012

1¢ Other Aﬃliates

28¢ Therapeutic & Diagnostic Services

CHARITY CA RE (MILLIONS OF DOLLARS)

1¢ Insurance & Other 3¢ Administration 6¢ Depreciation & Interest

7¢ Support Services

2012

7¢ Facilities & Services

*adjusted **estimated

24¢ Nursing Services

COST C OM PA RIS ON OF AV E RAGE PATIE NT S TAY

HOPKINS

HUP

JEFFERSON

COOPER

8¢ Medical Education & Social Services

15¢ Employee Beneﬁts

TEMPLE

CROZER

CHRISTIANA CARE

Source: American Association of Medical Colleges’Autumn 2011 Databook.

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P.O. Box 1668 Wilmington, Delaware 19899-1668 800-693-CARE (2273)

www.christianacare.org

Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit www.christianacare.org/donors. 13GEN1