Christiana Care 2015 Year in Review by ChristianaCare

2015 YEAR IN REVIEW

Advancing The Christiana Care 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.

Christiana Care ranks at the top in volume among leading health care systems, with only 20 hospitals in the U.S. having more admissions. We operate the only Level I trauma center between Philadelphia and Baltimore, and our Level III neonatal intensive care unit makes us the only delivering hospital in Delaware offering this specialized care. Our Lines of Service >> Acute Medicine >> Behavioral Health >> Cancer Care >> Heart & Vascular Health >> Musculoskeletal Health >> >> Neurosciences >> Primary Care & Community Medicine >> Surgical Services >> Women & Children >>

Our Service Volume & Rankings*

East Coast

14/ 29 U.S.

East Coast

15/ 32 U.S.

Births

6,469

Surgical Procedures

East Coast

13/ 21 U.S.

187,317

38,712

10/

U.S.

53,072

Admissions

Emergency Department Visits

*Rankings by American Hospital Association survey database for fiscal year 2013.

Christiana Care is one of the largest

Wilmington Campus

health systems in the nation, attracting

Wilmington Hospital (290 beds)

patients from Delaware, Maryland,

The Rocco A. Abessinio Family Wilmington Health Center

New Jersey and Pennsylvania.

Center for Advanced Joint Replacement Center for Rehabilitation

Our network of facilities makes it easy

Roxana Cannon Arsht Surgicenter

for neighbors to receive expert care at

Swank Memory Care Center

the right place, at the right time.

First State School Wilmington Hospital Gateway Building

Regional Facilities Concord Health Center Eugene du Pont Preventive Medicine & Rehabilitation Institute HealthCare Center at Christiana Middletown Emergency Department

Christiana Campus Christiana Hospital (906 beds) Level I Trauma Center and Level III Neonatal Intensive Care Unit

Middletown Care Center Smyrna Health & Wellness Center Rehabilitation Services

Center for Heart & Vascular Health

School-Based Health Centers

Helen F. Graham Cancer Center & Research Institute

Imaging Services

Center for Translational Cancer Research

Primary Care Centers (in DE, PA and NJ)

John H. Ammon Medical Education Center

Alzheimerâ&#x20AC;&#x2122;s and Dementia Day Programs

Virtual Education & Simulation Training Centerr

Home Health & Community Services â&#x20AC;&#x201C; Visiting Nurse Association

Christiana Care Breast Center Christiana Care Surgicenter Medical Arts Pavillion

A young patient shows how happy she is about her healthy smile at Christiana Careâ&#x20AC;&#x2122;s free dental check-ups for children in our community at the Sunday Breakfast Mission.

2015 YEAR IN REVIEW

Message from the president and CEO

Dear Neighbors, These are exciting times in health care. At Christiana Care Health System, our guiding principles in serving our neighbors are expressed in The Christiana Care Way: We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective and affordable systems of care that our neighbors value. We are transforming health care, moving from a traditional model of care, in which patients come to us in our hospitals and medical offices, to a dynamic, new model where we reach out to “populations” of people in our community. Under this new model, we take greater responsibility for the health of people in our community. For example, we will partner with people who have chronic problems, such as diabetes or heart failure, to manage their conditions and avoid unneeded hospitalization. We will connect at-risk expectant mothers or people with behavioral health issues to the care they need so they can prevent the need for urgent or emergency care. In fulfilling our promise to reach out and become more accessible and accountable, we will improve health outcomes for the people we are privileged to serve. Christiana Care is meeting this challenge by providing services that are innovative and personalized. We aim to provide our patients with a positive experience and that enhances their quality of life. Through the newly formed Christiana Care Quality Partners Accountable Care Organization, we are bringing together physicians and other health care professionals to assist the Medicare population through value-based care. Medicare beneficiaries — and their physicians — can take advantage of Christiana Care’s Care Link, a robust information-technology-enabled network of care coordination support services. As we embrace this new model of providing optimal health and exceptional experience, our goal is to achieve better health outcomes, better experience of care and lower costs. With an emphasis on greater quality and value, we focus on doing the right thing, in the right place, at the right time and with the right set of health care providers. With this approach, our extraordinary team of colleagues and I are committed to advancing The Christiana Care Way to build a stronger and healthier community. 

JANICE E. NEVIN, M.D., MPH

CHRISTIANA CARE HEALTH SYSTEM

PRESIDENT AND CHIEF EXECUTIVE OFFICER

Advancing care in our community.

At Christiana Care Health System, we are committed to innovative programs and models of care that make care more accessible to our neighbors and also improve the overall health of the community. Weâ&#x20AC;&#x2122;re also making appointments more convenient and efficient, providing care in ways patients value. Our electronic health record system helps to identify patients who need extra help, while empowering health care providers to partner with colleagues and patients to eliminate costly duplications of services and other waste. Our education and outreach workers take screenings directly to underserved communities, helping connect uninsured people with coverage and other resources. We treat patientsâ&#x20AC;&#x2122; minds, as well as their bodies, embedding behavioral health services with primary and specialty care. 2015 YEAR IN REVIEW

‘‘

I truly appreciate your help.

CHRISTIANA CARE HEALTH SYSTEM

Glennis

Caring for our community

Primary care put her on the road back to health

Glennis Fistzgiles has high blood pressure. She is anemic. She has asthma and uses an inhaler to help her breathe. Her hip was damaged by avascular necrosis, which occurs when blood flow to a bone is reduced, and she needs a joint replacement. For years, she relied on the Emergency Department when she got sick. Now, she is connected to respectful, expert partners in her health who are keeping Fistzgiles out of the hospital through an innovative, affordable model of care. “She is a shining example of how we can improve population health through highquality primary care,” said her physician, Sarah Schenck, M.D. Population health addresses the health outcomes of a group of individuals. The population can be a neighborhood, employees, an ethnic group or any other defined group. In Fistzgiles’ case, the population is high-risk patients, defined as individuals who are dealing with multiple illnesses or medications, or may have been hospitalized numerous times.

For patients like her, a visit with her doctor is seldom routine. “Now we are at the point where we can replace your hip,” Dr. Schenck told Fistzgiles during a recent appointment. “After that, you’ll be feeling much better and be able to walk more.” Dr. Schenck connected her with a pulmonologist in the community, who will make sure her lungs are strong enough for anesthesia. She ordered a hip X-ray that will be forwarded to an orthopaedic surgeon.

She noted that it is time for her to get a tetanus shot and a mammogram. Months ago, the 54-year-old mother of five was much sicker. She had a large abdominal abscess. There was a suspicious spot on her lung. She was hospitalized for two weeks. To help keep her out of the hospital, Fistzgiles was enrolled in a program a called Ambulatory ICU, which includes short-term intensive nursing follow-up. continued

“ With so many doctors and follow-ups to coordinate, we were concerned that Glennis would be lost in the shuffle. We are her health care team, and Dr. Schenck is the quarterback.” Crystal Pollock, RN-BC, care coordinator

2015 YEAR IN REVIEW

Primary care Crystal Pollock, RN-BC, her care coordinator, makes her appointments with Dr. Schenck, as well as specialists and other resources in the community. She arranges for tests and transportation. And she calls Fistzgiles often to remind her of upcoming appointments, make certain she understands her medications and answer any questions. “With so many doctors and follow-ups to coordinate, we were concerned that Glennis would be lost in the shuffle,” Pollock said. The primary care team at the Rocco A. Abessinio Family Wilmington Health Center at Wilmington Hospital is enhanced with a pharmacist, a social worker and a behavioral health specialist to seamlessly connect patients who need extra help with care. Dr. Schenck is chief of the Division of Ambulatory Medicine, Section of General Internal Medicine, and medical director of the Wilmington Adult Medicine Practice. “We are Glennis’ health care team, and Dr. Schenck is the quarterback,” Pollock said. Health problems have taken a toll on Fistzgiles. She lives with chronic pain, making it difficult to walk the nine blocks from her home to Wilmington Hospital. She has been unable to work since 1999. The new model of care is proving to be a game changer. It has been almost a year since Fistzgiles was discharged from the hospital. She has not been readmitted or required care 6

CHRISTIANA CARE HEALTH SYSTEM

in the Emergency Department since. She feels better than she has in years. “Now I have Dr. Schenck and Crystal to keep me on track,” she said. Treating her abdominal abscess required six weeks of intravenous antibiotics. Pollock coordinated infusion service specialists to go to her home to change her dressings and educate her husband on administering the medications. It’s the care coordinator’s job to keep up-to-date with all the resources in the health system and the community and to link patients with care they value. Before Fistzgiles leaves the office, Pollock gives her a printout with a list of the appointments she has made for her. “Afternoons are still best for you, right?” she asked. “Yes, thank you,” Fistzgiles replied. “I truly appreciate your help.” Fistzgiles helps, too, by partnering with the team. After many years of smoking, she was able to kick the habit. Dr. Schenck prescribed medication to get her over the rough patches and explained to her that giving up cigarettes would help her to heal faster. If she has a concern about her health, Fistzgiles is proactive. She doesn’t wait for a small problem to become a big problem. “When she needs something, when she has a question, she calls me and we get an answer for her right away,” Pollock said. “There is a trust there.” 

Did you know? Population health addresses the health of a group of individuals. The population can be a neighborhood, employees, an ethnic group or any other defined group.

Caring for our community

Highlights

O F O U R COM M U N I T Y P RO G R A M S A N D S E RV I C E S

Integrative model blends behavioral health and primary care Christiana Care’s innovative model of integrating therapists within specialty and family medicine practices is opening doors to many children, adolescents and adults who might otherwise not seek care. About 25 percent of patients seen by primary care providers have behavioral health issues. Many never ask for help because they are concerned about the stigma often associated with mental health or they don’t understand the impact mind-related issues have on their bodies. If they are referred to a therapist, there is often a wait.

Independence at Home offers patient-centered care for homebound seniors Christiana Care is one of only 16 health systems nationwide selected to participate in the three-year Centers for Medicare and Medicaid Services Independence at Home (IAH) project. This model 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. “In the home, we get to see patients in their own environment and gain insight into their lifestyles and support systems,” said Ina Li, M.D., director of Geriatrics

for the Department of Family & Community Medicine, medical director of the Visiting Nurse Association and IAH program director. “Through our visits, we are able to learn how patients are living with their medical conditions and how they use their medications.” A team of physicians, nurse practitioners, physician assistants, nurses, social workers and medical assistants coordinate services, including phlebotomy, home nursing, physical and occupational therapy, radiology and social services in the home for about 550 homebound patients in New Castle County.

Real-time collaboration among patient, primary care provider and behavioral health specialist means patients get help faster, often that same day. With the patient’s permission, the primary care physician can ask the on-site therapist to join them in a confidential consultation that is part of the medical office visit, eliminating barriers to care.

Taking breast cancer education to the community People who want to learn more about breast cancer found education and answers at Every Woman Matters: A Breast Health & Wellness Conference

sponsored by Christiana Care’s Helen F. Graham Cancer Center & Research Institute and partner organizations. The all-day event featured lectures and question-and-answer sessions on exercise, nutrition, genetic links to breast and ovarian cancers, and spiritual and emotional wellness. Breakout sessions focused on metastatic breast cancer and clinical trials, young survivors and improving self-image.

An ‘A’ in school-based wellness centers For 30 years, Christiana Care has made care more accessible for adolescents through wellness centers embedded in high schools. In the 2013-2014 school year, adolescents visited wellness centers in 15 schools a total of more than 21,000 times. Each visit was a chance for the doctors, nurse practitioners, social workers and registered dietitians supporting the centers to provide care to students who are uninsured or uncomfortable seeking care at a physician’s office or other facility. The centers provide services that include physical exams, health screenings, women’s health care, nutrition and weight management, drug and alcohol abuse counseling, and individual, family and group counseling.

2015 YEAR IN REVIEW

Caring for our community Addressing the health needs of the older LGBTQ community Clinicians and community members, including outreach workers and transgender people, learned about the challenges of caring for older lesbian, gay, bisexual, transgender and questioning people at a day-long seminar, “LGBTQ Aging and Healthcare: A Cultural Competency Perspective.” Having conversations about sexual orientation and gender identity is essential in providing high-quality care. LGBTQ patients often have different risk factors than straight people, said the Rev. Timothy D. Rodden, M.Div., MA, director of Pastoral Services at Christiana Care and co-chair, Delaware LGBTQ Health Equity Task Force.

Volunteer dental residents promote healthy smiles There were smiles all around at the Sunday Breakfast Mission when Christiana Care dental residents partnered with community dentists to provide free dental screenings for children headed back to school. For the second consecutive year, medical residents volunteered at the event at the homeless shelter in Wilmington. Besides identifying cavities and other problems, the residents educated parents and kids to seek regular dental care. They also encouraged families to avoid sugary foods and demonstrated proper brushing techniques. Christiana Care distributed free toothbrushes, toothpaste and dental rinse.

CHRISTIANA CARE HEALTH SYSTEM

Strong and Healthy Latinas At the 9th Annual Strong and Healthy Latinas: Love Yourself, Love Your Family event, women and their families came to learn about breast health, receive flu shots and screenings, schedule mammograms, exercise and hear inspiring speakers give tips for keeping their families healthy and strong. The outreach and education staff at the Helen F. Graham Cancer Center & Research Institute work to educate people, particularly women, who then take what they learned back to their families and communities. The day-long Spanish-language program also featured an educational Latina Baby Shower for new moms and dads or those considering starting families.

Gay men are 43 times more likely to develop anal cancer. Lesbians are more likely to have risk factors for breast and gynecological cancers, yet are less likely to get screenings. LGBTQ people overall are at a higher risk for depression and substance abuse.

25 years of free skin cancer screenings For the past 25 years, Christiana Care and the Academy of Dermatology have partnered to offer skin cancer screenings to help people get diagnosed early, when melanoma is highly curable. At the June 2015 event, 132 individuals were screened at the Helen F. Graham Cancer Center & Research Institute. Of that number, 58 were referred for followup visits, including 11 people who do not have insurance. For some people, screening is a lifesaver. Diagnoses of melanoma, the deadliest form of skin cancer, were

23 percent higher in Delaware than the national average from 2006-2010, according to the Centers for Disease Control and Prevention.

Partnering with homeless people to provide care, respect In the heart of one of the city’s poorest neighborhoods, Christiana Care workers and volunteers deliver riches beyond measure in the form of care, respect, nourishment and hope to homeless people at St. Patrick’s Center on Wilmington’s east side. Volunteer teams of Christiana Care employees and friends prepare and serve bagged lunches. Sharing food and conversation helps Christiana Care nurses and social workers embedded at St. Pat’s uncover the needs of homeless people and coordinate services to help. Since Christiana Care teamed with St. Pat’s to coordinate social services, the number of people using the Emergency Department for social needs dropped an astounding 83 percent. 

Advancing heart and vascular medicine. The Center for Heart & Vascular Health provides patients in Delaware and the surrounding area with superb access to expert care and leading-edge technology â&#x20AC;&#x201D; and is the only center in the region to offer these services under one roof, offering patients the convenience of comprehensive care without missing a beat. From prevention to planned care and emergency care, through rehabilitation and ongoing support, we are your partners in achieving your best heart health.

2015 YEAR IN REVIEW

‘‘

They have shown in so many ways that they truly care for me as a person.

CHRISTIANA CARE HEALTH SYSTEM

Aaron

Advancing heart and vascular medicine

Advanced technology and expert care offer new hope to heart patient

Aaron Lee grew up giving his whole heart to everything he pursued. He was an Eagle Scout, the loftiest achievement in scouting. He amassed an impressive coin collection. He expected to earn a college degree while working a part-time job, without missing a beat. “I was overweight but I didn’t have a problem with it,” said Lee, 26, of Middletown. “I used to ride my bike to pick up groceries.” Then he got too tired to pedal to the store. His mother became even more alarmed when he turned blue. For expert care, he turned to Christiana Care Health System’s Center for Heart & Vascular Health. The center’s Heart Failure Program is the only program in Delaware to receive advanced certification in heart failure from the Joint Commission. Lee was diagnosed with familial cardiomyopathy, a hereditary condition in which the heart muscle becomes enlarged, thick or rigid. His mother and brother also learned they have the disease. As cardiomyopathy progresses, the heart becomes less able to pump blood through

the body and maintain a normal electrical rhythm. Lee was only 20 when doctors implanted a defibrillator, a device that delivers a therapeutic dose of electricity to “shock” the heart into a healthy rhythm. “It went off three times,” he recalled. “It was clear I was very ill.” He wondered if he would ever be able to go to school or build a career. “It was hard to go anywhere because I was so short of breath,” he said. “I couldn’t walk more than a few yards.” Lee found a lifeline in the Left Ventricular Assist Device (LVAD), the most advanced treatment short of transplant for people with heart failure. Introduced in 2011, Christiana Care is the only health system in the state to offer LVAD and earn Joint Commission Advanced Certification in Ventricular Assist Device Destination Therapy. Lee was 22 and the second patient to receive the device. The battery-powered LVAD is implanted during open-heart surgery and replaces the pumping action of the heart. For Lee, the device serves as a bridge to

“Aaron is a true partner in his health, working with the multidisciplinary team at the Heart Failure Program to reclaim an active life. He also can receive tests and procedures at the Center for Heart & Vascular Health to prepare for his transplant, allowing him to receive care close to home.” Mitchell Saltzberg, M.D., medical director, Heart Failure Program

continued

2015 YEAR IN REVIEW

Advanced technology and expert care transplant. LVAD also helps patients for whom a transplant is not an option. LVAD is part of a comprehensive approach that allows patients to receive tests, medications, stress management, nutrition counseling, psychological care and other highquality services, said Mitchell Saltzberg, M.D., medical director, Heart Failure Program. Lee remembers the days after his surgery at Christiana Hospital, where the team focused on both his physical and emotional recovery. “My dog Lucy was incredibly depressed because I wasn’t at home,” he said. “So they made arrangements for her to come to the hospital and visit me.” After his recovery, LVAD provided a significant boost in his energy level. “With LVAD I can do things. I can walk distances without getting tired.” He went back to school and received an associate degree in applied science at Delaware Technical Community College. Now he is pursuing his bachelor’s degree at Wilmington University. He landed a contract job with DuPont. His next milestone was undergoing bariatric surgery in order to meet weight requirements for a heart transplant. “I weighed 400, and my goal is to lose at least 130 pounds,” he said.

CHRISTIANA CARE HEALTH SYSTEM

Dr. Saltzberg noted that Lee is a true partner in his health, working with the multidisciplinary team at the Heart Failure Program to reclaim an active life. He also can receive tests and procedures at the Center for Heart & Vascular Health to prepare for his transplant, allowing him to receive care close to home. “Aaron has persevered to obtain a degree, find employment and face his chronic issues with obesity to proceed with bariatric surgery and become a transplant candidate,” he said. Lee said the Heart Failure team provides him with much more than expert care. They help him with paperwork. They offer encouragement and compassion.“When I lost my insurance, they connected me with a program to forgive my medical bills,” he said. “They helped me through the maze so that I could get other coverage.” One day, Lee forgot the backup batteries that power his LVAD. “They were able to quickly find me a loaner set,” he said. “They basically made it so that I could keep my job.” Three months after he received his LVAD, Lee’s father died. The team offered immediate support. “They kept the office open late so I could see my psychologist,” he said. “They have shown in so many ways that they truly care for me as a person.”  Joint Commission Award Advanced Certification in Ventricular Assist Device Destination Therapy for patients with advanced heart failure.

2015 Patient Care Stats: Open-heart cases Ventricular assist device cases Transcatheter aortic valve replacements Cardiac-catheterizations Electrophysiology cases Vascular surgeries Vascular interventional radiology cases Cardiovascular non-invasive studies Vascular ultrasound studies Cardiac rehabilitation monitored visits

726 5 51 4,760 1,633 1,346 4,851 17,727 21,081 20,105

Advancing heart and vascular medicine

Highlights

F ROM T H E C E N T E R F O R H E A RT & VA S C U L A R H E A LT H

An initial study that led to dramatic reduction in cardiac telemetry use at Christiana Care demonstrated that less than 1 percent of telemetry alarms represented relatively important clinical events. The new study probed the 1 percent of 78 telemetry alarms that were considered “real” alarms. Of the 78 alarms, only one presented an actual life-threatening situation — and even that case quickly resolved itself without any medical interventions. Only 29 alarms were classified as clinically important.

An innovative approach to exploring heart failure

Building bridges to fully integrated health information Christiana Care’s transformative Bridging the Divides program, which helps patients with ischemic heart disease to transition successfully from hospital care and improve their long-term health, has achieved a historic milestone. The program is now fully integrated with the Delaware Health Information Network. This monumental achievement means that care managers can obtain instant updates on new medical information at any time from any one of the 3,000 patients in the Bridges program anywhere in the state. For example, if a patient enters an urgent-care

center in Smyrna or visits a specialist in Claymont, care managers receive immediate notifications and can proactively make changes to their care plan. This new milestone represents significant progress toward the program’s fundamental goals of achieving medicine’s Triple Aim: better health, better health care and reduced costs.

Follow-up study affirms safety of reduced cardiac telemetry The prestigious Journal of the American Medical Association affirms a study indicating that reduced use of cardiac telemetry is safe outside the intensive care unit.

Four fellows from diverse academic backgrounds are working together at Health for America, an innovative program focused on improving the treatment of chronic disease. Last year, the fellowship’s focus was heart failure. The inaugural initiative was a partnership with Christiana Care, Discover Bank, Start It Up Delaware and the Delaware Community Foundation. Fellows took an entrepreneurial approach to developing a solution for patients that is effective, sustainable and commercially viable. Heart failure, in which the heart can’t pump enough blood to meet the body’s needs, is responsible for 1 million hospital admissions in the U.S. each year. The fellows are engaging a wide range of stakeholders at Christiana Care and across

the country in addressing heart failure, including patients, doctors, pharmacists, policy makers, caregivers and others.

Dr. Garrett is associate medical director Kirk Noel Garrett, MSc, M.D., a noted interventional cardiologist, researcher and author, has been named associate medical director of the Center for Heart & Vascular Health. Dr. Garratt spent 25 years at Mayo Clinic and was a member of the team of physicians who first performed minimally invasive procedures at the clinic, including laser angioplasty, directional coronary atherectomy and coronary stent implantation. In 2005, he joined North ShoreLIJ, Lenox Hill Hospital and Lenox Hill Heart and Vascular Institute in New York, serving as staff interventional cardiologist and director of cardiac intervention and cardiovascular research programs for physician education and training, quality and process improvements.

2015 YEAR IN REVIEW

Advancing heart and vascular medicine

Highlights F ROM N E U RO S C I E N C E S Expert stroke care Christiana Care ranks in the top 10 health institutions in the U.S. in the number of stroke cases we treat and is among an elite group to achieve Comprehensive Stroke Center Certification from the Joint Commission and the American Heart Association/American Stroke Association. We provide 24-7 availability of expertise in stroke care, including neurologists, neurosurgeons and neurointerventional radiologists.

Ranked 10th in the U.S. for the treatment of stroke.

Neuro Critical Care Unit for serious neuro illness and injury Dr. Gardner honored with lifetime achievement award Timothy J. Gardner, M.D., medical director of Christiana Care’s Center for Heart & Vascular Health and executive director of the Value Institute, received the American Association for Thoracic Surgery’s Lifetime Achievement Award. This award recognizes individuals for their significant contributions to the specialty in the areas of patient care, teaching, research or community service. He served as AATS president in 2001-2002. He also served as president of the American Heart Association and was the first International Councilor for the European Association for Cardio-Thoracic Surgery.  American Heart Association Awards • Heart Failure Gold Plus Award for exceptional care of patients with heart failure. • Mission Lifeline Bronze Award for improving STEMI and cardiac resuscitation systems of care. American College of Cardiology Foundation Award National Cardiovascular Data Registry ACTION Registry-GWTG Gold Performance Achievement Award for success in carrying out a higher standard of care for heart attack patients.

CHRISTIANA CARE HEALTH SYSTEM

The Lanny Edelsohn, M.D., Neuro Critical Care Unit at Christiana Hospital provides patients their greatest chance of survival through expert care that is critical to treating serious neurovascular illnesses and injuries. The unit treats as many as 650 acute-stroke patients each year, providing high-quality treatment close to home. The NCCU is equipped with electro-encephalogram (cEEG) technology for more advanced neuromonitoring, which is considered fundamental in helping to prevent irreversible neurological damage, severe disability and death. This innovative technology also improves the evaluation and treatment of seizure disorders.

Neurovascular Symposium highlights advances in stroke care Comprehensive stroke care — from ambulance to rehabilitation — was the topic of the Third Annual Christiana Care Neurovascular Symposium on April 17 at the John H. Ammon Medical Education Center. The conference highlighted an evolution in stroke care that has taken it from a chronic disease to a treatable emergency. Christiana Care is one of the highest-volume health systems for stroke in the U.S., with 1,200 stroke patients each year. Christiana Hospital is certified as a comprehensive stroke center by the Joint Commission and the American Heart Association/American Stroke Association, a promise of the highest standard of care.  American Heart Association Award Get With The Guidelines-Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll.

Advancing the fight against cancer.

The Helen F. Graham Cancer Center & Research Institute is leading the way in Delawareâ&#x20AC;&#x2122;s dramatic decline in cancer and deaths from cancer, benefiting patients through enhanced access to evidence-based medicine, research and preventive care, including screenings through community outreach. From 2007 to 2011, Delawareâ&#x20AC;&#x2122;s cancer mortality declined 15.8 percent. That is 21 percent more than the national decline of 13.1 percent. Mortality from breast cancer declined 24.5 percent. That is 37.6 percent more than the U.S. average decline of 17.8 percent. One of the first designated National Cancer Institute Community Cancer Centers Program sites, the Graham Cancer Center is a national leader in enrolling patients in clinical trials and providing comprehensive care, including a team of world-class cancer specialists. Our patient navigation system advances patient- and family-centered care and is a model emulated around the country. 2015 YEAR IN REVIEW

Supporting survivors in life after cancer In 2013, Dawn Phifield rang the bell at Christiana Care’s Helen F. Graham Cancer Center & Research Institute, a traditional celebration for patients who have completed radiation therapy. But the journey for Phifield and other cancer survivors doesn’t end with treatment. “Having cancer changes your whole outlook on life,” she said. “It’s something you think about every day.” At the Graham Cancer Center, the Cancer Psychosocial Oncology & Survivorship Program offers counseling and outpatient social work services to help patients and

families through all stages of cancer, as well as a survivorship program to educate and prepare people for life after treatment. Led by psychologist Scott Siegel, PhD., it’s a fastgrowing service that has nearly doubled in less than a decade with 2,000 patient contacts in the last year alone. “Since 2007, we have integrated psychology and psychosocial services into the multidisciplinary approach to treatment at the Graham Cancer Center,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director. “Our model is replicated around the country.”

Phifield, 53, of Bear, underwent treatment for stage 3 breast cancer, including a double mastectomy, radiation, chemotherapy and Herceptin therapy. “I am a very optimistic person, but it was still frightening to learn that I had cancer,” she said. Receiving expert care that also was compassionate and respectful gave Phifield a feeling of comfort and reassurance. She recalls being examined by her surgeon, Diana Dickson-Witmer, M.D., medical director, Christiana Care Breast Center. “She touched me and it was like silk,” she said. “She has the gentlest, kindest hands.” After the examination, Phifield thanked Dr. Dickson-Witmer for her care.“She said, ‘it is my privilege,’” Phifield recalled. “That attitude pervaded everyone who cared for me at the Graham Cancer Center.” continued

“They don’t have to find me. I go to the patient. They have been on a roller coaster, focused on their appointments, their treatments, and getting well. Then they ring the bell and ask, now what?” Darcy Burbage, MSN, RN, AOCN, CBCN, nurse navigator

CHRISTIANA CARE HEALTH SYSTEM

‘‘

Advancing the fight against cancer

The people here have been my rock... thanks to them, I am a survivor. Dawn

2015 YEAR IN REVIEW

Supporting survivors Halfway through her radiation treatments, Phifield heard another patient ring the bell and wept with joy for her. She yearned for the day when she, too, would mark that milestone. Darcy Burbage, MSN, RN, AOCN, CBCN, Survivorship nurse navigator, was in the treatment area. She approached and asked if she would like to talk. Phifield welcomed the opportunity. “Darcy was like a warm blanket, so comforting.” Burbage is embedded in radiation oncology and engages patients midway through treatment. “They don’t have to find me. I go to the patient,” Burbage said. She sees about 30 patients a week. Most are still in treatment, but some completed care years ago. Providers refer patients, or patients can refer themselves. There is never a fee. Burbage also connects patients with resources, including evidence-based management techniques for dealing with treatment side effects, research assistance at the Graham Cancer Center library, nutrition education, counseling, and resources in the community, such as support groups. “Patients have been on a roller coaster, focused on their appointments, their treatments and getting well,” Burbage said. “Then they ring the bell and ask, now what?” She educates patients about side effects that may linger, such as fatigue, neuropathy, skin changes and decreased range of motion.

CHRISTIANA CARE HEALTH SYSTEM

“We discuss changes in responsibilities at home and work, changes in body image and sexuality, and ‘chemo brain,’ in which people have difficulty with recall,” she said. Phifield enrolled in physical therapy at the Graham Cancer Center to help ease neuropathy in her feet, a painful nerve condition that is a side effect of treatment. She regained much of her upper-body mobility through stretching exercises. She became part of the powerful community of survivors and their loved ones who support people who have cancer. When she comes to the Graham Cancer Center for follow-up care she visits patients in chemo “to help them pass their time.” She also has been affirming life. On May 17, 2014, she got married on the beach in Rehoboth. Her new husband Skip and the wedding party then immediately embarked on the Delaware Breast Cancer Coalition walk, arriving with a Just Married Sign and streaming tin cans on the back of their car. Phifield carried her bridal bouquet. Life keeps happening. Phifield is back at work at Delaware Park. She and her husband enjoy rides on his motorcycle. In April, she celebrated the wedding of her daughter. The whole family is planning a trip to Disney World. “The people at the Helen F. Graham Cancer Center have been my rock, from the greeter at the door to the doctors and nurses,” she said. “Thanks to them, I am a survivor.” 

24.5

decline in Delaware’s breast cancer mortality from 2007 to 2011, exceeding the U.S. average decline by more than 37%.

1,679,043 patient visits to the Helen F. Graham

Cancer Center & Research Institute since opening in 2003.

top 10 in clinical trials in the U.S.

Advancing the fight against cancer

Highlights Transforming community cancer care The National Cancer Institute has selected Christiana Care’s Helen F. Graham Cancer Center & Research Institute to join its Community Oncology Research Program (NCORP), an elite network of cancer centers. A five-year, $8.2 million grant from NCORP bolsters Graham Cancer Center initiatives to bring leading-edge cancer screenings, prevention, control, treatment and imaging research trials to more people in places close to where they live and work. The Graham Cancer Center is one of only 34 NCORP Community Sites joined by 12 Minority/Underserved Community Sites that will implement the latest, most scientifically advanced clinical research designed and led by NCORP. The trials will test new technologies and strategies to fight cancer. They also will enable research on delivering care in ways that improve outcomes and reduce disparities.

Christiana Care ranks in top 10 in clinical trials Christiana Care’s Helen F. Graham Cancer Center & Research Institute has earned distinction as a top accruing member of the National Clinical Trials Network (NCTN) sponsored by the National Cancer Institute (NCI).

F ROM T H E H E L E N F. G R A H A M C A N C E R C E N T E R & R E S E A RC H I N ST I T U T E

The Graham Cancer Center ranks 8th among NCI Community Oncology Research Program (NCORP) sites enrolling the highest numbers of patients into network clinical trials led by NRG Oncology research group, one of five U.S. research groups now participating in the NCTN. In 2007, the Graham Cancer Center was one of 16 original sites selected by NCI to establish their Community Cancer Center Program. Since then, the center’s overall clinical trial accrual rate has soared upwards of 20 percent, far above the national average of about 4 percent for similar programs.

Patient advocates for clinical care At the Helen F. Graham Cancer Center & Research Institute, members of Oncology Patient Advocates for Clinical Trials (OPACT) inform other patients of the importance and benefits of participating in clinical trials. In addition to supporting patients who are considering clinical trials, OPACT builds bridges between patients and the cancer care community. Currently, there are more than 100 active treatment and preventive trials going on at the Graham Cancer Center.

Medical support helps patients avoid Emergency Department

New radiation oncology residency program

When patients at the Helen F. Graham Cancer Center & Research Institute need prompt medical care, and their doctors aren’t available, they can receive immediate care at an on-site Medical Support Unit.

The Helen F. Graham Cancer Center & Research Institute has initiated its first Radiation Oncology residency program, with approval from the Accreditation Council for Medical Education (ACGME). The four-year program is offered in partnership with Drexel University College of Medicine and Hahnemann University Hospital in Philadelphia, one of the oldest radiation oncology training programs in the nation.

A family medicine physician and nurse practitioner can help patients with side effects of treatment and other issues, as well as administer IV fluids and order CT scans and X-rays. The goal is to provide care that prevents unnecessary hospitalization or trips to the Emergency Department.

2015 YEAR IN REVIEW

Advancing the fight against cancer Tissue microarray technology provides cancer clues

Outreach at Hindu temple helps women access screenings

The Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute is now producing tissue Microarrays or, TMAs, that can preserve hundreds of tiny tumor samples on a single glass slide.

At a Hindu temple in New Castle, women talk about their faith and their families, what they will serve for dinner and what they do at work. Until recently, they did not talk about women’s health. To remove barriers to care, outreach and education workers from the Helen F.

Funding for this leading-edge technology is part of a translational research collaboration between the Graham Cancer Center and the Wistar Institute in Philadelphia. TMAs allow scientists to analyze hundreds of tumor markers using the same set of specimens, all at the same time. This rapid analysis could be a game changer in the drive to translate findings from the bench to the bedside.

Authoring ‘Progress Against Cancer’ Gregory Masters, M.D., a medical oncologist at the Helen F. Graham Center & Research Institute, is co-author of an annual report by the American Society of Clinical Oncology entitled “Clinical Advances in 2015: ASCO’s Annual Report on Progress Against Cancer.” The ASCO Cancer Advance of the Year is the introduction of four new drugs to treat chronic lymphocytic leukemia that are highly effective and much easier for patients to tolerate.

Graham Cancer Center & Research Institute went directly to the temple to build relationships and schedule women for mammograms. They also made arrangements for the Breast Center at the Graham Cancer Center to be open on Sunday, staffed each exam room with an interpreter and arranged an expanded carpool with volunteer drivers at the wheel. 

Dr. Petrelli receives Delaware BioScience Service Award Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute, is the winner of the 2015 Delaware BioScience Association’s Service Award. Dr. Petrelli has championed the fight against cancer in Delaware and has developed the Graham Cancer Center into a national model of care, prevention, outreach and research.

2015 Patient Care Stats: Patient visits

New patients

External beam treaments

Patients in clinical trials

219,043 3,259 29,085 591

CHRISTIANA CARE HEALTH SYSTEM

Advancing science and knowledge.

At Christiana Care, we are passionate about clinical, translational and outcomes research that speeds new technologies, treatments and models of care to improve our neighborsâ&#x20AC;&#x2122; health. Our robust partnerships fuse science and humanity in finding innovative ways to propel research and enhance education. Our diverse patient population is ideally suited to groundbreaking studies that draw national attention. Weâ&#x20AC;&#x2122;re a highly respected teaching institution, attracting the brightest and the best to serve as faculty members and mentors in our acclaimed, fully accredited graduate medical education programs and undergraduate rotations.

2015 YEAR IN REVIEW

‘‘

Genetic research could change everything.

CHRISTIANA CARE HEALTH SYSTEM

Eric Kmiec, Ph.D.

Advancing science and knowledge

Research to ‘skyrocket’ progress toward personalized genetic medicine

The newly founded Gene Editing Institute at the Center for Translational Cancer Research (CTCR) establishes Christiana Care’s Helen F. Graham Cancer Center & Research Institute as part of an elite group of companies and organizations capable of making the latest generation genomeengineering tools. CTCR’S Gene Editing Institute is directed by world-renowned molecular biologist and gene editing pioneer Eric Kmiec, Ph.D., who has worked for 25 years to create tools to tailor genes that change or mutate to cause disease, including cancers. His research teams have developed geneediting technologies, including seminal work on oligonucleotide gene repair, and genetic therapies for inherited disorders such as sickle cell anemia, muscular dystrophy and Huntington’s disease. “Bringing together Dr. Kmiec and his team with our clinicians under one roof promises to be the catalyst that will skyrocket progress toward personalized genetic medicine for our patients,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Graham Cancer Center.

The CTCR’s Gene Editing Institute is dedicated to education, technology development and scientific research into the very core of the human genome. This means designing the tools scientists need to manipulate and alter human genetic material more efficiently than ever before and to better understand and cure many genetic diseases. “Only in the last four or five years have scientists succeeded in putting together a genetic toolbox for us to manipulate and control the genetic material in human cells for therapeutic purposes,” Dr. Kmiec said.

“This could change everything from the way we develop treatments to how we impact patients.” Currently, designer proteins such as ZFNs, TALENs and CRISPRs are capable of honing genetic material into “super shears” used to disrupt and repair rogue genes. These programmable nucleases, genetically engineered in the lab from plants and bacteria, enable researchers to essentially perform microsurgery on genes, acting like molecular scissors to precisely cut into and continued

“ Bringing together Dr. Kmiec and his team with our clinicians under one roof promises to be the catalyst that will skyrocket progress toward personalized genetic medicine for our patients” Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute

2015 YEAR IN REVIEW

Research to ‘skyrocket’ progress delete, add to or modify a faulty strand of DNA to restore it to normal or use it to test new, targeted drugs. But the tools are not perfect. Even CRISPRs, the most efficient models, cut off-target 2 percent of the time, a process called off-site mutagenesis. Dr. Kmiec has improved CRISPRs with a template designed to enhance accuracy. “If you are designing treatment for an inherited disease like sickle cell anemia, for example, where targeted genes are surrounded by a family of close cousins, mistaking the target could be very serious and lead to permanent unwanted genetic defects,” Dr. Kmiec said. His groundbreaking research on sickle cell anemia has led to R&D on the next generation of CRISPRs and TALENs and to even more promising variations such as single-stranded DNA oligodeoxynucleotides to improve precision and reliability. In their largest research project to date, Dr. Kmiec’s team is perfecting these tools to study chromosomal translocations, essentially what happens when bits of chromosomal DNA swap places in a cell, which is known to set off the chain of events leading to several types of leukemia.

CHRISTIANA CARE HEALTH SYSTEM

“We are using CRISPRs to make the translocations in normal cells and changing them into leukemia cells in our lab,” he explained. “This allows us to study in real time how the cell adapts, stage by stage, to that translocation event. In this way we hope to create a series of snapshots of how cancer progresses, and to model these events one by one.” Although his team is currently focused on blood cell cancers, Dr. Kmiec plans to study chromosomal translocation factors in solid tumor cancers, as well. “This work will probably be a major focus of our research over the next 10 years,” he said. The ability to map a cell’s journey toward cancer would be a treasure trove for cancer drug development. Using such an atlas, scientists could change or disable target genes at any point along the cancer continuum to screen anti-cancer drugs for maximum therapeutic benefit. Dr. Kmiec notes that this strategy also could be used to establish tester cell lines that contain genotypes from individual patients who represent the most common genetic backgrounds of a particular cancer, benefitting generations to come. 

Did you know? CRISPRs enable researchers to perform microsurgery on genes, acting like molecular scissors to change a faulty strand of DNA restoring it to normal or using it to test new drugs.

Advancing science and knowledge

Highlights

O F O U R R E S E A RC H A N D E D U C AT I O N I N I T I AT I V E S

Nurses and Value Institute collaborate to reduce falls

10 years of Achieving Competency Today

Nurse leaders and researchers in the Value Institute collaborated to develop strategies to reduce patient falls, focusing on patient-centered hourly rounding, verbally communicating patient fall risks at handoff during shift change and assessing mobility.

For a decade, Christiana Care has supported Achieving Competency Today (ACT), which applies a formal approach to staff education and training in order to facilitate changes in health care delivery that create innovative, effective, affordable systems of care that our neighbors value.

Their success is the topic of a seminal research paper published in Nursing, titled “Patient Falls: The Search for the Elusive Bullet,” the first of five planned articles on identifying issues and finding solutions.

Provided through the Value Institute Academy, interprofessional learners have collaborated on 70 performanceimprovement projects in 19 ACT courses. Participants include resident physicians, physician assistants, pharmacists, nurses, social workers, pastoral care members, laboratory professionals and many others.

The article reports that during the course of a year the fall rate improved a combined 52 percent in three targeted units.

Specialty certification demonstrates commitment to nursing There are more than 1,500 certified nurses at Christiana Care, representing more than 100 specialties. That includes 66 percent of bedside nurses and 88 percent of nurse leaders. National certification is a professional achievement that demonstrates a nurse’s commitment to the pursuit of excellence in specialty nursing practice areas. To support nurses in their certification efforts, Christiana Care offers in-person and online review courses in addition to initial testing fees and certification renewal.

Research probes accuracy of medication records

Patients fare better when referred to VNA from Emergency Department

Christiana Care researchers who compared pharmacy claims on primary care practices’ Electronic Health Records (EHR) show discrepancies between the two nearly half the time. Their findings were reported in the American Journal of Managed Care.

Within 24 hours, patients who are referred directly from the Emergency Department to the Visiting Nurse Association are getting care and education at home. As a result, 94 percent of those patients did not seek readmission to the hospital within seven days.

Researchers wanted to see how accurately EHRs listed patient medications. The findings suggest the potential benefits and drawbacks of using aggregated claims data to improve the efficiency and quality of medication reconciliation.

It’s an example to how Christiana Care is working to take care of neighbors in a way that is both cost effective and in keeping with the way patients want to be treated.

2015 YEAR IN REVIEW

H E L E N F. G R A H A M C A N C E R C E N T E R & R E S E A RC H I N ST I T U T E

Pioneers in early testing for lung cancer Clinicians at the Helen F. Graham Cancer Center & Research Institute are working with scientists at The Wistar Institute in Philadelphia to develop the first commercially viable blood test for lung cancer. Established in 2011, the Graham Cancer Centerâ&#x20AC;&#x2122;s partnership with Wistar is a compelling example of the growing translational research effort at Christiana Care. This initiative seeks to develop a simple blood test to identify a marker for non-small cell lung cancer, the most commonly diagnosed form of lung cancer.

The test has the potential to distinguish malignant from benign lung nodules in high-risk patients, saving them years of follow-up CT scans and needless biopsies. The test also could indicate if cancer surgery is successful and if the cancer might return.

Unlocking the key to aggressive breast cancers The breast cancer research program at the Helen F. Graham Cancer Center & Research Institute is focused on identifying factors that contribute to the formation and progression of aggressive breast cancers. Women with triple negative breast cancer (TNBC) have worse outcomes than women with

hormone receptor positive breast cancer but previous research focused on genetic mutations within tumor cells has failed to provide an explanation why. Preliminary data gathered in the laboratory of Jennifer Sims-Mourtada, Ph.D., senior clinical scientist in the Center for Translational Cancer Research, suggests that the aggressive nature of TNBC is a result of the early recruitment and activity of immune cells in the microenvironment of the breast. Researchers believe these inflammatory cells release cytokines that initiate a cascade of events that not only result in malignant transformation and growth of breast cancer, but may determine the type of breast cancer that develops. Recent studies using the cytokine interleukin-6 show expansion of normal breast stem cells (a population of cells that are thought to be involved in tumor initiation), and increased expression of markers that are commonly associated with TNBC. The next step is to introduce a genetic mutation in these normal cells, to determine if inflammation in combination with a certain genetic mutation can cause the cells to look and behave like TNBC. If this happens, researchers will test the ability of anti-inflammatory agents to prevent this transformation.

CHRISTIANA CARE HEALTH SYSTEM

Hope for lung cancer patients in advanced stages Patients with advanced lung cancers can feel better and live longer even after conventional therapies fail, according to results of a clinical trial of sacituzumab govitecan, which combines a chemotherapy drug with a humanized antibody created in the lab to target the Trop-2 receptor expressed by many solid tumors. Michael Guarino, M.D., investigator, and Gregory Masters, M.D., coinvestigator, are medical oncologists at the Helen F. Graham Cancer Center & Research Institute. A multicenter study showed that treatment with sacituzumab govitecan produced tumor shrinkage of 30 percent or more in patients with non-small cell lung cancer (32 percent) and small cell lung cancer (30 percent). The study also showed that patients who had already undergone chemotherapy with or without radiation were able to safely tolerate sacituzumab govitecan.

Advancing science and knowledge C E N T E R F O R H E A RT & VA S C U L A R H E A LT H

Clinical trial for diabetic heart patients Christiana Care is part of an important trial to determine if a drug that has been used for decades to reduce inflammation and symptoms in patients with rheumatoid arthritis also reduces the risk of stroke and heart attacks. The Cardiovascular Inflammation Reduction Trial (CIRT) focuses on patients with diabetes or the metabolic syndrome who are at higher risk of developing major adverse cardiovascular events because of vascular inflammation. In the trial, patients randomly receive either a low dose of methotrexate or a placebo and are followed for stroke, heart attack or death for three to four years.

Grafting outperforms angioplasty in study An article by Christiana Care researchers in the January 2015 Journal of the American College of Cardiology reports that coronary artery bypass graft surgery (CABG) commonly used to treat patients with coronary heart disease results in improved quality of life, but costs more than another often-used, less invasive technique: percutaneous coronary intervention (PCI). The research is the first of its kind nationwide to evaluate and compare hundreds of thousands of clinical and administrative claims data to determine both the survival benefit and overall costs of CABG compared to PCI.

The American College of Cardiology Foundation/The Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies (ASCERT) study found that patients who underwent bypass graft surgery lived longer, were able to function better and had fewer additional procedures than those treated with angioplasty. As a large observational study, it has demonstrated a survival advantage associated with CABG, but surgery is more expensive, due almost entirely to the initial costs associated with the operation.

Review discloses more reasons to ‘hold the salt’ A review of more than 100 studies by Christiana Care and the University of Delaware concludes that excess salt intake wreaks havoc on multiple organs in the body in addition to contributing to high blood pressure. Consuming too much salt can adversely impact the heart, kidneys, blood vessels and brain, according to research published in the March 17, 2015 issue of the Journal of the American College of Cardiology co-authored by William Weintraub, M.D., the John H. Ammon Chair of Cardiology and founding director of Christiana Care’s Center for Outcomes Research.

“Our goal is to arm patients and their families with the information they need to make healthy decisions about their diets so they can live healthy lives,” Dr. Weintraub said.

Studying radial catheterization outcomes Transradial cardiac catheterization (TRI), in which a catheter is introduced via an artery in the wrist, has grown in popularity compared to the standard transfemoral (TFI) approach through the groin, driven by improved patient comfort, decreased bleeding and reduced mortality. Research at Christiana Care’s Center for Heart & Vascular Health focuses on short- and long-term changes in radial artery anatomy as measured by ultrasound following TRI to determine whether the procedure leads to short- and longterm endothelial dysfunction, which impacts the ability of the inner lining of blood vessels to dilate and contract, and whether anatomic changes can predict the development and maintenance of endothelial dysfunction. Sandra Weiss, M.D., an interventional cardiologist at Christiana Care, is working in partnership with the vascular biology research department at the University of Delaware. Funding was awarded to Dr. Weiss as part of a Young Investigator DE-CTR Pilot Project. William Weintraub, M.D., the John H. Ammon Chair of Cardiology and founding director of the Center for Outcomes Research, is senior mentor. 2015 YEAR IN REVIEW

Advancing science and knowledge N E U RO S C I E N C E S

WOM E N ’ S & C H I L D R E N ’ S H E A LT H

Studying measures for coma patients

Studying development in at-risk newborns

Patient and family council for Women’s and Children’s

Researchers are using a minimally invasive electroencephalogram system that is equipped with a sensor net fitted to the head of comatose patients. This technology will isolate measures of resting electroencephalogram (rEEG) and Event Related Potentials (ERP), and may help neuro-specialists evaluate prognosis after brain injury.

Christiana Care is a key player in a study to assess if a device that assists in lifting infants’ arms can advance the ability of high-risk babies to explore, play and solve problems. The study focuses on babies with diagnoses that have the potential to lead to problems with development, such as injury to the brachial nerves, bleeding in the brain, neonatal stroke or lack of oxygen to the brain, Down syndrome, arthrogryposis, and neonatal encephalopathy. The project is in collaboration with the University of Delaware and Nemours/ Alfred I. duPont Hospital for Children and is funded by the National Institutes of Health.

Women of all ages, parents and family members are providing fresh insights through the recently introduced Patient and Family Advisory Council for Women’s and Children’s Services. Members partner with Christiana Care leaders and staff to provide a patient’seye view of projects and services in women’s health and pediatrics.

The goal is to investigate the feasibility of obtaining rEEG and ERP measures from patients early in their hospital stay, and to determine whether combining the two measures will improve accuracy in predicting awareness after coma. If robust signals can be isolated early enough, this technology has the potential to help family members who are faced with the difficult decision between long-term care or withdrawal of care for their loved one. Ethan Kahn, D.O., a Christiana Care neuro intensivist, is partnering with James Hoffman, Ph.D., a professor of psychology at the University of Delaware, with support from the Lanny Edelsohn Fund and funds provided by the Delaware CTR Young Investigator Pilot Project Grant.

CHRISTIANA CARE HEALTH SYSTEM

Preventing lung trauma in premature babies Research by Christiana Care’s Division of Neonatology shows that a bundled clinical guideline approach reduces scarring of the lungs — known as bronchopulmonary dysplasia or BPD — in premature infants. The bundled approach includes increasing the early use of continuous positive airway pressure (CPAP) and minimizing babies’ exposure to mechanical ventilation. The study concludes that introducing CPAP in the delivery room results in a decrease in the need for mechanical ventilation at the time of birth that continues over the first 72 hours of life.

Delayed cord clamping reduces transfusions Christiana Care researchers studied the impact of guidelines by the American College of Gynecology and American Academy of Pediatrics recommending that umbilical cord clamping be delayed in infants born before 37 weeks gestation. Researchers found that the need for packed red blood cell transfusions in infants weighing less than 1,500 grams decreased from 54 percent to 32 percent, with no increase in neonatal complications. The cost savings was $100,000 in the first year.

Internationally recognized obstetrics research Richard J. Derman, M.D., MPH, Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology, is a coauthor of a study that assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality and neonatal mortality rates in rural Belgaum, India. The study, published in the journal Maternal and Child Health, concludes that while most women are now reaching health facilities for delivery in this region, additional efforts to improve quality of care at those facilities are needed to further improve perinatal and newborn outcomes. Dr. Derman is a principal investigator of the Global Research Network for Women’s and Children’s Health, funded by the National Institutes of Health. 

Student researcher Rachel Brown is collaborating with staff in Christiana Careâ&#x20AC;&#x2122;s Lanny Edelsohn, M.D., Neuro Critical Care Unit to improve the care of stroke patients. Brown is pictured here with Valerie Dechant, M.D., medical director of neurocritical care unit and nurse Nicholas D. Tricarico.

Advancing solutions to care for our population

The Value Institute at Christiana Care Health System leads the way in conducting real-world research on todayâ&#x20AC;&#x2122;s most pressing health care issues. The mission of the Value Institute is to develop, deliver and evaluate innovative practice and policy solutions that improve the experience, efficiency and effectiveness of health care for patients and providers alike.

2015 YEAR IN REVIEW

Value Institute symposium addresses health disparities This year’s Value Institute Spring Symposium, “Eliminating Health Care Disparities,” featured distinguished experts Lisa Cooper, M.D., MPH, and Giselle Corbie-Smith, M.D., MSc., who have succeeded in engaging underserved communities and addressing the health care disparities they face. Value Institute symposia are designed to advance The Christiana Care Way through a strong emphasis and expertise in population health, fully integrated and supported service lines, and leveraging value-based payment models to achieve optimal health, exceptional experience and organizational vitality.

Held on May 19 at the John H. Ammon Medical Education Center at the symposium drew more than 200 participants. “The event, titled “Eliminating Healthcare Disparities,” was hosted by Eric Jackson Jr., M.D., MBA, associate director of the Value Institute, in collaboration with Leroi Hicks, M.D., MPH, vice chair of the Department of Medicine and the Learning Institute. “Achieving optimal health is about more than what happens in the four walls of a hospital — it’s about what happens in the community. We need to embrace that,” said Janice Nevin, M.D., MPH, Christiana Care’s

president and CEO. “In an environment where we are talking about value, population health and patient experience, ‘patient experience’ is about every person we serve. We are reframing how we think about the people we serve to understand and anticipate their needs, so we can create a culturally competent system of care that addresses the disparities that currently exist.” Dr. Cooper, a James F. Fries Professor of Medicine and director of the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, set the stage for discussion by defining health disparities and health equity. “Health disparities are preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged patients. Health disparities are pervasive. They affect mortality, quality of life, health care costs – they impact us all. To address them, you have to understand how they originate,” she said. “Health equity is when everyone has the opportunity to attain his full health potential and no one is disadvantaged from achieving The Value Institute Spring Symposium “Eliminating Health Care Disparities” featured distinguished experts and numerous Christiana Care leaders.

CHRISTIANA CARE HEALTH SYSTEM

Advancing solutions to care for our population

this potential because of social position or other socially determined circumstances.” Dr. Corbie-Smith is director for the Center for Health Equity Research at the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. She discussed social determinants of health — specifically, neighborhood and environment, health and health care, economic stability, social and community context, and education — and how health equity can be achieved by addressing these factors. “Where a person lives can change life expectancy by 15 years, income by 10 years, education by nine years and race by seven years,” Dr. Corbie-Smith said. After the symposium, Drs. Cooper and Corbie-Smith met with scholars and staff from The Value Institute to answer specific questions about their work and about conducting research on health care disparities and equity. “Partnerships are critical to our ability to successfully eliminate health care disparities,” Dr. Jackson said. “Only through partnerships can we create innovative, effective, affordable systems of care that our neighbors value.” 

The Value Institute comprises four centers that bring together expert researchers and skilled clinicians with project managers, biostatisticians and data analysts to produce and disseminate high-quality, high-impact information: The Center for Health Care Delivery Science creates and analyzes system-based processes of care that improve patient outcomes and experience, increase access and lower costs. The Center for Organizational Excellence redesigns services to improve the safety and efficiency of health care delivery. The Center for Outcomes Research, with established expertise in clinical, population health and cost-effectiveness research, focuses on the impact of alternative approaches to prevention, diagnosis and treatment of disease.

“ Partnerships are critical to our ability to successfully eliminate health care disparities.” Eric Jackson, Jr., M.D., MBA, associate director of the Value Institute

The Center for Quality and Patient Safety develops, implements and benchmarks nationally recognized programs for providing the safest, most effective care to our patients and neighbors. In addition to these four centers, the Value Institute Academy contributes to our mission by providing educational opportunities relevant to the Triple Aim in areas including research, improvement science and patient safety.

2015 YEAR IN REVIEW

CHRISTIANA CARE HEALTH SYSTEM

giving back We are fortunate to have the support of genereous individuals and corporations who are committed to advancing The Christiana Care Way. Their engagement is vital and helps us to continue to make our community stronger and healthier. Here are some highlights from the year.

Champions send Blood Pressure Ambassadors into heart of the community A committed group of community advocates known as the Champions for the Center for Heart & Vascular Health is providing leadership and securing financial support for a community outreach program built upon peer-to-peer relationships in the African-American community, where almost 40 percent of the population has high blood pressure. Thanks to impressive work engaging community leaders in important dialogue about the impact of untreated high blood pressure, the Champions have helped transform Christiana Care’s Blood Pressure Ambassador Program into a more formal and effective community-based model. Trained volunteers, who live and work in the heart of vulnerable communities at highest risk for hypertension, are now earning neighbors’ trust in barbershops, at places of worship and in community centers in ways hospital staff could not do through occasional health fairs alone. “Trusted peers are dramatically more effective in reaching vulnerable populations for screening and encouraging lifestyle changes than we, as clinicians,”

said Angela Parker, MSN, RN-BC, project manager for the Blood Pressure Ambassador Program. “Even more, the ambassadors’ role goes beyond high blood pressure management to help improve the way their neighbors look at health in general.” Under the leadership of Trustee Michelle Shepherd and fundraising lead Champion Michelle Schwandt, also a trustee, the Champions are engaging community support to expand the program, already securing corporate gifts from Astra Zeneca and Wawa, as well as a generous individual leadership gift from Trustee Phil Reese and his wife Daphne, who are both Heart & Vascular Champions themselves.

THROUGH CORPORATE AND INDIVIDUAL GIFTS, CHAMPIONS SUPPORT EXPANDING OUTREACH THAT HELPS OUR NEIGHBORS IMPROVE AND MANAGE THEIR HEALTH.

continued

2015 YEAR IN REVIEW

Champions

2,500

people throughout the

To date, Christiana Care has recruited and trained 68 volunteer blood pressure ambassadors, arming each with a blood pressure monitor and necessary supplies, as well as educational materials. In just the first two months of the program’s expansion, ambassadors screened more than 500 individuals and identified African-Americans with undiagnosed or inadequately controlled high blood pressure and referred them to care. By fiscal year’s end, as many as 100 ambassadors are expected to reach 2,500 individuals living in neighborhoods with the highest prevalence of high blood pressure throughout the city of Wilmington.

city of Wilmington are expected to be screened for

high blood pressure by the end of the fiscal year.

“We are extremely grateful to the Champions for their tireless work raising community awareness and critical funding to take this important outreach program beyond our hospital walls to the medically underserved in Wilmington,” said Timothy J. Gardner, M.D., medical director for the Center for Heart & Vascular Health. 

To learn how you can help the Champions send even more Blood Pressure Ambassadors into the heart of the community, contact the Office of Development at 302-327-3305 or email developmentoffice@ christianacare.org.

CHRISTIANA CARE HEALTH SYSTEM

Daphne and Phil Reese

“It has been engaging for us to be directly involved as Champions, not only in funding the Blood Pressure Ambassadors, but in helping to outline the program, improving the idea and involving representatives from the African-American and Hispanic communities in the process.” Phil and Daphne Reese

Giving back

DuPont gift bulids Gateway to health at Wilmington Hospital The new Gateway Building at Wilmington Hospital is a testament to DuPont’s longtime partnership with Christiana Care Health System, providing a “gateway” to health and wellness services through high-quality primary and specialty care. “DuPont’s exceptional gift served as a cornerstone of our Wilmington Hospital transformation,” said Janice E. Nevin, M.D., MPH, Christiana Care president and CEO. “The investment in our Wilmington campus enables us to offer leading-edge preventive and wellness services, ensuring that Delawareans receive the highest level of care and comfort.” DuPont is a long-time supporter of Christiana Care, with gifts for the expansion of Christiana Hospital and the establishment of the Helen F. Graham Cancer Center & Research Institute. Wilmington Hospital has served patients since 1888, and its $210 million transformation into a state-of-the-art urban health center is nearly complete. continued

210 million

investment is transforming Wilmington Hospital

into a state-of-the-art urban health center.

“Our Wilmington campus enables us to offer leading-edge preventive and wellness services, ensuring that Delawareans receive the highest level of care and comfort.” Janice Nevin, M.D., MPH, president and CEO of Christiana Care Health System

2015 YEAR IN REVIEW

DuPONT’S GENEROUS GIFT ADVANCES OUTPATIENT SERVICES IN THE GATEWAY BUILDING, WHERE HEALTH CARE PROVIDERS FOCUS ON PATIENT- AND FAMILYCENTERED CARE.

Gateway to health. The lobby of Wilmington Hospital’s Gateway Building

CHRISTIANA CARE HEALTH SYSTEM

Giving back

DuPont gift

Rocco Abessinio with staff of Wilmington Health Center

DuPont’s cornerstone gift of $5 million, made in 2011, advances outpatient services in the Gateway Building, where health care providers focus on patientand family-centered care. The proximity between primary care and specialty care creates a collaborative environment that benefits communication, wellness initiatives and treatment.

“Our Gateway Building is just that — a gateway to health and wellness services to people of all ages and diverse medical needs.” Edmondo J. Robinson, M.D., MBA, FACP, senior vice president and executive director of Christiana Care Health System - Wilmington; associate chief medical officer

“Our Gateway Building is just that — a gateway to health and wellness services to people of all ages and diverse medical needs,” said Edmondo J. Robinson, M.D., MBA, FACP, senior vice president and executive director of Christiana Care Health System — Wilmington and associate chief medical officer. The first services to be offered in the Gateway Building are:

The Gateway Building is the keystone of the Wilmington Hospital transformation, which has created:

• Specialty care services, including neurology, physiatry, rheumatology and women’s health.

• An expanded Emergency Department that has doubled in size.

• An infusion center for chemotherapy and other treatments for chronic illnesses.

• A new surgical suite, including 13 operating rooms and four procedure rooms.

• The First State School, a pioneering educational model, giving children and adolescents who would otherwise be homebound with serious illnesses the opportunity to attend school with their peers while receiving the medical treatment they need. When renovations are complete, the Gateway Building also will include specialty care in cardiology, endocrinology, pulmonary health and weight management.

• The Rocco A. Abessinio Family Wilmington Health Center. • A new intensive care unit. • An expanded, 30-bed unit for the Center for Advanced Joint Replacement. • More private patient rooms. • A new main lobby entry repositioned on Jefferson Street. • An enclosed parking garage named for Gary and Lear Pfeiffer, Wilmington Campus Executive Campaign Committee co-chairs. 

2015 YEAR IN REVIEW

Giving back

Carpenter Foundation Inc. gift to advance cancer stem cell research The legacy of R. Ruliph “Ruly” Carpenter and his wife Margaretta du Pont Carpenter began in the early 1900s and continues today and into the future through cancer stem cell research. Marking a century of commitment to excellence, The Carpenter Foundation Inc. has made a gift to the Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute for the Stem Cell Research Program, which will be recognized as the Margaretta and R.R.M. Carpenter, Sr., Cancer Stem Cell Research Program. “Groundbreaking work in the Center for Translational Research is empowering us to make great strides in diagnosing, treating and preventing cancer,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “The Carpenter Foundation has long been a supporter of cancer research, and this generous gift funding stem cell research continues that tradition of caring for patients and our community.” In the first half of the 20th century, cancer treatment was still fragmented and inconsistent. The Carpenters helped to improve care for the people of Delaware by providing the money and leadership to establish the first-ever cancer clinic in the state, the Memorial Hospital Carpenter Clinic. Officially opened in 1935, the Carpenter Clinic provided a multidisciplinary team approach to cancer and offered patients the most effective care available at the time. Margaretta Carpenter continued the family tradition of caring until the transition of cancer care to the Graham Cancer Center. Margaretta’s granddaughters – Renée K. Lickle, Margaretta K. Stabler, Nancy K. Lickle, C. Victoria Kitchell, and Leslie K. Bullock – have committed to supporting cancer care through 2035 through the Carpenter Foundation. That exceptional gift seals a century of caring from 1935-2035. Established in 2004, the Center for Translational Cancer Research is a formal collaborative program among the Graham Cancer Center, the University of Delaware, Nemours/Alfred I. duPont Hospital for Children and the Delaware Biotechnology Institute.  38

CHRISTIANA CARE HEALTH SYSTEM

From left: C. Victoria Kitchell, Renée Lickle, Bill Lickle, Margaretta Stabler, Renee Lickle, Nancy Lickle, Le Dée Lickle Wakefield

“Groundbreaking work in the Center for Translational Research is empowering us to make great strides in diagnosing, treating and preventing cancer.” NICHOLAS J. PETRELLI, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute

Giving Back back

CONTINUING THE LEGACY OF RULY AND MARGARETTA CARPENTER TO HELP CANCER PATIENTS, THE CARPENTER FOUNDATION WILL SUPPORT VITAL RESEARCH.

R. Ruliph “Ruly” Carpenter and Margaretta du Pont Carpenter

2015 YEAR IN REVIEW

An up-close look at cancer research Researchers and physicians are getting a closer, more detailed look at blood cancers through a new, high-tech microscope at the Helen F. Graham Cancer Center & Research Institute. The microscope was purchased with $50,000 donated by the Leukemia Research Foundation of Delaware (LRFDE), a volunteer group dedicated to supporting cutting-edge research while actively advocating for advanced therapy and care. Those goals are shared by researchers and health care providers at the Graham Cancer Center, said Denni Ferrara, LRFDE founder and president.

Denni Ferrara and Frank Beardell, M.D., with the microscope in the Lab.

“When we find the right doctors and the right facility, doing the research that makes a difference, that is where we want to put our dollars,” she said. “We found that right in our own back yard at the Helen F. Graham Cancer Center & Research Institute.” In previous years, LRFDE had made smaller gifts to the Graham Cancer Center, to a special fund that helps families who are unable to pay for tests. The money for the microscope is the group’s largest gift to date.

THE GIFT FROM LRFDE ENABLED THE PURCHASE OF A HIGH-TECH MICROSCOPE, GIVING RESEARCHERS A MORE DETAILED VIEW OF CANCER CELLS.

“The Leukemia Research Foundation of Delaware is a valued partner in supporting groundbreaking research that will help us to diagnose, treat and prevent cancer,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Graham Cancer Center. “Their generosity will make a difference for blood cancer patients, today and in years to come.” Microscopy is an essential technology in all stages of cancer research, allowing researchers to visualize the details of cancer cells. Microscopes also are invaluable tools in diagnosing leukemia and other cancers. The new, state-of-theart microscope will give both researchers and oncologists an even closer and more detailed view of cells. “The medical students and residents are impressed with the dual-head microscope that allows for side-by-side teaching opportunities,” said Frank Beardell, M.D., medical director, Blood and Bone Marrow Stem Cell Transplant Program at Christiana Care. “With the digital camera set up, larger groups can review the clinical images facilitating group education.” Dr. Beardell noted that the microscope ultimately will help patients and families benefit from advances in treatment of hematological malignancies. “I know that the microscope is being used every single day by the dedicated team at the Graham Cancer Center,” Ferrara said. “It is technology that is being put to very good use.” 

CHRISTIANA CARE HEALTH SYSTEM

by each salesperson. Pie charts show each category’s 52,884 value as a percentage of the whole. 52,779

52,700

2011

2012

2013

2014

2015

2012

5.01

20%

2013

5.11

2014

5.27

Christiana Care Health System statistics FISCAL YEAR 2015 2015

6,346

6,300

2011

2012

5.26

Pie Chart

Column Chart

55,000

5.20

5.26

53,072

5.19

5.10

5.11

5.00

50,000

20%

52,500

5.01

4.90

2011 2011

2011 9,750 BIRTHS

admissions

5.27

2012

2012 2013

2013 2014

2015

2014

2015

Christiana Care ranks 20% tenth on the East Coast in hospital admissions.

20%

6,500

11,390

births

2012 2013 2014 2015

10,606

7,000

9,576

3,250

19%

6,500

John HopkinsHUP JeﬀersonTemple Cooper Dollars 6,000

2011

2012

2013

2014

2015

COST COMPARISON OF AVERAGE PATIENT STAY

5.00

2011

2012

2013

2014

2015

$6,000

Christiana Care

$7,300

Crozer

$8,600

Cooper

5.25

Temple

$9,900

8,701

Jefferson

$11,200

Hosp. Univ. of Penn.

5.26

Johns Hopkins

$12,500 5.50

8,946

6,469

cost comparison

AVERAGE HOSPITAL STAY (DAYS) inpatient stay

2014

13,000

12,259 ADMISSIONS 5.30

2013

Column Chart

John Hopkins HUP Jeﬀerson Temple Crozer Christiana Untitled Care Untitled 1 2

Johns Hopkins 2015 YEAR IN REVIEW

total operating revenue

TOTAL OPERATING REVENUE* (BILLIONS)

VOLUNTEERS

2.00

1.66

1.56

1.32

1.00

1.44

1.38

1.50

2011

1,210

Volunteers

2012

2013

2014

+ 79,603 =

1.83

Million in Value

Hours Worked

2015

30.58 million

tax revenue paid to Delaware

Fundra

iser Results

OPERATING DOLLAR

by Salesp

erson

UNITS

Services | .23 Other Affiliates | .01 Services | .07 Therape utic & Diagnos Services tic | .28 Support

8 23 1 7 28

Therapeutic & Diagnostic Services | .29

SOLD

4 6 15 7 1

Nursing

▯

▯ Administration | .04 ▯ Depreciation & Interest

| .06

▯ Employee Benefits ▯ Other Affiliates | .01 ▯

CHARITY CARE ( ESTIMATED)

Support Services | .07

Nursing Services | .23

| .14

▯

CHRISTIANA CARE HEALTH SYSTEM

▯ Medical Education & Social Services

1,690,000

▯ Facilities & Services | .07 ▯ Insurance & Other | .01

| .08

pare values in a er of products sold how each category’s e.

ld y’s

2011

2012 2013 PARTICIPANT

2015 WILMINGTON 2011 HOSPITAL 2012

2014

2013 CHRISTIANA 2014 2015 HOSPITAL

MIDDLETOWN ED 2012 2013

2011

2014

2011

52,625

114,320

2012

53,804

118,706

2013

54,394

115,939

3,542

106,441

RADIOLOGY 21,134 PROCEDURES Column Chart Radiology procedures

2014 CENTER VISITS HEALTH Health Center Visits 2015

80,000 PARTICIPANT

53,662 PRIMARY CARE PHYSICIAN OFFICE VISITS PCP Oﬃce Visits

Fundraiser Results 55,572 by Salesperson

230,000 WILMINGTON HOSPITAL

2011

52,625

2012

53,804

75,000

2013

CHRISTIANA HOSPITAL

76,381

25,213

40,250

40,220

115,939

3,542

375,000

21,134

399,933

38,750

106,532227,295

163,333

39,827

39,500

106,441

55,572

41,000

118,706

196,667

53,662

201570,000

System statistics

400,000 MIDDLETOWN ED

114,320

54,394

2014

106,532

25,213

38,803

38,453 38,000 65,000

2011

2012

2013

2014

2015

2011

52,625

2012

53,804

118,706

2013

54,394

115,939

2014

53,662

106,441

2015

55,572

0 EMERGENCY DEPARTMENT VISITS 2011

52,625

2012

53,804

118,706

2013

54,394

115,939

2014

53,662

106,441

2015

55,572

2012

2013

2014

350,000

2015

2011 2011

2012

2013

2013 2014

2014

2015

21,134

106,532

25,213

100,000

Christiana Hospital

SURGICAL PROCEDURES Surgical procedures

3,542

150,000

45,000

200,000

38,712

Middletown ED

114,320

Christiana Hospital

40,000

3,542 21,134

106,532

50,000 Wilmington Hospital

2011

114,320

50,000

Wilmington Hospital

130,000

25,213

100,000 Middletown ED

150,000 Total number of visits:

187,317

200,000 35,000

2011

2012

2013

2014

2015 YEAR IN REVIEW

2015

38,

2011

2012

2013

2014

2015

System statistics REHABILITATION SERVICES VISITS rehab services visits

CENTER FOR ADVANCED JOINT REPLACEMENT

140,000

2,536 Knee & Hip Replacements

108,600

120,000

HOME HEALTH & COMMUNITY SERVICES

CENTER FOR REHABILITATION 100,000

2011

Christiana Care has

2012

2013

2014

11,101

3,696 1,618 289 |

659

CHRISTIANA CARE HEALTH SYSTEM

Alzheimer’s Day Program Visits

SCHOOL-BASED HEALTH CENTERS

Employees

Medical and Dental Staff

5,318

Patients

Staffed by Christiana Care

Nurses and Patient Care Technicians

Residents and Fellows

2015

23,300 Student Visits

308,096 Home Visits

It’s an honor to provide our patients with award-winning care We’re advancing the The Christiana Care Way as respectful, expert, caring partners in our neighbors’ health. We are committed to our patients, our employees and our community in providing high-quality care in innovative, effective and affordable models of care that patients value.

100 Top Hospitals

Magnet Re-designation

Best in Class Hospital

From Truven Health Analytics for major teaching hospitals and we are one of just 17 hospitals to win the 100 Top Hospitals Everest Award for national benchmarks for the fastest long-term improvement among health systems over the last five years.

Christiana Care has earned re-designation as a Magnet organization for nursing excellence from the American Nurses Credentialing Center, the pre-eminent recognition for hospital systems in the U.S.

From the American Hospital Association’s Institute for Diversity in Health Management in the category of Cultural Competency and Engaging Communities.

U.S. News & World Report Best Hospitals No. 1 in Delaware and No. 3 among the 96 hospitals in the Philadelphia region. Department of Obstetrics and Gynecology, Section of Endocrinology and Metabolic Diseases and Section of Pulmonary and Critical Care Medicine rank in the top 50 in those specialties among hospitals nationwide.

Comprehensive Stroke Center Certification The designation from The Joint Commission and the American Heart Association/American Stroke Association affirms that Christiana Hospital offers the medical expertise and state-of-the-art infrastructure necessary to successfully treat the most complex stroke cases. Fewer than 80 hospitals nationwide have earned this designation.

Gold Seal of Approval for Hip and Knee Replacement Programs Christiana Care’s Center for Advanced Joint Replacement has demonstrated compliance with The Joint Commission’s national standards for health care quality and safety in disease-specific care.

Meritorious Outcomes in Surgical Patient Care From the American College of Surgeons (ACS) Clinical Congress for the second consecutive year.

Leaders in Healthcare Equality The Human Rights Campaign Foundation, the educational arm of the country’s largest lesbian, gay, bisexual and transgender civil rights organization, has named Christiana Care a leader three years in a row.

Exemplar Status for Senior Care Christiana Care has earned exemplar status for the third consecutive year for the care it provides to older adults under the national NICHE (Nurses Improving Care for Healthsystem Elders) program.

Exceptional Cancer Care The National Cancer Institute has selected Christiana Care’s Helen F. Graham Cancer Center & Research Institute to join its Community Oncology Research Program, one of only 34 community site in the U.S.

Health Devices Achievement Award From the ECRI Institute for Christiana Care’s new national guideline-driven provider ordering process leading to more appropriate telemetry use in non-intensive care settings.

Best of the best. Christiana Care has again been named one of the the nationâ&#x20AC;&#x2122;s 100 Top Hospitals in the major teaching hospital category by Truven Health Analytics, and is one of only 17 hospitals across the nation to win the 100 Top Hospitals Everest Award for being among the select few to set national benchmarks for the fastest long-term improvement among health systems over the last five years.

To learn more about Christiana Care visit: news.christianacare.org facebook.com/christianacare P.O. Box 1668 Wilmington, Delaware 19899-1668 800-693-CARE (2273)

twitter.com/christianacare

www.christianacare.org

pinterest.com/christianacare

flickr.com/christianacare youtube.com/christianacare

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

16GEN1