Facts & Figures 2009

Facts & Figures 2009

caring for you Christiana Care Health System is one of the country’s largest health care providers, serving more than 600,000 patients yearly, placing it as the 17th leading hospital in the nation and 10th on the East Coast in terms of admissions.

With more than 10,000 employees, Christiana Care is the largest private employer in Delaware and the 10th largest employer in the Philadelphia region.

Christiana Care is a $1.8 billion dollar health care system and provided the community with $46.8 million of free care and medicine in 2009.

According to the American Hospital Association’s latest survey of 6,280 U.S. hospitals, Christiana Care ranks among the leaders by volume in several categories.

ON THE EAST COAST:

ADMISSIONS 10th BIRTHS 14th EMERGENCY VISITS 13th IN THE U.S.:

ADMISSIONS 17th BIRTHS 30th EMERGENCY VISITS 24th TOTAL SURGERIES 18th

TOTAL SURGERIES 9th

Dear Neighbors, On behalf of Christiana Care Health System, I am pleased to share with you our 2009 Facts & Figures publication. This document reflects our mission in action during 2009, made possible thanks to your confidence and support.

These are historic times for health care in America and for Christiana Care in particular. But as Congress debates reform in Washington D.C. and Christiana Care begins the landmark transformation of our Wilmington Campus, our mission remains simple: to take care of our neighbors in the community.

With the help of our extraordinary 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. We take very seriously the responsibility of serving you, your family, your friends and your neighbors.

As you read, you will learn a great deal about what we have achieved this year with your help and the help of our friends in business, government and the community. We continue to provide the very best in care to all who need it, regardless of ability to pay.

If you have required our services in the past, I hope you will see your own experience reflected in the pages that follow. If you have not needed our assistance, I hope you will be assured of our readiness to serve you if the time ever comes. Thank you for your confidence in Christiana Care.

Best regards,

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

Christiana Care exists to take care of our neighbors. Our ability to deliver 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.

Facts & Figures 2009 page 1

leaders in heart & vascular care

Faster treatment means better outcomes after heart attack

THE CENTER FOR HEART & VASCULAR HEALTH FEATURES A FULL RANGE OF CARDIOVASCULAR SERVICES. OPEN-HEART CASES

713

CARDIAC CATHETERIZATION CASES

4,667

ELECTROPHYSIOLOGY CASES

1,786

VASCULAR SURGERY CASES

1,504

VASCULAR INTERVENTIONAL CASES

3,785

CARDIOVASCULAR NON-INVASIVE STUDIES

19,053

VASCULAR ULTRASOUND STUDIES

33,363

CARDIAC REHABILITATION MONITORED VISITS

19,129

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Christiania Care is shortening time to treatment for patients experiencing a heart attack. Emergency cardiac catheterization, or balloon angioplasty, is often the best method to reopen blocked blood vessels and prevent irreversible heart damage. Cardiologists, emergency and cath lab teams are working aggressively to improve outcomes by shaving “door-to-balloon times” at Christiana Hospital down to 60 minutes—one-third off the national benchmark of 90 minutes or less. For heart attack patients transferring from neighboring hospitals, the new time-totreatment target is within 90 minutes of arrival—30 minutes faster than national guidelines.

Timothy Gardner, M.D., completes AHA presidency

Stereotaxis remote navigation system goes live

Timothy Gardner, M.D., medical director of Christiana Care’s Center for Heart & Vascular Health, completed his term as president of the American Heart Association in June 2009.

Dr. Gardner, active with the AHA for more than 25 years, served as chief volunteer science and medical officer for the association’s national board of directors and was responsible for medical, scientific and public health matters. During his presidency, Dr. Gardner turned the spotlight on Christiana Care as a top-flight health system and a leading force in cardiovascular medicine.

Innovative vascular interventions bring hope to DVT patients A revolutionary way to treat chronic or hard clots relating to deep vein thrombosis (DVT) is enabling many patients to reclaim active lives without debilitating pain. Mark Garcia, M.D., section chief of Vascular & Interventional Radiology, and his team combine standard treatment with newer, ultrasound-enhanced techniques. To chisel a channel through the clot, the interventional radiologist uses catheters and traditional balloon angioplasty, first attempting to vacuum out the clot. The team then works to dissolve the clot, using a combination of ultrasound and medicine.

Dozens of patients are benefiting from the technique, sparking inquiries from as far away as Dubai. Also, interventional radiology procedures are now available at Wilmington Hospital, making care more accessible for patients and reducing the expense and inconvenience of transferring patients to Christiana Hospital.

Available at only about 100 hospitals in the United States, stereotaxis remote navigation performs cardiac catheter procedures with greater speed and accuracy. The $1.5 million system includes two giant external magnets that drive a thin, magnet-tipped catheter through a patient’s veins to the heart. The advanced technology treats atrial fibrillation, which occurs when the heart rhythm is irregular. This irregular beating can cause blood clots to form in the heart. Stereotaxis is much more precise than the standard procedure of manually snaking a catheter to the heart, which typically takes about six hours and has a success rate of only about 60 to 70 percent. Stereotaxis has a success rate as high as 90 percent.

Stereotaxis technology treats atrial fibrillation, which occurs when the heart rhythm is irregular.

Facts & Figures 2009 page 3

Rapid assessment stroke alert protocol saves lives

New endograft helps vascular specialists address inoperable aortic aneurysms

Prompt treatment is critical for people experiencing symptoms of stroke, the third leading cause of death among Americans. At Christiana Care, a streamlined stroke alert protocol ensures rapid identification of patients who may benefit from powerful clotdissolving therapy with tPA (tissue plasminogen activator) in the first three hours after a stroke. The advantage of having an on-call neurointerventional radiologist extends this narrow treatment window for patients with acute strokes caused by a blocked artery, offering the latest intra-arterial technologies to remove clots, restore blood flow and reduce the risk of disability or death.

Abdominal aortic aneurysm patients who have not been good candidates for open surgery or commercially available endografts now have an exciting option: the UNITE stent.

Christiana Care and 20 other research sites are in trials with the stent, a single, flexible tube running from the aorta into only one of the iliac arteries. It is an alternative for people with diseased or smaller than usual arteries who aren’t suited to a Y-shaped stent currently on the market.

Already in wide use in Europe, UNITE requires a two-hour procedure. The patient returns home the next day. Abdominal aneurysm surgery typically takes at least three hours, followed by a week in the hospital.

The UNITE stent is an alternative for patients with diseased or smaller than usual arteries.

Heart surgeons reduce need for blood transfusions New protocols at Christiana Care that limit the need for transfusions during heart surgeries are resulting in fewer deaths and infections. Although transfusions are sometimes necessary to save lives, research shows that receiving blood products also boosts a patient’s risk of inflammation, infection, hepatitis or HIV. Cardiac patients who do not receive a transfusion tend to rebound more quickly and leave the hospital sooner. Surgeons are reducing the need for transfusions during coronary artery bypass grafts and valve replacements by using fewer IV fluids, which can dilute blood volume.

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New clinic serves adults with congenital heart disorders

AHA Scientific Sessions features research and clinical practice

Adults who were born with heart disorders no longer have to leave Delaware for care after they leave their pediatric cardiologists. Because more children with heart problems are surviving and growing up, the Center for Heart & Vascular Health operates a clinic to serve these patients.

Christiana Care is a standout at the American Heart Association’s 2008 Scientific Sessions, one of the world’s preeminent gatherings of health care professionals dedicated to the study, prevention and treatment of cardiovascular disease and stroke.

Some of the findings of our investigators: • Acute heart failure patients do better with shorter hospital stays when treated on a dedicated heart failure unit.

• Very tight blood-sugar control may provide no real advantage in preventing heart attack or stroke in Type 2 diabetics.

• Angina patients with severe physical limitations are more likely to experience heart attack or death whether or not they have been treated with percutaneous coronary intervention.

Grant supports heart-healthy education for women

Heart failure mortality rates among lowest in nation

Women across Delaware are learning how to keep their hearts healthy in a program developed by the Community Center of Excellence in Women’s Health in collaboration with the Center for Heart & Vascular Health.

The latest Medicare data on mortality rates for patients with heart failure and pneumonia places Christiana Care among the top 5 percent in the nation. Outcomes for hospitals nationwide are analyzed by Medicare, which publishes the results on its Hospital Compare Web site.

In the program, primary care providers are educating women on cardiac health, emphasizing modifiable risk factors, such as hypertension, cholesterol, smoking, obesity and lack of exercise.

One metric Medicare uses to gauge hospital quality and safety is the 30-day mortality rate after a patient leaves a hospital. Christiana Care is one of only 213 out of 4,700 U.S. hospitals with heart-failure mortality rates better than the national rate and 253 hospitals with pneumonia rates better than the national average.

Facts & Figures 2009 page 5

innovative cancer care

Expansion of Helen F. Graham Cancer Center brings world-class services under one roof

THE CANCER PROGRAM FEATURES A FULL RANGE OF CANCER SERVICES. PATIENTS NEWLY DIAGNOSED AND/OR NEWLY TREATED

3,239

RADIOLOGY ONCOLOGY CONSULTS

2,186

EXTERNAL BEAM TREATMENTS 32,374 PATIENTS ENROLLED IN CLINICAL TRIALS*

839

*MOST RECENT DATA AVAILABLE

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With more than triple the space in its new expansion, the Helen F. Graham Cancer Center brings together the entire continuum of resources for cancer care. Having all the patient’s care in one place fosters interaction among various specialists, who share knowledge about new technologies, drug regimens and treatments for cancer. The expanded center, with more than 200,000 square feet, also is more convenient for patients, who can obtain a variety of services under one roof. The expansion makes room for the Center for Translational Cancer Research, bringing advancements in the lab to the clinic.

Dr. Petrelli and William Bowser, Esq., accept the award from former President George H.W. Bush and former First Lady Barbara Bush

NCI extends Community Cancer Center partnership The Helen F. Graham Cancer Center is making tremendous strides to speed research and raise the quality of care for patients in a ground breaking program that has been extended for an additional year. One of only 16 cancer centers in the U.S. selected for the National Cancer Institute Community Cancers Centers Program, the Helen F. Graham Cancer Center places special emphasis on minority patients, as well as on people who are old, poor or live in rural areas. The result is expanded clinical trials in those communities, with patients receiving access to cutting-edge treatment in as many as 130 studies. The goal of the initiative is to determine what it will take to establish a national network of community cancer centers fully engaged in research, which can provide the latest, evidence-based treatment for patients of all ethnic and economic origins.

State cancer control program earns national honors The Delaware Cancer Consortium is the winner of the 2009 Exemplary State Comprehensive Cancer Control Implementation Award. The honor comes from C-Change, a group of business, government and nonprofit leaders dedicated to eradicating cancer. The Helen F. Graham Cancer Center plays a leading role in the consortium. Among the accomplishments are: • Mortality rates in Delaware dropping by more than twice the national average. • First in the nation in the percentage of people who have had a colonoscopy or sigmoidoscopy in the last five years. • Third in the U.S. in percentage of women over 50 who have had a Pap smear within three years or a mammogram within two years.

In 2008, the Helen F. Graham Cancer Center recorded 110,630 patient visits.

60,112

75,639

97,135

108,395

109,506

110,630

03

04

05

06

07

08

Facts & Figures 2009 page 7

National leader in recruiting for radiation trials Christiana Care enrolled more patients in Radiation Therapy Oncology Group (RTOG) clinical trials in 2008 than any other Community Clinical Oncology Program in the U.S. RTOG trials lead to important new cancer therapies by linking basic research with clinical care. Currently, 15 RTOG trials that integrate radiation with new drugs, systemic therapies and surgery are open to Christiana Care patients to treat brain, breast, cervical, gastrointestinal, genitourinary, head, neck and lung cancers.

CyberKnife now treats prostate cancer Patients with less advanced forms of prostate cancer can now receive treatment with the CyberKnife® Robotic Radiosurgery System. The most advanced noninvasive technology in the world, CyberKnife targets cancer with pinpoint accuracy and minimal radiation side effects. The Helen F. Graham Cancer Center is one of only three health care centers in the Delaware Valley with CyberKnife.

Community Clinical Oncology Program is accrual champion The Cancer and Leukemia Group B, known as CALGB, places Christiana Care’s Community Clinical Oncology Program (CCOP) at the top in accrual, or recruiting patients for clinical trials. Christiana Care’s accrual rate is 26 percent, far above the national average of 2-3 percent. That is due, in part, to recruiting community physicians to CCOP and placing nurses in the offices of oncology practices to enroll patients. Clinical trials play an essential role in cancer research.

da Vinci technology enhances precision in gynecologic and urologic cancer surgery Surgeons at the Helen F. Graham Cancer Center are increasing their use of the da Vinci Surgical System, a new, minimally invasive technology that enables the most delicate gynecologic and urologic surgeries with robotic precision. Patients are likely to experience better outcomes with significantly less pain, blood loss and scarring, and shorter recovery times.

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Breast MRI shows tumor size, shape and extent The first designated breast MRI in Delaware is an exciting step forward in cancer screening, detecting breast cancer with more than 95 percent accuracy.

For women diagnosed with breast cancer, MRI—that is, Magnetic Resonance Imaging—can discern the size, shape and extent of the tumor, as well as enhance detection in the opposite breast. Unlike mammography, there’s very little compression involved, only enough to hold the breast steady during testing.

Nurse Navigator program shares with other cancer centers The Helen F. Graham Cancer Center’s team of patient navigators is teaching nurses at other cancer centers around the nation how to model our successful program. Tricia Strusowski, RN, MS, director of Cancer Care Management, is conducting one-day training sessions at six hospitals that belong to the Association of Community Cancer Centers. She also is the author of a workbook for the program. The Graham center is among the first in the nation to introduce nurse navigators, who are specially trained to oversee and help to orchestrate all aspects of a cancer patient’s treatment.

Molecular geneticist joins Center for Translational Cancer Research Csilla I. Szabo, Ph.D., a molecular geneticist who studies breast cancer, is the new associate director of cancer genetics at the Center for Translational Cancer Research at the Helen F. Graham Cancer Center. She comes from the Mayo Clinic.

Percentage of cancer cases diagnosed and/or treated at Christiana Care Source: Delaware Cancer Registry, 2007.

•

Practice wins HOPE Award for leadership Regional Hematology and Oncology, PA earns a HOPE Award for leadership excellence from Hematology & Oncology News and Issues magazine. HOPE stands for Hematology & Oncology Practice Excellence. The magazine explains how the practice developed a successful relationship with the Helen F. Graham Cancer Center and implemented an electronic medical record system.

Cancer Center offers wellness coaching In taking a family approach to treating cancer, patients and their loved ones can learn how to take an active role in wellness. Goals might include exercising more, eating more nutritious meals, improving family communication, managing fatigue and coping with sleep disturbances.

•

3,057 Delaware and surrounding area cancer patients

2,503 Delaware cancer patients

62% treated at Christiana Care

65% treated at Christiana Care

Facts & Figures 2009 page 9

dedicated to the community

Hospitals receive environmental excellence awards

Christiana Care purchases wind power In its search for greener energy, Christiana Care’s Facilities and Engineering team found the answer blowing in the wind. Starting Jan. 1, 2010, the health care system will obtain 30-40 percent of its electricity from a wind farm in Pennsylvania. In addition to environmental benefits, Christiana Care’s electricity bills will not go up during the nine-year contract.

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Christiana and Wilmington hospitals each are winners of a prestigious Environmental Excellence Award for making facilities healthier—for patients, employees and the earth.

Practice Greenhealth, a national organization for health care institutions committed to environmentally responsible operations, awards Christiana Hospital the Partner for Change Award. Wilmington Hospital earns the Making Medicine Mercury Free Award. They are the only hospitals in Delaware to receive the honors.

Wilmington campus transformation underway

When completed in 2012, the expansion will include: • A nine-story, 286,000-square-foot tower.

• An upgraded Emergency Department double its current size.

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

• Capacity for 120 private patient rooms.

• A new intensive-care unit.

Christiana Care is expanding and renovating the Wilmington campus—a $205 million investment that helps us continue building a healthy community for our neighbors in the city of Wilmington. The hospital is open and fully operational during construction. The Wilmington campus will grow by 337,000 square feet, creating a 1 million-square-foot, state-of-the-art medical center.

• An upgraded, 30-bed unit for the Center for Advanced Joint Replacement.

• A 51,000-square-foot, state-of-the-art medical office building, allowing more physicians to practice on-site.

• A new main lobby entry repositioned on Jefferson Street, with an enclosed connector to the parking garage.

• A tranquil atrium and healing garden.

Enrollment event helps neighbors understand Medicare plans Counselors from the Centers for Medicare and Medicaid Services (CMS) helped nearly 100 senior citizens to navigate the complexities of Medicare prescription plans in special sessions at Wilmington Hospital Health Center. “This is an opportunity for us to partner with CMS to facilitate access to health care coverage for our neighbors in familiar surroundings where they can walk out the door feeling they achieved a desired outcome,” says Mary Theresa Lednum, RN, Health Center director.

Rx clean-out day yields bumper crop Medicine Cabinet Clean-out Day at Christiana Hospital drew more than 146 households from the tri-state area.

The state Office of Controlled Substances and Board of Pharmacy were co-sponsors, with the Delaware Nurses Association serving as host. The event collected and disposed of in an environmentally responsible way more than 346 pounds of unused and expired medication with a street value of more than $300,000. The oldest item is a bottle of paregoric from 1974.

Facts & Figures 2009 page 11

Computerized doctors’ orders transform patient care

In January 2010, a new software system that works with PowerChart, the electronic medical record system, will put Christiana Care in the forefront of health care. Only 17 percent of U.S. hospitals today have implemented Computerized Physician Order Entry (CPOE), information technology that standardizes care and increases efficiency.

Emergency departments on SuperTrack In an emergency, patients expect to receive care quickly.

So spending more than an hour in a hospital emergency department can make them extremely dissatisfied.

Now, both Wilmington and Christiana hospital are on SuperTrack, a process that eliminates bottlenecks and time wasters to quicken the pace at which less-acute patients move through treatment. Results are impressive.

The average amount of time patients stay in the ED dropped from more than two hours to less than one hour. Christiana Hospital is testing a similar process for sicker patients. Synchronous Provider Evaluation in the Emergency Department (SPEED) is set to go live in December.

Kidney transplant program launches downstate clinic

Submitting orders electronically reduces the risk of medical errors. With CPOE, pharmacists, laboratory technicians and others who need to read doctors’ orders no longer have to question illegible handwriting and inconsistent medical abbreviations. The new system also will eliminate the need for transcribing and scanning handwritten orders into the system before sending them to the pharmacy or lab. Removing these steps in the process will improve overall order processing time.

Obesity prevention program receives international audience Dietitians from Christiana Care spoke about healthy changes that prevent obesity in children at the 2009 School Nurse International Conference. Denise Taylor, MS, RD, a registered dietitian at Christiana Care, developed the two-year program with an elementary school nurse. The model advocates open gym nights, nutrition programs, a video dance game, a girls’ running program, staff-directed exercise and a school garden. The 10-week initiative could become a model for other schools. pa ge 12 Christiana Care Health System

Patients who live south of Dover and are awaiting transplants at Christiana Care are now receiving six-month checkups at the Christiana Care Center for Heart & Vascular Health satellite office on the Beebe Medical Center campus in Lewes. The program means that more than 30 patients—about 15 percent of the people on the waiting list—no longer have to commute to Christiana Hospital for routine evaluations.

VNA uses technology to improve wound care

Unique program trains police as tactical paramedics Physicians and staff members from Christiana Care Emergency Department earned a Distinguished Community Member Award from the Wilmington Police Department for assisting in a first-of-its-kind program in the state to educate police officers to be paramedics. The training allows police to respond quickly to high-level emergencies to provide first aid to injured officers even when agency and jurisdictions overlap.

eCare teams begins connecting across Maryland Calvert Memorial Hospital in Prince Frederick, Md., is the first of six rural hospitals in the Maryland eCare network to connect in real time to critical care physicians and nurses at Christiana Care’s eCare Central. By 2011, Christiana Care will connect to almost 80 beds in intensive care units in the network. eCare virtually connects physicians, nurses and patients via voice, camera and data, enabling remote hospitals to provide the highest level of sophisticated care around the clock. Calvert Memorial will work most closely with eCare on nights, weekends and holidays, when fewer local specialists are in-house.

eCare virtually connects Christiana Care doctors, nurses and patients, remotely providing the highest level of care around the clock.

The Wound Advisor, a digital imaging system, allows nurses from the Visiting Nurse Association to send photos of a patient’s wound to VNA headquarters, where a wound-care specialist can quickly evaluate the wound without visiting the patient. In eliminating the time devoted to a home visit, the system enables a wound-care specialist to immediately notify the patient’s doctor if a wound is not healing as it should.

The doctor can then change the course of treatment.

Excellence in Women’s Health Christiana Care is the region’s only National Community Center of Excellence in Women’s Health. That prestigious designation is based on: • Improving the health and wellbeing of women through community-based organizations.

• Providing integrated, coordinated care with strong links to existing programs in the community.

• Offering comprehensive care in a way that reduces fragmentation and recognizes the complexity of women’s lives.

In addition, Christiana Care also provides excellent clinical care and preventive services, training for health care professionals and public outreach and education.

Facts & Figures 2009 page 13

cutting-edge research

Advancing medical care through research Christiana Care is one of the largest community-based teaching hospitals involved with research in the United States.

The number of clinical research and pharmaceutical studies include: Bone Marrow Transplant Cardiac Surgery Cardiovascular Research Community Outcomes Critical Care Diabetes & Metabolic Education Emergency Medicine Family Medicine Genetics Genetics-Oncology GYN Oncology

9 1 61 6 16 13 5 58 4 1 3 20

Hematology Hemophilia Infectious Disease Internal Medicine Maternal/Fetal Medicine Neonatology Neurology/Neurosurgery Nursing OB/GYN Oncology Ophthalmology Orthopedics

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10 2 15 12 32 15 1 22 10 193 1 2

Other Research (Non-categorized)

Outcomes Pathology/Laboratory Pediatrics Performance Improvement Pharmaceutical Oncology Pharmacy Plastic Surgery Psychiatry/Psychology Pulmonary/Respiratory Care

5 33 22 3 2 31 4 5 2 10

Radiation Oncology Radiology/Interventional Radiology Surgery Surgical Critical Care/ Trauma Visiting Nurse Association

39 1 13 4 2

Christiana Care’s research and studies total 688.

Leaders of the Delaware Health Sciences Alliance

Delaware Health Sciences Alliance multiplies strengths by four

Developing a better test for cancer genes

Christiana Care and three other leading hospitals and educational institutions have formed the Delaware Health Sciences Alliance, a dynamic partnership dedicated to cutting-edge research, quality education for health care providers and better health care for the people of Delaware. The alliance joins Christiana Care with Thomas Jefferson University, the University of Delaware and Nemours/Alfred I. du Pont Hospital for Children. The historic foursome will share resources on such vital topics as cancer treatment and prevention, cardiovascular disease and rehabilitative medicine. A key component of the initiative is establishing a Jefferson presence near UD. The campus will house classrooms, study halls and residences for up to 150 medical, pharmacy, nursing, occupational and physical therapy students.

A study at the Center for Translational Cancer Research could lead to the development of a faster, cheaper blood test to identify individuals who are at high risk for colon cancer and other cancers.

Researchers are focusing on two genes, MSHZ and MLH1, known as mismatch repair genes. Four of five people who inherit these genes will develop cancer.

In the study, researchers are examining blood samples from patients in the Familial Risk Assessment Program at the Helen F. Graham Cancer Center.

Center for Translational Cancer Research is a collaboration The opening of the new Center for Translational Cancer Research at the Helen F. Graham Cancer Center enhances the center as a comprehensive cancer program that highlights prevention, treatment and laboratory research. Under the leadership of Bruce Boman, M.D., Ph.D., medical director of Cancer Genetics and Stem Cell Biology, the CTCR is a collaboration with the University of Delaware and the Delaware Biotechnology Institute.

Pioneering research into fetal growth Christiana Care is undertaking groundbreaking research to establish a national standard for normal fetal growth, gathering data that will help doctors to more accurately determine if babies are developing normally. One of only six institutions in the U.S. selected for a $1.136 million grant from the National Institutes of Health, Christiana Care is the first to enroll expectant mothers in the three-year program.

The study focuses on low-risk women, age 18-40 and of all ethnicities, living above the poverty line.

Christiana Care’s large, diverse population—7,249 babies were born here last year—and proven track record in OB/GYN research make it an ideal institution for the project.

Facts & Figures 2009 page 15

Evaluating cost and care to find best treatment Christiana Care is leading the way in comparative effectiveness research, identifying the best ways to treat patients at the most efficient cost. The Christiana Care Center for Outcomes Research (CCOR) is one of approximately a half-dozen national groups in the science of evaluating the consequences of health care delivery. “We compare one form of therapy or treatment with another,” says William Weintraub, M.D., John H. Ammon chair of Cardiology and director of CCOR. “We look at different approaches to management, how we take care of people, not just comparing one pharmaceutical to another.”

Delaware’s dense, diverse population makes Christiana Care ideally suited to these types of studies. The health care system’s patient base includes 1.2 million people in Delaware and its surrounding areas.

More findings from COURAGE research Angioplasty could add $10,000 to treatment costs without improving the quality or length of life for patients with angina, according to a new evaluation of data from the now seminal COURAGE study (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). The debut issue of the American Heart Association publication Circulation: Cardiovascular Quality and Outcomes published the findings. William Weintraub, M.D., chair of Cardiology and chief of the Section of Cardiology, is lead author of the article.

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Discovery in colon cancer research Scientists searching for a cure for colon cancer could benefit from the discovery of an enzyme common to both normal and malignant colon stem cells that could determine what drives tumor growth. The marker, known as ALDH1, was discovered by researchers at the Helen F. Graham Cancer Center led by Bruce Boman, M.D., Ph.D., director of Cancer Genetics and Stem Cell Biology. The study was published in the April 15 edition of Cancer Research.

Cancer Research

Widening diabetes screening The glucose challenge test commonly used to test pregnant women for diabetes could be an accurate, convenient and inexpensive way to screen the general population for undiagnosed diabetes and pre-diabetes, potentially improving the health of more than 40 million people. Researchers at the Christiana Care Center for Outcomes Research collaborated with colleagues at Emory University and Johns Hopkins University. Results of the study were published in June in the journal Diabetologia.

Working together for clinical and translational science Christiana Care has joined with Nemours/Alfred I. du Pont Hospital for Children, Thomas Jefferson University and the University of Delaware to form the Delaware Valley Institute for Clinical and Translational Science (DVICTS). The consortium brings together experts in medicine, health economics, population science, public health, and biomedical and materials science. The group’s mission expands on collaborative work already in progress that will benefit patients by streamlining the way research findings translate into practice.

Delaware babies in national spotlight Christiana Care is one of only two dozen health care centers and universities selected for the National Children’s Study, the largest long-term study of children’s health ever in the U.S. Researchers hope to develop a snapshot of American children by following 100,000 youngsters from before birth to age 21. The government-funded study could help researchers understand how genetics and the environment interact to impact health. It also could provide clues to conditions such as autism, asthma, mental illness, obesity and other disorders.

In Delaware, the emphasis will be on perinatal care, focusing on 1,000 babies in New Castle County.

Christiana Care is working with the University of Delaware and Alfred I. du Pont Hospital for Children to provide input for investigators at Children’s Hospital of Philadelphia and Drexel University College of Medicine.

Cancer Genome Atlas charts genetics The Helen F. Graham Cancer Center is part of the Cancer Genome Atlas, a massive, federally funded effort to speed up scientific insight into the molecular basis of cancer so doctors can ultimately diagnose and treat patients based on their genetic profiles.

Christiana Care received a four-year, $4.6 million subcontract from the National Cancer Institute, part of the National Institutes of Health. The Graham center plays a vital role in the initiative, collecting, storing and sharing tissues and blood samples for research.

The Helen F. Graham Cancer Center is part of the Cancer Genome Atlas, a federally funded effort to speed up scientific insight into cancer so doctors can diagnose and treat patients based on their genetic profile.

Grants boost heart, cancer research Christiana Care is the recipient of two grants for heart and cancer research from the National Institutes of Health, part of the $5 billion government stimulus package aimed at cutting-edge medical research. One grant goes to the Christiana Care Center for Outcomes Research to study elevated levels of the protein troponin often found in patients with chronic kidney disease.

The other goes to the Community Cancer Oncology Program to develop software to more accurately track and manage patients in clinical trials of new treatments.

Facts & Figures 2009 page 17

Cardiovascular and cancer research expands with federal grant A five-year, $17.4 million federal grant broadens research into the diagnostics and treatment of cancer and cardiovascular disease. The funding supports 15 projects, including research on cancer stem cells and biomarkers and how kidney function impacts the link between obesity and heart disease.

The National Institutes of Health awarded the grant to the Delaware IDeA Network of Biomedical Research.

INBRE includes Christiana Care, the Delaware Biotechnology Institute at the University of Delaware, Nemours/Alfred I. du Pont Hospital for Children, Delaware State University, Delaware Technical and Community College and Wesley College.

Breast cancer and relationships Research at the Helen F. Graham Cancer Center takes an intimate look into the relationships of women with breast cancer and their partners, providing important insights on how couples can cope with stress and support one another. The two-year study funded by the National Cancer Institute involves 50 couples. Each partner registers his or her feelings for 10 days using a Personal Digital Assistant. Partners rate such factors as their stress level, positive and negative emotions, sense of connectedness, emotional intimacy and how much support they have given or received from their loved one.

Learning to recognize and manage these emotions can significantly improve the patient’s well-being emotionally, socially and medically, says Scott Siegel, Ph.D., health psychologist.

Unlocking the key to motivating patients

Heart attack study largest in U.S. Patients who are resuscitated from cardiac arrest in the early stages of a heart attack—even those who remain unresponsive—have a good chance of surviving and making a full neurological recovery after they receive emergent coronary angioplasty to restore blood flow through the blocked artery that caused the heart attack. That’s the finding of Christiana Care researchers who undertook the largest study of its kind in the U.S. and the only one in which all the patients were treated at one specific hospital.

Led by Ehsanur Rahman, M.D., the study was published in the Journal of the American College of Cardiology.

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Christiana Care is helping to determine the most effective way primary care physicians can motivate patients to get screened for colorectal cancer. The Tailored Navigation Intervention study randomly divides patients into three groups: Standard Intervention, Tailored Screening Intervention and Navigation Intervention. The Standard group receives a generic invitation kit and a mailed screening reminder. Patients in the Tailored group are asked by phone or online whether they prefer to be screened by endoscopy or a biennial immunological fecal occult blood test. A nurse contacts patients in the Navigation group. “This study is a good example of how research and patient care can come together to have a positive impact on the community we serve,” says Heather Bittner-Fagan, M.D., the primary investigator.

excellence every day The MICU at Christiana Care winners of the Beacon Award

Joint Commission seal of approval Christiana Care Health Services is the recipient of the Joint Commission’s Gold Seal of Approval, based on an unannounced on-site survey.

The seal is proof of our organization-wide dedication to providing quality care for our neighbors.

US News & World Report Best Hospital For the third straight year, Christiana Care is one of “America’s Best Hospitals,” an elite list of 174 institutions named by US News & World Report, which evaluated more than 4,800 hospitals. The only hospital in Delaware to make the list, Christiana Care is among the top hospitals in two specialties: Diabetes & Endocrine Disorders and Digestive Disorders.

Medical Intensive Care Unit wins Beacon Award The Medical Intensive Care Unit at Christiana Care is the recipient of a spring 2009 Beacon Award for Critical Care Excellence, one of only 35 hospitals nationwide and the first in Delaware to achieve the honor. The award from the American Association of CriticalCare Nurses recognizes units that achieve the highest standards in patient outcome, nurse recruitment and retention, staff training and a healthy work environment.

Facts & Figures 2009 page 19

Thomson Reuters awards 2009 Healthcare Advantage Award Christiana Care’s efforts at optimizing the number of tests doctors order and the amount of time patients spend in the hospital earned a 2009 Healthcare Advantage Award from Thomson Reuters, a nationally known provider of health information. Christiana Care is one of only five organizations in the U.S. honored in the health and clinical outcomes category.

Tops in nursing satisfaction Christiana Care rates among the top 100 places to work in a Nursing Professionals survey.

The magazine bases its ranking on a job satisfaction survey sent to 25,000 randomly selected hospital nurses throughout the country in 2008.

Christiana Care wins Best in the Business honors For the sixth consecutive year, the News Journal names Christiana Care a Best in the Business employer, an honor based on employee surveys from 97 companies.

Christiana Care is one of only 15 large employers honored. Here is what some of the employees say: • I would highly recommend working at this organization to others.

• I believe this organization is going in the right direction.

• This organization motivates me to give my very best at work. pa ge 20 Christiana Care Health System

First State School earns an A+

For the second year in a row, First State School, located on the Wilmington campus, is at the head of the class, receiving an A+ from the Delaware Department of Education, achieving a “superior” rating. First State School educates chronically ill children.

Supporting blind people in the workforce Christiana Care receives the Corporate Achievement Award from the Delaware Department of Heath and Social Services for hiring workers who are visually impaired. The state honors Christiana Care for placing two people who are blind in the medical transcription department.

Lt. Gov. Matt Denn presents award to Christiana Care representatives

Consumer Choice Award earned again Christiana Care has been the top choice of health care providers for 14 consecutive years, based on a National Research Corporation survey of 200,000 area households.

Gold medal winner for organ donation Christiana Care is one of 18 regional health care facilities awarded the Department of Health and Human Resource’s Medal of Honor recognizing excellence in empathetic family care coupled with outstanding organ donation levels.

Gerald Fulda, M.D., medical director of Christiana Care’s surgical critical care complex, right, with fellow medalists

Robert Laskowski, M.D., chairs Delaware Public Policy Institute Christiana Care Health System President and CEO Robert J. Laskowski, M.D., is chair of the Delaware Public Policy Institute.

The nonprofit, nonpartisan, nongovernmental organization conducts research and encourages the study and discussion of public policy issues affecting the citizens of Delaware. Dr. Laskowski is also a member of the Council of Teaching Hospitals (COTH) and Health Systems Administrative Board and is a COTH representative to the Association of American Medical Colleges Assembly.

‘Go Red for Women’ wins multiple awards The American Heart Association says Christiana Care shows heart in working to prevent cardiovascular disease in women at the 2008 ‘Go Red for Women’ Luncheon and Fashion Show. Cardiologist Robin A. Horn, M.D., and the Community Health Outreach and Education Program of the Helen F. Graham Cancer Center each receive Go Red Heart Beat awards.

Liz O’Neill, Community Outcomes Program manager, earns a special Heart of the Community Award.

Timothy Gardner, M.D., receives Leadership Award

Christiana Care award winners House Speaker Nancy Pelosi and Dr. Gardner

Timothy J. Gardner, M.D., medical director of Christiana Care’s Center for Heart & Vascular Health and immediate past president of the American Heart Association, received a Distinguished National Leadership Award from the AHA. Dr. Gardner was also named chair, Steering Committee, Cardiothoracic Surgery Clinical Research Network of the National Heart Lung and Blood Institute of the National Institutes of Health.

Facts & Figures 2009 page 21

Nicholas Petrelli, M.D., is ASCO president-elect nominee Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center, is a president-elect nominee of the American Society of Clinical Oncology and chair of the ASCO’s Cancer Communication Committee. He is also a member of American College of Surgeons, Commission on Cancer, Cancer Program Standards 2011 Outcomes Workgroup.

Marc Zubrow, M.D., a top health leader Marc Zubrow, M.D., director of Critical Care Medicine and eCare at Christiana Care, is named to HealthLeaders magazine’s annual list of people who are “truly making a difference” in today’s complex health care world. The publication praises Dr. Zubrow as a telemedicine advocate for his role in Maryland eCare, which addresses a shortage of critical care physicians by connecting six rural hospitals with Christiana Care’s eICU.

Laureate Award winner Virginia U. Collier, M.D., Hugh R. Sharp, Jr., Chair of the Department of Medicine, receives the 2009 Laureate Award from the Delaware Chapter of the American College of Physicians.

Leading breast cancer education Diana Dickson-Witmer, M.D., associate medial director of the Christiana Care Breast Center at the Helen F. Graham Cancer Center, is appointed to the American Society of Breast Disease’s Education Program Committee for a three-year term. She joins a national panel of breast cancer experts to oversee the development of medical education programming promoting multidisciplinary breast health care in the United States and around the world.

Fellow of National Lipid Association Ed Goldenberg, M.D., is elected a fellow in the National Lipid Association for his special contribution to the field of treatment of hyperlipidemia.

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Leading cancer research

A leader in Med-Peds

Stephen Grubbs, M.D., is now a member of the Institute of Medicine’s (IOM) Committee on Cancer Clinical Trials and NCI (National Cancer Institute) Cooperative Group System. He serves from November 2008 through April 2010.

Allen Friedland, M.D., director of our Med-Peds Residency Program, is selected to the Executive Committee of the American Academy of Pediatrics and American College of Physicians, section of MedicinePediatrics.

COURAGE article named top medical story

Resident wins national competition

Both the American Heart Association and The New England Journal of Medicine’s “Journal Watch” name the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Quality-of-Life article a top medical story of 2008.

The Christiana Care Center for Outcomes Research (CCOR) performed all analytical work for the article that illustrated how science can benefit medical care. Lead author was William Weintraub, M.D., John H. Ammon chair of Cardiology and chief of the Section of Cardiology. The data from the analysis provides physicians with more information as they consider options for treating patients with chronic, stable angina.

Emergency/Internal Medicine Resident Michael Perraut, M.D., takes top honors in the national CPC (clinical pathology case) championship at the annual American College of Emergency Physician’s Scientific Assembly in Chicago. It is the first time one of our residents has brought home the award.

The excellence of our physicians, surgeons, nurses, health care professionals, community outreach coordinators and staff is recognized as truly making a difference in health care delivery.

Facts & Figures 2009 page 23

Joanne Brice, M.D, hospitalist fellow Joanne C. Brice, M.D., is a member of the Inaugural Class of Fellows, the first-ever formal designation by the Society of Hospital Medicine (SHM). Hospital Medicine is the fastest-growing specialty in health care, according to SHM.

Linda Laskowski-Jones is editor-in-chief of Nursing2009 Linda Laskowski-Jones, MS, RN, vice president of Emergency, Trauma & Aeromedical Services at Christiana Care, is named editor-in-chief of Nursing2009. With more than 200,000 worldwide subscribers, the award-winning, peer-reviewed journal aims to improve nursing by providing evidence-based practical information. Laskowski-Jones also receives a national faculty appointment to Key Concepts in Emergency Department Management, a learning program sponsored by the Emergency Nurses Association.

Cynthia Barlow is Pharmacist of the Year A leader in dental care Edwin Granite, D.M.D., chair of the Department of Maxillofacial Surgery & Hospital Dentistry, is honored with the Henrietta Johnson Medical Center 2009 Community Award for Outstanding Work in Dental Care Issues for Delaware.

pa ge 24 Christiana Care Health System

Cynthia E. Barlow, Pharm.D., BCOP, clinical pharmacy specialist in hematology-oncology and pain and palliative care, receives the Delaware Society of Health System Pharmacists’ 2009 Pharmacist of the Year Award. An ardent patient advocate, Barlow has raised funds for both the American Cancer Society and Kay’s Camp, a retreat for children with cancer.

Regina Janney receives Excellence Award Regina Janney, RN, received the Award for Excellence in Practice—RN Psychiatric Mental Health Registered Nurse—from the American Psychiatric Nurses Association. The honor recognizes a psychiatric mental health registered nurse who provides exemplary psychiatric mental health nursing practice to patients, families and populations through collaboration for optimal outcomes, patient and public advocacy, mentoring/supervision of other nurses and continuously improving his/her skills.

Gordon Reed receives Visionary Award Gordon Reed, M.D., medical director of the forensic nurse examiner program at Christiana Care, is honored with the Visionary Award from the International Association of Forensic Nurses.

A voice for inmate health care Holly Wright, MSN, FNP, Department of Family Medicine, is the first-ever representative of the Delaware Nursing Association on the new Adult Correction Healthcare Review Committee. Created by the Delaware General Assembly, the seven-member committee will advise the Commissioner of the Department of Corrections on inmate health care.

Danielle Brown earns Patient Service Award A senior social worker in the Cancer Care Management Center, Danielle Brown, MSW, is the winner of the 2008-2009 Patient Service Award of the Leukemia and Lymphoma Society of Delaware. Brown facilitates two support groups, one for multiple myeloma patients and one for leukemia patients. For the past three years, she has recruited and captained a Helen F. Graham Cancer Center team in the Light the Night Walk, raising money for blood cancer research.

Facts & Figures 2009 page 25

vital to the region

Our regional impact by the numbers The following statistics and service information help to further illustrate our full network of health care services and Christiana Care’s impact on the health and well-being of Delaware and the region.

OUTPATIENT VISITS

ADMISSIONS

53,045

54,556

55,512

55,049

54,597

05

06

07

08

09

454,961

450,238

457,348

05

06

07

528,897* 552,831*

08

09

* Updated to include Outpatient Radiology procedures previously at CCHI.

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WILMINGTON HOSPITAL HEALTH CENTER VISITS

COST OF AVERAGE PATIENT STAY

Christiana Care Health System 69,811

05

67,281

68,937

06

70,047*

07

71,562*

08

$ 8,003

Temple University Hospital

$ 8,594

Thomas Jefferson University Hospital

$ 9,278

Crozer-Chester Medical Center

$ 9,474

Georgetown University Medical Center

$ 9,567

09

* Includes patient visits at two off-site locations.

PRIMARY CARE PHYSICIAN OFFICES* number of visits

Source: American Association of Medical Colleges’ Autumn 2008 Databook.

AVERAGE INPATIENT STAY number of days

174,679 168,698 179,289 191,587

06

07

08

09

5.33

5.21

5.30

5.43

5.41

05

06

07

08

09

* Includes the Medical Group of Christiana Care, Inc., and the Department of Family & Community Medicine.

The Medical Group added 7 clinicians during the year.

EMERGENCY DEPARTMENT VISITS 05

46,801

91,391

06

47,051

99,477

146,528 total

07

48,518

100,996

149,514 total

08

49,881

103,670

153,551 total

09

51,559

108,932

Wilmington Hospital

138,192 total

160,491 total

Christiana Hospital, a 907-bed tertiary care and regional referral center, is designated by the state of Delaware, and verified by the Committee on Trauma of the American College of Surgeons, as a Level-I (highest capability) regional trauma center for Delaware and neighboring counties in Pennsylvania, New Jersey and Maryland.

Christiana Hospital is the only Level-I trauma center between Philadelphia and Baltimore.

Christiana Hospital Facts & Figures 2009 page 27

SURGICAL PROCEDURES

BIRTHS

7,122

7,219

7,100

7,249

7,199

46,428

45,091

42,834

42,362

42,686

05

06

07

08

09

05

06

07

08

09

At Christiana Hospital, Delaware’s only Level-3 (highest capability) neonatal intensive care unit provides the most advanced neonatal care for newborns delivered prematurely or with congenital medical conditions.

PHYSICAL THERAPY PLUS number of visits

RADIOLOGY PROCEDURES

251,108

253,957

258,814

335,776

320,907

84,633

84,718

88,325

94,421

101,877

05

06

07

08

09

05

06

07

08

09

CHRISTIANA CARE HOME HEALTH AND COMMUNITY SERVICES Home Health Care Visits

High School Wellness Centers and Alzheimer’s Day Program Visits

272,716

CENTER FOR ADVANCED JOINT REPLACEMENT AND CENTER FOR REHABILITATION Total Knee and Hip Replacements

1,792

pa ge 28 Christiana Care Health System

Rehabilitation Patients

938

22,668

CHARITY CARE in millions of dollars

$ 28.4

$ 32.4

WHERE CHRISTIANA CARE HEALTH SERVICES’ OPERATING DOLLAR GOES

$ 35.7

.27 Therapeutic & Diagnostic Services

$ 46.8

$ 37.7

06

07

08

.06 Depreciation & Interest .07 Support Services

.24 Nursing Services 05

.01 Insurance & Other .01 Other Affiliates .03 Administration

.08 Facilities & Services

09 .15 Employee Benefits

.08 Medical Education & Social Services

TOTAL PATIENT REVENUE in millions of dollars

1,273,876

05

1,408,818

1,546,441

06

1,695,688*

07

08

1,870,275

1,276 Christiana Care volunteers gave a total of 105,547 hours of service this year. That translates to more than $2.1 million.

09

*Adjusted to reflect removal of Riverside patient revenue.

PERSONNEL STATISTICS

Christiana Care Employees Medical-Dental Staff Medical & Dental Residents & Fellows

10,487 1,444 228

Medical & Dental Residents Trained in Our 100-Year History

3,917

RNs, LPNs and Patient Care Technicians

3,752

Facts & Figures 2009 page 29

Christiana Care offers a wide range of health care services in Delaware and surrounding communities.

On the Christiana campus: • Christiana Hospital (907 beds) • Center for Heart & Vascular Health in the Bank of America Pavilion • Helen F. Graham Cancer Center • Breast Center • Christiana Surgicenter

On the Wilmington campus: • Wilmington Hospital (241 beds) • Wilmington Hospital Health Center • Center for Advanced Joint Replacement • Center for Rehabilitation • Roxana Cannon Arsht Surgicenter

Delaware and the community: • 16 School-Based Health Centers • Home Health & Community ServicesVisiting 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 Therapy PLUS sites • 10 Christiana Care Imaging Services locations

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 provider and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission.

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