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Cleveland Clinic

The Quality Performance Report shows how Cleveland Clinic has been doing at providing the right care for certain common conditions and keeping patients safe.

What is a Heart Attack?

A heart attack (also called AMI or acute myocardial infarction) happens when the arteries leading to the heart become blocked and the blood supply is slowed or stopped. When the heart muscle can’t get the oxygen it needs, the part of the heart tissue that is affected may die.

The symptoms of a heart attack can include:

  • chest pain (often described as a crushing, squeezing or burning pain in the center of the chest and may radiate to your arm or jaw)
  • shortness of breath
  • dizziness or faintness
  • sweating
  • nausea
  • cold or clammy skin
  • a gray or very ill appearance

Sometimes there may be no symptoms, especially if you have diabetes. Women sometimes have different symptoms, such as a different kind of chest pain and/or abdominal pain.

For more information about heart health go to:

View other publicly reported data about heart attack care in hospitals:

Why Heart Failure Care Measures are Important

Heart failure is a weakening of the heart's pumping power. With heart failure, your body doesn't get enough oxygen and nutrients to meet its needs. Your heart tries to pump more blood, but the muscle walls become weaker over time. These measures show some of the standards of care provided for most adults with heart failure.

Symptoms of heart failure may include:

  • shortness of breath from fluid in the lungs
  • swelling (such as in legs, ankles or abdomen)
  • dizziness
  • fatigue
  • weakness
  • cold or clammy skin
  • a rapid or irregular heartbeat

Heart failure can be a result of heart condition due to:

  • hardening of the arteries, also known as coronary artery disease a heart attack
  • cardiomyopathy (heart muscle damage from infection or alcohol or drug abuse)
  • an overworked heart (caused over time by conditions like high blood pressure, kidney disease, diabetes, or a defect from birth)

For more information about heart health go to:

View other publicly reported data about heart failure care in hospitals:

How is Cleveland Clinic performing on heart failure care?

This score tells you the percent of heart failure patients who got all the recommended care appropriate for them from the list below:

  1. left ventricular systolic (LVS) function was evaluated before hospital arrival, during hospitalization, or scheduled for after discharge
  2. angiotensin-converting enzyme (ACE) inhibitor medication or an angiotensin receptor-blocker (ARB) medication was prescribed at discharge from the hospital (applies only to patients with left ventricular systolic dysfunction, also called LVSD)
  3. received written instructions or educational material about heart failure before discharge from the hospital

This information is important because one way to tell if a hospital is doing a good job is to look at the percent of heart failure patients who got all the recommended care on the list (as appropriate for each individual).

Higher numbers are better.

Cleveland Clinic (October 2013 - December 2013) 97%
U.S. Hospitals (July 2013 - September 2013)  95%

Updated: June 2014

Heart Failure Patient Mortality (Death)

This score tells you about the percent (rate) of heart failure patients that died within 30 days of going into the hospital.

This information is important because one way to tell if a hospital is doing a good job is to see if the death (mortality) rate for heart failure patients treated at that hospital is better than, the same as or worse than the U.S. national average. The death rates take into account how sick patients were before they were admitted to the hospital.

Lower numbers are better.

How is Cleveland Clinic doing with heart failure patient deaths?

July 2009 – June 2012

Cleveland Clinic 9.7%
U.S. national average 11.7%

The heart failure death rate shown for Cleveland Clinic is lower (better) than the national average, but that difference is not significant. This means that Cleveland Clinic's rate is basically the same as the national average.

Only regular Medicare patients are included. People in Medicare Advantage (managed care plans) and people who do not have Medicare are not included.

Updated: May 2013

Heart Failure Patient Hospital Readmission

This score tells you about the percent (rate) of hospitalized heart failure patients who go back into a hospital again within 30 days after going home. Patients may have been readmitted back to the same hospital or to a different hospital. They may have been readmitted for heart failure-related care or for a different reason.

This information is important because one way to tell if a hospital is doing a good job is to see if the readmission rate for heart failure patients is better than, the same as or worse than the U.S. national average. The readmission rates take into account how sick patients were before they were admitted to the hospital.

Lower numbers are better.

How is Cleveland Clinic doing with heart failure patient hospital readmission?

July 2009 – June 2012

Cleveland Clinic 24.5%
U.S. national average 23.0%

Cleveland Clinic's heart failure readmission rate is higher (worse) than the national average, but that difference is not significant. This means that Cleveland Clinic's rate is basically the same as the national average.

Only regular Medicare patients are included. People in Medicare Advantage (managed care plans) and people who do not have Medicare are not included.

Updated: July 2013

What is a Stroke?

A stroke, or “brain attack,” occurs when a blood vessel in the brain becomes blocked or bursts. The brain cannot store oxygen, so it relies on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke results in a lack of blood supply, causing nerve cells in that area of the brain to be cut off from oxygen. When tissue is cut off from its supply of oxygen for more than three to four minutes, the brain tissue begins to die.

There are three kinds of stroke: hemorrhagic strokes, ischemic strokes, and transient ischemic attacks.

  • Hemorrhagic stroke — This type of stroke takes place when a weakened blood vessel in the brain breaks. Bleeding, or hemorrhage from the blood vessel, occurs suddenly. The force of blood that escapes from the blood vessel can also damage brain tissue in that area. Hemorrhagic stroke is the most serious kind of stroke.
  • Ischemic stroke — This type of stroke occurs when a blood vessel in the brain develops a clot and cuts off the blood supply to the brain. A blood clot that forms in a blood vessel in the brain is called a "thrombus." A blood clot that forms in another part of the body, such as the neck or lining of the heart, and travels to the brain is called an "embolus." Blood clots often result from a condition called "atherosclerosis," the build-up of fatty deposits within blood vessel walls.
  • Transient ischemic attack (TIA) — A TIA should be treated as seriously as a stroke. A TIA occurs when blood flow to a certain part of the brain is cut off for a short period of time, usually 15 minutes or less. Although TIA is painless, it is an important warning sign that a stroke may follow.

The symptoms of a stroke can include:

  • Sudden numbness or weakness of the face, arm or leg, mainly on one side of the body
  • Sudden difficulty understanding or speaking – you may have slurred speech or confused speech
  • Sudden difficulty seeing in one eye or both eyes
  • Sudden loss of balance, coordination or the ability to walk
  • Sudden, severe headache

What is Pneumonia?

Pneumonia is an infection of the lungs. It is caused by bacteria or a virus. The lungs fill with mucus. This lowers the oxygen level in your blood. Symptoms of pneumonia can include the following:

  • difficulty breathing
  • "wet" cough – mucus may look green or bloody
  • chest pain
  • fever and chills
  • fatigue

You should also be aware that flu shots reduce the risk of influenza, a serious and sometimes deadly lung infection that can spread quickly in a community. Hospitals should check to make sure that pneumonia patients get a flu shot during flu season to protect them from another lung infection and to help prevent the spread of influenza in the community.

For more information about lung health go to:

View other publicly reported data about pneumonia care in hospitals:

How is Cleveland Clinic performing on pneumonia care?

This score tells you the percent of pneumonia patients who got all the recommended care appropriate for them from the list below:

  1. had a blood culture (test to check type of bacteria) in the emergency department before receiving any antibiotic in the hospital
  2. were given the right antibiotic

This information is important because one way to tell if a hospital is doing a good job is to look at the percent of pneumonia patients who got all the recommended care on the list (as appropriate for each individual).

Higher numbers are better.

Cleveland Clinic (October 2013 - December 2013)

89%
U.S. Hospitals (July 2013 - September 2013) 96%

Updated: June 2014

Pneumonia Patient Mortality (Death)

This score tells you about the percent (rate) of pneumonia patients that died within 30 days of going into the hospital.

This information is important because one way to tell if a hospital is doing a good job is to see if the death (mortality) rate for pneumonia patients treated at that hospital is better than, the same as or worse than the U.S. national average. The death rates take into account how sick patients were before they were admitted to the hospital.

Lower numbers are better.

How is Cleveland Clinic doing with pneumonia patient deaths?

July 2009 – June 2012

Cleveland Clinic 12.4%
U.S. national average 11.9%

The pneumonia death rate shown for Cleveland Clinic is higher (worse) than the national average, but that difference is not significant. This means that Cleveland Clinic's rate is basically the same as the national average.

Only regular Medicare patients are included. People in Medicare Advantage (managed care plans) and people who do not have Medicare are not included.

Updated: May 2013

Pneumonia Patient Hospital Readmission

This score tells you about the percent (rate) of hospitalized pneumonia patients who go back into a hospital again within 30 days after going home. Patients may have been readmitted back to the same hospital or to a different hospital. They may have been readmitted for pneumonia-related care or for a different reason.

This information is important because one way to tell if a hospital is doing a good job is to see if the readmission rate for pneumonia patients is better than, the same as or worse than the U.S. national average. The readmission rates take into account how sick patients were before they were admitted to the hospital.

Lower numbers are better.

How is Cleveland Clinic doing with pneumonia patient hospital readmission?

July 2009 – June 2012

Cleveland Clinic
21.5%
U.S. national average 17.6%

Cleveland Clinic's pneumonia readmission rate is higher (worse) than the national average.

Only regular Medicare patients are included. People in Medicare Advantage (managed care plans) and people who do not have Medicare are not included.

What are we doing to improve? Cleveland Clinic is:

  • checking each patient’s risk for readmission
  • using a consistent process for discharging patients that includes making sure patients understand their medications and other instructions
  • arranging prompt follow-up care

Updated: July 2013

Why Surgical Care Measures are Important

Hospitals can improve surgical care and reduce the risk of wound infection after surgery by making sure they provide care that’s known to get the best results for most patients.

There are also steps that you, as a patient, can take to make sure the surgery is as safe as possible. For example, your doctor or nurse can tell you how to wash with an antibiotic soap the day before surgery. You can also give your doctor or nurse a list of all your medications, including vitamins, herbal medicines and over-the-counter medications. You should also tell your doctor or nurse about any allergies and bad reactions to anesthesia. Sometimes patients get an infection after surgery, even if the hospital took steps to prevent it. Here are signs to look out for:

  • the surgical wound is red, hot, and swollen
  • you have a fever of over 100 degrees after you go home
  • a smelly or yellow/green fluid is coming out of the wound
  • your pain is increasing even though you are taking pain medication

Call your doctor or local hospital immediately if you have any of these signs.

View other publicly reported data about surgical care in hospitals:

How is Cleveland Clinic Doing at Preventing Infections?

Central Line Associated Blood Stream Infections (CLABSI) Acquired while in Intensive Care Units

A central line is a catheter (small tube) that is inserted and passed into a large vein or the heart. Central line blood stream infections can often be prevented.

This score tells you the number of Central Line Associated Blood Stream Infections (CLABSI) among patients in Cleveland Clinic ICUs (Intensive Care Units) per 1,000 central line days.

What does “Central Line Days” mean? Central lines are counted each day. Each patient with one or more central lines at the time the count is performed is counted as one central line day.

Lower numbers are better. All hospitals aim for zero central line infections.

Q = Quarter. Example: January - March

What we are doing to improve – CLABSI is a priority for all Cleveland Clinic caregivers. A hospital-wide team is dedicated to staff education and promoting best practices that reduce CLABSI. Cleveland Clinic has joined hospitals across the country to keep patients safe by consistently applying a basic, simple set of steps that reduce the risk of infections for patients with central lines, focused on:

  1. Proper line insertion
  2. Proper line maintenance
  3. Removing the line when it is no longer needed

Cleveland Clinic is using the steps above to reduce CLABSI in all areas of our hospital, not just ICUs.

Updated April 2014

 

Clostridium difficile (C. diff or CDI) Infections Acquired While in the Hospital

This score tells you the number of Clostridium difficile (C. diff or CDI) infections per 1,000 patient days (total number of days spent by all adult patients in the hospital).

We are reporting infections per 1,000 patient days. Some hospitals report infections per 10,000 patient days. It is important make sure patient days are the same when comparing hospitals. Only infections identified by the hospital laboratory that developed on or after day 4 of hospital admission are included.

This information is important because CDI is a bacterial infection that causes diarrhea and more serious intestinal conditions, such as colitis (inflammation of the colon). People who get CDI are usually elderly and are taking antibiotics for another infection. Clostridium difficile bacteria are found in the feces (bowel movements) of an infected person. Other people can become infected if they touch items or surfaces that are contaminated with the bacteria and then touch their mouth.

Lower numbers are better.

Q = quarter. Example: January - March

What we are doing to improve – We focus on hand hygiene, patient placement, and environmental cleaning to reduce CDI infections.

Updated April 2014

Methicillin-Resistant Staphylococcus aureus (MRSA) Blood Stream
Infections Acquired While in the Hospital

This score tells you the number of methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections per 1,000 patient days (total number of days spent by all adult patients in the hospital).

We are reporting infections per 1,000 patient days. Sometimes infections are reported per 10,000 patient days. It's important to make sure the number of patient days is the same when comparing one hospital to another. Only infections identified by the hospital laboratory that developed on or after day 4 of hospital admission are included.

This information is important because blood stream infections can sometimes be life threatening. Unlike most infections, blood stream infections spread through the entire body, sometimes causing the patient to become seriously ill. Blood stream infections can most often be prevented by preventing infections that can get into the blood. Treating those infections quickly and thoroughly can minimize the risk of spreading infection into the blood stream.

Lower numbers are better.

Q = Quarter. Example: January - March

Updated April 2014

Methicillin-Susceptible Staphylococcus aureus (MSSA) Blood Stream Infections Acquired While in the Hospital

This score tells you the number of methicillin-sensitive Staphylococcus aureus (MSSA) blood stream infections per 1,000 patient days (total number of days spent by all adult patients in the hospital).

We are reporting infections per 1,000 patient days. Sometimes infections are reported per 10,000 patient days. It's important to make sure the number of patient days is the same when comparing one hospital to another. Only MSSA blood stream infections identified by the hospital laboratory that developed on or after day 4 of hospital admission are included.

This information is important because blood stream infections can sometimes be life threatening. Unlike most infections, blood stream infections spread through the entire body, sometimes causing the patient to become seriously ill. Blood stream infections can most often be prevented by preventing infections that can get into the blood stream. Treating those infections quickly and thoroughly can minimize the risk of spreading infection into the blood stream.

Lower numbers are better.

Q = Quarter. Example: January - March

Updated April 2014

These scores tell you about how often patients had certain serious, but potentially preventable complications (listed below) related to medical or surgical inpatient hospital care.

Where does the score come from? The information comes from documenting certain events in patient medical records. These events are then “coded” by the hospital for billing Medicare. Coded information is sometimes called “administrative” data.

This information is important because one way to tell if a hospital is doing a good job is to look at how often patients experienced certain complications that might have been preventable.

Lower numbers are better.

How is Cleveland Clinic doing with preventing certain serious complications?
July 2010 – June 2012

Rate per 1,000 Hospitalized Patients
Serious Complication U.S. National Average Cleveland Clinic
Death among surgical patients with serious treatable complications 110.25 113.97*
Collapsed lung due to medical treatment

0.32

0.21*
Blood clot in the lung or large vein after surgery 4.14 6.63**
Wound that splits open after surgery 0.92 0.62*
Accidental cut or tear during surgery or other procedure 1.83 3.42**

Includes only people with “regular” Medicare. People in Medicare Advantage (managed care plans) and people who do not have Medicare are not included.

* The difference between Cleveland Clinic and the national average is not significant. This means that Cleveland Clinic’s rate is basically the same as the national average.
** Cleveland Clinic’s rate is worse than the national average.

For details, visit Medicare.org | Hospital Compare.

What is Cleveland Clinic doing to improve? Cleveland Clinic has many initiatives underway to keep patients safe. Standard “best” practices are the key to success. Examples:

  • To prevent collapsed lungs due to medical treatment, Cleveland Clinic implemented a standard procedure for placing and checking central lines (small tubes inserted and passed into a large vein or the heart).
  • To prevent blood clots in the lung or large vein after surgery, Cleveland Clinic implemented a standard approach that includes checking each hospitalized patient’s risk for blood clots and providing medications or other treatment as indicated.

    Updated: September 2013

Preventing Patient Falls

Nationally, falls are a leading cause of hospital patient injury. A fall is more likely to occur in an environment that is unfamiliar such as a hospital room. Other risks for falling in the hospital include: medications that cause dizziness and tests or treatments that make you feel weak or unsteady. Some falls cause moderate to severe injuries.

How is Cleveland Clinic Doing at Preventing Falls with Injuries?

This score tells you how many patients fell during their hospital stay and had a moderate or serious injury such as a cut that needed stitches, a head injury or a hip fracture.

This information is important because one way to tell if a hospital is doing a good job is to look at how many patients are moderately or seriously injured due to falls.

Lower numbers are better.

Cleveland Clinic (January 2013 – December 2013) 28
Target 0
What we are doing to prevent falls

All hospitals aim for zero patient injuries. Our fall prevention efforts include: identifying patients who are at risk for falls, checking on them frequently, assisting them to the bathroom and providing non-skid footwear. Caregivers make sure patients have all necessary items, including a call light, within easy reach.

    Updated: March 2014

This report reflects office-based care by Cleveland Clinic internal medicine and family medicine doctors at the main campus and at Cleveland Clinic Family Health Centers across northeast Ohio.

How is blood pressure recorded?

Blood pressure is written as two numbers, such as 118 / 72 (or “118 over 72”). The first number is the systolic pressure. This is the pressure in the arteries when the heart beats and fills the arteries with blood. The second number is diastolic pressure. This is the pressure in the arteries when the heart rests between beats.

What is high blood pressure? How will I know if I have it?

High blood pressure is a measurement of the pressure or force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels), which carry blood throughout the body. High blood pressure, also called hypertension, means the pressure in your arteries is above the normal range. You usually cannot feel high blood pressure. Many people with high blood pressure don’t know they have it. People with high blood pressure are more likely to have heart attacks and strokes. That’s why it’s important to have a health care provider check you and get a blood pressure reading once a year.

What is a normal blood pressure reading? What numbers are considered high blood pressure?

Normal Blood Pressure Pre- Hypertension Stage 1 Hypertension Stage 2 Hypertension
Systolic (top number) less than 120 120-139 140-159 160 and above
Diastolic (bottom number) less than 80 80-89 90-99 100 and above

How is Cleveland Clinic doing helping patients with high blood pressure control it?

About 75% of Cleveland Clinic patients with high blood pressure have readings below 140/90. This means that 75% of Cleveland Clinic high blood pressure patients achieved a blood pressure that lowers their risk of heart attacks and strokes. This result is excellent compared with other organizations.

Higher percents are better.

Cleveland Clinic (2012) 75%
NCQA Average* (2012) 63%

*NCQA (National Committee for Quality Assurance) averages are the best available for comparing performance. However, these averages are based on care of insurance health plan members, not on care provided by specific groups of doctors. The 2012 NCQA average for care of commercial HMO members is shown.

What is Asthma?

Asthma is a disease of the bronchial tubes (branches of the windpipe) and airways of the lungs. Asthma is not contagious but tends to run in families. Air is normally taken into the body through the nose and windpipe and into the bronchial tubes. At the end of these tubes are tiny air sacs (alveoli) that deliver fresh air (oxygen) to the blood. During normal breathing, the bands of muscle that surround the airways are relaxed and air moves freely. During an asthma episode or "attack," three main changes stop air from moving easily through the airways:

  • The bands of muscle that surround the airways tighten and make the airways narrow. This tightening is called bronchospasm.
  • The airway linings become swollen or inflamed, allowing less air into the breathing passages.
  • The cells that line the airways produce more mucus, which is thicker than normal.
What causes an asthma attack?

Asthma attacks may be brought on by "triggers." We do not know why they cause this reaction, but we do know they can cause an attack.

Asthma triggers include:

  • Infections (colds, viruses, flu, sinus infections)
  • Exercise
  • Weather (cold air, changes in temperature, humidity)
  • Tobacco smoke and air pollution
  • Allergens: substances that cause an allergic reaction in the lungs (dust mites, pollens, pets, mold spores, foods and cockroaches)
  • Strong odors from chemical products
  • Strong emotions, such as crying or laughing hard
  • Certain medications, including ibuprofen
What are symptoms of an asthma attack?
  • Shortness or loss of breath
  • Wheezing
  • Fast breathing
  • Chest tightness, pain, or pressure
  • Coughing fits
  • Cannot talk in a full sentence
  • Feelings of weakness or fatigue
When does a child need to be hospitalized for an asthma attack?

Your child will need to be hospitalized if he or she:

  • Is not responding to medication at home, doctor's office, or emergency room
  • Needs extra oxygen
  • Needs very frequent breathing treatments
  • Needs close monitoring
  • Needs medication through an IV
When should you call your health care provider?

Call your health care provider if your child:

  • Experiences a need for an increased use of breathing treatments/medications at home
  • Experiences a changing or worsening of wheezing and fast breathing
  • Becomes more inactive/talks less frequently

For more information about asthma go to:

View other publicly reported data about children’s asthma care in hospitals:

Updated: September 2013

Keep in mind that you should not choose a hospital based solely on reported data.
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