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.

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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:

How is Cleveland Clinic performing on heart attack care?

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

  1. received angioplasty (also know as a stent or PCI) treatment quickly — within 90 minutes after arrival at the hospital
  2. were given fibrinolytic ("clot buster") medication quickly — within 30 minutes after arrival at the hospital
  3. were given an aspirin prescription when discharged from the hospital
  4. were given a statin (cholesterol-lowering) medication prescription when discharged 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 attack 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) 100%
U.S. Hospitals (July 2013 - September 2013)   98%

Updated: June 2014

Heart Attack Patient Mortality (Death)

This score tells you about the percent (rate) of heart attack 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 attack 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 attack patient deaths?

July 2009 – June 2012

Cleveland Clinic 14.9%
U.S. national average 15.2%

The heart attack 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 Attack Patient Hospital Readmission

This score tells you about the percent (rate) of hospitalized heart attack 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 attack-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 attack 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 attack patient hospital readmission?

July 2009 – June 2012

Cleveland Clinic 20.1%
U.S. national average 18.3%

Cleveland Clinic's heart attack 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

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

How is Cleveland Clinic performing on stroke care?

This score tells you Cleveland Clinic's overall performance on the stroke care items listed below:

  1. medication or other treatment was given to prevent blood clots in veins
  2. an antithrombotic medication such as aspirin, clopidogrel (Plavix®) or aspirin combined with dipyridamole (Aggrenox®) was given by end of hospital day two
  3. an anticoagulant medication such as warfarin (Coumadin®) was prescribed at discharge from the hospital (applies only to patients with atrial fibrillation or flutter)
  4. a tissue plasminogen activator (tPA) medication (sometimes called a “clot buster”) was given within 3 hours of start of stroke symptoms (applies only to patients who arrived at the hospital within two hours of start of stroke symptoms)
  5. a cholesterol lowering medication (called a “statin” medication) was prescribed at discharge, (applies only to patients with an LDL or “bad” cholesterol level greater than 100 or who were on a cholesterol lowering medication prior to hospitalization)
  6. advice and stroke education material were provided before discharge from the hospital
  7. an antithrombotic medication such as aspirin, clopidogrel (Plavix®) or aspirin combined with dipyridamole (Aggrenox®) was prescribed at discharge from the hospital
  8. patients were assessed for rehabilitation services

This information is important because one way to tell if a hospital is doing a good job taking care of stroke patients is to look at how consistently the hospital provides the care listed above.

Higher numbers are better.

Q = Quarter. Example: January – March

* National stroke program percentage is the most current available for all hospitals participating in the American Heart Association Get With the Guidelines ® (GWTG) stroke program. Please note: “This Get With the Guidelines (GWTG) Aggregate Data report was generated using the Outcome PMT system. Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and Outcome Sciences, Inc. (Outcome).”

Updated: June 2014

For more information about brain health, go to:

View other publicly reported data about stroke care in hospitals:

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 performing on surgical care?

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

  1. an antibiotic (medicine that prevents and treats infections) was given at the right time (within one hour before surgery)
  2. the right kind of antibiotic was given
  3. antibiotics were stopped at the right time (within 24 hours after surgery ended - or 48 hours after open heart surgery or other cardiac surgery)
  4. cardiac surgery patients’ blood sugar (blood glucose) was kept at a normal level in the days right after surgery
  5. urinary catheter (a small tube placed in the bladder to drain urine) was removed on the first or second day after surgery
  6. steps were taken to keep patients warm in the operating room and/or body temperature was near normal by the end of surgery
  7. patients on beta-blocker medicine before going into the hospital continued to get that medicine during the time before and after surgery
  8. the right treatment to prevent blood clots was provided at the right time (within 24 hours before or after surgery)
This information is important because one way to tell if a hospital is doing a good job is to look at the percent of surgery 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) 92%
U.S. Hospitals (July 2013 - September 2013) 95%

Updated: June 2014

What is Cleveland Clinic Doing to Prevent Infections?

Cleveland Clinic has an Infection Prevention program designed to improve the quality of health care through the practice and management of infection prevention, education and research. The Infection Prevention team collects data on hospital acquired infections and analyzes the data to identify patterns and trends. Infection rates are shared and discussed with physician and nursing colleagues in an effort to identify and implement best practices to reduce the risks for infection.

Hand Hygiene

Hand hygiene is the best means of preventing the spread of infection. Hand hygiene includes washing with soap and water or using alcohol hand sanitizer before and after each patient contact. An example of Cleveland Clinic’s aggressive hand hygiene efforts is the placement of alcohol hand sanitizers in public areas throughout the hospital including hallways, elevators and cafeterias, making them readily accessible to staff, patients, families and visitors.

Environmental Cleaning

An important aspect of infection prevention is environmental cleaning. Cleveland Clinic’s Environmental Services staff use approved disinfectants for cleaning patient rooms and equipment. High level disinfection and sterilization are used according to national guidelines to ensure clean patient care items.

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.

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.

What is diabetes?

Diabetes (also called diabetes mellitus) is a disease that prevents your body from properly using the energy from the food you eat. Diabetes can occur when the pancreas (an organ behind your stomach) produces little insulin or no insulin at all. It also can occur when the pancreas makes insulin, but the insulin made does not work as it should. These problems cause high blood sugar.

Blood Sugar Control for People with Diabetes

People with diabetes are at risk for long-term problems affecting the eyes, kidneys, brain, heart, feet and nerves. The best way to prevent or delay these problems is to control your blood sugar.

Hemoglobin A1c Test (Glycolated Hemoglobin Test)

The hemoglobin A1c test is an important blood test to diagnose diabetes or determine control of diabetes. It provides an average blood glucose (“sugar”) measurement over the past six to twelve weeks and is used along with home glucose test results to make diabetes treatment adjustments. The normal range for an A1c test is between 4 percent and 6 percent. People with a high A1c test have a higher chance of complications from diabetes. The ideal for most, but not all people with diabetes is less than 7 percent. Physicians may sometimes adjust this goal higher or lower for individual patients.

A1c Corresponds with Average
Daily Blood Sugar Around
7% 154 (123-185)
6% 126 (100-152)
5% 97 (76-120)
How is Cleveland Clinic doing helping patients with diabetes control their blood sugar?

Results below 7: More than half of Cleveland Clinic patients with diabetes achieved A1c results below 7 percent. This means that more than half of our diabetes patients have results in the recommended range for most people with diabetes.

Higher percents are better.

Cleveland Clinic (2012) 57%
Average* n/a

* There is no HbA1c<7% average for all people with diabetes because that target is not appropriate for everyone who has diabetes.

Results above 9: Even though the hemoglobin A1c goal can vary slightly from patient to patient, a result above 9 percent always means a person has extremely high blood sugars and is at very high risk of complications from diabetes. The percentage of Cleveland Clinic patients with poor blood sugar control is much lower than national averages. Cleveland Clinic staff work hard to help patients with diabetes lower their health risks.

Lower percents are better.

Cleveland Clinic (2012) 14%
NCQA Average* (2012) 29%

* 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.

Lipid (LDL or “bad cholesterol”) Control for People with Diabetes

What is cholesterol?

Cholesterol is a waxy substance produced by the body and found in some foods, especially meat and dairy products. You can not live without some cholesterol in your body. However, too much cholesterol causes the build-up of fatty substances in your arteries (blood vessels), reducing or blocking the flow of blood and oxygen to your heart and other organs. This can cause a heart attack, stroke, or damage to other parts of the body.

People with diabetes often have high cholesterol levels and are at much greater risk for heart and vascular disease. An LDL blood test result of less than 100 is considered excellent for diabetes patients who do not have heart disease.

How is Cleveland Clinic doing helping patients with diabetes control their LDL Cholesterol?

63% of Cleveland Clinic’s diabetes patients achieved an LDL of less than 100. This result is excellent when compared with national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 63%
NCQA Average* (2012) 48%

* 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.

Blood Pressure Control for People with Diabetes

High blood pressure (or “hypertension”) raises your risk for heart attack, stroke, kidney disease and eye problems. Blood pressure control is especially important for people with diabetes, many of whom have high blood pressure. Blood pressure of less than 140/90 is recommended for people with diabetes.

How is Cleveland Clinic doing helping patients with diabetes control their blood pressure?

80% of Cleveland Clinic patients with diabetes achieved a blood pressure of less than 140/90. This result is excellent when compared with national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 80%
NCQA Average* (2012) 67%

* 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.

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.

Breast Cancer Screening

Mammograms can detect breast cancer early. We monitor our rates of screening mammography (mammograms to check for breast cancer in women without a prior diagnosis of breast cancer) in women ages 40 to 69.

How is Cleveland Clinic doing helping women get mammograms?

83% of Cleveland Clinic patients (women 40 to 69 with no history of breast cancer) had a mammogram in the previous two years. This result exceeds national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 83%
NCQA Average* (2012) 70%

*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.

Colorectal Cancer Screening

Colorectal cancer screening tests help find cancer early and reduce the risk of death from colorectal cancer. We report the percentage of patients ages 50 to 75 who had appropriate colon cancer screening.

How is Cleveland Clinic doing with screening patients for colorectal cancer?

About 73% of Cleveland Clinic patients (ages 50 – 75) were screened for colon cancer. This results exceeds national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 73%
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.

Preventing Pneumonia – Pneumococcal Immunization Shots for Adults ≥ 65 yrs

Immunization against bacterial pneumonia is recommended for older adults. We report the percentage of patients over 65 who received the immunization.

How is Cleveland Clinic doing with immunizing older patients against pneumonia?

About 85% of Cleveland Clinic’s older adult patients were immunized against pneumonia. This result exceeds national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 85%
NCQA Average* (2011) 69%

*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 2011 NCQA average for care of Medicare HMO members is shown.

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

Childhood Immunizations By Age Two

What is immunization?

Immunization is a way to protect your child from getting a number of illnesses. Many of these illnesses are easily spread from child to child and can cause serious health problems. They can even cause death.

During their first two years of life, children should be given vaccines (medicines) to protect them from:

  • Pertussis (whooping cough)
  • Hepatitis B
  • Rubeola (measles)
  • Tetanus (lockjaw)
  • Mumps
  • Diphtheria
  • Rubella (German measles)
  • Polio
  • Haemophilus influenzae type B (Hib disease)
  • Chickenpox
  • Pneumococcal disease (pneumonia)
How is Cleveland Clinic doing with immunizing children by age two?

88% of Cleveland Clinic pediatrics patients under age two got the recommended immunizations. This result exceeds national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 88%
NCQA Average* (2012) 77%

*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.

The Right Treatment of Your Child’s Upper Respiratory Infection

What is an upper respiratory infection? What is the treatment?

Uncomplicated childhood upper respiratory infections are very common and can last up to two weeks. Symptoms may include:

  • Runny nose
  • Sore throat
  • Red eyes
  • Hoarseness
  • Coughing
  • Fever
  • Swollen lymph nodes

Antibiotics are not effective against uncomplicated upper respiratory infections like colds and should not be prescribed.

How is Cleveland Clinic doing with giving the right treatment for children’s upper respiratory infections?

About 99% of Cleveland Clinic pediatric patients received the right treatment for uncomplicated upper respiratory infections. This result exceeds national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 99%
NCQA Average* (2012) 84%

*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.

The Right Treatment for Your Child’s Sore Throat

What causes sore throat?

Sore throat, or pharyngitis, is an infection of the throat and sometimes tonsils. Most sore throats are caused by viruses (like the common cold) and not by bacteria like strep. Antibiotics are only effective against sore throats caused by strep and should not be prescribed for sore throats caused by viruses and colds.

Strep throat can cause severe complications such as rheumatic fever (a disease of the heart valves), so it is important to seek prompt evaluation for your child.

How will I know if my child has strep throat? What is the treatment?

Your child’s doctor or provider will rub a cotton swab across the back of the throat and send the swab to the lab for testing (also called a throat “culture”). If the throat culture results show that strep bacteria are present, an antibiotic will usually be prescribed.

How is Cleveland Clinic doing with the right treatment for children’s sore throats?

About 95% of Cleveland Clinic pediatric patients received the right treatment for sore throat. This result exceeds national benchmarks.

Higher percents are better.

Cleveland Clinic (2012) 95%
NCQA Average* (2012) 80%

*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.

Updated: December 2013

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

Overall Score for Children's Asthma Care

This score tells you the percent of children hospitalized for asthma who got all the recommended care appropriate for them from the list below:

  1. were given a reliever medication (fast-acting, quick relief medication) while hospitalized
  2. were given systemic corticosteroid medication (oral and IV medication that reduces inflammation and controls symptoms) while hospitalized
  3. were given a home management “Plan of Care” document 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 children hospitalized for asthma who got all the recommended care on the list (as appropriate for each individual).

Higher numbers are better.

Cleveland Clinic (October 2013 – Decembre 2013)  97%
University HealthSystem Consortium Average* (October 2012 - September 2013)  79%

**The University HealthSystem Consortium is an alliance of academic medical centers and their affiliated community hospitals (www.uhc.edu).

The UHC average represents the performance of all hospitals that send their results to CMS (Centers for Medicare & Medicaid Services) through UHC. The UHC average shown here is the most current available at the time this report was updated; the UHC average for other time periods may be different. The recommended care list used for Cleveland Clinic’s performance may differ slightly from the list used for the UHC average, because the time periods are different.

    Updated: June 2014

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