2019 Orthopedic & Spine

OUTCOMES
Report
Contents Introduction

03 | Introduction 15 | Hip Replacement In 2018, more than 3,500 California residents put their trust in Palomar Health Orthopedic and Spine Center to
resolve their bone, joint and spine disorders. Our expertise and commitment to providing the highest quality
care has resulted in superior patient outcomes with fewer complications and readmissions. These exceptional
04 | 
Award-Winning Orthopedic 16 | Knee Replacement results have earned us national recognition, and we are proud to share some of the details of our efforts
and Spine Care through this report.

19 | Shoulder Replacement Centers of Excellence

06 | About our Patients
While we serve a large patient population, each patient deserves to be our top priority. That’s why we’ve
developed a Center of Excellence (COE) model of care for patients with hip, knee, shoulder and spine
disorders. Each COE focuses on a specific condition and is designed around the patient’s needs, including
education, pain control, rapid recovery and rehabilitation.

●● Dedicated physicians and staff members

●● High-quality patient outcomes
●● Personalized care at every step of the journey
●● Faster recovery and less pain
20 | Spine Surgery
09 | The Patient Experience
Members of our COEs constantly challenge each other to improve. We rely on intensive data collection to fine
tune our treatment pathways and remain steadfast in our pursuit of excellence.
22 | Hip Fracture Repair
10 | 
Steps to a Successful Surgery

24 | Where to Find Us

We specialize in a full spectrum of procedures

26 | Acknowledgments
from total joint replacement to spinal
decompression. Our skilled surgeons also address
complicated issues like hip fractures, and perform
more intensive operations such as joint revision
11 | 
Education and Community Events surgery and complex spine surgery.

12 | 
Total Joint Replacement

2 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 3

Award-Winning Orthopedic and Spine Care

Palomar Health Orthopedic and Spine Center of San Diego County ranks in Healthgrades
the top 10 percent of U.S. hospitals. Superior patient outcomes mean fewer Palomar Medical Center Escondido was recognized
complications and readmissions. We are proud to be nationally recognized for our by Healthgrades for superior outcomes in back and
neck surgery, spinal fusion, hip fracture treatment, hip
exceptional results.
replacement and knee replacement.
Distinctions include:
●● America’s 100 Best Joint Replacement 2017 – 2019
U.S. News & World Report ●● America’s 100 Best Orthopedic Surgery 2017 – 2019
To help patients decide where to receive care, ●● Five-Star Recipient Back Surgery 2019
U.S. News & World Report evaluates data on
●● Five-Star Recipient Total Hip Replacement 2019
nearly 5,000 hospitals in 16 adult specialties,
9 adult procedures and conditions, and 10 pediatric ●● Five-Star Recipient Total Knee Replacement 2019
specialties. A hospital must excel in caring for the Palomar Medical Center Poway also achieved:
sickest, most medically complex patients to be ●● Five-Star Recipient Total Knee Replacement 2019

nationally ranked in a specialty.

●● Palomar Medical Center Poway – Knee Replacement 2019
●●  alomar Medical Center Escondido – Knee and Hip
P
Replacement 2018 – 2019 Women’s Choice Awards
Palomar Medical Center Escondido was named
as one of America’s Best Hospitals for Orthopedics
in 2018.
Blue Distinction Center
Palomar Health is designated as a Blue Distinction
Center for the following:
●●  alomar Medical Center Poway – Knee and Hip
P
Replacement 2013 – 2018 Blue Shield of California
An independent member of the Blue Shield Association

●●  alomar Medical Center Escondido – Knee and Hip

P
Excellence doesn’t arise from the competence of any
Replacement 2013 – 2018
one person – not the general practitioner, surgeon, floor nurse,
●●  alomar Medical Center Escondido – Spine Surgery
P physical therapist or patient. They all need to be placed within a
2013 – 2018 system designed for success; a complex system built on the
hard work of many hours developing and improving protocols,
and mountains of data. And at the center of that system must be
the patient.
Aetna Institutes of Quality Aetna Institutes of Quality recognizes
R
– James Bried, MD
The Aetna Institutes of Quality awarded Palomar Medical Center Escondido for Orthopedic Medical Director, PMC Poway
consistently delivering evidence-based,
Palomar Medical Center Escondido with the
quality care for Orthopedic Spine & Total
Quality distinction for or thopedic and spine surgery Joint Replacement.
for 2013 – 2018.

4 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 5

About Our Patients

7.2% 63.2% 29.6%

3% Foot and Ankle Hip & Knee
Replacement
3% Hand and Upper
Extremity 30.8% 51.6% 17.7%
Spine
4% Sports Medicine Surgery
Surgical Volumes Clinical Advances Driving
By Specialty 14% Spine 47.6% 38.1% 14.3%
Demand Across the Sports
2018 15% Trauma Generations Medicine

61% Joint Replacement

Generation X Baby Boomer Greatest Gen.
or Younger (54 – 72) or Older (73+)

Baby Boomers are the most common generation cohort for

orthopedic and spine surgery. However, minimally invasive
surgical techniques have opened the door for younger
Patients from all across the country come to Palomar Health patients (Generation X) to have surgery without a lot of down
for their care. From Maine to Hawaii, we are known for our time, and for older patients (Greatest Generation) to return
excellence in orthopedic and spine care. to a higher quality of life.

Patient Locations

32% PH Primary

Palomar Health District-North Sports Medicine
RIVERSIDE Primary (PH District) and Spine
COUNTY
17% PH Primary
Secondary Service Areas District-South
Gender
Temecula
Trauma
BONSALL/
FALLBROOK
12% North County Foot and Ankle
Coastal
NORTH
COUNTY Joint Replacement
COASTAL
PH PRIMARY 5% Coastal
DISTRICT 30% 40% 50% 60% 70%
NORTH

Oceanside
4% Bonsall/Fallbrook
Carlsbad Female Male
Escondido
3% Inland South
COASTAL
PH PRIMARY
DISTRICT 3% Riverside County While females outnumber males for joint replacement
SOUTH
procedures, both genders report a near equal share of other
25% Other
Poway

INLAND
orthopedic and spine issues.
SOUTH

El Cajon
6 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 7

San Diego
 ROOM
HUSBAND
DOCTORS DISCHARGE PHYSICAL
NIGHTSHIFT
GREA FEELING

NIC
ADMITTING PLEASANT RESPECT
The Patient Experience
AWESOME PHYSICIAN
BEST COURTEOUS PLEASED IMPRESSED
ALWAYS
VISITORS

NURSES

POSITIVE
Patients come first. We pride ourselves in combining the best technologies with the brightest, most
caring professionals to provide you the best patient care possible. During your stay at a Palomar Health

EXPLAINED
hospital, every member of our staff will treat you and your loved ones like family. Here’s what our patients told
us about their orthopedic and spine experience in 2018.

QUICK
REHAB

CARED
THANK WONDERFUL
FOOD
ATTENTION
PROFESSIONALISM NEEDS
PEOPLE FAMILY
ASKED

Measure
Palomar Medical Center

National
Poway

Grade
Palomar Medical Center
Escondido

National
Grade
Rank Rank

OVED PALOMAR CARING SERVERS

EXCELLENT
THERAPIST PAIN
Communication with Nurses 88% B 94% A
Communication with Doctors 98% A 98% A
Pain Always Well Controlled 97% A 97% A
Quality of the Food 98% A 91% A

SURGEONS
B A
Would you recommend the Hospital to Family
At Palomar Health Orthopedic and Spine Center, patient satisfaction is our greatest and Friends?
83% 95%
accolade. From communication to food quality and pain control, we strive to
provide a superior experience every day in every way. This word cloud represents Discharge Information and Care Transitions 99% A 98% A
actual patient feedback gathered from 2018 satisfaction surveys. The bigger
the word appears, the more frequently it was used by patients to describe their
experience with us.
I’m really proud of our success in controlling pain after
surgery. This allows patients to recover faster, and even walk the

EXPERIENCE
very same day of surgery. We don’t want to be the hospital where
TREATED HAPPY your pain is ‘usually’ under control, we strive for ‘always.’ I frequently

HELPFUL hear from my patients that they had surgery years ago, but that it’s

GOOD
improved so much, they wished they hadn’t waited so long.

COMFORTABLE – Thomas Knutson, MD

IND

Orthopedic Medical Director, PMC Escondido

FRIENDLY FANTASTIC WIFE

PALOMAR HEALTH OUTCOMES REPORT 9

Steps to a Successful Surgery Education and Community Events

Our goal is to improve your quality of life, increase your mobility, and make your care experience as easy as As leaders in the orthopedic and spine industry, our team of experts is committed to educating our staff and
possible. For patients who need surgery, most are leaving our facility sooner than they may have expected. the community. Classes are led by physicians and health education experts who are passionate about their work.
That’s why our team has designed a CarePath that keeps you and the rest of your care team connected and
The 5th Annual
moving towards the same goals. The 5th The
Annual
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ORTHOPEDIC & SPINE
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Your Best Enhanced Advanced 5th Annual Orthopedic & Spine Symposium READY
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Patient Early Care Transitions

SET
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Health Before Recovery and Surgical

GO
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Education Mobilization and Hand-Offs More than 130 nurses, therapists and case managers attended our symposium on September 28, 2018. The event

SET SE
Surgery Pain Control Techniques
featured an expert panel of speakers from Palomar Health and Mayo Clinic who led us in a fun and informative day of
Avoid surgery Attend a Pre- Our multi-modal Minimally invasive You’ll often walk Coordinated care is orthopedic and spine education. We explored innovative ways to get people moving and back to the lives they love.
09.28.18 09.28
until all other Operative Class pain control surgical techniques the same day as the key to getting 09.28.18
09.28.18 09.28
●● 6.25 CEU’s approved by BRN Board of Registered Nursing
conservative taught by our reduces reliance on allow for faster surgery to speed you home faster.
treatments have specialized nurses. opioids. recovery, a up recovery and ●● 6.25 CEU’s approved for Physical Therapy Board of California
Name: _______________________________________________________________________________
Name: __________________________________________________________
been exhausted. shorter hospital improve range of We work to Name: Name:
___________________________________________________________________________________
____________________________________________________________________________
Name: __________________________________________________________
Engage with your Anesthesia engage you and
●● 6.25 CEU’s approved for Occupational Therapy of California
stay and fewer motion. Organization: ___________________________________________________
Organization: ___________________________________________________
Phone: __________
Minimize health personalized protocols reduce complications. your caregiver so ●● 5.75 hours approved for ONCB Category
Organization:
Organization:
___________________________________________________
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forOrganization:
Category B ___________________________________________________
Phone: Phone:
______________
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factors that Online CarePath. medication side Our physical and you feel supported Have each vendorHave initialeach
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A nurse is available Special thanks to our top sponsors:
risk for potential
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nausea. times reduce blood
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surgery. any questions or Pre-surgery infection. every stage, from programs, home SPINE SYMPOSIUM
concerns. hydration helps you hospital to home, visits, nurse check- READY
SET
GO!
feel better after to one of our ins, online surveys PalomarHealth.org/Symposium2018

surgery. outpatient clinics. and follow-up visits 09.28.18

are all designed to

Orthopedic & Spine Center
keep you on track.

Community Classes and Events

Online CarePath Our mission is to heal, comfort and promote health in the communities we
serve. That’s why we offer free classes to the community. More than 1,100
To prepare for surgery, Palomar Health offers Online CarePath, a custom
guests attended our Orthopedic and Spine classes in 2018.
roadmap to get patients prepared and organized for surgery and recovery.
Patients can interact with their care team about their health, from sleeping and 840 patients attended our Pre-Operative Joint and Spine Classes
With these classes, and
eating, to pain control. Palomar Health specialists can reply with recommendations. ●● 16 Pre-Op Spine Classes ●● 44 Pre-Op Total Joint Classes our Online CarePath,
patients can walk away with
345 guests attended one of our 14 community education a better understanding
of how to manage and be

98
classes, including:

%
more proactive in their post-
of patients felt I was very impressed with the ease and ●● Why Does My Hand Hurt? ●● Heal Your Hips op care.

prepared for
straightforward CarePath programs.
●●  ostural Awareness and
P ●●  ocus on Your Feet
F
EXHIBITORS
EXHIBITORS EXHIBITORS
EXHIBITORS
EXHIBITORS
It truly helped me in preparation and – Najeebe Geagea, MSN, RN
their surgery answered my concerns beforehand.
Back Care and Ankles
Palomar Health Acute RehabPalomar
Palomar Health
PalomarAcute
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Acute
Unit
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Palomar
Health Acute RehabClinical
Unit
Health Acute Rehab Unit
Coordinator
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Palomar Health
PalomarHuman
Palomar Health
HealthResources
Human Palomar
Resources
Health
●● Integrative Spine Care ●● Beat Back Pain
– Steve McCoy Palomar Health Home Caregivers
Palomar Health
PalomarHome
Health
Caregivers
Palomar
& Home
Home Caregivers
&
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10 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 11
Total Joint Replacement

Palomar Health Orthopedic and Spine Center ranks in the top 10 percent of U.S. hospitals, and is the top
knee and hip replacement destination in North County San Diego. Our orthopedic surgeons are pioneers
in their field, using surgical best practices and advanced pain reduction techniques to provide more rapid
recoveries for patients.

As a leader in total joint replacement, Palomar Health provides:

●● Leading surgeons with minimally-invasive surgery options
●● Pre-operative educational classes to give you the tools you need throughout your journey
●● A personalized joint replacement therapy plan with customized recommendations from your surgeon
●● Comprehensive clinical support, from pre-operative tests and surgery, to therapy and home recovery

2018 Total Joint Replacement Outcomes

Length of Stay 30-Day Readmission Rate
4 4%

2 6 2% 6%
1.58 1.72%
1.55 1.36%

0 8 0% 8%
Excellent Poor Excellent Poor
2.43 days = National Average 3.14% of Patients = National Average
1.8 days = Top 10% in Nation 2.02% of Patients = Top 10% in Nation
PMC Poway PMC Escondido PMC Poway PMC Escondido
Why is this Important? In 1988, patients had a 10- to 14-day Why is this Important? Every member of our team plays a
hospital stay. Today, it’s less than 2 days, with better patient role in reducing the likelihood of a patient needing to return
outcomes. Our lower length of stay means our patients met to the hospital. To achieve these low rates, we focused on
their therapy goals and were ready to go home faster. This patient safety after discharge, and improved hand-offs from
reduces their chances of a complication like infection. the hospital to home caregivers.

San Diego County is a national leader for orthopedic

Percent of Patients Discharged Home Complication Rate excellence. We’ve resolved major problems in our field,
4%
like reducing infections and avoiding complications and
50%
readmissions. Now we’re addressing a large number of smaller
75% 2% 6%
25% gaps in care, like care transitions, opioids and managing
the growing list of patient risk factors like obesity, diabetes,
89% 0.9%
0.68% heart disease and fragility. Palomar Health’s role as a large
96%
100% 0% 0% 8% volume institution is to stay at the forefront of these issues and
Excellent Poor Excellent Poor
influence others around us. We have that San Diego mentality
2.53% Complications = National Average
70% of Patients = National Average 1.69% Complications = Top 10% in Nation for excellence, and it drives us to be better every day.
PMC Poway PMC Escondido PMC Poway PMC Escondido

Why is this Important? There is no place like home to Why is this Important? Achieving superior clinical outcomes – Brian Cohen, MHA
recover from surgery. The Palomar Home Health team can after surgery requires a smooth start on the road to recovery. Director, Orthopedic and Spine Services
provide wellness programs, home visits and nurse check-ins.
Plus, our online surveys and follow-up visits are designed to
keep you on track in the comfort of your own home.

12 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 13

 Hip Replacement

The hip joint is one of the body’s largest weight-bearing joints. A healthy hip joint lets you walk, squat and turn
without pain. With a damaged hip joint, the cartilage in the joint is worn down, causing severe pain and stiffness.

Palomar Health Leads the Region in Hip Replacement Expertise

Total hip replacement surgery, or hip arthroplasty, is one of the most common and effective forms of
orthopedic surgery, resulting in excellent outcomes.

What to Expect as a Hip Replacement Patient

San Diego’s Palomar Health Orthopedic and Spine Center offers the expertise and experience of sub-specialty
trained orthopedic surgeons covering:

●● Partial hip replacement and hip resurfacing ●●  evision of hip replacement – patients come to
R
●● Total hip replacement us from all over to replace worn implants, or to
correct a previous surgery
●● Minimally invasive hip approaches

Volume by Procedure Type How Long Does a Hip Replacement Last?

70.2 57.9 % %
900
19 20

600
have lasted 20+ years have lasted 25+ years
25
Years of research have allowed Palomar Health Orthopedic
300
247 671 685 and Spine Center surgeons to extend the lifetime use of
Palomar Health leads the region in hip implants while helping to speed up recovery and reduce
100
replacement expertise. Years of research have allowed
0 101 108 103 post-operative discomfort. Wear rates can vary based on
our surgeons to extend the lifetime use of implants 2010 2014 2018 patient factors like activity and weight. The good news
while helping to speed up recovery and reduce post- is that modern materials used in hip and knee implants
operative discomfort.  evision of Hip
R  otal Hip
T  artial Hip
P should be even more durable than those in the study.
Replacement Replacement Replacement

Patient Reported Improvement in Function

Before and Pain
Surgery 53
Why is this Important? Palomar Health wants to know
3 Months how much surgery has improved our patients’ daily lives.
After Surgery 81
That’s why we ask our patients to report on their function
and pain before surgery, 90-days after surgery and again,
1 Year
After Surgery
One-year results available late 2019 after one year. We use a standardized survey called the
HOOS Jr, which is scored on a scale of 0 – 100. 0 is the
(n=108)
0 20 40 60 80 100 lowest score, and 100 means full function.
Level of Disability Extreme Severe Moderate Mild Limited
to None

14 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 15

Knee Replacement

Knee pain is a common complaint across many age groups. Due to the high amount of strain placed on
the knee throughout the years, orthopedic knee surgeries like arthroscopic knee surgery and total knee
Free your knees! Palomar Health
replacement remain common.
Orthopedic and Spine Center is the top knee
replacement destination in North County
Palomar Health Leads the Region in Knee Replacement Expertise San Diego, and is nationally recognized for
If you are faced with a knee condition, Palomar Health Orthopedic and Spine Center can help. We offer the shorter hospital stays, fewer complications
expertise and experience of sub-specialty trained surgeons in orthopedic knee surgery covering: and faster recoveries.

●● Partial knee replacement

●● Total knee replacement
●●  evision of knee replacement – patients come to us from all over to replace worn implants, or to correct a
R
previous surgery

Median Patient Age by Knee Replacement Type Volume by Procedure Type

Age: Volume:
75 1800

70 1400 27
31
65 1000

60 600 22

200
504 1150 1342
55
2010 2014 2018 0
58 38 25
2010 2014 2018
 evision of Knee
R  otal Knee
T  artial Knee
P
Replacement Replacement Replacement
 evision of Knee
R  otal Knee
T  artial Knee
P
Replacement Replacement Replacement
Serving Younger Patients with Partial Knee Replacements

Patient Reported Improvement in Function

Before
Surgery 52 and Pain
Why is this Important? Palomar Health wants to know
3 Months how much surgery has improved our patients’ daily
After Surgery 68
lives. That’s why we ask our patients to report on their
function and pain before surgery, and again 90-days
1 Year
One-year results available late 2019 after surgery. We use a standardized survey called the
After Surgery
KOOS Jr, which is scored on a scale of 0 – 100. 0 is the
(n=177)
0 20 40 60 80 100 lowest score, and 100 means full function.
Level of Disability Extreme Severe Moderate Mild Limited
to None

16 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 17

 Shoulder Replacement

Sturdy and flexible shoulders are essential to an active lifestyle and

daily functions. However, shoulder functionality can be severely
limited by arthritis, fractures, tears and inflammation such as bursitis.

Experts in All Types of Shoulder and Elbow

Surgery
Palomar Health Orthopedic and Spine Center incorporates a
multidisciplinary team that works together to provide you with a
customized care plan. By using minimally invasive arthroscopic
shoulder and elbow techniques, our aligned orthopedic surgeons
can provide faster recovery, less pain and improved function.
Palomar Health leads the region in
●● Total shoulder replacement shoulder replacements.
●● Reverse total shoulder replacement

What is a Reverse Total Shoulder Replacement?

Reverse total shoulder replacement reverses the natural ball and socket anatomy of the shoulder joint which
allows the stronger deltoid muscles to take over for strength and function. Reverse total shoulder replacement
may be recommended for patients with:

●● Completely torn or irreparable rotator cuff tendons

●● Severe shoulder fracture

2018 Shoulder Replacement Outcomes

Length of Stay Complication Rate

4 4%
Palomar Health Orthopedic and Spine
Center ranks among the top 10 percent of 2 6 2% 6%
hospitals in the nation for successful shoulder
surgery outcomes. 1.38
1.31
0 8 0% 8%
Excellent Poor Excellent Poor
2.04 days = National Average 1.55% Complications = National Average
1.53 days = Top 10% in Nation 1.27% Complications = Top 10% in Nation
PMC Poway PMC Escondido PMC Poway PMC Escondido

Why is this Important? Our average length of stay ranks in the top 10 percent in the nation (less than two days), and we're proud
to report a zero percent complication rate at both hospitals.

18 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 19

Spine Surgery

3D Image Guidance
Our goal is to improve surgical
Palomar Medical Center Escondido has been at the forefront of spine care innovation for more than 20 years.
accuracy and reduce X-ray exposure
We offer advanced treatment for back and neck disorders in a state-of-the art, patient-centered environment.
to our patients, staff and providers.
Our goal is to simplify the complexity of spine care and get you back to your normal routine as quickly as possible.
The answer is the Ziehm Vision RFD
3D, which enables our surgeons to use
A Better Approach to Treating Back and Neck Disorders less-invasive surgical approaches.
We offer the latest conservative treatments along with minimally invasive surgical options. Patients can expect
prompt appointments with leading specialists and individualized attention from the entire care team. This helps to
ensure that every step of your experience – from diagnosis to rehabilitation – progresses smoothly and successfully.

San Diego’s Palomar Health Orthopedic and Spine Center offers the expertise and experience of sub-specialty
trained orthopedic and neurosurgeons covering:
●● Micro-discectomy ●● Minimally invasive lumbar and cervical fusion
2018 Spine Surgery Outcomes
●● Motion-sparing disc arthroplasty ●● Spine tumor removal
Hospital Acquired Conditions per 1,000 Spine Complications of Spine Fusion
Nearly a third of our surgical patients do not require instrumentation. When fusion is necessary, our surgeons
Fusion Patients
use the most minimally invasive technique possible for:
1.5 10%
●● Smaller incisions ●● Improved range of motion
.75 2.25 5% 15%
●● Quicker recovery with less pain ●● Fewer complications
2.33%

0 3 0% 20%
Spine Surgery by Type Excellent
1.26 HACs = National Average
Poor Excellent Poor
5.36% Complications = National Average
.79 HACs = Top 10% US Hospitals 3.46% Complications = Top 10% in Nation
Palomar Health Palomar Health

Why is this Important? A hospital-acquired condition (HAC) Why is this Important? Achieving superior clinical outcomes
is an undesirable situation or condition that affects a patient in back and neck surgery requires you start on the road to
1% Other Our primary goal is to and that presented during a stay in the hospital. Palomar recovery without any setbacks.
improve each person’s quality Health’s spine fusion patients have had zero HACs since 2016.
3% Arthroplasty of life and reduce their pain.
Cutting-edge technology
8% Pain Pump/ and low complication rates
Neurostimulators are a means to that end, Oswestry Disability Index
but not the goal itself.
20% Cervical Fusion We remain focused on the Why is this Important? Palomar Health wants to know how
Before Surgery much surgery has improved our patients’ daily lives. That’s
outcomes that patients 38
32% Discectomy/ tell us are important, so
(baseline) why we ask our patients to report on their function and pain
Laminectomy
together we can make before surgery, and again 90 days after surgery. We use a
more informed healthcare 3 Months After standard survey called the Oswestry Disability Index (lower
35% Lumbar Fusion Surgery 22 67%
decisions. score is better).
1 Year That’s a 67% improvement within the first 90 days.
– Andrew Nguyen, MD, PhD One-year results available late 2019 Function Levels:
After Surgery
Spine Medical Director
0 – 20%: minimal disability
PMC Escondido 0 20 40 60
Level of Disability Minimal Moderate Severe 21 – 40%: moderate disability
41 – 60%: severe disability

20 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 21

Hip Fracture Repair

Implementing a Hip Fracture Across the Nation Rapid Recovery Protocol

Pathway to Improve Patient The care team involves everyone along the continuum, including emergency physicians, anesthesiologists,
Outcomes
Hip fractures for seniors can be extremely painful.
Without proper treatment, hip fractures can lead to
258,000 hospitalists, orthopedic surgeons, nurses, pharmacists and therapists.

The number of hip fractures reported among

a rapid loss of independence and mobility, and even
people 65 and older in the U.S. in 2010.
a high rate of mortality.
Fall Injury ED Arrival Diagnosis Pain Block
Speed is the Key

30 Billion
Ninety-five percent of hip Clinical team mobilizes X-ray, labs and cardiac Anesthesiologist performs
Our goal is to diagnose the fracture quickly so
we can reduce the patient’s pain. Then we follow
$ fractures are caused by falls,
age 65 and older –
when a patient arrives with a
suspected hip fracture
workup to determine
fracture location and other
a nerve block to reduce
pain dramatically
evidence-based guidelines that advance the patient call 9-1-1 patient symptoms
through their care plan, including surgery within The cost to the U.S. health care system
24 hours if necessary. for falls among older adults in 2010. Falls
cause 95 percent of hip fractures.
Improved patient outcomes:
●● Better pain control
●● Early return to activity
Nursing Unit Surgery Nursing Unit Discharge
●●  void adverse events (e.g., infections, falls,
A

95 75
Multimodal approach Goal is to get patient ready Focused care to prevent Discharge to most
readmissions, revision surgery) % % to pain control led by for surgery within 24-hours post-op complications and appropriate level of care –
●● Satisfied patients and family members anesthesiologist until patient of arrival maximize future range of skilled nursing facility,
is ready for surgery Palomar Health averages motion and function rehabilitation hospital or
19 hrs, 34 min home with home
health services
Hip fractures that are Fractures sustained
caused by falls by women
Length of Stay for Hip Fractures (White women are more likely
to break a hip than Black or
Days:
Asian women.)
Palomar Health By the Numbers
4.8

1 per day
70 %
4.7
4.4
4.5
4.0
33% 20% Average frequency of patients with a hip
Palomar Health patients who
3.6 3.8 said their pain was always
3.6 fracture that arrive in a Palomar Health ED
well-controlled
3.2
Adults 65 and older who

twenty
Hip fracture patients

47
3.0

%
PMC Escondido PMC Poway fall each year who die within a year of
(Of those who fall, 20 – 30%
Reduction in
their injury
 efore Hip Fracture
B  fter Hip Fracture
A suffer moderate to severe opioid use

percent
Pathway (2016) Pathway (2017 – 2018) injuries that make it hard for Percent of hip fracture patients through Palomar
them to get around or live
independently, and increase that arrive in a Palomar Health ED Health’s hip
Time spent in the hospital dropped by almost their risk of early death.) between Friday and Sunday fracture pathway
half a day. M T W Th F S S
Source: Centers for Disease Control and Prevention, KERA Research

22 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 23

Where to Find Us To Learn More:
PalomarHealth.org/Ortho

Palomar Medical Center Escondido Palomar Medical Center Poway

●●  edicated Orthopedic Unit – Orthopedic
D ●●  edicated Orthopedic Unit – Patients
D
patients recover on the 7East Unit, featuring recover on our 2nd Floor Center of Excellence
dedicated nursing staff and therapists Unit dedicated to medical surgical patients
●●  edicated Spine Unit – Spine surgery patients
D recovering from various surgeries
recover on the 7West Unit, featuring dedicated
neuro/spine nursing staff and therapists

Rehabilitation Services
Our services span from hospital to home or outpatient clinic. The patient and the therapy team partner
together to provide a seamless rehabilitation experience that begins on the day of surgery and continues until
recovery goals are achieved.

Outpatient Rehabilitation Services Villa Pomerado Skilled Nursing Facility

Diagnostic, preventive and therapeutic services The ideal place to receive care when additional
designed to maximize function and return you expertise is necessary to recover from an accident,
to your physical best. Our services include: illness or surgery. For patients recovering from
Physical Therapy, Occupational Therapy, Pelvic stroke, cardiac, orthopedic surgery, traumatic injury;
Floor Therapy, Lymphedema Management and chronic or acute pulmonary conditions, brain injury,
Neuromuscular Rehabilitation. complex wounds and other conditions.
As the patient transitions out of the hospital to skilled
Poway: 15615 Pomerado Road, Poway, CA 92064
nursing, home health, or outpatient therapy, our entire
San Marcos: 120 Craven Road, San Marcos, CA 92078 Home Health team provides hands-on care with a focus on clinical
After illness or injury, Palomar Home Health Services excellence and high-quality outcomes to help patients
The Rehabilitation Institute at Palomar Medical brings licensed and certified healthcare services to improve their mobility and regain independence.
Center Downtown you in the comfort of your home.
A 36-bed facility with comprehensive physical – Amy Walsh
and cognitive rehabilitation programs dedicated
●● Nursing care Physical Therapist
exclusively to treating individuals who have ●● Physical, occupational & speech therapy Manager, Rehabilitation Services
experienced a disabling injury or illness. Stroke ●● Telehealth monitoring
(CVA), Brain Injury, Spinal Cord Injury, Amputation,
●● Personal care services
Major Multiple Trauma, Orthopedic Injury.
●● Homemaker/companion services

24 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 25

Acknowledgments

The 2018 Orthopedic

This Outcomes Report is dedicated to the countless individuals who cared for our patients in 2018. and Spine Symposium
Special thanks to those that contributed to this report:
More than 130 nurses, therapists
Derryl Acosta, MBA David Lee, MD
and case managers attended our
Kelly Brazil, BSN, RN, CEN Valerie Martinez, RN, symposium on September 28, 2018.
BSN, MHA, CIC, CPHQ, NEA-BC
James Bried, MD
Gino Merida
Brian Cohen, MHA
Andrew D. Nguyen, MD, PhD
Najeebe Geagea, MSN, RN
James Puckett, MD, PhD
Allan Hansen, MD
Prashant Vaswani, MD
Maseeha S Khaleel, MD
Amy Walsh, PT
Thomas Knutson, MD
Lien Lam

It is an honor to be a part of such an exceptional care team.

The San Diego orthopedic and spine community is watching
Palomar Health! We have a great story to tell. Everyone here
plays a special role in advocating for patients and helping to
achieve superior outcomes for each and every one.

– Brian Cohen, MHA

Director, Orthopedic and Spine Services

Sources:
●●  merican Joint Replacement Registry Patient-Facing
A ●● Improving Value in Total Joint Arthroplasty: A Comprehensive
Interim Report, 2018 Patient Education and Management Program Decreases
Discharge to Post-acute Care Facilities and Post-operative
●● Continuum of Care, Advisory Board, 2019
Complications. The Journal of Arthroplasty, 2018
●●  urrent Trends in Discharge Disposition and Post-
C
●● Palomar Health Administrative Data
Discharge Care After Total Joint Arthroplasty.
Current Reviews in Musculoskeletal Medicine, 2017 ●● Press Ganey and Associates, 2019
●● Hospital Compare Preview Report, 2018 ●●  rojected Volume of Primary Total Joint Arthroplasty in the U.S.,
P
2014 – 2030. The Journal of Bone and Joint Surgery, 2018
●●  ow Long Does a Hip Replacement Last? A Systematic
H
Review and Meta-Analysis of Case Series and National ●●  ariation in the Cost of Care for Primary Total
V
Registry Reports with More than 15 Years of Follow-up. Knee Arthroplasties. Arthroplasty Today, 2017
The Lancet, 2019

26 PALOMARHEALTH.ORG/ORTHO PALOMAR HEALTH OUTCOMES REPORT 27

 PalomarHealth.org/Ortho
28 PALOMARHEALTH.ORG/ORTHO