Growing with Care

World-class talent and big plans for Christiana Hospital are good news for everyone–from patients to future physicians.

CEO Dr. Robert J. Laskowski (right) has lured
many talented doctors to Christiana Care,
including Dr. Timothy J. Gardner, who has
since been named president-elect of the
American Heart Association.

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Photograph by Pat Crowe II

For Thomasina Richie, visits to Christiana Care Health System’s emergency department were about as frequent as visits to the mall are for most of us.

The 60-year-old has a history of chronic obstructive pulmonary disease and heart failure, along with other problems, including obstructive sleep apnea and chronic renal disease. From September 2006 to mid-January 2007, she made seven visits to the emergency room. She was hospitalized three times for heart failure.

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Later in January 2007, Richie was referred to the hospital’s Visiting Nurse Association’s Telehealth Program. Provided with a telemonitoring device in her home, she was able to transmit pulse rates and other vital signs to the VNA for review.

Daily monitoring allows for detection of small changes in her condition that helps avoid repeated hospital admissions. Since becoming part of the Telehealth Program, Richie has remained “hospital free.”

Even as Christiana Care’s campus continues to sprawl vertically and horizontally as part of an ongoing $225 million expansion, one of the hospital’s most vital goals is to make hospital visits as rare as possible. And that puts Christiana Care on the cutting edge of medicine.

“One of our missions here at the Center for Heart and Vascular Health is to grow our home care programs, especially in the area serving patients with chronic heart failure, in order to keep them both functional and out of the hospital,” says center director Dr. Timothy J. Gardner.

Gardner says Christiana Care is “in front of the curve” in terms of the number of patients being treated for advanced heart failure, which is why physicians such as Mitchell T. Saltzberg, a leading heart failure specialist, have joined the heart center.

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Indeed, one of the most significant areas of growth for Christiana Care is not in brick and mortar, but in attracting nationally recognized talent in the health field.

“The building itself is the last piece of the puzzle for us,” says Christiana Care president and CEO Dr. Robert J. Laskowski. “First we build the program, then we let the program determine the size of the building to house it.”

In addition to Gardner and Saltzberg, Christiana has lured Dr. Michael K. Banbury from the Cleveland Clinic as chair of cardiovascular surgery and Dr. William S. Weintraub, an internationally distinguished cardiologist from Atlanta’s Emory University Hospital, to serve as chief of cardiology. Weintraub will also lead Christiana’s new Center for Outcomes Research, which is designed to identify and support best practices in medicine and improve health care using data and evidence collected from Christiana Care’s high-volume referral centers. They all join longtime Christiana Care heart surgeon Dr. Gerald M. Lemole, who opened the first open heart surgery practice in Delaware in 1986.

But the heart center is not the only facility to attract big names. At the Helen F. Graham Cancer Center, medical oncologist Bruce M. Boman was recruited as the first director of the center’s cancer genetics and stem cell biology department. Boman had only recently founded and directed the division of medical genetics and cancer prevention at Thomas Jefferson University Hospital in Philadelphia.

Boman’s work focuses on a genetic component in cells that appears to regulate gene expression. When that component mutates, the risk of developing cancer increases. “The best way to beat cancer is to first determine if you’re predisposed to the gene mutation that may produce it,” Boman says. By identifying high-risk patients, based on family history for this mutation, preventative measures can be taken.

Christiana’s cancer center is among the national leaders in early identification of high risk individuals. “The Clinical Community Oncology program, which is celebrating its 20th anniversary, and has since become a national effort, began right here,” says Boman.

A national trial for colon cancer prevention will also be based at the cancer center. Boman believes the close partnership with the University of Delaware, which has advanced math and computer modeling expertise, helps provide a strong base for the research and trials underway at Christiana. The Center for Translational Cancer Research, a group that focuses on “bringing cancer research from the lab to the bedside and back to the lab again,” Boman says, will be housed at both the University of Delaware and Graham Center.

“Continued study and research correlates to clinical trials, resulting in improved patient care,” he says.

Boman also believes Delaware’s improvement in incidence of cancer—once the highest in the country—is the result of work done at Christiana on early identification of risk.

That improvement for the state no doubt influenced the National Cancer Institute to select the Helen F. Graham Cancer Center as one of just 14 cancer programs nationally to participate in the NCI’s Community Cancer Centers Program. The pilot program is designed to expand clinical trials (especially in minority communities), reduce disparities in cancer health care, collect and share tissue and blood samples for research, and explore the use of a national database of electronic medical records.

Boman says the program’s focus on collecting tissue samples and record keeping can help considerably in his research.

“Studying tissues helps us develop more preventative approaches to curing cancer,” says Boman. “Bringing new modalities of care to Delaware means faster delivery of services to the state’s residents.”

Mary C. Farach-Carson, a professor of biological sciences at the University of Delaware, helped recruit Boman. She says both the NCI’s selection and the establishment of the Center for Translational Cancer Research are natural outgrowths of assets that have been broadening at Christiana, especially since 2002.

“I originally became involved in [Helen F. Graham Cancer Center] while on sabbatical there,” says Farach-Carson. “That experience paralleled the development that was going on in biomedicine, both at the university and Christiana.”

The partnership has helped raise UD to a Research I level in biomedicine while raising Christiana’s reputation and capabilities beyond that of a community hospital.

“We now have 70 graduate students in biology at the university, where before there were maybe 10,” says Farach-Carson. “With our students becoming more interested in personalized medicine and stem cell research, we knew we needed a stronger presence at Christiana. I think Dr. Boman recognized that expanding relationship in clinical research developing between the two institutions, and was drawn here because of it.”

As important as the high caliber of medical expertise that has been attracted to the Christiana Care campus, so are the reasons behind the doctors’ decisions to move their families to Delaware.

“We are a teaching hospital,” says Laskowski. “Recruits love the teaching aspect and the collegiality of being one of only 300 academic instructors here.”

Yet Christiana differs from many other teaching hospitals in that it is a university-affiliated hospital (with Thomas Jefferson University Hospital), not a university-based hospital, such as Johns Hopkins in Baltimore.

“At a university-based hospital, physicians have to teach and participate in academic production,” says Gardner. “There’s an element of ‘publish or perish’ at an academic-based hospital that is not present here. Here we are one step removed from the demands of a university-based medical center, so we can concentrate primarily on patient care.”

That’s not to say there’s less aggressive research conducted at Christiana than at Johns Hopkins. “The research conducted here has more to do with clinical applications than it does pure academics,” Laskowski says.

That Christiana is a teaching hospital translates into a boon for patients. There is “an energy and inquisitiveness that translates into more focus and detailed care,” Laskowski says.

The combination of high-quality recruiting and research is a self-sustaining dynamo that is driving Christiana to ever greater success and capability.

Since being verified as a Level 1 trauma center by the American College of Surgeons in 1998, Christiana has improved its capacity to care for trauma patients instead of transporting them out of state. Individual honors followed when Gardner was named president-elect of the American Heart Association.

Christiana has received several important national recognitions, most recently from HealthGrades, a leading independent, national health ratings company, which placed Christiana Care Health System in the nation’s top 5 percent of hospitals, according to a study of mortality and complication rates.

HealthGrades awarded Christiana its 2007 Distinguished Hospital Award for Clinical Excellence. Christiana is the only recipient of the award in Delaware. The award was based on a HealthGrades study that found patients at Christiana were, on average, 28 percent less likely to face mortality and 5 percent less likely to suffer from a major complication. This year only 266 of the nation’s 4,971 non-federal hospitals will receive such recognition.

For the future, both Gardner and Laskowski believe home health care will be a major part of the hospital’s ongoing improvements and expansion of services. “We will continue to develop leading programs in the area of heart failure, including programs for young adults with congenital heart disease,” says Gardner. (There is no regional program for dealing with the condition.)

Laskowski promises to remain on the lookout for the best medical talent for Christiana, which is now the largest private employer in the state. With a $205 million expansion of Wilmington Hospital, Christiana Care’s need to recruit has grown.

The Wilmington expansion will add more than 300,000 square feet of space to the existing structures, bringing the hospital’s total footprint to 1 million square feet. The project will add operating rooms, provide an additional 90 patient care beds, add a new medical office building and expand the hospital’s emergency room services by doubling its current size.

“Delaware is a great place to live, and there is a great collegial spirit among those already with us,” Laskowski says. “Talent is attracted to talent, and there is plenty of talent already here.”

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