Clinical Outcomes at Fortis Healthcare

Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from patient care. Reporting of outcomes and their continuous monitoring provides an opportunity for both assessing and improving the quality of patient health and care.

Fortis Healthcare Limited, one of the largest integrated, healthcare service provider in the country is the first hospital network to implement and monitor clinical outcomes in India. This initiative further strengthens our commitment to PATIENT CENTRICITY by striving towards continuous clinical excellence through improvement and enhancement of our clinical care services. Further, the introduction of Patient-Reported Outcomes Measurement [PROM] lends the voice of the patient to the entire process and helps enhance patient engagement and experience. Constant evaluation of our clinical outcomes against best available global standards motivates our medical workforce to continuously improve all aspects of our practice.

Fortis clinical outcomes are based on measurement of disease course and progression, quality of clinical care being provided, the success of the procedures/interventions carried out, and actual benefit perceived by the patient.

Details of individual procedure outcomes as measured using internationally accepted parameters and criteria, and further validated by our clinical experts, are published here and showcase our commitment to transparency in healthcare. Fortis is the FIRST to embark on the journey of publishing clinical outcomes data in the public realm.

Fortis Clinical Outcomes Journey

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January 2013

Kick off with
Clinical Outcomes
Monitoring for
3 procedures – CABG,
PTCA, KTP

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January 2014

Fortis joins the
ICHOM Working Group
on
Coronary Artery Disease (CAD)

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June 2015

Partnership with Vital Health
(ICHOM certified
software supplier)

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August 2015

Implementation of
ICHOM CAD standard set

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February 2016

1st In India to publish
clinical outcomes
data
on website

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May 2017

CAD PROM
implemented

We at Fortis continuously monitor and evaluate our outcomes for the following procedures and specialities

Coronary Artery Bypass Graft (CABG)

ABOUT THE PROCEDURE

Coronary Artery Bypass Graft (CABG), commonly known as Heart Bypass surgery/ Coronary Bypass surgery, is a surgical procedure which creates alternate routes for blood to flow to the heart tissue, bypassing the narrowed/blocked arteries (leading to what is known as Coronary Artery Disease). For this purpose, a healthy blood vessel (also called a graft) taken from one area of patient’s own body is placed around the narrowed/blocked area to restore blood flow to the heart. The goal of this procedure is to relieve symptoms of coronary artery disease (including angina), enable the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems.

ABOUT CABG CLINICAL OUTCOMES

CABG outcome indicators provide measures of overall success of the surgery and patient’s post-procedure clinical condition. These parameters are globally accepted evidence-based scientific criteria to indicate quality of procedure and patient’s health status. Fortis hospitals measure the following outcomes parameters for CABG, and our performance consistently matches the global benchmarks set by best-in-class hospitals.

Outcome Parameters:

Use of left Internal Thoracic Artery graft Know more
PeriodOutcomeBenchmarks
201785.03%74.20%*
Need for a Bail out Intra-Aortic Balloon Pump (IABP) Know more
PeriodOutcomeBenchmarks
20171.77%--
Perioperative Myocardial Infarction Know more
PeriodOutcomeBenchmarks
20170.28%0.96%**
Post procedure neurological stroke Know more
PeriodOutcomeBenchmarks
20170.17%0.80%*
Need of Re-exploration surgery Know more
PeriodOutcomeBenchmarks
20171.55%3.50%*
Deep sternal wound infection Know more
PeriodOutcomeBenchmarks
20170.78%0.20%*
Predicted mortality (using EuroScore II) Know more
PeriodOutcomeBenchmarks
20172.52%--
Observed mortality Know more
PeriodOutcomeBenchmarks
20171.66%--
Internal Mammary (Thoracic) Artery grafts are associated with long-term patency and improved outcomes as compared to all other grafts
This is an urgent life-saving procedure where an inflatable balloon is placed in the aorta to help the heart pump blood to the vital organs and body parts
A heart attack occurring during or immediately after CABG. It is a predictor for short and long term disability and death
A Brain stroke occurring after CABG due to reduced blood flow to a brain part
Redo surgery which may be needed to explore for any abnormal or unusual bleeding after CABG
Infection involving tissue/muscle/bone involved in the surgical wound; this may require aggressive treatment including further surgery
This is a predictor for risk of death after a cardiac operation. It is a globally accepted scoring system based on multiple factors like patient’s age, gender, clinical conditions and type of surgery
Number of deaths reported in the observed patient group across different risk categories, expressed in percentage

References

  • *Cleveland Clinic Outcomes Report 2014
  • **Texas Heart Institute 2014

Percutaneous Transluminal Coronary Angioplasty (PTCA)

ABOUT THE PROCEDURE

Percutaneous coronary intervention (PCI/PTCA), also known as coronary angioplasty, is a nonsurgical technique for treating narrowed/blocked coronary arteries which supply blood to the heart muscle. PTCA involves inserting a tiny balloon or stent across the narrowed part to widen the affected artery and restore blood flow to the heart muscle without requiring an open-heart surgery.

ABOUT PTCA CLINICAL OUTCOMES

PTCA outcome indicators provide measures of overall success of the surgery and patient’s post-procedure clinical condition. These parameters are globally accepted evidence-based scientific criteria to indicate quality of procedure and patient’s health status. Fortis hospitals measure the following outcomes parameters for PTCA, and our performance consistently matches the global benchmarks set by best-in-class hospitals.

Outcome Parameters:

Emergency cardiac revascularisation (restoring blood flow to heart) surgery like CABG may be required to correct an emergency complication of PTCA such as abrupt closure of a vessel, perforation and injury to vessels.
Local injury to the blood vessel puncture site [usually groin or wrist] may occur. Usually these require only pressure being applied by mechanical compression, but sometimes additional surgical or non-surgical measures may be required
Sudden narrowing of the blood vessel which requires urgent repeat/additional procedure to restore the blood supply
A Brain stroke occurring after PTCA due to reduced blood flow to a brain part
Acute renal (kidney) failure is a rare but known complication resulting from acute kidney injury, more so in pre-existing renal failure patients, and may require dialysis
In a few cases, acute bleeding may occur after PTCA from the puncture site and evidence shows 4% of such incidences may require blood transfusion
Vascular complications which may include occlusions at insertion site, peripheral embolization, tear and injury to blood vessels, bulging of the arterial wall and/or AV fistulas, may occur at a later period after procedure, even after discharge
A heart attack occurring immediately or within 30 days after PTCA. It is a predictor for long term disability and death
Though rare, both sudden cardiac death and death at a later stage my occur depending on a number of factors including Patient history of heart attack, multi-vessel disease, advanced age, complex lesions, Location of the blockage in the coronary artery, other conditions

References

  • *US National Registry Data 2013
  • **Cleveland Clinic Outcomes Report 2014

Kidney Transplant

ABOUT THE PROCEDURE

Kidney transplantation means replacement of the failed kidney with a healthy kidney from another person, called a donor, living or deceased. When kidneys fail to filter fluid and wastes, these may accumulate in the body to the harmful level. When the kidneys have lost about 90 percent of their normal functioning ability, patients have kidney failure (or End-stage Renal Disease) and require either dialysis or transplantation to sustain their life. Kidney transplant provides significant quality-of-life benefits and survival in patients with end-stage kidney disease/Kidney failure/ in this condition.

ABOUT KTP CLINICAL OUTCOME

Monitoring of patient survival over longer and defined periods is regarded as successful outcomes of kidney transplant procedure. Acute rejection within the first-year post-transplantation is a negative predictor of long-term renal allograft survival.

Outcome Parameters:

One year survival Know more
PeriodOutcomeBenchmarks
(Apr’ 2015 - Mar’ 2016)96.25%90-95%*
90-95%**
97%***
Graft (transplanted kidney) survival is defined as survival of the transplanted kidney in a live recipient without requiring dialysis. Acute rejection within the first-year post-transplantation is a negative predictor of long-term renal allograft survival.

References

  • *Kidney Research UK
  • **Kidney Foundation of Canada
  • ***National Kidney Foundation, USA

Radiation Oncology

ABOUT THE PROCEDURE

Radiation is one of the most common treatments for cancer, and is utilised for more than 60% of cancer therapy. It uses carefully measured and optimally controlled high-energy particles or waves, such as x-rays, gamma rays, electron beams or protons aimed to destroy cancer cells in body. This therapy can also be combined with other treatment options like chemotherapy and surgery. The goal is to use this as primary curative treatment for cancer or adjuvant therapy or to prevent recurrence of tumour and improve a person’s quality of life.

Sometimes in advanced or late-stage of a cancer, it is not possible to destroy all of the tumour cells, then doctors may use palliative radiation therapy to shrink tumours and relieve/reduce pain, pressure and other symptoms.

ABOUT OUTCOMES

Every person reacts differently to treatment. Acute radiation toxicities are side effects that may occur during treatment or in the immediate post-treatment period, depending on the type of cancer, location, dose and length of radiation and patient’s general health. Onset may be 2–3 weeks after the commencement of a regimen of radiation therapy. Typically, severity and timing are tied to the total biologic dose and the turnover rate of the tissue in question, respectively.

Outcome Parameters:

Treatment aim – Curative Know more
PeriodOutcomeBenchmarks
201677%--
Treatment aim – Palliative Know more
PeriodOutcomeBenchmarks
201623%--
Acute morbidity post Radiotherapy (Grade 3 and 4) Know more
PeriodOutcomeBenchmarks
20166.4%5 – 15%
It is aimed at curing the cancer completely
Radiation therapy may be given to relieve pain and other symptoms only in cancer patients when complete cure is not possible, in most cases patients with short term life expectancy
Depending upon various factors systemic toxicity may affect different body systems involving Skin, Nervous system, lungs, Heart, Fertility etc.

References

Radiation Therapy Oncology Group (RTOG) common toxicity criteria (CTC) v.2.0 Toxicity severity grading:-

  • Grade 0—Absent or none
  • Grade 1—Mild
  • Grade 2—Moderate
  • Grade 3—Severe and undesirable
  • Grade 4—Life-threatening or disabling
  • Grade 5—Death

Endoscopic Retrograde Cholangio Pancreatography (ERCP)

Clinical outcomes of following procedures and specialities are also monitored and shall be published

Total Knee Replacement (TKR)

Mental Health

Caesarean Section

Hysterectomy

To View Hospital Clinical Outcomes

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