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Orthopedics Maryland’s leader in orthopedics 2017 Outcomes Anne Arundel Medical Center Orthopedics
Orthopedics
Maryland’s leader in orthopedics
2017 Outcomes Anne Arundel Medical Center Orthopedics
About AAMCFACTS AND FIGURES FISCAL YEAR 2017 (July 2016–June 2017)
Magnet® Recognition by the American Nurses Credentialing Center (ANCC)
Consumer Reports Top 10 Hospitals for Surgical Safety
Delmarva Foundation Excellence Award for Quality Improvement
Exemplar recognition for family presence awarded by the Institute for Patient- and Family-Centered Care (IPFCC)
Top 25 of the Nation’s Best Practices in Patient and Family Centered Care by the Caregiver Action Network
HealthStream Award for Highest Community Perception of Quality
Blue Distinction® Center for knee and hip replacement
A not-for-profit regional health system headquartered in Annapolis, Maryland, Anne Arundel Medical Center serves an area of more than one million people. AAMC is recognized for orthopedic care, emergency heart attack response and cancer care. A leader in women’s services, AAMC ranks second in Maryland for number of births annually and has a Level III neonatal intensive care unit.
The state’s third busiest hospital (measured by inpatient discharges)
Outpatient locations in Bowie, Kent Island, Odenton, Pasadena and Waugh Chapel
A multi-specialty medical group in 55+ locations throughout the region
An accountable care organization (ACO) participating in the Medicare Shared Savings Program
A research institute with a simulation and innovation center.
Total licensed beds ............... 425*
Inpatient admissions ..........26,300
Joint replacements ...............2,299
Births ..................................5,500
Emergency visits ................97,000
Outpatient visits ............110,000+
Medical staff ......................1,100+
Employees .........................4,700+
Operating revenue .....$695 millionAAMC Includes:
* Includes 40-bed facility, Pathways, dedicated to
substance use and mental health treatment
Awards:
Dear Colleague:
Welcome to the first Anne Arundel Medical Center (AAMC) Orthopedic Outcomes Report. This year’s report expands upon our flagship publication, The Center for Joint Replacement Outcomes Report, that you’ve recieved in previous years. The following pages provide an overview of the patient-reported outcomes, clinical measures, and operational and financial data we use to define the success of the orthopedic program at AAMC.
In this year’s report we highlight the breadth and depth of outcomes data being tracked across the Orthopedics service line. We are proud to present results from The Center for Joint Replacement, The Center for Spine Surgery, The Osteoporosis Screening and Treatment Program, and the Sports Medicine, Upper Extremity and Foot/Ankle Surgery Programs. While you will notice parallels between programs, the unique approaches employed to drive the highest quality, highest value care to patients will become apparent. By anchoring our approach to care in patient-centered outcomes data, we are able to empirically evaluate our results and continuously improve the quality of care we deliver.
This report highlights the many notable achievements of Orthopedics at AAMC. We believe that publishing these health care outcomes enhances our culture of continuous quality improvement, and increases the value of care delivered to patients. At AAMC we are dedicated to delivering the highest quality care and are proud to be a leader in presenting transparent results.
Building on the foundation of work presented in this year’s report we are proud to announce the launch of The Center for Orthopedic Outcomes at AAMC. The center presents an exciting opportunity to formalize our outcomes program, and is built around a dedicated manager of Orthopedic Outcomes. By centralizing resources, and collaborating with institutional programs such as the Department of Surgery Research and AAMC Research Institute, we are confident that 2017 marks the beginning of an exciting time for AAMC Orthopedics.
Respectfully,
Jeff GelfandMedical Director of Orthopedics
TABLE OF CONTENTSJoint Replacement................4-17
Multidisciplinary Protocol.......6-7
Case Volume..........................8-9
Length of Stay....................10-11
Clinical Quality Measures.........12
Patient Outcomes....................13
Cost of Care.............................14
Patient Satisfaction..................15
Research Activity......................16
Spine Surgery.....................18-23
Care Pathway ........................19
Case Volume............................20
Length of Stay..........................20
Patient Outcomes.....................21
Cost of Care..............................22
Clinical Quality Measures..........22
Research Activity......................23
Sports Medicine.................24-27
Case Volume...........................25
Patient Outcomes....................26
Community Involvement...........27
Upper Extremity.................28-29
Case Volume............................28
Patient Outcomes.....................29
Osteoporosis......................30-31
Care Pathway............................30
Program Outcomes...................31
Overall Orthopedics............32-33
ACS-NSQIP...............................32
Reducing Opioid Use................33
Note: Unless otherwise noted, all data in this year’s report is presented on a fiscal year (July–June) basis.
2017 Orthopedics Outcomes » 3
6,000+
7 YEARSin a row as the busiest joint replacement program in Maryland
patients discharged within 1 day of surgery
10th busiest joint replacement program in the country for Medicare beneficiaries
69%
joint procedures performed in 2017, the most in Maryland
2,299 patient-reported outcomes captured
1 DAY DISCHARGE
10THBUSIEST IN THE COUNTRY
Top 10 U.S. Hospitals with Medicare “DRG-Payment” Hip and Knee Replacement Procedures 2016
JOIN
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PLAC
EMEN
T
20%
than any other program in
Maryland over the last five years
more procedures performed
22%
than the Maryland hospital average in
FY 2017
shorter average
length of stay
The Center for Joint Replacement at AAMC is a national model for knee and hip replacement, and it’s the most sought-after program in Maryland. We draw patients from around the country and remain committed to continually advancing our mission of delivering high-quality, low-cost care.
2017 Orthopedics Outcomes » 5
BEFORE SURGERY
Determine surgery is the right decision.
Schedule candidate for a target one or same-day
discharge and communicate to care team and patient.
Maximize patient mobility and ambulation
with therapy sessions.
Discharge most patients by mid-day.
INPATIENT STAY
Ambulate most patients on the day
of their surgery.
The Multidisciplinary Rapid Recovery Protocol provides the highest level of care for our patients in the most efficient manner. In place since 2013, it combines evidence-based medicine, clinical outcomes measurement and lean methodologies.
Based on the success of the protocol, we’re proud to now offer same-day discharges for appropriate patients.
Multidisciplinary Rapid Recovery ProtocolJO
INT
REPL
ACEM
ENT
Host joint patient
reunions.
Provide same-day PT/OT evaluation,
where appropriate.
Schedule candidate for a target one or same-day
discharge and communicate to care team and patient.
Establish contact between dedicated joint navigator and patient to discuss a target one or same-day discharge
to rehab and any other special circumstances.
Transfer the patient efficiently from
post-anesthesia care unit to floor.
Prevent readmissions and emergency room visits through contact with
dedicated joint navigators.
DAY OF SURGERY
FOLLOWING DISCHARGE
Establish contact between dedicated joint navigator and
patient.
Refer patient to pre-op
physical therapy or PT360, our home
therapy program.
Multidisciplinary Rapid Recovery Protocol
2017 Orthopedics Outcomes » 7
The Center for Joint Replacement at AAMC is Maryland’s highest-volume joint replacement program for seven consecutive years.
The Center for Joint Replacement at AAMC maintains a 6 percent annual growth rate over the past five years, double the
total growth rate of joint replacement surgery in Maryland.
JOIN
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PLAC
EMEN
T Case Volume
AAMC Joint Volume: 5-Year Trend
Joint Volume: 5-Year Annual Growth Rate
2,500
2,000
1,500
1,000
500
0
2017
1,695
1,910 2,0092,221
2,299
2013 2014 2015 2016
6%
3%
AAMC Maryland
7%
6%
5%
4%
3%
2%
1%
0%
AAMC performed 20 percent more joint replacements than the second busiest program in the state over the past five years.
AAMC performed more than 2,299 joint replacements in FY17, 19 percent more than the second busiest program in the state.
AAMC performed 819 total hip replacements in FY17, 3 percent more than the second busiest program in the state.
AAMC performed 1,349 total knee replacements in FY17, 14 percent more than the second busiest program in the state.
Maryland Joint Volume: 5-Year Cumulative Comparison to Top 10 Maryland Hospitals
FY 2017 Joint Volume: Top 10 Maryland Hospitals
FY 2017 Knee Replacement Volume: Top 10 Maryland Hospitals
FY 2017 Hip Replacement Volume: Top 10 Maryland Hospitals
12,000
10,000
8,000
6,000
4,000
2,000
0
7,720
3,679
7,361 7,757
6,345
8,440
10,134
3,6283,5023,260
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
2,500
2,000
1,500
1,000
500
0
1,741
877
1,7161,831
1,167
1,940
2,299
840775707
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
900
800
700
600
500
400
300
200
100
0
600
336
560
681
364
794 819
257238207
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
1,600
1,400
1,200
1,000
800
600
400
200
0
979
502
822
1,096
603
1,183
1,349
466450433
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
Maryland’s leader in joint replacement
2017 Orthopedics Outcomes » 9
JOIN
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T Length of StayOur high volume, paired with an average length of stay (ALOS) .58 days shorter than the Maryland hospital average, prevents 1,330 patient days in the hospital: a tangible benefit to our community and the Maryland health care system.
AAMC has reduced its ALOS for joint replacement patients by 29 percent since 2013 and had a 22 percent shorter ALOS than the Maryland hospital average in 2017.
AAMC has reduced its ALOS for primary total hip replacement patients by 27 percent since 2013 and had an 18 percent shorter ALOS than the Maryland hospital average in 2017.
AAMC has reduced its ALOS for primary total knee replacement patients by 31 percent since 2013, and had a 13 percent shorter ALOS than the Maryland hospital average in 2017.
Average Length of Stay: 5-Year Trend
Primary Total Hip Replacement Average Length of Stay: 5-Year Trend
Primary Total Knee Replacement Average Length of Stay: 5-Year Trend
3.40
3.20
3.00
2.80
2.60
2.40
2.20
2.00
3.10
2.90
2.70
2.50
2.30
2.10
1.90
1.70
1.50
3.10
2.90
2.70
2.50
2.30
2.10
1.90
1.70
1.50
2013
2013
2013
2014
2014
2014
2015
2015
2015
2017
2017
2017
3.26
2.90
2.94
2.66
2.34
2.27
2.09
1.91
1.97
2.95
2.63
2.85
AAMC
AAMC
AAMC
Maryland Hospitals
Maryland Hospitals
Maryland Hospitals
2016
2016
2016
Getting patients home sooner
80%
70%
60%
50%
40%
30%
20%
10%
0%
60%
50%
40%
30%
20%
10%
0%
Jul-13
Jul-13
Oct-13
Oct-13
Apr-14
Apr-14
Jan-14
Jan-14
Oct-14
Oct-14
July-15
July-15
Jan-15
Jan-15
Jan-16
Jan-16
Apr-16
Apr-16
Oct-15
Oct-15
Jul-16
Jul-16
Oct-16
Oct-16
Jul-14
Jul-14
Apr-15
Apr-15
Percent of 1-Day Stays for Joint Replacement Patients
Percent of 2- and 3-Day Stays for Joint Replacement Patients
3%
44%
42%
Each month the multidisciplinary Center for Joint Replacement team gathers at its Joint Pathway meeting to evaluate empirical data and opportunities for improvement. Using this performance improvement methodology, AAMC has been able to improve its proportion of 1-day stays to 69 percent in 2017 and has implemented same-day discharges in 3 percent of carefully selected patients.
Jan-17
Jan-17
Apr-17
Apr-17
69%
17%
Hip/Knee Combined 3-Day LOS
Hip/Knee Combined 2-Day LOS
11%
80%
70%
60%
50%
40%
30%
20%
10%
0%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Jul-13
Jul-13
Oct-13
Oct-13
Apr-14
Apr-14
Jan-14
Jan-14
Oct-14
Oct-14
July-15
July-15
Jan-15
Jan-15
Jan-16
Jan-16
Apr-16
Apr-16
Oct-15
Oct-15
Jul-16
Jul-16
Oct-16
Oct-16
Jul-14
Jul-14
Apr-15
Apr-15
Percent of 1-Day Stays for Hip Replacement Patients
Percent of 1-Day Stays for Knee Replacement Patients
78%
63%
7%
Jan-17
Jan-17
Apr-17
Apr-17
0%
2017 Orthopedics Outcomes » 11
1.01
JOIN
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T Clinical Quality MeasuresIn 2016, AAMC began participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The ACS-NSQIP is the first nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care. The program employs a prospective, peer-controlled, validated database to quantify 30-day risk-adjusted surgical outcomes. This allows valid comparison of outcomes among all hospitals in the program, 680 as of the CY2016 Semi-Annual Report. In 2016, The Center for Joint Replacement received an exemplary designation (top 10 percent nationally) in six measures: Total Knee Replacement: VTE and Renal Failure; Total Hip Replacement: SSI, Sepsis, Return to OR and Readmission.
These highlights of our performance are presented as odds ratios. This reports the estimated odds of an event happening at AAMC compared to the estimated odds of that event happening in all hospitals in the ACS-NSQIP database. A number of 1.0 means the hospital is performing as expected. A number less than 1.0 means the hospital is performing better than expected. A number greater than 1.0 means the hospital is performing worse than expected.
CY16 NSQIP Outcomes: AAMC Total Knee Replacements vs. National Benchmark
CY16 NSQIP Outcomes: AAMC Total Hip Replacements vs. National Benchmark
1.2
1
0.8
0.6
0.4
0.2
0
1.2
1
0.8
0.6
0.4
0.2
0
0.93
0.88
0.8
0.97
0.94
0.75
0.76
0.7
0.71
0.87
0.96
0.78
0.89
Readmission
Readmission
Return to OR
Return to OR
Sepsis
Sepsis
SSISSI
Renal
FailureRenal
Failure
VTEVTE
Total
Morbidity
Total
Morbidity
Pneumonia
Pneumonia
0.93
0.84
National Database Participant Comparison
National Database Participant Comparison
Observed Rate/ Expected Rate Odds Ratio
Observed Rate/ Expected Rate Odds Ratio
Patient OutcomesThe Center for Joint Replacement measures patient-reported outcomes (PROMs) using industry-leading methodologies to understand the value of surgery from the patients’ perspective. AAMC began capturing PROMs in 2010. Since then we’ve captured outcomes for more than 6,000 patients. This gives us the unique ability to analyze trends across a large sample size and longitudinally for individual patients. Using the multidisciplinary rapid recovery protocol, we’re able to significantly improve quality of life and physical function for hip and knee replacement patients, while minimizing their time in the hospital.
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
Cumulative Patients with PROMs Captured
Average Patient Outcome Scores: 2011-2017 (through June)
6,207
2010 2011 2012 2013 20152014 2016 2017
From preoperative to one-year postoperative, patients undergoing joint replacement at AAMC experienced dramatic improvements in Harris Hip Score (132 percent), Knee Society Score (154 percent) and Knee Function Score (92 percent).
(Through June)
100
90
80
70
60
50
40
30
20
10
0Preop 3-6 Mos
Postop1 year Postop
Knee Society Score
Knee Function Score
Harris Hip Score
4037
47
92
85
93949191
2017 Orthopedics Outcomes » 13
Cost of Care
Joint Replacement Average Charge Per Case: 5-Year Trend
Total Hip Replacement Average Charge Per Case: 5-Year Trend
Total Knee Replacement Average Charge Per Case: 5-Year Trend
$30,000
$28,000
$26,000
$24,000
$22,000
$20,000
$18,000
$16,000
$14,000
$12,000
$10,000
$29,000
$27,000
$25,000
$23,000
$21,000
$19,000
$17,000
$15,000
$29,000
$27,000
$25,000
$23,000
$21,000
$19,000
$17,000
$15,000
2017
2017
2017
2013
2013
2013
2014
2014
2014
2015
2015
2015
2016
2016
2016
$23,969
$23,894
$22,476
$22,040
$21,825
$20,379
$19,142
$20,216
$18,336
$20,916
$23,353
$18,773
AAMC
AAMC
AAMC
Maryland Hospitals
Maryland Hospitals
Maryland Hospitals
The Center for Joint Replacement strives to deliver high-quality, low-cost care that maximizes the value to patients and the health care system. We’re proud to maintain an average charge per case below the state average for five consecutive years.
JOIN
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Patient Satisfaction
Patients’ likelihood to recommend the Center for Joint Replacement at AAMC has remained in the top five percent of the nation for seven consecutive years.
The Center for Joint Replacement at AAMC Patient Satisfaction Scores: 2011-2017
National Percentile Rank
100
90
80
70
60
50
40
30
20
10
020122011 2013 2014 20162015 2017
TOP 5%for seven consecutive
years
In 2017, 88 percent of patients who came to the Center for Joint Replacement at AAMC rated their overall hospital experience as either a 9- or 10-out-of-10, putting us in the top five percent nationally.
100
75
50
25
0May
2016July
2016Sep
2016Nov
2016Jan
2016Mar
2017May
2017July
2017Sep
2017
GOAL
TopBox Score For Period
TopBox Rank For Period
2017 Orthopedics Outcomes » 15
JOIN
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T Research Activity
SCIENTIFIC FORUM PRESENTATIONS
1. ACS-NSQIP (July 2017): Sibia US, Turcotte JJ, MacDonald JH, King PJ. The Cost of Unnecessary Hospital Days for Medicare Joint Arthroplasty Patients Discharging to Skilled Nursing Facilities.
2. Maryland Orthopaedic Association (February 2017): Sibia US, Turcotte JJ, MacDonald JH, King PJ. The Cost Implications of Unnecessary Inpatient Days for Medicare Total Joint Replacement Patients Discharging to Rehabilitation.
PUBLISHED MANUSCRIPTS
1. Sibia US, Turcotte JJ, MacDonald JH, King PJ. The Cost of Unnecessary Hospital Days for Medicare Joint Replacement Patients Discharging to Skilled Nursing Facilities. Journal of Arthroplasty (September 2017).
PUBLISHED ABSTRACTS
1. Sibia US, Turcotte JJ, MacDonald JH, King PJ. The Cost of Unnecessary Hospital Days for Medicare Joint Replacement Patients Discharging to Skilled Nursing Facilities. ACS-NSQIP (July 2017).
2. Sibia US, Turcotte JJ, MacDonald JH, King PJ. The Cost Implications of Unnecessary Inpatient Days for Medicare Total Joint Replacement Patients Discharging to Rehabilitation. Maryland Orthopaedic Association (February 2017).
3. Stone AH, Sibia US, MacDonald JH, King PJ. Trend in Treatment for Femoral Neck Fractures: Hemiarthroplasty Versus Total Hip Arthroplasty. American Academy of Orthopedic Surgeons (March 2018).
Research is a core element of the continuous quality improvement process at the Center for Joint Replacement. The dedicated research team at the center includes clinical research coordinators, data analysts and a research fellow. As a high-volume center, we feel it’s our duty to conduct high-quality research and disseminate our results. We’re proud to present the following research activity from the past year.
2017 Orthopedics Outcomes » 17
SPI
NE
SU
RGER
Y
spine procedures performed in 2017, the third busiest spine program in Maryland.1,098
20%
than the national average for spine
centers
higher patient
satisfaction scores
40%
than the Maryland average for
inpatient spine surgery
shorter length of
stay
Patient Centered Pathway Team
Our multidisciplinary team approach drives our ability to deliver the highest quality care tailored to each patient’s needs. A variety of programs have been implemented through our Spine Pathway.
SPINE
SURGEONS
PRE-OP CLASSES:
Offers day and evening
classes weekly to
accommodate patient
schedules.
PHYSICAL
AND
OCCUPATIONAL
THERAPY
DEDICATED
NURSING AND
OR TEAMS
HOSPITALIST AND PHYSICIAN
ASSISTANTS
PHARMACISTS
INPATIENT AND OUTPATIENT
NURSE NAVIGATORS
MULTI-MODAL PAIN MANAGEMENT: Uses both opioid
and non-opioid medications to control pain (i.e. Tylenol, NSAIDs,
muscle relaxers, etc.).
GROUP THERAPY:
Provides emotional
support and
encouragement, with a
special focus on non-
pharmacologic methods
of pain control.
EARLY MOBILIZATION:
Gets patients out of bed
the day of surgery and
ready for group therapy
early the following
morning.
PT360 VISITS: Offers home
physical therapy pre- and/
or post-surgery to help
patients prepare their home
environment for surgery and
increase safety after discharge.
2017 Orthopedics Outcomes » 19
Case Volume and Length of StayS
PIN
E S
URG
ERY
2,500
2,000
1,500
1,000
500
0
6.00
5.00
4.00
3.00
2.00
1.00
0.00
898
4.60
697
3.46
765
4.50
1,325
5.22
729
3.67
2,089
5.31
1,098
2.63
569
3.22
449
2.98
363
2.21
AAMC
AAMC
Hosp.1Hosp.1
Hosp.2Hosp.2
Hosp.3Hosp.3
Hosp.4Hosp.4
Hosp.5Hosp.5
Hosp.6Hosp.6
Hosp.7Hosp.7
Hosp.9Hosp.9
Hosp.8Hosp.8
FY 2017 Spine Surgery Volume: Top 10 Maryland Hospitals
FY 2017 Average Length of Stay (Days): Inpatient Spine Surgery
Maryland Average
Patient OutcomesWe capture patient-reported outcomes measures for patients treated by spine surgeons at AAMC Orthopedics. These tools allow providers to track the impact of surgical intervention over time from the patient’s perspective. We use PROMs both in research and clinical practice to evaluate each patient’s quality of life. On average, patients undergoing lumbar spine surgery lowered their disability score by more than 60 percent. Lower scores means a patient is less disabled.
100
80
60
40
40
0
Lumbar Spine Surgery Patient Reported Outcomes: Oswestry Disability Index
AAMC Center for Spine Surgery Patient Satisfaction Scores
FY15
Q1 Q1 Q1Q2 Q2 Q2Q3 Q3 Q3Q4 Q4 Q4
FY16 FY17
100%
95%
90%
85%
80%
75%
70%
65%
60%
Preop 3-6 Mos Postop
3-6 Mos Postop
1 year Postop
AAMC National Average
Note: A lower score on the Oswestry Disability Index (ODI) denotes a lower level of disability, and a better functional outcome for patients.
Spine surgery patient satisfaction scores have risen by 23 percent since 2015 and significantly exceed the 73 percent average for spine centers nationally.
68%
84% 84%
89%
80% 80%
100%
88%
91%
71%
2017 Orthopedics Outcomes » 21
Cost of CareS
PIN
E S
URG
ERY
AAMC recognizes the importance of delivering high-quality, low-cost care. The Center for Spine Surgery has decreased its average charge per inpatient case by 20 percent since FY 2012, while the average Maryland hospital charge has increased by 21 percent.
The average charge for inpatient spine surgery at AAMC in FY 2017 was 37 percent below the Maryland average, the lowest of the top 10 high volume spine centers in the state.
Clinical Quality Measures
The Center for Spine Surgery consistently measures a wide variety of clinical outcomes to guide our quality improvement efforts. In 2016, the center ranked in the top 10 percent of the country in postoperative pneumonia and sepsis rates. We also earned the “Exemplary” designation from the ACS-NSQIP program in these categories.
5-Year Average Charge per Inpatient Spine Surgery
$45,000
$40,000
$35,000
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$02016 20172012 2013 2014 2015
$38,799
$24,271
AAMC
Maryland Total
FY 2017 Average Charge per Case: Inpatient Spine Surgery $48,520
$43,198$38,434$35,928$35,765
$29,185$27,798
$24,271
$62,571
$24,771
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$0
1.07
CY 2016 NSQIP Outcomes: AAMC Spine Surgery vs. National Benchmarks
1.2
1
0.8
0.6
0.4
0.2
0
0.88 0.85
1.02
0.85
Readmission
Return to OR
Sepsis
SSI
VTE
Pneumonia
1.09
Research ActivityThe Center for Spine Surgery undertakes a wide variety of research projects including:
CLINICAL TRIALS:
Pfizer STRIVE (Staphylococcus aureus Surgical Inpatient Vaccine Efficacy) trial. The purpose is to evaluate the safety and efficacy of the vaccine to determine if it prevents postoperative invasive S. aureus infections in patients undergoing elective spinal surgery.
NATIONAL PRESENTATIONS:
Turcotte J., Jahnige S., Harrison A., Patton C. Predictors of Perioperative Resource Utilization Following Instrumented Posterior Lumbar Fusion. Podium presentation at: American Academy of Orthopaedic Surgeons National Meeting; March 2018; New Orleans, LA.
Turcotte J., Jahnige S., Harrison A., Patton C. Predictors of Perioperative Resource Utilization Following Instrumented Posterior Lumbar Fusion. Poster presented at: North American Spine Society’s 13th Annual Evidence and Technology Spine Summit; February 2017; Park City, UT.
SUBMITTED MANUSCRIPTS:
Turcotte J. & Patton C. Predictors of Postoperative Complications Following Surgery for Lumbar Spinal Stenosis and Degenerative Lumbar Spondylolisthesis. The Journal of the American Academy of Orthopaedic Surgeons. Submitted November, 2017.
INSTITUTIONAL PRESENTATIONS:
Turcotte J., Andersen, K., Grover, J., Patton C. The impact of risk-score based interventions on 30-day readmissions and ED visits following spine surgery. Poster presented at: Anne Arundel Medical Center Quality Improvement Showcase; May, 2017; Annapolis, MD.
Andersen, K., Patton, C., Turcotte, J., Grover, J., Clance, M., Rowse, B., Lee, S. The Impact of a Decolonization Protocol on the Prevention of Spine Surgical Site Infection. Poster presented at: Anne Arundel Medical Center Quality Improvement Showcase; May, 2017; Annapolis, MD.
Grover, J., Patton, C., Turcotte, J., Andersen, K., Plank, S. The Impact of Non-Opioid Pain Management Strategies Following Spine Surgery. Poster presented at: Anne Arundel Medical Center Quality Improvement Showcase; May, 2017; Annapolis, MD.
“Immediately after the surgery, I felt so much better,” says Hope. “It was amazing. I felt like I had my old leg back. I was basically pain free. I’m so glad I decided to have surgery.”
– Hope Lomvardias, spine surgery patient
“It was the best thing I could have done, I’m so glad they do this here.”
– Joan MacLean, iFuse patient
2017 Orthopedics Outcomes » 23
Defining Sports Medicine: A wide variety of procedures are encompassed by the term sports medicine. At AAMC we have defined this service as using the following CPT codes across three procedure categories:
hip arthroscopies in a year, the only program to do so
outpatient knee surgeries in a year, the only program to do so
MORE THAN
MORE THAN
100
1,000
25%
18%
SPO
RTS
MED
ICIN
E
Outpatient Shoulder Surgery: 2982, 29826, 29807, 23430, 23472, 29806
Outpatient Hip Surgery: 29916, 29915, 29914, 29862
Outpatient Knee Surgery: 29881, 29888, 29882, 29877, 29867
All data is based on the HSCRC hospital data set.
of all hip arthroscopies in Maryland are performed at AAMC
more outpatient shoulder surgeries than the second busiest program in Maryland in 2017
142%more outpatient knee surgeries than the second busiest program in 2017
14% of all outpatient shoulder surgeries in Maryland are performed at AAMC
We performed the most outpatient knee surgeries in the state of Maryland for the past three years.
We’re Maryland’s highest-volume outpatient shoulder surgery program for two of the past three years.
We performed the most hip arthroscopies in the state of Maryland each year for the past three years.
Case Volume
FY 2017 Outpatient Hip Arthroscopy Volume: Top 10 Maryland Hospitals
140
120
100
80
60
40
20
0
55
14
40
70
23
91
119
13109
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
FY 2017 Outpatient Shoulder Surgery Volume: Top 10 Maryland Hospitals
800
700
600
500
400
300
200
100
0
276231
265 279249
587
690
175160157
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
FY 2015-2017 Total Sports Medicine Surgery Volume: Top 10 Maryland Hospitals
6,000
5,000
4,000
3,000
2,000
1,000
0
1,836
1,3191,571
2,436
1,537
3,176
5,296
1,1921,1581,150
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
Our Sports Medicine program has maintained its leadership position as the highest volume program in Maryland over the past three years. We perform 67 percent more surgeries than the second busiest program in the state. In 2017, AAMC was Maryland’s highest volume center in hip arthroscopy, outpatient knee surgery and outpatient shoulder surgery.
1,000
900
800
700
600
500
400
300
200
100
0
371
263320
389318
391
947
253241237
AAMC
Hosp.1
Hosp.2
Hosp.3
Hosp.4
Hosp.5
Hosp.6
Hosp.7
Hosp.9
Hosp.8
FY 2017 Outpatient Knee Surgery Volume: Top 10 Maryland Hospitals
2017 Orthopedics Outcomes » 25
SPO
RTS
MED
ICIN
E Patient OutcomesHip Arthroscopy
Knee Surgery: ACL Repair
Knee Surgery: ACL Repair
Shoulder Surgery
Patients undergoing labral repair at AAMC experienced a 25 point improvement in M- HHS over one year.
Patients undergoing ACL surgery at AAMC have a 99.5 percent WOMAC functional score at one year, better than the national average of <95 percent.
SANE knee scores nearly doubled from preop to one year postop for AAMC patients, again outperforming national benchmarks.
Patients undergoing shoulder surgery at AAMC experienced results consistently superior to national averages, with ASES scores improving by > 30 points.
90
80
70
60
50
40
30
20
10
0
90
80
70
60
50
40
30
20
10
0
90
80
70
60
50
40
30
20
10
0
90
80
70
60
50
40
30
20
10
0
Preop
Preop
Preop
Preop
6 Mos Postop
6 Mos Postop
6 Mos Postop
6 Mos Postop3 Mos Postop
1 Year Postop
1 Year Postop
1 Year Postop
1 Year Postop
Other
Other
Other
AAMC
AAMC
AAMC
Patients undergoing hip arthroscopy at AAMC experienced 150% improvement in SANE scores at 6 months, on average.
3 Mos Postop
3 Mos Postop
3 Mos Postop
6 Weeks Postop
2 Year Postop
2 Year Postop
2 Year Postop
Community Involvement
Daniel Redziniak, MDChesapeake Bayhawks Professional Lacrosse Team, Bowie State, Anne Arundel Community College, Sever-na Park High School
Benjamin Petre, MDUSA Olympic Ski Team, USA Olympic Snowboard Team, Baltimore Orioles, Bowie Baysox AA Orioles affiliate, Annapolis High School
Peter Ove, MDBowie State, DeMatha Catholic High School
Christina Morganti, MDAnne Arundel Community College
Community Education
The Sports Medicine team is involved in volunteer community sports coverage at all levels from the weekend warrior to Olympic teams. We are very proud to be selected by the following teams to provide their medical coverage:
The Sports Medicine team is dedicated to providing educational opportunities to both providers and the community. Highlights of our 2017 educational activities include:
YIPS: Youth Injury Prevention Seminar. This annual conference put on by Dr. Christina Morganti aims to educate and update coaches, athletic trainers, parents, physical therapists, midlevel providers and other physicians on the most relevant injury prevention topics and techniques. Recent conferences have focused on topics such as concussion, the opioid crisis and what it means for injured youth, prevention of ACL tears, footwear and playing surface, etc.
Emerging Concepts in Orthopedic Surgery: Put on by Dr. Daniel Redziniak and Dr. Jeff Gelfand, this one-day course is targeted toward orthopedic surgeons, primary care providers, physical therapists, and other allied professionals who want to learn about emerging treatment options for common conditions encountered by orthopedic surgeons. Course lectures include new strategies for treating a range of orthopedic conditions and injuries, and discussion of new procedures compared with alternate management options.
Sports Medicine Fellowship: The AAMC Sports Medicine team is honored to be asked by the Uniformed Services University to take part in teaching their Sports Medicine Fellows.
2017 Orthopedics Outcomes » 27
Case VolumeU
PPER
EXT
REM
ITY,
FO
OT
AND
AN
KLE
SU
RGER
Y
Upper Extremity Surgery
Foot and Ankle Surgery
The Upper Extremity Surgery program is the second busiest program in Maryland, and the fastest growing high-volume program in the state. Upper extremity data includes cases with CPT codes: 29848, 25609 and 23472.
The Upper Extremity Surgery program performed 308 cases in 2017 and has maintained an annual growth rate of 14 percent over the past three years.
In 2017, AAMC was the third busiest foot and ankle program in the state, and has performed 775 procedures over the past three years. Foot and ankle data includes cases with CPT codes: 29898, 28308, 27792,28296 and 27698.
Upper Extremity Surgery 3-Year Annual Growth Rate: High Volume (>100 cases per year) Maryland Hospitals
FY 2017 Foot and Ankle Surgery Volume: Top 10 Maryland Hospitals
FY 2017 Upper Extremity Surgery Volume: Top 10 Maryland Hospitals
220
-6%
-1%
246
164
75
141
60
138
55
87
51
62
51
61
5%
48
58
11%
47
398
0%
246
308
14%
244
AAMC
AAMC
AAMC
Hosp.1
Hosp.1Hosp.1
Hosp.2
Hosp.2
Hosp.3
Hosp.2
Hosp.3
Hosp.3
Hosp.4
Hosp.4
Hosp.5
Hosp.5
Hosp.6
Hosp.6
Hosp.7
Hosp.7
Hosp.9
Hosp.5Hosp.9
Hosp.8Hosp.4
Hosp.8
450
400
350
300
250
200
150
100
50
0
20%
15%
10%
5%
0%
-5%
-10%
300
250
200
150
100
50
0
Hos
Patient OutcomesThe Upper Extremity Surgery program utilizes the The Disabilities of the Arm, Shoulder and Hand Score (QuickDash) to track the impact of surgery from the patient perspective. A lower score indicates a better functional outcome for patients. In 2017, patients undergoing surgery at AAMC displayed postoperative functional outcomes that outperformed national benchmarks at both six months and one year postop.
100959085807570656055504540353025201510
50
Preop 6 Mos Postop 1 Year Postop
OtherAAMC
3 Mos Postop 2 Year Postop
QuickDash Disability Symptom Score
2017 Orthopedics Outcomes » 29
AboutO
STEO
PORO
SIS
PRO
GRA
M
Our Osteoporosis and Screening program started in 2006 with the name of Bone Alert, under the leadership of Dr. Christina Morganti, an orthopedic surgeon who had studied exercise and aging, and developed an interest in osteoporosis through her research fellowship at Tufts University in the mid 90s. As osteoporosis awareness increased, it became apparent that the orthopedic surgeon is a logical bridge between the high-risk patient who has sustained a fragility fracture and the primary care doctor who traditionally manages chronic disease including osteoporosis. The concept of Fracture Liaison Service was developed and promoted. A Fracture Liaison Service typically refers to a hospital-based program, focusing on inpatient fragility fracture patients, especially hip fracture patients. However, we have found that the outpatient setting is the most appropriate and efficient for managing osteoporosis patients.
We started the Bone Alert program as a notification service to the primary care doctor of each fragility fracture patient who was at least 50 years old. It has evolved to a comprehensive outpatient program that includes evaluation and treatment of osteoporosis if desired.
How the program works
Intake Points:
Post fragility fracture referrals, PCP referrals,
patient self referrals
Care Coordination:
Ongoing osteoporosis management in
collaboration with PCP
DEXA ScanX-Ray
Blood Work
Lifestyle Management: Nutrition and
ExerciseSmoking Cessation
and Alcohol Reduction
Pharmaceutical Treatment as
Needed
Longitudinal Patient
Tracking
National Osteoporosis
Case Conferences
Program OutcomesOwn the Bone is a registry developed by the American Orthopedic Association to support the mission of improving the initiation of osteoporosis evaluation and management in patients after they have sustained a fragility fracture. Participating in the program allows us to benchmark our performance to other programs across the country. Since we began participating in the registry two years ago, the Osteoporosis and Screening program has been designated a Star Performer in both years. All data gathered through June 30, 2017.
Counseling Compliance Measures
Calcium
Vitamin D
Exercise
Fall Prevention
Smoking Cessation
Alcohol Consumption
Calcium
Vitamin D
Exercise
Fall Prevention
Smoking Cessation
Alcohol Consumption
AAMG Subjects All Subjects
20% 20%40% 40%0% 0%60% 60%80% 80%100% 100%
YES NO N/A
Patient and Physician LettersAAMG Subjects
AAMG Subjects AAMG Subjects
All Subjects
All Subjects All Subjects
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
SENT NOT SENT
Patient Letter
Patient Letter
Physician Letter
Physician Letter
N = 121 N = 41,449
Ribs 4%
Shoulder 3%
Knee 2%Thigh 1%
Pelvic Ring 3%
Arm 5%
Wrist 13%
Spine 36%Hip
7%
Ankle/Foot 15%
Leg 6%
Forearm 5%
N = 132
Arm 2% Forearm 5%
Hip 51%
Ankle/Foot 7%
Wrist 6%
Spine 11%
Pelvic Ring 3%
N = 44,453
Counseling Fracture Location
Compliance Measure: BMD Testing Recommended to Patient
Yes 91%
Yes 74%
No-Not Indicated 7%
No-Not Indicated 12%
No 2%
No 14%
Knee 4%
Thigh 3%
Leg 2%
Shoulder 6%
2017 Orthopedics Outcomes » 31
Outcomes and InitiativesAA
MC
ORT
HO
PED
ICS
In 2016, AAMC Orthopedics received an exemplary designation (top 10 percent nationally) from ACS-NSQIP in six postoperative occurrence categories: cardiac, pneumonia, renal failure, SSI, sepsis and readmissions.
The following are highlights of our performance, presented as Odds Ratios. This reports the estimated odds of an event happening at AAMC compared to the estimated odds of that event happening in all hospitals in the ACS NSQIP database. A number of 1.0 means the hospital is performing as expected. A number less than 1.0 means the hospital is performing better than expected. A number greater than 1.0 means the hospital is performing worse than expected.
1.8%
1.6%
1.4%
1.2%
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
1.4
1.2
1
0.8
0.6
0.4
0.2
0
0.14%
0.65
0.14%
1.08
0.14%
0.70
0.96%
0.79
0.07%
1.04
0.08%
0.78
0.47%
1.17
0.40%
0.65
0.58%
0.89
0.21%
0.78
1.61%
0.82
0.29%
1.05
SSI
SSI
Sepsis
Sepsis
Return to OR
Return to ORReadm
ission
UTI
UTI
Renal Failure
Renal Failure
VTE
VTE
Ventilator
>48 Hours
Ventilator
>48 Hours
Unplanned
Intubation
Unplanned
Intubation
Pneumonia
Pneumonia
Cardiac
Cardiac
Mortality
Mortality
Morbidity
Morbidity
CY 2016 NSQIP Outcomes: AAMC Orthopedics (All Procedures) 30-Day Risk-Adjusted Occurance Rates
CY 2016 NSQIP Outcomes: AAMC Orthopedics (All Procedures) vs. National Benchmark
0.91
Reducing Opioid Utilization2017 marked the introduction of the Orthopedic Patient-Centered Post-Procedure Opioid Prescribing Initiative. This initiative was developed in response to the overwhelming opioid epidemic facing our community and nation. The goal of the initiative was to determine, and prescribe, the actual amount of narcotic pain medication needed for a given procedure. Recent published literature has demonstrated that as much as 66 percent of the narcotic pills prescribed for patients undergoing orthopedic surgical procedures may go unused, thus creating a potential surplus of narcotic pills that may be diverted to support the opioid crisis. The initiative involved creating a consensus amongst treating surgeons on how much narcotic is actually needed for a given procedure. The patients undergoing those procedures were then asked to fill out a patient diary documenting actual opioids consumed in the immediate postoperative period. Finally, any time a second prescription was required during the postoperative period, it was documented and tracked within the medical record. This feedback loop of patient-reported consumption as well as the need to write a second prescription has enabled providers to ensure the amount being prescribed is the actual amount of narcotic needed during the postoperative period. The results to date have been remarkable. Through the first six months of the program patients experienced a 47.9 percent decrease in the amount of opioids prescribed, with only 8.5 percent of patients requiring a refill of their prescription.
Total Opioid MMEs Prescribed: 2017 May-November
Second Scripts for Opioid Prescription Required: 2017 May-October
300,000
250,000
200,000
150,000
100,000
50,000
0
16%
14%
12%
10%
8%
6%
4%
2%
0%
268,006
14%
224,518
8%
192,047
4%
184,415
3%
171,793
9%
173,152
10%
139,644
Nov
OctOct
SeptSept
August
August
JulyJuly
May
May
JuneJune
2017 Orthopedics Outcomes » 33
In the spring of 2018, AAMC Orthopedics launched a campaign to establish a higher-level brand identity and build awareness of its trusted orthopedic care. This campaign, Your Comeback Starts Here, featured four patients with compelling stories of how AAMC Orthopedics helped them get back to the things they love.
To read more of their stories, see the commercial and behind the scenes interviews, visit AAMCortho.com.
YOUR COMEBACK
STARTS HERE
Alma Adams loves her job as a crossing guard in Annapolis, helping young students safely navigate the intersection of Woods Drive and Tyler Avenue.
When she’s not working, she also keeps busy by traveling and volunteering.
“I am constantly on the go,” she says.
Firefighter Donny Fletcher was at the scene of an apartment fire when he felt a tightening across his shoulder and the next day, it was difficult for him to move his arm.
When fourth-grader Campbell Goodburn broke her ankle playing a game of tag, her mom wanted the very best care — Campbell just wanted to get back to swimming and dancing as quickly as possible.
Nyme Manns was playing in Bowie State University’s first football game of the year in 2014 when he took a blow to his knee that sidelined him for the rest of the season.
Alma Adams Tyler Heights Elementary Crossing Guard
Campbell Goodburn Fourth grade student, swimmer and dancer
Donny Fletcher Prince George’s Fire Department Battalion Chief
Nyme Manns Former Bowie State Football Player
Dr. King performed hip replacement surgery on both of Alma’s hips, using the direct anterior approach. This method uses a special operating table to perform a muscle-sparing hip replacement with the help of X-rays.
And now Alma is enjoying her life. She says she encourages anyone experiencing knee or hip pain to go to AAMC Orthopedics for treatment.
“I can drop it like it’s hot,” she says. “Without this surgery, I wouldn’t have felt like myself.”
Daniel Redziniak, MD, orthopedic surgeon, ordered an arthrogram – a test that gives high definition images with contrast.
The test detected a full labral tear.
Donny immediately began non-operative treatment, and struck a deal with Dr. Redziniak. He would keep going to rehab, as long as he was allowed to keep working.
Not only did his treatment help him get back to the work he loves, it has also helped him to enjoy other activities that are special to him.
“My husband and I didn’t want to take Campbell to the emergency room or urgent care for her injury. We are fortunate to have AAMC Orthopedics in our community. It’s a convenient solution when you need somewhere to have a broken bone looked at and treated by orthopedic specialists,” shares Dawn.
Thanks to excellent care from the entire team at AAMC Orthopedics, Campbell was able to perform at the Lyric Theater this past December and have an experience to last a lifetime.
Daniel Redziniak, MD, an orthopedic surgeon and team doctor for the Bowie State University Bulldogs, assured Nyme that everything would be okay.
When Nyme returned to the field the following season, it was his most successful year as a Bulldog, Nyme recalls. He was named the fifth-ranked receiver in the country, and landed on the Black College Football Hall of Fame’s watch list, after breaking every record in Bowie State football history.
“I feel like my injury made me a better athlete and a stronger person,” he says.
2017 Orthopedics Outcomes » 35
The Healing Power of PetsTherapy dogs bring smiles and comfort to patients and families
Dogs really are man’s best friend. That’s why you shouldn’t be surprised if you see some walking the halls of our hospital and visiting patients in their rooms. At AAMC, we harness the healing power of pets with more than 25 volunteer pet therapy teams. Each team is made up of a volunteer from the community who owns a pre-trained and certified dog.
Therapy dogs can help put people at ease both emotionally and physically. Their visits often create a happier, calmer atmosphere not only for patients, but for family and friends as well.
Katherine Tighe and her dog, Suzie, along with fellow volunteer George Benoit and his dog, Kallie, have provided pet therapy at AAMC since 2015. They make frequent stops to the emergency room, as well as the pediatric, cancer, joint replacement and elderly care units.
“My dad was in and out of hospitals and rehab centers for years before he died,” says Katherine, an animal-assisted therapist and social worker. “He was growing more and more depressed and unhappy.”
Then she remembers one day she came to visit him in the rehab facility, and something was different.
“There was this black lab there who had stolen my father’s slipper. He was going up and down the halls trying to get back his slipper,” she says. “My dad enjoyed it so much, and it made me happy to see him have a spark again.”
Adds George, “One time we walked up to a woman who was waiting for a loved one in surgery.” She started petting Kallie and immediately began crying.
“Somehow the dogs give people an emotional release.”“We’ll go in a room where a child is afraid and
screaming in pain, and he will see the dog and calm down immediately,” Katherine says. “The whole demeanor changes, and it’s beautiful.”
Dogs must go through basic obedience training and pass a canine good citizen test. The team receives an extra level of training that focuses on managing difficult situations and evaluating the dog’s temperament. We partner with five organizations to certify pet therapy teams: Caring Canines, Pets on Wheels, PAWS-AAC, Fidos for Freedom and Pet Therapy International.
Katherine Tighe, with her dog Suzie, and George
Benoit, with his dog Kallie, have been AAMC pet therapy
volunteers since 2015.
AAC-016-BOW
NON-PROFIT ORGUS POSTAGE
PAIDAnne Arundel
Medical Center
CONNECT WITH US!
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Questions? Call 443-481-5555.
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Get involved >> For information about our pet therapy team, or to learn how your dog can become certified to visit patients, call 443-481-5056.
The Healing Power of PetsTherapy dogs bring smiles and comfort to patients and families
Dogs really are man’s best friend. That’s why you shouldn’t be surprised if you see some walking the halls of our hospital and visiting patients in their rooms. At AAMC, we harness the healing power of pets with more than 25 volunteer pet therapy teams. Each team is made up of a volunteer from the community who owns a pre-trained and certified dog.
Therapy dogs can help put people at ease both emotionally and physically. Their visits often create a happier, calmer atmosphere not only for patients, but for family and friends as well.
Katherine Tighe and her dog, Suzie, along with fellow volunteer George Benoit and his dog, Kallie, have provided pet therapy at AAMC since 2015. They make frequent stops to the emergency room, as well as the pediatric, cancer, joint replacement and elderly care units.
“My dad was in and out of hospitals and rehab centers for years before he died,” says Katherine, an animal-assisted therapist and social worker. “He was growing more and more depressed and unhappy.”
Then she remembers one day she came to visit him in the rehab facility, and something was different.
“There was this black lab there who had stolen my father’s slipper. He was going up and down the halls trying to get back his slipper,” she says. “My dad enjoyed it so much, and it made me happy to see him have a spark again.”
Adds George, “One time we walked up to a woman who was waiting for a loved one in surgery.” She started petting Kallie and immediately began crying.
“Somehow the dogs give people an emotional release.”“We’ll go in a room where a child is afraid and
screaming in pain, and he will see the dog and calm down immediately,” Katherine says. “The whole demeanor changes, and it’s beautiful.”
Dogs must go through basic obedience training and pass a canine good citizen test. The team receives an extra level of training that focuses on managing difficult situations and evaluating the dog’s temperament. We partner with five organizations to certify pet therapy teams: Caring Canines, Pets on Wheels, PAWS-AAC, Fidos for Freedom and Pet Therapy International.
Katherine Tighe, with her dog Suzie, and George
Benoit, with his dog Kallie, have been AAMC pet therapy
volunteers since 2015.
AAC-016-BOW
NON-PROFIT ORGUS POSTAGE
PAIDAnne Arundel
Medical Center
CONNECT WITH US!
askAAMC.org
facebook.com/ AnneArundelMedicalCenter
youtube.com/AAMCnews
twitter.com/AAMCnews
Questions? Call 443-481-5555.
Recycle me! We care about your health and the environment. We encourage you to share with others and recycle when finished.
MOTIVATE
2001 Medical Parkway Annapolis, MD 21401
Get involved >> For information about our pet therapy team, or to learn how your dog can become certified to visit patients, call 443-481-5056.
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