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Outcomes | 2007
Respiratory Institute
Patients First
282964A.indd 2 6/19/08 8:44:33 AM
Respiratory Institute1
Outcomes 2007
Patients First
Quality counts when referring patients to hospitals and physicians, so Cleveland Clinic has created a series of Outcomes
books similar to this one for many of its institutes. Designed for a healthcare provider audience, the Outcomes books
contain a summary of our surgical and medical trends and approaches, data on patient volume and outcomes, and a
review of new technologies and innovations.
Although we are unable to report all outcomes for all treatments provided at Cleveland Clinic — omission of outcomes
for a particular treatment does not mean we necessarily do not offer that treatment — our goal is to increase outcomes
reporting each year. When outcomes for a specific treatment are unavailable, we often report process measures that
have documented relationships with improved outcomes. When process measures are unavailable, we report volume
measures; a volume/outcome relationship has been demonstrated for many treatments, particularly those involving surgical
technique.
Cleveland Clinic also supports transparent public reporting of healthcare quality data and participates in the following
public reporting initiatives:
• Joint Commission Performance Measurement Initiative (www.qualitycheck.org)
• Centers for Medicare and Medicaid (CMS) Hospital Compare (www.hospitalcompare.hhs.gov)
• Leapfrog Group (www.leapfroggroup.org)
• Ohio Department of Health Service Reporting (www.odh.state.oh.us)
Our commitment to providing accurate, timely information about patient care is designed to help patients and referring
physicians make informed healthcare decisions. We hope you find these data valuable. To view all our Outcomes books,
visit Cleveland Clinic’s Quality and Patient Safety website at clevelandclinic.org/quality/outcomes.
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22
Dear Colleague:
I am proud to present the 2007 Cleveland Clinic Outcomes books. These books provide information on results, volumes and innovations
related to Cleveland Clinic care. The books are designed to help you and your patients make informed decisions about treatments and
referrals.
Over the past year, we enhanced our ability to measure outcomes by reorganizing our clinical services into patient-centered institutes. Each
institute combines all the specialties and support services associated with a specific disease or organ system under a single leadership at a
single site. Institutes promote collaboration, encourage innovation and improve patient experience. They make it easier to benchmark and
collect outcomes, as well as implement data-driven changes.
Measuring and reporting outcomes reinforces our commitment to enhancing care and achieving excellence for our patients and referring
physicians. With the institutes model in place, we anticipate greater transparency and more comprehensive outcomes reporting.
Thank you for your interest in Cleveland Clinic’s Outcomes books. I hope you will continue to find them useful.
Sincerely,
Delos M. Cosgrove, MD
CEO and President
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what’s insideChairman’s Letter 04
Institute Overview 05
Quality and Outcomes Measures
Critical Care Medicine 06
The Respiratory Special Care Unit (ReSCU) 07
Bronchology 08
Asthma Center 09
Interstitial Lung Disease 10
Lung and Heart/Lung Transplantation 10
Patient Experience 12
Innovations 15
New Knowledge 18
Staff Listing 22
Contact Information 23
Institute Locations 24
Cleveland Clinic Overview 25
Online Services 25 eCleveland Clinic DrConnect MyConsult
Outcomes 2007 44
Chairman’s LetterThe Respiratory Institute is pleased to present our fourth edition
of Respiratory Disease Outcomes. This booklet provides a con-
densed overview of our clinical activities and programs, including
reports of clinical volumes and patient outcomes. We believe it is
important and useful to share this information with our referring
physicians, training program alumni, potential patients and other
individuals interested in respiratory diseases. At Cleveland Clinic,
patients with respiratory disease benefit from the expertise of a
multidisciplinary team consisting of clinicians specializing in pul-
monary and critical care medicine, allergy and clinical immunol-
ogy and thoracic surgery, all working in close collaboration with
thoracic radiologists and pulmonary pathologists. In 2007, we
experienced continued growth in our clinical programs, research
funding and application of innovative technologies. We are proud
of these accomplishments and thankful to all who helped us
achieve this level of success. We are firmly committed to provid-
ing ever-increasing levels of clinical excellence in the future.
Herbert P. Wiedemann, MD
Chairman, Respiratory Institute
5 Respiratory Institute5
2007 Total % Increase 2005 - 2007
Total Visits 57,808 10%
Interstitial Lung Disease Visits
2,094 30%
Pulmonary Arterial Hypertenstion Visits
1,375 54%
Sarcoidosis Visits 1,317 37%
Lung Cancer Visits 760 90%
COPD Visits 4,015 4%
2007 Total % Increase 2005 - 2007
Research Funding $4,700,000 18%
Research Grants/ Contracts
72 11%
Institute OverviewAt the Respiratory Institute, patients with pulmonary disorders benefit
from the expertise of a multidisciplinary team of specialists. At Cleveland
Clinic, experts in four departments – Pulmonary, Allergy and Critical Care
Medicine; Thoracic and Cardiovascular Surgery; Thoracic Imaging; and
Pulmonary Pathology – collaborate to care for these patients.
We provide comprehensive care for all patients with respiratory disorders.
National experts treat patients with the following conditions:
• Acute Respiratory Distress Syndrome (ARDS)
• Asthma
• Beryllium-induced lung disease
• Chronic obstructive pulmonary disease (COPD), including alpha-1
antitrypsin deficiency
• Idiopathic pulmonary fibrosis
• Interstitial lung disease
• Interventional bronchology
• Lung cancer
• Lung volume reduction surgery
• Lymphangioleiomyomatosis (LAM)
• Pulmonary alveolar proteinosis (PAP)
• Pulmonary vascular diseases (idiopathic pulmonary hypertension
pulmonary embolic disease, etc.)
• Sarcoidosis
The Respiratory Institute’s six formal sections provide advanced
sub-specialized care in the fields of allergy and clinical immunology,
bronchology, critical care medicine, lung transplantation, respiratory
therapy and sleep medicine. Diagnosing and managing the full spectrum
of respiratory and allergic disorders, the Respiratory Institute serves nearly
60,000 patients annually.
Also within our Institute are the following centers: Center for Major
Airway Diseases (in conjunction with thoracic surgery), Asthma Center and
Alpha-1 Antitrypsin Deficiency Center of Excellence.
Our Institute also brings care into the community, providing outpatient
services at the Beachwood Family Health and Surgery Center (Pulmonary
& Allergy), Brunswick Family Health Center (Pulmonary), Independence
Family Health Center (Pulmonary & Allergy), Strongsville Family Health
and Surgery Center (Pulmonary & Allergy), Westlake Family Health
Center (Allergy), and the Willoughby Hills Family Health Center (Allergy).
Respiratory Institute staff also provide comprehensive (ICU, inpatient,
outpatient) pulmonary care at Hillcrest Hospital and Euclid Hospital.
This past year, our Institute has seen continued growth in our clinical
programs and research activities, which are primarily conducted at
Cleveland Clinic’s main campus facilities (clinics, hospital and research
laboratories). The collaboration between our clinicians and researchers
helps to shorten the gap between the laboratory discoveries of today
and the patient care of tomorrow.
Outcomes 2007 6
Critical Care MedicineThe Respiratory Institute manages and staffs the Medical Intensive Care Unit (MICU) at Cleveland Clinic. We have seen a 28 percent increase in MICU admissions over the past five years, with 1,463 admissions in 2007. Hospital transfer cases are a major source of admissions and have increased 40 percent over 2003.
Patient outcomes in the MICU continue to be excellent, as exhibited by mortality rates significantly below the risk-adjusted predicted values. SAPS II and APACHE II are two validated statistical models for predicting mortality risk based on patient physiology 24 hours after admission to the ICU.
MICU Actual vs. Expected Survival (Based on 24-hour Assessment)
MICU Actual vs. Expected Survival (Based on 24-hour Assessment)
APACHE II Risk Quintile
Cases Deaths Actual Survival (%) Expected Survival (%)
First (highest risk) 58 47 19 11
Second 90 38 58 44
Third 116 36 69 62
Fourth 183 42 77 75
Fifth (lowest risk) 139 5 96 87
SAPS II Risk Quintile
Cases Deaths Actual Survival (%) Expected Survival (%)
First (highest risk) 85 73 14 7
Second 57 29 49 30
Third 94 33 65 51
Fourth 122 25 80 72
Fifth (lowest risk) 293 31 89 92
7 Respiratory Institute
PercentPercent
0
10
20
30
40
50
CompletelyWeaned
PartialVentilatorSupport
CompleteVentilatorSupport
Expired inReSCU
Transferred to IntensiveCare Unit
The Respiratory Special Care Unit (ReSCU)
Completely Weaned = 46%
Partial Ventilator Support = 10%
Complete Ventilator Support = 4%
Expired in ReSCU = 4%
Transferred to Intensive Care Unit = 36%
Disposition of ReSCU Discharge
Primary ReSCU Stats for the Weaning Ventilator Unit
The Respiratory Special Care Unit (ReSCU) was created for persons who depend on mechanical ventilation to breathe but who are otherwise healthy enough to leave the intensive care unit. The primary goals of the ReSCU are to:
• have patients breathe without the ventilator
• teach patients self-care
• teach family members how to care for the patient and manage the ventilator at home
• prepare the patient and family for the patient’s discharge to another facility
Number of Discharged Patients 62
Total ReSCU Days 1,672
Percent Completely Weaned from Ventilation 28/62 = 45.2%
Percent Survival 60/62 = 96.8%
Average Length of Stay 27.0 days
Based on data from January 1-December 31, 2007
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Outcomes 2007 8
The Respiratory Institute provides the full range of advanced diagnostic and interventional bronchoscopy techniques. We have some of the world’s most extensive experience with:
• electromagnetic navigation
• lung transplant related airway disease
• self-expanding metallic stents
• management of airway complications due to histoplasmosis
• benign airway diseases
• metallic stent removal
We performed 2,391 bronchoscopies during 2007, a 78 percent increase over 2003. Importantly, our complication rates remain low.
Bronchology
Flexible Bronchoscopies 2007
Post-Bronchoscopy Complication RatePercentPercent
0
0.1
0.2
0.3
0.4
0.5
Pneumothorax Clinically SignificantBleeding
Reversalof Sedation
Transbronchial Lung Biopsy 1,501
Airway Examination 415
Endobronchial Biopsy 113
Electrocautery 129
Bronchial & Tracheal Dilation/Stenting
213
Laser Ablation 20
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9 Respiratory Institute
Asthma control can be assessed by use of validated instruments, including the Asthma Control Test (ACT). The ACT includes five questions that assess daytime symptoms, nighttime symptoms, reliance on “rescue” medication, the impact of asthma on everyday functioning, and patient assessment of control, with each of these five responses scored on a 1-5 scale.
Use of serial ACT scores in asthma management objectifies the degree to which the goals of management as described in asthma guidelines are being achieved. A major objective of asthma management is to achieve well- (ACT=20-24) or totally- (ACT=25) controlled asthma. If asthma is poorly controlled (ACT<15) or not well controlled (ACT=15-19), evidence indicates such patients are at elevated risk for exacerbation of asthma over time.
We have used the ACT in Allergy/Immunology at Cleveland Clinic for three years on a routine basis, for all initial and return visits. Shown below are serial ACT scores categorized as totally- or well-controlled, not well-controlled, or poorly controlled, in patients seen in 2007 who completed ACT at their initial appointments and also at return visits.
Care in Allergy/Immunology at Cleveland Clinic is associated with improvement in asthma control over time.
ACT Score Categories Initial Visit Return Visit
Well and Totally Controlled 26% 57%
Not Well Controlled 22% 18%
Poorly Controlled 52% 25%
Asthma Center
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Outcomes 2007 10
Lung and Heart/Lung Transplantation2007 was another year of growth for Cleveland Clinic Lung and Heart/Lung Transplant Program, one of the most active in the country. The Transplant Program completed its 626th transplant since the program’s inception in 1990, and in 2007, performed 72 lung transplants, including three heart-lung transplants and the first lung-liver transplant in Ohio. More than 415 end-stage lung disease patients were evaluated nationally and internationally by the transplant team. The Transplant program continues a reputation for accepting and transplanting challenging complex patients. Cleveland Clinic’s Lung Transplant Team is involved in a series of multicenter trials aimed at therapy of primary graft dysfunction, acute rejection and induction therapy. In addition, our surgeons have pioneered certain transplant surgical techniques, including bronchial artery revascularization, that may improve outcomes further by reducing ischemic injury.
The average waiting time for a graft in our program remains stable despite the new Lung Allocation Score (LAS). Currently our average waiting time is 75 days. The Lung Transplant program has achieved very strong survival rates that are at or above the national average. Median and long-term outcomes continue to improve, with a one-year survival rate of 86 percent and two-year survival rate of 74 percent. A continued emphasis on quality assurance and quality improvement remain central to the program, reflected by the decrease in post-transplant length of stay to an average of 13 days.
Another unique feature of Cleveland Clinic’s transplant program is that patients can live within 1,000 miles of the Cleveland area while awaiting an organ without having to relocate to Cleveland. We follow our patients for the life of their transplant for continuity of care along with local physicians. Our transplant physicians are committed to helping the transplanted patients receive as much care as possible close to their homes. The goal is to return each transplant patient to his or her primary care physician or referring physician within three to six months after transplant.
In 2007, the U.S. Department of Health and Human Services identified Cleveland Clinic as one of six “high performing” centers for lung transplantation, based on volume, growth, and clinical outcomes. (HHS Final Report. “Transplant Center Growth and Management Collaborative: Best Practices Evaluation,” Sept 2007).
Interstitial Lung DiseaseThe interstitial lung disease program continued to grow with 2,094 total visits for idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis, and connective tissue disease associated ILD. This was an increase of 15 percent over 2006. We enrolled patients into clinical research trials of pirfenidone and bosentan for IPF and bosentan for sarcoidosis.
Nationally sanctioned outcomes for ILD have not been determined. However, our program has designated improved lung function after immunosuppressive therapy for cryptogenic organizing pneumonia (COP) as an achievable goal. This outcome encompasses our program’s ability to correctly diagnose and treat these complex patients. During 2007, 13 patients with COP were treated with immunosuppressive medications other than prednisone. Prior literature shows that if these patients are correctly diagnosed and treated, the majority should have improved lung function as measured by forced vital capacity (FVC) during treatment and, importantly, were able to reduce oral corticosteroid dosage. Our results are depicted in the table below. Patients were treated for an average of 674 days and 12 patients had stable or improved FVC at most recent evaluation.
n = 13 Pretreatment Posttreatment Paired t-test
FVC 61 ± 4% 70 ± 6% p = 0.041
Prednisone dosage 40 ± 7 mg/day 15 ± 5 mg/day p = 0.002
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11 Respiratory Institute
First Liver-Lung Transplant Jan. 31, 2007
First Double Lung Transplant with Bronchial Artery Revascularization
Dec. 15, 2007
By the end of 2007Cleveland Clinic performed 626 transplants.
PercentPercent
0
20
40
60
80
100
12 Months 24 Months
Lung Transplant Survival Rate
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Outcomes 2007 12
Overall Rating of Care 2007
Overall Rating of Provider Care 2007
Outpatient - Respiratory InstituteWe ask our patients about their experiences and satisfaction with the services provided by our staff. Although our patients are already indicating we provide excellent care, we are committed to continuous improvement.
Patient Experience
Excellent
PercentPercent
0
100
80
60
40
20
Very Good Good Fair Poor
N=1,223
Excellent
PercentPercent
0
100
80
60
40
20
Very Good Good Fair Poor
N=1,229
13 Respiratory Institute
0
20
40
60
100
Cleveland Clinic
Total Cleveland Clinic Survey Respondents = 4,725
HCAHPS National Average
Percent “9” or “10”Percent “9” or “10”
80
0
20
40
60
100
Cleveland Clinic HCAHPS National Average
Percent “Yes, definitely”Percent “Yes, definitely”
80
Total Cleveland Clinic Survey Respondents = 4,725
Overall Rating of Care (0 worst - 10 best scale) October 2006 - June 2007
Would Recommend Facility October 2006 - June 2007
Inpatient - Cleveland ClinicWith the support of the Center for Medicare and Medicaid Services (CMS) and its partner organizations, the first national standard patient experience survey was implemented in late 2006. Adult medical, surgical, and obstetrics and gynecology patients treated at acute care hospitals across the country are included in the survey. Results collected for initial public reporting, published on www.hospitalcompare.gov in March 2008, are shown here.
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Outcomes 2007 14
Ohio’s First Lung/Liver TransplantIn January 2007, a 25-year-old cystic fibrosis patient with end-stage lung and liver disease underwent a 12-hour operation at Cleveland Clinic, becoming Ohio’s first lung and liver transplant recipient. The patient began her workup at Cleveland Clinic in 2006. However, after the birth of her son, her cystic fibrosis disease progressed. Both her lungs and her liver continued to decline, and she began to have frequent and worsening episodes of hemoptysis that required several interventions. Because her liver would not withstand the immunosuppressive therapy needed for new lungs, the team decided to proceed with both a double-lung and a liver transplant simultaneously.
Cardiothoracic surgeon Gösta Pettersson, MD, PhD, Director of Heart/Lung Transplantation, and surgeon Charles Miller, MD, Director of Liver Transplantation, transplanted the patient’s lungs and liver, respectively. Currently in the United States, only a handful of centers are able to perform this type of multi-organ transplant surgery.
Following an uneventful recovery and four weeks after her landmark operation at Cleveland Clinic, the patient returned home to her family. At her first follow-up visit, she reported that she has begun to play the flute again, a hobby she had given up because of limited respiratory capacity.
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Respiratory Institute15
InnovationsOur mission includes research into pathophysiology of respiratory diseases to develop innovative methodologies and techniques that enhance and advance our ability to diagnose and treat respiratory diseases. The number of externally funded research grants and contracts, and the total funding of these activities, has increased substantially.
Major areas of research activity include asthma, acute respiratory distress syndrome (ARDS), mast cell function, the role of nitric oxide in respiratory disorders, pulmonary hypertension, beryllium-induced lung disease, idiopathic pulmonary fibrosis (IPF), sarcoidosis, chronic obstructive pulmonary disease (COPD) (including alpha-1 antitrypsin deficiency), and pulmonary alveolar proteinosis (PAP).
The Respiratory Institute was proud to sponsor five innovation summits in 2007.
“Asthma Summit 2007” The Respiratory Institute, in association with the Department of Pathobiology, presented the Asthma Summit 2007 in April 2007. The Asthma Summit focused on research and clinical care advances by global leaders in asthma. The meeting highlighted perspectives on future research that will influence the practice of asthma care, and described the most up-to-date diagnostic tools, asthma educational programs and new insights into clinical care. Each of the more than 175 attendees from around the country and the world were provided detailed information on recent innovations in asthma and potential interface with new technology. Speakers and participants, including physicians, nurses, allied health professionals, and researchers from both academics and industry, were provided with the opportunity to interact in breakout groups regarding priorities on research that will influence the future practice of medicine in the treatment of asthma in clinical care. The Asthma Summit was highly successful in promoting the rapid movement forward to realize today’s research becoming tomorrow’s asthma care.
“Major Airway Disease Summit 2007” The Major Airway Disease Summit, conducted by the Respiratory Institute in April 2007, focused on the interfaces among innovative technology, research and clinical care. This Summit was attended by physicians and allied health care professionals with an interest in pulmonary disease and diseases of the major airways, as well as individuals in the medical technology industry. The Summit provided a unique perspective on cutting-edge technologies that will influence the future practice of pulmonary and major airway disease.
“Lung Summit 2007: Innovations in Respiratory Therapy Management and Clinical Practice”This summit in May 2007, part of the Lung Summit series in the Respiratory Institute, addressed topical issues of the science and management of respiratory care. The state-of-the-art lectures and interaction engaged respiratory therapists, RT students, nurses and physicians. Summit objectives included addressing the issues of supply of RTs, demand for their services and manpower in respiratory care today, key issues in managing a respiratory therapy group, and current issues regarding new modes and optimal strategies of mechanical ventilation, and optimal aerosol delivery.
“Breath Analysis Summit 2007: Clinical Applications of Breath Testing”In November 2007, the Respiratory Institute hosted the first “International Breath Analysis Summit” and the Scientific Meeting of the International Association for Breath Research (IABR). The Summit was directed by Raed A. Dweik, MD, and was held in collaboration with the National Aeronautics and Space Administration (NASA), the Environmental Protection Agency (EPA), the Monell Chemical Senses Center and the Electrochemical Society (ECS).
The Summit brought together industry executives, entrepreneurs, scientists and clinicians to discuss key trends, future directions and upcoming technologies in breath analysis and medicine.
Breath testing is an innovative new approach for non-invasive disease diagnosis and monitoring and represents the new frontier in medical
testing. The major focus of the Summit was on medical applications. Topics included exhaled nitric oxide, exhaled breath condensate, electronic nose and sensor arrays, mass spectrometry and bench top instrumentation, and cutting edge sensor technologies. Medical applications that were covered included asthma, COPD, pulmonary hypertension, other respiratory diseases, gastrointestinal diseases, occupational diseases, critical illness, and cancer.
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Outcomes 2007 16
Participants in the two-and-a-half-day Summit came from 23 countries and 18 states. In his concluding remarks, the President of IABR, Professor Anton Amann of Austria, thanked Dr. Dweik and Cleveland Clinic for hosting a “perfect meeting at a perfect venue.”
“Pulmonary Hypertension Summit 2007” The Pulmonary Hypertension Summit 2007, on November 16 and 17 on the Cleveland Clinic campus, attracted more than 220 participants from 20 states and five countries to hear state-of-the-art presentations by 40 distinguished Cleveland Clinic and visiting faculty. Summit attendees included physicians and other health care professionals, researchers and scientists, industry representatives, patients and care givers and patient advocacy groups.
Outside of these summits, other major innovations included:
Non-invasive Diagnosis of Lung CancerA Cleveland Clinic team of pulmonologists and oncologists evaluated the ability of gaseous chemical sensing devices to detect lung cancer by analyzing exhaled breath. Prior study has suggested the pattern of chemicals in the breath, or volatile organic compounds, may be unique in individuals with lung cancer.
Previously, we described the use of a carbon polymer sensor system. The output from this system is a change in the conductivity of the sensors based on the chemicals in the breath that contact them. We also reported the use of a colorimetric sensor array. The sensor used in this system was composed of 36 colored dots impregnated on a disposable cartridge. The dots were made of chemically responsive compounds that change their color based on the pattern of chemicals with which they come in contact. We hypothesized that the pattern of color changes on the sensor would be unique in subjects with lung cancer.
In our first study, smellprints were obtained on the exhaled breath of 14 individuals with bronchogenic carcinoma, 19 with alpha-1 antitrypsin deficiency (a1-ATD), six with chronic beryllium disease (CBD) and 20 healthy controls. Unlike a1-ATD and CBD, exhaled breath of lung cancer patients clustered distinctly from controls. These data indicated that the exhaled breath of lung cancer patients has distinct characteristics that can be identified with a carbon polymer sensor system.
Subsequently, a cancer prediction model was prospectively evaluated in a group of 52 individuals, 12 with and 40 without cancer. In the prospective study, exhaled breath analysis by the electronic nose showed 71.4 percent sensitivity (CI: 41.9 to 91.6) and 91.9 percent specificity (CI: 82.1 to 97.3) for the diagnosis of lung cancer.
Our most recent study (see Mazzone et al in New Knowledge section) included 143 subjects, of which 49 had lung cancer, 73 had a variety of lung diseases, and 21 were healthy controls. A model was developed using 70 percent of the study subjects’ breath results. This model was tested on the remaining 30 percent of participants, where it was found to be 73.3 percent sensitive and 72.4 percent specific for the diagnosis of lung cancer.
These results support the potential for breath analysis to be developed into a useful diagnostic test for lung cancer, confirming previously performed work by us and others. We hope to learn more about the unique constituents of the breath of subjects with lung cancer and develop analysis systems that accurately screen for, and diagnose, lung cancer in a noninvasive manner.
Time to Board the “E-Bus” Bronchoscopy and Real-Time Ultrasonography: Partners in New TechnologyEndobronchial ultrasound (EBUS) is a new technology being used to evaluate airway, lung and lymph node abnormalities. EBUS offers pulmonologists and thoracic surgeons an improved ability to diagnose disease, stage cancer and determine which patients are candidates for surgery. The three general uses for intra-thoracic ultrasound include:
Peripheral Endobronchial Ultrasound (P-EBUS)
To evaluate peripheral lung lesions better and increase diagnostic accuracy, we use a peripheral probe. A miniaturized probe is introduced through the working channel of the bronchoscope. The differences in density between the lung lesion and the normal lung architecture are highlighted as the probe is introduced into the abnormal area. A catheter is then left in place and samples are taken. Recent data suggest an improved yield using P-EBUS.
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Respiratory Institute17
Balloon Probe
Often it is difficult to distinguish between tumor invasion in an airway wall vs. compression from outside the airway. To help differentiate an abnormal airway (airway involved with cancer) from a normal airway, we can insert an ultrasound probe, enveloped inside a balloon, into the airway. Once the balloon is inflated with saline, the ultrasonic image can show intrinsic (involved airway) from extrinsic (compression outside the airway) involvement. This technique can allow for improved detection of airway invasion and determine which patients are candidates for resection.
Endobronchial Ultrasound Trans-Bronchial Needle Aspiration
The hybrid bronchoscope (convex probe or puncture scope) is currently being used to improve the diagnostic yield of transbronchial needle aspiration (TBNA). The endobronchial ultrasound TBNA scope is designed with a small ultrasound probe on the tip that allows visualization of the lymph nodes. The scope also features a needle for sampling. The EBUS TBNA scope allows physicians to visualize the lymph nodes and vessels as well as to see the needle puncture the lymph node in real time, providing an improved recovery and a potentially safer procedure for the patient. Our current yield exceeds 94 percent using this technique. We currently are using the EBUS TBNA scope for minimally invasive mediastinal staging as well as initial diagnosis. We are adding a second EBUS TBNA scope so that we may serve more patients.
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Outcomes 2007 18
New KnowledgeJournal Articles
Aboussouan LS, Lewis RA, Shy ME. Disorders of pulmonary function, sleep, and the upper airway in Charcot-Marie-Tooth disease. Lung. 2007 Jan;185(1):1-7.
Allen D, Stoller JK, Minai OA, A 45-year-old woman with systemic lupus erythematosus and progressive dyspnea. Chest. 2007 Apr;131(4):1252-1255.
Asosingh K, Swaidani S, Aronica M, Erzurum SC, Th1- and Th2-dependent endothelial progenitor cell recruitment and angiogenic switch in asthma. J Immunol. 2007 May 15;178(10):6482-6494.
Branson RD, Chatburn RL, Should adaptive pressure control modes be utilized for virtually all patients receiving mechanical ventilation? Respir Care. 2007 Apr;52(4):478-485.
Budev MM, Lung retransplantation: A new era for lung transplantation. Current Opinion in Organ Transplantation. 2007 Oct;12(5):464-468.
Calfee CS, Budev MM, Matthay MA, Church G, Brady S, Uchida T, Ishizaka A, Lara A, Ranes JL, deCamp MM, Arroliga AC. Plasma receptor for advanced glycation end-products predicts duration of ICU stay and mechanical ventilation in patients after lung transplantation. J Heart Lung Transplant. 2007 Jul;26(7):675-680.
Cannady SB, Batra PS, Leahy R, Citardi MJ, Janocha A, Ricci K, Comhair SAA, Bodine M, Wang Z, Hazen SL, Erzurum SC. Signal transduction and oxidative processes in sinonasal polyposis. J Allergy Clin Immunol. 2007 Dec;120(6):1346-1353.
Chatburn RL, High-frequency assisted airway clearance. Respir Care. 2007 Sep;52(9):1224-1237.
Chatburn RL, McPeck M. A new system for understanding nebulizer performance. Respir Care. 2007 Aug;52(8):1037-1050.
Chatburn RL, Deem S. Should weaning protocols be used with all patients who receive mechanical ventilation? Respir Care. 2007 May;52(5):609-621.
Chatburn RL, Benchmarking for success. Case study: one hospital’s benchmarking experience. AARC Times. 2007 Feb;31(2):32-34.
Chatburn RL. Classification of ventilator modes: update and proposal for implementation. Respir Care. 2007 Mar;52(3):301-323.
Chowdhry AA, Mazzone PJ, Mohammed TLH. A small pulmonary nodule, found incidentally. Cleve Clin J Med. 2007 Jul;74(7):531-533.
Cox L, Li JT, Nelson H, Lockey R, Bernstein D, Bernstein IL, Khan DA, Blessing-Moore J, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Spector SL, Tilles SA, Wallace DV. Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol. 2007 Sep;120(3 Suppl):S25-S85.
Criner GJ, Scharf SM, Falk JA, Gaughan JP, Sternberg AL, Patel NB, Fessler HE, Minai OA, Fishman AP. Effect of lung volume reduction surgery on resting pulmonary hemodynamics in severe emphysema. Am J Respir Crit Care Med. 2007 Aug 1;176(3):253-260.
Culver DA, Newman LS, Kavuru MS. Gene-environment interactions in sarcoidosis: challenge and opportunity. Clin Dermatol. 2007 May;25(3):267-275.
Demeo DL, Sandhaus RA, Barker AF, Brantly ML, Eden E, McElvaney NG, Rennard S, Burchard E, Stocks JM, Stoller JK, Strange C, Turino GM, Campbell EJ, Silverman EK. Determinants of airflow obstruction in severe alpha-1-antitrypsin deficiency. Thorax. 2007 Sep;62(9):806-813.
Diaz-Guzman E, Dweik RA. Diagnosis and management of pleural effusions: a practical approach. Compr Ther. 2007;33(4):237-246.
Dweik RA. The lung in the balance: arginine, methylated arginines, and nitric oxide. Am J Physiol Lung Cell Mol Physiol. 2007 Jan;292(1):L15-L17.
El-Gabaly M, Farver CF, Budev MA, Mohammed TLH. Pulmonary capillary hemangiomatosis imaging findings and literature update. J Comput Assist Tomogr. 2007 Jul;31(4):608-610.
Erzurum SC, Ghosh S, Janocha AJ, Xu W, Bauer S, Bryan NS, Tejero J, Hemann C, Hille R, Stuehr DJ, Feelisch M, Beall CM. Higher blood flow and circulating NO products offset high-altitude hypoxia among Tibetans. Proc Natl Acad Sci U S A. 2007 Nov 6;104(45):17593-17598.
Farha S, Asosingh K, Laskowski D, Licina L, Sekigushi H, Losordo DW, Dweik RA, Wiedemann HP, Erzurum SC. Pulmonary gas transfer related to markers of angiogenesis during the menstrual cycle. J Appl Physiol. 2007 Nov;103(5):1789-1795.
Fisher MR, Criner GJ, Fishman AP, Hassoun PM, Minai OA, Scharf SM, Fessler AHE. Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J. 2007 Nov;30(5):914-921.
Folch E, Shakoor H, Gomez J, Hogan K, Mason D, Murthy S, Pettersson G, Mehta A, Budev M. Gastric bezoar after lung transplantation in non-cystic fibrosis patients and review of the literature. J Heart Lung Transplant. 2007 Jul;26(7):739-741.
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Golish J, Ioachimescu OC. Ambulatory titration of continuous positive airway pressure was as effective as polysomnography for obstructive sleep apnoea. Evid Based Med. 2007 Oct;12(5):148.
Golish J, Ioachimescu OC. Ambulatory titration of continuous positive airway pressure was as effective as polysomnography for obstructive sleep apnea. ACP J Club. 2007 Sep;147(2):45.
Heresi GA, Minai OA. Lupus-associated pulmonary hypertension: Long-term response to vasoactive therapy. Respir Med. 2007 Oct;101(10):2099-2107.
Heresi GA, Dweik RA. Pulmonary hypertension: evaluation and management. Compr Ther. 2007;33(3):150-161.
Ioachimescu OC, Mehta AC, Stoller JK. Hepatopulmonary syndrome following portopulmonary hypertension. Eur Respir J. 2007 Jun;29(6):1277-1280.
Karnak D, Avery RK, Gildea TR, Sahoo D, Mehta AC. Endobronchial fungal disease: an under-recognized entity. Respiration. 2007;74(1):88-104.
Kaw R, Sharma P, Minai O. What risks does a history of pulmonary hypertension present for patients undergoing noncardiac surgery? Cleve Clin J Med. 2007 Sep;74 Electronic Suppl 1:S20-S21.
Kurapati S, Mehta AC, Jain P. Benzocaine-induced methemoglobinemia. Journal of Bronchology. 2007 Jan;14(1):41-44.
Lang DM. An overview of EPR3 asthma guidelines: what’s different? Allergy Asthma Proc. 2007 Nov;28(6):620-627.
Lang DM, Davis RS. The long-acting beta-agonist controversy: a clinical dilemma. Allergy Asthma Proc. 2007 Mar;28(2):136-144.
Mason DP, Marsh DH, Alster JM, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Atrial fibrillation after lung transplantation: timing, risk factors, and treatment. Ann Thorac Surg. 2007 Dec;84(6):1878-1884.
Mason DP, Solovera-Rozas M, Feng J, Rajeswaran J, Thuita L, Murthy SC, Budev MM, Mehta AC, Haug M III, McNeill AM, Pettersson GB, Blackstone EH. Dialysis after lung transplantation: prevalence, risk factors and outcome. J Heart Lung Transplant. 2007 Nov;26(11):1155-1162.
Mason DP, Brizzio ME, Alster JM, McNeill AM, Murthy SC, Budev MM, Mehta AC, Minai OA, Pettersson GB, Blackstone EH. Lung transplantation for idiopathic pulmonary fibrosis. Ann Thorac Surg. 2007 Oct;84(4):1121-1128.
Masri FA, Xu W, Comhair SAA, Asosingh K, Koo M, Vasanji A, Drazba J, Anand-Apte B, Erzurum SC. Hyperproliferative apoptosis-resistant endothelial cells in idiopathic pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol. 2007 Sep;293(3):L548-L554.
Maurer JR, Ryu J, Beck G, Moss J, Lee JC, Finlay G, Brown K, Chapman J. McMahan J, Olson E, Ruoss S, Sherer S. Lung transplantation in the management of patients with lymphangioleiomyomatosis: baseline data from the NHLBI LAM Registry. J Heart Lung Transplant. 2007 Dec;26(12):1293-1299.
Mayse ML, Laviolette M, Rubin AS, Lampron N, Simoff M, Duhamel D, Musani AI, Yung RC, Mehta AC. Clinical pearls for bronchial thermoplasty. Journal of Bronchology. 2007 Apr;14(2):115-123.
Mazzone PJ, Obuchowski N, Mekhail T, Meziane M, Ahmad M. Lung cancer screening: is it time for a change in policy? Cleve Clin J Med. 2007 Jun;74(6):441-448.
Mazzone PJ, Mekhail T, Lung cancer screening. Curr Oncol Rep. 2007 Jul;9(4):265-274.
Mazzone PJ, Hammel J, Dweik R, Na J, Czich C, Laskowski D, Mekhail T. Diagnosis of lung cancer by the analysis of exhaled breath with a colorimetric sensor array. Thorax. 2007 Jul;62(7):565-568.
Mermigkis C, Chapman J, Golish J, Mermigkis D, Budur K, Kopanakis A, Polychronopoulos V, Burgess R, Foldvary-Schaefer N. Sleep-related breathing disorders in patients with idiopathic pulmonary fibrosis. Lung. 2007 May;185(3):173-178.
Minai OA, Rigelsky C, Eng C, Arroliga AC, Stoller JK. Long-term outcome in a patient with pulmonary hypertension and hereditary hemorrhagic telangiectasia. Chest. 2007 Apr;131(4):984-987.
Minai OA, Golish JA, Yataco JC, Budev MM, Blazey H, Giannini C. Restless legs syndrome in lung transplant recipients. J Heart Lung Transplant. 2007 Jan;26(1):24-29.
Minai OA, Pandya CM, Golish JA, Avecillas JF, McCarthy K, Marlow S, Arroliga AC. Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension. Chest. 2007 Jan;131(1):109-117.
Minai OA, Budev MM, Diagnostic strategies for suspected pulmonary arterial hypertension: a primer for the internist. Cleve Clin J Med. 2007 Oct;74(10):737-747.
Minai OA, Budev MM, Treating pulmonary arterial hypertension: cautious hope in a deadly disease. Cleve Clin J Med. 2007 Nov;74(11):789-806.
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Mireles-Cabodevila E, Sahi H, Farver C, Mohammed TL, Culver DA. A young patient with a minimal smoking history presents with bullous emphysema and recurrent pneumothorax. Chest. 2007 Jul;132(1): 338-343.
Moore WC, Bleecker ER, Curran-Everett D, Erzurum SC, Ameredes BT, Bacharier L, Calhoun WJ, Castro M, Chung KF, Clark MP, Dweik RA, Fitzpatrick AM, Gaston B, Hew M, Hussain I, Jarjour NN, Israel E, Levy BD, Murphy JR, Peters SP, Teague WG, Meyers DA, Busse WW, Wenzel SE. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol. 2007 Feb;119(2):405-413.
Murthy S, Gonzalez-Stawinski GV, Rozas MS, Gildea TR, Dumot JA. Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis Esophagus. 2007;20(5):386-389.
Murthy SC, Blackstone EH, Gildea TR, Gonzalez-Stawinski GV, Feng J, Budev M, Mason DP, Pettersson GB, Mehta AC. Impact of anastomotic airway complications after lung transplantation. Ann Thorac Surg. 2007 Aug;84(2):401-409,409.e1-e4.
Nethery DE, Ghosh S, Erzurum SC, Kern JA. Inactivation of neuregulin-1 by nitration. Am J Physiol Lung Cell Mol Physiol. 2007 Jan;292(1):L287-L293.
Orens DK, Chatburn RL, Volsko TA, Stoller JK. An analysis of needs for respiratory therapists in northeast Ohio and development of strategies to meet increased recruitment demands. Respir Care. 2007 Dec;52(12):1767-1773.
Padia SA, Budev M, Farver CF, Mohammed TLH. Intravascular sarcoidosis presenting as pulmonary vein occlusion: CT and pathologic findings. J Thorac Imaging. 2007 Aug;22(3):268-270.
Pandya C, Brunken RC, Tchou P, Schoenhagen P, Culver DA. Detecting cardiac involvement in sarcoidosis: a call for prospective studies of newer imaging techniques. Eur Respir J. 2007 Feb;29(2): 418-422.
Parambil JG, Myers JL, Aubry MC, Ryu JH. Causes and prognosis of diffuse alveolar damage diagnosed on surgical lung biopsy. Chest. 2007 Jul;132(1):50-57.
Philipson EH, Lang DM, Gordon SJ, Burlingame JM, Emery SP, Arroliga ME. Management of group B Streptococcus in pregnant women with penicillin allergy. J Reprod Med. 2007 Jun;52(6):480-484.
Qian Y, Liu C, Hartupee J, Altuntas CZ, Gulen MF, Jane-Wit D, Xiao J, Lu Y, Giltiay N, Liu J, Kordula T, Zhang QW, Vallance B, Swaidani S, Aronica M, Tuohy VK, Hamilton T, Li X. The adaptor Act1 is required for interleukin 17-dependent signaling associated with autoimmune and inflammatory disease. Nat Immunol. 2007 Mar;8(3):247-256.
Raj JU, Aliferis C, Caprioli RM, Cowley AW Jr, Davies PF, Duncan MW, Erle DJ, Erzurum SC, Finn PW, Ischiropoulos H, Kaminski N, Kleeberger SR, Leikauf GD, Loyd JE, Martin TR, Matalon S, Moore JH, Quackenbush J, Sabo-Attwood T, Shapiro SD, Schnitzer JE, Schwartz DA, Schwiebert LM, Sheppard D, Ware LB, Weiss ST, Whitsett JA, Wurfel MM, Matthay MA. Genomics and proteomics of lung disease: conference summary. Am J Physiol Lung Cell Mol Physiol. 2007 Jul;293(1):L45-L51.
Reddy AJ, Govert JA, Sporn TA, Wahidi MM. Broncholith removal using cryotherapy during flexible bronchoscopy: a case report. Chest. 2007 Nov;132(5):1661-1663.
Reddy AJ, Zaas AK, Hanson KE, Palmer SM. A single-center experience with ganciclovir-resistant cytomegalovirus in lung transplant recipients: treatment and outcome. J Heart Lung Transplant. 2007 Dec;26(12):1286-1292.
Rivera MP, Mehta AC. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):131S-148S.
Sahi H, Avery RK, Minai OA, Hall G, Mehta AC, Raina P, Budev M. Scedosporium apiospermum (Pseudoallescheria boydii) infection in lung transplant recipients. J Heart Lung Transplant. 2007 Apr;26(4): 350-356.
Sahi H, Zein NN, Mehta AC, Blazey HC, Meyer KH, Budev M. Outcomes after lung transplantation in patients with chronic hepatitis C virus infection. J Heart Lung Transplant. 2007 May;26(5):466-471.
Shah SS, Karnak D, Budev M, Avery RK, Mehta AC. Endobronchial Pseudallescheria boydii in lung transplant patient with cystic fibrosis. Journal of Bronchology. 2007 Jan;14(1):48-50.
Shah SS, Karnak D, Shah SN, Budev M, Machuzak M, Gildea TR, Mehta AC. Broncholith caused by donor-acquired histoplasmosis in a lung transplant recipient. J Heart Lung Transplant. 2007 Apr;26(4): 407-410.
Solares CA, Citardi MJ, Budev M, Batra PS. Management of frontal sinus mucoceles with posterior table erosion in the pretransplant cystic fibrosis population. Am J Otolaryngol. 2007 Mar;28(2):110-114.
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Stephany BR, Alao B, Budev M, Boumitri M, Poggio ED. Hyperlipidemia is associated with accelerated chronic kidney disease progression after lung transplantation. Am J Transplant. 2007 Nov;7(11):2553-2560.
Stoller JK, McCarthy K. Benefits of a modified spirometry technique. Eur Respir J. 2007 Oct;30(4):813-814.
Stoller JK, Gildea TR, Ries AL, Meli YM, Karafa MT. Lung volume reduction surgery in patients with emphysema and alpha-1 antitrypsin deficiency. Ann Thorac Surg. 2007 Jan;83(1):241-251.
Stoller JK, Berkowitz E, Bailin PL. Physician management and leadership education at the Cleveland Clinic Foundation: program impact and experience over 14 years. J Med Pract Manage. 2007 Jan;22(4):237-242.
Stoller JK, Hoisington ER, Lemin ME, Karol JA, Chatburn RL, Mascha EJ, Kester L. Concordance of respiratory care plans generated by protocols from different hospitals: a comparative study. Respir Care. 2007 Aug;52(8):1006-1012.
Stoller JK, Fromer L, Brantly M, Stocks J, Strange C. Primary care diagnosis of alpha-1 antitrypsin deficiency: issues and opportunities. Cleve Clin J Med. 2007 Dec;74(12):869-874.
Stoller JK, Blackstone E, Pettersson G, Mihaljevic T. Coronary artery bypass graft and/or valvular operations following prior pneumonectomy: Report of four new patients and review of the literature. Chest. 2007 Jul;132(1):295-301.
Swaisgood CM, Aronica MA, Swaidani S, Plow EF. Plasminogen is an important regulator in the pathogenesis of a murine model of asthma. Am J Respir Crit Care Med. 2007 Aug 15;176(4):333-342.
Vadi S, Lapinsky S. Case study. HFOV and iNO in the treatment of Wegener’s granulomatosis. RT. 2007 Feb;20(2):38-39.
Wenzel SE, Balzar S, Ampleford E, Hawkins GA, Busse WW, Calhoun WJ, Castro M, Chung KF, Erzurum S, Gaston B, Israel E, Teague WG, Curran-Everett D, Meyers DA, Bleecker ER. IL4R alpha mutations are associated with asthma exacerbations and mast cell/IgE expression. Am J Respir Crit Care Med. 2007 Mar 15;175(6):570-576.
Wood DE, McKenna RJ Jr, Yusen RD, Sterman DH, Ost DE, Springmeyer SC, Gonzalez HX, Mulligan MS, Gildea T, Houck WV, Machuzak M, Mehta AC. A multicenter trial of an intrabronchial valve for treatment of severe emphysema. J Thorac Cardiovasc Surg. 2007 Jan;133(1):65-73.
Xu W, Koeck T, Lara AR, Neumann D, DiFilippo FP, Koo M, Janocha AJ, Masri FA, Arroliga AC, Jennings C, Dweik RA, Tuder RM, Stuehr DJ, Erzurum SC. Alterations of cellular bioenergetics in pulmonary artery endothelial cells. Proc Natl Acad Sci U S A. 2007 Jan 23;104(4): 1342-1347.
Yared JP, Bakri MH, Erzurum SC, Moravec CS, Laskowski DM, Van Wagoner DR, Mascha E, Thornton J. Effect of dexamethasone on atrial fibrillation after cardiac surgery: prospective, randomized, double-blind, placebo-controlled trial. J Cardiothorac Vasc Anesth. 2007 Feb;21(1):68-75.
Zuluaga Toro T, Hsieh FH, Bodo J, Dong HY, Hsi ED. Detection of phospho-STAT5 in mast cells: a reliable phenotypic marker of systemic mast cell disease that reflects constitutive tyrosine kinase activation. Br J Haematol. 2007 Oct;139(1):31-40.
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Staff ListingChairmanHerbert P. Wiedemann, MD, MBA
Quality Review OfficerJeffrey T. Chapman, MD
Department of Pulmonary and Critical Care Medicine
Loutfi S. Aboussouan, MD
Muzaffar Ahmad, MD
Marie M. Budev, DO, MPH, Associate Medical Director, Lung Transplantation
Robert Castele, MD
Jeffrey T. Chapman, MD, Director, Interstitial Lung Disease Program
Daniel A. Culver, DO, Director, Sarcoidosis Program
Raed A. Dweik, MD, Director, Pulmonary Vascular Disease Program
Serpil C. Erzurum, MD, Chair, Department of Pathobiology
Samar Farha, MD
Andrew Garrow, MD
Thomas R. Gildea, MD, Co-Director, Center for Major Airway Disease
Jorge Guzman, MD, Director, Medical Intensive Care Unit
David A. Holden, MD
Constance A. Jennings, MD
Michael S. Machuzak, MD
Peter J. Mazzone, MD, MPH, Director, Lung Cancer Program
Atul C. Mehta, MD, Head, Section of Bronchology; Medical Director, Lung Transplantation
Omar A. Minai, MD
Beverly V. O’Neill, MD
Thomas G. Olbrych, MD
Joseph G. Parambil, MD
Anita J. Reddy, MD
Hina Sahi, MD
Madhu Sasidhar, MD
James K. Stoller, MD, MS, Head, Section of Respiratory Therapy
Carmen Swaisgood, PhD
Allergy and Clinical ImmunologyDavid M. Lang, MD, Head, Section of Allergy and Clinical Immunology
Mark A. Aronica, MD
Sandra J. Hong, MD
Fred H. Hsieh, MD
Rachel A. Koelsch, MD
Lily C. Pien, MD
Cristine Radojicic, MD
Some physicians may practice in multiple locations. For a detailed list including staff photos, please visit clevelandclinic.org/staff.
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Contact InformationGeneral Patient Referral
24/7 hospital transfers or physician consults
800.553.5056
Pulmonary Appointments/Referrals
216.444.6503 or 800.223.2273, ext. 46503
Allergy Appointments/Referrals
216.444.3386 or 800.223.2273, ext. 43386
On the Web at clevelandclinic.org/pulmonary
Additional Contact InformationGeneral Information
216.444.2200
Hospital Patient Information
216.444.2000
Patient Appointments
216.444.2273 or 800.223.2273
Special Assistance for Out-of-State Patients
Complimentary assistance for out-of-state patients and families
800.223.2273, ext. 55580, or email [email protected]
International Center
Complimentary assistance for international patients and families
800.884.9551 or 001.631.439.1578 or visit clevelandclinic.org/ic
Cleveland Clinic in Florida
866.293.7866
For address corrections or changes, please call 800.890.2467
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Institute LocationsMain Campus
9500 Euclid Avenue Cleveland, OH 44195
Beachwood Family Health and Surgery Center
26900 Cedar Road Beachwood, OH 44122 Pulmonary and Allergy: 216.839.3800
Brunswick Family Health Center
3724 Center Road, Suite 100 Brunswick, OH 44212 Pulmonary: 330.225.8886
Euclid Hospital
Medical Office Building 99 Northline Circle, Suite 235 Euclid, OH 44119 Pulmonary: 216.692.7848
Hillcrest Hospital
Hillcrest Atrium Medical Office Building 6780 Mayfield Road, Suite 323 Mayfield Heights, OH 44124 Pulmonary: 440.312.7140
Independence Family Health Center
5001 Rockside Road Crown Center II Independence, OH 44131 Pulmonary and Allergy: 216.986.4000
Strongsville Family Health and Surgery Center
16761 SouthPark Center Strongsville, OH 44136 Pulmonary and Allergy: 440.878.2500
Westlake Family Health Center
30033 Clemens Road Westlake, OH 44145 Allergy: 440.899.5555
Willoughby Hills Family Health Center
2570 SOM Center Road Willoughby Hills, OH 44094 Allergy: 440.943.2500
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Cleveland Clinic Overview Online Services
Cleveland Clinic, founded in 1921, is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Today, 1,800 Cleveland Clinic physicians and scientists practice in 120 medical specialties and subspecialties, annually recording more than 3 million patient visits and more than 70,000 surgeries.
In 2007, Cleveland Clinic restructured its practice, bundling all clinical specialties into integrated practice units called institutes. An institute combines all the specialties surrounding a specific organ or disease system under a single roof. Each institute has a single leader and focuses the energies of multiple professionals onto the patient. From access and communication to point-of-care service, institutes will improve the patient experience at Cleveland Clinic.
Cleveland Clinic’s main campus, with 37 buildings on 140 acres in Cleveland, Ohio, includes a 1,000-bed hospital, outpatient clinic, specialty institutes and supporting labs and facilities. Cleveland Clinic also operates 14 family health centers; eight community hospitals; two affiliate hospitals; a 150-bed hospital and clinic in Weston, Fla.; and health and wellness centers in Palm Beach, Fla., and Toronto, Canada. Cleveland Clinic Abu Dhabi (United Arab Emirates), a multispecialty care hospital and clinic, is scheduled to open in 2011.
At the Cleveland Clinic Lerner Research Institute, hundreds of principal investigators, project scientists, research associates and postdoctoral fellows are involved in laboratory-based research. Total annual research expenditures exceed $150 million from federal agencies, non-federal societies and associations, and endowment funds. In an effort to bring research from bench to bedside, Cleveland Clinic physicians are involved in more than 2,400 clinical studies at any given time.
In September 2004, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University opened and will graduate its first 32 students as physician-scientists in 2009.
Cleveland Clinic is consistently ranked among the top hospitals in America by U.S.News & World Report, and our heart and heart surgery program has been ranked No. 1 since 1995.
For more information about Cleveland Clinic, visit clevelandclinic.org.
eCleveland CliniceCleveland Clinic uses state-of-the-art digital information systems to offer several services, including remote second medical opinions to patients around the world; personalized medical record access for patients; patient treatment progress for referring physicians (see below); and imaging interpretations by our subspecialty trained radiologists. For more information, please visit eclevelandclinic.org.
DrConnectOnline Access to Your Patient’s Treatment Progress
Whether you are referring from near or far, DrConnect can streamline communication from Cleveland Clinic physicians to your office. This online tool offers you secure access to your patient’s treatment progress at Cleveland Clinic. With one-click convenience, you can track your patient’s care using the secure DrConnect website. To establish a DrConnect account, visit eclevelandclinic.org or email [email protected].
MyConsultMyConsult Remote Second Medical Opinion is a secure online service providing specialist consultations and remote second opinions for more than 600 life-threatening and life-altering diagnoses. The MyConsult service is particularly valuable for people who wish to avoid the time and expense of travel. For more information, visit eclevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext 43223.
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9500 Euclid Avenue, Cleveland, OH, 44195
© The Cleveland Clinic Foundation 2008
Cleveland Clinic is a nonprofit multispecialty academic medical center. Founded in 1921, it is dedicated to providing quality specialized care and includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education institute and a research institute.
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