Hartford Healthcare Tallwood Urology and Kidney Institute Outcomes Report 2016 Hartford Healthcare Tallwood Urology and Kidney Institute 2016 Outcomes Report

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Hartford HealthCare Tallwood Urology and Kidney Institute Outcomes Report 2016 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

TABLE OF CONTENTS

3 | Welcome Elliot Joseph, Chief Executive Officer — 3 4 | Leadership Steven J. Shichman, MD, Physician In Chief, Tallwood Urology and Kidney Institute — 4 Jan Ruderman, Vice President, Tallwood Urology and Kidney Institute — 5 6 | The Tallwood Urology and Kidney Institute About Us — 6 Statistical Highlights — 7 Patient Experience — 8 9 | Outcomes Report Kidney Cancer — 9 Nephrectomy — 10 Robotics — 11 Prostate Cancer — 12 Benign Prostatic Hyperplasia — 13 Bladder Cancer — 14 Chronic Kidney Disease — 15 16 | Success Stories Neville Brooks, Prostate Cancer — 16 Robert Burbank, Men’s Health — 20 Steven Chilleri, Adrenal Cancer — 17 Brian Macfarlane, Men’s Health — 21 Paula McNeill, Pelvic Cancer — 18 Sarah Lyman, Kidney Stones — 22 Margaret Schenk, Pelvic Cancer — 19 Community Involvement — 23 24 | About Hartford HealthCare 25 | Recent Publications and Research 30 | Our Institute Model Jeffrey A. Flaks, President, Chief Operating Officer — 30 31 | Metrics for Patients Rocco Orlando, MD, Executive Vice President, Chief Medical Officer — 31

2 Hartford HealthCare Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

WELCOME

Elliot Joseph | Chief Executive Officer

“Most trusted for personalized coordinated care.” — The Hartford HealthCare vision

At Hartford HealthCare, our vision is our compass – guiding us as we work to transform healthcare and provide our patients and families with superb, seamless care. In earning the trust of our communities, we promise to never stop improving and inno- vating as we shape a new, high-value model of customer-centered care.

Excellence without evidence is empty. Still, hospitals and health systems have had a hard time reporting quality and outcomes in useful ways. As clinical data moves increasingly to digital platforms and we see more demand for the information from payers and the public, Hartford HealthCare is leading the way to demonstrate our commitment to clinical excellence and full transparency.

Reflected in this report is the work of our multidisciplinary teams of physician leaders, other clinicians, support staff and partners, who are collaborating to set and meet high-quality standards. In our quest for excellence, we have adopted best practices from industries far outside of healthcare. These include High Reliability Training and Lean practices and principles that are part of our H3W (How Hartford HealthCare Works) operating model.

Our success is evident in our improving safety metrics, especially in the area of hand hygiene, where we are among the best in the nation.

We at Hartford HealthCare are benchmarking ourselves against the best healthcare organizations in America to reassure those we serve that they will receive world-class care no matter what hospital, outpatient location or home service they utilize at Hart- ford HealthCare.

Sincerely,

Elliot Joseph Chief Executive Officer

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LEADERSHIP

Steven J. Shichman, MD | Physician In Chief, Hartford HealthCare Tallwood Urology and Kidney Institute

A board-certified urologist, Dr. Shichman specializes in robotic surgery, renal cancer and adrenal disorders. Following his education and work experience as a chemical engineer, Dr. Shichman earned his medical degree from the University of Connecticut School of Medicine in 1986. He completed his General Surgery and Urology training at the University of Connecticut as well. He also completed a fellowship in Laparoscopy and Minimally Invasive Surgery at New York Hospital and Cornell Medical Center. Dr. Shichman serves as an associate clinical professor at the UConn School of Medicine.

Dr. Shichman is a pioneer in urologic minimally invasive surgery and is recognized nationally and internationally as a leader in the field. He is among the country’s most experienced surgeons in laparoscopic adrenalectomy, laparoscopic and hand-assisted laparoscopic nephrectomy and robotic partial nephrectomy. As a course director for the American Urological Association postgraduate courses from 1999 to 2013 he has taught laparoscopic techniques to over 1,200 urologists from around the world. Dr. Shichman has been recognized as one of Connecticut’s top doctors in urology by Con- necticut Magazine and Hartford Magazine. Over the past twenty years, Dr. Shichman has helped develop the Hartford Hospital’s Department of Urology’s nationally and internationally recognized reputation for innovation in laparoscopic and robotic surgery. His department has hosted numerous post-graduate courses in minimally invasive surgery, including national symposiums on robotic urologic surgery.

Dr. Shichman is also the Executive Director of Hartford Hospital’s Center for Educa- tion, Simulation and Innovation – “CESI”. CESI is one of the country’s largest and most comprehensive medical simulation training centers.

Dr. Shichman has been affiliated with Hartford Hospital (and subsequently Hartford HealthCare) since 1993. He sees patients at Hartford Hospital as well as Hartford HealthCare Medical Group (HHC MG) offices in Hartford and Avon.

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LEADERSHIP

Jan Ruderman | Vice President, Hartford HealthCare Tallwood Urology and Kidney Institute

In her role as vice president of Hartford HealthCare’s Tallwood Urology and Kidney In- stitute, Ms. Ruderman partners with physician leaders to identify and address opportunities to improve the quality of care provided to Tallwood patients. She does this by co-leading disease management teams, which focus on the delivery of evidence-based medicine, patient education, community education and process improvement.

She has been with Hartford HealthCare for 18 years, in a variety of leadership roles in operations and quality/process improvement. They include director of rehabilitation for HHC at Home, vice president of quality for the Rehabilitation Network and business architect for the design of the Institute Model that has been deployed throughout the system.

Jan has a master’s degree in business administration, with a focus on healthcare, and a bachelor’s degree from Tufts University. She is also trained in Lean management.

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THE TALLWOOD UROLOGY AND KIDNEY INSTITUTE

An approach unlike any other in Connecticut

The Hartford HealthCare Tallwood Urology and Kidney Institute has fellowship-trained physicians who cover six specialty areas including general urology, men’s health (fertility/andrology, men’s sexual function), pelvic health and incontinence, kidney stones and urologic cancer along with a wide range of conditions and treatments. Tallwood nephrologists specialize in management of kidney disease and can be the link in coordination of care for kidney transplant patients.

Tallwood’s urologists and urogynecologists are recognized as regional and national leaders in their fields. Many have pioneered treatments that have become the gold standard of care nationwide.

All of this comes within the framework of an innovative, coordinated disease management team model that ensures the highest-quality, safest and most cohesive care.

Our innovative Institute approach is unlike any other in the state and is among the most highly regarded in the nation. Through our Institute, which is organized around specific diseases and not necessarily locations, we can apply best practices throughout our system so that patients receive the same high standards of care no matter where they live or which Hartford HealthCare facility they choose.

We rank in the top 10 percent nationally for lowest complication rates for benign prostatic hyperplasia (BPH), chronic kidney disease, prostate cancer, kidney cancer, bladder cancer and robotic surgery. Specifically, we are a destination for the most complex urologic surgery cases in Connecticut.

Tallwood’s urology oncology team is also part of the Hartford HealthCare Cancer Institute, the charter member of the Memorial Sloan Kettering Cancer Alliance. This gives urologic cancer patients access to state-of-the-art clinical trials closer to home. We are the leaders in treating urologic cancers in Connecticut.

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STATISTICAL HIGHLIGHTS

Volume statistics

Being a leader in urologic health means patients seek us out for their care.

The Hartford HealthCare Tallwood Urology and Kidney Institute treated more than 24,000 patients in the acute care setting in FY16 and is the state’s market leader for treatment of kidney stones, urologic cancer (prostate, bladder, kidney and adrenal cancers), and pelvic health. 1,633 3,186 4,277 patients with a patients with patients with urologic cancer kidney stones a pelvic health diagnosis 13,270 47,354 general urology hemodialysis patients treatments

The Hartford HealthCare Tallwood Urology and Kidney Institute is the market leader in Connecticut for:

n Kidney Stones n Urologic Cancer (Prostate, Bladder, Kidney and Adrenal Cancers) n Pelvic Health

Our physicians’ experience in complex and routine procedures means better outcomes for patients. Research shows that increased patient volume correlates to lower complication and operative mortality rates.

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PATIENT EXPERIENCE

Effective communication puts patients at ease

Communications survey of patients The Hartford HealthCare under the care of a Tallwood physician Tallwood Urology and Kid- ney Institute is dedicated to providing patients with ex- 100 ceptional, coordinated care and a single, high standard 95 91.1 of service. 90 87.3 As a recognized clinical 85 84.1 84.1 leader with demonstrated 80 respect for our patients, the 80 77.1 Tallwood team is committed to effective communica- 75 tion with patients and their families because we know 70 patients who are actively engaged in their care have 65 better outcomes. 60 55 50 Doctors who Doctors Doctors treat listen carefully explain in a patients with to you way patients courtesy and understand respect

HHC Tallwood National average

Source: Press Ganey

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OUTCOMES REPORT

Kidney Cancer Complications — Inpatient (observed rate)

Because of our expertise, we Kidney Cancer Complications see the highest volume of (lower is better) cases statewide for a number of conditions, including 25.29 kidney cancer. 26

The Hartford HealthCare 24 Tallwood Urology and 22 19.21 Kidney Institute, in con- 20 junction with the Hartford 18.41 HealthCare Cancer Institute, 18 16.17 15.95 is a tertiary referral center 16 for Connecticut and New England. Our team of fellow- 14 11.76 shiptrained urologists, 12 nephrologists and oncolo- gists care for the most com- 10 plex kidney cancer cases. 8

Our multidisciplinary 6 team meets regularly for 4 discussions on evidence- 2 based medicine. In addition, the team holds case con- 0 ferences for decisions on FY 2014 FY 2015 FY 2016 patient-specific treatments and planning with experts from across the system and HHC from Memorial Sloan Ket- tering. Peer (Top decile) Source: Premier

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OUTCOMES REPORT

Nephrectomy Complications — Inpatient (observed rate)

For patients faced with kidney cancer or diseases of the kidney, the removal of Nephrectomy Complications a kidney and loss of kidney (lower is better) function can have serious 25.25 impacts on their quality 26 of life for years to come. 24 Management of the primary 22 disease and preserving the 19.91 maximum amount of the 20 19.0 patient’s kidney function 18 17.17 whenever possible is our goal. 16 14.6 14.02 14 At the Hartford HealthCare Tallwood Urology and Kid- 12 ney Institute, our surgeons 10 are among the world’s most experienced in performing 8 nephron-sparing surgery 6 (NSS) including robotic 4 partial nephrectomies. Our surgical teams routinely 2 remove even the more 0 complex and larger tumors using minimally invasive FY 2014 FY 2015 FY 2016 approaches such as robotic surgery, which offers reduced morbidity, shorter HHC hospital stays and more rapid return to baseline Peer activities. (Top decile) function dramatically im- NSS allows preservation of proves the patient’s overall Source: Premier the affected kidney without health and well-being, and compromising cancer cure reduces the incidence of rates. Preserving kidney chronic kidney disease.

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OUTCOMES REPORT

Robotics Complications — Inpatient (observed rate)

The Hartford HealthCare Tallwood Urology and Kid- ney Institute is a national leader in robotic urologic Robotics Complications surgery. The urologic robotic (lower is better) surgery program, led by Dr. Joseph Wagner, includes 16 14.97 10 robots across Hartford HealthCare. 14 This technology, coupled with the expertise and 12 experience of the Institute’s urologists and urogyno- 10 9.48 cologists, has resulted in 8.55 complication rates that are 7.87 8 consistently well below the national average. Tallwood’s 5.59 progressive department 6 4.88 is one of the most experienced in the world and rou- 4 tinely uses robotic surgery to treat prostate, kidney and 2 bladder cancer patients.

Robotic surgical systems 0 have a 3D high-definition FY 2014 FY 2015 FY 2016 vision system (which provides a highly magni- fied, close-up view), special instruments and computer procedures that would be that patients undergoing software which provide extremely difficult to per- robotic surgery may have HHC the surgeon with enhanced form with standard laparo- less bleeding, fewer blood vision, precision, dexterity scopic techniques. transfusions, less need for Peer and control. These features narcotic pain medication, (Top decile) allow surgeons to perform Compared to open surgery, less scarring and faster precise, minimally invasive many studies have shown recovery times. Source: Premier hartfordhealthcare.org/services/urology-kidney 11 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

OUTCOMES REPORT

Prostate Cancer Complications — Inpatient (observed rate)

In prostate cancer care, the Prostate Cancer Complications ability to make decisions (lower is better) about care is enhanced with state-of-the-art equip- 10 ment. MRI and ultrasound 9.29 fusion equipment can more 9 accurately take biopsies of suspected prostate cancer 8 and identify disease progression. 7 6.27 5.7 According to the National 6 Institutes of Health, there 5 are approximately one 4.55 2.01 million prostate biopsies 4 done in the United States every year, with 240,000 3 men being told they have 2.27 prostate cancer. Because 2 current traditional biopsy techniques don’t involve 1 full “sight,” (meaning there is some uncertainty as to 0 exactly what tissue is being FY 2014 FY 2015 FY 2016 extracted), 23 percent of men with a negative biopsy actually have cancer. This new imaging equipment en- monitored but not yet ing active surveillance, HHC ables physicians to make a under treatment — this radiation and surgery. When precise diagnosis. It merges equipment will help doctors compared to leading institu- Peer ultrasound with MRI to cre- make confident treatment tions Hartford HealthCare (Top decile) ate a 3-D image, so they can decisions. has considerably lower see the entire biopsy area. complication rates for pa- Source: Premier For patients under ac- There are many treatment tients with prostate cancer tive surveillance — where options available for men who undergo surgical treat- prostate cancer is being with prostate cancer includ- ment.

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OUTCOMES REPORT

Men’s Health / Benign Prostatic Hyperplasia Complications — Inpatient (observed rate)

Benign prostatic hyperplasia, Benign Prostatic Hyperplasia Complications or BPH, is a common condi- (lower is better) tion addressed by our Men’s HHC Health team at the Hartford 12 Peer (Top decile) 10.95 HealthCare Tallwood Urol- 11 ogy and Kidney Institute. By Source: Premier 9.86 age 60, about 25% of men 10 have troublesome void- 9.0 8.89 9 8.33 ing symptoms and these percentages only increase 8 with age. Patients who do not see enough benefit from 7 medication may consider a 6 spectrum of bladder out- let procedures including 5 transurethral resection of 4 the prostate (TURP), laser ablation (either Greenlight 3 2.7 or holmium laser), UroLift, 2 open or robotic simple prostatectomy, or prostate artery 1 embolization. While TURP is classically considered the 0 gold standard, Tallwood urol- FY 2014 FY 2015 FY 2016 ogists are available to offer these advanced techniques expand our advanced treat- Kidney Institute additional- can ensure that screening is to best fit each man’s unique ment of erectile dysfunc- ly has recognized the need up to date and make quick anatomy, symptoms, and tion and Peyronie’s disease for collaborative multi-dis- referrals to other members desires. as well as provide unique ciplinary men’s health ser- of the men’s health team. male infertility procedures vices in the Hartford area. This model is gaining Jared Bieniek, a urologist such as vasectomy reversal, We have partnered with popularity nationwide for with fellowship training in microsurgical varicocele other Hartford HealthCare its acceptance by patients andrology, recently joined repair, sperm aspiration or services to better under- and improvement in overall the team, providing further extraction, or stimulated stand specific disease pro- care; Hartford area men expertise and enhancing ejaculation for men with cesses of men and provide deserve the same level of male fertility and male sex- spinal cord injuries. timely and comfortable care and the Tallwood Urol- ual function services. With care. Through the use of a ogy and Kidney Institute is his help, we continue to The Tallwood Urology and men’s health checklist, we doing just that. hartfordhealthcare.org/services/urology-kidney 13 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

OUTCOMES REPORT

Bladder Cancer Complications — Inpatient (observed rate)

The great work that has Bladder Cancer Complications been accomplished to lower (lower is better) complication rates across 29.82 Hartford HealthCare is il- 30 lustrated by the Hartford 28 25.74 HealthCare Tallwood Urol- ogy and Kidney Institute 26 bladder cancer team as 24 22.51 21.78 complications from blad- 22 21.46 19.7 der cancer surgery have 20 decreased consistently over the past two and half years. 18 16 In the framework of the 14 Hartford HealthCare Cancer 12 Institute’s disease management model, the disease 10 team has worked to cre- 8 ate an effective strategy 6 to reduce complications 4 for patients who undergo a 2 cystectomy. 0 These high-risk patients FY 2014 FY 2015 FY 2016 are vulnerable to infection, failure to thrive, blood clots and gastrointestinal complications. HHC Peer (Top decile)

Source: Premier

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OUTCOMES REPORT

Chronic Kidney Disease Complications — Inpatient (observed rate)

One in 10 adults in the Unit- Chronic Kidney Disease Complications ed States have some stage (lower is better) of chronic kidney disease (CKD.) The incidence of CKD 10 more than doubled in those 9.0 older than 65 from 2000 to 9 2008 and the prevalence rate 7.94 for end-stage renal disease 8 increased nearly 600 percent 7 between 1980 and 2009. 6 Early detection of kidney disease is important in 5 4.69 kidney preservation and in 4.08 quality of life. Our Chronic 4 3.93 3.56 Kidney Disease Manage- ment team includes ne- 3 phrologists, interventional nephrologists vascular/ 2 access surgeons, emergency 1 room physicians, care coordinators and dialysis nurses. 0 The team has been focused on improving the handoffs FY 2014 FY 2015 FY 2016 between acute care hospital and community dialysis centers in order to address complications and re-ad- HHC missions. Peer Hartford Hospital was recog- (Top decile) nized in U.S. News and World Source: Premier Report as high peforming for nephrology services.

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SUCCESS STORIES PROSTATE CANCER

Neville Brooks | Healthy habits fuel an active lifestyle

Being vigilant about his risks for developing prostate cancer and staying in great shape helped save Neville Brooks’ life.

The 56-year-old retired Hartford deputy police chief wasn’t surprised when he was diagnosed in 2009. His father and several uncles died from the disease. He said he’d forgotten to follow through with his yearly screening and was reminded after hearing on the news that actor Dennis Hopper had died from prostate cancer.

“I had the paperwork but had been very busy. When I saw the story on TV, I made the appointment,” Brooks said.

Once diagnosed, Brooks decided to have surgery to remove his prostate.

“Everyone diagnosed with pros- Neville Brooks gets ready for his next yoga class at the Sweat Yoga studio in Hartford. The 56-year-old retired Hartford deputy police chief was diag- tate cancer has treatment options nosed in 2009, but is now cancer free and continues a rigorous physical whether it’s active surveillance, fitness regimen. radiation, androgen deprivation therapy, or surgery. For a young guy Now cancer free, Brooks continues til my procedure. It definitely helped like Neville, surgery was the right a rigorous physical fitness regimen me recover. I’m in the best shape choice,” said his surgeon, Tallwood including immersing himself in yoga I’ve been since college” Brooks said. Urology and Kidney Institute physi- and consulting with a dietitian to “Cancer hasn’t impacted my lifestyle. cian Joseph Wagner, MD, who also help him maximize his workouts. I want to tell my story and help guys serves as Director of Robotic Surgery like me. No one needs to die of pros- at Hartford Hospital. “I made sure to work out right up un- tate cancer.”

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SUCCESS STORIES ADRENAL CANCER

Stephen Chilleri | ‘Incredible coordination’ yields positive result

Stephen Chilleri was just hoping to switch medications to help his battle against ulcerative colitis when his doctor noticed something wasn’t right.

“I had a boil that had to be removed because I couldn’t make the switch to Humira with an active infection,” Chilleri said. “On the morning of the procedure I had a high fever that I couldn’t shake. My surgeon (Windham Hospital’s general surgeon Francis Siracusa) said, ‘you’ve got something else going on here,’ and sent me for a CT scan.”

The diagnosis was adrenal cancer, a 13-centimeter tumor in the gland A blood clot that formed as a result of a cancerous adrenal tumor made above his kidney. The tumor was so urology patient Stephen Chilleri’s procedure a multi-step process. large that it was compressing the gland. The surgery was a success. inferior vena cava (the largest vein in Dr. Kesler said detailed discussions the body). Blood flow was restricted took place between the vascular, “Everything worked out without a because of the compression and a cardiothoracic, and transplant surgery hitch due to the incredible coordina- blot clot formed as a result. teams to develop a safe and effective tion of care between multiple special- strategy for the patient. Together the ties,” said Dr. Kesler. “A very large adrenal mass is usually teams decided that, shortly before hard enough to deal with, but in this Chilleri’s adrenalectomy, the vascular Chilleri didn’t require further treat- case Mr. Chilleri also had a very large surgery team would perform an en- ment for cancer and is now cancer blood clot. Because of this, I was very doscopic surgery to literally “suck out” free. worried that during surgery when the clot with “a thin vacuum cleaner.” the adrenal mass was removed, the “My care from Dr. Kesler and his blood clot would get dislodged and Now that the clot had been safely re- practice was phenomenal,” Chilleri the patient could end up with a life- moved, Dr. Kesler, with the assistance said. “I was really impressed with how threatening condition known as a of Patricia Sheiner, Chief of Transplant coordinated all of the specialty [care] pulmonary embolus,” said Tallwood Surgery at Hartford Hospital, was able groups were. As a patient with many Urology and Kidney Institute physi- to perform the adrenalectomy to re- different things going on, I really got cian Stuart Kesler, MD. move the patient’s cancerous adrenal to see that up close.” hartfordhealthcare.org/services/urology-kidney 17 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

SUCCESS STORIES PELVIC HEALTH

Paula McNeill | On the move with no time to slow down

Despite a 2009 snowmobile acci- dent that left her a paraplegic, Paula McNeill is as committed as ever to her pursuits as an athlete and to staying active. She swims, cycles up to 90 miles a week, and rides in a 50-mile charity event each September. McNeill wasn’t going to let urinary incontinence slow her down.

But, leakage was ruining her rides and dehydration from medication wasn’t allowing her to maximize her workouts.

“It was a vicious cycle,” McNeill said. “I couldn’t even eat peanut butter without choking it was so bad.”

McNeill originally underwent Botox treatments for her incontinence. The neurotoxic protein, used most com- Paula McNeill is a committed paraplegic athlete, but urinary incontinence monly for facial rejuvenation, has wasn’t allowing her to maximize her workouts. But after undergoing blad- proven to be effective in easing the der augmentation surgery, she is able to train and stay active for longer symptoms of overactive bladders for periods of time. people with neurological conditions. sometimes quadrupling the capacity Eventually, the Botox stopped work- “Incontinence was making it dif- of the organ. ing and Richard Kershen, the urolo- ficult for her to enjoy her life,” said gist she had trusted for years, had Dr. Kershen. “For patients whose McNeill is happy she made the joined the Tallwood Urology and kidney functions aren’t at risk [as in choice. Kidney Institute at Hartford Hospital. McNeill’s case], this procedure is a A Vermont resident, McNeill trav- good option.” “It’s helped ten-fold. It’s back to eled to Connecticut and together she normal where I don’t have to worry and Kershen decided that bladder The procedure entails expanding the about leaking and always having an augmentation surgery was the best bladder by attaching a piece of the extra change of clothes with me,” she option to keep McNeill active. patient’s small intestine tripling and said.

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SUCCESS STORIES PELVIC HEALTH

Margaret Schenk | Choice of procedures puts mind at ease

Margaret Schenk is so grateful she had choices when it came to her care.

Schenk, a retired executive assistant to a college president, began having intense discomfort when bending over. When the pain became more frequent, Schenk went to see her primary care provider and then her gynecolo- gist who referred her to Hartford HealthCare Tallwood Urology and Kidney Institute Urogynecologist Christine LaSala, MD. The diagnosis was cystocele, a condition that occurs when the supportive tissue in the vagina weakens causing the bladder to drop into the vagina.

“The pain was terrible. It felt like something was tear- ing or breaking. It became more frequent, whether I was working in the garden or reaching for something in a dresser drawer,” says Schenk.

Schenk and Dr. LaSala discussed her options.

“When someone has prolapse like this it’s not a life- threatening condition, but it’s very uncomfortable. I feel Margaret Schenk had a number of options when try- it’s very important that the patient is knowledgeable and ing to decide how to deal with her cystocele condition. is part of the decision making,” LaSala says. Knowing she had the power to choose made the exeri- ence less nerve-wracking. Dr. LaSala discussed three options with Schenk: managing The surgery was a success and after a one-night stay at the cystocele conservatively and non-surgically with the Hartford Hospital Schenk was back to a normal level of insertion of a pessary ring to hold up the bladder; or with activity in a matter of weeks and is now pain free. surgery which could be done vaginally (non-invasive) or laparoscopically with the assistance of the daVinci surgi- “I feel great and I can do whatever I want,” she says. “I’m cal robot. Schenk chose the latter surgical option (known so happy I went to see Dr. LaSala. She explained to me as sacrocolpopexy) and to have it done robotically. what was wrong and why, and she gave me three ways that we could fix it from the most invasive to the least “It’s a technically difficult procedure. The mesh graft that invasive, explaining the benefits of each and the chances holds up the bladder has to be placed perfectly. There are of having to come back if the first procedure didn’t work. a lot of blood vessels and nerves there,” says Dr. LaSala. It was the most thorough explanation I’ve ever had from a “The robot allows for great visualization and accuracy.” physician.” hartfordhealthcare.org/services/urology-kidney 19 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

SUCCESS STORIES MEN’S HEALTH

Robert Burbank | A father again after all these years

Robert Burbank was hoping to add to his new family. The divorced father of three boys, ages 13, 11, and 9, had remarried and wanted to have a baby with his new wife but thought the vasectomy he underwent eight years prior would prevent him from growing his family.

A friend referred him to Hartford HealthCare Tallwood Urology and Kidney Institute physician Jared Bieniek, MD, who he said might be able help. After consultation with Dr. Bieniek, a fellowship-trained infertility expert and mi- crosurgeon, Burbank underwent a vasectomy reversal, a same day procedure to reestablish the flow of sperm through the vas deferens which were cut during the vasectomy.

“Dr. Bieniek was very informative. He mapped everything out for me and walked me through what to expect [before and after the procedure],” says Burbank.

The procedure went well with Burbank say- ing he had much less discomfort following the reversal than he did after the original vasectomy. And the best part, just a month after the operation, his wife was pregnant. Their healthy baby girl was born in July. After getting remarried, Robert Burbank had his vasectomy “Up to 6 percent of men change their minds reversed so he could have children again. He is now the proud after a vasectomy,” says Dr. Bieniek. “A vasec- father of a healthy baby girl who was born in July. tomy reversal is an excellent option for having children again but may require complex intraoperative decision making and vasoepididymostomy reconstruction, as in Robert’s case. It is imperative that you have an experienced and well-trained surgeon on your side.”

Burbank is thankful his friend helped him make the connection with Dr. Bieniek.

“It’s worked out perfectly,” he says.

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SUCCESS STORIES MEN’S HEALTH

Brian Macfarlane | Enjoying retirement without discomfort

You might find it hard to believe that Brian Macfarlane has already been retired for 10 years. It’s easy to imagine the youthful 71-year-old still driving the beer distribution truck that he drove for more than 30 years. He’s enjoying retirement and staying active by walking three to four miles a day and making trips to his second home in Melbourne, Fla.

There’s no way he was going to let Benign Prostatic Hyperplasia (BPH), also known as an enlarged prostate, slow him down. The constant urges, stops and starts, and the feeling of a full bladder were making his retirement less enjoyable.

The UroLift procedure, which relieves the feeling of a full bladder by slight- “I’ve been up and down with this for ly moving the prostate gland, has made life more comfortable again for a few years. It had gotten difficult,” retired truck driver Brian Macfarlane. Macfarlane said. urethra. There is no cutting, heating happy with the results.” After consulting with Tallwood or removal of prostate tissue. Urology and Kidney Institute physi- After feeling some discomfort for cian Arthur Tarantino, MD, Macfarlane “UroLift is great choice for men who several days after the procedure, decided it was time explore surgical qualify and are looking for an effec- McFarlane said his symptoms from options to address his BPH. After tive, less invasive option [for BHP]. BHP began to subside. And, he was an assessment, Dr. Tarantino told There is now five-year data show- happy to have avoided a more inva- MacFarlane he was a candidate for ing durability of results,” said Dr. sive procedure. the UroLift procedure, a minimally Tarantino. “Patients can get back to invasive, same-day operation that work and other physical activity more “[My BPH] is absolutely better. I lifts the enlarged prostate tissue out quickly than with some of the more would definitely recommend the proof the way so it no longer blocks the invasive procedures. Most guys are cedure,” McFarlane said.

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SUCCESS STORIES KIDNEY STONES

Sarah Lyman | Pregnancy discomfort comes from unusual place

Sarah Lyman was seven months pregnant with her third child when she began feeling a terrible pain in her back. Frightened that it might have something to do with her unborn baby, Lyman went to Hartford Hospital where an ultrasound showed that she had several very large kidney stones lodged in her right kidney. Relieved that her baby was healthy, Lyman would have to wait until after her daughter was born to have them removed.

“I had a great support system including my hus- band and parents,” said Lyman who also has twin girls who were only 18 months old at the time.

Lyman was referred to Hartford HealthCare Tallwood Urology and Kidney Institute physician Jeffrey Morgenstern, MD, and just weeks after her baby girl was born was back at Hartford Hospital to undergo two separate percutaneous nephroli- thotomies, a minimally-invasive procedure that uses lasers and ultrasound through a scope in- serted in the patient’s side to break-up the stones. Because one stone was particularly difficult to reach, Lyman came back for a third procedure that required inserting a small scope into her bladder using a laser to break up the stone.

Lyman now sees nephrologist Joseph M. Tremaglio, MD, who advises her on lifestyle behaviors, like increased water intake and dietary limitations, to prevent more kidney stones in the future.

“From our team, to the nephrologists, to the interventional radiologists who helped us gain access for the procedures, this was a team approach to achieve the best outcome for our patient,” said Dr. Sarah Lyman was treated at Hartford Hospital for kidney Morgenstern. stones following the birth of her third daughter.

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COMMUNITY INVOLVMENT

Outreach programs, events spread the word

Educating our community Our team believes that educated patients get better outcomes. We have provided 24 community education events this year based on topics our Disease Management Teams identify as valuable information for patients to know about their given disease. Some highlights: n Men’s Health: the psychology and physiology of sexual function n Men’s Health: the role of the PCP, urologist and cardiologist in caring for men n Men’s Health: understanding PSA testing n Understanding kidney stones n Understanding prostate cancer n Understanding bladder cancer n Understanding kidney cancer Dr. Joseph Wagner gives a presentation to the Omega Fraterni- n Understanding female incontinence ty at the Hartford Legacy Foundation on risks of and screening n Life after prostate cancer for prostate cancer in black men.

Supporting Hartford HealthCare was one of the main the community sponsors of the 2017 This year, the Hartford ZERO Prostate Cancer HealthCare Tallwood Urology Run/Walk in June. The and Kidney Institute partnered race began and ended with ZERO Prostate Cancer, a at the new Dunkin’ national not-for-profit orga- Donuts Park in Hart- nization with a mission to ford. Dr. Steven Shich- man from Hartford eliminate prostate cancer HealthCare Medical through awareness, research Group at Hartford and education. We held one of Hospital introduced the most successful first-time prostate cancer survi- ZERO Prostate Cancer aware- vors and caregivers at ness events in the country. the start of the event.

hartfordhealthcare.org/services/urology-kidney 23 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

About Hartford HealthCare

Hartford HealthCare is Connecticut’s most comprehensive healthcare network. Our fully integrated health system includes a tertiary-care teaching hospital, an acute-care community teaching hospital, an acute-care hospital and trauma center, two community hospitals, the state’s most extensive behavioral health services network, a large primary care physician practice group, a regional home care system, an array of senior care services, and a large physical therapy rehabilitation network. The Hartford HealthCare Cancer Institute provides coordinated care across five cancer centers and is the charter member of the Memorial Sloan Kettering Cancer Alliance.

Today, Hartford HealthCare is creating a better future for healthcare in Connecticut and beyond. We are a community of caregivers engaged in developing a coordinated, consistent high standard of care. We use research and education as partners in care delivery. We create and engage in meaningful alliances to enhance access to services. We invest in technology and training to develop new pathways to improve the timeliness, efficiency and accuracy of our services. Our vision To be most trusted for personalized coordinated care. Our values Caring — We do the kind thing. Every Hartford HealthCare staff member touches the lives of the patients and families in our care. We treat those we serve and each other with kindness and compassion and strive to better understand and respond to the needs of a diverse community.

Safety — We do the safe thing. Patients and families have placed their lives and health in our hands. At Hartford HealthCare, our first priority – and the rule of medicine – is to protect them from harm. We believe that maintaining the highest safety standards is critical to delivering high-quality care and that a safe workplace protects us all.

Excellence — We do the best thing. In Hartford HealthCare, only the best will do. We work as a team to bring excellence, advanced technology and best practices to bear in providing the highest-quality care for our patients and families. We devote ourselves to continuous improvement, excellence, professionalism and innovation in our work.

Integrity — We do the right thing. Our actions tell the world what Hartford HealthCare is and what we stand for. We act ethically and responsibly in everything we do and hold ourselves accountable for our behavior. We bring respect, openness and honesty to our encounters with patients, families and coworkers and support the well-being of the communities we serve.

Visit us at www.hartfordhealthcare.org

24 Hartford HealthCare Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

Recent Publications For a complete list of publications by our doctors, please visit hartfordhealthcare.org/services/urology-kidney.

PUBLICATIONS

AC Steinberg, MO Schimpf, AB White, C Mathews, DR Ellington, P Jeppson, C Crisp, SO Aschkenazi, MM Mamik, EM Balk, M Murphy. Preemptive Analgesia for Postoperative Hysterectomy Pain Control: Systematic Review and Clinical Practice Guidelines. American Journal of Obstetrics and Gynecology. Accepted for publication awaiting print. E16-1157.

Anderson C, Weber R, Patel D, Lowrance W, Mellis A, Cookson M, Lang M, Barocas D, Chang S, Newberger E, Montgomery JS, Weizer AZ, Lee CT, Kava BR, Jackson M, Meraney A, Sjoberg D, Bochner B, Dalbagni G, Donat M, Herr H. A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor. J Urol. 2016 October;196(4):1014-20. doi: 10.1016/j.juro.2016.03.151. Epub 2016 April 1. PMID: 27044571

American College of Obstetrics and Gynecology, Practice Bulletin 176, Pelvic Organ Prolapse, developed by the Committee on Practice Bulletins-Gynecology and the American Urogynecologic Society in collaboration with Paul Tulikangas, MD, April 2017. (This is the national document on evaluation and treatment of pelvic organ prolapse)

Bieniek, Jared and Kirk Lo. “Recent advances in understanding & managing male infertility.” F1000 Research, 24 (5): 2756, November 2016.

Bieniek, Jared, James Kashanian, Christopher Deibert, Ethan Grober, Kirk Lo, Robert Brannigan, Jay Sandlow, and Keith Jarvi. “Influence of increasing BMI on semen and reproductive hormonal parameters among a multi-institutional cohort of subfertile men.” Fertility and Sterility, 106 (5): 1070-5, October 2016.

Bieniek, Jared, Andrei Drabovich, and Kirk Lo. “Seminal biomarkers for the evaluation of male infertility.” Asian Journal of Andrology, 18 (3): 426-33, May-June 2016.

Cusano A, Haddock P Jr, Jackson M, Staff I, Wagner J, Meraney A. A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy. Int Braz J Urol. 2016 July-August; 42(4):663-70. doi: 10.1590/S1677-5538.IBJU.2015.0393. PMID: 27564275

hartfordhealthcare.org/services/urology-kidney 25 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

Recent Publications For a complete list of publications by our doctors, please visit hartfordhealthcare.org/services/urology-kidney.

Den RB, Santiago-Jimenez M, Alter J, Schliekelman M, Wagner JR, Renzulli Ii JF, Lee DI, Brito CG, Monahan K, Gburek B, Kella N, Vallabhan G, Abdollah F, Trabulsi EJ, Lallas CD, Gomella LG, Woodlief TL, Haddad Z, Lam LL, Deheshi S, Wang Q, Choeurng V, du Plessis M, Jordan J, Parks B, Shin H, Buerki C, Yousefi K, Davicioni E, Patel VR, Shah NL: Decipher cor- relation patterns post prostatectomy: initial experience from 2,342 prospective patients. Prostate Cancer Prostatic Dis. 2016 December; 19(4):374-379.

Jackson, M.A., Bellas, N., Siegrist, T., Haddock, P., Staff, I., Laudone, V., and Wagner, J.R.: Experienced Open vs Early Robotic-assisted Laparoscopic Radical Prostatectomy: A 10-year Prospective and Retrospective Comparison. Urology. 2016 May; 91:111-8. Propst K, Tunitsky-Bitton E, O’Sullivan DM, Steinberg AC, LaSala C. Use of Phenazopyridine for Evaluation of Ureteral Patency: A Randomized Controlled Trial. Obstet Gynecol. 2016 August; 128(2):348-55.

Propst K, Steinberg AC, O’Sullivan DM, Schimpf M, LaSala C. Resident Education in Female Pelvic Medicine and Reconstructive Surgery. Female Pelvic med Reconstr Surg. Accepted for publication awaiting print. FPMRS-16-00163R1

Propst K, Tunitsky-Bitton E, O’Sullivan DM, Steinberg AC, LaSala C. Phenazopyridine for Evaluation of Ureteral Patency: A Randomized Controlled Trial. Obstet Gynecol. 2016 August; 128(2):348-55. doi: 10.1097/AOG.0000000000001472. PMID: 27399998

Propst K, O’Sullivan DM, Tulikangas PK. Suburethral sling procedures in the United States: complications, readmission, and reoperation. Int Urogynecol J. 2017 February 24. [Epub ahead of print] PubMed PMID: 28236038.

Propst K, O’Sullivan DM, Tulikangas PK. Transdermal Scopolamine and Acute Postoperative Urinary Retention in Pelvic Reconstructive Surgery. Female Pelvic Med Reconstr Surg. 2016 September-October;22(5):328-31. PubMed PMID: 27054794.

Reagan KM, O’Sullivan DM, Gannon R, Steinberg AC, Decreasing Post-operative Narcotics in Reconstructive Pelvic Surgery; A Randomized Controlled Trial. American Journal of Obstetrics and Gynecology. Accepted for publication awaiting print E17-139R2

26 Hartford HealthCare Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

Recent Publications For a complete list of publications by our doctors, please visit hartfordhealthcare.org/services/urology-kidney.

NATIONAL AND INTERNATIONAL RESEARCH PRESENTATIONS

Armstrong, J., Haddock, P., Wiener, S., Staff, I., Cusano, J., Wagner, J.: Timing of Confirmatory Biopsies Influences Eligibility for Active Surveillance. American Urological Association New England Section Annual Meeting, Portland, ME, Abstract #10.

Baber, Jacob, Jared Bieniek, Joel Sumfest. “To cup or not to cup? Decisional factors influencing the use or non-use of genital protective equipment among young male athletes.” Podium presentation at Mid-Atlantic Sectional Meeting of the AUA, Hot Springs, VA, October 6, 2016.

Bienek, Jared. Invited speaker at Chilean Andrology Society Annual Meeting (March 9-10) in Santiago on the following topics: • The evolving male body habitus and fecundity • Novel biomarkers of male infertility • Update on male oncofertility

Bienvenu, J., Haddock, P., Cusano, J., and Wagner, J.: Gleason Scoring of Prostate Biopsies in Active Surveillance Patients Obtained by Standard TRUS and MRI: An Update. American Urological Association Annual Meeting, San Diego, CA, Abstract MP16-16.

Crawley, D., Bienvenu, J., Kershen, R., and Wagner, J.: Simultaneous Robotic-Assisted Mitrofanoff Procedure and Urethrectomy for Urethral Carcinoma. American Urological Association Annual Meeting, San Diego, CA, Abstract V1- 11.

Hennessey, A., Staff, I., Haddock, P., Jackson, M., Tortora, J., Champagne, A., Cusano, J., and Wagner, J.: Post- Prostatectomy Radiation: Are Indications and PSA Thresholds Changing? American Urological Association New England Section Annual Meeting, Portland, ME, Abstract #12.

Morosky C, Steinberg AC. Ultrasound Assessment of Fetal Head Position. APGO/CREOG. Orlando FL 3/2017

hartfordhealthcare.org/services/urology-kidney 27 Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

Recent Publications For a complete list of publications by our doctors, please visit hartfordhealthcare.org/services/urology-kidney.

Murphy, G., Haddock, P., Staff, I., Tortora, J., Champagne, A., Cusano, J., and Wagner, J.: Comparing Quality of Life Outcomes in Men Receiving Early Versus Late Post- Prostatectomy Radiation Therapy. American Urological Association Annual Meeting, San Diego, CA, Abstract MP04-11.

Murphy, G. and Wagner, J.: Bladder Neck Closure and Mitrofanoff. American Urological Association Annual Meeting, San Diego, CA, Abstract V10-12.

Reagan KM, Steinberg AC, O’Sullivan DM. Impact of Pelvic Floor Dysfunction on Recreational Runners. American Urogynecologic Society. Denver CO 9/2016

Reagan K, Tunitsky-Bitton E, O’Sullivan D, Lewis C. “Lower Urinary Tract Pathology in Joint Arthroplasty Patients” Presented at American Urogynecologic Society (AUGS), September 2016, Denver, CO

Satava RM, Gallagher AG, Smith R3 Darzi AW, Moglia A, Brand TC, Dorin R, Dumon K, Francone T, Georgiou E, Goh AC, Marcet J, Martino MA, Sudan R, Stefanidis D, Vale J, and Levy JS. Double-Blinded, Randomized Controlled Trial of the Fundamentals of Robotic Surgery (FRS): A Proficiency-based Progression Curriculum for Teaching Basic Technical Skills in Robotic Surgery

Steinberg AC, Soergel D, Burt D, SkobierandaF. Gastrointestinal Tolerability with Oliceridine, a Novel µ Receptor G Protein Pathway Selective (µ-GPS) Modulator. ACOG, San Diego May 2017

Steinberg, AC. “Multimodal Post-operative Pain Management” University of Arizona, Department of OB/GYN MIGS Conference, Scottsdale, AZ March 8,2016

28 Hartford HealthCare Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

Recent Publications For a complete list of publications by our doctors, please visit hartfordhealthcare.org/services/urology-kidney.

Steinberg, AC. “Incontinence for the PCP, how to diagnose, treat and when to refer”, ROME conference, Providence, RI, Aug. 5, 2016

Steinberg, AC. “Enhanced Recovery After Surgery to Improve Patient Outcomes”, SGS Post Graduate Course, San Antonio, TX, March 26, 2017

Steinberg, AC. Female Genital Prolapse: To mesh or not to mesh? XIV Congresso Paulista Urologia, September 2016 Sao Paulo, Brazil

Steinberg, AC. Urinary Incontinence in Women clinical debate. XIV Paulista Congress of Urology, September 2016 Sao Paulo, Brazil Tunitsky, E. “Vaginal Hysterectomy: On the Verge of Extinction?” Invited speaker at the 55th Reunion of Baystate Medical Center OBGYN Residency, Springfield, MA, October 2016

Wiener, S., Haddock, P., Staff, I., and Wagner, J.: Incidence of Clinically Significant Prostate Cancer After a Diagnois of Atypical Small Acinar Proliferation (ASAP), Prostatic Intraepithelial Neoplasia (PIN), or Benign Tissue. American Urological Association Annual Meeting, San Diego, CA, Abstract PD26-10.

Wiener, S., Haddock, P., Staff, I., Cusano, J., and Wagner, J.: Gleason 6, Stage T3 Prostate Cancer is Associated with Low Rates of Recurrence. American Urological Association Annual Meeting, San Diego, CA, Abstract MP79-04.Chalmers D, Cusano A, Haddock P, Staff I, Wagner JR. Are Pre-existing Retinal and Central Nervous System-Related Comorbidities Risk Factors for Complications Following Robotic-Assisted Laparoscopic Prostatectomy? Int Braz J Urol. 2015 July-Aug; 41(4):661-8.

hartfordhealthcare.org/services/urology-kidney 29 Transforming care delivery - Windham Hospital: We are committed to sustaining and improving the health of the Windham community and ensuring that Windham Hospital remains a cornerstone of care in our East Region. We will enhance care coordination, with a focus on shorter hospital stays, coordinated outpatient services and appropriate transitions whenever a higher level of care is need.

- Bradley campus: We will continue to transform Bradley in Southington, which is a campus of The Hospital of Central Connecticut.Hartford We already HealthCare have committed Tallwood to maintain and Urology upgrade the and Bradley Kidney Institute Emergency Department with private beds. This will offer a more versatile and efficient means to provide medically appropriate2016 care Outcomes there when overnight Report stays are needed. Bradley, with its new ambulatory surgery center and services, will continue to be the focal point of care for Southington. OUR INSTITUTE MODEL Vendor-supplied services - We have reached out to vendors who supply Hartford HealthCare with goods and services, and asked them to participate significantly in our expense reduction and cost containment efforts. We will work with our clinical and quality councils to ensure that greater standardization of supplies results in both improved safetyJeffrey and costA. savings.Flaks Our | businessPresident, partners Chief recognize Operating the value of Officera strong and responsive healthcare system such as ours. Hartford HealthCare We believe these actions are sufficient to meet the financial challenges we face today. This report is an important part of Hartford HealthCare’s quality and safety journey. It is important to note that we are not simply cutting.We strongly believe that our future progress will be linked to the evolution of our Institute model, which will allow us to integrate a strong customer experience with As a successful organization, we must invest heavily inadvancements the jobs, technologies in clinical quality. and facilities We have that launched we six such institutes: Behavioral need to continue as leaders in the new world of healthcare.Health, Bone and Joint, Cancer, Heart and Vascular, Ayer Neuroscience, and Tallwood Urology and Kidney. Each is in a different state of development; Hartford HealthCare’s We are working hard to complete our HHC Unity: CareConnectCancer Institute initiative was to the launch first to the roll Epic out. electronic health record and create a strong platform for data analysis so that we can help keep Our institutes are not service lines by another name. They have been designed around populations healthy. We have just opened our new HHC Cancer Institute facility at The Hospital of our patients, and with patients’ needs in mind. Our institutes are becoming the in- Central Connecticut. We continue to focus on the programmatic development of our service lines frastructure of care at Hartford HealthCare. Each institute uses the system’s standard for orthopedics, neurosciences, cancer and cardiac care.operating With our model patients and has preferring a common care governance closer to structure. Each is co-led by a physi- home, we are expanding our outpatient options, with newcian andto ensure convenient that patients ambulatory and families care receivecenters the same high level of clinical excel- throughout our service area. lence across our system. Our institutes have been created to both establish and meet industry-leading quality standards and to continuously raise the bar. These investments not only serve our patients, they also provide new employment and professional-development opportunities for our staff andOur create vision entirelyis to be most new trusted categories by our of patients and other customers. That trust is built healthcare jobs. This is why we are investing in care coacheson clinical and excellence. coordinators, Through case our managers institutes, wefor are creating a foundation for ever-im- chronic conditions, and specialists in informatics and dataproving analytics clinical. quality available to all the people we serve across Hartford HealthCare.

We know that change is difficult, but it is essential if weThis are report to keep is a signour promiseof our ongoing to our commitment patients to quality, transparency and account- ability. Thank you for your interest in Hartford HealthCare. and families. Thank you for everything you do every day on behalf of those we serve.

Sincerely, Sincerely,

President Jeffrey Executive A. Flaks Vice President Chief Executive Officer President, Chief Operating Chief Operating Officer Officer

30 Hartford HealthCare Hartford HealthCare Tallwood Urology and Kidney Institute 2016 Outcomes Report

METRICS FOR PATIENTS

Rocco Orlando | Senior Vice President, Chief Medical Officer Hartford HealthCare

Today, consumers are being asked to make healthcare decisions that touch their well- being and their wallets. They want — and deserve — to know the results of care, including complication rates and how experienced we are in treating certain conditions. Every provider claims “high quality” and “comprehensive care.” It’s easy to lay claim to excellence, but the proof is in the data.

While such information is becoming more widely available, especially online, it is of- ten complex and highly variable and difficult for the average consumer to navigate. Hartford HealthCare is committed to transparency when it comes to reporting our performance, and we understand that the information we provide must be clear, compre- hensible and useful. We strive to be among the leaders helping to shape performance- reporting parameters. We want to raise the bar in this new era of consumerism.

We are providing this information in an understandable format and sharing our quality measures in a meaningful way so doctors, patients and their loved ones can make informed, fact-based decisions. In the end, our quality metrics are for our patients. This report showcases much of the work done by our physicians, other clinicians and support staff across Hartford HealthCare. We have embarked on an incredible journey together to offer highly coordinated, consistently safe care. This outcomes information is another important step. We hope you find it informative and useful.

Sincerely,

Rocco Orlando, MD Senior Vice President, Chief Medical Officer

hartfordhealthcare.org/services/urology-kidney 31 Tallwood Urology and Kidney Institute 80 Seymour Street Hartford, CT 06102

To find a Hartford HealthCare physician at the Tallwood Institute, call 1.855.HHC.HERE

Learn more about our services and providers at hartfordhealthcare.org/services/urology-kidney