2020 Outcomes Report Portland Shriners Hospital

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2020 Annual Outcomes Report

Table of Contents

About us A message from our leadership Value-based health care & population health Clinical outcomes Meet our team Treatment specialties

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Mission • Provide the highest quality care to children with neuromusculoskeletal conditions, burn injuries and other special health care needs within a compassionate, family-centered and collaborative care environment. • Provide for the education of physicians and other health care professionals. • Conduct research to discover new knowledge that improves the quality of care and quality of life for children and families. • This mission is carried out without regard to race, color, creed, sex or sect, disability, national origin, or ability of a patient or family to pay. Vision Become the best at transforming children’s lives by providing exceptional health care through innovative research, in a patient and family-centered environment.

Hospital address: 3101 SW Sam Jackson Park Rd. Portland, OR 97239-3009 General Information: 503-241-5090 Initial appointments & Provider Referrals: 503-221-3422 Provider to Provider Line: 971-282-4600 Outpatient Clinic: 503-221-3422 Website: portlandshrinershospital.org @shrinershospital.portland @shcportland @shcportland Shriners Hospitals for Children – Portland

Specialty clinics Support services Advanced technology Providing care during COVID-19 Awards & accolades Patient-centered care Access to care Family resources Education Research Shriners fraternity Publications & presentations

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2020 Annual Outcomes Report

29-bed pediatric inpatient unit 4 operating rooms 28 outpatient exam rooms

In-house prosthetics and orthotics services Motion analysis center for evaluating gait abnormalities 3D imaging center with ultra-low radiation dose Physical, occupational, speech, and recreational therapy Activity room complete with games, pool table, air hockey, puzzles, arts & crafts, and more. Accessible play structure on the outdoor 7th floor playdeck Specialty Clinics Cerebral Palsy care including Spasticity Clinic and Tone Management/Baclofen Clinic Spinal Muscular Atrophy Spina Bifida Muscular Dystrophy Arthrogryposis Skeletal Dysplasia Service Area Shriners Hospitals for Children — Portland is a regional pediatric orthopaedic hospital, serving children from Oregon, Washington, Idaho, Alaska, British Columbia, and Alberta. However, our families travel from across the United States to receive specialty care.

About Us Shriners Hospitals for Children — Portland is changing lives every day through innovative pediatric specialty care. The Portland Shriners Hospital focuses on a wide range of pediatric orthopaedic conditions, including anything from fractures and sports injuries to rare diseases and syndromes. Our medical staff are leaders in the field of pediatric orthopaedics, anesthesiology, pain management, spine conditions, hip disorders, skeletal dysplasia, cleft lip and palate care, and rehabilitation. For a complete list of conditions treated, please refer to page 23. Designed with convenience in mind for patients and their families, the hospital offers a full range of services and resources under one roof so children can receive care for all of their orthopaedic needs in one building. Our inpatient and outpatient units are designed to reflect the unique character of the Pacific Northwest and put children and families at ease.

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Shriners Hospitals for Children — Portland

A message fromour leadership

Welcome to the Shriners Hospitals for Children - Portland 2020 Annual Outcomes Report. While the novel virus COVID-19 epidemic in 2020 will be long remembered, Shriners Hospitals for Children - Portland is no stranger to facing the challenges of epidemics. Established in Portland over 96 years ago, our hospital initially answered a community and nation-wide calling to address the needs of children affected by the polio epidemic. Throughout the COVID-19 epidemic, our hospital remains a safe place for all children and teens with bone and muscle conditions to receive outstanding pediatric orthopaedic care. With expanded telehealth services and outreach clinics, Shriners Hospitals for Children - Portland continues to provide reliable, high-quality care throughout Oregon, Washington, Idaho and Alaska. As a premier pediatric orthopaedic institute, our basic science and clinical research teams have advanced the knowledge in pediatric orthopaedics resulting in innovative treatments. Currently, our clinical research team is conducting several drug trials for patients with specific neuromuscular conditions. Our entire team is committed to improving patient outcomes and providing excellent value. We are delighted to report that our awards for quality and patient satisfaction continued in 2020. Most notably, we are now ranked by U.S. News and World Report as one of the top pediatric orthopaedic hospitals in the nation. In late 2020, we won another Press Ganey Award for our continued outstanding patient experience. I am honored to share with you our second Annual Outcomes Report for 2020. We hope that you will share this report with your family, friends, physicians, and even employer health plans. As always, we welcome your comments and feedback.

Welcome to our 2020 Annual Outcomes Report. Although this has been an unpredictable and eventful year, we have managed to remain successful as the premier pediatric musculoskeletal subspecialty hospital in Oregon, providing the highest quality care in the Pacific Northwest. Whether for scoliosis, hip dysplasia, clubfeet, sports injuries, or countless other conditions, our comprehensive wrap-around care is focused on the child, striving to achieve the best possible outcome for themselves and their family. The Portland Shriners Hospital combines the largest number of pediatric board certified orthopaedic surgeons in the Pacific Northwest, each with subspecialized training to treat your patient’s specific problem, with board certified pediatric anesthesiologists, award winning nursing staff, therapists, technicians, world-renowned researchers and more. In addition, we have the only clinical motion analysis laboratory for children in Oregon. Our staff is prepared to serve children from all over the Pacific Northwest and abroad in a family- centered environment. I invite you to browse this report and look forward to serving your patient in the future.

Sincerely, Robert M. Bernstein, M.D. Chief of Staff

Sincerely, Dereesa Reid, MBA Hospital Administrator

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13,733 Patient visits from children across the Pacific Northwest and beyond

1,556 Telehealth visits 2,433 Specialized orthotics & prothetics made

Value-based health care For the last 96 years, Shriners Hospitals for Children — Portland has been serving the pediatric orthopaedic needs of patients in the Pacific Northwest. Our patient-centered model of care serves the needs of all children ranging from fractures to the most complicated bone and muscle conditions. Through this unique integrated model of care, we provide a complete spectrum of pediatric orthopaedic and rehabilitation services. As early pioneers of population health during the polio epidemic, our 96 years of research and advancements in pediatric orthopaedic and neuromuscular conditions is the foundation of our world-class care. Today, as families and our entire nation face the need to access affordable, high-quality health care, Shriners Hospitals for Children — Portland’s commitment to this cause is even stronger. We believe that health care should provide high value, meaning excellent outcomes at an affordable price. The value-based health care framework developed by Professors Michael Porter, Elizabeth Teisberg and Robert S. Kaplan at Harvard Business School was a natural fit for our organization. Adopting a value-based approach to the delivery of care is central to continuously improving health outcomes of each patient and delivering value. Our patient-centered team approach is an Integrated Practice Unit (IPU). This focused approach allows our team to serve the needs of each patient over the full-cycle of care. Designed to produce better outcomes and efficiency, our Integrated Practice Unit (IPU) is comprised of several key elements:

29 Beds in our kid- friendly, family- centered facility 6,927 Patients seen in orthotics & prosthetics dept.

15,268 Therapy visits

• Care organized around pediatric orthopaedic and neuromuscular conditions • Dedicated multidisciplinary team • Comprehensive services available within our facility • Telehealth services available directly to the patient’s home • Care coordination across full-cycle of care • Outcomes and quality measurement • Interdisciplinary team approach to quality and cost improvements

13 Pediatric orthopaedic surgeons

2,806 Surgical hours

8,356 Radiology procedures

96 Years in Portland

365 Motion analysis center visits

1 Reference: Michael E. Porter, PhD and Thomas H. Lee, The Strategy that will Fix Health Care, (Harvard Business Review, October 2013) https://hbr.org/2013/10/the-strategy-that-will-fix-health-care Michael E. Porter PhD, Organize Care Around Medical Conditions, (Harvard Business School, Institute for Strategy & Competiveness), https://www.isc.hbs.edu/health-care/vbhcd/Pages/integrated- practice-units.aspx

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Clinical outcomes Shriners Hospitals for Children - Portland strives to deliver an exceptional experience for our patients and families. Our caregivers provide the highest quality and compassionate care to children with specialized health care needs. As a testament to this quality, Shriners Hospitals for Children — Portland was awarded the 2020 Guardian of Excellence Award for Patient Experience in Inpatient Pediatric by Press Ganey Associates. Press Ganey honors hospitals nationally with this award that have reached the 95th percentile for patient experience, employee or physician engagement, or clinical quality performance. We are committed to quality, patient safety and public reporting in order to advance treatments that improve patient outcomes. Shriners Hospitals for Children — Portland consistently ranks in the top decile among pediatric facilities for patient and family satisfaction. Patient Satisfaction Shriners Hospitals for Children — Portland utilizes Press Ganey Associates to capture and measure patient perspectives around their care experiences. Questions cover topics such as communication with nurses, physicians and hospital staff, facility comfort and cleanliness, pain management, admission and discharge processes, patient and family education, and many more. Collected data is aggregated and benchmarked against peer hospitals. The Portland Shriners Hospital’s Press Ganey patient satisfaction scores are consistently at or above peer hospital mean scores.

I have a wonderful experience every time we visit the facility. My son is always excited to see everyone, and they are always so friendly and attentive.

Population health The Portland Shriners Hospital prides itself on delivering the safest and highest-quality patient care within a family-centered and collaborative environment. Our commitment to achieving and surpassing the highest standards is evident not only through our accreditation by The Joint Commission, but also through our performance on numerous patient quality and safety indicators. Our adoption of patient-reported outcome assessment tools and use of innovative care models to address the comprehensive needs of our patients further illustrate our focus on offering superb and value-driven pediatric orthopaedic care.

Inpatient Overall Patient Satisfaction

Inpatient Likelihood to Recommend

Anonymous Press Ganey Review.

*Press Ganey Pediatric Hospital Mean for 7/1/2020 - 12/31/2020; Portland Shriners score based on standard overall rating by survey received date

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Clinical outcomes Patient Satisfaction (cont.)

Clinical outcomes Spinal procedures performed

Shriners Hospitals for Children — Portland offers an extensive spinal deformity program for spinal conditions, including scoliosis. Staff help ensure that patients receive an optimal outcome by providing all aspects of inpatient and outpatient pediatric orthopaedic care, including surgery, on-site rehabilitation, and psychological support.

*Press Ganey Pediatric Hospital Mean for 7/1/2020 - 12/31/2020; Portland Shriners score based on standard overall rating by survey received date

Medical Practice (Outpatient) Overall Patient Satisfaction

Medical Practice (Outpatient) Likelihood to Recommend

Ambulatory Surgery Overall Patient Satisfaction

Ambulatory Surgery Likelihood to Recommend

Spinal Procedures Performed 2018-2020

Spinal Procedures Performed 2018-2020

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Clinical outcomes

Clinical outcomes

Surgical Site Infections:

Orthotics Outcomes Quality

Surgical site infections (SSIs) are associated with increased morbidity and mortality, poorer patient quality of life, and higher cost of medical care. Shriners Hospitals for Children — Portland is committed to delivering care that meets and outperforms industry benchmarks around SSIs.

Adolescent idiopathic scoliosis (AIS) is a very common spinal deformity treated at the Portland Shriners Hospital. Conservative treatment of this condition requires a brace called Thoracic Lumbar Sacral Orthosis (TLSO). The Pediatric Orthotics & Prothetics Services - Northwest (POPS) department produces around 200 TLSOs for AIS patients annually. A successful conservative treatment requires two important factors: initial in-brace correction and brace wear compliance. The gold standard for initial in-brace correction is 50%. On average, our patients’ average in-brace correction is 46%. Patients with a baseline curve of less than 30 degrees on average saw an initial in-brace correction of 48% with a maximum of 92% correction. Patients with a baseline curve of 30 degrees or greater on average saw an initial in-brace correction of 45% with a maximum of 80% correction. Over 80% of AIS patients saw an improvement in their pain interference, upper extremity function and mobility about one year post-operatively.

TLSO Average In-Brace Correction Quality For AIS Patients

In all wound clean-class 1 (non-contaminated) cases, the hospital performs well-below the literature benchmark of 1.8%. Note: These rates include spinal fusion cases (both idiopathic and non-idiopathic)

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Surgical Site Infections: All Clean Class 1 Cases

Adolescent Idiopathic Scoliosis: 11 months post-operative improvements as measured via PROMIS

Surgical Site infections : Spinal fusion (Adolescent non-idiopathic Scoliosis)

Surgical Site infections: Spinal Fusion (Adolescent Idiopathic Scoliosis)

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Photo Gallery

PROMISing Outcomes Quality Ample evidence affirms that patients who are more involved in their medical care experience better outcomes and choose less costly, yet effective, interventions. In December of 2017, the Portland Shriners Hospital implemented PROMIS, a pediatric non-disease specific health-related quality of life patient-reported outcome tool developed by the National Institutes of Health in the outpatient clinic. PROMIS stands for Patient-Reported Outcomes Measurement Information System. Since that time, over 4,200 pediatric patients have been administered the PROMIS assessment at the Portland Shriners Hospital. 4,200 pediatric patients have been administered the PROMIS assessment at the Portland Shriners Hospital. Psychosocial health To improve the outcomes of quality, care, and value we bring to our patients, the use of PROMIS has identified several opportunities for improvement. First, PROMIS highlighted 16% of patients aged 8 -17 years reported fair to poor in the category of psychosocial health. In addition, mental health has been a top need in our Community Health Needs Assessment (CHNA) for the past two surveys (spanning a course of 6 years) which validated the need to expand our services to address the psychosocial needs of our patients. With these findings, we added a child psychologist to the team in 2020. Care expansion to include child psychology has been an invaluable addition to our medical staff team. Pediatric obesity Current data confirms that nearly 1 in 5 young people aged 6-19 in the United States has obesity. Currently, about 16% of our patient population are obese and 20% are overweight, which closely aligns with prevalence rates of obesity in the United States. Furthermore, patient-reported PROMIS data identified reduced outcomes quality in patients that were overweight or obese who received both surgical and non-surgical treatment. In response to this data, our second quality improvement initiative targets pediatric obesity and comorbidities associated with obesity, such as type 2 diabetes. The initiative’s goal is to reduce readmission rates over time and improve outcomes quality in both surgical and conservative treatments among our overweight and obese pediatric population.

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Photo Gallery

Health and Wellness Clinic Making value-based, data-driven changes to our interventions and treatment pathways will help drive quality at the Portland Shriners Hospital and positively affect patients’ quality of life. In recognizing an unmet need in our patient population, staff at the Portland Shriners Hospital have begun planning for the implementation of a Health and Wellness Clinic in 2021. This Health and Wellness clinic will include mental health professionals, physical therapists, recreational therapists, nutritionists, and a

We absolutely love the Portland Shriners Hospital so much, from the front greeters to the therapists, everyone makes you feel so welcome and comfortable to ask any questions.

Angela, patient parent (Mother of Jack, age 3)

primary practitioner to deliver an effective multidisciplinary care approach to both patients and their families. This quality driven initiative targeting diabetes and obesity was accepted as a poster presentation at the 2020 ICHOM Conference.

National Surgical Quality Improvement Program The Portland Shriners Hospital recently joined the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). ACS NSQIP has enabled hundreds of hospitals across the country to gauge the quality of their surgical programs with unrivaled precision and measurably improved surgical outcomes. Data collection begins preoperatively and continues through 30-days postoperatively on randomly assigned patients. Patient data is risk-adjusted and surgical case-mix adjusted, allowing surgical outcomes and complications rates to be nationally benchmarked. Antimicrobial Stewardship Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. At the Portland Shriners Hospital, a multidisciplinary team reviews 100% of all antibiotic orders for appropriateness, including those used for surgical prophylaxis.

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Orthopaedic Surgeons

Robert M. Bernstein, M.D. Chief of Staff Pediatric Orthopaedic Surgeon Scoliosis & Spinal Deformity, Skeletal Dysplasias, General Pediatric Orthopaedics, and more Education: University of Southern California Residency: Massachusetts General Hospital under the Harvard Combined Orthopaedic Residency Program Fellowship: Beth Israel Hospital and Boston Children’s Hospital Jeremy P. Bauer, M.D. Pediatric Orthopaedic Surgeon Pediatric Sports Medicine, Lower Extremity Deformity, Hip Dysplasias, and Neuromuscular Disorders Education: University of Washington and Drexel University College of Medicine Residency: University of Washington Fellowship: Shriners Hospitals for Children – Portland

Daniel J. Bouton, M.D. Pediatric Orthopaedic Surgeon Scoliosis & Spinal Deformity, Adolescent Spondylolysis and Spondylolisthesis Education: Washington University in St. Louis and Drexel University College of Medicine Residency: Cleveland Clinic Akron General Fellowship: Texas Scottish Rite Hospital for Children

Kathryn O. Fuchs, M.D. Pediatric Orthopaedic Surgeon Neuromuscular Disorders, Hip Dysplasias, Lower Extremity Inequality/Deformity, Clubfoot, Musculoskeletal Infections Education: Middlebury College and Albany Medical College Residency: Dartmouth Hitchcock Medical Center Fellowship: Boston Children’s Hospital

J. Ivan Krajbich, M.D., FRCS, BSc Pediatric Orthopaedic Surgeon Spinal Deformities, Bone Tumors, and Lower Limb Deficiencies Education: University of Waterloo, Canada and University of Toronto Residency: University of Toronto Fellowship: Mount Sinai Hospital – Toronto

Ellen M. Raney, M.D. Medical Staff President Pediatric Orthopaedic Surgeon Cerebral Palsy, Gait Analysis, Limb Length Inequality/Deformity, Clubfoot, and Hip Dysplasias Education: Tulane University Residency: Tulane University Fellowship: Shriners Hospitals for Children – Tampa

Michelle C. Welborn, M.D. Pediatric Orthopaedic Surgeon Spinal Deformities & Scoliosis Education: University of California, Berkeley and Pennsylvania State University College

of Medicine Residency: University of Illinois, Chicago Fellowship: University of Utah

Heather M. Kong, M.D. Pediatric Orthopaedic Surgeon General Pediatric Orthopaedics, Injury Care, Lower Extremity Deformity Education: University of California, Berkeley and Washington University in St. Louis Residency: Rutgers University Fellowship: St. Louis Children’s Hospital and Shriners Hospitals for Children — St. Louis

Krister P. Freese, M.D. Pediatric Orthopaedic Surgeon Pediatric Hand & Upper Extremity Conditions Education: Pacific Lutheran University and University of Washington Residency: University of Hawaii Fellowship: University of Colorado

Dominique D. Laron, M.D. Pediatric Orthopaedic Surgeon Pediatric Sports Medicine, Gait Abnormalities, Neuromuscular Disorders, and Cerebral Palsy Education: University of California Los Angeles and University of California San Francisco Residency: University of California San Francisco Fellowship: Cincinnati Children’s Medical Center

Dennis Roy, M.D. Pediatric Orthopaedic Surgeon Hip Deformities, Skeletal Dysplasias, and Foot Deformities Education: Medical College of Georgia Residency: National Naval Medical Center Fellowship: Scottish Rite Hospital and Alfred I DuPont Institute

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Honorary Staff (Retired) Michael D. Aiona, M.D. Honorary Medical Staff Retired end of 2020 Cerebral Palsy and Myelodysplasia, Limb Length Inequality, Clubfoot, Lower Extremity Deformities and Gait Abnormalities Education: University of California Irvine School of Medicine Residency: University of Utah Medical Center Fellowship: Shriners Hospitals for Children - Greenville

Division Heads Cerebral Palsy Ellen M. Raney, M.D. Myelodysplasia Dominique D. Laron, M.D. Hip Jeremy P. Bauer, M.D. Sports Jeremy P. Bauer, M.D. Skeletal dysplasia Robert M. Bernstein, M.D.

Treatment specialties Shriners Hospitals for Children — Portland focuses on a wide range of pediatric orthopaedic conditions, including anything from fractures and sports injuries to rare diseases and syndromes. Our medical staff are leaders in the field of pediatric orthopaedics, anesthesiology, pain management, spine conditions, cleft lip and palate care, and rehabilitation. The Portland Shriners Hospital is a place where hope and healing come together. Through our innovative care, we instill confidence and teach our patients there are no limits to what they can do. Our patients and their families benefit from the expertise of our multidisciplinary team and their dedication to serving our patients’ needs. The hospital’s medical staff includes board certified pediatric orthopaedic surgeons. The medical team is supported by residents, physician assistants, nurse practitioners, prosthetists, orthotists, therapists, nurses and consulting physicians, each of whom play an essential role in our multidisciplinary approach to care. We have an in-house prosthetics and orthotics provider, a motion analysis center, a radiology department and a rehabilitation department. All of these services are located under one roof in an effort to coordinate your child’s care in the best and most efficient way possible.

General pediatric orthopaedics Sports injuries/fractures Scoliosis and spinal deformities Chest wall deformities Hand and upper extremity care Hip disorders (congenital or developmental) Clubfoot and congenitial deformities of the foot Cerebral Palsy (orthopaedic related issues) Gait abnormalities Skeletal growth abnormalities Skeletal dysplasia Limb length discrepancies Spina bifida Craniofacial Conditions, Cleft

Michael D. Sussman, M.D. Honorary Medical Staff Retired end of 2020 Cerebral Palsy, Muscular Dystrophies, and Foot Deformities, including Clubfoot Education: Johns Hopkins University and Children’s Hospital in Boston Residency: Johns Hopkins University School of Medicine & Surgical Medical College of Virginia Fellowship: Johns Hopkins and Children Hospital Boston

Lee A. Taylor M.D. Honorary Medical Staff Retired end of 2020 Pediatric Anesthesiology

Outcomes Daniel J. Bouton, M.D.

Anesthesia Joselyn S. Davidson, M.D.

Pediatric Anesthesiology Joselyn S. Davidson, M.D., Chief of Anesthesia Inca Chui, M.D. Rebecca Hall, M.D. Jorge Pineda, M.D. Advanced Practice Professionals Bing Sun, PA-C Maria Moredock, PA-C Nancy Jacobs, CNS Stephanie Cadman, RN, MSN, FNP-BC Elizabeth Mandel, RN, CPNP Andrea Johnson, D.O. William M. Klein, M.D.

Upper extremity Krister P. Freese, M.D.

Neuromuscular Kathryn O. Fuchs, M.D. Fractures/trauma Heather M. Kong, M.D. Clinical research Ellen M. Raney, M.D. Arthrogryposis Ellen M. Raney, M.D. Spine Michelle C. Welborn, M.D.

Lip and Cleft Palate Burn scar revisions Limb deficiency and amputations

Musculoskeletal injuries and diseases, subacute and chronic Musculoskeletal tumors Myelodysplasia (spina bifida, myelomeningocele) Neuromuscular disorders (Muscular Dystrophy, SMA, CMT)

Pediatric Psychology Catherine McClellan, Ph.D.

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Specialty clinics Shriners Hospitals for Children — Portland offers multidisciplinary specialty clinics for patients who benefit from a collaborative approach to care with multiple medical specialists. Coordinated by our care management team of registered nurses and social workers, our specialty clinics bring together a variety of specialists all in one place. Specialists include pediatric practitioners; geneticists; neurologists; endocrinology; cleft lip and palate/dental; and orthopaedists. In addition, social workers; child life specialists; physical, occupational and speech therapists; and orthotics and prosthetic services staff are available. Following each clinic, the team of professionals meets to discuss each child and develop a treatment plan. This interdisciplinary program allows specialists in various disciplines to assess the nuances of each case and collaborate to identify the problem. This collaboration ultimately results in the most well-rounded, thorough and comprehensive care for each patient. Specialty clinics include:

Spina Bifida Spina bifida can manifest in a number of ways, from major

complications to mild symptoms that don’t require as much medical intervention. Shriners Hospitals for Children - Portland is active in the most up-to-date research, leveraging evidence-backed treatment to help children with spina bifida live their best lives. Our team is comprised of experienced pediatric orthopaedists, neurologists, urologists, and pediatricians with expertise in spina bifida care. Common spina bifida treatments and therapies include physical and occupational therapy, orthotics, and surgery.

Muscular Dystrophy This specialty clinic provides comprehensive care from pediatric neurologists, orthopaedic surgeons and pediatric rehabilitation specialists to provide care for muscular dystrophy. Patients may also see nurse practitioners, physical, occupational and speech therapists, pediatric psychologist, care coordinator, social worker and clinical dietician during the appointment. On the day of the visit, we have an expert on hand to make adjustments to wheeled mobility devices and orthotists to help with braces.

Cerebral Palsy care including Spasticity Clinic and Tone Management/Baclofen Clinic

Our medical team, including pediatric orthopaedists, therapists and orthotists, work together with each patient and their family to prescribe a customized care plan for children with cerebral palsy. Treatment options may include referrals to our tone management clinic or Baclofen clinic, a visit to our motion analysis lab, and a customized plan involving surgery to correct contractures and bony alignment when necessary. We also specialize in spasticity and tone management for patients with conditions, like cerebral palsy, that reduce spasticity. A multidisciplinary team works collaboratively to improve each patient’s range of motion, motor function, and comfort.

Arthrogryposis Our medical team specializes in providing comprehensive and ongoing care and management for the rare orthopaedic condition arthrogryposis. Our team utilizes both non-operative and operative options to help patient’s improvement in range of motion and ultimately, their quality of life. Skeletal Dysplasia At Shriners Hospitals for Children — Portland, we are uniquely equipped to provide specialized care for patients who have any form of skeletal dysplasia. Our multidisciplinary clinic includes pediatric specialists in the areas of orthopaedics, genetics, endocrinology, physical therapy, and more. Robert Bernstein, M.D., chief of staff at the Portland Shriners Hospital, is nationally and internationally recognized for the care and treatment of children with skeletal dysplasia. He is on the medical advisory board for Little People of America.

Spinal Muscular Atrophy At Shriners Hospitals for Children - Portland, we treat the child, not the condition. While there currently is no cure for spinal muscular atrophy (SMA), the Portland Shriners Hospital focuses our treatment goals on managing any pain that children with this condition may have and improving their quality of life. The specific treatment will vary depending on the patient’s age, general health, medical history and the type of SMA they have. Once symptoms of SMA are exhibited, Portland Shriners Hospital medical staff can conduct several tests to diagnose the type of SMA they may have, such as blood tests, muscle biopsy, or electromyogram (EMG).

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physical therapists will evaluate your child to determine a therapy program specifically tailored to their individual needs and developmental abilities. Physical therapy services are available onsite to tend to the needs of children in both our inpatient unit and outpatient clinics. Occupational Therapy Our occupational therapists evaluate each patient and identify barriers the child may face in their activities of daily life. Through an assessment of their environment and abilities, the therapists identify creative solutions that encourage

After I healed from the surgery, nothing seemed to hurt anymore. When I got approval to try a back hand spring, it really didn’t feel that much different than before surgery

Rylie, age 15 patient and cheerleader

participation in meaningful activities. Occupational therapy helps maximize independence in daily activities such as dressing, grooming, bathing, social participation, play and education by assessing orthopaedic abilities and addressing deficits related to each task. Our occupational therapists specialize in assistive technology, upper extremity function, powered mobility and adaptive equipment. Speech Therapy The speech-language pathology team at Shriners Hospitals for Children — Portland specializes in evaluating and treating children with complex communication needs. Therapeutic services are provided in the areas of augmentative and alternative communication (AAC), articulation and phonology, expressive and receptive language, feeding and swallowing, and craniofacial disorders. Clinicians receive continuing education and training on state-of-the-art assistive technology and augmentative and alternative communication to provide your child with the best care. Recreational Therapy Our recreational therapy program aims to promote an active and healthy lifestyle while increasing the quality of life for patients through outdoor adventure, sports, creative movement, art and social engagement. Participation in recreational activities can improve physical, emotional and mental health and well-being. Our programs provide opportunities for families to recreate together and provide supportive environments for kids to foster friendships. We provide year-round programs and individual consultation regarding recreation opportunities and leisure education to patients and families. Instruction and adaptive equipment are provided.

Support services Rehabilitation Services

The rehabilitation services provided at Shriners Hospitals for Children — Portland are a combination of clinical excellence and evidence-based research to provide the best care for children. Our therapists hold advanced certifications in many treatment interventions. Our team offers a wealth of clinical and medical expertise to patients who are seeking increased participation in daily activities, or are recovering from surgery or sports injuries. Our rehabilitation team advances the care we provide by collaborating in research to develop best treatment practices. We are dedicated to helping your child succeed. We specialize in pediatric therapy services for children with orthopaedic needs, communication disorders, and burn or cleft/craniofacial care from birth to 18 years of age. Our family-centered approach ensures that both the patient and their family are included in establishing a plan of care that allows the patient to achieve greater independence and overall better quality of life.

Physical Therapy Physical therapy is an important component of care that serves to optimize independence by helping children improve their level of function through a variety of therapeutic activities. Our

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Motion Analysis Center The high-tech motion analysis conducted in the motion analysis center is integral to the complex, comprehensive care provided by Shriners Hospitals for Children — Portland. Computerized motion analysis provides insight into a child’s gait or movement abnormalities and helps inform treatment planning and outcome evaluation. The multidisciplinary team reviews the patient’s video, physical exam measurements, kinematic and kinetic data, foot pressure data and electromyography data. After a group discussion, a treatment recommendation is made.

Shriners is such a safe and caring place. They are the experts in this field, from prosthetics and orthotics to child life – they know how to make you and your kiddo smile and feel at ease, even if the reason you’re there isn’t exactly easy or fun.

Recommendations provided after a motion analysis study may include surgical procedures, tone management, physical therapy, occupational therapy, orthoses, prostheses and assistive walking devices.

Ashlee, patient parent (Mother of Quinn, age 3)

Radiology Radiology provides a window into the body for the physician to assess pathology, extent of deformity or injury, and physical changes over time. It is a key component for diagnosis, treatment planning and surgical correction. The Portland Shriners Hospital strives to keep radiation doses as low as possible during X-ray procedures by tailoring technical factors to the appropriate age and size of our patients. All images are then interpreted by our board certified pediatric radiologists. EOS EOS is used for all patients with spine and lower extremity disorders except for infants and patients who are physically unable to utilize this machine. EOS 2D/3D imaging technology, which captures whole-body images using only one-ninth of the radiation of a traditional X-ray, provides detailed images for our physicians. O-arm The O-arm is an intraoperative imaging system that, when used in a surgery setting, provides surgeons with a 3-dimensional view of the spine on an accompanying monitor to increase the accuracy of hardware insertion. The O-arm also provides high image quality, is easy to handle and can help decrease the time the patient needs to spend in surgery because of its efficiencies.

Advanced technology Pediatric Orthotics & Prosthetics Services – Northwest (POPS) Children living with orthopaedic conditions, such as missing limbs, deserve every opportunity to thrive and participate in desired activities and sports, and feel confident in their abilities. Located within the Portland Shriners Hospital, our POPS team helps carry out this vision, whether it’s creating personalized prosthetics or matching a child to the most effective and least-restrictive assistive device. The POPS team located within the Portland Shriners Hospital is the west coast fabrication center, building devices for multiple Shriners Hospitals for Children locations. Using the latest technology and software, POPS has forged a new path forward that no longer relies on cumbersome plaster casts and lengthy fabrication times. By taking a multidisciplinary approach, the POPS team crafts effective treatment plans that involves the family as well as the child’s entire health care team including physicians, physical and occupational therapists, prosthetists, orthotists and more.

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Providing care during COVID-19

2020 was certainly an unexpected year for us all, but throughout the entire COVID-19 pandemic, the health and safety of our patients, families, and staff remained our top priority. Throughout the pandemic, the Portland Shriners Hospital implemented and maintained extensive safety and sanitation protocols, ensuring that any step to protect our patients and families was taken. Since 1924, we have remained committed to our patients each and every day, and our tradition of caring for kids did not stop now. During the pandemic, we enhanced our services to meet the need of our community. We launched our telehealth program (Fast Track Video Visits) which was developed as a convenient option for patients and families to help eliminate barriers to care. Through the use of Fast Track Video Visits, providers at the Portland Shriners Hospital were able to continue to provide specialized orthopaedic care to new and established patients from the comfort of the patient’s home via video software. By utilizing

I am forever grateful to the Portland Shriners Hospital. The work that they do is so critical and important – they will help any child become the best person they can be. I am who I am today because of Shriners.

Maria, past patient

telehealth, our providers were able to reduce the number of patients who needed to come to the hospital while also providing the same level of specialized care that our patients and families have come to expect. Even as we move past COVID-19, our telehealth program will continue to enable us to provide care for patients in a way that is most convenient for families. To help relieve the burden on emergency rooms and urgent care systems during COVID-19, the Portland Shriners Hospital also extended our Walk-in Fracture & Sports Injury Clinic during the height of the pandemic. Beginning in April, the clinic, which is typically 5-days per week, expanded to 7 days per week. There is never a good time for kids to experience an injury or a fracture, but our hope was to give families peace of mind in knowing that the Portland Shriners Hospital is available as a reliable resource for families throughout the COVID-19 crisis. The clinic returned to regular hours in June. “We wanted to do our part to help our community during the COVID-19 pandemic,” said Robert Bernstein, M.D., chief of staff at the Portland Shriners Hospital. “We are uniquely positioned to provide urgent care for children with musculoskeletal injuries in a clean environment, and our hope is to offload the burden of non-COVID-19 pediatric patients seen in emergency departments.” Despite the far-reaching effects of the pandemic, the comprehensive care model at the Portland Shriners Hospital never changed.

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Staff awards: Ellen M. Raney, M.D. was awarded the Distinguished Service Award in the Section on Orthopaedics by the American Academy of Pediatrics (AAP). Dominique Laron, M.D. won Best Scientific Poster from the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) during their annual meeting. His presentation titled Fascia iliaca pain block results in lower overall narcotic usage and shorter hospital stays than epidural anesthesia after hip reconstruction in children with cerebral palsy received the highest score among scientific poster abstracts upon review from the awards committee during the meeting. Michael Sussman, M.D. , pediatric orthopaedic physician at the Portland Shriners Hospital, was honored with the Lifetime Achievement Award from the American Academy for Cerebral Palsy and Developmental Medicine.

Michelle Welborn, M.D. , was awarded Best Basic Science Paper from the Pediatric Orthopaedic Society of North America (POSNA) for advancing research using biomarker CXM in relation to scoliosis care, a protein discovered by the Portland Shriners Hospital staff in 2018. Nan Wecker, RN , was recognized as the Portland Shriners Hospital’s DAISY Award® Winner for 2020. The DAISY Foundation was established in 2000 and recognizes extraordinary nurses everywhere who make an enormous difference in the lives of their patients through the superhuman work they do every day. Ronen Schweitzer, Ph.D. , researcher at the Portland Shriners Hospital, was included in the American Academy of Orthopaedic Surgeon’s Kappa DeltaYoung Investigator Award for his work co-authoring a project on cell and molecular mechanisms of tendon development, regeneration and scar formation. Saundra Schlesinger , researcher at the Portland Shriners Hospital, was awarded Best Poster Award at the Orthopaedic Research Society for her poster titled Smad4 Conditional Deletion In Mouse Using Scleraxis-cre Causes Postnatal Limb Contracture . Susy Molano , certified medical interpreter at the Portland Shriners Hospital, was presented with the Robert Wood Johnson Foundation Award for Health Equity presented by the Asian Pacific Islander Caucus for Public Health. This award is given each year to a leader who has made outstanding contributions towards achieving health equity and implemented system changes in their community.

Recognized for Excellence: Awards & Accolades Hospital awards:

U.S. News and World Report’s ranking for Best Children’s Hospitals in the category for Orthopaedics . Through a nationally conducted survey, U.S. News & World Report selects hospitals based on clinical data that includes measures such as patient safety, infection prevention and adequacy of nursing staffing. To earn this prestigious recognition in a specialty category, hospitals must demonstrate exceptional care models and the ability to treat medically complex patients. Guardian of Excellence Award for Patient Experience in Inpatient Pediatric : Press Ganey presents this award to hospitals that have reached the 95th percentile for patient experience, employee or physician engagement, or clinical quality performance. Being recognized in the category for “patient experience” means that the Portland Shriners Hospital ranked higher than 95% of other hospitals when it comes to the quality of the patient experience.

Five pediatric orthopaedic physicians from the Portland Shriners Hospital were recognized by Portland Monthly Magazine as a Top Doc. Each year, Portland Monthly polls doctors, physician assistants and nurses in Portland to determine the best doctors in the area based on their accomplishments, education, patient satisfaction surveys and other criteria. Physicians included are Jeremy Bauer, M.D., Daniel Bouton, M.D., Krister Freese, M.D., Kathryn Fuchs, M.D., and Ellen Raney, M.D.

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TEDI Team For patients who have experienced adverse childhood events such as abuse or the loss of a parent, or who have spent time in foster care, being in a hospital setting can be overwhelming. To help combat such prior negative experiences, the TEDI Team was established at the Portland Shriners Hospital in 2018. TEDI stands for:

Trauma Informed Evidence-Based Driven by Research Inspired

The goal of the TEDI team is to ensure that children with prior developmental trauma receive the extra attention to safety, transparency, and compassion that they need to decrease stress while receiving care at Shriners Hospitals for Children — Portland. Social workers Licensed social workers assist families and children with personal issues, providing emotional support to the child and family, coordinating discharge arrangements and linking the family with resources in their community.

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Access to care Shriners Hospitals for Children — Portland is a regional pediatric orthopaedic hospital, serving children from across the Pacific Northwest, Alaska, and western Canada. Our highly specialized medical team often draws patients from all over the United States and beyond. We continually focus on improving access to our trusted specialists and eliminating barriers to our specialized orthopaedic care. In doing so, our hope is to ensure all children in need of pediatric orthopaedic medical care receive it. In order to make care accessible to patients wherever they may live, we offer a range of services to expand our reach, including telehealth visits and outreach clinics. Each year, Portland Shriners Hospital staff travel to the locations of our outreach clinics in order to bring excellent orthopaedic care closer to our patients. These clinics occur in Pendleton OR, Medford OR, Bellingham WA, and Anchorage AK.

Patient-centered Care Pediatric Psychology In 2020, Shriners Hospitals for Children – Portland welcomed a pediatric psychologist to the medical team, Catherine McClellan, PhD. With the development of this new role, Shriners Hospitals for Children — Portland has taken a meaningful step in bridging a gap identified by the

results of the patient survey platform, PROMIS. The findings from the survey identified a correlation between patients’ psychosocial health and their physical health, and a need to provide consistent care for

patients’ behavioral and emotional well-being. Dr. McClellan focuses her time on developing quality improvement programming to evaluate and improve care, provider and staff education surrounding pediatric behavioral health. Additionally, she delivers interventions for patients in the areas of pain management, medical phobia, sleep disruption, anxiety and depression.

Community Benefits Council Portland Shriners Hospital staff who serve on the Community Benefits Council aim to create awareness and a culture of support for community health needs and benefits at Shriners Hospitals

Child Life

Our certified child life specialists are trained in child development and help reduce the stresses associated with the hospital experience. They teach patients coping skills through offering opportunities to play, learn and interact with others in an emotionally and socially safe environment. Play experiences help children express fears and misconceptions of hospitalization and medical procedures. Services include procedural support, pain management techniques, pre-operative teaching prior to surgery, group activities and education about upcoming procedures/ hospital visits. Additionally, our child life specialists facilitate a number of special activities including therapy animals, musicians, magicians or costumed characters, or holiday- themed parties.

for Children – Portland. Some of their key functions include leading all planning and execution related to the triennial Community Health Needs Assessment (CHNA) and annual community benefits reporting, support existing community benefit programs at the hospital while also exploring and identifying new benefit opportunities, and actively promote community benefit awareness activities within the hospital.

Patient Care 1 1 specialist 5-8

patients a day average per

Interpretation services Shriners Hospitals for Children — Portland offers

interpretive services for patient families with 3 Spanish interpreters onsite. Additionally, we can arrange for interpreters for about 200 additional languages to attend appointments and assist with phone calls. It is vital for families to have access to clear and understandable information about their child’s medical care.

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