SC Portland Outcomes Report 2023

OUTCOMES REPORT 2023

MISSION • Provide the highest quality care to children with orthopedic 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.

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CONTENTS

About Us

4

A Message From Our Leadership

6

Value-Based Health Care & Population Health

9

Clinical Outcomes

12

Quality of Life

17

Meet Our Team

20

Treatment Specialties

23

Specialty Clinics

24

Support Services

28

Advanced Technology

30

Shriners Children’s Pediatric Spine Program

31

Specialized Care

34

Awards & Accolades

37

Patient-Centered Care

38

Family Resources

42

Education

44

Annual Conferences

45

Research

46

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ABOUT US

Shriners Children’s Portland is changing lives every day through innovative pediatric specialty care. The Portland Shriners Hospital focuses on a wide range of pediatric orthopedic conditions, from fractures and sports injuries to rare diseases and syndromes. Our medical staff are leaders in the field of pediatric orthopedics, anesthesiology, chest wall deformities, 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, Shriners Children’s Portland offers a full range of services and resources under one roof so children can receive care for all of their orthopedic 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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ABOUR OUR HOSPITAL • 29-bed pediatric inpatient unit • 3 operating rooms • 26 outpatient exam rooms • In-house orthotics and prosthetics lab, Pediatric Orthotic and Prosthetic Services (POPS) — Northwest • Motion analysis center for evaluating gait abnormalities • 3D imaging center with ultra-low radiation dose • Cutting edge advanced surgical tools like the Pentero Microscope and O-arm • 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 play deck

SPECIALTY CLINICS • Cerebral palsy care • Muscle Tone/Baclofen Clinic • Spinal Muscular Atrophy • Spina Bifida • Muscular Dystrophy • Arthrogryposis

• Skeletal Dysplasia • Cleft Lip & Palate • Chest Deformity • Brachial Plexus and Peripheral Nerve Injuries • Sports Health and Medicine • Walk-in Fracture and Sports Injury • Bone Health

SERVICE AREA Shriners Children’s Portland is a regional pediatric orthopedic hospital, serving children from Oregon, Washington, Idaho, Alaska, British Columbia, and Alberta. Additionally, our families travel from across the United States to receive specialty care.

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A MESSAGE FROM OUR LEADERSHIP

WELCOME TO SHRINERS CHILDREN’S PORTLAND 2023 ANNUAL REPORT

As we celebrate the turn of a century of serving children in Portland, Shriners Children’ss has weathered many extraordinary events beginning in 1924 with the polio epidemic to more recent times with COVID and the recovering economy. As always, our hospitals and clinics remain steadfast in providing excellent, family-centered care for all children to teens with bone and muscle conditions. Over the past six years, our hospital continues to receive more recognition for our achievements from U.S. News and National Press Ganey patient satisfaction awards year over year. These awards reflect Shriners Children’s unwavering dedication to highly reliable patient care. Committed to serving more kids, in more places, our network of clinics continues to grow. In addition to our Anchorage, Alaska and Pendleton, Oregon outreach clinics, we now have clinics in Medford, Oregon and Redmond, Oregon (opened in 2024). Continuously serving Oregon, Washington, Alaska, Idaho, and Western Canada, we also serve more international children from around the world that need complex spine and other inpatient care. Our daily walk-in fracture and sports injury clinic offers quick access and the best venue of care for children and teens. Our clinical research, bench research imaging core, and genomics research continue to assure that Shriners Children’s patients have access to the latest treatments. Accordingly, our medical education program extends our teaching mission to orthopedic residents and to a wide variety clinical student rotations. I am delighted to share with you our fifth Annual Report for 2023. 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.

Sincerely, Dereesa Reid, MBA Administrator

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As we approach the 100th anniversary of Shriners Children’s Portland, we have a lot to celebrate. Our hospital’s unwavering commitment to our mission and quality, as made clear by this year’s annual report. Our hospital continues to receive more recognition for our achievements including a Press Ganey Pinnacle of Excellence award for patient satisfaction. Shriners Children’s Portland provides care for all types of pediatric orthopedic issues including spinal problems, neuromuscular conditions, hip dysplasia, clubfoot and other foot problems, hand and upper extremity problems and fractures. We’ve added a Brachial Plexus and Peripheral Nerve clinic, expanded our Sports Health and Medicine Program, and continue to offer a walk-in fracture and sports injury clinic that allows for easy access to our specialists for kids in high-need situations. Add to this our research and educational programs for medical students, residents and international fellows, primary care providers and others, and it is clear that Shriners Children’s Portland is at the forefront of pediatric orthopedic care in the Pacific Northwest. Shriners Children’s Portland’s reach is wide, encompassing Oregon, Washington, Alaska, Idaho, and the Canadian Northwest provinces of British Columbia and Alberta. We continue to offer a weekly clinic in Medford that allows families from Southern Oregon and Northern California high quality care without having to travel 5 hours to Portland.

I invite you to browse this report and look forward to serving your patients in the future.

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

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8,417 INDIVIDUAL CHILDREN SERVED ACROSS THE PACIFIC NORTHWEST AND BEYOND

1,362 TELEHEALTH VISITS

11,941 REHABILITATION VISITS

4,705 PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES (POPS) VISITS

2,796 ORTHOTIC AND PROSTHETIC DEVICES PROVIDED

11 PEDIATRIC ORTHOPEDIC SURGEONS

339 MOTION ANALYSIS CENTER STUDIES

99 YEARS IN PORTLAND

11,995 RADIOLOGY PROCEDURES

1,222 SURGERIES

29 BEDS IN OUR KID FRIENDLY, FAMILY CENTERED FACILITY

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VALUE-BASED HEALTH CARE

For the last 99 years, Shriners Children’s Portland pioneered patient centered, high quality care in pediatric orthopedics. As families and our entire nation face the need to access affordable, high quality healthcare, our commitment is unwavering. We believe that healthcare should provide high value, meaning excellent outcomes at an affordable price. The value-based healthcare framework developed by Professors Michael Porter, Elizabeth Teisberg and Robert S. Kaplan at Harvard Business School reflects Shriners framework for delivering outstanding value and highly reliable quality. Our patient centered approach is central to measuring and continuously improving health outcomes of each patient. The Shriners Children’s Portland team serves the needs of each patient over the full-cycle of care. By design, we are able to produce better outcomes and efficiency. The Shriners Children’s Integrated Practice Unit (IPU) is comprised of several key elements: • Care organized around pediatric orthopedic and neuromuscular conditions • Surgical, inpatient, and clinic teams focused specifically on best practices in pediatric orthopedic care • Dedicated multidisciplinary teams • 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 • Patient report health outcomes • Interdisciplinary team approach to quality and cost improvements • Community telehealth clinic • Reaching more kids in more places, like our Medford clinic location and partnership with Providence health system

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/ integratedpractice- units.aspx

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All the staff members were very understanding and accommodating to all our needs.̶

Grateful parent, 2023 Press Ganey review

POPULATION HEALTH True to our mission, our team at Shriners Children’s Portland is committed to serving all children with pediatric orthopedic and neuromuscular conditions. Our pediatric psychologist plays a critical role in our multi-disciplinary team. While our focus remains on treating bones and muscles, a child’s mental health status is important to achieving optimal health outcomes. Moreover, in response to the growing pediatric depression and suicide rates in our community, our outpatient clinic conducts suicide screening on all eligible patients. The mind is inseparable to ensuring a holistic approach to treating musculoskeletal and neuro-muscular conditions. Our daily walk-in fracture and sports injury clinic is available for all kids from age 0 to 18 years old. This allows one stop treatment and prompt access to pediatric orthopedic experts avoiding unnecessary wait. Parents, referring physicians and even insurance companies have found our clinics to be a wonderful value in serving our community with high quality, easy access. COMMUNITY HEALTH Shriners Children’s Portland is committed to providing care within the scope of our mission without regard for the family’s ability to pay. We work collaboratively with community partners to assess community needs and to develop new clinical and community benefit programs that enhance the health and well-being of children in our community. These efforts are reported via our Community Health Needs Assessment (CHNA), completed every three years in accordance with the Patient Protection and Affordable Care Act of 2010. Annually, Shriners Children’s Portland reports to the State of Oregon on benefit provided to the community through programs such as education for medical providers and other healthcare professionals, research, and charity care. These benefits have averaged $14.4 million yearly for the past five years.

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PATIENT SATISFACTION Shriners Children’s 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.

95 100

98.4% 97.9%

96.1%

Shriners Children’s Portland Press Ganey Mean

90 85 80 75 70

*Portland Shriners score based on Likelihood to Recommend by survey received date

91.5%

Inpatient Likelihood to Recommend

2021

2022

2023

Press Ganey pediatric hospital mean for 7/1/2023 - 12/31/2023

95 100

96.5%

94.8%

94.8%

93.2%

90 85 80 75 70

Medical Practice (Outpatient) Likelihood to Recommend

2021

2022

2023

Press Ganey pediatric sites mean for 7/1/2023 - 12/31/2023

95 100

98.0%

97.9%

96.6%

96.8%

90 85 80 75 70

Ambulatory Surgery Likelihood to Recommend

2021

2022

2023

Press Ganey ambulatory pediatric survey group mean for 10/1/2023 - 12/31/2023

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CLINICAL OUTCOMES Shriners Children’s 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 Children’s Portland was awarded two Press Ganey awards: 2023 Human Experience (HX) Pinnacle of Excellence Award® and 2023 Human Experience (HX) Guardian of Excellence Award. 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 Children’s Portland consistently ranks in the top decile among pediatric facilities for patient and family satisfaction.

SPINAL PROCEDURES PERFORMED Shriners Children’s 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 orthopedic care, including surgery, on-site rehabilitation, and psychological support.

Spinal Procedures Performed 2021-2023

200

63

Mehta Casting 30.1% Spinal Fusion 64.7% Magec Rods 5.2%

150

55

45

100

140

107

103

50

0

12

9

7

2021

2022

2023

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

Surgical Site Infections: All Clean Class 1 Cases

Surgical Site Infections: Spinal Fusion (Adolescent Idiopathic Scoliosis)

3

3

<2.6% Literature Benchmark

2

2

<1.8% Literature Benchmark

1

1

0.5% 0.7%

0.4%

2023 0.0%

2021 0.0%

2022 0.0%

0

0

2021

2022

2023

Benchmark source: Ortega G, Rhee DS, Papandria DJ, Yang J, Ibrahim AM, Shore AD, Makary MA, Abdullah F. (2021, May 1). An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. The Journal of Surgical Research.

UNPLANNED READMISSIONS 30-day hospital readmission rates have become a key measure of healthcare quality. Not only do readmissions disrupt the lives of patients and their families, they are costly and expose patients to further risks from hospitalization. Shriners Children’s Portland is proud to report an average unplanned 30-day readmission rate of 3.3% for the past three years. This compares to a literature mean rate of 11.3% for children’s hospitals.*

30-Day Readmission Rate

*Data Source: Katherine A. Auger, MD; Ronald J. Teufel, II, MD; J. Mitchell Harris, II, PhD . . . Samir S. Shah, MD. (2017, February 1). Children’s Hospital Characteristics and Readmission Metrics. American Academy of Pediatrics, 139 (2).

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CONSISTENTLY

0.0% FOR CATHETER-ASSOCIATED URINARY TRACT INFECTIONS AND CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS

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9,600+ PEDIATRIC PATIENTS HAVE BEEN ADMINISTERED THE PROMIS ASSESSMENT AT SHRINERS CHILDREN’S PORTLAND.

QUALITY OF LIFE

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. Shriners Children’s Portland uses 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. PSYCHOSOCIAL HEALTH PROMIS data was instrumental in our decision to add a pediatric clinical psychologist to our medical staff team in 2020. This addition enabled a very successful rollout of our suicide screening and assessment program using the Ask Suicide-Screening Questions (ASQ) tool. Shriners Children’s Portland now consistently screens 100% of eligible outpatients using this validated questionnaire.

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NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM Shriners Children’s Portland participates in 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 complication 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 Shriners Children’s Portland, a multidisciplinary team reviews 100% of all antibiotic orders for appropriateness, including those used for surgical prophylaxis.

The best thing about our experience with the hospital was that we were certain that our kid was safe, well cared for and on her way to a full recovery. Also, our kid adds, getting an ice cream sundae at dawn on the day of her discharge was the best. ̶

Grateful parent, 2023 Press Ganey review

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MEET OUR TEAM BOARD CERTIFIED PEDIATRIC ORTHOPEDIC SURGEONS

Robert M. Bernstein, M.D. Chief of Staff Pediatric Orthopedic Surgeon Scoliosis & Spinal Deformity, Skeletal Dysplasias, General Pediatric Orthopedics, and more Education: University of Southern California Residency: Massachusetts General Hospital under the Harvard Combined Orthopedic Residency Program Fellowship: Beth Israel Hospital and Boston Children’s Hospital

Daniel J. Bouton, M.D. Pediatric Orthopedic 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 Orthopedic 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

Jeremy P. Bauer, M.D. Pediatric Orthopedic 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 Children’s Portland

Dominique D. Laron, M.D. Pediatric Orthopedic 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

Michelle C. Welborn, M.D. Pediatric Orthopedic 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 Orthopedic Surgeon General Pediatric Orthopedics, 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 Children’s St. Louis

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

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Ellen M. Raney, M.D. Medical Staff President Pediatric Orthopedic Surgeon Cerebral Palsy, Gait Analysis, Limb Length Inequality/ Deformity, Clubfoot, and Hip Dysplasias Education: Tulane University Residency: Tulane University Fellowship: Shriners Children’s Florida

Ahmad F. Bayomy, M.D. Pediatric Orthopedic Surgeon Pediatric and Adolescent Sports Medicine, Fractures and Injury Care, Lower Extremity Deformity Education: Washington State University and University of Washington School of Medicine Residency: University of Washington Fellowship: Columbia University Children’s Hospital of New York-Presbyterian (Pediatric Orthopedics), Cleveland Clinic Foundation (Orthopedic Sports Medicine)

Chinmay Paranjape, M.D. Pediatric Orthopedic Surgeon Spinal Deformities & Scoliosis Education: Duke University School of Medicine Residency: University of North Carolina Department of Orthopaedic Surgery Fellowship: Rady Children’s Hospital of San Diego

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HONORARY STAFF (RETIRED) J. Ivan Krajbich, M.D., FRCS, BSc Pediatric Orthopedic Surgeon Retired 2021 Michael Sussman, M.D. Pediatric Orthopedic Surgeon Retired 2020 Michael Aiona, M.D. Pediatric Orthopedic Surgeon Retired 2020 Dennis R. Roy, MD Pediatric Orthopedic Surgeon Retired 2021

PEDIATRIC ANESTHESIOLOGY Joselyn S. Davidson, M.D., Chief of Anesthesia Inca Chui, M.D.

Andrea Johnson, D.O. William M. Klein, M.D. Rebecca Hall, M.D. Jorge Pineda, M.D.

DIVISION CHIEFS Cerebral Palsy Ellen M. Raney, M.D. Myelodysplasia Dominique D. Laron, M.D. Hip Jeremy P. Bauer, M.D. Motion Analysis Center Jeremy P. Bauer, M.D. Sports Medicine Ahmad F. Bayomy, M.D. Skeletal dysplasia Robert M. Bernstein, M.D. Outcomes Daniel J. Bouton, M.D. Anesthesia Joselyn S. Davidson, 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.

ADVANCED PRACTICE PROFESSIONALS Bing Sun, PA-C Maria Moredock, PA-C Nancy Jacobs, CNS Ingrid Daniella Schlecter-Keenan, PA Elizabeth Mandel, RN, CPNP

PEDIATRIC HOSPITALIST Arija Iverson, M.D.

BEHAVIORAL HEALTH Catherine McClellan, Ph.D.

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TREATMENT SPECIALTIES

Osteochondroma Polydactyly (extra digits) Post-traumatic cubitus varus (Gunstock deformity) Radial/ulnar deficiency Shoulder injuries

Scoliosis and Other Spine Conditions Back pain Congenital scoliosis Infantile scoliosis Juvenile/adolescent idiopathic scoliosis Kyphosis Lordosis Neuromuscular scoliosis Post-traumatic spine disorders Spina bifida Spinal fractures Spinal muscular atrophy Spinal stenosis Spondylolysis Spondylolisthesis Thoracic insufficiency syndrome

Syndactyly (conjoined digits) Lower Extremity Conditions Blount’s disease Bowed legs Clubfoot Congenital foot deformities

Deformity secondary to trauma Femoral-acetabular impingement Flat feet (flexilble or rigid) Fracture and fracture complications In-toeing Iselin’s disease Knock knees Legg-Calvé-Perthes disease Limb deficiencies Limb deformities Length discrepancies Multiple hereditary exostosis (MHE) Osteochondroma Out-toeing Polydactyly (extra digits) Sever’s disease Syndactyly (conjoined digits) Tarsal coalition Vertical talus Hip Care Apophysitis Deformity secondary to trauma Developmental dislocation of the hip (DDH) Hip dysplasia Hip dislocation Legg-Calve-Perthes disease Slipped capital femoral epiphysis (SCFE) Chest Wall Conditions Pectus Carinatum Pectus Excavatum Poland Syndrome Others Achondroplasia Benign bone tumors Burn scars Cleidocranial dysplasia Cleft lip and palate Ear deformities (i.e., Microtia) Ehlers Danlos Syndrome Hypophosphatasia Jaw deformities Multiple Hereditary Exostosis Nail Patella Syndrome Proxima Femoral Focal Deficiency (PFFD) Torticollis

Musculoskeletal Disorders and Orthopedic Consequences of Neuromuscular Problems in Children, including: Amniotic band syndrome Arthrogryposis multiplex congenita (AMC) Cerebral palsy (CP) Charcot-Marie-Tooth disease Congenital neuromuscular disorders Skeletal dysplasia (dwarfism) Friedreich’s ataxia Metabolic bone disease

Muscular dystrophy Neurofibromatosis

Osgood-Schlatter disease Osteogenesis imperfecta Osteomyelitis Rickets Sports Injuries, including: Anterior cruciate ligament (ACL) injury

Bankart lesion Elbow injuries Hip impingement Hip labral tear Meniscus Osteochondral lesions Patella dislocation Patella-femoral instability Shoulder instability

Upper Extremity Conditions Brachial plexus palsy Brachial plexus and peripheral nerve injuries Congenital hand deformities Crooked digits Elbow injuries Fracture and fracture complications Hypoplasia of the thumb Limb deficiencies (congenital and acquired) Multiple hereditary exostosis (MHE) Obstetric birth plexus palsy

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SPECIALTY CLINICS Shriners Children’s 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; urologists; geneticists; genetic counselors; neurologists; endocrinology; cleft lip and palate/ dental; and orthopedists. 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. These interdisciplinary programs allow specialists in various disciplines to assess the nuances of each case and collaborate to identify problems. Such collaboration ultimately results in well rounded, thorough and comprehensive care for each patient. 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 Children’s 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 orthopedists, neurologists, urologists, physical and occupational therapists, and pediatricians with expertise in spina bifida care. Common spina bifida treatments and therapies include physical and occupational therapy, orthotics, and surgery.

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BONE HEALTH CLINIC The bone health clinic at Shriners Children’s Portland specializes in care for children with fragile bones. Installed in early 2023, the DEXA scan, a bone density scanner, allows our specialists to have the best information before deciding on treatments for children with weaker bones.

Treatments like infusions of zoledronic acid. Most notably, the DEXA scan helps inform medical staff to know the precise amount needed for each child who undergoes infusions.

MUSCULAR DYSTROPHY This specialty clinic provides comprehensive care from pediatric neurologists, orthopedic 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. ARTHROGRYPOSIS MULTIPLEX CONGENITA (AMC) Our medical team specializes in providing comprehensive and ongoing care and management for this rare orthopedic condition. 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 Children’s 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 orthopedics, 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 serves on the medical advisory board for Little People of America. CEREBRAL PALSY CARE INCLUDING SPASTICITY CLINIC AND TONE MANAGEMENT/ BACLOFEN CLINIC Our medical team, including pediatric orthopedists, neurologists, 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 center, and a customized plan involving surgery to correct contractures and bony alignment when necessary. A multidisciplinary team works collaboratively to improve each patient’s range of motion, motor function, and comfort.

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A very warm and welcoming experience, from the front desk security who helped us figure out where to park to the receptionist who directed us, to the registration person who answered questions and provided her phone number in case we had additional questions later.

Grateful parent, 2023 Press Ganey review

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SPINAL MUSCULAR ATROPHY At Shriners Children’s 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 improving function and managing pain that children with this condition may have and improving their quality of life. Thespecific 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, Shriners Chilren’s Portland’s medical staff can conduct several tests to diagnose the type of SMA they may have, such as blood tests, muscle biopsy, or electromyogram (EMG). BRACHIAL PLEXUS AND PERIPHERAL NERVE INJURIES The brachial plexus and peripheral nerve is a group of nerves that originate at the spinal cord in the neck and travel down the arm. These nerves control the muscles of the shoulder, elbow, wrist and hand and provide feeling in the arm. A common misconception is that brachial plexus and peripheral nerve injuries resolve on their own. Early intervention makes a big difference. The brachial plexus and peripheral nerve clinic is unique as two hand specialists are available to see each patient at the same time. Krister Freese, M.D., and Jenna Godfrey, M.D., MSPH, collaborate for the best experience for each child and their family. In addition to orthopedic hand specialists, occupational therapy, orthotics and social work are also available at the clinic. COMPREHENSIVE SPORTS HEALTH AND MEDICINE Shriners Children’s Portland’s sports medicine program boasts a highly specialized team of orthopedic surgeons, physical therapists, and an athletic trainer. Our collaborative approach allows us to provide elevated care in regards to injury prevention, surgical and non-surgical care, and guide a safe return back to activity. The background we have with children and adolescents sports injuries or other bone and joint problems, helps promote that patient’s care. The concerted efforts of the athlete’s family, coaches, school athletic trainers, and local physical therapists also helps to accomplish our #1 priority of returning them to play safely. WALK-IN FRACTURE AND SPORTS INJURY Shriners Children’s Portland offers a walk in clinic for fractures and sports injuries five days a week, no appointment necessary for children up to 17 years old. An orthopedic specialist is available to see patients upon arrival. This non-emergent clinic does not require you to bring X-rays, as radiology services are available on-site.

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SUPPORT SERVICES

REHABILITATION SERVICES The rehabilitation services provided at Shriners Children’s 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 orthopedic 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 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.

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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 participation in meaningful activities. Occupational therapy helps maximize independence in daily activities such as dressing, grooming, bathing, social participation, play and education by assessing orthopedic 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 Children’s 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.

My child has complex medical needs and we have been inpatient at many local hospitals. Shriners Children’s Portland is always the hospital that we feel most comfortable at. We have always been treated with gentleness and respect and the good care received means that recovery is easier. Really can’t say enough good things about how well the whole experience went, this time, and every time. ̶

Grateful parent, 2023 Press Ganey review

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ADVANCED TECHNOLOGY

MOTION ANALYSIS CENTER The high-tech motion analysis conducted in the motion analysis center is integral to the complex, comprehensive care provided by Shriners Children’s 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. Recommendations provided after a motion analysis study may include surgical procedures, tone management, physical therapy, occupational therapy, orthoses, prostheses and assistive walking devices. PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES (POPS) – NORTHWEST Children living with orthopedic 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. POPS — Northwest is the west coast fabrication center, building devices for multiple Shriners Children’s 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. 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. Shriners Children’s Portland 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.

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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. PENTERO MICROSCOPE The Pentero Microscope provides detailed magnified views of surgeries which allow for incredibly complex procedures like spine surgeries and surgeries that involve nerve repair. Advanced illumination deliver visual clarity and provides up to a 39x magnification boost. LOKOMAT® The Lokomat® device is a unique and valuable rehab tool for children. It combines an exoskeleton with dynamic body support. The device moves up and down with the patient to mimic a natural walking pattern, a valuable tool for physical therapy.

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SHRINERS CHILDREN’S PORTLAND PEDIATRIC SPINE PROGRAM At Shriners Children’s Portland, we have a dedicated multidisciplinary team approach when it comes to the care of pediatric spinal disorders. We have four pediatric fellowship-trained surgeons dedicated to treating patients with pediatric spinal disorders, making it one of the largest groups on the west coast. Additionally, to create a holistic care model for children, we have a pediatric psychologist as an integral part of the team, as well as in-house physical therapists and orthotists, dedicated radiology technicians, advanced practice providers, dedicated inpatient and outpatient nurses, medical assistants and care managers to complete the team. We offer a wide array of both nonsurgical and surgical treatments for pediatric spinal disorders, including innovative surgical treatments such as vertebral body tethering (VBT) and magnetically controlled growing rods (MCGR or MAGEC rods). We scrutinize and analyze patient-reported outcomes with all of our treatments to improve our care delivery, efficiency and efficacy. Additionally, every single surgical case, no matter how big or small, is presented at a weekly conference for discussion amongst the spine surgeons to ensure the optimal treatment is being performed for every child and for continued quality improvement. Through all of this, safety remains our top priority. Certain technological advancements have allowed us to better achieve this goal. We are one of the only centers in the Pacific Northwest with the EOS imaging system, which allows for low-radiation x-rays of the spine to be obtained in growing children. In surgery, spinal cord monitoring allows us to monitor the health and function of the spinal cord in real-time during surgery and has become the standard of care at our institution. Finally, we are the only pediatric center in Oregon with an imaging device known as the O-arm specifically only using it for children, allowing us to obtain real-time 3D imaging of the spine in surgery. Combined with a technology known as navigation, this allows us to safely place our implants into the spine in a reproducible manner with accuracy down to the millimeter. The combination of our multidisciplinary team, ongoing analysis and scrutiny of patient reported outcomes and enabling technologies such as the O-arm, EOS and spinal cord monitoring allows us to provide the best and safest care for children with spinal disorders.

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SPECIALIZED CARE

NEUROMUSCULAR We have several specific specialists running studies at Shriners Children’s Portland that are not being done anywhere else. Some include: Dr Welborn’s biomarker study looking at each child’s specific biomarker level to help inform individualized care. The intense motor learning camp allows children to set individual goals in which games are adapted to help them reach their goals. Dr Bauer’s idiopathic toe walking study, is designed to determine if there are a series of screening tools that will help us determine whether they have idiopathic toe walking or mild cerebral palsy, in addition to determining whether there is a difference in outcomes following surgery or serial casting and if there is a genetic link.

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The wonderful team at Shriners Children’s provided outstanding care to our son. Many thanks to all.

Grateful parent, 2023 Press Ganey review

CHEST WALL CONDITIONS At Shriners Children’s Portland, we specialize in treating children with chest wall malformations of all degrees, including pectus excavatum (sunken chest), pectus carinatum (raised chest) and Poland Syndrome (under-developed chest muscles.) Treatments for these conditions are very effective, especially when diagnosed early. Our pediatric specialists guide all treatment decisions, and consider minimally invasive options for each patient. The medical team works collaboratively to create a personalized plan focused on the unique needs of each patient. Our comprehensive care is delivered under one roof to ensure children and their families receive the finest care in a convenient, wrap-around care environment. CLEFT LIP & PALATE Shriners Children’s Portland specializes in the repair of facial clefts and cleft palates in children, along with other oral and maxillofacial conditions. Our multidisciplinary team, including a plastic surgeon, oral and maxillofacial surgeons, otolaryngologist, speech pathologists and more, work together in coordinated appointments to repair patients’ cleft lip and palate and address other related needs and concerns. Our team focuses exclusively on children and understands how growth and development affects the outcomes for a child’s appearance and function. Our specialists evaluate each child and create a customized treatment plan that ensures a comprehensive and family-centered approach to care.

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Shriners Children’s Portland became an American Cleft Palate Craniofacial Association (ACPA) approved team in 2023.

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AWARDS & ACCOLADES

PRESS GANEY AWARDS: 2023 Human Experience (HX) Pinnacle of Excellence Award® 2023 Human Experience (HX) Guardian of Excellence Award®

US NEWS & WORLD REPORT: Best Children’s Hospitals: Pediatric Orthopedics 2023 -2024 Shriners Children’s Portland together with Doernbecher Children’s Hospital

STAFF AWARDS: Portland Top Doctors

Fifteen members of Shriners Children’s Portland medical staff were honored with Portland Top Docs award, as voted by their peers in the medical community. Seven pediatric orthopedic surgeons, four pediatric anesthesiologist and four advanced practice practitioners.

Pediatric orthopedic surgeons Jeremy P. Bauer, MD Ahmad F. Bayomy, MD Daniel J. Bouton, MD Krister P. Freese, MD Kathryn O. Fuchs, MD Heather Marie Kong, MD Michelle C. Welborn, MD Pediatric Anesthesiologists Inca Chui, MD Rebecca Ann Hall, MD Andrea Michelle Johnson, DO Jorge A. Pineda, MD

Bauer, Jeremy, MD • SCORES (Sports Medicine) Grant • Bosch Sensortec/Matusi Grant $50,000 • The William E and Thelma F Housman Foundation for Medical Research $80,000 (Along with Dr. Bouton) Freese, Krister, MD • Decoding Motor Intent for Hand Prosthesis Control (Freese/ Multicenter) Welborn, Michelle, MD • 2022- Current: Physician Leadership Committee Shriners Children’s • 2020-2024: POSNA Educational Courses Committee • 2022-2023: POSNA Chair Webinar Committee (reelected as Chair) • Reviewer for Spine • SRS Grant Committee • SRS Research Council for 2022-2023 • Principal Researcher with the Pediatric Spine Foundation

APPs Maria T. Mordock, PA Nancy Jacobs, NP Elizabeth A. Mandel, NP Bing Sun, PA

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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 Shriners Children’s Portland in 2018. TEDI stands for: PATIENT-CENTERED CARE

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 Children’s Portland.

TRAUMA INFORMED EVIDENCE-BASED DRIVEN BY RESEARCH INSPIRED

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CARE MANAGEMENT AND SOCIAL WORKERS The care management team at Shriners Children’s consists of registered nurses and social workers who understand the challenges that dealing with health conditions and medical procedures can cause. Their main goal is to be a resource for families throughout treatment and help them navigate the process so that the family can focus on the child and helping them recover. 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. PEDIATRIC PSYCHOLOGY Access to quality mental health services is an increasing need for the younger population. Child psychologist Catherine McClellan, PhD helps shepherd children through their healthcare journey. She works with patients pre-surgically, including children preparing for spine surgery and amputation, to help prepare for surgery and develop enhanced pain management skills. Given the well-established connection between physical and mental health outcomes, Dr. McClellan and her team work with patients to cultivate resiliency, support families, and provide targeted and timely care so that Shriners Children’s patients can feel their best. 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.

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