St Mary Medical Center


About the Facility

CMS Certification Number (CCN)
05T191
Ownership Type
Non-profit
CMS Region
San Francisco
Certification Date
Address
1050 Linden Ave
Phone Number
(562) 491-9170

Facility Medical Condition Statistics

All other conditions
49
Brain disease or condition (non-traumatic)
15
Brain injury (traumatic)
14
Hip or femur fracture
29
Hip or knee replacement, amputation or other bone or joint condition
28
Nervous system disorder (excluding stroke)
18
Spinal cord disease or condition (non-traumatic)
Data not available for this reporting period.
Spinal cord injury (traumatic)
Data not available for this reporting period.
Stroke
28

Facility Quality of Patient Care Measures

Catheter-associated urinary tract infections (CAUTI)
Standardized infection ratio (SIR) 95% confidence interval - lower limit
Not Available
SIR 95% confidence interval - upper limit
Not Available
Comparative performance category
Not Available
Catheter days
375
Predicted number of infections (B)
0.775
Number of infections reported (A)
1
SIR (A/B)
Not Available
Percentage of patients whose functional abilities were assessed and functional goals were included in their treatment plan
Numerator
170
Denominator
170
Facility rate
100.0
Change in patients ability to care for themselves
Average risk-adjusted change score
9.1
Denominator
146
Average observed change score
9.1
Change in patients ability to move around
Average risk-adjusted change score
28.2
Denominator
146
Average observed change score
29.7
Percentage of patients who are at or above an expected ability to care for themselves at discharge
Numerator
51
Denominator
146
Facility rate
34.9
Percentage of patients who are at or above an expected ability to move around at discharge
Numerator
70
Denominator
146
Facility rate
47.9
Percentage of IRF patients who experience one or more falls with major injury during their IRF stay
Numerator
0
Denominator
170
Facility rate
0.0
Clostridium difficile Infection (CDI)
Standardized infection ratio (SIR) 95% confidence interval - lower limit
0.020
SIR 95% confidence interval - upper limit
1.977
Comparative performance category
No Different than the National Benchmark
Patient days
5,326
Predicted number of infections (B)
2.495
Number of infections reported (A)
1
SIR (A/B)
0.401
Percentage of healthcare personnel who got a flu shot for the current season
Number of health care workers vaccinated
46
Number of health care workers
54
Rate of flu vaccination
85.2
Rate of potentially preventable hospital readmissions 30 days after discharge from an IRF
Number of potentially preventable readmissions following discharge
22
Number of eligible stays
244
Unadjusted potentially preventable readmission rate
9.02
Risk-standardized potentially preventable readmission rate (RSRR)
8.92
Lower limit of the 95% confidence interval on the RSRR
7.11
Upper limit of the 95% confidence interval on the RSRR
11.27
Comparative performance category
No Different than the National Rate
Rate of potentially preventable hospital readmissions during the IRF stay
Number of potentially preventable readmissions
10
Number of eligible stays
269
Unadjusted potentially preventable readmission rate
3.72
Risk-standardized potentially preventable readmission rate (RSRR)
4.42
Lower limit of the 95% confidence interval on the RSRR
2.98
Upper limit of the 95% confidence interval on the RSRR
6.30
Comparative performance category
No Different than the National Rate
Rate of successful return to home or community from an IRF
Observed number of discharges to community (DTC)
138
Number of eligible stays
217
Observed discharge to community rate
63.59
Risk-standardized discharge to community rate
65.08
Lower limit of the 95% confidence interval on the risk-standardized discharge to community rate
59.56
Upper limit of the 95% confidence interval on the risk-standardized discharge to community rate
70.29
Comparative performance category
No Different than the National Rate
Medicare Spending Per Beneficiary (MSPB) for patients in IRFs
MSPB score
1.11
Number of eligible episodes
227
Percentage of patients whose medications were reviewed and who received follow-up care when medication issues were identified
Numerator
169
Denominator
170
Facility rate
99.4
Percentage of patients with pressure ulcers/pressure injuries that are new or worsened
Numerator
3
Denominator
170
Facility observed rate
1.8
Facility risk-adjusted rate
1.7
Percentage of IRF healthcare personnel who completed COVID-19 primary vaccination series
Number of health care workers vaccinated
52
Number of health care workers
52
Rate of COVID-19 vaccination
100.0