Smdc Medical Center Dba Essentia Health-Duluth


About the Facility

CMS Certification Number (CCN)
24T019
Ownership Type
Non-profit
CMS Region
Chicago
Certification Date
Address
502 East Second Street
Phone Number
(218) 786-5980

Facility Medical Condition Statistics

All other conditions
54
Brain disease or condition (non-traumatic)
20
Brain injury (traumatic)
34
Hip or femur fracture
Data not available for this reporting period.
Hip or knee replacement, amputation or other bone or joint condition
22
Nervous system disorder (excluding stroke)
19
Spinal cord disease or condition (non-traumatic)
13
Spinal cord injury (traumatic)
Data not available for this reporting period.
Stroke
166

Facility Quality of Patient Care Measures

Catheter-associated urinary tract infections (CAUTI)
Standardized infection ratio (SIR) 95% confidence interval - lower limit
0.555
SIR 95% confidence interval - upper limit
4.213
Comparative performance category
No Different than the National Benchmark
Catheter days
840
Predicted number of infections (B)
2.290
Number of infections reported (A)
4
SIR (A/B)
1.747
Percentage of patients whose functional abilities were assessed and functional goals were included in their treatment plan
Numerator
338
Denominator
338
Facility rate
100.0
Change in patients ability to care for themselves
Average risk-adjusted change score
11.8
Denominator
280
Average observed change score
9.6
Change in patients ability to move around
Average risk-adjusted change score
30.0
Denominator
286
Average observed change score
26.6
Percentage of patients who are at or above an expected ability to care for themselves at discharge
Numerator
152
Denominator
287
Facility rate
53.0
Percentage of patients who are at or above an expected ability to move around at discharge
Numerator
169
Denominator
287
Facility rate
58.9
Percentage of IRF patients who experience one or more falls with major injury during their IRF stay
Numerator
0
Denominator
338
Facility rate
0.0
Clostridium difficile Infection (CDI)
Standardized infection ratio (SIR) 95% confidence interval - lower limit
0.338
SIR 95% confidence interval - upper limit
2.568
Comparative performance category
No Different than the National Benchmark
Patient days
7,282
Predicted number of infections (B)
3.758
Number of infections reported (A)
4
SIR (A/B)
1.065
Percentage of healthcare personnel who got a flu shot for the current season
Number of health care workers vaccinated
60
Number of health care workers
61
Rate of flu vaccination
98.4
Rate of potentially preventable hospital readmissions 30 days after discharge from an IRF
Number of potentially preventable readmissions following discharge
10
Number of eligible stays
176
Unadjusted potentially preventable readmission rate
5.68
Risk-standardized potentially preventable readmission rate (RSRR)
8.10
Lower limit of the 95% confidence interval on the RSRR
6.39
Upper limit of the 95% confidence interval on the RSRR
10.28
Comparative performance category
No Different than the National Rate
Rate of potentially preventable hospital readmissions during the IRF stay
Number of potentially preventable readmissions
6
Number of eligible stays
197
Unadjusted potentially preventable readmission rate
3.05
Risk-standardized potentially preventable readmission rate (RSRR)
4.31
Lower limit of the 95% confidence interval on the RSRR
2.58
Upper limit of the 95% confidence interval on the RSRR
6.45
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)
102
Number of eligible stays
159
Observed discharge to community rate
64.15
Risk-standardized discharge to community rate
64.87
Lower limit of the 95% confidence interval on the risk-standardized discharge to community rate
58.01
Upper limit of the 95% confidence interval on the risk-standardized discharge to community rate
70.51
Comparative performance category
No Different than the National Rate
Medicare Spending Per Beneficiary (MSPB) for patients in IRFs
MSPB score
1.02
Number of eligible episodes
162
Percentage of patients whose medications were reviewed and who received follow-up care when medication issues were identified
Numerator
338
Denominator
338
Facility rate
100.0
Percentage of patients with pressure ulcers/pressure injuries that are new or worsened
Numerator
6
Denominator
338
Facility observed rate
1.8
Facility risk-adjusted rate
2.1
Percentage of IRF healthcare personnel who completed COVID-19 primary vaccination series
Number of health care workers vaccinated
44
Number of health care workers
48
Rate of COVID-19 vaccination
91.7