Community Service Plan 2013

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1 Community Service Plan 2013

2 Table of Contents Introduction... 2 New York State s Prevention Agenda The Adirondack Rural Health Network... 3 Saratoga Hospital s Mission, Vision, and Values... 4 Saratoga Hospital Service Area... 7 Public Participation & Health Needs Assessment Process Three Year Action Plan Dissemination of the Report Maintaining Engagement and Tracking Progress Appendix 1: Methodology and Data Sources Appendix 2: Community Health Needs Assessment Process Data Consultants Appendix 3: Adirondack Rural Health Network Membership Affiliation, Steering Committee & Community Health Planning Committee Appendix 4: Community Health Planning Committee Meeting Schedule and Attendance List Appendix 5: ARHN Survey Response List of 22

3 Introduction In keeping with the New York State Department of Health s efforts to reform health and healthcare in New York, local health departments and hospitals were requested to collaborate in community health assessment and community health improvement planning in In conjunction with the development of the state s new health regional planning hospitals and local health departments were asked to work together with community partners to assess the health challenges in communities, identify local priorities and develop and implement plans to address them. Hospitals and local health departments were charged with working together and with other partners to identify and develop a plan for addressing at least two priorities in the new Prevention Agenda. New York State s Prevention Agenda The Prevention Agenda is New York State s health improvement plan for 2013 through 2017, developed by the New York State Public Health and Health Planning Council (PHHPC) at the request of the Department of Health, in partnership with more than 140 organizations across the state. This plan involves a unique mix of organizations including local health departments, health care providers, health plans, community based organizations, advocacy groups, academia, employers as well as state agencies, schools, and businesses whose activities can influence the health of individuals and communities and address health disparities. This unprecedented collaboration informs a five-year plan designed to demonstrate how communities across the state can work together to improve the health and quality of life for all New Yorkers. Recent natural disasters in New York State that have had an impact on health and wellbeing re-emphasize the need for such a roadmap. In addition, the Prevention Agenda serves as a guide to local health departments as they work with their community to develop mandated Community Health Assessments and to hospitals as they develop mandated Community Service Plans and Community Health Needs Assessments required by the Affordable Care Act over the coming year. The Prevention Agenda vision is New York as the Healthiest State in the Nation. The plan features five priority areas: Prevent Chronic disease Promote healthy and safe environments Promote healthy women, infants and children 1 Excerpt from New York State Department of Health web site 2 of 37

4 Promote mental health and prevent substance abuse Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcare-associated Infections The Prevention Agenda establishes goals for each priority area and defines indicators to measure progress toward achieving these goals, including reductions in health disparities among racial, ethnic, and socioeconomic groups and persons with disabilities. Working within the framework provided by New York State s Prevention Agenda, Saratoga Hospital and Saratoga County Public Health Nursing Service collaborated in the development of a Community Health Needs Assessment. Additionally, Saratoga Hospital and Saratoga County Public Health Nursing Service participated in regional health assessment and planning efforts conducted by the Adirondack Rural Health Network The Adirondack Rural Health Network The Adirondack Rural Health Network is a program of the Adirondack Health Institute, Inc. (AHI). AHI is a 501c3 not-for-profit organization that is licensed as an Article 28 Central Service Facility. AHI is a joint venture of Adirondack Health (Adirondack Medical Center), Community Providers, Inc. (Champlain Valley Physicians Hospital Medical Center) and Hudson Headwaters Health Network. The mission of AHI is to promote, sponsor, foster and deliver programs, activities and services which support the provision of comprehensive health care services to the people residing in the Adirondack region. Established in 1992 through a New York State Department of Health Rural Health Development Grant, the Adirondack Rural Health Network (ARHN) is a regional multi-stakeholder coalition that conducts community health planning activities by providing the forum for local public health services, community health centers, hospitals, community mental health programs, emergency medical services, and other community-based organizations to assess regional needs and the effectiveness of the rural health care delivery system. ARHN plans, facilitates and coordinates many different activities required for successful transformation of the health care system including: conducting community health assessments, provider education and training, patient and family engagement, identifying and implementing best practices to optimize health care quality, and publishing regional and county-specific data and reports at Since 2002, the ARHN has been recognized as the leading sponsor of formal health planning for Essex, Fulton, Hamilton, Saratoga, Warren and Washington Counties. During of 37

5 the ARHN expanded its regional community health planning efforts to include Clinton and Franklin counties, and currently includes critical stakeholders from all eight counties in the regional planning process. The ARHN provides a neutral, trusted mechanism through which key stakeholders throughout the region can plan, facilitate and coordinate the activities necessary to complete their required community health planning documents, and strategize on a regional level to address common health care concerns. The ARHN provides guidance and technical assistance to the Community Health Planning Committee (CHPC), a regional forum for hospitals, county health departments and community partners, who provide oversight of planning and assessment activities. The group is further comprised of subcommittees developed to address areas specific to hospital, public health and data-specific requirements. Regular meetings of each subcommittee and the full CHPC have resulted in a systematic approach to community health planning and the development of regional and local strategies to address health care priorities. Saratoga Hospital s Mission, Vision, and Values Saratoga Hospital, located in the city of Saratoga Springs, is an acute-care hospital licensed for 171 beds, including 129 medical/surgical, 12 pediatric, 14 maternity and 16 psychiatry beds. Saratoga Hospital also offers emergency medical and ambulatory surgery services, as well as a full range of other outpatient services. The Hospital also operates a 36-bed skilled nursing facility on-site. Additionally, the Hospital operates hospital-based extension clinics as well as Saratoga Surgery Center, a free-standing ambulatory surgery center. Saratoga Hospital encompasses an integrated delivery system that includes the acute-care Hospital as well as the following outpatient facilities listed below. These facilities offer an array of convenient, accessible diagnostic and treatment programs, including outpatient medical imaging, occupational health, urgent care, and rehabilitation. Galway Family Health Center Malta Medical Arts Regional Therapy Center at Malta Regional Therapy Center of Saratoga Hospital Saratoga Family Health Center Saratoga Hospital Outpatient Physical Therapy Center Saratoga Surgery Center 4 of 37

6 Schuylerville Family Health Center Wilton Medical Arts Saratoga Outpatient Center on Care Lane Saratoga Outpatient Center at One West Saratoga Medical Oncology/Hematology Scotia-Glenville Family Medicine Mission To serve the people of the Saratoga region by providing them access to excellence in healthcare in a supportive and caring environment. Vision Saratoga Hospital will be the preeminent provider of the highest quality healthcare for Saratoga region residents. We will be a regional provider for certain service lines and, as an organization, will occupy a niche between traditional community hospitals and tertiary medical centers. We will be both a high-quality and high-service provider and will be known for our timely acquisition of cutting-edge technology. We will increase inpatient capacity to keep pace with our growing region. Eventually, all inpatient rooms will be private to help provide the privacy and dignity that all patients deserve. We will develop, over time, the Saratoga Medical Park at Malta into an integrated healthcare campus to serve the growing needs of the Saratoga region. We will continue to expand outpatient services, choosing the most convenient locations possible. Our goal is for the majority of Saratoga residents to be within 10 minutes of a Saratoga Hospital-affiliated facility. We will recruit and retain highly skilled physicians. We will build relationships with physicians and other providers to help ensure their long-term commitment to the Saratoga region. 5 of 37

7 We will be recognized as a community leader. Employees will be encouraged to assume leadership roles in community-based organizations. The Hospital will partner with other worthy organizations whose goals are to improve the communities we serve. We will be known as an innovative organization one that is always looking for a better way to provide a service or meet a community need. We will generate sufficient operating margin to allow it to meet community needs. Values QUALITY: Saratoga Hospital continuously evaluates and monitors our quality against performance benchmarks from regional and national organizations. Saratoga Hospital continuously cultivates a culture of quality whereby every employee is always focused on the delivery of high-quality care and encouraged to make suggestions when improvements are possible. SERVICE: Saratoga Hospital places the highest priority on providing outstanding customer service to our patients, physicians, and visitors. Service excellence is part of the culture at Saratoga Hospital, and the organization is committed to constantly enhancing the patient experience. PEOPLE: Saratoga Hospital understands that people are our most valued resource and, as such, every employee, physician, and volunteer deserves respect. Saratoga Hospital offers a caring and supportive environment for its employees and one that cultivates leadership development. GROWTH: Saratoga Hospital remains ready to meet the needs of a growing Saratoga region, through expansion of existing services or the development of new services and sites when justified. 6 of 37

8 FINANCE: Saratoga Hospital maintains financial strength in order to provide resources for a growing Saratoga region. Saratoga Hospital recognizes the important role that our community plays in philanthropic support. We nurture the partnership between Saratoga Hospital and the community to meet the growing healthcare needs of the Saratoga region. Saratoga Hospital Service Area 2 The service area for Saratoga Hospital is composed of all of the ZIP codes in Saratoga County and the ZIP codes for Greenwich and Fort Edward which are in Washington County. Historically, about 90% of Saratoga Hospital s patients reside within this geography. Saratoga Hospital s Service Area 2 Saratoga Hospital s service area is defined as all of the ZIP codes in Saratoga County plus two ZIP codes that lie in Washington County along the Saratoga County border. The demographic characteristics of these two Washington County ZIP codes closely resemble those of Saratoga County. Over 84% of Saratoga Hospital s inpatients reside in Saratoga County. For the purposes of determining the health needs of the community, Saratoga Hospital assumed that the needs identified for Saratoga County reflect the health needs for the two Washington County ZIP codes as well. 7 of 37

9 In 2012, almost 22,600 residents of Saratoga Hospital s service area required hospitalization. Of this total, over 7,600 (34%) were discharged from Saratoga Hospital. These 7,600 discharges represented 87% of the total discharges from Saratoga Hospital. The following table shows the patient distribution by ZIP Code for Saratoga Hospital Patient Origin for Saratoga Hospital 3 ZIP Code Discharges Discharges Saratoga Hospital Saratoga Hospital Saratoga Hospital Of Patient From All NYS From Percent of Cumulative Market Residence Town Name Hospitals Saratoga Hospital Total Dependency Share Saratoga Springs 3,648 2, % 28.2% 68.1% Ballston Spa 3,126 1, % 48.6% 57.4% Gansevoort 1, % 56.6% 45.6% Corinth % 60.2% 41.7% Mechanicville 1, % 63.6% 19.4% Schuylerville % 66.7% 55.7% Greenfield Center % 69.7% 68.4% Clifton Park 3, % 72.5% 6.9% Ballston Lake 1, % 74.7% 18.2% Greenwich % 76.9% 31.3% Stillwater % 78.8% 33.3% Middle Grove % 80.6% 58.1% Porter Corners % 81.8% 56.9% Galway % 82.8% 37.5% Fort Edward 1, % 83.7% 5.6% Hadley % 84.5% 21.1% South Glens Falls % 85.0% 5.3% Burnt Hills % 85.5% 14.5% Rock City Falls % 85.9% 50.8% Waterford 1, % 86.2% 2.5% Rexford % 86.5% 4.7% Round Lake % 86.7% 31.8% Service Area Total 22,621 7, % Other Areas 1, % 100.0% Saratoga Hospital Total 8, % 3 Source: HANYS Market Expert On-Line System based on SPARCS Data 8 of 37

10 Based on estimates for 2013, 234,048 people live within Saratoga Hospital s service area of which 49% are male and 51% are female. Of the total female population, approximately 36% are of child-bearing age. People over the age of 65 constitute 15% of the population and children under the age of 15 make up 18% of the population. The average household income is $81,850 which is 15% higher than the national average of $69,637. Ethnically, 92% of the population is white, non-hispanic and 35% of the population over the age of 25 has achieved an educational level of Bachelor s degree or higher. By 2018 the population of this area is expected to grow by 1.8% making it one of the fastest growing regions in New York State. The greatest growth will be for people 65 years and older. This segment of the population is expected to grow by over 15% within the next five years. The following tables summarize the socio-demographic profile for the residents of Saratoga Hospital s service area. 4 4 Copyright 2013, The Nielsen Company, 2013 Truven Health Analytics 9 of 37

11 DEMOGRAPHIC CHARACTERISTICS Service Area USA Total Population 231, ,745, Total Population 234, ,861, Total Population 238, ,322,277 % Change % 3.3% Average Household Income $81,850 $69, % Change Total Male Population 115, , % Total Female Population 118, , % Females, Child Bearing Age (15-44) 42,699 41, % POPULATION DISTRIBUTION Age Distribution Age Group 2013 % of Total 2018 % of Total USA % , % 40, % 20.1% , % 10, % 4.3% , % 21, % 9.8% , % 25, % 13.4% , % 63, % 28.6% , % 35, % 11.0% , % 41, % 12.7% Total 234, % 238, % 100.0% HOUSEHOLD INCOME DISTRIBUTION Income Distribution 2008 Household Income HH Count % of Total USA % <$15K 7, % 12.8% $15-25K 7, % 10.7% $25-50K 19, % 26.4% $50-75K 18, % 19.5% $75-100K 14, % 12.0% Over $100K 25, % 18.6% Total 94, % 100.0% EDUCATION LEVEL Education Level Distribution 2013 Adult Education Level Pop Age 25+ % of Total USA % Less than High School 3, % 6.2% Some High School 8, % 8.4% High School Degree 44, % 28.4% Some College/Assoc. Degree 49, % 28.9% Bachelor's Degree or Greater 56, % 28.1% Total 162, % 100.0% RACE/ETHNICITY Race/Ethnicity Distribution Race/Ethnicity 2013 Pop % of Total USA % White Non-Hispanic 216, % 62.3% Black Non-Hispanic 3, % 12.3% Hispanic 6, % 17.3% Asian & Pacific Is. Non-Hispanic 4, % 5.1% All Others 4, % 2.9% Total 234, % 100.0% 10 of 37

12 Public Participation & Health Needs Assessment Process 5 The process of identifying the important healthcare needs of the residents of Saratoga County involved both data analysis and consultation with key members of the community. The data was collected from multiple sources including publically available health indicator data, data collected from a survey conducted by the Adirondack Rural Health Network and a survey conducted by Saratoga Hospital. The results have been published in the Saratoga County Community Health Needs Assessment 2013 (CHNA). The health indicator data is collected and published by New York State and contains over 300 different health indicators. Since 2003, The Adirondack Rural Health Network has been compiling this data for the region and producing reports to inform healthcare planning on a regional basis. Last year, ARHN undertook a project to systemize this data into a relational database to provide improved access and analysis. The results of this analysis provide a statistical assessment at the health status for the region and each county therein. In December 2012 and January 2013, the Adirondack Regional Health Network (ARHN) conducted a survey of selected stakeholders representing health care and service-providing agencies within the eight-county region. The results of the survey are intended to provide an overview of regional needs and priorities, to inform future planning and the development of a regional health care agenda. The survey results were presented at both the county and regional levels. Saratoga Hospital also conducted a survey of the residents of Saratoga County to solicit information regarding attitudes about healthcare and healthcare challenges people face in their daily lives. Using the results of the indicator analysis and the surveys, a community health assessment team (CHAT) was convened to identify and prioritize the current healthcare challenges for the residents of Saratoga County. The CHAT consisted of representatives from Saratoga Hospital and the Saratoga County Public Health Nursing Service. Three Year Action Plan To address health needs identified, Saratoga Hospital will engage key community partners in implementing evidence-based strategies across Saratoga County. Acknowledging that many 5 See Appendix 1 for details 11 of 37

13 organizations and resources are in place to address the health needs of our community, Saratoga Hospital has strategically reviewed both internal and external resources. This implementation strategy will explain how Saratoga Hospital will address health needs identified in the CHNA by continuing existing programs and services and by implementing new strategies. The implementation strategy will also explain why the Hospital cannot address all the needs identified in the CHNA and, when applicable, how Saratoga Hospital will support other organizations in doing so. How Saratoga Hospital will address health needs The following Saratoga Hospital Community Health 2013 plan outlines the challenges, strategies, activities, and outcomes for each of the five Prevention Agenda focus areas identified as needs in the CHNA. The plan includes existing Hospital programs, services, and resources that will continue to address priority health needs. Some activities will require Saratoga Hospital to secure grant funding before they can be implemented. Many of the strategies and activities address risk factors associated with multiple health problems. For example, strategies to reduce obesity will affect heart disease and diabetes. These strategies also might have a positive impact on mental health, as will strategies to reduce substance abuse. The strategies and activities outlined here will be implemented in coordination with Saratoga County Public Health Nursing Service. Many of these strategies align closely with those of other community-based organizations. I. New York State Prevention Agenda Topic: Prevent Chronic Disease Focus Area: Increase access to high-quality chronic-disease preventive care and management in both clinical and community settings Community Health Need: The rate of diabetes deaths is increasing in Saratoga County. Many residents are at risk for developing diabetes or have poorly controlled diabetes. Disparities exist for diabetes management, care, and education. Coordination of care for diabetes patients is not optimal. Saratoga Hospital s Strategy: Through the Saratoga Center for Endocrinology and Diabetes, Saratoga Hospital continues to meet the needs of diabetic patients in the 12 of 37

14 community. Saratoga Hospital will increase screening rates for diabetes by providing a diabetes risk-assessment quiz to communities at health fairs and refer at-risk patients to primary care providers for follow-up. Saratoga Hospital will also provide evidencebased programs addressing strategies for diabetes prevention to high-risk patients by researching, designing, and implementing new programs to meet the standards set by the CDC. Nutrition & Diabetes Education Services staff will be trained to deliver CDC Prevention Programs in community settings. Saratoga Hospital will offer high-quality diabetes education and support for all diabetes patients by using evidence-based resources for education programs and support groups. Staff will be qualified and credentialed in their fields. To reduce disparities, Saratoga Hospital will improve access to diabetes management programs for residents of outlying areas and will include provision of nutrition and diabetes education services in plans for new primary care sites. To improve access to diabetes management education for low-income patients, Saratoga Hospital will offer nutrition and diabetes education services at the new Saratoga Community Health Center and the Hospital s three family health centers. With our community partners, Saratoga Hospital will provide vouchers for the purchase of fresh fruits, vegetables, diabetes medication, and testing supplies for those people needing assistance. Saratoga Hospital will reduce language and cultural barriers to diabetes care and education by providing diabetes educational services in Spanish as needed and continuing to offer interpreter services for many languages, including sign language for those with hearing impairments. Saratoga Hospital will improve diabetes patient care by disseminating advanced automated medical record systems among providers, enhancing the collection of program data and streamlining communication. Inpatient Clinical Nutrition will refer appropriate patients to Outpatient Nutrition for counseling. Community Partners: Primary care providers, health fair sponsors, CDC, NYSDOH, Center for Excellence in Aging & Community Wellness (SUNY Albany), Cornell Cooperative Extension, Diabetes Program Advisory Board, Saratoga County Public Health Nursing Service, Lions Club, Saratoga Farmers Market, Price Chopper, and Novo Nordisk (Spanish-speaking diabetes educator and dietitian, and electronic medical records system developers). 13 of 37

15 Outcomes: Reduce the rate of short-term diabetes hospitalizations and increase the number of patients with diabetes whose blood glucose is well-controlled. Community Health Need: Heart disease and cancer are the leading causes of death in Saratoga County. Heart disease and cancer patients in Saratoga County need more access to high-quality care and support services. The number of malignant melanoma cases is increasing in Saratoga County. Almost 30% of adults in the community are obese. Saratoga Hospital s Strategy: Saratoga Hospital will enhance the management of congestive heart failure (CHF) patients, reducing readmissions by moving CHF patients to the high nutrition-risk category of care. Community programs will be offered twice a year to reinforce CHF self-management concepts and address diet more thoroughly. Saratoga Hospital will continue the NYSDOH grant-funded, Cancer Screening Program which engages community partners in providing a robust program of outreach to build demand for cancer screening utilizing the existing partnerships of 31 providers to offer screening services and continue to build new partnerships and facilities that will ensure coverage for all residents of Saratoga County. By working with community partners to establish and maintain a breast cancer support group, Saratoga Hospital will offer support for breast cancer patients in Saratoga Springs. Saratoga Hospital will help defray the cost of treatment for financially challenged cancer patients by conducting annual fundraising events, such as the Run for the ROC, to support oncology patients. A grant from the Capital Region Special Surgery Race for Hope will help support cancer patients in need. Saratoga Hospital will help cancer patients find support services by providing the services of a licensed social worker who is training as an American Cancer Society Patient Navigator. Saratoga Hospital will also offer a comprehensive skin cancer detection and screening program to increase screening rates and educate patients on skin cancer prevention and the benefits of early detection. Saratoga Hospital will continue to develop a comprehensive obesity prevention and management program. The Hospital will reinstate bariatric surgery services, will achieve accreditation as a Bariatric Center of Excellence, and will design evidence-based services and outreach programs to address weight management. 14 of 37

16 Community Partners: Saratoga Cardiology Associates, Saratoga County Office for Aging, primary care physicians, patients and their families, Breast Cancer and Women s Health Education & Support, Get Your Rear in Gear Colon Cancer Coalition of Saratoga County, Leukemia and Lymphoma Society, Rainbow Access Initiative for LGBT health, Southern Adirondack Tobacco-Free Coalition and Cancer Survivors Ambassadors American Cancer Society, Capital Region Special Surgery, The Community Foundation for the Greater Capital Region, American Academy of Dermatology, Saratoga County Public Health Nursing Service, community-based psychologists, and GRENO Industries, Adirondack Trust, Hudson River Community Credit Union, Longfellows/Olde Bryan Inn, Empire State College, Fort Miller, and other community sponsors. Outcomes: Improve quality and transition from inpatient care to home/other care settings for CHF patients. Decrease the death rate for cancer; reduce the rate of malignant melanoma; reduce the rate of obesity among adults. Community Health Need: The community does not have adequate access to the full continuum of care. Healthcare providers need to form more strategic partnerships to address gaps in care. Saratoga Hospital s Strategy: Saratoga Hospital will continue to explore and establish partnerships with other providers, including a collaborative relationship between the Hospital s bariatric program and the program at a tertiary-care facility. Saratoga Hospital will engage in physician-centered dialogues regarding future coverage of critical care. Saratoga Hospital will work to standardize the process for the transfer of cardiac patients to higher levels of care and establish a joint task force to guide collaborative efforts. Saratoga Hospital will develop a shared Tumor Board with another local hospital and meet quarterly. Saratoga Hospital will also develop collaborative research activities with another local hospital. Saratoga Hospital will explore the feasibility of developing a partnership with home care and communitybased providers to give Saratoga Hospital patients appropriate and timely access. Community Partners: Tertiary care providers, local hospitals, home care agencies, and community-based providers. 15 of 37

17 Outcomes: Continue the development of tertiary relationships on a service-specific basis; develop a new collaborative relationship with a hospital partner; develop a community-linked case management system. II. New York State Prevention Agenda Topic: Prevent HIV/STDs, Vaccine-Preventable Diseases, and Healthcare-Associated Infections Focus Area: Vaccine-Preventable Diseases Community Health Need: Pertussis cases are increasing; adults and children are not receiving adequate vaccinations against pertussis. Saratoga Hospital s Strategy: Saratoga Hospital will continue its program to increase pertussis vaccination rates by vaccinating all parents and other caregivers of infants born at Saratoga Hospital. Community Partners: Primary care providers, OB/GYN physicians, Saratoga County Public Health Nursing Service. Outcomes: All infants born in Saratoga County vaccinated against pertussis; all parents and caregivers of infants born at Saratoga Hospital vaccinated against pertussis. Focus Area: Healthcare-Associated Infections Community Health Need: The number of patients contracting infection due to contact with the healthcare system is increasing. Overuse of antibiotics is resulting in the emergence of antibiotic-resistant strains of disease. Infection control measures on the part of healthcare providers must be constantly taught, improved, and enforced. Infection can be spread by the use of medical devices. Saratoga Hospital s Strategy: Saratoga Hospital will continue to encourage the reduction of antibiotic use at Saratoga Hospital and in the community by developing programs, policies, and procedures aimed at reducing the use of antibiotics. Saratoga Hospital will continue to include infection control education as part of mandatory staff education. Hand hygiene and isolation practices will be monitored. Saratoga Hospital 16 of 37

18 will enforce the policy of using medical devices only when necessary by performing daily nursing assessments for the necessity of devices. Saratoga Hospital will ensure proper maintenance of medical devices by following maintenance schedules and routines. Saratoga Hospital will provide ongoing education programs for all clinical staff on the proper methods of insertion and maintenance of devices. Community Partners: Granting agencies, community-based providers, equipment providers. Outcomes: Decrease antibiotic use and C. diff rates; decrease healthcare-associated C. diff; reduce infections transmitted via medical devices. III. New York State Prevention Agenda Topic: Promote Healthy Infants and Children Focus Area: Child Health Community Health Need: Children in Saratoga County, especially low-income children, do not receive adequate preventive healthcare. Saratoga Hospital s service area covers a large geographic area, and some rural areas or areas located outside population centers have insufficient access to preventive care. Almost 40% of all 3 rd graders in Saratoga County have untreated tooth decay. This is especially true for lowincome children. Saratoga Hospital s Strategy: Saratoga Hospital will continue to improve access to ambulatory care services throughout the community by opening new extension clinics or acquiring practices that offer ambulatory care. Saratoga Hospital will improve access to high-quality dental care for low-income members of the community by offering dental services at Saratoga Community Health Center. Saratoga Hospital will continue to offer facilitated enrollment services for Child Health Plus and Family Health Plus to assist low-income families obtain health insurance. 17 of 37

19 Community Partners: Town officials, primary care providers, dentists, school systems, Saratoga County Public Health Nursing Service, New York State Department of Health. Outcomes: Increase the rates of well-child visits; reduce the rate of untreated tooth decay in 3 rd graders to 21.6% (Prevention Agenda Goal). IV. New York State Prevention Agenda Topic: Promote Mental Health and Prevent Substance Abuse Focus Area: Mental Health Community Health Need: Alcohol abuse poses a threat to the health and well-being of residents of Saratoga County. Too many adults engage in binge drinking. Rates of alcohol-related accidents are higher than expected, and too many residents die of alcohol-related injuries. Many residents suffer from serious mental illness. Rates for treatment of children and teens in the emergency department are above the stateside benchmarks. Rates of suicide and self-inflected injuries in Saratoga County are also above statewide benchmarks. Saratoga Hospital s Strategy: Saratoga Hospital will increase access to quality outpatient mental health services by providing comprehensive mental health counseling at Saratoga Community Health Center. Community Partners: Primary care providers, mental health providers, Saratoga County Public Health Nursing Service, Saratoga County law enforcement agencies. Outcomes: Reduce rates of alcohol abuse in Saratoga County; decrease the rate of emergency department visits for mental health patients; reduce the rates of suicide and self-inflicted injuries. 18 of 37

20 Needs not addressed in the Saratoga Hospital Plan Saratoga Hospital intends to address needs within the five Prevention Agenda focus areas identified as significant needs in Saratoga County; however, some of the challenges identified for those focus areas will not be addressed directly by Hospital-led initiatives. The Saratoga County CHNA notes that only 62.3% of children 19 to 35 months of age receive the recommended vaccinations. This is 28% below the Prevention Agenda Goal of 80%. Additionally, 33.4% of females age 13 to 17 received the HPV vaccine in This is almost 50% below the Prevention Agenda goal of 50%. Vaccinations are handled in the context of wellbaby care by pediatricians in private practice or by public health. Any community activity around this should come from public health (or community health centers). In general this is not a Hospital system-centered activity. The key to improving vaccination compliance is improving access to primary care. Therefore Saratoga Hospital focuses efforts on improving access to primary care by subsidizing the local pediatrician group for coverage of our labor and delivery and aggressively recruiting family practice physicians, primary care pediatricians, and obstetricians. Access to continuity of care ensures that deadlines for vaccination are not missed and the necessary education of the importance of and relative safety of vaccination is provided. The CHNA also notes that too few children in Saratoga County are screened for exposure to lead. Saratoga County Public Health Nursing Service has a very robust lead screening program that is grant-funded. Saratoga Hospital supports this public health program and will assist the public health efforts led by the County. Alcohol abuse also poses a threat to the health and well-being of residents of Saratoga County. While Saratoga Hospital s mental health programs address the needs of patients impacted by alcohol abuse, Saratoga Hospital does not plan any Hospital-led initiatives for alcohol abuse. Residents of Saratoga County have access to programs sponsored by other agencies whose missions include addressing substance abuse. These include the Saratoga County Alcohol and Substance Abuse Services, private psychologists and psychiatrists, The Alcohol and Substance Abuse Prevention Council, and others. Saratoga Hospital supports the work of these agencies. Other health issues include the promotion of a healthy and safe environment, as well as preventing Lyme disease, chlamydia, and rabies. These issues will not be directly addressed by Saratoga Hospital; however Saratoga Hospital is committed to improving the health and 19 of 37

21 wellness of our communities, and fully supports local governments and wellness coalitions in their efforts to impact these issues. Dissemination of the Report There are three ways you can obtain information about Saratoga Hospital s Community Service Plan: Saratoga Hospital s website home page, includes access to Saratoga Hospital s Community Service Plan. The January 2014 edition of Saratoga Hospital s community newsletter, Access, will contain a full page dedicated to health care in our community which will include information about this Community Service Plan. This newsletter is mailed to almost 50,000 households in the greater Saratoga Region. Additionally, copies are given out to newcomers to the community, new hospital employees, physician offices and other community locations. Saratoga Hospital s website home page, now includes a link to The ARHN website homepage where you can read and download more information about the Community Health Planning Committee and regional programs it sponsors. Maintaining Engagement and Tracking Progress Saratoga Hospital is committed to achieving the goals set forth in this Community Service Plan and intends to remain an active member of ARHN s Community Health Planning Committee. This group meets at least quarterly each year and has become an important forum for sharing views, ideas and feed-back for stakeholders throughout the region. Saratoga Hospital and Saratoga County Public Health Nursing Service are also exploring ways to convene a Community Health Stakeholder group in Saratoga County to provide continuous community input and guidance at a more local level. Saratoga Hospital s new Community Health Center is supported by grant funds provided by the City of Saratoga Springs. This grant requires the reporting of outcomes data that will be used to track progress in meeting the needs of the uninsured and underinsured using this new facility. Another grant-funded program for cancer screening also requires collection of data which will also be used to assess progress in that area. Saratoga Hospital carefully tracks heart patients 20 of 37

22 in the interest of reducing avoidable readmissions and that data will be the source for assessing those results. Saratoga Hospital has a very robust Infection Control program that carefully tracks hospital-acquired infection rates and all of our primary care physicians track patient visits. Since the ultimate goal of these plans is to improve the health of the residents of Saratoga County, in 2016 Saratoga Hospital will conduct another Community Health Needs Assessment. The results of that assessment will be used to compare benchmarks and results from this most recent assessment. It is hoped that Saratoga Hospital s efforts and those of other community stakeholders will have had a positive impact on the overall health of the people we serve. 21 of 37

23 Appendix 1: Methodology and Data Sources The Center for Health Workforce Studies at the University at Albany School of Public Health (the Center) under contract with the Adirondack Rural Health Network, a program of the Adirondack Health Institute, identified and collected data from a variety of sources on the nine counties in the Adirondack region. Those counties include: Clinton, Essex, Franklin, Fulton, Hamilton, Montgomery, Saratoga, Warren, and Washington. The initial step in the process was identifying which data elements to collect. Center staff received an initial list of potential data elements from the ARHN Data Subcommittee and then supplemented that information with data from other sources. Since most of the health behavior, status, and outcome data were only available at the county level, the Center in conjunction with the ARHN Data Subcommittee concluded that all data used for the project would be displayed by county and aggregated to the ARHN region. 6 Additionally, other data were collected to further enhance already identified data. For example, one Prevention Agenda indicator was assault-related hospitalizations. That indicator was augmented by other crime statistics from the New York State Division of Criminal Justice. The overall goal of collecting and providing these data to ARHN members was to provide a comprehensive picture of the individual counties within the Adirondack region, including providing an overview of population health as well as an environmental scan. In total, counties and hospitals were provided with nearly 450 distinct data elements across the following four reports: Demographic Data; Educational Profile; Health Behaviors, Health Outcomes, and Health Status; and Health Delivery System Profile. Data was provided to all counties and hospitals as PDFs as well as in Excel files. All sources for the data were listed and made available to the counties and hospitals. The sources for the data elements in the Health Behaviors, Health Outcomes, and Health Status report were listed in a separate file and included their respective internet URL links. The data in each of the four 6 Aggregated data for the ARHN region included Clinton, Essex, Franklin, Fulton, Hamilton, Saratoga, Warren, and Washington counties but did not include Montgomery County. 22 of 37

24 reports were aggregated, when feasible, into the ARHN region, Upstate New York (all counties but the five in New York City), and statewide. Demographic Data Demographic data was primarily taken from the American Community Survey, supplemented with data from the Bureau of Labor Statistics, Local Area Unemployment Statistics for 2011; the New York State Department of Health (NYSDOH) Medicaid Data for 2011; and employment sector data from the American Community Survey. Among the information incorporated into the demographic report included: Race/Ethnicity; Age by groups (0 4, 5 17, 18 64, and 65 plus); Income and poverty, including the percent who received Medicaid; Housing stock; Availability of vehicles; Education status for those 25 and older; Employment status; and Employment sector. Educational Profile The education profile was taken mainly from the New York State Education Department (NYSED), School Report Card for , supplemented with data from the National Center for Education Statistics, Integrated Post-Secondary Data System on Post-Secondary graduations for and registered nurse graduations from the Center. Among the data displayed in the educational profile included: Number of school districts; Total school district enrollment; Number of students on free and reduced lunch; Dropout rate; Total number of teachers; Number of and graduations from licensed practical nurse programs; and Number of and graduations from registered nurse programs. Health Behaviors, Health Outcomes, and Health Status 23 of 37

25 The vast majority of health behaviors, outcomes, and status data come from NYSDOH. Data sources included the: Community Health Indicators Report ( County Health Indicators by Race/Ethnicity ( County Dashboards of Indicators for Tracking Public Health Priority Areas, ( and Behavioral Risk Factor Surveillance System (BRFSS) ( Information on NYSDOH s methodologies used to collect and display data from the above sources can be found on their respective data pages. NYSDOH data used in this report are updated annually, with the exception of BRFSS data, and most of the data were for the years Cancer data were for the years , and BRFSS data were from the 2008 and 2009 survey. Data displayed in this report included an average annual rate or percentage and, when available, counts for the individual three years. The years the data covered were listed both in the report as well as in the sources document. NYSDOH data also was supplemented from other sources such as the County Health rankings, the New York State Division of Criminal Justice Services, the New York State Institute for Traffic Safety Management and Research, and the New York State Office of Mental Health Patient Characteristics Survey, among others. To the extent possible, Center staff used similar years for the additional data that were collected. Nearly 300 data elements are displayed in this report broken out by the Prevention Agenda focus areas. Data were downloaded from their various sources and stored in separate Excel files, based on their respective focus area. The Health Behaviors, Health Outcomes, and Health Status report was created in Excel and linked to the raw data, and population rates were recalculated based on the number of cases as well as the population listed in the data source. Data in the report were organized by the six priority areas as outlined by NYSDOH at The data were also separated into two subsections, those that were identified as Prevention Agenda indicators and 24 of 37

26 those that were other indicators. The data elements were organized by 17 focus areas as outlined in the table below. Focus Area Number of Indicators Prevention Agenda Other Health Disparities 8 11 Injuries, Violence, and Occupational Health 7 21 Outdoor Air Quality 2 0 Built Environment 4 0 Water Quality 1 0 Obesity in Children and Adults 2 35 Reduce Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke Exposure Increase Access to High Quality Chronic Disease Preventive Care and Management Maternal and Infant Health 9 19 Preconception and Reproductive Health 9 20 Child Health 6 29 HIV 2 2 STDs 5 10 Vaccine Preventable Diseases 3 6 Healthcare Associated Infections 2 0 Substance Abuse and other Mental, Emotional, and Behavioral Disorders 3 20 Other Illnesses 0 9 Those data elements that were Prevention Agenda indicators were compared against their respective Prevention Agenda benchmarks. Other indicators were compared against either Upstate New York benchmarks, when available or then New York State benchmarks when Upstate New York benchmarks were not available. The report also included a status field that indicated whether indicators were met, were better, or were worse than their corresponding benchmarks. When indicators were worse than their corresponding benchmarks, their distances from their respective benchmarks were calculated. On the report, distances from benchmarks were indicated using quartiles rankings, i.e., if distances from their corresponding benchmarks 25 of 37

27 were less than 25%, indicators were in quartile 1, if distances were between 25% and 49.9% from their respective benchmarks, indicators were in quartile 2, etc. The Health Behaviors, Health Outcomes, and Health Status Report also indicated the percentage of total indicators that were worse than their respective benchmarks by focus area. For example, if 21 of the 35 child health focus area indicators were worse than their respective benchmarks, the quartile summary score would be 60% (21/35). Additionally, the report identified a severity score, i.e., the percentage of those indicators that were either in quartile 3 or 4 compared to all indicators which were worse than their corresponding benchmarks. Using the above example, if 9 of the 21 child health focus indicators that were worse than their respective benchmarks were in quartiles 3 or 4, the severity score would be 43% (/9/21). Quartile summary scores and severity scores were calculated for each focus area as well as for Prevention Agenda indicators and for other indicators within each focus area. Both quartile summary scores and severity scores were used to understand if the specific focus areas were challenges to the counties and hospitals. In certain cases, focus areas would have low severity scores but high quartile summary scores indicating that while not especially severe, the focus area offered significant challenges to the community. Health Delivery System Profile The data on the health system came from NYSDOH list of facilities, NYSED licensure file for 2011, the UDS Mapper for 2011 Community Health Center Patients, the Health Resources and Services Administration Data Warehouse for health professional shortage (HPSAs) areas for 2012, and Center data on 2011 physicians. Among the data incorporated into this report included: Hospital, nursing home, and adult care facility beds; Number of community health center patients; Number of and population within primary care, mental health, or dental care HPSAs; Total physicians and physicians by certain specialties and sub-specialties; and Count of individuals licensed. 7 Community Provider Survey 7 County is determined by the main address listed on the licensure file. The address listed may be a private residence or may represent those with active licenses but not actively practicing patient care. Therefore, the information provided may not truly reflect who is practicing in a profession in the county. 26 of 37

28 A survey of providers was conducted by the Center for Human Services Research (CHSR) at the University at Albany School of Social Welfare between December 5, 2012 and January 21, The purpose of the study was to provide feedback from community service providers in order to: 1) guide strategic planning, 2) highlight topics for increased public awareness, 3) identify areas for training, and 4) inform the statewide prevention agenda, including rating the relative importance of five of the New York State Prevention Agenda Priority areas 8. Results were presented for each of the eight ARHN counties 9 and aggregated for the region. The 81 question survey was developed through a collaborative effort by a seven-member ARHN Subcommittee during the fall of The seven volunteer members are representatives of county public health departments and hospitals in the region that are involved in the ARHN. Subcommittee members were responsible for identifying the broad research questions to be addressed by the survey, as well as for drafting the individual survey questions. Subcommittee members were also charged with identifying potential respondents to participate in the survey. Because each county in the region is unique in its health care and serviceprovision structure, ARHN members from each of the counties were asked to generate a list of relevant stakeholders from their own communities who would represent the full range of programs and service providers. As such, the survey population does not necessarily represent a random sampling of health care and service providers, but an attempt at a complete list of the agencies deemed by the ARHN to be the most important and representative within the region. The survey was administered electronically using the web-based Survey Monkey program and distributed to an contact list of 624 individuals identified in the stakeholder list created by the Subcommittee. Two weeks before the survey was launched on December 5, 2012, an announcement was sent to all participants to encourage participation. After the initial survey , two reminder notices were also sent to those who had not yet completed the survey. Additionally, participation was also incentivized through an opt-in gift card drawing, with 20 entrants randomly selected to receive a $25 Stewart s gift card at the conclusion of the survey. Ultimately, 285 surveys were completed during the six-week survey period, a response rate of 45.7%. Response rates varied by Individual County, respondents may have been counted in more than one county depending on the extent of their service area. 8 At the time of the survey, the New York State had identified five priority areas (1) Promote a Health and Safe Environment; (2) Preventing Chronic Disease; (3) Promoting Healthy Women, Infants, and Children; (4)Prevent HIV/STDs, Vaccine-Preventable Disease, and Health Care-Associated Infections; and (5) Promote Mental Health and Prevent Substance Abuse. The sixth priority area, Improve Health Status and Reduce Health Disparities, had not yet been identified and was not included as part of the provider survey. 9 Montgomery County was not included in the survey. 27 of 37

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