1 Community Service Plan EASTERN NIAGARA HOSPITAL 2013 ~ 2015
2 Eastern Niagara Hospital COMMUNITY SERVICE PLAN I.) MISSION STATEMENT: Eastern Niagara Hospital s mission is to meet the health care needs of the community with quality, compassionate, state of the art and personalized medical care. Its motto of Committed to Caring reflects the ongoing focus of physicians, staff and volunteers to enhance the physical, emotional and social well-being of each patient whom they have the privilege to serve. The Hospital continuously strives to improve access to services, while ensuring patient satisfaction through a supportive and progressive environment. In carrying out its mission, Eastern Niagara Hospital serves as a responsible employer and maintains fiscal integrity in its goal to remain a reliable and strong health care system well into the future. No changes were made to the mission statement during II.) DEFINITION/DESCRIPTION OF COMMUNITY SERVED: Eastern Niagara Hospital (ENH) is a non-sectarian, 205 bed community hospital that has been serving the community for 105 years. ENH has two acute care sites one in Lockport approximately thirty miles northeast of Buffalo and one in Newfane, a semi-rural area north of Lockport. The Hospital is a major community health resource for eastern Niagara County, serving more than 85,000 residents of the City of Lockport and the Towns of Lockport, Pendleton, Cambria, Royalton, Hartland, Somerset, Newfane and Wilson. A map is provided below. The Hospital provides general acute care services (both primary and specialized) as well as a diverse array of outpatient services. Its inpatient program consists of medical/surgical services, intensive care, pediatrics and OB/GYN. Services include: 24 hour ED, an off-site walk-in immediate care service (ENH Express Care), ambulatory surgery, orthopedics, urology, diagnostic radiology, nuclear medicine, cardiac rehab, cardiology, computerized tomography (CT) scanning, lab, physical, occupational and speech therapy, respiratory therapy and occupational health. The Lockport site has a 20-bed residential chemical dependency treatment unit, a 12-bed child and adolescent psychiatry unit, and an MRI. The Newfane site offers outpatient dialysis. Additionally, ENH operates a primary care clinic in Lockport that provides significant care to uninsured and underinsured individuals throughout the community. The Hospital is the only provider of acute care hospital services in eastern Niagara County.
3 Hospital Service Area No changes occurred in the Hospital s primary service area during Chart 1: Eastern Niagara Hospital Service Area Map The Service Area of Eastern Niagara Hospital spans two-thirds of the geographic area of Niagara County and a total population of 85,825 (40% of the 216,469 Niagara County residents). Population - ENH Service Area 2000 population 2010 population Area (Sq. Mi) Barker, Village of Cambria, Town of 5,393 5, Hartland, Town of 4,165 4, Lockport, City of 22,279 21, Lockport, Town of 19,653 20, Newfane, Town of 9,657 9, Royalton, Town of 7,710 7, Somerset, Town of 2,865 2, Wilson --- Town of 5,840 5, Wilson --- Village of 1,213 1,264 - Pendleton, Town of 6,050 6, Total 85,402 85,
4 III.) PUBLIC PARTICIPATION: Eastern Niagara Hospital, in cooperation with the Niagara County Health Department and the other three hospitals located in Niagara County (Niagara Falls Memorial Medical Center, Mt. St. Mary s Hospital and Kaleida s DeGraff Memorial Hospital), conducted a community health needs assessment. These entities combined efforts and distributed the survey to the public via various means. Surveys were distributed to the public in the Eastern Niagara Hospital lobby and distributed to local community residents in the Hospital s service area by members of the ENH Auxiliary and Guild, students and staff. Additionally, the participating hospitals and Health Department engaged the participation of Tops markets in order to reach more diverse demographics. The survey was also translated into Spanish. The total number of survey respondents was 1,453. The survey respondents ranged from age 15 80, with the majority aged Of those completing the survey, 23.8% were male and 74.96% were female. 1.23% preferred not to list gender. 85% were white/caucasian; 6.8% were African American; 2.8% were American Indian and 2.3% were Hispanic/Latino. The average household income of those completing the survey ranged as follows: 15% - Under $25,000 27% - $25,000-$49,000 18% - $50-75,000 23% - over $75,000 *Remainder preferred not to answer Respondents indicated the following as the most important health issues/concerns: Cancer (50.24%) -- Prevent Chronic Disease Heart-Related Issues (37.23%) -- Prevent Chronic Disease Overweight/Obesity (31.93%) -- Prevent Chronic Disease Alcohol/Drugs (27.94%) -- Promote Mental Health/Prevent Substance Abuse Nutrition/Healthy Diet (27.32%) -- Prevent Chronic Disease, Healthy & Safe Env. Physical Activity (23.33%) -- Prevent Chronic Disease, Healthy & Safe Environment Stress Management (22.57%) -- Promote Mental Health/Prevent Substance Abuse Diabetes (22.16%) -- Prevent Chronic Disease Food & Water Safety (21.4%) -- Healthy & Safe Environment Abuse or Neglect (15.97%) -- Promote Mental Health/Prevent Substance Abuse Asthma/COPD (13.15%) -- Healthy & Safe Environment Tobacco, Nicotine, Quitting Smoking (12.04%) -- Prevent Chronic Disease Immunizations, Infectious Disease (9.7%) -- Infectious Disease Dental Health (9.54%) Family Planning (9.29%) -- Maternal & Child Health Suicide Prevention (8.81%) -- Promote Mental Health/Prevent Substance Abuse Injury Prevention (8.33%) -- Healthy & Safe Environment STDs, HIV/AIDS (7.98%) -- Infectious Disease Maternal Health Care (5.92%) -- Maternal & Child Health
5 The Niagara County hospitals and NC Health Department coalition also conducted focus groups, consisting of representatives of their respective service areas. These groups discussed health priorities, barriers to health care, facilitators of health, and sources of health information. The Eastern Niagara Hospital (ENH) focus group was convened in June, 2013 by notice in the public lobby and specific invitations granted through members of the Hospital s volunteer and auxiliary membership and local business community. The focus group consisted of 24 individuals ages from both the Lockport and Newfane communities. Eighteen members of the group were females and six were males. Highlights of the discussion on community health: Individuals felt a healthy community consisted of access to services, including physicians and specialists who are accepting patients, hospital and clinics, as well as the availability of walk-in services. Education on disease and the availability of services (medical and social) were also important to participants. A number of current changes in the group revolved around health insurance. Many felt the changes in policies were confusing. Billing policies were difficult to understand. Some had insurance that did not meet their needs. Contributing factors to health problems revolved around job loss and loss of health insurance, as well as the high incidence of heart disease and cancer in the region. Some members of the group felt that people are kept from being healthy due to their own choices (laziness). Others felt low income families may not be able to afford healthy foods and medical care, and be interested in exercise. Lifestyle choice was a topic of discussion eg. people make the choices that lead them to poor health. Others felt certain things are out of their control, such as pollution, chemical companies in the region etc. The group indicated they appreciated the presence of the hospital, nursing homes and other related services. They felt resources were generally adequate and were grateful they did not have to drive to a larger city to obtain services. Discussion on Personal Health: Cancer was the number one health concern among participants. Many had either experienced it personally or had a close family member or friend with cancer. Issues related to children and youth also came up in the discussion. Since ENH opened its Child & Adolescent Psychiatric Unit, individuals seem to be more aware of the prevalence of mental health issues among this population and it concerns them. Several in the group felt that they were prone to certain diseases, weight issues etc. due to heredity. A few stated they felt they would rate themselves as being in good health. Concerns about weight, obesity, and childhood obesity emerged as a discussion point. Many expressed dismay that so many children today appear to be overweight and there is so much fast food and unhealthy choices readily available. About 75% of the group stated they obtain health information online and the others relied on brochures and written information from physicians and other resources.
6 The group discussed at length how they wished health care could revert back to the way things were a decade or two ago. Many felt their physicians were complying with so many government regulations and policies and procedures that the care they were providing was not as personalized as it once had been. Many felt physicians were being forced to comply with standards set forth by the insurance companies instead of relying on their own knowledge, experience and instincts as physicians. IV.) ASSESSMENT AND SELECTION OF PUBLIC HEALTH PRIORITIES: Eastern Niagara Hospital participated in an extensive collaborative effort with a workgroup formed of participants from the Niagara County Department of Health (NCDOH), the P2 Collaborative of Western New York, Niagara Falls Memorial Medical Center, Mt. St. Mary s Hospital, DeGraff Memorial Hospital/Kaleida Health, the Niagara County Department of Mental Health and the University at Buffalo Department of Preventive Medicine. The group met several times during an eight month period to discuss and determine the final joint efforts in response to the priorities set forth in the New York State Prevention Agenda These five major priorities are: Prevent Chronic Disease Promote a Healthy and Safe Environment Promote Healthy Women, Infants and children Promote Mental Health and Prevent substance Abuse Prevent HIV, STDs, Vaccine-Preventable Disease, and Hospital-associated Infections Each priority area above includes multiple focus areas. The workgroup meetings were conducted as follows: Planning Meetings - location March 7 th 2013 (NCDOH and P 2 to discuss initial survey development) NCDOH April 9 th 2013 Niagara County Emergency Services Training Building May 16 th 2013 NCDOH July 2 nd 2013 Niagara Falls Memorial Medical Center August 27 th 2013 Eastern Niagara Hospital, Lockport September 11 th 2013 DeGraff Memorial Hospital October 3 rd 2013 Mt. St. Mary s Hospital In addition to a Community Health Needs Assessment -- conducted throughout Niagara County jointly by participants-- several of the participating organizations also facilitated focus groups to get an even better understanding of their community s health needs and priorities:
7 Outreach Events NFMMC Focus Group DeGraff Focus Group Eastern Niagara Hospital Focus Group August 14 th 2013 Niagara County Community Health Meeting* Niagara County Community Health Survey (n = 1,455) * Participants in the August 14 th community meeting, included the original work group, as well as invited guests/representatives from Niagara county Community College, the Dale Association, and Opportunities Unlimited of Niagara. Following all of these efforts, the P 2 Collaborative of WNY summarized all of the input and data obtained and presented a report of the joint findings. The workgroup studied and extensively discussed the data and input obtained from the surveys/focus groups to reach a consensus on which priorities focus areas and disparity would be selected for the years. It was noted that the priority of Prevent Chronic Disease was heavily weighted in all collections from the population. The priorities of Promote a Healthy and Safe Environment and Promote Mental Health and Prevent Substance Abuse were second leading subjects. At the August 27, 2013 meeting, the workgroup finalized its priority areas for , deciding on the following two initiatives: Priority 1: Prevent Chronic Disease: Focus Area: Increase access to high-quality chronic disease preventative care and management in clinical and community settings Disparity: People with Mental Hygiene Issues Priority 2: Promote a Healthy and Safe Environment Focus Area: Injuries, Violence, and Occupational Health Falls Prevention
8 V.) THREE YEAR PLAN OF ACTION: Eastern Niagara Hospital s two Prevention Agenda priorities with specific goals, objectives, improvement strategies and performance measures with measurable and time-framed targets are outlined below. Promote a Safe and Healthy Environment Focus Area Injury prevention Goal - Reduce falls risks among vulnerable populations Objective - By December 2017, reduce the rate of hospitalizations due to falls among Niagara County residents ages 65 and over by 10%. Activities and Interventions: (By 12/31/14) 1. Research and review ENH specific data related to falls hospitalizations by 6/ Research and review the Hospital s specific data related to falls ED visits by 6/ Identify Hospital resources and personnel to address initiatives for reducing falls. 4. Develop a falls prevention team, including members of the Physical Therapy, Emergency Department, Nursing Education and Community Relations Departments. 5. In cooperation with NCDOH and other community hospitals, identify other community resources for reducing falls risks by 6/ Review other falls education programs already in place in WNY. 7. Develop educational resources for falls prevention. 8. In cooperation with NCDOH and other community hospitals, identify other community organizations that may be potential participants 9. Collaborate with NCDOH and Niagara County hospitals to apply for the Match Grant. 10. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data.
9 (By 12/31/2015) 1. Review hospital specific data related to falls hospitalizations from prior year. 2. Research and review hospital specific data related to falls ED visits from prior year. 3. Distribute falls prevention educational material to ENH Medical Staff offices, all ENH off site clinics and outpatient diagnostic services locations. 4. Distribute falls assessment and prevention materials to patients age 65 years of age or older and others at risk at the ENH Express Care facility. 5. Collaborate with NCDOH to conduct Falls Prevention Train the Trainer Programs with ENH outreach personnel. 6. Promote falls prevention on the ENHS website. 7. Schedule a minimum of one Healthlines column in the Lockport Union Sun & Journal newspaper for the topic of falls prevention. 8. Provide falls prevention educational material and/or brochures at community outreach events throughout the year. 9. Provide falls prevention educational material to patients presenting in the ED with injuries sustained in falls. 10. Distribute falls assessment and prevention materials to patients age 65 years of age or older and others at risk at the ENH Express Care facility. 11. Collaborate with community service organizations and the NCDOH to provide a minimum of two community education programs in the ENH service area. 12. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. (By 12/31/2016) 1. Collect hospitalization, ED visit and Express Care data related to falls. 2. Revaluate the falls prevention program. Look for opportunities to improve or revise the plan to enhance success. 3. Collaborate with NCDOH to provide 2 additional falls prevention classes for the eastern Niagara County community.
10 4. Continue promoting falls prevention on the ENH website. 5. Produce a Healthlines column in the Lockport Union Sun & Journal newspaper with the topic of falls prevention. 6. Connect with the ENH Medical Staff to assess participation in the program. Look for opportunities to enhance participation. 7. Continue providing fall prevention educational material to patients age 65 years and older and those presenting in the ED and Express Care with injuries sustained in a fall. 8. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. 9. Provide falls prevention educational material at community outreach events. (By 12/31/2017) 1. Analyze data on hospitalization and ED/Express Care visits related to falls from prior two years. 2. Continue to collect data from ED and Express Care related to falls. 3. Assess program and revise or implement new strategies to ensure ongoing success as needed. 4. Continue promoting falls prevention on the ENH website. 5. Continue providing fall prevention educational material to patients age 65 years and older and those presenting to the ED and Express Care with injuries sustained in a fall. 6. Continue providing falls prevention educational material to physician offices and outreach organizations in the community. 7. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. 8. Provide falls prevention educational material and/or brochures at community outreach events. 9. Collaborate with hospitals and community partners to hold a community event and press conference to outline the success and challenges of the priority area.
11 Prevent Chronic Disease Focus Area Increase access to high quality chronic disease preventative care and management in both clinical and community settings. Goal - Promote culturally relevant chronic disease self-management education. Objective - By December 2017, increase by at least 5% the percentage of adults with diabetes who have taken a course or class to learn how to manage their condition. Activities and Interventions: (By 12/31/14) 1. Research and review hospital specific data related to individuals diagnosed with diabetes participating in a diabetes management program. By 6/14 2. Separately evaluate this data and procedures from the ENH Reflections Recovery Center to specifically focus on the disparity of mental hygiene, including substance abuse. By 6/14 3. Identify hospital resources and personnel to participate in the project. By 6/14 4. Develop a team, consisting of the Manager of the Reflections Recovery Unit, Nursing Education Director, Diabetes Educator, Community Relations Director and others who will meet quarterly to evaluate the progress of increasing participation in the diabetes management program. By 6/14 5. Develop process for providing blood glucose screening and diabetes diagnosis as indicated for patients who are admitted to the substance abuse unit, in order to screen for diabetes or pre-diabetic conditions at the start of the patients 2-4 week programs. 6. Develop a diabetes management program specific for the patients of the substance abuse unit to incorporate the diabetes related curriculum into the current substance abuse program. 7. Determine the best method and timing for incorporating this educational program into the patient s 2-4 week program in the Reflections Recovery Center. 8. Develop an education program specifically for pre-diabetic patients. 9. Discuss additional initiatives for increasing community participation in the ENH monthly diabetes management program and pre-diabetes programs with representatives from the NCDPH, NC hospitals and community organizations. 10. Collaborate with the NCDOH and other community organizations to seek assistance in promoting the Hospital s diabetes management classes.
12 11. Seek opportunities to partner with members of the Hospital s Medical Staff to promote the availability of diabetes management classes at the Hospital. 12. Promote the monthly diabetes management classes in the local media. 13. Promote the diabetes management classes on the Hospital s website. 14. Develop a minimum of one article related to diabetes management to run in the Hospital s bi-weekly health column in the local newspaper. 15. Distribute a schedule of all diabetes management classes at community events throughout the year. 16. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. (By 12/31/2015) 1. Review hospital data regarding participation in the community diabetes management program. 2. Review data related to participation in the diabetes management program by patients from the Reflections Recovery Center substance abuse unit. 3. Continue providing blood glucose testing, and follow-up by physicians as indicated for patients who admit to the substance abuse unit, in order to screen for diabetes or pre-diabetic conditions at the start of the patients programs. 4. Provide diabetes management classes and pre-diabetes classes to the patients as needed, based on screening results/physician diagnosis following admittance to the unit or admittance to the unit with a pre-diagnosis of diabetes. 5. Evaluate progress of the plan with the team. Discuss opportunities for improvement. 6. Develop new initiatives for increasing the community participation in the ENH monthly diabetes management program and pre-diabetes programs. 7. Collaborate with the NCDOH and other community organizations to seek assistance in promoting the Hospital s diabetes management classes. 8. Evaluate participation by members of the Hospital s Medical Staff in promoting the diabetes management classes at the Hospital. Develop initiatives to increase patient referrals. 9. Promote the monthly diabetes management classes in the local media. 10. Promote the diabetes management classes on the Hospital s website.
13 11. Develop an article related to diabetes management to run in the Hospital s bi-weekly health column in the local newspaper. 12. Distribute the schedule of all diabetes management classes at community events throughout the year. 13. Distribute information and schedules for the ENH community diabetes management program in the ED, outpatient facilities, lobbies and at the Express Care facility. 14. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. (By 12/31/2016) 1. Review hospital data regarding participation in the community diabetes management program. 2. Review data related to participation in the diabetes management program by patients from the Reflections Recovery Center substance abuse unit. 3. Evaluate progress of the plan with the team. Discuss opportunities for improvement. 4. Continue providing blood glucose testing to patients who are admitted to the substance abuse unit, in order to screen for diabetes or pre-diabetic conditions prior to the start of the patients 2-4 week program. 5. Provide diabetes management classes and pre-diabetes classes to the patients as needed based on screening results/physician diagnosis or admittance to the unit with a pre-diagnosis of diabetes. 6. Develop new initiatives for increasing the community participation in the ENH monthly diabetes management program and pre-diabetes programs. 7. Collaborate with the NCDOH and other community organizations to seek assistance in promoting the Hospital s diabetes management classes. 8. Evaluate participation by members of the Hospital s Medical Staff in promoting the diabetes management classes at the Hospital. Develop initiatives to increase patient referrals. 9. Promote the monthly diabetes management classes in the local media. 10. Promote the diabetes management classes on the Hospital s website. 11. Develop an article related to diabetes management to run in the Hospital s bi-weekly health column in the local newspaper. 12. Distribute the schedule of all diabetes management classes at community events throughout the year.
14 13. Distribute information and schedules for the ENH community diabetes management program in the ED, outpatient facilities, lobbies and at the Express Care facility. 14. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. (By 12/31/2017) 1. Review hospital data regarding participation in the community diabetes management program. 2. Review data related to participation in the diabetes management program by patients from the Reflections Recovery Center substance abuse unit. 3. Evaluate progress of the plan with the team. Discuss opportunities for improvement. 4. Continue providing blood glucose testing to patients who are admitted to the substance abuse unit to screen for diabetes or pre-diabetic conditions. 5. Provide diabetes management classes and pre-diabetes classes to the patients as needed based on screening results/physician diagnosis or admittance to the unit with a pre-diagnosis of diabetes. 6. Collaborate with the NCDOH and other community organizations to seek assistance in promoting the Hospital s diabetes management classes. 7. Confirm continued support and participation by members of the Hospital s Medical Staff in promoting the diabetes management classes at the Hospital. Develop ongoing initiatives to increase patient referrals. 8. Promote the monthly diabetes management classes in the local media. 9. Promote the diabetes management classes on the Hospital s website. 10. Develop an article related to diabetes management to run in the Hospital s bi-weekly health column in the local newspaper. 11. Distribute the schedule of all diabetes management classes at community events throughout the year. 12. Distribute information and schedules for the ENH community diabetes management program in the ED, outpatient facilities, lobbies and at the Express Care facility. 13. Meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data. 14. Collaborate with hospitals and community partners to hold a community event and press conference to outline the success and challenges of the priority area.
15 VI.) Dissemination of the Plan to the Public: Eastern Niagara Hospital s Community Service Plan will be made available to the public at the Hospital s website: VII.) Plan for Monitoring: Eastern Niagara Hospital will monitor the plan and internally discuss opportunities for improvement on an ongoing basis. Additionally, as indicated in the Activities and Interventions section of the Community Service Plan, ENH will meet with NCDOH and Niagara County Hospitals on a quarterly basis to assess progress and report data.
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