MERCY MEDICAL CENTER COMMUNITY SERVICE PLAN September 2009

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1 Mission Statement Mercy Medical Center, a community hospital providing general services, strives to be faithful to the tradition of its founders by providing quality, compassionate health care to the whole person. The Mission Statement has not changed. Mercy Medical Center s mission strives to be faithful to its tradition of providing quality, compassionate healthcare services to all people, regardless of their ability to pay. From its humble beginnings to the constantly changing healthcare needs of the 21st century, Mercy remains steadfast to its commitment to adhere to the standards of compassion and respect for human dignity established by the Sisters of the Congregation of the Infant Jesus. As we enhance Mercy Medical Center internally and externally, our vision remains the same. We look forward to continuing to offer medical advances with the tradition of caring, the foundation on which Mercy has built its reputation. Service Area Mercy Medical Center defines its Primary Service Area (PSA) as those zip codes representing approximately 50% of its inpatient admissions and its Secondary Service Area (SSA) representing another 25% of its inpatient admissions. Mercy used SPARCS data through Market Expert to define its service area. Mercy s PSA comprises nine zip codes, listed in descending order of their inpatient volume: Hempstead, Rockville Centre, Uniondale, Freeport, West Hempstead, Baldwin, Lynbrook, Roosevelt and Valley Stream. Mercy s SSA comprises fourteen zip codes, listed in descending order of their inpatient volume: East Meadow, Merrick, Elmont, Oceanside, Bellmore, Long Beach, Far Rockaway, Franklin Square, Wantagh, Valley Stream, Malverne, Massapequa, East Rockaway and Rosedale. Mercy s primary catchment area includes medically underserved communities in Nassau County such as Roosevelt, Uniondale, Hempstead and Freeport. In the report entitled Vital Signs Measures of Long Island's Social Health, Ambulatory Care Sensitive (ACS) conditions were used to identify communities who may experience difficulty in accessing the health care system. ACS conditions are those that present in the hospital emergency departments and because of their severity, result in an inpatient admission. Had there been better preventive care, the situation might not have warranted a trip to the hospital. There were nine zip codes identified in all of Long Island with higher ACS volume, four are in Nassau County and of these four, three are in Mercy s primary service area - Hempstead, Roosevelt and Freeport. Not surprisingly, when other socio-demographic indicators such as morbidity, mortality, poverty, household income, or the presence and type of insurance are analyzed these same communities appear time and time again. These communities have been referred to as "Communities at Risk". Mercy has been identified as one of the three top hospitals serving the Central Nassau Communities at Risk. The Nassau County Health Assessment recognized that there are substantial differences between the County as a whole and the communities that contain its neediest residents. Although the County has one of the highest median household incomes, many residents live in poverty and have poor health outcomes. The assessment has identified seven selected communities in which these circumstances are most severe: Freeport, Hempstead Village, Inwood, Long Beach, Roosevelt, Uniondale, and Westbury. Four of the seven communities are in Mercy Medical Center s primary service area. A brief demographic overview of Mercy s PSA indicates the following. Mercy draws slightly more than half of its inpatient cases from its PSA compared to the average community hospital that draws approximately 75% of inpatients from the PSA. Mercy is highly dependent on one zip code, Hempstead, for both inpatient and ED volume, drawing 19% of inpatient admissions and 30% of ED visits from this community. While the PSA is expected to decline by 2013, the age cohort is projected to increase significantly. By 2013, the 55+ population will represent over 25% of this population. Only half of the page 1 of 1

2 population has higher than a high school degree; 60% are either Black Non-Hispanic, Hispanic or Asian; and a third have a household income less than $50,000. Public Participation Community Organizations There were many participants involved in identifying community health needs with Mercy Medical Center. By working within the community, with neighboring schools, businesses, community centers, and local chapters of organizations, Mercy strives to reach individuals of all ages with quality care and health education. Over the year, Mercy has worked with many organizations to develop health care programs for residents in the area: American Cancer Association, American Heart Association, Catholic Charities; Coalition for Community Well Being (Hempstead); Downstate New York Healthy Start Program; Economic Opportunity Center (Hempstead and Rockville Centre); Nassau County Department of Health Immunization Programs; Nassau County Department of Drug & Alcohol; Nassau County Department of Mental Health; Rockville Centre Chamber of Commerce, Fundacion Hispano Americano and many others. Mercy Medical Center has been an active participant in the Downstate New York Healthy Start Consortium. This Consortium strives to identify and reach out to low-income pregnant and/or parenting women in the community and connect them to perinatal health services, thus improving access to existing services for these women and families. This Consortium is a partnership with health and welfare providers, business and legislative leaders and community representatives. Partners include area hospitals, Headstart, CASA, Citibank, Cornell Cooperative Extension, Fidelis, Black Women Enterprises and many others. Monthly meetings were conducted under the auspices of the Economic Opportunity Commission (EOC) of Nassau County who was responsible to send out or post meeting notices. Of significant note in these meetings was the gap in health care services and insurance coverage for these most at-risk pregnant and parenting women. New this year was Mercy s ongoing participation with the Rockville Centre Community Council and the Rockville Centre Youth Council. The Rockville Centre Community Council is a collaborative planning structure for local service providers with a mission to determine priority issues and solutions in the health and human services arena; unite as partners to significantly impact service delivery; increase awareness/access to services in order to enhance the quality of life for youth, adults and families in Rockville Centre. In an effort to coordinate health and community services and enhance the quality of life for youth, adults and families in Rockville Centre, Mercy became a partner in a Leader s Forum sponsored by the Community Council, to determine which issues to tackle. The Community Council is made up of organizations representing drug and alcohol, police, fire, health, education, religion, housing and social services, as well as representatives of the community at large. Specific organizations that Mercy worked closely with included: Community Based Organizations - Hispanic Brotherhood, Equal Opportunity Council, Rockville Centre Library, Martin Luther King Center; Faith Based organizations St. Agnes Youth Ministry, Holy Trinity Lutheran Church; Community health centers Confide Counseling and Consultation; and Schools Rockville Centre Union Free School District, Greenhouse Alternative High School, Molloy College, and parochial schools in the area. Access to services, including health, housing and transportation and finding and helping people in the community who are isolated, emerged as a major issue that the group would like to work on. They plan to begin their work by developing a resource directory for senior citizens in the area. Notices for these bi-weekly meetings were sent by mail, and postings in the Rockville Center Herald newspaper and This Month In Rockville Centre. Issues related to adolescents surfaced as a significant problem during discussions in the Community Council meetings and thus the Rockville Center Youth Council was created as a spin-off of the Community Council. The mission of this group is to ensure a safe, nurturing social community for the development of value driven youth with respect for themselves and others. Again, Mercy was extremely involved in this new initiative which is focusing on underage alcohol and substance abuse, smoking, teen pregnancy and page 2 of 2

3 other issues relating to youth and families. Local organizations such as the Hispanic Brotherhood, South Side High School, Sacred Heart Academy, Recreation Center and Martin Luther King Center were asked to send student volunteers to be on the Council. Adult volunteers were solicited through contacts with organizations, clubs, service agencies, schools and the local newspaper. Meetings are held bi-weekly. Mercy Family Community health needs are discussed and assessed on a continual basis among the Hospital Board of Trustees, the Mission and Ministry Committee and the Planning Committee of the Board, Mercy Senior Leadership, and various committees within the Hospital management groups. This year Mercy reactivated the Community Outreach Committee which has multi-disciplinary representation of staff at the Hospital. Through this committee, contacts were made with local libraries, senior centers, legislators and others, soliciting their input as to what community health programs we could offer to their constituents. As a result, we hope to maintain an ongoing relation with these groups and begin a calendar of programs to meet their needs. Over the year, Mercy continually solicited input from our auxiliary organizations at the Hospital - the Friends of Mercy Medical Center and the Council of Leagues, representing over 2000 voices. Community health needs are also assessed by the administrative staff and Board of Trustees of our parent corporation, Catholic Health Services of Long Island (CHS), which represents five hospitals, three nursing homes, a community-based home for those with special needs, home care and a hospice. Outside Consulting Firm In 2008 Mercy hired an outside consulting firm to assist in our strategic planning efforts. During their assignment, they interviewed over 25 individuals representing Mercy s board, medical staff, administration and community members. During these interviews questions were continually asked as to what are the health care needs of the community and how can Mercy meet those needs. Comments included expanding the primary care base and developing strong community and physician relationships, improving the quality and service in the Emergency Department, building upon the surgical services and overall revalitization of Mercy Medical Center as a community hospital. As a result of this engagement, Mercy developed five strategic development areas that it will be working on over the next few years: Primary Care Referral Base, Program Mix, Financial Performance and Position, Quality and Service, and Workforce Development. Community Surveys Mercy strives to distribute a community needs survey at all of our outreach programs. These programs vary from health screenings, community education lectures, or participating in a health fair. They are spread across the County and represent various socio-economic groups, so a good indicator of health needs is assessed in this way. A large group of Nassau County hospitals has been meeting this past year and is currently discussing the creation of a standardized community needs assessment survey. This survey would be distributed at each hospital s community health programs and sites throughout the year. This will provide a broader source of data which will be helpful as the group continues to assess public health priorities in Nassau County. Mercy worked with the Downstate New York Health Start Consortium in the distribution of its Community Perinatal Satisfaction Survey that was given out at Mercy Medical Center as well as other labor and delivery sites. Its main focus was to determine the prenatal experience that mothers are receiving and the pregnancy outcome. Based on the analysis, Mercy will be working with this Consortium towards healthier pregnancy outcomes for all births. Through the Press Ganey patient satisfaction surveys, inpatients as well as Emergency Department patients have the opportunity to make comments about their experience at the hospital as well as their ongoing and future health care needs. Mercy s Patient Relation s Department reviews these comments daily and sends the appropriate ones to the Community Outreach Committee for follow-up. Each nurse manager at Mercy is responsible to call all discharged patients, including those from the Emergency Department, to see how they are doing and to address any health care issues or concerns. Our Care Management Department staff also calls those discharged patients that they followed while in the hospital, for this same reason. This page 3 of 3

4 follow-up process also provides another means to speak to community residents concerning their health care needs. Parish Outreach Another way Mercy solicits community needs input is through information obtained at area parishes. Through a joint community needs assessment by Mercy administration, the Pastoral Care Department, the Catholic Health Services of Long Island outreach coordinator and the parish community, Mercy is able to identify those populations at greatest risk. Through our CHS healthcare system, Mercy has become an active participant in the Healthy Sundays (see page 9) program. By collaborating with local faith-based organizations and reaching out to migrant populations, Healthy Sundays is able to provide the community with services that meet their specific needs. Nassau County Department of Health (NCDOH) and Nassau Hospitals In particular this year, Mercy worked with the NCDOH, many of the Nassau County community hospitals and several other partners (Center for Tobacco Control and Tobacco Action Coalition of Long Island) in discussing the health needs of the area and the Prevention Agenda priority selection process. Over the past six months the group as a whole, or subcommittees of the group, met nine times (February 27, March 27, April 20, April 24, April 30, May 21, June 1, June 3 and July 23) to discuss community wide health planning (which will be highlighted in the next section of the Community Service Plan). This was a wonderful exchange of information and the beginnings of a true partnership that will be continued going forward. As a result of this exchange, Mercy tried to gather community input based on some of the experiences of the other hospitals and the Nassau County Department of Health. A representative from Mercy attended one of the publicized community forums sponsored by a local hospital but unfortunately no persons attended. NCDOH sponsored two community forums in April and May of 2009 from which Mercy hoped to get valuable input. The purpose of these sessions was to invite Nassau County residents to share their thoughts on issues they believe affect their health and well-being. Unfortunately both sessions were poorly attended and the majority of attendees were employees of health care agencies, rather than individuals from the community. Most of the comments made at the meeting dealt with budget cuts and their effect on health care, access to health care, ways to encourage community presence at meetings and outreach efforts. The NCDOH also conducted an online survey of health related questions describing social determinants of health that Mercy hoped to gain insight from but the data was somewhat skewed as it over represented employees of NCDOH. Notification of above was done through press releases, newspaper announcements, community calendars, libraries, etc. Assessment of Public Health Priorities Mercy Medical Center is proud to have become a part of a collaborative effort among the six hospital systems in Nassau County for the purpose of community health planning. In February the NCDOH invited all of the hospital systems for a meeting to discuss their Community Service Plans. During this initial meeting, NCDOH presented the New York State Prevention Agenda Toward the Healthiest State which includes health goals designed to improve the health of New York s communities. The guidelines for the hospital Community Service Plan as well as the local Department of Health Community Health Assessment Plan were also reviewed. There was a willingness of each hospital to work together in selecting 1-2 priorities to work on as a joint county-wide effort utilizing existing coalitions or programs. Over the next six months the collaborative group met nine times to discuss and review the Prevention Agenda and how we could work together to make the most positive impact on health care in Nassau County. After thorough discussion and review of the Nassau County Indicators for Tracking Public Health Priority Areas obtained from the NYSDOH website, NCDOH highlighted nine priority areas where Nassau County fell short of the goals for the state. Those indicators were: page 4 of 4

5 Lung Cancer Incidence in Males/Females Percent Early Prenatal Care (1 st Trimester) Percent of Children with at least one lead screening by age 36 months Percent of Obese Children in Preschool (2-4 years (WIC)) Unintentional Injury Hospitalizations Fall related Hospitalizations Age 65+ Years Diabetes Prevalence in Adults Coronary Heart Disease Hospitalizations Percent of Adults Age 65+ Years with Flu and Pneumonia Immunizations NCDOH encouraged the group to select at least two priorities from the NYSDOH s Prevention Agenda that would allow all of the hospitals in the county to collaborate towards achieving a common county-wide goal. The group then developed a priority setting grid to help decide which of the ten priorities outlined in the Prevention Agenda would be feasible to address and fulfilled the needs of the Nassau County area. The grid included the following criteria to consider for determining the priorities: County indicators showing the greatest opportunity for impact Community need Alignment with existing hospital strategy/mission Availability of outcome measures Benchmarks available on Performance Quality Indicators Grant/funding potential Existing groups/programs/resources After consideration of the above priority scoring tool, the group decided to select: Tobacco Use in Adolescents and Adults Unintentional Injury from Fall Related Hospitalizations age 65+ Falls were the most agreed upon priority. It was noted that falls is a timely topic as there is so little coordinated action on this topic. Given that 15% of Nassau s residents are age 65+ and there is a high incidence of fall related hospitalizations among that population (233.3 per 10,000) as compared to New York State (196.0 per 10,000), the group recognized the opportunity to make an improvement toward the Prevention Agenda 2013 Objective (155.0 per 10,000). Each of the participating hospitals also realized the potential for creating partnerships in their own communities to reach seniors in various settings (i.e. home, hospital, nursing home/rehabilitation/assisted living center). It was also agreed that not enough attention is paid to health concerns that affect an aging population. At the Healthy Seniors Conference in Nassau County, it was reported that falls are the #4 cause of death in the 65+ population. According to The State of Home Safety in America TM (2004) conducted by the Home Safety Council, falls are by far the leading cause of unintentional home injury death. Falls account for an average of 5.1 million injuries and nearly 6,000 deaths each year. Injuries by type and age group can be seen in the SPARCS data and a large majority of these injuries are attributed to falls. In 2008 for Mercy s combined PSA and SSA, nearly 2,500 persons age 65+ were hospitalized due to a fall injury. Of this total, 233 patients were hospitalized at Mercy Medical Center. Besides the Nassau County Department of Health, hospital partners to be involved in the Falls priority included: Long Beach Medical Center, New Island Hospital, North Shore Long Island Jewish Health Center, South Nassau Communities Hospital, St. Francis Hospital and Winthrop University Hospital. page 5 of 5

6 The second priority objective selected by the collaboration was to reduce the prevalence of smoking in New Yorkers. For the percent of cigarette smoking in adolescents, the Prevention Agenda 2013 goal is 12%. Currently NYS is 16.3% and the data is not available for Nassau County. For the percent of cigarette smoking in adults, the Prevention Agenda 2013 goal is also 12%. Currently NYS is 18.2% and Nassau County is 15.4%. Tobacco use and dependence is the leading preventable cause of morbidity and mortality in NYS and in the US. The list of illnesses caused by tobacco use is long and contains many of the most common causes of death, including heart disease and stroke, many forms of cancer, and lung and vascular diseases. There is much data in the field that supports the Smoking Prevention Agenda Objectives. Mercy reviewed SPARCS data for diagnoses that could be related to tobacco use and reviewed its own Cancer Care Registry data and was able to see a direct correlation between tobacco use and lung cancer. Mercy reviewed the Nassau County Behavioral Risk Factor Surveillance Survey (BRFSS) where respondents were queried about preventive health practices and risk behaviors such as tobacco use. The Prevention Quality Indicators (PQI) were also reviewed to assess community health need. Besides the Nassau County Department of Health, hospital partners to be involved in the Smoking Cessation priority included: Long Beach Medical Center, New Island Hospital, North Shore Long Island Jewish Health Center, South Nassau Communities Hospital and Winthrop University Hospital. As there was already a system in place in Nassau County for tobacco cessation, it was decided that we could build on those resources available. Two known Community Based Organizations at this time included the Center for Tobacco Control and the Tobacco Action Coalition. The Center for Tobacco Control (CTC) is grant funded from the NYSDOH Bureau of Tobacco Use, Prevention, and Control. This grant was recently funded again for the next five years. The CTC is the designated Tobacco Cessation Center for Nassau and Suffolk Counties. The grant activities include educating healthcare providers about evidence-based treatment of tobacco users. They work collaboratively with all hospitals, clinics and physicians to ensure that patients are properly screened for tobacco use and provide assistance with quitting. The Center for Tobacco Control has many resources, handouts, educational materials, and programs for residents, hospital staff and physicians that would be available for each hospital. Through this grant the CTC will work to make sure Nassau and Suffolk are among the leaders in the state in treating tobacco dependence. The Tobacco Action Coalition of Long Island (TAC) was established in 1990 and is one of thirty community partnerships funded by the NYS Department of Health s Tobacco Control Program. The Coalition consists of healthcare providers, local and state government agencies, non-profit organizations, youth agencies, community groups and other concerned citizens. Their mission is to increase the acceptance of non-smoking as the social norm. Their goals are prevention, cessation and protection: the prevention of youth initiation; the cessation of tobacco use; and the protection of non-smokers. They strive to meet these goals by working through media advocacy, policy initiatives and existing tobacco education and control programs. TAC, like CTC, is also a strong resource for our collaboration as much of their work revolves around advocacy and policy. There is also the NYS Quitline which would benefit us. All of these programs are already well established and funded and would be helpful for our future planning. Thought Leaders work groups were established for each priority. The Thought Leaders consisted of representatives from each hospital and NCDOH to assess the current status, programming, resources, and potential partners under each priority chosen and to develop a strategic plan to address each priority over the next three years. The Fall Prevention Thought Leaders met several times since starting this joint initiative (April 24, May 21, and June 1). The Thought Leaders on Smoking Cessation met two times (April 20 and June 3). page 6 of 6

7 Status of Priorities Both of the initiatives selected were new to Mercy Medical Center. While Mercy has an extensive educational program in place to prevent falls by hospital inpatients, it does not have a falls prevention program aimed at senior residents living in the community. When a patient is admitted to the nursing unit, Mercy does a health assessment which includes tobacco use and follows-up as needed with smoking cessation information. At this time, Mercy does not have a smoking cessation outreach program for residents of the community. Falls Prevention is a new community initiative for the partnership. Smoking Cessation seems to be an existing program through the Center for Tobacco Control, Tobacco Coalition of Long Island and NY Quits, but not all of the Nassau County hospitals were involved in these programs. As a result of this collaborative effort, these existing programs will be supplemented by input and support from community partners such as Mercy Medical Center. Non-Prevention Priorities Mercy Medical Center provides many services designed to assist populations most in need, many of whom have no health insurance expectant mothers, behavioral health clients, seniors and many more. The next section describes several of Mercy s community service health initiatives. Interesting to note is that each of these has some component that is found in the Indicators for Tracking Public Health Priority Areas. Behavioral Health Services Mercy Medical Center continues to provide comprehensive Behavioral Health Services offering the full continuum of care. This continuum provides both mental health and chemical dependency services including Inpatient Psychiatry, Outpatient Mental Health Clinic, Chemical Dependency Day Programs and Clinics, as well as residential programs for the Mentally Ill/Mentally Retarded and Chemical Dependency populations. During 2008, as one of the largest contract agencies for Nassau County s Department of Drug and Alcohol Addictions, Mercy provided 33,028 units of service through its four Substance Abuse Outpatient Programs (Family Counseling, Mercy Hall, Recovery House and New Hope). Mercy s eleven Mental Health Outpatient programs provided 78,811 units of service. Mercy provides a Behavioral Health 24 hour Crisis and Referral phone line. Behavioral Health Services represents a strong advocacy voice for the Hospital. Mercy sponsors Genesis Club, in which mentally disabled members of this social club learn to advocate for themselves and for others, for the right to health care. Mercy has representation on the Long Island Legislative Committee that focuses on the needs of the underserved locally, both medical and psychiatric and Mercy also has a director on the Board of the Nassau/Suffolk Coalition for the Homeless that advocates for the housing and varied services, including health needs for those who are homeless or at risk of homelessness. Mercy will soon be starting the new outpatient program PROS (Personalized Recovery Oriented Services) which will combine treatment, psychiatric rehabilitation and coordination of the patients behavioral health needs. The goal of the program is for the consumer to reintegrate as a more productive member of society. This program is also looking to move into a new building in Mercy s Recovery House will be relocating from Plainview to Uniondale within the next 18 months in order to place this OASAS funded halfway house for men in a more centrally located community, as well as a community who in the past has displayed a need for enriched substance abuse services. Emergency Department Services The Mercy Medical Center Emergency Department (ED) serves a community need that cannot go without mention. The need for emergency care is very apparent as more patients are turning to the ED for primary page 7 of 7

8 care as they do not have their own physician. The ED also serves as a refuge for behavioral health patients in light of dwindling psychiatric care options. The rising uninsured population also results in increased reliance of the ED for basic care. During 2008, there were over 30,000 visits to Mercy s ED. Approximately 20% of all ED patients had no insurance and more than 45% of the ED volume came from four local communities, all of which have been identified as communities at risk Hempstead, Uniondale, Freeport and Roosevelt. Continuing the operation of the ED at a financial loss to the Hospital furthers the fulfillment of our mission of providing care to the vulnerable populations. Primary Care Outpatient Services Mercy s Primary Care Outpatient Services is another program that serves a definite community need. Mercy takes pride in having a full service outpatient obstetrical, gynecological and pediatric service, providing comprehensive healthcare for the low income patients on Medicare, Medicaid, uninsured or underinsured. This Service also includes Pediatric sub-specialty care for cardiology, neonatology, and synagis treatment for high-risk babies The Department is staffed by obstetricians, pediatricians, neonatologists and a nursing staff especially trained in these areas of expertise. During 2008, there were more than 5,000 patient visits seen in this service. Of these patients, 219 received P-CAP services (Prenatal Care Assistance Program), an enhanced Medicaid pre-natal program providing a comprehensive set of services. These services include hospital care during pregnancy, labor and delivery; routine pregnancy medical checkups; lab work; access to specialists; nutrition counseling and more. The pediatric outpatient services sees on average 1,600 annual visits and MMC has seen a 70% increase in the number of new pediatric patients from 2006 to Besides the PCAP program, the OB/GYN services feature general as well as high-risk obstetrics, post-partum and ante-partum services, vaginal and C/section delivery & follow-up. Maternal fetal medicine services are available on site twenty-four hours a day. The OB clinic sees over 2,200 visits annually and has also seen about a 27% increase in new patients. The number of deliveries has increased about 22% and the number of ante-partum admissions has tripled from 2006 to Assuring the health of mothers and infants remains an issue of importance for MMC and the community it serves. According to the Nassau County Health Assessment , the percent of women initiating early prenatal care is 23% greater in the rest of Nassau County than those living in the selected communities. While overall teen pregnancy and birth rates have declined, teen birth rates are much higher in low-income communities and among minorities. The teen birth rate in the select communities was 44.9 per 1,000 teens in 2002 compared to 6.1 for the rest of the county. Teens in general are less likely to receive adequate prenatal care so Mercy providing this service is most important to the welfare of the new mother and baby. In the near future, Mercy hopes to expand the outpatient department space to continue to accommodate the increased utilization of the PCAP program and allow for continued growth of its other primary care services. There is currently a small presence in the Department for internal medicine and geriatrics. The internal medicine service provides an important aftercare option for discharged patients living in the community who have no primary care physician. The Geriatric Consultation Service was established to meet the complex medical needs of the rapidly growing population of older community residents. It provides the opportunity for comprehensive evaluations by Mercy s Board Certified Director of Geriatric Medicine. This service can provide unique insights and information that are invaluable to elderly patients, their families and their primary care physicians. Geriatric Assessments include: Screenings for age-related depression and cognitive dementia Recommendations on gait and balance to avoid falls Nutritional guidance Preventive services Recommendations for patient and family Consultative recommendations for referring physician page 8 of 8

9 Healthy Sundays Mercy, in conjunction with Catholic Health Services of Long Island, participates in Healthy Sundays, a community outreach program held in parishes designed to promote education on many important health subjects such as cancer awareness, diabetes, blood pressure, healthy eating, smoking cessation and cholesterol. This program helps the underserved population overcome a multitude of barriers that they currently face, by providing translation services; having medical personnel and services brought to their communities; and regardless of immigration status or ability to pay, provide primary care services at no cost. The Healthy Sundays program provides underserved communities with healthcare programs, preventive screenings and primary care services, regardless of faith and belief, which are otherwise unavailable. This program reaches out to communities of need to help bridge the gap between the individual and the health provider to improve accessibility to primary and preventive healthcare services for the poor and underserved, ultimately building a link for the coordination of care. Programs are offered that focus on health promotion, education, the importance of prevention, and other basic primary care services. The primary goal of the Healthy Sundays Program is to improve access to and provide comprehensive healthcare services for all individuals, regardless of their ability to pay or immigration status, in order to achieve better health outcomes for the community. Many of the participants do not have insurance, some are new immigrants and many are undocumented. In many cases Mercy is their only source of health care. In 2008, Mercy participated in four Healthy Sundays at various churches throughout Long Island, providing free screenings for diabetes, cholesterol, blood pressure and BMI : - St. Martha s Church in Uniondale people generating 600 screenings - St. Brigid in Westbury people generating 450 screenings - Queen of the Most Holy Rosary in Roosevelt - 74 people generating 296 screenings - Our Lady of Loretta in Hempstead 230 people generating 690 screenings Each program had a different focus but the overall theme to all of them is making lifestyle changes to improve one s health. Besides the screenings, some of the Healthy Sundays had programs such as Smoking Cessation, Healthy Eating: Focus on Hispanic Cuisine, Breast Cancer Awareness and Healthy Eating: Focus on Haitian-Creole Cuisine. Participants who are in need of follow-up are referred back to their private physician if they have one, if not they are given a name and number of a physician on the Mercy medical staff who has agreed to see these patients, regardless of their ability to pay. Mercy continued actively participating in Healthy Sundays in 2009 with five programs to date, and four additional ones targeted for the last quarter of The churches included St. Marthas in Uniondale, St. Patricks in Glen Cove, Our Lady of Loretto in Hempstead, Queen of the Most Holy Rosary in Roosevelt, and St. Agnes in Rockville Centre. Weight Management Managing weight and associated health issues has become a fact of life and challenge for many Americans. This issue is becoming more prevalent, encompassing all demographics across age, gender and race/ethnicity. Being overweight increases the risk of health conditions such as heart and respiratory problems, high blood pressure, diabetes and certain types of cancer. Being overweight is also a serious health concern for young Americans. The medical consequences of obesity vary. However, children and adolescents who are overweight or obese have greater incidences of hypertension, respiratory problems, diabetes, cardiovascular disease, sleep apnea and other illnesses. Statistics also indicate that: - The prevalence of overweight children and teens has tripled during the past 30 years - 27% of today s children are obese, an increase of 54% in the last 15 years - 21% of today s teens are obese, an increase of 40% in the last 15 years - 50% of obese children and 70% of obese adolescents will be obese adults - If obesity persists through adolescence, the teen has a 1 in 28 chance of normalizing weight - There are many psychosocial disadvantages peer teasing, scholastic discrimination, low self esteem and negative body image page 9 of 9

10 As a Bariatric Center of Excellence, Mercy Medical Center has developed three weight management programs to begin in. Mercy will provide a facilitated support group for post bariatric surgery patients, as well as conducting two facilitated weight-management groups, one for adults and the other for adolescents. The weekly, ten or twelve-session programs will be conducted by a multidisciplinary team of healthcare professionals with long experience in assisting with the lifelong commitment and lifestyle modifications required for weight management. The Mercy professionals in Behavioral Health, Nutrition and Physical Therapy will focus on a broad range of issues including healthy behaviors, stressreduction, social relationships, exercise, disease prevention and healthy diets. Group sizes will be limited to assure personal attention. The program for adolescents will use the nationally recognized SHAPEDOWN curriculum developed at the University of California, San Francisco. The SHAPEDOWN Weight Management Program for adolescents combines diet, exercise and other techniques that help young people become healthier and happier. More than 100,000 children, adolescents and their families have successfully completed SHAPEDOWN throughout the country. The program s short and long term effectiveness has been documented in controlled clinical trials published in a peerrefereed journal. SHAPEDOWN s orientation is to promote successive small changes in behavior that create a new lifestyle for child or teen and their family. SHAPEDOWN helps young people change their food and exercise habits, improve their self-esteem and lose unwanted pounds. Parents must also attend the meetings. Research shows that weight difficulties in children and adolescents are highly treatable when a family-based approach is used. The children and adolescents who are the most successful are the ones whose parents make a strong commitment and make real changes in their own lives as well. Mercy Medical Center hopes to partner with the Nassau County Department of Health s Healthy Youth Initiative. This Initiative aims to improve the health of children and teens in Nassau County. The program's mission is to inform youth about healthy foods, the importance of staying active, the benefits of making healthy choices, and providing a healthy environment. Mercy believes this would be a good partnering opportunity for both organizations. Diabetes Diabetes has become such an epidemic that in 2007, according to the Kaiser Family Health Foundation, 24 million or 8% of the U.S. population has diabetes (18.3 million diagnosed, 5.7 million undiagnosed), making it the 7 th leading cause of death in the United States. This is mirrored in New York State, where approximately 8.4% of the adult population has been medically diagnosed with diabetes and another 1.1% of the population is considered pre-diabetes or borderline. According to the Nassau County Community Health Assessment report , in 2000, the diabetes discharge rate in the selected communities, of which 3 of the 7 are located in Mercy Medical Center s primary service area, on average was over 1.5 times greater compared to Nassau County as a whole. Not only is this a national, state, and county-wide concern, but a truly staggering prevalence in the immediate community that Mercy serves. According to the NYSDOH Prevention Quality Indicator (PQI) website, the percentage of African Americans in the Hempstead area (11550) admitted to Mercy with a primary diagnosis of uncontrolled Diabetes is 443% of the expected admission rate taken from the statewide average. There is a clear and present danger in the community for diabetes and hypertension, both related to obesity and poor access to care. The chart below details the staggering admissions rates for preventable conditions related to hypertension and diabetes in the community served by Mercy. The top 3 treat and release zip codes for Mercy include Hempstead (11550), Uniondale (11553), and Roosevelt (11575), a total population of 73,524. The second group is the top 7 patient distribution percentages as indicated by the PQI website, including Hempstead, Uniondale, West Hempstead, Lynbrook, Rockville Centre, Baldwin, and Freeport, a total population of 175,998. Across the board, for each condition, for both community areas, the area rate is higher than the statewide rate and the admissions are greater than the percent of the expected admissions for the given condition. In addition, the health disparity for African Americans in these areas is clearly displayed. page 10 of 10

11 MERCY MEDICAL CENTER PREVENTIVE QUALITY INDICATOR (PQI) COMMUNITY ANALYSIS Area Rate Statewide Rate Admissions as % expected Admissions as % expected A.A. Hypertension Top 7 Patient Pop. from PQI % 377% Top 3 treat & release zips for MMC % 422% All Diabetes Top 7 Patient Pop. from PQI % 238% Top 3 treat & release zips for MMC % 258% Short Term Complication Diabetes Top 7 Patient Pop. from PQI % 236% Top 3 treat & release zips for MMC % 225% Long Term Complication Diabetes Top 7 Patient Pop. from PQI % 208% Top 3 treat & release zips for MMC % 223% Lower Extremity Amputation Top 7 Patient Pop. from PQI % 282% Top 3 treat & release zips for MMC % 313% Uncontrolled Diabetes Top 7 Patient Pop. from PQI % 313% Top 3 treat & release zips for MMC % 392% Information gathered from the PQI website confirms the need for specific focus and services to decrease the admission to the hospital for conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. In addition, the PQI data reveal racial and ethnic disparities in basic measures of health care. As part of a future project for which Mercy has a State grant pending, Mercy hopes to target specific efforts to combat these measures by expanding access to high quality primary care and better chronic disease management for both diabetes and wound care. Three Year Plan of Action Falls Prevention The partnership formed between the Nassau County Department of Health and Nassau County Hospitals (as previously identified) have agreed to work together in order to make an impact on reducing the prevalence of falls in Nassau County residents aged 65+ years. This reduction will in turn reduce the number of hospitalizations related to falls in this age group. Year 1 Inventory hospital and other partners to determine what services are already in place Hold focus groups to assess needs and get community feedback Develop a standardized falls assessment tool, based on national best practices (Center for Disease Control materials selected as they are valid, evidenced-based and easy to access) Develop a pre/post measurement tool based on national best practices that can be administered to participants at the program before and after the presentation Develop at least one standardized falls educational prevention handout based on national best practices that can be distributed to community program participants (recommendation was to use page 11 of 11

12 Year 2 Year 3 CDC educational handouts What you can do to prevent falls and Check for Safety A home fall prevention checklist for older adults )Hold two community educational programs utilizing new standardized education handout and assessment tool Educate and create community awareness on the impact of and risk factors for falls Review current programs for opportunities to expand and improve Continue to provide community education programs, at least two Develop county wide campaign and brand it with a tag line such as Long Island Stands Up for Falls and use it on marketing and educational materials Increase public awareness of falls by utilizing community newsletters, public service announcements, web sites, physician offices, politicians announcements, brochures, and various hospital newsletters - community, physician and employee Provide educational program for the children of our senior groups to further promote this awareness campaign Increase awareness within the hospital staff by offering fall prevention education to include home assessment tools and balance strengthening exercises Increase awareness for inpatients by providing fall prevention education as part of discharge planning Partnership to meet to assess strategies and goals to determine needs for the third year There are several ways the outcome of this initiative can be measured. Scores of the pre and post test will be determined to see at least from a knowledge base, if the educational program increased one s understanding of the risk factors for senior falls. The number of community programs in 2009 can be compared to those in 2010 to see if there was an increase in program offerings. Assuming there were many programs offered at assisted living type of facilities, a survey could be sent to these facilities after year one to see if there was a noticeable reduction of falls after the program was given. SPARCS data can be reviewed to analyze whether the number of Emergency Department visits due to falls was reduced from the year before. Inpatient data can be reviewed to see if there was a reduction of falls due to increased education of the patients. A baseline of the number of patients who reviewed the hospital video on senior fall prevention can be taken this year and compared to next year to see if more patients had been encouraged to watch it. Mercy Medical Center has already begun working on its Falls Prevention strategy. Mercy was involved in two focus groups partnering with the Rockville Centre Community Council, the Rockville Centre Department of Senior Services and the National Council of Jewish Women South Shore Section. During these focus groups, questions were asked about how best to educate the senior population on fall prevention. One session was held at the Leonard Sandel Senior Center and the other at the Rockville Centre Recreation Center. Mercy has been researching materials on falls and purchased a senior falls prevention video from the Home Safety Council. This video was put on the patient education channel of all the patient televisions and nurses are encouraging patients to view the video. Mercy is in the process of reevaluating its Patient/Family Education Record and corresponding educational materials to make sure appropriate information is given to inpatients to prevent falls in the hospital. Mercy is also reviewing its policy and procedures on inpatient fall prevention. page 12 of 12

13 In 2009 Mercy formed an in-house Community Outreach committee for the development and implementation of programs to meet community needs. The committee works to set up programs within the community on disease prevention (screenings, immunizations) and health promotion (health education, support groups, etc.). Mercy developed a Speaker Bureau program which included preparing a host of health care related topics and identifying key employees or members of the medical staff to speak on one at community outreach programs. The list of topics now includes Fall Prevention and Smoking Cessation as well as Nutrition and Weight Loss Management. In 2009 the brochures were mailed to select libraries, senior centers and assisted living facilities inviting them to call Mercy for a presentation in their chosen topic or any other health related topic. As a result of this mailing, we are now partnering with many of these community based organizations as well as the Town of Hempstead Department of Senior Enrichment and the Nassau County Department of Senior Affairs, specifically for the fall prevention program. Mercy has also begun integrating falls prevention in seniors in its community outreach programs as can be seen by those past programs and those forthcoming: - April handouts distributed at Rockville Centre Chamber of Commerce Health Fair (included both Falls and Smoking Cessation) - June - handouts distributed at Rockville Centre Chamber of Commerce street fair (included both Falls and Smoking Cessation) - July included in power point presentation entitled My Parents are Aging held at Mercy Medical Center for community residents - September Mercy will bring attention to this initiative for National Falls Awareness Day (September 22) by having a display booth in the hospital lobby with handouts - October Mercy will be staffing a table at three senior fairs where the falls video will be playing on a continuous loop and handouts will be discussed and distributed - Senator Dean Skelos Golden Gathering Senior Health Fair, Senator Charles Fuschillo 9 th Annual Golden Gathering and Senator Kemp Hannon s Health & Awareness Day Senior Health Fair - October The Bristol Assisted Living Facility in Lynbrook - October - Merrick Library on Safety and Well Being for Seniors which includes a section on senior fall prevention - October - The Bristol Assisted Living Facility in North Woodmere - Partnering also with National Council of Jewish Women South Shore Section on a program on caring for your aging parent which will include fall prevention in seniors In the near future, a hospital wide task force will be convened to address fall prevention for seniors in the community. Some of the initiatives they will undertake, besides the ones listed previously as part of the joint partnership, include: - Building on the campaign slogan Stand Up for Falls - Working with the NCDOH Healthy Homes initiative which is designed to help residents learn about ways to improve their homes through seven simple steps; work with them on adding an eighth step to Keep it Fall Free to include points like removing area rugs, installing hand rails and brighter bulbs in hallways, etc. - Looking at the hospital discharge packets to include information on falls prevention - Evaluating the pre-op patient education program Joint Endeavor to ascertain whether risk factors for senior falls is addressed properly - Working with RVC Department of Senior Services, especially the Leonard Sandel Senior Center as part of their REFER program where neighbors assist in identifying senior needs in the community - Evaluating various other promotional materials to be given out at local health fairs such as those sponsored by the National Institute on Aging or the National Center for Injury Prevention and Control - Continuing to review with the nursing department inpatient procedures that may reduce inpatient falls - risk admission assessments/high risk criteria, fall plan of care, patient/family education, specialty beds with exit alarms, safety watch, frequent toileting, etc. page 13 of 13