Strategic Plan for

Transcription

1 Strategic Plan for Adopted by the Person County Board of Health July 28,

2 Executive Summary: The Person County Board of Health and the Person County Health Department s Management Team met on January 5, 2014 for the purpose of strategic planning and began stakeholder analysis. Additionally, Management Team convened on February 5, 2014 and July 14, 2014 to continue the planning process. During these meetings, the group assessed the status of the Strategic Plan objectives; identified objectives to continue working towards over the next year; reviewed and analyzed data from the 2013 State of the County Health Report (SOTCH) and 2011 Community Health Assessment (CHA) and community health survey as well as other influencing data; prioritized objectives; and identified department strengths and weaknesses applicable to meeting the objectives for the new fiscal year. The status of the objectives and outcomes/explanations are detailed in Appendix A. Members of the Person County Board of Health received a draft of the proposed Strategic Plan by mail for review prior to their July meeting. After discussion at their July 28, 2014 meeting, the Strategic Plan for was approved. The final plan was made available to staff and the Board of Health through and is on the department s share drive. It is accessible to the public and partners through the department s website. Person County Health Department s Strategic Plan: Includes a review and analysis of factors influencing the health department s ability to improve the community s health Uses local health status data and information to set goals and objectives Uses community input where applicable States desired outcomes for each element Sets priorities Uses community collaborations to implement activities Tagline: Promoting, Protecting and Nurturing the Health of Our Community Mission The mission of the Person County Health Department is to promote, educate and protect personal, family and community health; ensure a safe environment, provide and assure access to healthcare throughout life; prevent and control the incidence and spread of disease; and provide community based education and information to encourage healthy lifestyle choices. Vision Statement The result of the work of the Person County Health Department is a community that is healthy, able to reach its full potential and supported throughout life, in a safe and clean environment. Core Beliefs What are Core Beliefs? Core Beliefs capture the beliefs we hold about what matters most. The Individual We value all individuals We respect all individuals We support and foster trust between individuals and groups We recognize the need to balance work and family 2

3 Client and Community We respect client confidentiality We treat all clients with dignity and respect We commit to the health and safety of our clients and the community We recognize that all persons have the right to health care that promotes dignity and respect We do all we can for those we serve Achievement through Teamwork We respect and appreciate differences We value open, honest and constructive communication We recognize that quality emerges from individuals who share a mission and values Integrity We own up to our mistakes We do what we say we will do We endeavor to do the best we can We will not compromise on what is right We take responsibility for our own behavior Goals and Objectives The goals and objectives established for the department s Strategic Plan are based on data from the 2013 SOTCH; the 2011 CHA; a community survey conducted through a market research project; internal records/databases and contracts for various programs; and mandates through the North Carolina General Assembly as well as some funding sources. Data and information reviewed in the development of this plan from the 2013 SOTCH: Pregnancy Rate (per 1,000) for females ages 15-19: Person County rate for (down from 2011 when it was 51.8); NC rate for Actual # of pregnancies (in females ages 15-19) in 2012 was 58, which was down from 65 in Infant Mortality (infant deaths per 1,000 live births) Person County rate 6.5 (slightly down from which was 6.6); NC rate 7.5 Actual # of infant deaths from was 14 (down by 1 death from ). Leading Causes of Death (Overall) in Person County for (age-adjusted death rates) 1. Cancer 2. Heart Disease 3. Cerebrovascular Disease 4. Chronic Lower Respiratory Diseases 5. All Other Unintentional Injuries 6. Diabetes 7. Alzheimer s Disease 8. Pneumonia and Influenza 9. Unintentional Motor Vehicle Injuries 10. Septicemia 3

4 When comparing data for leading causes of death to that of , the rankings remained about the same with the exception of pneumonia/influenza and unintentional motor vehicle injuries. All of Person County s death rates, except for All Other Unintentional Injuries and Alzheimer s disease, were above the state s rates for In spite of this, death rates for all leading causes of death in the county, except pneumonia/influenza, had decreased from to One significant change revealed in the data from the aforementioned time periods is that Alzheimer s disease ranked amongst the top 10 leading causes of death in Person County. In , Alzheimer s disease was the 11th leading cause of death. For and , it moved up in the rankings to #7. However, the death rate for Alzheimer s Disease was below the state s rate for both the and time periods. Leading sites of cancer deaths, ranked in descending order of death rates include: trachea/bronchus/lung; prostate; breast; colon/rectum/anus; and pancreas. Communicable Disease (CD) Data Overall cases of CDs decreased from 2011 (244 cases) to 2012 (232 cases) Cases of Foodborne Illnesses decreased from 2011 (17 cases) to 2012 (15 cases) Cases of STDs slightly increased from 2011 (194 cases) to 2012 (196 cases) Cases of General CDs decreased from 2011 (33 cases) to 2012 (21 cases) Obesity Data Childhood Obesity: We were only able to compare overweight and obesity in children ages 2-4 from 2010 to 2011 due to very limited data available through NC-NPASS (North Carolina Nutrition and Physical Activity Surveillance System). Data provided is from WIC which represents a small sample size. (Note: Italicized information in parenthesis represents NC percentages.) In 2010, 16.6% (16.1%) of Person County children sampled, ages 2-4, were overweight. In 2011, 13.1% (16.2%) were overweight. In 2010, 16.6% (15.6%) of Person County children sampled, ages 2-4, were obese. In 2011, 18.2% (15.7%) were obese. Adult Obesity: Person County Health Department s preference is not to use data from the Behavioral Risk Factor Surveillance System to track overweight/obesity in adults in Person County. The data is too broad to use as the county is part of a 35 county sample. In the fall of 2013, the Health Department participated in a market research project which collected information from 300 residents over the age of 18 through a phone survey. Surveyors made a concerted effort to get a proportionate sampling of responses from both men and women, various age ranges, different ethnic backgrounds, and targeted zip codes representing all areas of the county. When respondents were asked a question in regards to what they had ever been told by a doctor about their weight, 32% responded that they were overweight while 3% said they were obese. Other Notable Information from the SOTCH: In January 2013, the Person County Board of Commissioners adopted a non-smoking ordinance prohibiting smoking within 50 feet of any recreation, health and wellness facilities. Designated smoking areas were established at each facility. The county experienced its first West Nile Virus cases in the fall of In September, a mare received a positive diagnosis while in November, the first human case was diagnosed. In July 2013, the electronic health record component of Patagonia was implemented in some personal health clinics. The Health Department became a Certified Application Counselor. Three staff members were trained to assist persons interested in obtaining insurance through The Marketplace. 4

5 Work with the Person County Farmers Market, the non-smoking ordinance, and a market research project was done through support from the Community Transformation Grant Project. Data and information reviewed in the development of this plan from the 2011 CHA: o Person County s 10 leading causes of death ( ) according to this report were (1) heart disease; (2) cancer; (3) stroke; (4) chronic lower respiratory disease; (5) unintentional non-motor vehicle injury; (6) diabetes; (7) pneumonia and influenza; (8) unintentional motor vehicle injury; (9) kidney disease; and (10) septicemia. o Additional data from the most recent CHA on pregnancy rates for teens ages 15-19; infant mortality; and childhood obesity was also taken in account when preparing this strategic plan. o Other considerations in the development of this plan include the 778 responses received from the community through a survey during the CHA process in (The survey was conducted via random sampling and convenience-style.) The community indicated through these surveys that the top 10 Most Important Health Problems in the county are: (1) cancer; (2) obesity/overweight; (3) heart disease/heart attack; (4) diabetes; (5) problems of aging; (6) mental health; (7) teenage pregnancy; (8) stroke; (9) lung disease; and (10) non-vehicle accident injuries. They also concluded that (1) drug abuse; (2) alcohol abuse; (3) lack of exercise; (4) poor eating habits; (5) smoking/tobacco use; (6) lack of parenting skills; (7) lack of preventive medical care; (8) having unsafe sex; (9) reckless/drunk driving; and (10) violent/angry behavior were the 10 Most Important Unhealthy Behaviors that needed to be addressed. Respondents revealed that the 10 Most Important Community Issues were (1) under/unemployment; (2) gang activity; (3) affordability of health services; (4) crime; (5) low income/poverty; (6) lack of health insurance; (7) dropping out of school; (8) neglect and abuse; (9) availability of healthy foods; and (10) lack of recreational facilities. o After thoroughly reviewing both the primary and secondary data at length, the Community Health Assessment Team established the following health priorities for : Chronic Disease (cancer; heart disease/stroke, diabetes) Unhealthy Behaviors (lack of exercise; having unsafe sex; poor eating habits; substance abuse tobacco, alcohol and drugs; lack of parenting skills) Overweight/Obesity Teen Pregnancy Alzheimer s Disease/Problems of Aging Community Health: Access and Awareness of Services (preventive, educational, and mental health services) In conclusion, health issues and associated risk factors will be addressed as the department has the capacity to do so. The availability of federal, state and local funds will continue to be an influencing factor in the department s ability to improve the community s health. These funds along with grants and donations obtained will support existing efforts and make provisions for additional programs and services. Individual contract addenda through various department programs will also address some of these goals. Additional influencing factors recognized by the department that are key to working towards objectives in this plan include staff retention and training. The department s Workforce Development and Staff Development Plan detail department directives in retaining staff and ensuring they are appropriately trained. The objectives in this plan are department-wide focused. Public health also relies on numerous partners, both traditional and nontraditional, to help fulfill its mission, goals and objectives. 5

6 Department Goals 1. Implement the North Carolina Crossroads WIC Computer System. 2. Prepare to improve health outcomes, clinic efficiency, and provide cost effective services by initiating and implementing Practice Management processes. 3. Prepare an assessment of the addition of primary care services. 4. Assist with the implementation of the local stormwater program for new development as required by: Stormwater Management for New Development (15A NCAC 02B.0277) and assist with the implementation of the local stormwater program for existing development as required by: Stormwater Management for Existing Development (15A NCAC 02B.0278). 5. Deliver quality and efficient services to the community. 6. Determine the health status of the county and any emerging issues. 7. Mitigate all hazard preparedness by offering communication resource, immunizations, and educational materials to clients during current visit. Mitigate noncompliance with immunization status and emergency alert notification registration. Increase success of response to Strategic National Stockpile activation with functional Local Receiving Site (LRS) and LRS staff. Increase success of Point of Dispensing (POD) operations. Increase staff and volunteer response by providing education, training and supplies to function during disaster response. 8. Determine the feasibility of the department going through a branding process. 9. Across the state, collectively impact the rates and prevalence of cardiovascular disease/hypertension, obesity and diabetes. 10. Determine the barriers which inhibit nursing mothers from breastfeeding until infants reach 6 weeks of age. Provide strategies to facilitate nursing relationships both in the hospital and at home to assist WIC participants toward successful achievement of their goals. Objectives Matched to Goals The department s objectives for FY were prioritized by the management team and are listed below in descending order. Each objective was written on a piece of paper and posted on the wall. Factors taken into consideration throughout the prioritization process included such things as: the time and steps each objective will require; the resources and support that would be available and needed; the urgency of meeting some objectives as opposed to others; the progress that has been made already towards objectives; the availability of staff and community partners to work towards meeting objectives, etc. The team literally arranged the objectives in order of priority #1-10 by posting them around the room. Several objectives were rearranged throughout the process until a consensus was met by the team. 6

7 Objective 1: By December 31, 2014, the WIC Program will replace the DOS-based computer system with a web-based client accessible system through the Nutrition Services Branch. o Implement the North Carolina Crossroads WIC Computer System o Nutrition and WIC Services Section o PCHD Staff o Local and State Information Technology Staff o Nutrition Services Branch Staff o Conduct User Acceptance Testing. o Train Nutrition and WIC Services Section on Crossroads. o Educate Person County WIC Applicants and Recipients. Desired Outcome(s): o Updated computer system was implemented. Objective 2: By January 31, 2015, a Readiness Assessment and request for consultation will be done by the Health Director in preparation for the implementation of Practice Management. o Prepare to improve health outcomes, clinic efficiency, and provide cost effective services by initiating and implementing Practice Management processes. o State consultant o Health Director o Run and analyze clinical and financial reports. o Complete Readiness Assessment and request for consultation. Desired Outcomes: o Completed the Readiness Assessment. o Received an assigned consultant. o Determine extent of Practice Management implementation. o Improve outcomes; provide cost-effective services, and clinic efficiency. Objective 3: By January 31, 2015, assess the viability of expanding current clinical services to include primary care services. o Prepare an assessment of the addition of primary care services o Health Director o Board of Health 7

8 o Community Medical Providers o County and City Managers o County and City Human Resources Directors o PCHD Staff o Community Members o Meet with stakeholders for input. o Assess data to determine the need for primary care. o Develop business plan for presentation. o Present plan to stakeholders. Desired Outcome(s): o Submitted proposal of implementation with budget for FY Objective 4: On an ongoing basis, continue to provide support for the implementation of stormwater and water quality regulations as required by state law. o Assist with the implementation of the local stormwater program for new development as required by: Stormwater Management for New Development (15A NCAC 02B.0277). o Assist with the implementation of the local stormwater program for existing development as required by: Stormwater Management for Existing Development (15A NCAC 02B.0278). o Person County Government o Person/Granville County Stormwater Utility o Upper Neuse River Basin Association o North Carolina Department of Environment and Natural Resources/ Division of Water Quality o Maintain an inventory of septic systems in the Flat River Watershed. o Continue to identify and facilitate repair of failing septic systems countywide. o Provide assistance to utilities, including BMP Inspections. o Maintain grant program to provide financial assistance to repair failing septic systems. Desired Outcome(s): o Improved surface water quality in the Flat River watershed. o Reduced amounts of nutrients exported from Person County via the Flat River. o Ensured all relevant NCDENR program requirements, including implementation, data collection, and reporting. Objective 5: By June 30, 2015, provide opportunities to increase the community s accessibility to immunization and communicable disease services. o Deliver quality and efficient services to the community. 8

9 o Management support staff o Clinical staff o Media outlets o Roxboro Community School o Bethel Hill Charter School o Roxboro Christian Academy o Southern and Northern Middle Schools o Patients of Person County Health Department o Perform flu immunization clinics in the community. o Conduct at least 1 immunization outreach or education event within the county per fiscal quarter to improve immunization awareness in the community and increased vaccine coverage rates among residents of the county. o Ensure that the Communicable Disease Nurse has a trained back-up nurse to assist with communicable disease and immunization services. o Explore and implement the identification of recommended immunizations from the state immunization record for each patient and provide an opportunity for patient to receive immunizations during visit. Desired Outcome(s): o Enhanced convenience of immunization services to the community. o Increased Person County s immunization rates. Objective 6: By June 1, 2015, complete the 8 phases of the Community Health Assessment (CHA) process. o Determine the health status of the county and any emerging issues. o NC State Center for Health Statistics (NCSCHS) o Health Education o Management Team o Community Health Assessment Team o Contract Consultant o Finish collecting primary and secondary data. o Finish collecting local data available through various community organizations. o Analyze and interpret primary and secondary data. o Determine health priorities for o Create the CHA document and submit to the state. o Disseminate the CHA document and results in compliance with the department policy and accreditation standards. o Develop community health action plans for health priorities and submit to the state. Desired Outcomes: o Health priorities for were identified. o A CHA document was submitted to the state. (by March 1, 2015) 9

10 o Results from the CHA were disseminated according to the department policy and accreditation standards. (by June 1, 2015) o Community health action plans were developed for each health priority and submitted to the state. (by June 1, 2015) Objective 7: By June 30, 2015, increase the ability of the public health workforce, volunteers, and community to mitigate and respond to health threats through integration of at least 3 community preparedness campaigns. o Mitigate all hazard preparedness by offering communication resource, immunizations, and educational materials to clients during current visit. o Mitigate noncompliance with immunization status and emergency alert notification registration. o Increase success of response to Strategic National Stockpile activation with functional LRS and LRS staff. o Increase success of POD operations. o Increase staff and volunteer response by providing education, training and supplies to function during disaster response. o Person County Local Emergency Planning Committee o Person County Health Department Staff o Person County Medical Reserve Corps o Person County Health Department Board of Health o North Carolina Public Health and Preparedness and Response o CDC Division of Strategic National Stockpile o Offer Code Red sign up to 50% of clients of Home Health and Hospice and Personal Health. o Assess North Carolina Registry eligibility and delinquent immunization status on 50% of clients and offer an opportunity to complete immunizations during current visit. o Initiate Flu Near You campaign and offer sign up to all clients. o Inquire from 50% of clients if they have an emergency preparedness kit and educate on basic items to include when developing a kit. o Provide emergency preparedness introduction training with competency check at one scheduled staff meeting. o Prepare Homeland Security Exercise Evaluation Program compliant Full-Scale Exercise documents for utilization during five year required FSE scheduled in 8/2015. o Provide responder health and safety training at staff meeting and one quarterly MRC training o Secure contract for new LRS. o Provide specialized training to registered and licensed practical nurses for countermeasure dispensing and POD operations. o Secure inventory management tool for LRS and train LRS staff on its use. Desired Outcomes: o Improvement in responder health and safety competence by 10%. o Increase in volunteer membership by 25%. o Increase in immunization rates and compliance by 10%. o Increase registration in CodeRed by 10% and implement the use of Flu Near You. o Functional LRS in place. 10

11 Objective 8: By June 30, 2015, gather information from at least 3 sources about what would be involved in implementing a facilitated branding campaign in the department. o Determine the feasibility of the department going through a branding process. o Management Team members o Staff members as designated by Management team o Other health departments o Marketing/branding consultation firms o Participate in webinars, calls, etc. to become more informed about what is involved in a facilitated branding process. o Contact other health departments or agencies that have been through a branding process to gather information about what was involved and the cost. o Obtain information from marketing/branding consultation firms. o Present information to the management team and Board of Health as appropriate. Desired Outcome(s): o The management team and Board of Health will have enough information to determine if the department should pursue going through a facilitated branding process and should budget for such in the next fiscal year if feasible. Objective 9: By June 30, 2015, implement at least 1 of the 3 evidenced-based strategies selected statewide for collectively addressing cardiovascular disease/hypertension, obesity or diabetes. o Across the state, collectively impact the rates and prevalence of cardiovascular disease/hypertension, obesity and diabetes. o State consultants o To be determined by whichever evidenced-based strategy is implemented o Obtain direction from the state about requirements with regards to the implementation of select evidenced-based strategies. o Obtain information from the state about what resources and supports are available for implementing these strategies. o Determine which evidenced-based strategy to implement (Living Healthy Chronic Disease Self- Management Program; comprehensive early care and education standards and policies for nutrition and physical activity; DERP Diabetes Education Recognition Program). o Establish partnerships to implement whichever strategy is chosen. Desired Outcome(s): o At least 1of the select evidenced-based strategies addressing cardiovascular disease/hypertension, obesity or diabetes was implemented. 11

12 Objective 10: By June 30, 2015, increase the percentage of infants who participated in WIC who were breastfeeding at 6 weeks of age from 23.8% per FY 2013 Agreement Addenda data to 24.5% per FY 2014 Agreement Addenda data. o Determine the barriers which inhibit nursing mothers from breastfeeding until infants reach 6 weeks of age. o Provide strategies to facilitate nursing relationships both in the hospital and at home to assist WIC participants toward successful achievement of their goals. o Nutrition and WIC Services Section Staff o PCHD Breastfeeding Coordinator o PCHD Personal Health Nursing Coordinators and Staff o PCHD Pregnancy Care Managers and Care Coordination 4 Children Managers o Contract and Private OB-GYN Medical Providers o Local and Private Pediatricians o Local and Private Family Practice Physicians o Nutrition Services Branch Consultants o Region IV Breastfeeding Consultant o Seek input and ideas from WIC prenatal participants through question-and-answer sessions. o Create a facts and myth activity sheet to address potential barriers to breastfeeding. o Collaborate with experienced breastfeeding mothers regarding their personal experiences. Desired Outcome: o The percentage of infants who participated in WIC who were breastfeeding at 6 weeks of age increased to 24.5% per the FY 2014 Agreement Addenda data. 12

13 Department Strengths and Weaknesses The participants identified the following strengths and weaknesses that would be factors in the department s ability to meet the objectives in this strategic plan. Strengths Seasoned employees offering various expertise; motivated and professional employees Partners/local support for programs Support from national, state and private consultants Weaknesses Funding (reduction in federal, state and local funding) Change and reduction in partnerships (due to change of employment, retirement, reduction in force, etc.) Internal teamwork in some areas and communication Board of Health support Knowledge of resources and/or accessibility of resources Planning and Management Grant and revenues- funding accountability Training opportunities available to staff Facilities Credibility- Viewed as a model Customer and County Focus 13

14 Appendix A: Status of Strategic Plan Objectives and Outcomes/Explanations 14

15 Appendix A: Status of Strategic Plan Objectives and Outcomes/Explanations Objective 1: By June 30, 2014, Home Health and Hospice of Person County will become reaccredited through the Accreditation Commission for Health Care, Inc. o Status: Met o Outcome/Explanation: Both the Home Health and Hospice programs were reaccredited with deemed status. Objective 2: By June 30, 2014, an electronic health record system will be implemented in clinics as dictated by Patagonia. o Status: Met o Outcome/Explanation: EHR system implemented successfully in July Additionally, maternity EHR system was upgraded from Duke OB-TraceVue to Maestro in March Objective 3: By June 30, 2014, the WIC Program will replace the DOS-based computer system with a webbased client accessible system through the Nutrition Services Branch. o Status: Not Met o Outcome/Explanation: Due to delays by the NC Division of Public Health, Crossroads is scheduled to be implemented in October Objective 4: By June 30, 2014, the QI team will explore opportunities to increase the community s accessibility to immunization and communicable disease services. o Status: Met o Outcome/Explanation: Through the QI team s investigation and coordination, PCHD now offers monthly Tb screenings and immunization for the Person County Group Homes at a central location. Objective 5: By June 30, 2014, two nurses will have completed the Adult Health Assessment and STD Assessment trainings. o Status: Met o Outcome/Explanation: Two nurses have successfully completed the Adult Health Assessment and STD assessment trainings, and are now certified as Enhanced Role STD nurses. Objective 6: On an ongoing basis, continue to provide support for the implementation of stormwater and water quality regulations as required by state law. o Status: Met o Outcome/Explanation: Successfully developed and implemented an ongoing program to provide financial assistance for the repair of failing septic systems. Of the 11 applications submitted, 9 families qualified for assistance ranging from 40% to 100% of repair costs. Approximately $16,200 in grant funds were approved; however, only 6 of the 9 repairs were installed by June 30, Therefore, $9,364 in grant funds provided assistance in the last 6 months of the fiscal year. 15

16 Established and implemented a protocol for annual inspections of Stormwater BMP s in Person County. Staff have conducted both residential and commercial BMP inspections and provided documentation to the Stormwater Administrator. Objective 7: By December 31, 2013, a State of the County Health Report will be completed and results will have been disseminated in compliance with the department policy and accreditation requirements. o Status: Met o Outcome/Explanation: The 2013 SOTCH was produced and met state requirements. It was also disseminated to the public, county stakeholders and community partners in compliance with the department s CHA/SOTCH Dissemination policy. Objective 8: By June 30, 2014, increase the percentage of infants who participated in WIC who were breastfeeding at 6 weeks of age from 22.5% per FY 2012 Agreement Addenda data to 24.5% per FY 2013 Agreement Addenda data. o Status: Not Met o Outcome/Explanation: The Person County WIC Program did not meet our objective of 24.5% per FY 2013 Agreement Addenda data for percentage of infants who participated in WIC who were breastfeeding at 6 weeks of age. Person County had 23.8% of infants who participated in WIC who were breastfeeding at 6 weeks of age which is a difference of 0.7%. Objective 9: By June 30, 2014, increase the number of Person County Medical Reserve Corps volunteers by at least 35% and offer quarterly orientations/activities/trainings to keep them engaged. o Status: Met o Outcome/Explanation: The Person County Medical Reserve Corps has 32 volunteers which is an increase of 56%. During FY 2014, 15 activities were offered which included orientations and trainings. Objective 10: Through September 2016, participate in the regional Community Transformation Grant (CTG) Project by serving as the fiscal agent for region 5 and working with partners to execute Community Transformation Implementation Plans. o Status: In Progress o Outcome/Explanation: PCHD has served as the fiscal agent for region 5 for the CTG project since the start of the program; however, due to termination of federal funding for the project, the grant will terminate on September 30, 2014; therefore, we will no longer be needed to serve as the fiscal agent. CTG initiatives implemented this fiscal year included: work with the Person County Farmers Market, a shared use agreement with Person County Recreation, Arts, and Parks (PCRAP), a media campaign with WTVD, a market research project, and work on a Facilities Master Plan with PCRAP. Objective 11: On an ongoing basis, market department services and programs. o Status: Met (but an ongoing work in progress) o Outcome/Explanation: Department services and programs continue to be marketed as resources allow and as opportunities present themselves. Within the timeframe of this plan, additional marketing strategies (other than routine media efforts and presentations) included: The maintaining of current information on the department s and the MRC Facebook pages. The maintenance of the website (from the Person County website). 16

17 Articles and ads were published in the Courier Times to promote various programs. Ads and public service announcements aired on the local radio station. Overall, the number of health department patients increased from 3,712 to 4,439 from May 2011-April 2012 to May 2012-April *This does reflect unduplicated clients. In comparing May 2011-April 2012 to May 2012 April 2013, there was an increase in the number of Home Health referrals (from 243 to 305) and a decrease (from 98 to 73) in the number of Hospice referrals. 17