SUNY UPSTATE MEDICAL UNIVERSITY

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1 SUNY UPSTATE MEDICAL UNIVERSITY UPSTATE UNIVERSITY HOSPITAL Downtown and Community Campus Community Service Plan: Upstate University Hospital Community Service Plan Page 1

2 Table of Contents I. Mission & Vision Statement 3 II. Upstate University Hospital Service Area 4 9 III. Programs and Services IV. Community Health Needs Assessment: Community Engagement Process V. Setting Health Priorities VI. VII. VIII. IX. Results of Community-wide and Local Health Department Priority Areas Selected Community-wide and Local Health Department Priority Areas Prevention Agenda Priority Areas: Upstate University Hospital Initiatives Changes (Actual and Potential) Impacting Community Health, Provision of Charity Care And Access to Services X. Financial Assistance Program XI. Conclusion.. 44 XII. Dissemination of Report to Public 45 APPENDICES Appendix I: Community Health Forums Appendix II: 2013 Onondaga County Health Assessment Appendix III: Upstate Medical University Strategic Planning Report Care: Appendix IV: Onondaga County Community Health Improvement Plan Appendix V: Prevention Quality Indicators by Zip Code, Onondaga County, Appendix VI: New York State Prevention Agenda Priorities, Focus Areas, Goals and Objectives, (1/25/2013) Upstate University Hospital Community Service Plan Page 2

3 I. Mission, Vision and Values SUNY Upstate Medical University's Mission: The mission of SUNY Upstate Medical University is to improve the health of the communities we serve through education, biomedical research and health care. University Hospital's Vision Statements: University Hospital will provide comprehensive, seamless and innovative patient and family centered health care to improve the health status of the communities we serve. University Hospital will be the preferred area employer by offering an environment where employees and volunteers are personally and professionally valued, recognized and supported. University Hospital will be a clinical center of educational and research excellence by continuously evaluating and adopting innovative practices in technology and health care. This Mission is achieved through our shared values: Upstate University Hospital Community Service Plan Page 3

4 II. Upstate University Hospital Service Area SUNY Upstate Medical University ( Upstate ), located in Syracuse, New York, is the only academic medical center serving the 17 counties of Central New York. Upstate consists of four colleges (Medicine, Health Professions, Nursing and Graduate Studies) and University Hospital. Upstate is currently the largest employer in Central New York with a workforce of more than 8,000 employees, 1,500 students, over 400 medical residents in post-graduate training and over 700 providers on its medical staff. In July 2011, Community General Hospital (CGH) merged under the SUNY Upstate Medical University umbrella and the existing license for University Hospital. University Hospital and CGH operates as one (1) hospital, with two (2) campuses (Downtown and Community) and total 715 inpatient beds. The impetus is to allow the combined hospital to share resources (including personnel), integrate and align services between the two campuses, realizing efficiencies and a more effective means to ensure continued access to quality health care services for the community. The Community Campus (CC) (formerly Community General Hospital) is a 306 bed hospital located in the Onondaga Hill section of The Greater Syracuse area, New York, and housed on a 42 acre campus. It is Central New York s only suburban hospital campus, and is nationally recognized for its premier orthopedic program, spinal surgery and maternity services. In 2012, the Community Campus experienced 7,557 inpatient admissions (917 of which are newborns), 23,277 emergency department visits and 30,043 outpatient visits. Currently, there are approximately 1,100 staff employed and a medical staff of approximately 460 physicians. The Community Campus s primary service area reflects patient volumes from several Syracuse city zip-codes as well as many surrounding townships to include the western townships of Camillus, Auburn, Baldwinsville, Marcellus, Skaneateles; northern townships of Liverpool, Cicero; Fulton (NW) and to lesser degree eastern townships of Manlius, Fayetteville and Jamesville. In 2012, of the 7,557 patients admitted, 76.4% originated from within Onondaga County. 1 In a plan to increase access the Golisano Pediatric After Hours Center was opened in February 2012 on the Community Campus with over 4,185 visits in the first year. The strategy was this would decrease the number of pediatric emergency room visits; however, information and data suggests that these visits is an entirely new population of patients. 1 Epic Business Objects Upstate University Hospital Community Service Plan Page 4

5 Upstate University Hospital or the Downtown Campus is a 409 bed public teaching institution which in 2012 experienced 21,276 inpatient admissions, 64,885 emergency department visits and 533,525 outpatient visits. University Hospital is Upstate s primary clinical classroom for its students and residents. Unlike many other large medical institutions, especially in these challenging economic times, University Hospital has been very successful and has grown substantially over the last several years. Serving as the regions only Level 1 Trauma Center, the Downtown Campus features a full range of academic programs and highly specialized clinical services to include the Clark Burn Center, AIDS Care Center, Kidney Transplant Center, Poison Center, the Gamma Knife Center, Joslin Diabetes Center, NYS Designated Stroke Center; and, is the home of the region s only children s hospital, the Upstate Golisano Children s Hospital. As noted in the table, 57.7% of University Hospital inpatients originated from Onondaga County in This is a direct result of the merger in 2011 and is a substantial increase from 48.8% in 2009, before the merger. The remaining 42% of patient admissions originate from surrounding counties outside of Onondaga County. On a year to year basis, the service area of both campuses; but, particularly the Downtown Campus has consistently represented 17 counties within the Central New York region. The Downtown Campus is especially renowned for its specialty care and services that have been robust and successful, increasing the hospital s ability to care for a large disparate population for inpatient, outpatient and emergency services. This service region extends to the Canadian border to the North, the Pennsylvania border to the South, and mid-point between Rochester/Syracuse to the West and mid-point between Albany/Syracuse to the East. County % % UH/CC UH Only Primary Market ONONDAGA 57.7% 48.8% Secondary Market: Between 2 and 10% OSWEGO 10.1% 10.4% CAYUGA 5.5% 5.9% ONEIDA 5.2% 6.9% JEFFERSON 4.4% 5.2% MADISON 4.1% 4.3% CORTLAND 2.4% 2.8% ST. LAWRENCE 2.0% 2.6% Total 33.7% 38.1% Tertiary Market: Between 0.5 and 1.9% BROOME 1.4% 1.6% TOMPKINS 1.3% 1.3% OTHER NOT NYS 1.0% 0.0% LEWIS 0.9% 0.0% CHENANGO 0.8% 0.0% Total 5.4% 2.9% All Other 3.2% 10.2% Upstate University Hospital Community Service Plan Page 5

6 Upstate University Hospital provides a variety of care levels throughout the region, from primary care through quaternary care. The care delivery model highlights concentric circles of care surrounding Onondaga County. The Clinical Enterprise for Upstate Medical University, University Hospital is characterized in the model below. Ring 1: Onondaga County UH: Downtown Campus - comprehensive care for a limited population, share secondary/ tertiary care, maintain high tech services UH: Community Campus secondary care services, referrals and limited specialty care in Mental Health, Physical Medicine & Rehabilitation and Maternity and Newborn services Crouse Irving/St. Joseph s Health Center- locations to ensure faculty success, referrals Enough Primary Care to meet teaching/ research missions Ring 2: Surrounding Hospitals Develop good Hospital/ Hospital and Medical Staff/ Medical Staff Relationships Easy referral in process for tertiary care Provide specialists in their communities (i.e., Oncology, GI, Dialysis, Urology, Radiation Oncology, etc.) Upstate University Hospital Community Service Plan Page 6

7 Assist Hospitals to survive- (i.e., Laboratory services, Anesthesia, Emergency Management, management, workforce, etc) Ring 3: CNY Corridor Network relationships with Primary Care Providers and with Specialists for referral Easy referral in process Educational Offerings Contract Offerings Practice Management expertise Workforce Upstate Medical University and Upstate University Hospital (Downtown and Community campus) is the only academic medical center in the region. The hospital and Medical Center are inextricably connected in complimentary missions of patient care, teaching and research. As indicated below, there exist many clinical and teaching sites which serve the region in a variety of clinical disciplines. Upstate University Hospital Community Service Plan Page 7

8 H= Hospital Affiliates, R= R Med Sites Service areas defined using patient zip code origins extracted from the SPARCS database indicates the following: Upstate University Hospital Community Service Plan Page 8

9 Primary Service Area Designation A 2% cut-off was applied to determine primary zip code patient origin for Upstate University Hospital patients. This resulted in a 17 zip-code listing representing 73% of all patients cared for. For 2012, there is a doubling of the patients cared for in each zip code area due again to the merger in 2011 with Community General. The listing, by zip-code and city is as follows: Zip 2012 Code City 2009 *13205 Syracuse** 9.6% 4.1% *13204 Syracuse** 7.9% 4.1% *13208 Syracuse** 5.6% 3.0% *13207 Syracuse** 5.2% 2.0% *13203 Syracuse** 4.9% 2.8% Syracuse 4.7% 1% Baldwinsville 4.3% 2.5% Syracuse** 4.3% 3.1% Liverpool 3.5% 2.1% Camillus 3.4% 1.1% Syracuse 3.3% 2.0% Syracuse 3.1% 1.1% Syracuse** 3.0% 2.0% Liverpool 3.0% 2.0% *13202 Syracuse** 2.6% 2.0% Rome 2.6% 2.5% Syracuse 2.2% 1.0% Total 73.3% 38.4% *Zip code with negative birth outcome ratios in various categories, e.g., LBW, VLBW, birth age yrs, born <37 weeks, early/no PNC, smoke, drink, drugs, etc. **Zip code with negative prevention quality ratios in various chronic diseases, e.g., angina, CHF, hypertension, diabetes, asthma and COPD. All Other Patients The remaining 26% of patients cared for reflect zip code volumes below 2% and represent over 450 unique zip codes, spanning 425 different townships. The geographic distribution brought to light by this zip code analysis represents the broad catchment area of the region served by Upstate Medical University, downtown and community campus. Upstate University Hospital Community Service Plan Page 9

10 III. Upstate University Hospital - Programs and Services As indicated Upstate University Hospital is licensed to operate 715 beds; which, are broken down as follows: Bone Marrow Transplant 4 Burns Care 6 Coma Recovery 2 Coronary Care 8 Intensive Care 65 Maternity 32 Medical/Surgical 423 Pediatric 46 Pediatric ICU 15 Physical Medicine & Rehabilitation 50 Prisoner 10 Psychiatric 50 Traumatic Brain Injury 4 TOTAL 715 Upstate University Hospital, both campuses are certified to operate the following services: After Hours Care Center (peds) Perinatal AIDS Center Pharmaceutical Service* Ambulatory Surgery* Multi Specialty Physical Medical Rehabilitation* - Burn Center/Burn Care inpatient and outpatient CT Scanner Primary Medical Care O/P (pediatric Cardiac Catheterization ( Adult and adult) Diagnostic*; Electrophysiology (EP); Poison Control Center Pediatric Diagnostic; Percutaneous Psychiatric Adult Inpatient*; adult, Coronary Intervention (PCI) child & adolescent outpatient Clinical Pathology Laboratory Svcs.* Radiology* Diagnostic & Dental Ambulatory Therapeutic Emergency Department* Renal Dialysis Acute & Pediatric Family Planning Outpatient Chronic Health Fairs O/P* Therapy (Occupational, Physical, Intensive Care Vocational Rehabilitation outpatient; Linear Accelerator Speech Language Pathology) Maternity Transplant Bone Marrow and Magnetic Resonance Imaging* Kidney (pediatric & adult) Medical Social Services* Traumatic Brain Injury Medical/Surgical* Trauma Care Nuclear Medicine* Diagnostic & Therapeutic Outpatient Clinics/Services* - Multi- Specialty (pediatric and adult) *denotes program/service provided at both campuses Upstate University Hospital Community Service Plan Page 10

11 The certification from the NYS DOH to provide extension clinics is noted below for both campuses: Developmental Evaluation Center (Syracuse, NY) Downtown Hutchings Psychiatric Center (Syracuse, NY) Downtown Joslin Diabetes Center (Syracuse, NY) Downtown Adult and Children Manlius Physical Medicine & Rehabilitation (Manlius, NY) Downtown Institute of Human Performance (Syracuse, NY) Downtown Physician s Office Building (Syracuse, NY) Downtown Upstate Child Abuse Referral Evaluation (CARE) (Syracuse, NY) Downtown Upstate Pediatrics (Baldwinsville, NY) Downtown Outpatient Rehabilitation (Camillus, NY) Community Physical & Occupational Therapy (Syracuse, NY) - Community As noted, Upstate University Hospital is a nationally recognized academic medical center that offers a comprehensive range of services and programs related to clinical patient care. The hospital counts the following among its statewide and nationally recognized programs and services including the 2012 Blue Distinction Center by Excellus Blue Cross/Blue Shield for Spine Surgery, Knee and Hip Replacement; CNY s 1 st Geriatric Emergency Department (Community Campus) opened in June 2013; CEO Cancer Gold Standard Accreditation by CEO Roundtable on Cancer; Joslin Diabetes Center is a NYS Center of Excellence; Level 4 Epilepsy Center (highest designation possible); fully accredited Chest Pain Center; Breast Cancer Program, region s only National Accreditation Program for Breast Centers (by American College of Surgeons); accredited NYS DOH Designated Stroke Center; NYS Designated SAFE site; NYS Regional Poison Center; Designated AIDS Center (children and adults); and, Five-Star Bariatric Surgery Center, among many honors. IV. Community Health Needs Assessment: Community Engagement Process The Onondaga County Health Department (LHD) partnered with the hospitals in Onondaga County to conduct a community health assessment process that engaged health improvement efforts already underway and drew on local resources. The process was designed to result in a clear picture of the health of the community and to identify meaningful and realistic community health improvement initiatives that are supported by key constituencies. Upstate University Hospital Community Service Plan Page 11

12 The process began with meetings between the leadership of the Onondaga County Health Department (Commissioner of Health and Chair of the Advisory Board of Health) with the chief executive officers of the three hospitals in the community (St. Joseph s Hospital Health Center, Crouse Hospital and Upstate University Hospital (including the Golisano Children s Hospital and Upstate at Community General)) to discuss the process and gain support of the leadership. The outcome of the meeting was an agreement that the community health assessment process would be a collaborative effort that would focus on building on existing partnerships to ensure that the outcome would incorporate initiatives that have a strong base of support. The community health assessment process undertaken in Onondaga County was also structured to meet the requirements of the New York State Prevention Agenda and Title IX of the Patient Protection and Affordable Care Act of The process was supported by work done by graduate students in the Central New York Master of Public Health program (CNYMPH), a graduate program in public health sponsored by Syracuse University and Upstate Medical University. The graduate students began their work by convening and facilitating five forums in October and November The Lerner Center for Public Health Promotion at the Maxwell School for Citizenship and Public Affairs at Syracuse University provided logistical support and assistance with recruiting forum participants in collaboration with the Onondaga County Advisory Board of Health, the Syracuse City Schools, and Say YES to Education. The forums were held at the Central New York Community Foundation Philanthropy Center and the schoolfocused forum was held at the Say Yes to Education offices. Altogether, 92 people participated in the forums. The purpose of the forums was to find out what health issues are perceived to be of importance in the community. These qualitative findings provided a backdrop against which data was collected and analyzed to better understand the concerns raised by community members. The results of the forum, summarized in a report issued in January of 2012, are included in Appendix I. The data collection and analysis phase followed. Data from a number of sources were utilized, including the New York State Prevention Agenda, the 2013 Community Needs Assessment Report developed by the United Way of CNY as well as internal information from the LHD and hospitals. Again, students from the CNYMPH program were engaged to support the community health assessment effort. Teams of students were paired with the hospitals and with the LHD to support data collection and analysis. The teams, at the direction of the hospital and LHD, collected and organized data that was used by the leadership of the organizations to understand the health needs of the community. The students provided formal reports to each of the organizations in the Upstate University Hospital Community Service Plan Page 12

13 Spring of Over the course of 2012/2013, a task force composed of representatives from the LHD and the hospitals met regularly to review the data and explore areas for collaboration. During the course of the community health assessment, an issue related to neonatal abstinence syndrome, drug withdrawal in a baby, surfaced. The issue was identified initially by local physicians and hospital staff; it was brought to the Onondaga County Advisory Board of Health by a neonatologist. A review of the data revealed that Onondaga County has the highest rate of hospital discharges for newborns with drugrelated issues. A community solution, detailed in later sections of the community health assessment, is under development and is one of the priority/focus areas chosen in Onondaga County. The findings of the community health assessment, detailed in Appendix I, revealed that one of the priority issues revolved around chronic disease and more specifically physical activity and nutrition as it relates to chronic disease. The data supports the community perception that chronic disease is an important issue and will be discussed in later sections of the community health assessment as one of the priority/focus area chosen in Onondaga County. Through discussions with the task force and the leadership of the LHD and the hospitals, two priority areas were chosen: Prevent Chronic Disease Promote Mental Health and Substance Abuse o Neonatal Abstinence Syndrome At a meeting on May 1, 2013 of the Thursday Morning Roundtable, a community forum sponsored by Syracuse University, the Commissioner of Health and Chair of the Advisory Board of Health presented The State of our County s Health: An Assessment of Onondaga County s Health. This presentation is included as Appendix II. With the priority areas identified, the LHD and hospitals have collaborated to refine the focus areas and strategies, building on community health initiatives that are underway, that will be undertaken to address these issues. Upstate University Hospital Community Service Plan Page 13

14 V. Setting Public Health Priorities Project Focus and Initiatives The Upstate University Health System is critical to the health and wellness of Central New York. The Health System includes Upstate University Hospital, Downtown and Community campuses, Upstate Golisano Children s Hospital, and Upstate Cancer Center (opening 2014). All of these hospitals are intricately connected to SUNY Upstate Medical University, the only academic medical center and largest employer in the region. SUNY Upstate serves 1.8 million people, covering one-third of the state. The Upstate University Health System is committed to improving the health of the diverse community it serves. They are currently supporting and collaborating with other local hospitals, community health centers, and the Onondaga County Health Department to address priorities set by the New York State Prevention Agenda. All of these community partners have chosen to focus on the same two priority areas: (1) Promote Mental Health and Prevent Substance Abuse (Neonatal Abstinence Program) and (2) Prevent Chronic Disease. In order to address these priority areas, Upstate University Health System must first have a firm grasp of all of its programs and services related to chronic disease, mental health, and substance abuse. Therefore, a team of CNYMPH students (Sarah Evans, Pat Forken, Margaret Lapp, Janine Morris, Jessica Soule and Karen Wentworth) was designated to create a survey for all departments within Upstate (all campuses inpatient and outpatient) to establish an inventory of the programs and services they currently offer to the community. Additionally, they helped identify obstacles and barriers to current programs and services from the survey responses and from internal patient complaint data. Through the survey, they were also able to identify community boards and organizations that serve as partners to Upstate. Upstate Program and Service Inventory The first objective was to design and implement a survey of all the departments within Upstate to establish an inventory of the programs and services they currently offer to the community. The survey was created using Surveymonkey.com, which collected information electronically and provided preliminary data analysis. The survey questions focused on gathering information on Upstate programs, services, and initiatives related to the two priority areas from the NYS Prevention Agenda selected by all hospitals in Onondaga County and by the County Department of Health including (1) Promote Mental Health and Prevent Substance Abuse and (2) Prevent Chronic Disease. Within these priority areas, specific questions were asked regarding programs, services, and initiatives related to various topical areas. Within the mental health and substance abuse section, participants were asked about programs, services, and initiatives related to adult mental health, child and adolescent Upstate University Hospital Community Service Plan Page 14

15 mental health, drug and alcohol abuse, prescribed medication abuse, child abuse, elder abuse, and domestic violence. Within the chronic disease section, participants were asked about programs, services, and initiatives related to arthritis, asthma, cancer screening, cardiovascular screening, diabetes, hypertension, medication management, nutrition, obesity, physical activity, and tobacco. All of the participant responses were used to create an excel inventory of current Upstate programs, services, and initiatives. Contact information for the participants was included in the inventory to allow follow up if necessary for clarification or further information. The survey was ed to 340 people throughout Upstate University Hospital-Downtown and Community campuses and Upstate Golisano Children s Hospital. The survey was completed by 74 people for a 22% response rate. From the respondents, an inventory was completed of 181 programs and services related to chronic disease, mental health, and substance abuse. Identification of Barriers and Obstacles to Current Upstate Programs and Services The second objective was to identify barriers and obstacles to current Upstate programs and services. This was accomplished through synthesis of employee perspectives from survey responses and patient perspectives from internal complaint data. Employee perspectives were obtained through survey questions concerning obstacles that prevent patients from getting the best level of care. The most commonly identified obstacles included cost, lack of insurance, and lack of communication services, transportation, and location of services. Patient perspectives on obstacles and barriers to current Upstate programs and services were obtained via internal hospital complaint data. The areas with the most patient complaints include care, communication, access, and attitude. Identification of Upstate Community Partnerships The third objective was to identify existing Upstate community partnerships through employee survey responses regarding involvement in community boards and organizations. Employees identified various local and national organizations that members of their departments are involved with, a synopsis is included below. Syracuse Community Health Center Onondaga Nation Arise, Inc. United Way of Central New York Heart Campaign, Food Pantry Collection, various hospital sponsored walks American Cancer Society, Regional Advisory Board, Eastern Division Board, Syracuse International Film Festival Board, Jennifer Daniels MD Scholarship Fund Board American Cancer Society, Healthy Syracuse, Work Site Wellness Coalition, B/P monitoring of adults of minority groups, Education for African Americans on hypertension, Education of teens on health and wellness (nutrition), Holiday Angel through AIDES, Community Resource Coalition Upstate University Hospital Community Service Plan Page 15

16 Activities (head shaving) to raise money for Pediatric Cancer Research, Biking for Pediatric cancer care Teach heart healthy exercise class at Oasis every 4 months Community Literacy events American Association for Respiratory Care President, President New York State Society for Respiratory Care Board Cystic Fibrosis Foundation Donate Life Month, National Kidney Foundation Tobacco Free Onondaga County, Nursing Association, Volunteer at Samaritan Center Alliance for Clinical trials for oncology Western New York State Infection Control Organization Board of Education in the ESM school district, Special Olympics, Heart Walk, Sacred Heart Church Palm Sunday Breakfast Breast Walks, Heart Walk Fundraisers, Aids Prevention Activities Health Foundation of Western and Central New York; CNY Ronald McDonald House Charities; Cornell University Applied Research & Extension Program; CNY Regional Healthcare Quality Benefit Management Committee; Mentor for On Point for College Board of Directors of Southwest Community Center and the Amaus Health Services Clinic. We have 16 sites within the community where we run programs for our student volunteers: Upstate Dialysis, Amaus Clinic, Rahma Clinic, Westside Clinic, Rescue Mission, Rescue Mission Foot Care Clinic, Salvation Army, Hope Prints, Catholic Youth Organization, Refugee Clinic, From the Ground Up Riding Therapy Program, Martin Luther King After School Program, Martin Luther King Reading Buddies Program, Board of L'Arche Syracuse. VNA Professional Advisory Board, Central Counties Professional Nursing Association, CNY- NCARE New York Organization for Nurse Executives Baldwin Gala, Baldwin Run, Upstate Cancer Center, American Heart Walk, St. Baldrick's Jordan Volunteer fire service, various pet shelter adoption groups, Kids Coalition, Girl Scouts Upstate continuously builds upon its current community partnerships to improve the health of Central New York citizens. The employee survey demonstrated that Upstate has a wide variety of local and national partners that can be used to improve patient outcomes and strengthen the community as a whole. Upstate has and will continue to collaborate with other local hospitals, health care centers, and the Onondaga County Health Department to find ways to utilize their shared resources and strengths to improve the health of the community. VI. Results of Community-wide and LHD Priority Areas Following are the results of the community-wide and local health department priority areas noted in the Community Service Plans from at Upstate University Hospital and Community General Hospital (prior to merger in 2011). This is critical in that it provides a building block to some of Upstate s goals for the NYS Prevention Agenda, especially as it relates to the continuation of Tobacco Cessation. Upstate University Hospital Community Service Plan Page 16

17 Upstate Current Status: Tobacco Cessation Increasing the number of tobacco cessation programs and participants as well as the creation of smoke-free campuses has been a part of Upstate University Hospital s Strategic Plan Goal #4. Commitment to Our Community. For the last four years, the following metrics were developed and achieved. Reporting is done on a bi-annual basis to the Upstate Medical University Leadership Council; which, is chaired by the President and includes the Deans of the four schools, officers of the hospital and university. The full Upstate Medical University Strategic Planning Report Card is attached as Appendix III. Upstate Medical University and University Hospital have been very active supporters of tobacco-free health care campuses and have been heavily involved in supporting the legislation in Onondaga County to extend the boundaries of the smoke-free zone around hospitals. The Community Campus continues to promote a smoke-free hospital campus and smoke-free living through various methods, including the recommended 5 A s strategy (Ask, Advise, Assess, Assist and Arrange). Results : Metrics and Measurement Plan to Address Tobacco Use: Upstate Current Status: Recertification of Public Insurance Coverage This initiative included the development of a systematic approach to identifying health insurance coverage among children within the Syracuse City School District and providing those uninsured children and their families with Facilitated Enrollment services. Facilitated Enrollment services support families' navigation of the public health insurance enrollment process. Implementation of this approach would decrease the number of uninsured children in our highest risk geographic area and address one of the significant factors contributing to disparities in our community. Upstate University Hospital Community Service Plan Page 17

18 Following is the progress that was made in the implementation of the collaboration between the hospitals and the Say Yes to Education and Syracuse City School District in the re-certification of patients/families for public insurance coverage with the use of facilitated enrollers. The next step was working with the state in simplifying the application and re-certification process. The expectation is that the process will go through substantial changes with the implementation of the Health Care Affordability Act and establishment of exchanges in New York State. However, the results noted in the Upstate Medical University Strategic Planning Report Card: (see Appendix III) shows consistent improvement. The project was discontinued in 2012 due to its level of success in achieving its goal. Results : Metrics and Measurement Plan to Address Recertification of Public Insurance Coverage: VII. Selected Community-wide and LHD Priority Areas Following is the Current Status, Proposal, Plan and Metrics to be used by Upstate in addressing the two priority areas identified by the LHD in collaboration with the community health care organizations. Prevent Chronic Disease Promote Mental Health and Substance Abuse o Neonatal Abstinence Syndrome Prevent Chronic Disease: Tobacco Cessation Prevent initiation of tobacco use by NY youth and young adults, especially among low socioeconomic status (SES) populations; Promote tobacco use cessation, especially among low SES populations and those with poor mental health; and, Eliminate exposure to secondhand smoke. Upstate University Hospital Community Service Plan Page 18

19 The hospitals in Onondaga County have been leaders in our community in establishing their campuses as smoke-free. Onondaga County government has been in the forefront of tobacco control with a number of initiatives aimed at engaging organizational decision makers and providing technical assistance in the enactment of policy change to strengthen tobacco control measures throughout the local community. Proposal: To build on the model of success of our local hospital s smoke-free campus policies and extend smoke-free campuses in the community. The program would support, through practical organizational consultation and carefully developed policy, all the health care organizations in the Onondaga County community in becoming smoke-free. The program itself would leverage the county s capacity at the policy level to craft law and regulation and develop programming that would lead toward smoke-free campuses. It is the intention that this program will be developed and implemented in such a way that it could be adopted by surrounding counties in the Central New York area which the three Onondaga County hospitals currently serve. A project addressing tobacco control benefits the community by reducing the prevalence of certain chronic diseases associated with tobacco use and exposure to secondhand smoke. Tobacco control interventions in the health care provider environment offer an opportunity for the medical care system to utilize a social marketing strategy and make a clear statement about its role in enhancing public health. This program will build on local good practice models by disseminating the experience of the hospital community in implementing smoke-free campuses, and engage the public policy system through development of targeted laws and regulation. Plan: The plan is to continue the success and efforts of the workgroup (consisting of the four hospitals and the Onondaga County Health Department convened by Tobacco- Free Onondaga County) established in 2009, to develop an action plan that will encourage and assist other Onondaga County organizations and social service agencies with a higher percentage of disparate population to create smoke-free campuses. This project will leverage existing community activities, particularly building on the Tobacco-Free Onondaga County initiative and St. Joseph s Hospital Health Center (St. Joseph s) s Tobacco Cessation Center. Through the Tobacco-Free Onondaga County Coalition, the Onondaga County Health Department, in cooperation with local organizations, agencies, and community members, works to encourage a tobacco-free environment in Onondaga County. The program s goals are to: eliminate exposure to secondhand smoke; decrease the social acceptability of tobacco use; promote tobacco Upstate University Hospital Community Service Plan Page 19

20 cessation; prevent the initiation of tobacco use among youth and young adults; and contribute to the science of tobacco control. Upstate Plan Tobacco Cessation: The plan for is to continue to work through HealthLink, our Upstate outreach, public and patient medical education program and its six week Tobacco Cessation program. The program will be offered to individuals and workplace programs with a major focus on offering tobacco cessation and education counseling at Amaus Health Clinic, Addiction Treatment and Supportive Living Facilities where there are tobacco free policies currently in place to support cessation education; however, the education is not readily accessible for the participants. Additionally, work will continue with the Amaus Health Clinic where respiratory therapists and mid-level providers will be trained to provide the cessation and education counseling on a one-to-one basis at Pioneer Homes and Syracuse Housing Authority. Initial results in 2013 with the Amaus Clinic show 14 of 14 participants completing some form of cessation education and 4 participants have actually quit for a 29% success rate. The metrics used to measure the level of success or penetration of the Tobacco Cessation program and education of other allied healthcare professionals at Upstate to provide this program are noted below. Bi-annual reporting of results will be provided to the Upstate Leadership Council. Upstate Metrics/Goals Tobacco Cessation: Metrics Number of non-healthcare/treatment facilities where HealthLink programming/cessation counseling are scheduled: Goal Participants completing HealthLink Smoking Cessation Program: Goal 85%. Participants that quit smoking at least one month: Goal 75%. Participants of non-healthcare/treatment facilities that quit smoking at least 2 weeks: Goal 30. Participants of Pioneer Homes and SHA that complete HealthLink programming: Goal 60. Participants of Pioneer Homes and Syracuse Housing Authority that are not smoking one (1) month after completion of program: Goal 60. Data Sources Number of participants registered for HealthLink Smoking Cessation Program. Survey of participants to determine current tobacco-free status Promote Mental Health and Prevention of Substance Abuse: Neonatal Abstinence Syndrome Decrease rate of newborn drug-related-discharges. Introduction*: According to the New York State Health Department, Onondaga County has the highest rate of newborn drug-related-discharges in the state with discharges per 10,000 *The Onondaga County Health Department gratefully acknowledges the contributions of Sufyan Siddiqui and Sarah Tabi, fourth year medical student in 2012 and2013 respectively who wrote papers addressing this challenge. The introduction is adapted from Mr. Siddiqui s work while the section on Community Collaborations is adapted from Ms. Tabis. Upstate University Hospital Community Service Plan Page 20

21 births compared to the state average of Although these numbers do not take into account the differing screening methods and protocols per county, the numbers do represent the increasing number of infants physiologically dependent on drugs of abuse. In an analysis of five months of data on drug screening laboratory results from newborns and/or their mothers in Onondaga County over a five month time period, opiates and cannaboids were the most commonly identified drugs. 2 Neonatal abstinence syndrome (NAS) is one of the most concerning drug related discharges in newborns. NAS is defined as the presence of withdrawal symptoms in the newborn caused by prenatal maternal use of illicit drugs. This syndrome is primarily caused by maternal opiate use. 3 Adverse neonatal outcomes including low birth weight and increased morbidity and mortality have been associated with illicit drug use and specifically the dependence of opioids during pregnancy. 3-7 In neonates, the withdrawal symptoms are similar to those experienced by adults and include feeding intolerance, seizures, emesis, and respiratory distress. 3,9 This syndrome reflects a growing concern over the prescription drug abuse epidemic in the United States. The national incidence of NAS increased from 1.2 to 3.39 per 1000 births from 2000 to During the same period, the number of mothers using or dependent on opiates at the time of birth, increased from 1.19 to 5.63 per 1000 births. 3 The 3 fold increase in NAS diagnosis and 5 fold increase in maternal opiate use have significantly increased health care expenditures nationwide. In hospitals across the United States, newborns diagnosed with NAS were associated with a 35% increase in hospital expenses when compared to the 30% increase in expenses for all other hospital births. 3 Total hospital charges for NAS were estimated to have increased from 190 million dollars to 720 million dollars after adjusted for inflation. 3 The Centers for Disease Control and Prevention found that sales and deaths related to opiate pain relievers quadrupled between 1999 and ) Accessed October ) Siddiqui S. Fourth Year Medical Student. Neonatal Abstinence Syndrome in Onondaga County, 2012 Onondaga County Health Department report. 3) Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: US, JAMA. 2012;307 (18): ) 4) Hulse GK, Milne E, English DR, Holman CDJ. The relationship between maternal use of heroin and methadone and infant birth weight. Addiction. 1997; 92 (11): ) Madden JD, Chappel JN, Zuspan F, Gumpel J, Mejia A, Davis R. Observation and treatment of neonatal narcotic withdrawal. Am J Obstet Gynecol. 1977; 127(2): ) Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG. 2009; 116(5): ) Minozzi S, Amato L, Vecchi S, Davoli M. Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database Syst Rev. 2008;(2): CD ) American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. Pediatrics. 1998; 101 (6): ) Signs V; Centers for Disease Control and Prevention (CDC). Vital signs; overdoses of prescription opioid pain relievers-us MMWR Morb Mortal Wkly Rep. 2011; 60 (43): Upstate University Hospital Community Service Plan Page 21

22 Onondaga County has not been spared in this epidemic. Given the extent of the problem, the Onondaga County Health Department, Crouse Hospital, St. Joseph s Hospital and Upstate University Hospital have all agreed to address this challenge in their Community Health Improvement Plans/ Community Service Plans. In addition, numerous community partners have also become very involved in addressing this acute public health challenge. Five current collaborative efforts to address the multiple issues related to prescription and illicit drugs as well as alcohol are described below. Community Collaborations for : 1) Syracuse Healthy Start-Perinatal Substance Abuse Committee: Description: This committee is convened by SUNY Upstate Center for Maternal and Child Health (CMATCH) as a collaborative effort of the Syracuse Healthy Start program, a program of the Onondaga County Health Department to improve outcomes of mothers and infants affected by substance abuse (e.g., tobacco, alcohol, recreational drugs, prescription medications) and to reduce disparities in infant mortality by data analysis, making recommendations, and developing educational materials. The Committee was formed out of recognition that substance use in the prenatal period presents a major risk to the health of women and infants and contributes to poor birth outcomes. The Committee brings together clinical and human service providers to share information from practice, examine local data, share current medical literature, and identify best practices with the goal of developing policies, procedures, and educational messages to improve local efforts to prevent, identify, and treat perinatal substance abuse among pregnant and parenting women in Syracuse. CMATCH, as a part of the CNY Regional Perinatal Program, often shares the efforts and recommendations of the Committee throughout the CNY Region. Committee recommendations may be reviewed by the Upstate OB/GYN Department and Crouse Hospital s Policies and Standards Committee then, if appropriate, the Regional Perinatal Center sends the recommendations to the hospitals/health care providers in Central NY. Members: Open to clinical and human service provides interested in this issue. Current members include Crouse Hospital s NICU, St. Joseph s Hospital, SUNY Upstate Center for Maternal and Child Health, Reach CNY, Neonatal Associates of CNY, Regional Perinatal Center, Onondaga County Health Department, Prevention Network, and Upstate Poison Control Center. Initiatives: The committee suggests that at their initial prenatal visit, all pregnant women should be educated about the importance of avoiding recreational drugs and prescription narcotics. Education should be reinforced as indicated. The committee also recommends verbal screening via a standard tool (e.g. 4 P s) and urine drug screening are recommended for all pregnant women. Upstate University Hospital Community Service Plan Page 22

23 2) Neonatal Abstinence Syndrome Elimination Team: Description: A collaboration to address current drug trends in the community based on identified needs assessments. The NAS team is currently focused on reducing and eliminating Onondaga County s extremely high rate of neonatal drug related discharge rate (28/1,000 births) with an emphasis on babies with neonatal abstinence syndrome. Environmental strategies have been developed to assist women of child bearing age and pregnant women in targeted City zip codes. Members: Upstate Poison Control Center, Prevention Network, CONTACT Community Services, Crouse Hospital (including Outpatient Rehabilitation Services and Chemical Dependency Service), Reach CNY, Onondaga County Departments of Health and Mental Health. Initiatives: SBIRT Training (Screening/Brief Intervention/Referral to Treatment). Its objective is to identify patients in the early stages of addiction. Prevention Network will train health care providers from various local hospitals, practices, and clinics to identify drug-using mothers. OASAS (Office of Alcoholism and Substance Abuse Services) is writing the SBI training curriculum. SAMSHA- Fetal Alcohol Spectrum Disorder FASD Center for Excellence Grant Community partners (Prevention Network with support from the Perinatal Substance Abuse Committee) were recently awarded a grant to focus on SBI (Screening and Brief Intervention) training. It involves working with 5 community groups (Children s Consortium, Salvation Army, OCHD-WIC Program, Catholic Charities, and PEACE, Inc.) and case managers that work with high-risk women. Public Health Campaign. Community partners are working together to eliminate NAS in Onondaga County by educating and providing help to drug-using females who are pregnant or of child-bearing age via billboards and brochures. Focus groups were created to test market materials for the campaign. The focus groups consisting of women who are of child-bearing age with a history of substance abuse during pregnancy were selected by the Crouse Chemical Dependency Treatment Program to participate. Prevention Network provided funding for the billboards; Reach CNY helped develop a script to guide the process and provided $500 for gift cards for focus group participants; and the Onondaga County Health Department assisted with development of educational materials based on focus group feedback. Upstate University Hospital Community Service Plan Page 23

24 3) District Attorney s Opiate Task Force: Description: In the spring of 2012, the Prescription Drug Abuse Task Force was formed to develop recommendations to combat the synthetic marijuana and bath salts concerns in Onondaga County. As these drug related issues receded, the group refocused on opiates and prescription drugs as needs indicated. This group s collaborative effort targets policies and enforcement regarding opiates including expanding the prescription drug take back, community awareness, cross-system networking, information sharing and potentially other legislative matters. This is the only group with a significant presence of both enforcement and health care providers that meet monthly to discuss possibilities and trends to combat drug use in the community. Members: Onondaga County District Attorney s Office, DeWitt Police, Onondaga County Departments of Health, Mental Health and Social Services, Crouse Chemical Dependency Treatment Services, Upstate Poison Control, Prevention Network, Upstate Hospital, Kinney Drugs, Wegman s Pharmacy, Syracuse Behavioral Health-Care, NY State and Federal legislative personnel. Initiatives: The Task Force is currently discussing potential options to change existing laws to allow pharmacies to take back controlled substances in an effort to reduce the supply of unused medication. This could establish formal take-back days and could increase education of the public on proper disposal methods (i.e. placing pills in coffee grounds or cat litter before throwing it away). Drug Take Back Day (October 26, 2013): This is an initiative of the Drug Enforcement Agency in collaboration with Prevention Network and the Alcohol and Drug Abuse Prevention Program. 4) FASD - Center for Excellence (Fetal Alcohol Spectrum Disorders) Description: The purpose of the FASD Center for Excellence is to expand capacity in FASD prevention service delivery and produce new knowledge on effective FASD prevention and services in Onondaga County. The FASD Center for Excellence will work with five key community stakeholders to target pregnant women for universal screening and provide brief interventions to those women who report current alcohol use or past high risk alcohol use. FASD is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. Alcohol can permanently damage the developing fetal brain during pregnancy and is in fact the leading preventable cause of developmental disabilities and birth defects. Results of the damage that alcohol can cause include lifelong physical, behavioral, mental, and/or learning disabilities. Specific effects on any individual fetus depend on a range of factors, including the amount of consumption, and the time of exposure during Upstate University Hospital Community Service Plan Page 24

25 the pregnancy. (Guerri, Bazinet, & Riley, 2009) The prevalence of the full spectrum of FASD in the general population is estimated at 9.1 per 1,000 live births, but a review of in-school screening and diagnosis studies suggests that the national rate could be potentially closer to 50 per 1,000 (May et al., 2009). These figures suggest that it is imperative to make women of childbearing age aware of the risks of alcohol consumption during pregnancy. This FASD Center for Excellence Program proposes to do just that. Members: Community stakeholders and representatives from targeted community agencies/organizations serving pregnant women in Onondaga County. Initiatives: The FASD Center for Excellence is working with key community agencies to provide screening and brief intervention (SBI) to pregnant women who are reporting current alcohol use or past high risk alcohol use. SBI will be infused into screening procedures for the following agencies that interact with the target population: Salvation Army, Children s Consortium, PEACE, Inc., Catholic Charities, and Onondaga County Health Department: Healthy Families Division. 5) Safe & Healthy Neighborhoods (SaHN) Description: A committee to ensure safe and healthy neighborhoods in the city of Syracuse through collaborative planning, community action, civic engagement and policy advocacy. Members: Prevention Network, Syracuse United Neighbors (SUN), New York Alcohol Policy Alliance, Creating Healthy Places to Live, Work and Play in Onondaga County (Onondaga County Health Department), Tobacco Free Onondaga County (Onondaga County Health Department), Interdenominational Ministerial Alliance of Syracuse and Vicinity, Alliance of Communities Transforming Syracuse (ACTS) and Model Neighborhood Facility, Inc. (Southwest Community Center). Technical Assistance is provided by the Central Region Prevention Resource Center, an initiative of the New York State Office of Alcoholism and Substance Abuse Services. Initiatives: Sub-committees have been formed to plan activities to support the Safe and Healthy Neighborhood goals to enforce the City of Syracuse Business Certificate of Use Ordinance; advocate for health in all policies and the enforcement of policies to increase healthy and safe resources and reduce unhealthy and unsafe resources with special focus on young adults, youth and children. Specific areas of interest are to: Reduce access and availability of alcohol, tobacco and other drugs. Decrease crime and violence by increasing health and safety. Increase access and availability to healthy food options. Upstate University Hospital Community Service Plan Page 25

26 VIII. Prevention Agenda Priority Areas: Upstate Initiatives As in the Community Service Plan and Community Needs Assessment for Onondaga County for , it was felt that the hospitals and the health department already have collaborations in terms of preparedness around disasters, infectious disease, etc., so Community Preparedness was not a significant issue for collaboration. Further, the group felt the county fared well with respect to Infectious Disease and Unintentional Injury. While Mental Health is still a Priority Area of concern to our members, the discussions related to the Office of Mental Health plan to regionalize mental health services for adults, children and adolescents has not been fully formalized and until then initiatives to address the needs of this population are limited. However, following is a synopsis of multiple initiatives and programs at Upstate University Hospital and/or Upstate Medical University in attempts to assist the community and local health department in achieving the five Priority Agenda areas, especially among the disparate population. The five Priority Agenda areas include: Promote a Health and Safe Environment Prevent Chronic Disease Prevent HIV/STDs, Vaccine Preventable Diseases & Healthcare-Associated Infections Promote Healthy Women, Infants and Children Promote Mental Health and Prevention Substance Abuse Prevent Chronic Disease: Cancer Screenings Prevent initiation of tobacco use by NY youth and young adults, especially among low socioeconomic status (SES) populations; Promote tobacco use cessation, especially among low SES populations and those with poor mental health; and, Eliminate exposure to secondhand smoke. Many initiatives have been developed and are ongoing in the efforts to reduce cancer not the least will be the completion of the Upstate Cancer Center expected in Spring The work completed to date has resulted in Upstate being awarded the CEO Cancer Gold Standard Accreditation by CEO Roundtable on Cancer, for our efforts to decrease the risk of cancer for employees and their families by promoting healthy life style choices and early detection through cancer screenings. Our greatest impact and success has been in tobacco cessation and outreach and educational programs. Upstate HealthLink promotes the following tobacco cessation program and links on their website: New York Smokers Quitsite, Tobacco-Free Nurses, CDC: Tobacco Information and Upstate University Hospital Community Service Plan Page 26

27 Prevention Sources, Ex: Re-learn Life Without Cigarettes, Free community wide classes from Upstate HealthLink sponsored by the Advocates of Upstate. Smoking cessation education programs for adults in the community are provided every 6-8 weeks. Also a smoking cessation program that includes nicotine replacement (at cost) for private companies. Upstate s Quit Smoking brochure uses the NYS DOH patient education for quitting smoking. Tobacco cessation resources are available on the Patient Education website. Smoking cessation information is included in all new booklets being revised Maternity, Patient Education booklet, Pediatric Patient Education booklet and Surgery. Upstate's Pathway to Wellness promotes tobacco cessation programs and events through "Kick Butts", "Great American Smokeout" (GAS0); and regular communication. Upstate is the only facility in Central New York to be listed by the Lung Cancer Alliance as among the nation s experienced sites in offering a comprehensive Lung Cancer Screening Program. Geneva Tower, Upstate Medical University s downtown Syracuse residence hall, is the first smoke-free high rise building in upstate New York (joining 14 buildings in the New York City area) to be designated as a Healthy High Rise by the American Cancer Society. Healthy High Rises is an American Cancer Society recognition program for multi-unit residential housing in New York and New Jersey that have a smoke-free policy, meaning no one is allowed to smoke anywhere in the building. The program is designed to promote healthier environments, reduce cancer risk, and improve the quality of people s lives by reducing exposure to harmful secondhand smoke seeping into people s homes. Geneva Tower isn t just a smoke-free building; tobacco products are prohibited on tower grounds. In fact, smoking and tobacco products are not allowed in any university building or on any property owned or leased by the university. In addition, all Upstate employees and students are able to receive free smoking cessation counseling. In 2005, Upstate became the first SUNY campus to become smoke free. Following is a grid outlining in greater details the metrics identified by Upstate to measure the impact of its smoking cessation initiatives, especially as it relates to disparate populations and the goals we have for the program. As noted earlier, results will be reported on a bi-annual basis to the Upstate Leadership Council and to the public via our website. Upstate University Hospital Community Service Plan Page 27

28 Prevent Chronic Disease: Reduce Obesity in Children and Adults Prevent childhood obesity through early child care and schools; Expand the role of health care and health service providers and insurers in obesity prevention. Similar to the strategy used in the smoking cessation initiative, Upstate has started by being a role model and focusing on an employee, faculty and student population of over 8,000 people coming from all over the central New York area, in its efforts to reduce obesity. An additional tool available has been the Epic electronic medical record system implemented in all outpatient areas in This system has the ability to capture information required under the federal Affordability Act what are determined to be Meaningful Use. These Meaningful Use data include many of the prevention agenda priority focus areas including the capture of smoking status of patients and level of obesity among all patients. This is critical information and access to an average of 150,000 individual outpatients cared for at Upstate. Upstate's Pathway to Wellness program provides numerous employee physical activity options, including: Walking Trails with 22 Options for.3 to 1.2 mile circuits, inside and outside to encourage walking, along with a walking log; "Mile Monday" is a walk up the hill to SU; Burn and Learn encourages people to walk and learn for meetings; Signage has been posted at some elevators in the hospital to encourage people to take the stairs. They also promote wellness opportunities in the community. Upstate University Hospital Community Service Plan Page 28

29 Upstate's Pathway to Wellness provides numerous healthy eating and nutrition activities. Including: collaboration with SU's Falk School of Nutrition for employees to receive nutrition counseling; "Lunch and Learn" where employees receive healthy information while they eat lunch; "New Year New You" where employees are offered a free month gym membership at one of the YMCA's, healthy eating cooking demonstrations etc; "Healthy Holiday" cooking demonstrations; Campus catering service provides Pathway to Wellness options for meetings including a brochure with healthy options; brought SU's Learner Center "Meatless Monday's" to Upstate campus highlighting meatless entrees. Meatless options are available every day, but wellness planners say highlighting the meatless menu can help promote healthy eating. "Health Weight Management Skills Program" a six week program highlighting 5 skills. The program is online for those who cannot attend. Upstate Medical University recently received an award for being a "Fit Friendly Company." Heart disease is the No. 1 killer in the U.S., and physical inactivity doubles the risk. Fit-Friendly Worksites are recognized by the American Heart Association as employers who go above and beyond when it comes to their employees' health. HealthLink On Air every Sunday at 9am on WSYR features physicians and faculty from Upstate Medical University on topics that relate to healthy eating, physical exercise, and many other prevention topics. Sponsored by Upstate Medical University s OASIS program in partnership with the Syracuse "Say Yes to Education" After School program, Active Generations enlists older adults in fighting childhood obesity at after-school programs in three Syracuse elementary schools. It is offered to students in grades three to five at Meachem, Roberts, and Van Duyn elementary schools. Upstate s OASIS program was selected by the OASIS National Institute as the first in New York to implement the program. Continue and expand community healthy eating and physical activity programs with Pioneer Homes and Mozart Guerrin on the community garden as well as community garden with kids from a Syracuse City school at the CAB with Tom Pelis. Prevent Chronic Disease: Access to High Quality Chronic Disease Preventative Care Increase screening rates for cardiovascular disease, diabetes and breast, cervical and colorectal cancer, especially among disparate populations; Promote use of evidence-based care to manage chronic diseases; and, Promote culturally relevant chronic disease self-management education. As noted earlier, screening rates for breast, cervical and colorectal cancer have increased and will continue to increase through the opening of the Upstate Cancer Center. Also of note is the annual Diabetes Forum, which provides education and screening for diabetes through Upstate s Joslin Center. However, a novel initiative is the Breast Mammogram program at our Community Campus, twice a year for members of the Onondaga Nation. There was a wane in the program; however, over the last two years there has been a resurgence with over 30 members making an appointment at each of these sessions. The Nation will work with the Director of HealthLink for development of other screenings and education programs that can be held at the Nation. In 2011, Oasis implemented the Stanford Chronic Disease Self-Management Program. In the program was expanded and includes a partnership with the Onondaga County Office of Aging and Youth to expand the program to disparate populations. The program has Upstate University Hospital Community Service Plan Page 29

30 also been expanded with its partnership with St. Camillus for other parts of the community. The Stanford Chronic Disease Self-Management Program is a workshop given two and a half hours, once a week, for six weeks, in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with chronic diseases themselves. Subjects covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, 6) decision making, and, 7) how to evaluate new treatments. Audits are done every 3 months on all patients who have a diagnosis of Asthma and are over 2 years of age. Care and treatment for children w/asthma; includes completion of asthma action plans that are collaborative with the care team, patient and family. Upstate Family Resource Center through the Health Sciences Library is staffed and open to the community to help respond to popular health topics and help people stay informed and find quality information. The community can also use the interactive tools online to learn more about their health. Questions can be addressed in person, calling in, or by . Most popular topics include: burns, healthy lifestyles for adults, exercise and weight control, losing weight, body fat and obesity. Vascular Screening for at risk populations at Bethany Baptist Church, Syracuse Housing Authority - Toomey Abbott Towers. Strong, Women, Strong Heart, presented by Upstate cardiovascular nursing staff, provides a free day of education and entertainment. The event includes health screenings, exercise, nutritional information, heart-healthy tastings, reiki therapy, massage, yoga, meditation. The program over the last two years has approximated more than 400 participants each year. The Upstate Cancer Center is working to increase screening among underscreened populations and assist in meeting the New York Cancer Plan targets for screening. The plan is for Upstate to become the organization of choice for colorectal, breast and lung cancer screening, doubling the number of screenings done by Upstate Women's Imaging Center, and increasing the number of colonoscopies received by employees. Upstate Cancer Center has partnerships with Onondaga County, American Cancer Society, outreach to numerous community groups and family practices and will also be developing exercise and nutrition programs for cancer patients. Expand use of Upstate MyChart to support a clinical referral/recommendation system that links patients to community based resources. This internet connection allows patients to connect to their doctor's office, and request appointments and prescription refills, review your health history, access test results and more. Prevent HIV/STDs, Vaccine Preventable Diseases and Healthcare-Associated Infections Vaccine Preventable Diseases Improve Childhood and Adolescent immunization rates; Decrease the burden of Pertussis Disease; Decrease the burden of Influenza Disease The University Pediatric and Adolescent Center (UPAC) an outpatient clinic that is part of Upstate Golisano Children s Hospital was awarded a $1.1 million Patient Centered Medical Home grant by the NYS DOH in Among the goals for the three year grant is the increase in immunization rates for children as well as increasing the Upstate University Hospital Community Service Plan Page 30

31 proportion of well child visits. A particular focus for UPAC is the provision of culturally competent care for its patient population; which, includes a large refugee population. Syracuse is rated third in the country for the number of refugees settled per 100,000. Upstate University Hospital is the initial medical care site for adult and children refugees; and, as such is also the choice of provider for this population. UPAC has worked closely with our information management team to develop the reporting capability within the Epic system to capture the appropriate data and statistics related not only to this prevention agenda but also Promote Healthy Women, Infants and Children. Prevent HIV/STDs, Vaccine Preventable Diseases and Healthcare-Associated Infections Healthcare Associated Infections Reduce Clostridium difficile (C. difficile) Infections; Reduce device-associated infections As a health care organization and especially as an academic medical center, people come to Upstate University Hospital for the latest in medical and scientific technology. The impetus of any healthcare associated infections is taken very seriously. Upstate has a number of initiatives focused on decreasing the rate of infections, especially as delineated by Center for Medicaid and Medicare Services (CMS) as part of their Value Based Purchasing (VBP) Incentive Program. Effective October 2012, nationally all hospitals that accepted Medicaid and Medicare payments were required to participate in VBP. This included a reduction of 1% in Medicare inpatient payments beginning FFY 2013; increasing, 0.25% each year until the maximum of 2% is reached in FFY2017. Hospitals are measured for results in clinical process of care domains at 70%; which, includes, AMI, Heart Failure, Pneumonia and Surgical Care Improvement (SCIP) and 30% for patient experience or scoring in patient satisfaction surveys. Quality measure results for all adult inpatients is maintained and reported monthly for the following areas: Hospital-acquired C-diff per 10,000 patient days Hospital-acquired MRSA rate per 1,000 patient days Hospital-acquired VRE per 1,000 patient days Central Line Related Infection Rate per 1,000 patient days Urinary Catheter Related Infection Rate per 1,000 patient days Unit Acquired Pressure Ulcers Upstate University Hospital Community Service Plan Page 31

32 For pediatric patients, Upstate Golisano Children s Hospital is a member and participant of the Children s Hospital Association Central Line Associated Blood Stream Infections. As of July 2013, GCH experienced 678 days since its last central line associated blood stream infection (CLA-BSI) in the pediatric intensive care unit and 630 days for the pediatric hematology/oncology inpatient unit. GCH also in became a part of the Ohio Children s Hospital Solutions for Patient Safety; which, focuses on ten individual hospital acquired conditions that jeopardize the health and safety of pediatric patients. GCH participates and provides data and improvement initiatives on nine of the ten (denoted by *). The overall goal of over 80 children s hospitals across the country is to reduce hospital inpatient harm by 40% and readmissions by 20% over a 3 year period. The team members addressing these patient safety issues includes pharmacists, social workers, RN case managers, residents, attending physicians, nurses, nurse practitioners, infection control and medical students. Adverse Drug Events* Catheter-Associated Urinary Tract Infections (CA-UTI)* Central Line Associated-Blood Stream Infections (CLA-BSI)* Falls (moderate or greater injury)* Obstetrical Adverse Events Pressure Ulcers* Venous Thromboembolism (VTE)* Ventilator Associated Pneumonia (VAP)* Readmissions </= 7 days from Discharge* Surgical Site Infections (SSI)* Promote Healthy Women, Infants and Children Maternal and Infant Health Increase proportion of NYS babies who are breastfed. Breastfeeding is viewed as the most effective and well documented preventive modality available to health care providers to reduce the risk of common causes of infant s morbidity. Significantly, lower rates of diarrhea, otitis media, lower respiratory tract infection, Type 1 & Type 2 diabetes, childhood leukemia and sudden infant death syndrome occur among those who were breastfed (Chung M, Raman 2007). The Community Campus is home to about a 1,000 newborns annually and with the merger with Upstate University Hospital, it is a great opportunity to establish it as a baby friendly hospital in the next three years. University Hospital in compliance with Healthy People 2020 objectives and target goals, will utilize all their resources and personnel to Upstate University Hospital Community Service Plan Page 32

33 increase the proportion of infants who are breastfed at certain intervals, reduce the proportion of breastfed newborns that receive formula supplementation within the first 2 days of life, and also increase the lactation support programs. It is our goal to accomplish a phase of the Baby Friendly Hospital in each year through The following grid shows the metrics identified to gauge the level of progress made in increasing the number and percentage of breastfeeding at the Community campus. Promote Healthy Women, Infants and Children Child Health Increase proportion of NYS children who receive comprehensive well child care in accordance with AAP guidelines; Reduce the prevalence of dental caries among NYS children University Pediatric and Adolescent Center (UPAC) serves a uniquely diverse urban and rural population throughout 17 counties in Upstate New York. In Syracuse and Onondaga County, where the majority of its patient population resides, some 70% of patients are from low-income, white, African American, Latina and refugee families. In Upstate University Hospital Community Service Plan Page 33

34 2012, Syracuse welcomed 805 refugees primarily from Burma/Myanmar, Bhutan, Somalia, South Sudan and Iraq. Since 2001, over 7,200 refugees have resettled in Syracuse. UPAC performs health assessments for newly arrived refugee children and serves as a medical home for their health care needs. UPAC is the largest pediatric and adolescent outpatient facility in CNY serving over 6,000 children with an average of three visits per year. As such it is also a critical site to provide dental evaluations for children. They work closely with the Upstate Dental Clinic as well as other providers of dental care, especially for children with public health insurance. Good dental health is integral to a child s overall health and well-being. Yet, tooth decay is the single most prevalent chronic disease and unmet health care need of children; disproportionately affecting minority and children of lower socio-economic groups who often do not receive routine dental care. As noted, childhood tooth decay is preventable and when coupled with regular dental checkups, fluoride varnish a temporary protective coating that is painted on teeth, has proven to be a significant weapon of defense against tooth decay in children of all ages. A practical method to ensure that children maintain optimal dental health is by incorporating oral health care into the well child physical exam in the pediatric medical setting. UPAC and Upstate Dental have collaborated on a grant with Wal-Mart to Introduce Oral Health and Preventive Dentistry Into the Well Child Physical Exam. The grant would cover the cost of supplies and equipment needed for oral examinations, fluoride treatments, educational materials and home care kits. We expect to be notified of results in December Proposal/Plan: The pilot project would integrate an oral examination, dental screening and an application of fluoride varnish into the routine well child physical exam for 10,000 children through age seven seen at Upstate Medical University s Pediatric and Adolescent Center (UPAC). The Upstate Medical University, Division of Dentistry would provide training and instruction to UPAC healthcare providers that includes introduction to oral health, oral examination, fluoride application and preventive office-based and home care strategies for patients and families. Educational materials would be provided to families on the importance of oral hygiene, regular dental care, and tooth healthy nutrition as well as home care kits. A dental home will be promoted for each child to ensure a continued comprehensive program of oral health care. Following are the metrics to measure the success of the grant and proposal. Upstate University Hospital Community Service Plan Page 34

35 Introduction of Oral Health and Preventive Dentistry Into the Well Child Physical Exam Project Metrics 100% of UPAC providers will be trained by the UMU Division of Dentistry in oral health and preventive dental curriculum. 100% of children through age seven associated with the project will receive an oral examination and screening as part of their well child visit. 90% of children associated with the project will receive an application of fluoride varnish at least once a year during their well child visit. 100% of families associated with the project will receive educational materials and home care kits. Promote Mental Health and Prevention Substance Abuse Prevent Substance Abuse and other Mental, Emotional and Behavioral Health (MEB) Disorders Prevent and reduce occurrences of mental, emotional and behavioral disorders among youth and adults; Support collaboration among professionals working in fields of mental, emotional, behavioral health promotion and chronic disease prevention, treatment and recovery. ENHANCE (Excellence in Health Care for Abused and Neglected ChildrEn) is a nationally recognized multidisciplinary clinic which provides comprehensive health care to children in foster care. ENHANCE was developed as a cooperative venture by the Department of Pediatrics and the Division of Child Psychiatry at SUNY Upstate Medical University, and the Onondaga County Department of Social Services to serve the special medical, emotional/behavioral and developmental needs of this vulnerable population of children. University Pediatric and Adolescent Center has partnered and received a grant from Arise, Inc. to provide onsite, psychiatric evaluation, counseling and therapy for children and adolescents. Collaborations with Onondaga County OnCare Program and initiatives, including Crisis Intervention Program, Respite Care, etc. to coordinate suicide prevention initiatives. Increase collaboration and development of initiative by OnCare such as Crisis Intervention and Respite Care Services at Upstate s Pediatric Emergency Room. OnCare is a community initiative that improves outcomes for Onondaga County children and youth (ages 5-21) with significant behavioral and emotional challenges and their families by developing a more effective system of services and supports. OnCare is a federally funded project, and uses system of care principles and strategies to improve our local service system. Upstate also has Linkage agreements with numerous community service providers for making referrals. Spiritual Care including the pediatric chaplain work closely with patients, hospital departments and community groups and hosts a Clergy Day training on Suicide Prevention and Awareness. Designated Aids Center's program to reduce drug and alcohol abuse. The Upstate New York Poison Center at Upstate Medical University is engaged in an awareness campaign aimed at educating the public on the dangers of synthetic marijuana. The Poison Center's campaign targets parents, teachers, youth, healthcare workers and others in hopes of increasing the level of awareness this dangerous product and its potentially fatal effects. The campaign will include presentations and public service announcements. Training first responders on how to deal with patients using bath salts through HealthLink. Upstate University Hospital Community Service Plan Page 35

36 Improve Health Status and Reduce Health Disparities Reduce percentage of premature deaths (before age 65 years). Reduce age-adjusted rate of preventable hospitalizations among adults. Studies show that teen drivers have a higher risk of fatal crashes than older drivers at all alcohol levels. According to a National Institute on Alcohol Abuse and Alcoholism (NIAAA) study, combining classroom and community interventions to prevent alcohol use by adolescents reduced the onset of alcohol use by 28 percent. Let s Not Meet By Accident brings students into University Hospital to expose them to paramedics and to the trauma resuscitation process. Nurses and paramedics, confronted everyday with the tragic aftermath of drinking and driving, talk to students about how alcohol and drugs are a factor in 70 percent of all traffic deaths in the United States. Let s Not Meet By Accident won the 1999 Onondaga County Traffic Safety Advisory Board s Norma Coburn Award, which recognizes organizations that demonstrate a commitment to enhancing traffic safety and consistently contribute organizational resources to benefit the community. While the focus of this Prevention Agenda Focus Area is on preventable hospitalizations among adults, what is not as well known is that the #1 killer of children in the United States is preventable injuries. Safe Kids Upstate New York (SKUNY) sponsored under the umbrella of Upstate Golisano Children s Hospital has an extremely wide network of partners that include the Onondaga, Cortland and Madison County Health Departments, as well as fire, police, sheriff s and state trooper departments among health insurance companies and local community agencies such as Children s Consortium, St. Joseph s Family Medicine Clinic and Child Care Solutions. Table 1 shows the breakdown of children with unintentional injuries that result in emergency department visits, subsequently hospitalizations and in some cases death in New York State. Upstate University Hospital Community Service Plan Page 36

37 Table 1: Unintentional Injury Pyramid Source: NYS DOH Unintentional Injury Program, Hospital Discharge Data, Table 2 indicates by age spread the leading causes of unintentional injury. All causes are addressed in some way, shape or form by a Safe Kids Upstate New York initiative. They include safe sleep, car seat checks, helmet checks and distribution of helmets at various planned events throughout the year and education of parents, children and coaches of the signs and dangers of concussions. A Peds to Parents blog provides information from pediatricians and other pediatric allied professionals on the areas of interest and questions submitted by parents. Table 3 is a synopsis of the initiatives to address the risk areas of unintentional injury for children by Safe Kids Upstate New York (SKUNY). Upstate University Hospital Community Service Plan Page 37

38 Table 2: Leading Causes of Unintentional Injury Deaths by Age Group Source: NYS DOH Unintentional Injury Program, Vital Statistics Death Files and Multiple Cause of Death Files Table 3: Risk Areas Addressed by Safe Kids Upstate New York Program Upstate University Hospital Community Service Plan Page 38

39 IX. CHANGES IMPACTING COMMUNITY HEALTH, PROVISION OF CHARITY CARE AND ACCESS TO SERVICES Provision of Charity Care Upstate University Hospital is different from other area hospitals in that it is a designated Disproportionate Share Hospital ( DSH ) a safety net hospital. A DSH is a hospital that treats a significant number of indigent patients. DSH payments assist in covering the costs of care to low-income patients not covered by Medicare, Medicare HMO or other forms of health coverage. Although Upstate has demonstrated greater patient volumes and exhibited financial stability, provisions in the Patient Protection and Affordable Care Act of 2010 (HR 3590), the Health Care and Education Act of 2010 and New York State budget cuts may undercut the hospital s DSH payments. HANYs estimates that Upstate's DSH revenue could decrease by as much as $30M by Recent budget crises and delays in DSH payments have temporarily halted some capital projects. Upstate is also unique in that all of its Medicaid costs are reimbursed by DSH. Although we have a fierce commitment to charity care, a severe cut in DSH funds will threaten the viability of the numerous inpatient, outpatient, and community support safety net services Upstate provides, such as trauma care and burn services. A major part of the NYS Prevention Agenda, the focus areas and the Community Service Plan is the care and services provided to disparate populations. While this is demonstrated by the primary zip code patient origins, it is also demonstrated by the insurance type or payor mix of patients. The following table correlates the level of disproportionate share patient mix in volume of patients. This equates to 34.4% (204,104) of all outpatient visits and 29.4% (8,466) of all inpatient discharges. A further breakdown is included in the grid below. Upstate University Hospital Community Service Plan Page 39

40 Upstate University Hospital Payor Mix Payor Inpt Discharges Outpatient Visits Blue Cross 11.82% 3, % 83,286 Commercial 7.77% 2, % 71,686 Government 3.00% ,119 HMO 8.04% 2, % 69,612 Institutional 0.09% % 1,049 Medicaid 9.11% 2, % 35,740 Medicaid HMO 17.90% 5, % 128,269 Medicare 27.93% 8, % 101,332 Medicare HMO 7.83% 2, % 27,851 No Fault 2.52% % 5,489 Research 0% % 1,674 Self Pay 2.42% % 40,095 Unknown 0.06% % 930 Worker s Comp 1.51% % 7,649 TOTAL 100% 28, % 593,781 Changes Impacting Community Health Upstate like all hospitals and community agencies and organizations that provide health care services are in an extremely volatile time of change that will forever change community health, health care services and the individual person and families. Some include the impetus of the Electronic Medical Records and required aspects of the system or meaningful use. This has required a standardization of services and information to be provided to patients and their families that will allow them to participate in an informative manner in their health care as well as mandating health care providers and organizations to provide information to the patient in a timelier manner. An example of this is the implementation at Upstate for all its outpatient and ambulatory care areas to the Epic EMR system. Part of the meaningful use requirements include a more thorough review of patient habits, including smoking, drinking, mental health status; thus, allowing us to focus on preventative care and be able to determine whether interventions have made a real impact on the health of our patients and subsequently, the community. Standards that determine obesity (BMI), diabetes and hypertension have been developed to be used across the health care spectrum. Of even greater importance, is the availability of this information to multiple health care providers and even other health care organizations at the same time as well as the ability to send health care information, brochures, etc. to patients identified with the need for this info. Provisions in the Patient Protection and Affordable Care Act of 2010 (HR 3590), the Health Care and Education Act of 2010 is another substantial challenge faced by Upstate and all other health care organizations and the individual person seeking care. Upstate University Hospital Community Service Plan Page 40

41 While we have been unable to complete an analysis of the financial impact of the Health Care Exchanges, we are essentially in-network with most of the plans selling on the exchange in Onondaga and surrounding counties; understanding, that these insurance plans sold to individuals on the exchange are very commercial like and not government programs like Medicaid. Similarly, the impact of Obamacare has not been estimated (too many variables and unknowns) - they're concepts mostly and until you see the mechanics of how concepts are going to be implemented and enforced, it is very tough to estimate the impact. As of now the hospitals are working with HANYs to get all of this sorted out. The act did not address patients who are currently in the hospitals who are the high dollar patients and the county has been unable to address these issues either. Patients that do not qualify for Medicaid are being referred to the NYS exchange. Many of the health status indicators in Onondaga County suggest that the overall health status is comparable to the rest of New York State. However, discussion by the participants and review of these indicators on a more specific level (geographic and/or socio-economic) reveal disparities. Focused data collection may identify a sub-set of the population that bears a disproportionate burden of disease. This subset can be the target of an initiative to improve health status. Further, the design of such an initiative should be informed by the experiences of other communities that have developed collaborative strategies that bring the hospital and public health systems together in a broad-based approach to improvement in health status for a specific population. The goals of the project would be related to strengthening a local collaborative process as well as the design of community action models that could improve health status through a range of initiatives, recognizing that good health status does not depend on health care alone. Critical to making an impact on the NYS Prevention Agenda Priority Focus Areas and Healthy People 2010 is access to medical care which includes sufficient number and type of health care providers. Upstate Medical University has a pivotal role as an academic medical center in the training and education of physicians, mid-level providers (NP, PA) and other allied health professionals. The UMU Strategic Plan (See Appendix IV) includes goals related to the increase in the number of professionals educated and trained. Providing an outstanding educational experience for students and medical residents is the number one goal for Upstate s colleges and teaching hospital. As the only academic medical center in Central New York and one of only 131 in the country, Upstate Medical University is in a unique position to affect access to care for the upstate Upstate University Hospital Community Service Plan Page 41

42 New York community. We are responsible for producing some of the brightest, welltrained health professionals for the state of New York, particularly in light of a growing, increasingly aging patient population. Upstate New York will also require a larger health care workforce to meet the demand of newly insured patients, as a result of the recent health care reform. Upstate Medical University, as part of its Strategic Plan in 2009, planned to enroll 30% and 87% more students in the Colleges of Medicine and Nursing, respectively, by Through 2012 there was an increase of 10.8% and 113.9% in the Colleges of Medicine and Nursing, respectively. There was a 55.2% increase in students in the College of Health Professions; which, includes graduates from the Central New York Master s in Public Health program (partnership of Syracuse University s Maxwell School of Citizenship and Public Affairs and SUNY Upstate Medical University). Graduates of the program are prepared to assume leadership roles to address preventable diseases, injuries, and health disparities through a specialized focus on public health practice and policy and were integral to the completion of community forums, community health needs assessment and community service plans. X. FINANCIAL ASSISTANCE Financial Assistance Program Upstate University Hospital is a regional medical center dedicated to meeting the healthcare needs of the community within its 17-county service area. As part of our mission, it has a program to ensure that financial assistance is available for low income, uninsured patients, or patients with an inability to pay for the services they receive. We will also provide information and assist patients in accessing Medicaid, Family Health Plus, and Child Health Plus and Healthy New York. During the intake and registration process, all patients identified as uninsured (Self Pay) upon presenting at registration will receive a letter notifying them of the availability of financial assistance programs, as well as other resources offered by the Hospital to assist patients with obtaining appropriate financial resources. This notice contains the income levels used to determine eligibility for assistance, the description of the Hospital s primary service area, and instructions to the patient describing how to apply for assistance. Patients are strongly encouraged to apply for public funding, such as Medicaid, Family Health Plus, Child Health Plus, Healthy NY, and any other available public programs. Upstate University Hospital Community Service Plan Page 42

43 Upon consent by the patient, an initial screening for eligibility for Medicaid will be performed to identify which appropriate resources may be available. If eligibility is expected, patients may be required to apply for public health insurance (Medicaid, Medicaid Managed Care, Family Health Plus, Child Health Plus, Healthy NY, etc.) before obtaining Hospital financial assistance. All uninsured patients, as well as patients with self-pay balances after insurance, will receive a statement indicating that payment is due. Statements shall indicate that financial assistance is available and provide a contact telephone number. Under the New York State Charity Care Laws, uninsured patients with incomes below three hundred percent of the federal poverty level are qualified for charity care and shall be deemed presumptively eligible. As part of the financial assistance application process, the Hospital will not seek sale or foreclosure of a patient s primary residence. Consideration of financial assistance will be extended not only to the uninsured, but also to any patient who has exhausted his or her health insurance benefits or is unable to pay the patient responsibility amount determined by the insurer. All qualified patients receiving medically necessary care at Upstate University Hospital, regardless of their medical condition, and who reside within the primary service area shall be eligible to apply for financial assistance under the New York State Charity Care Laws. The primary service area includes the counties of Onondaga, Cayuga, Cortland, Madison, Oswego, Jefferson, Lewis and St. Lawrence. Residents of the following counties shall also be included for consideration as well: Broome, Chenango, Herkimer, Oneida, Tompkins, and Tioga. Financial assistance under the New York State Charity Care Law is also available to qualified New York State residents receiving services from the emergency department at the Hospital regardless of county of residence. As a public teaching facility, University Hospital reserves the right to extend additional care to patients at no or reduced charge that qualify for consideration of financial assistance under its Teaching Case Policy and Gift of Life Policy. Brochures and signage in multiple languages are available at all registration sites, including the Emergency Department, of Upstate University Hospital to inform patients of the Hospital s Financial Resource Center, the availability of financial assistance programs, and the opportunity to meet with a representative from the Financial Resource Center and/or a Facilitated Enroller from one of various Medicaid HMO plans. Upstate has been the county leader in assisting low-income people gain access to care. Staff is available to assist the public to quality for free or low-cost health insurance or a possible reduction in health care bills. Since January 2007, Fidelis Care facilitated Upstate University Hospital Community Service Plan Page 43

44 enrollers have been onsite at Upstate University Hospital as part of our Financial Assistance Programs. Upstate University Hospital s Patient Financial Services has experienced some challenges; which, has included implementation of an EMR system in all the outpatient areas and preparation for the extension of the system to the inpatient areas in March 2014 (Downtown Campus) and May 2014 (Community Campus). As a direct result of the economic recession, we have also witnessed a dramatic increase in the number of financial assistance applications. Many Eastern European, African, Asian and Middle Eastern immigrants and refugees call our community home. As our area has become more linguistically diverse, non- English speakers have exhibited difficulty reading and completing the required documentation. Upstate makes every effort and attempt possible to accommodate non- English languages, including the use of a non-english translation hotline if on-site translators are not available. Contact with Patient Financial Services is an educational and outreach experience as much as it is a purposeful activity. We attempt to develop relationships with families, informing them of not only the importance of obtaining insurance coverage, but also the importance of maintaining their coverage once enrolled. However, many families are not aware when they must re-certify their insurance plan. XI. CONCLUSIONS The implementation of the Patient Protection and Affordable Care Act of 2010 (HR 3590), the Health Care and Education Act of 2010, impetus of electronic medical records, increasing technology and the constant financial challenges evident in health care emphasize the importance of prevention of illnesses and access to primary care. The Upstate University Hospital Community Service Plan is just a microcosm of the response needed to address these issues. Upstate Medical University and especially Upstate University Hospital, Downtown and Community campus, Upstate Golisano Children s Hospital and Upstate Cancer Center are proud of the work and every day achievements toward the improvement of the communities we serve. We look forward to engaging with other health care providers on the initiatives that have emerged from the Onondaga County Community Needs Assessment and Community Service Planning process. We view this process as an ever evolving and continuing process during which we are able to learn about and better meet the needs of our surrounding community. Upstate University Hospital Community Service Plan Page 44

45 XII. DISSEMINATION OF THE REPORT TO THE PUBLIC This report will be disseminated to senior leadership of Upstate Medical University, as well as our critical community partners. The report will also be available to the public via our website Upstate University Hospital Community Service Plan Page 45

46 APPENDIX I: COMMUNITY HEALTH FORUMS Upstate University Hospital Community Service Plan Page 46

47 Findings from 2011 Community Health Needs Assessment Forums: Syracuse, New York January, 2012 INTRODUCTION Title IX of the Patient Protection and Affordable Care Act of 2010 requires charitable hospitals to meet certain provisions related to community benefit in order to maintain their taxexempt status. Among those requirements is that every three years they are to conduct a community health needs assessment (CHNA) that includes community and public health input. Local health departments in New York State are required to conduct periodic community health assessments (CHA) in order to ensure that their programming remains consistent with community needs. These two community planning processes run parallel and have similar attributes. The Central New York Masters in Public Health Program, run jointly by the State University of New York Upstate Medical Center and Syracuse University, initiated a process of community engagement that can support the hospital s CHNA and the Onondaga County Health Department s CHA. Students in the program s Public Health Administration course coordinated and facilitated five forums convened in October and November 2011 and analyzed data collected during those forums as their semester s project. The Lerner Center for Public Health Promotion at the Maxwell School for Citizenship and Public Affairs at Syracuse University provided logistical support and assistance with recruiting forum participants in collaboration with the Onondaga County Advisory Board of Health, the Syracuse City Schools, and Say YES to Education. The forums were held at the Central New York Community Foundation Philanthropy Center; the school-focused forum was held at the Say Yes to Education offices. Altogether, 92 people participated in the forums. APPROACH The forums were conducted using a small-table format that included five to seven participants per table as well as two students from the public health administration course a facilitator and a scribe (for transcribing ideas onto newsprint). Each table, regardless of the type of representatives present, was presented with a common set of core questions/topics. These consisted of an exercise in composing a picture of an ideal community; describing that community succinctly in narrative form; identifying strengths and weaknesses of the current public health situation in our community; issues needing attention in the domains of the public health system and the health status of individuals; and, based upon what they had identified in previous portions of the session, recommendations for local public health priorities. Each session was designed to last two hours. The data used for the analysis presented in this report consist of responses given during the portion of the sessions devoted to identifying issues needing attention in the domains of the Upstate University Hospital Community Service Plan Page 47

48 public health system and the health status of individuals. The analysis process, carried out by an independent researcher assigned to the project as well as public health experts from the Lerner Center, consisted of thematically coding the responses inductively into categories that are consistent with dimensions targeted by the public health field. The following presentation of findings is divided into those representing system-level needs and those representing health status issues. The report s final section attempts to draw conclusions regarding public health priorities for the next three years. System-Level Issues FINDINGS Chart 1 shows the distribution of responses among the four main categories that emerged from the data regarding system-level issues. Social conditions generally consists of responses in which people indicated that public health priorities should target community-level factors that are not directly related to the delivery of health, such as the economy, the school system, the public transportation system, and policies affecting safety. The remaining responses generally can be categorized as relating to the public health system s capacity to provide needed care, the difficulties many people have in accessing healthcare either due to problems with the availability of affordable health insurance or in obtaining clear, useful, and unbiased information about healthcare. Chart 1 Percent of Responses Related to Four Main Categories (N=141) Social Conditions Access to Care: Capacity Access to Care: Financial Access to Care: Information Based upon the number of responses that comprise the social conditions category (see Chart 2), forum participants apparently are concerned that the City and County are not favorable locations in which healthcare and health can thrive. Over half of the responses in this category Upstate University Hospital Community Service Plan Page 48

49 indicate needs for stronger policies regarding safety (especially crime prevention), jobs, and access to healthy food Chart 2 Percent of Responses Related to the Theme "Social Conditions" (N=51) Charts 3, 4, and 5 present the distribution of responses within each of the Access to Care categories shown in Chart 1. Chart 3 shows that most (77%) of the responses are related to the healthcare system s inability to accommodate consumers healthcare needs, particularly primary and mental health care. Forum participants placed relatively little emphasis on dental care and options for eldercare Chart 3 Percent of Responses Related to the Theme "Access to Care: Capacity" (N=48) C h Primary Care Mental Health and Substance Abuse Dental Eldercare Options Upstate University Hospital Community Service Plan Page 49

50 Chart 4 shows that between the private insurance market and public coverage (largely Medicaid), it is the private market that caused the most concern to forum participants. Individual responses in the private category primarily focused on coverage and cost while those in the public category mainly focused on a lack of providers that accept Medicaid. Chart 4 Percent of Responses Relating to the Theme "Access to Care: Financial" (N=24) Private Insurance System Public Insurance System Chart 5 shows that forum participants who mentioned problems with obtaining information about healthcare were mostly concerned about a general lack of consumer information. They mentioned information overload, a lack of communication about healthcare opportunities such as free screenings, and a general lack of consumer education. Political responses included mentions of public officials lack of knowledge about local health concerns, politics driving of healthcare decisions, and difficulties posed by the state regulatory environment Chart 5 Percent of Responses Related to the Theme "Access to Care: Information" (N=18) Consumer Information Cultural Competency Less Political Healthcare System Easier-to-navigate Healthcare System Upstate University Hospital Community Service Plan Page 50

51 Health Status Issues Chart 6 presents the distribution of responses across four general categories impacting health status. Over half of the responses are captured in the chronic disease, mental health and substance abuse, and physical activity and nutrition categories. Chart 6 Percent of Individual-level Responses Included in Each Main Category (N=188) Chronic Disease Mental Health and Substance Abuse Physical Activity and Nutrition Maternal and Child Health Social Determinants Other Conditions Chart 7 shows that the forum participants identified the need for prevention and treatment of chronic disease to be of importance to the local community. They particularly mentioned asthma as needing attention Chart 7 Percent of Responses Relating to Chronic Disease (N=41) Respiratory Disease Diabetes Cancer Cardiovascular Disease Upstate University Hospital Community Service Plan Page 51

52 Chart 8 shows that forum participants identified obesity as the status in this category that is most in need of attention. They also are concerned about hunger and poor nutrition among people of all ages. The accessibility category consists of responses in which people identified difficulties people have in getting good food and exercise. Chart 8 Percent of Responses Related to Physical Activity and Nutrition (N=33) Obesity Nutrition Accessibility Fitness Chart 9 shows that participants regard mental health for both children and adults as important issues. Substance abuse, including prescription drugs and smoking are also seen as problems. Chart 9 Percent of Responses Related to Mental Health and Substance Abuse (N=36) Mental Health Substance Abuse Smoking Upstate University Hospital Community Service Plan Page 52

53 Chart 10 shows that almost all of the responses in the maternal and child health category consisted of infancy-related problems. Mentions of infant mortality and low birth weight predominated within this category. Chart 10 Percent of Responses Related to Maternal and Child Health 86.2 (N=29) 13.8 Infancy-related Teen/unplanned Pregnancy Chart 11 presents information about the distribution of other conditions that arose during the sessions. Other conditions mainly include infectious diseases (especially STDs), injuries (especially falls among elderly people), and general oral health. Other conditions within this overall category that were mentioned by forum participants were diseases of the eye, seasonal affective disorder, and allergies. Chart 11 Percent of Responses Related to Other Conditions (N=24) Infectious Disease Injuries Dental Health Disability Aging Other Upstate University Hospital Community Service Plan Page 53

54 Chart 12 presents findings regarding social factors that are connected to health status. Most responses related to violence mentioned crime or domestic violence, including child abuse; most responses in the education category mentioned either the cost of education or low rates of achievement; all of the responses in the income category either mentioned the cost of health insurance or poverty; and lead poisoning was mentioned by three people. Chart 12 Percent of Responses Related to Social Determinants of Health Status (N=26) Violence Education Income Lead Poisoning Overall Assessment of Public Health Issues When the health system and health status issues are considered together, social conditions is the set of factors that are most frequently cited as impacting overall health of the community. These social issues are wide ranging and clearly demonstrate the enormous effect of social and environmental conditions on health. Interventions to address these issues are also broad and would include economic development and expansion of educational opportunities. Access to health care is also a dominant theme. Access is defined broadly and includes financial access and capacity as well as the degree to which consumers are a partner in their health care. In particular, access to primary care and mental health care were identified as problematic. Health status was also negatively impacted by a number of variables including physical activity and nutrition which drives, in large measure, chronic disease, another area of concern frequently cited. Other health concerns relate to mental health and substance abuse as well as maternal and child health, problems exacerbated by limited access to care and poor social conditions. Upstate University Hospital Community Service Plan Page 54

55 APPENDIX II: 2013 Onondaga County Health Assessment Draft 10/1/13 Cynthia B. Morrow, MD, MPH and Rebecca Shultz, MPH Onondaga County Data are from the U.S. Census Bureau unless otherwise noted. Onondaga County is located in Central New York State. It covers 780 square miles consisting primarily of forests and agricultural land. It is bordered by Oswego County to the north, Cayuga County to the west, Cortland County to the south, and Oneida County to the east. The Onondaga County Health Department gratefully acknowledges the contributions of Thomas H. Dennison, PhD and his Masters students for all of their hard work in the research and preparation of this document. Upstate University Hospital Community Service Plan Page 55

56 Figure 1. Location of Onondaga County within New York State Source: The population of Onondaga County is 466,615, making it the sixth most populous county in Upstate New York (i.e. New York excluding New York City). The County seat is the City of Syracuse, located near the center of the county. In addition, 19 towns, 15 villages and the Onondaga Nation territory lie within the County s borders. Onondaga County contains an abundance of forests and agricultural lands, and the population density is 600 persons/mi 2. Figure 2. Map of Onondaga County Source: New York State. Syracuse is the largest city in the Central New York (CNY) region with a population of 145,135. Syracuse residents account for almost one-third of the total County population and Syracuse is the fourth largest Upstate NY city, after Buffalo, Rochester and Yonkers. Other heavily Upstate University Hospital Community Service Plan Page 56

57 populated towns in Onondaga County include Clay, Salina, and Cicero in the northwest sector and Dewitt and Manlius in the southeast. Figure 3 shows the urban population of Onondaga County by census tract for Urban population is defined as the percent of residents of a territory who live in areas that encompass at least 2,500 people, at least 1,500 of which reside outside institutional group quarters. Figure 3. Urban population by census tract, Onondaga County, 2010 Urban Population, Percent by Tract, 2010 Census 100% Urban Population % % Under 50.1% No Urban Population Source: Community Commons Map Room at Upstate University Hospital Community Service Plan Page 57

58 A. Population Characteristics The demographic characteristics of a population can impact a variety of health outcomes through differences in health behaviors, and health care access and utilization. There are significant differences in the demographics between residents of Syracuse and the rest of Onondaga County, which contribute to geographic disparities in health. Other disparities are discussed throughout this section. Disparities must be considered throughout the process of health planning for the community. Age and Gender Age distribution can have a major impact on the health needs of a community. The median age in Onondaga County is 38.7 years; greater than the median age of 29.2 years in Syracuse. Onondaga County s population distribution is relatively comparable to that of New York State (Figure 4), though the population of Syracuse skews younger than both, with a higher proportion of residents under age 5 years, and a lower proportion over age 65. Figure 4. Population distribution by age group, Syracuse, Onondaga County and New York State, % 2% 4% 6% 8% 10% 12% 14% Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 years and older Syracuse Onondaga County New York State Source: U.S. Census Bureau, American Community Survey, Upstate University Hospital Community Service Plan Page 58

59 There are over 27,000 children under age 5 in Onondaga County, representing 5.9% of the population. Outside of Syracuse, there are relatively large numbers of preschoolers living in the towns of Clay, Cicero, Salina, Manlius and Dewitt. With respect to older populations, there are over 65,000 county residents age 65 years and older (14.0%) living in Syracuse. Outside of Syracuse, substantial populations of senior citizens reside in the towns of Clay, Salina, Manlius, Dewitt and Camillus. Projections from the Cornell Program on Applied Demographics show that by 2030, nearly 20% of Onondaga County s population will be age 65 year or older (Figure 5). Elderly populations typically face a unique set of health issues that the County must be prepared to address over the next 15 years. Figure 5. Projected age distribution for Onondaga County, 2030 Source: Cornell Program on Applied Demographics, 2011: Women comprise 51.8% of the population of Onondaga County and 52.3% of the population of Syracuse. Women of childbearing age (generally years) may have specific health needs. There are nearly 95,000 women in this category in Onondaga County, with roughly 37,000 residing in Syracuse. Upstate University Hospital Community Service Plan Page 59

60 Race and Ethnicity Among Onondaga County residents, 97.6% identified as being one race. Of these, 81.6% are white and 10.9% are black. The majority of County s black residents live in Syracuse, particularly on the near-south and west sides of the city. Between the 2000 and 2010 Census, the black population in Syracuse increased by nearly 16%. Asians and American Indian/Alaska Natives are the other racial groups represented in comparatively large numbers. There are 15,000 Asians living in the County, comprising 3.2% of the total population. Persons of Native American descent account for 0.7% of the population. Figure 6. Population by race, Onondaga County, % 3.2% 1.1% 2.4% White 10.9% Black or African American American Indian and Alaska Native Asian Some other race 81.6% Two or more races Source: U.S. Census Bureau, American Community Survey, Figure 7. Population by race, Syracuse, % 2.8% 4.1% 5.4% 0.9% White Black or African American American Indian and Alaska Native Asian Some other race 57.5% Two or more races Source: U.S. Census Bureau, American Community Survey, Hispanic ethnicity is reported by over 19,000 County residents of all races (4.1%). This represents a 70.1% increase in Hispanic ethnicity from Upstate University Hospital Community Service Plan Page 60

61 the 2000 U.S. Census. Currently, nearly two-thirds of local Hispanics reside in Syracuse, particularly in neighborhoods on the near-west side of the city. The towns of Clay, Geddes, and Salina also have notable numbers of Hispanic residents. Figure 8. Population by Hispanic ethnicity, Onondaga County, Not Hispanic or Latino, 95.9% Hispanic or Latino, 4.1% Hispanic or Latino, 0.0% Mexican, 0.4% Puerto Rican, 2.2% Cuban, 0.4% Other Hispanic or Latino, 1.1% Source: U.S. Census Bureau, American Community Survey, Figure 9. Population by Hispanic ethnicity, Syracuse, Not Hispanic or Latino, 91.5% Mexican, 0.5% Hispanic or Hispanic Puerto Latino, Rican, 5.2% 0.0% or Latino, 8.6% Cuban, 1.0% Other Hispanic or Latino, 1.9% Source: U.S. Census Bureau, American Community Survey, Upstate University Hospital Community Service Plan Page 61

62 In Onondaga County, 7.3% of residents are foreign-born. Among residents in Onondaga County from , the greatest percentage was born in Asia, followed by Europe, Latin America and Africa. The percent of foreign-born residents increases to 11.2% in Syracuse, where the largest percentage was also born in Asia, followed by Latin America, Europe and Africa. A number of foreign-born residents, particularly in Syracuse, are recently settled refugees. Since 2007, over 6,000 refugees, including 2,000 children, have resettled in the Syracuse area. While refugees have resettled from many countries in Southeast Asia, Africa and the Middle East, primary countries of origin include Burma/Myanmar, Bhutan, Thailand, Nepal, Somalia and Iraq. Job opportunities and the relatively low cost of living continue to make the Syracuse area popular for resettlement. According to an Onondaga County Citizens League report, an estimated 12,000 refugees and former refugees currently reside in Syracuse, many in neighborhoods on the Northside of the city. Newly arrived refugees have specific healthcare needs, as well as a unique set of barriers to accessing appropriate care including language, education and transportation. Ensuring access to care and positive health outcomes for this vulnerable population requires a coordinated response among many local service agencies. Spoken languages and linguistic isolation English language proficiency can impact everything from an individual s educational success, to the ability to communicate with healthcare providers or secure employment. In Onondaga County, English is the most commonly spoken language. The next most commonly spoken language is Spanish, which is the primary spoken language at home for 2.9% of County and 6.3% of City residents ages 5 and older. Primary speakers of other Indo-European languages (e.g. French, Polish, Ukrainian, Russian, Bosnian, Turkish, etc.) account for 4.1% of county residents and 4.5% of Syracuse residents. Primary speakers of Asian and Pacific Islander languages (e.g. Chinese, Burmese, Nepali, Karen dialects, etc.) account for 2.0% of county residents and 3.7% of Syracuse residents, and primary speakers of other languages (e.g. Arabic, American Indian languages including Onondaga, African languages including Swahili and other Bantu languages, Somali, etc.) account for 0.9% of county residents and 2.0% of Syracuse residents. A household is considered linguistically isolated if all adults (age 14 and older) speak a language other than English and none speaks English very well. Residents who speak a language other than English at home and do not speak English very well and households in which a language other than English is spoken and no adult speaks English at least very well are considered linguistically isolated Figure 10 compares the percent of the population, ages 5 and older, who speak a language other than English at home including who speak English less than very well across localities. Upstate University Hospital Community Service Plan Page 62

63 Figure 10. Linguistic characteristics by geographic area, % 25.0% Language other than English Speak English less than "very well" 13.3% 20.0% 8.7% 15.0% 6.8% 6.1% 16.2% 10.0% 9.7% 3.7% 9.7% 11.6% 5.0% 6.2% 0.0% Syracuse Onondaga County NYS excl. NYC New York State U.S. Source: American Community Survey, Regarding English language proficiency among children, 11.9% of the nearly 21,000 students in the Syracuse City School District are English language learners (ELLs). These students represent 80 countries, with 74 different languages spoken. Approximately half of ELLs are refugees. Most other ELLs are secondary refugees or migrants, immigrants, or individuals who were born in the U.S., but grew up in a home where a language other than English is spoken. B. Socioeconomic Characteristics Education Educational attainment is an important predictor of health outcomes. As seen in Table 1, among adults age 25 years and older in Onondaga County, 89.3% have a high school education or higher, and 32.6% have a bachelor s degree or higher. These fall to 80.2% and 26.1% in Syracuse, respectively. Table 1. Highest level of education obtained among adults age 25 years and older, Syracuse, Onondaga County and New York State, City of Syracuse Onondaga County New York State Less than high school education 19.9% 10.7% 15.1% High school graduate or higher 80.2% 89.3% 84.8% Bachelor's degree or higher 26.1% 32.6% 32.6% Source: U.S. Census Bureau American Community Survey, Upstate University Hospital Community Service Plan Page 63

64 There are 18 school districts in Onondaga County with an enrollment of approximately 70,000 students, including nearly 20,000 students in the Syracuse City School District (SCSD). Disparities in education between Syracuse and the rest of the county are evident, as SCSD students consistently test significantly below the state average on standardized tests. The district is generally considered one of the lowest performing in New York State, as evidenced by the low pass-rate on tests administered between grades 3 and 8 (pass rates ranged from 19% to 31% for all tests over the 6 grades). In addition, the high school dropout rate in Syracuse was 11% for the school year, significantly higher than the average rate of 1% seen in suburban schools. The percent of graduates in Syracuse who will go on to some type of college is 77.2%, compared with 86.8% among suburban students. Within the SCSD, the average graduation rate is 52% compared with suburban school districts in Onondaga County that have an average graduation rate of 84.4% (New York State Report Cards, ). The Central New York region is home to a large number and variety of post-secondary educational institutions. Over 32,000 students currently attend colleges within Onondaga County, which include Syracuse University, LeMoyne College, SUNY Upstate Medical University, the State University of New York College of Environmental Science and Forestry, and Onondaga Community College. Two local hospitals also have schools of nursing, and a number of professional skills and licensing programs are offered in the community. An additional 35 institutions of higher learning are located within 100 miles of Onondaga County. Unique to the Syracuse area is the Say Yes to Education program. Initiated in 2008, the mission of the program is to dramatically increase high school and college graduation rates for urban youth. To achieve this mission, the program seeks to unite a diverse group of academics, educators, government agencies, corporations, research institutions and community partners to provide support to Syracuse City School District students from K-12 and beyond. This support is demonstrated through offering extended academic programming, mentoring, tutoring, family outreach, health care, social work, psychological services and/or legal assistance. One special feature of the Say Yes program is the promise of free college tuition for those SCSD students who meet residency, graduation and admission requirements. Since 2009, nearly 2,000 Say Yes students have enrolled in 2 and 4 year colleges. Other early successes have been seen, including a 3.5% increase in Syracuse city home values since the program s inception. The impact of Say Yes to Education in Syracuse will continue to be evaluated in the years to come (Say Yes to Education Syracuse). Employment The educational services, health care and social assistance sectors employ 30.0% of Onondaga County civilians age 16 and older. This is followed by the retail sector (11.4%), the professional, scientific, and management, and administrative and waste management sectors (10.1%), manufacturing (8.3%) and the arts, entertainment and recreation, and accommodation and food services sectors (8.2%). According to the Onondaga County Office of Economic Development, the leading employer in the Onondaga County area is Upstate University Health System with 9,525 employees. Other major employers in the area include Syracuse University, St. Joseph s Hospital Health Center, Wegmans and Crouse Hospital. Recent data from the New York State Department of Labor show job growth in the Syracuse Metropolitan Statistical Area Upstate University Hospital Community Service Plan Page 64

65 (MSA) in the fields of education and health, trade, transportation and utilities, and leisure and hospitality. Job losses have occurred in manufacturing, financial activities and information. According to the U.S. Bureau of Labor Statistics, the unemployment rate in Onondaga County was 7.1% in April 2013, and has declined slowly from a high of 8.8% in January The current unemployment rate is nearly identical to the statewide unemployment rate of 7.3% in April Consequences of unemployment can include a decrease in health care-related expenditures and a decrease in access to employer-sponsored health insurance programs, which may lead to higher rates of uninsured persons. As seen in Figure 11, racial disparities in unemployment exist both within Onondaga County and Syracuse. In general, white residents have lower unemployment rates than other races. The highest unemployment is seen in those who identify as some other race. Figure 11. Unemployment by race, Syracuse, Onondaga County and New York State, Syracuse Onondaga County New York State Percent White Black or African American Asian Some other race Two or more races Source: American Community Survey, Income The median household income in Onondaga County is $52,520. As illustrated in Figure 12, there is a significant disparity in income between Onondaga County and Syracuse residents. Upstate University Hospital Community Service Plan Page 65

66 Figure 12. Percent of residents by income, Onondaga County and Syracuse, Onondaga County Syracuse Percent Less than $10,000 $10,000 to $24,999 $25,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 $100,000 or more Source: U.S. Census Bureau, American Community Survey, Poverty Among all residents, 14.7% had income in the last 12 months that was below the federal poverty level. Especially striking is the poverty rate among children in Syracuse, where 49.0% of those under age 18 live in poverty, compared to 21.0% in Onondaga County. Poverty rates for families can be seen in Figure 13. Poverty rates are consistently higher in Syracuse than in Onondaga County, peaking at 56.0% among female-headed households with related children under 18 years of age. Upstate University Hospital Community Service Plan Page 66

67 Figure 13. Percent of families living below the federal poverty rate, Onondaga County and Syracuse, Onondaga County Percent All families Related children under 18 years Related children under 5 years only Source: U.S. Census Bureau, American Community Survey, Female householder, no husband present Female householder, related children under 18 years Female householder, related children under 5 years only Another indicator of poverty is the percent of students receiving free or reduced price lunch at school. As seen in Table 2, this varies by school district, with a far greater percentage of students in the SCSD receiving free or reduced price lunch compared to the surrounding county districts. If SCSD is removed from the dataset, there does not appear to be a strong relationship between the percent of minority students and the percent receiving a free or reduced lunch, suggesting that the disparity is mainly attributable to urban poverty, rather than based solely upon race. Upstate University Hospital Community Service Plan Page 67

68 Table 2. Free and reduced price lunch by school district, Minority students Free or Reduced School District Lunch Baldwinsville 8.9% 22.3% East Syracuse-Minoa 10.6% 33.5% Fabius-Pompey 4.5% 23.6% Fayetteville-Manlius 14.2% 8.3% Jamesville-Dewitt 21.0% 13.2% Jordan-Elbridge 3.6% 40.2% Lafayette 33.1% 35.3% Liverpool 17.7% 28.8% Lyncourt 17.2% 51.4% Marcellus 3.0% 12.9% North Syracuse 11.8% 28.3% Onondaga 16.4% 34.4% Skaneateles 3.7% 8.6% Solvay Union Free 15.9% 46.5% Syracuse City 73.9% 79.8% Tully 3.6% 37.1% West Genesee 9.0% 18.3% Westhill 8.1% 6.6% Data Source: NYS Report Cards, In addition to children and families, seniors living in poverty warrant special attention. In Onondaga County, 7.6% of residents age 65 years and older live in poverty, as do 17.4% of seniors in Syracuse. The poverty burden in an area can also be assessed through utilization of public benefits. In Onondaga County, nearly 9,000 (5.4%) households receive an average of $8,715 in Supplemental Security Income each year. Of these nearly 5,700 are in Syracuse, representing 10.2% of city households. In addition, almost 5,600 county households receive cash public assistance income, 4,100 of which are in Syracuse. Countywide, almost 23,000 (12.4%) households receive Supplemental Nutrition Assistance Program (SNAP) benefits. In Syracuse, nearly 15,000 (26.9%) households receive SNAP benefits. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Onondaga County served an average of 10,077 participants per month in 2012 (Onondaga County Health Department Annual Report). Upstate University Hospital Community Service Plan Page 68

69 Health Insurance Another important factor relating to health outcomes and access to care is the presence of health insurance. In Onondaga County, 9% of residents do not have any health insurance. This increases to 13% in Syracuse. Housing Onondaga County has been largely insulated from the unstable housing market that has plagued much of the rest of the nation over the last several years. Recent data from the U.S. Bureau of Labor Statistics accessed through National Public Radio show that the current foreclosure rate in Onondaga County is just 1 in 12,647 homes. The median home value in Onondaga County in 2010 was $134,700, compared to $88,400 in Syracuse. Disparities Overall, Syracuse has a younger and more racially and ethnically diverse population compared to the rest of Onondaga County. In addition, there is higher poverty and lower educational attainment in Syracuse than in the surrounding suburban and rural areas. These factors are important predictors of health outcomes and should be considered when evaluating populations at risk and allocating resources for public health activities. Some of these disparities are highlighted in Figure 14. Figure 14. Demographic disparities between Onondaga County and the City of Syracuse Percent Over age Below poverty level Children below poverty level High school education or higher Onondaga County Foreign-born Speak language other than English at home Source: U.S. Census Bureau, American Community Survey, Upstate University Hospital Community Service Plan Page 69

70 Health Status and Distribution of Health Issues in Onondaga County All data are from sources accessed through the NYSDOH Community Health Assessment Clearinghouse unless otherwise indicated. Improve Health Status and Reduce Health Disparities According to Healthy People 2020, a disparity exists if a health outcome is seen in a greater or lesser extent between populations (Disparities 2010, retrieved from healthypeople.gov). As part of an overall Community Health Assessment, health disparities must be addressed. Four primary indicators are intended to capture health outcome and access categories that are representative of overall health status and disparities in Onondaga County. Table 3. Indicators for the NYS Prevention Agenda:Improve Health Status and Reduce Health Disparities Indicator Percentage of premature deaths (before age 65 years) Ratio of black non-hispanic to white non-hispanic Ratio of Hispanic to white non-hispanic Age-adjusted preventable hospitalizations rate (per 10,000)(SPARCS) Onondaga County ( ) NYS (2010) NYS Prevention Agenda Objective ~Ratio of black non-hispanic to white non-hispanic ~Ratio of Hispanic to white non-hispanic Percentage of adults with health care coverage (Age years) (Expanded BRFSS Preliminary Report, ) Percentage of adults who have a regular health care provider (Expanded BRFSS Preliminary Report, ) ( ) (2011) Source: New York State Department of Health Prevention Agenda Office of Vital Statistics Upstate University Hospital Community Service Plan Page 70

71 Premature Deaths The percentage of premature deaths were calculated by aggregating the number of deaths occuring before age 65 per 100 total deaths in the specified time period ( ). Overall, 22.4% of Ononodaga County residents die prematurely, compared to 24.2% for New York State. Black non-hispanics and Hispanics experience a much higher pecentage of premature deaths, compared to white non-hispanics: for every one white non-hispanic premature death there are 2.53 black non-hispanic deaths and 2.53 Hispanic deaths (Figure 15). Figure 15. Racial and ethnic disparities in premature deaths, White non-hispanics Black non-hispanics and Hispanics For every one white non-hispanic premature death,there are 2.53 for both black non-hispanic deaths and Hispanic deaths in Onondaga County Source: Local life table analyses provide a deeper look into the disparities surrounding mortality in Onondaga County. Figure 16 shows the percent of deaths in each age catgory by race and sex for In Onondaga County, 59.1% of black males will die before age 65 years, compared to 25.1% for white males. Overall, there is a substantial disparity between black and white residents of Onondaga County. Upstate University Hospital Community Service Plan Page 71

72 Figure 16. Percent of deaths by age category, race and sex, Onondaga County, Black males Black females 60.0 White males White females Percent Age 0-24 Age Age Age 65+ Total deaths before age 65 Another way to assess disparities in premature death is by examining survivorship. Survivorship curves for race and sex are shown in Figure 17. This again illustrates quite strongly the disparity in survival among white and black county residents. Upstate University Hospital Community Service Plan Page 72

73 Figure 17. Survivorship by sex and age for selected races, Onondaga County, % 90% 80% Percent Surviving 70% 60% 50% 40% 30% 20% White Females White Males Black Females Black Males 10% 0% Age (Years) Preventable Hospitalizations The number of preventable hospitalizations are measured by the Prevention Quality Indicators (PQIs), which are a set of measures developed by the Agency for Healthcare Research and Quality (AHRQ) and are used to assess the quality of outpatient care for "ambulatory care sensitive conditions" (ACSCs). This indicator is defined as the combination of the 12 PQIs that pertain to adults: short-term complication of diabetes, long-term complication of diabetes, uncontrolled diabetes, and lower-extremity amputation among patients with diabetes, hypertension, congestive heart failure, angina, chronic obstructive pulmonary disease, asthma, dehydration, bacterial pneumonia, and urinary tract infection. In 2010, the baseline rate of age-adjusted preventable hospitalizations in New York State was per 10,000 compared to Onondaga County s rate of per 10,000. Onondaga County has already met the Prevention Agenda goal of overall age-adjusted preventable hospitalizations per 10,000 for ages 18 and older. Upstate University Hospital Community Service Plan Page 73

74 As with Onondaga County s percentage of premature deaths, racial disparities in preventable hospitalization rates are apparent. This is most pronounced in the ratio of preventable hospitalization rates for white non-hispanics to black non-hispanics: for every one white non- Hispanic preventable hospitalization, there are 2.5 preventable hospitalizations for black non- Hispanics (see Figure 18). The Prevention Agenda goal is to reduce disparities in the ratios of preventable hospitalizations for black non-hispanics and Hispanics to white non-hispanics by 10% (to 1.85 and 1.38, respectively). Onondaga County has met the Prevention Agenda objective for reducing the disparity of Hispanic to white non-hispanic preventable hospitalizations; for the ratio was Figure 18.Racial and Enthic Disparities in Preventable Hospitalizations, White non-hispanics Black non-hispanics For every one White non-hispanic preventable hospitalization, there are 2.5 black non- Hispanic preventable hospitalizations Source: Access to Care Ninety percent of Onondaga County adults report having a regular health care provider, and 92.8% report having healthcare coverage. These rates are greater than those reported for NYS as a whole (84.9% and 83.3%, respectively). Despite this report of improved access to care, Onondaga County adults are less likely to have had a checkup within the past 12 months (66.9%) compared to NYS (71.2%) and more likely to report 14 or more days of poor physical health in the past month (15.4%) compared to NYS (12.1%) (Expanded BRFSS Preliminary Report, ). Summary of Improving Health Status and Reducing Health Disparities When viewed at the county level, Onondaga fared better than New York State with respect to the baseline Prevention Agenda indicators for improving health status and reducing health disparities. However, as illustrated by the life table analyses in Figures 16 and 17, the County still faces considerable challenges with respect to achieving health equity through reducing disparities. In addition, more Onondaga County adults report poor physical health. To gain a deeper understanding of the health status of Onondaga County residents, data are presented below from each of the five Prevention Agenda Priority Areas. Upstate University Hospital Community Service Plan Page 74

75 Prevention Agenda Area: Preventing Chronic Disease An overview of chronic diseases is presented in Appendix VI. in the below sections. Areas of interest are highlighted Cardiovascular Disease Cardiovascular disease includes all diseases of the heart, coronary artery disease, and vascular diseases. Onondaga County enjoys a high standard of care for diseases of the heart and coronary heart disease. Mortality and hospitalization rates relating to these conditions are statistically significantly lower than New York State and the nation as a whole. In 2005, as heart disease mortality rates decreased more rapidly than cancer mortality rates, the leading cause of death shifted from heart disease to malignant neoplasms in Onondaga County. Currently in Onondaga County mortality rates due to coronary heart disease are 107 per 100,000, approaching the Healthy People 2020 target of per 100,000. Overall rates are seen in Figures 19 and 20. Figure 19.Age-adjusted mortality rate for diseases of the heart, per 100,000 population, Onondaga NYS US Sources: NYSDOH County Health Indicators, Cardiovascular Disease, Healthy People National Center for Health Statistics Upstate University Hospital Community Service Plan Page 75

76 Figure 20. Age-adjusted mortaliy rate per 100,000 for coronary heart disease, Onondaga NYS US HP 2020 Sources: NYSDOH County Health Indicators, Cardiovascular Disease, Healthy People National Center for Health Statistics Cancer In Onondaga County, the incidence of all cancers is increasing however that mortality associated with cancer is decreasing, as shown in Figure 21. Presumably these differences are attributable to improved screening with concomitant increase in early detection of cancer as well as to improvements in cancer treatment. Each week, approximately 52 Onondaga County residents are diagnosed with cancer and approximately 19 die from cancer. Figure 21.Age-adjusted incidence and mortality rates for all types of cancer in Onondaga County, Incidence Mortality Source: Note: Rates are per 100,000, age-adjusted to the 2000 US Standard Population Upstate University Hospital Community Service Plan Page 76

77 The incidence rates of three common cancers (breast, lung, and prostate) are illustrated in Figure 22. Please note that the incidence of both lung cancer and prostate cancer are statistically significantly higher in Onondaga County compared to NYS and the US. Figure 22: Incidence of breast, lung and prostate cancer in Onondaga County, New York State and the United States, Rate per 100, Onondaga NYS US Breast Lung Prostate Source: NYSDOH County Health Assessment Indicators, Cancer, Note: Rates are per 100,000, age-adjusted to the 2000 US Standard Population Similarly, the mortality rates of these common cancers are illustrated in Figure 23. Interestingly, while the mortality rate of lung cancer is statistically significantly higher in Onondaga County compared to NYS which is expected given the increased incidence, the mortality rate prostate cancer is actually lower, despite the dramatically increased incidence of prostate cancer. One can speculate that the relatively high rate of detection of prostate cancer without a commensurate increase in prostate cancer mortality may be associated with the tremendous attention to prostate cancer screening in this community. Upstate University Hospital Community Service Plan Page 77

78 Figure 23: Mortality of breast, lung and prostate cancer in Onondaga County, New York State and the United States, Onondaga NYS Rate per 100, US Breast Lung Prostate Source: NYSDOH County Health Assessment Indicators, Cancer, Note: Rates are per 100,000, age-adjusted to the 2000 US Standard Population Among the cancer data for Onondaga County, screening rates stand out as a bright spot. Preliminary data from the Expanded BRFSS show that 86.0% of Onondaga County adults, age have been screened for colorectal cancer using the most recent guidelines. This meets the NYS Prevention Agenda goal of 71.4% and is higher than the current NYS rate of 65.7%. In addition, 93.9% of Onondaga County women age have had a mammogram within the last two years, compared to 81.6% in NYS. Obesity and Diabetes Like the rest of the country and New York State, obesity and diabetes present significant challenges in Onondaga County. In Onondaga County, while adult overweight/obesity rates (BMI >25) are comparable to NYS and US rates, adult obesity rates (BMI >30) are statistically significantly lower than the national average. Preliminary data from the Expanded BRFSS ( ) show that 20.0% of adults are obese in Onondaga County, compared to 26.2% in NYS. This exceeds the NYS Prevention Agenda goal of 23.2%. Obesity and diabetes rates are shown below in Figures 24 and 25. Upstate University Hospital Community Service Plan Page 78

79 Figure 24. Obesity rates in Onondaga County, NYS and the US Percent Children Adults Onondaga NYS US HP 2020 NYS Prevention Agenda Source: Adults NYSDOH Expanded BRFSS Preliminary Report, , NHANES , Children / Adolescents Student weight status category reporting system, , NHANES *Obesity is defined as weight category 95 th percentile among children and as BMI 30.0 among adults The crude and age-adjusted rates of mortality due to diabetes in Onondaga County, New York State, and the United States are seen in Figure 25. The crude and age-adjusted rates of diabetes mortality in Onondaga County are not significantly higher than the New York State rate of 18.6 per 100,000, but the crude rate is lower than that of the United States. With respect to prevalence, 13.9% of Onondaga County residents report having been told that they have diabetes compared to 9.4% of NYS residents. In addition, 58.9% of county residents report having a diabetes test within the last three years, compared to 59.6% in NYS (Expanded BRFSS Preliminary Report, ). Upstate University Hospital Community Service Plan Page 79

80 Figure 25. Diabetes mortality rate in Onondaga County, New York State and the U.S., Crude Age adjusted Rate per 100, Onondaga NYS US Source: Vital Statistics Data, Note: Rates are per 100,000, age-adjusted to the 2000 US Standard Population Prevention Agenda Area: Promoting a Healthy and Safe Environment An overview of this section is presented in Appendix VI. The New York State Prevention Agenda Priority Area Promote a Safe and Healthy Environment gauges the conditions impacting individuals living, working, and going to school in Onondaga County. This section examines the community s work and school environments, as well as rates of violence. Areas of interest are highlighted below. Environment: Onondaga County offers citizens clean air and water as demonstrated by the number of days with unhealthy ozone or particulate matter levels. Several environmental indicators are listed in Table 4. According to the NYS Department of Environmental Conservation, all citizens of Onondaga County live within communities that have taken the Climate Smart Communities Pledge: 1. Pledge to Combat Climate Change by Becoming a Climate Smart Community 2. Set Goals, Inventory Emissions, Move to Action 3. Decrease Energy Demand for Local Government Operations 4. Encourage Renewable Energy for Local Government Operations 5. Realize Benefits of Recycling and Other Climate Smart Solid Waste Management Practices 6. Plan for Adaptation to Unavoidable Climate Change Upstate University Hospital Community Service Plan Page 80

81 The goal of the pledge is to keep the air and water clean while reducing energy needs and waste to protect the area s natural resources. An area that continues to be a challenge is the utilization of mass transit/alternative transportation in Onondaga County. Utilization of mass transit/alternative transportation is 19.4%, which is substantially lower than both NYS and U.S. The impact of recent local efforts, such as the development of the Connective Corridor, an expansion of walking, biking, and mass transit services between Syracuse University and the City, have not yet been fully evaluated. Table 4. Environmental Indicators Indicator Annual number of days with unhealthy ozone (Air quality index > 100) Annual number of days with unhealthy particulate matter % of population that lives in a jurisdiction that adopted the Climate Smart Communities pledge % of commuters who use alternate modes of transportation % of homes in Healthy Neighborhood Program that have fewer asthma triggers during the home revisits Percentage of residents served by community water systems with optimally fluoridated water Source: Health Indicators Warehouse, Onondaga County NYS US NYS Prevention Agenda n/a Asthma While asthma can be considered a chronic disease, asthma data are included here to reflect the impact of the environment on the disease. According to the Expanded BRFSS Preliminary Report ( ), 8.7% of Onondaga County adults currently report having diagnosed asthma, compared to 10.0% in NYS. In addition to the lower asthma prevalence, Onondaga County has lower hospitalization rates due to asthma (see Figure 26) and a lower mortality rate from asthma if compared to NYS and the nation. This could be associated with the air quality indicators listed in Table 4. Upstate University Hospital Community Service Plan Page 81

82 Figure 26. Asthma hospitalization rates in Onondaga County and New York State, Rate per 10, Source: NYSDOH County Health Assessment Indicators, Respiratory Disease Healthy People 2020 Objectives: Onondaga NYS HP Ages 0-4 Ages 5-64 Ages 65+ School and Adolescent Indicators: Schools are an essential element of a Healthy and Safe Environment. The Table 5 illustrates that overall, Onondaga County is quite similar to NYS and the US. Table 5. Schooling indicators Indicator Onondaga NYS US HP 2020 Objective High school on time graduation rate Free school lunch eligibility percent Illegal drugs on school property (percent) 39.5/22.6* Percent of adults over 18years of age reporting binge drinking % of bullying among adolescents % of adolescents who meet Federal physical activity requirement Source: Health Indicators Warehouse, *Source: NY State Youth Development Survey-Onondaga County; lifetime and past 30 days in 11th graders Higher graduation rates are generally associated with healthier communities. As seen in Figure 27, a direct correlation is seen between graduation rates and the percent of students who qualify for free/reduced lunch in Onondaga County. For additional information on education, please refer to Section 1-Demographics. Upstate University Hospital Community Service Plan Page 82

83 Figure 27.Highschool graduation rates and % of students receiving free lunch by district, Graduation Rate Rate of Free/reduced lunch Source: NYStart Additional information is needed to further examine bullying within schools and physical activity by adolescents. Neither topic was addressed in the most recent survey of students in Onondaga County. Bullying has become a national issue and comes in many forms including both physical and emotional intimidation. Access to Grocery Stores: In Onondaga County, low income residents are disproportionately affected by low access to grocery stores, with children even more disproportionately impacted. Overall, 5.5% of low income residents have low access to a grocery store compared to 2.5% in NYS. Among children, 6.3% have low access to a grocery store. Upstate University Hospital Community Service Plan Page 83

84 Figure 28. Access to grocery stores by census tract, 2010 Community Commons 2.0 Starter Map, Community Health Needs Assessment USDA Food Environment Atlas, 2010 Facility-associated Outbreaks: In June of 2012, an outbreak of shigella was associated with a child care facility. This outbreak was propagated and continued for over six months. Throughout that period of time, other clusters were seen in child care facilities. As a result of the first identified cluster, numerous policies and procedures were recommended by the OCHD to child care facilities in our community in an effort to promote a healthy and safe environment for all Onondaga County residents. Unintentional Injuries: The rate of age-adjusted unintentional injury mortality is significantly higher in Onondaga County (33.7/100,000) compared to NYS (22.4/100,000) for However, the Onondaga County unintentional injury hospitalization rate (49.1/10,000) is significantly lower than NYS (64.5/10,000). This discrepancy warrants further investigation. Upstate University Hospital Community Service Plan Page 84

85 Homicides: Overall, Onondaga County is a safe place to live and work based on non-violent injury/death indicators. As Table 6shows, with the exception of age-adjusted firearm-related deaths, Onondaga County has lower rates than NYS and the U.S. when comparison data are available. Table 6:Crime and violence-related morbidity and mortality, Onondaga County ( ) Indicator Onondaga NYS U.S. HP 2020 County Violent crime rate per 100, n/a n/a Age-adjusted homicide death rate per 100, Age-adjusted firearm-related death rate per 100, n/a Assault-related hospitalization rate per 100, n/a n/a Source: Health Indicators Warehouse (accessed Feb 2013) When the data for personal safety are viewed at a more detailed level, a disparity is seen between African American and white residents of Onondaga County. Within New York State and the nation; blacks have a homicide rate that is six-times that of whites; in Onondaga County, the rate for blacks is 15-times that of whites. When looking specifically at firearmrelated death, New York State and the U.S. the rate among blacks is roughly 2-3 times that of whites. In Onondaga County, the firearm-related death rate among blacks is six-times that of whites. Figure 29 presents the data for Onondaga County with data from two New York City Counties, Bronx and Queens, along with New York State and national data. For all counties, the rates for whites are lower than the total rates. When viewing the data for blacks, the rate compared to whites is substantially higher for blacks living in Onondaga County than for blacks living in New York State, the nation, and the two Downstate counties. Figure 29. Age adjusted homicide rate per 100,000, Onondaga County and comparison geographies, Total White Black/AA United States New York State Onondaga County Monroe County Source: Health Indicators Warehouse via National Vital Statistics System Mortality, : Bronx County Queens County Upstate University Hospital Community Service Plan Page 85

86 Prevention Agenda Area: Promoting Healthy Women, Infants and Children Onondaga County, specifically Syracuse, has historically experienced disproportionately poor birth outcomes, particularly with respect to infant mortality rates and disparities. In the mid- 1980s, Syracuse had one of the highest infant mortality rates among blacks in the United States when compared to similar sized communities. While there have been tremendous gains in reducing infant mortality, Onondaga County still has significant challenges in protecting and improving the health of women, infants and children in our community. A complete overview of indicators for Healthy Women, Infants and Children is available in Appendix VI. The following section will highlight priority areas for action for the Onondaga County Health Department. Infant Mortality: As seen in Figure 30, tremendous gains have been made in reducing infant mortality rates in Syracuse. However, as illustrated in Table 7, significant disparities continue to plague our community. Figure 30. Infant mortality by race, three-year averages, Syracuse, NY, White Black Infant Deaths per 1,000 Live Births Source: Onondaga County Health Department, Bureau of Statistics and Surveillance Upstate University Hospital Community Service Plan Page 86

87 Table 7. Infant Mortality in Onondaga County and Syracuse, Locality Infant deaths per 1,000 live births Onondaga County 5.5 White 4.3 Black 12.4 Hispanic 8.3 Syracuse 6.7 White 4.6 Black 11.5 Hispanic 7.8 Source: Statewide Perinatal Data System, OCHD Bureau of Surveillance and Statistics *2011 and 2012 data are provisional Other Maternal and Infant Health Outcomes and Disparities in these Outcomes: With respect to preterm births and low birth weight, Onondaga County is faring better than NYS and is approaching the NYS Prevention Agenda goal. However, the OCHD remains concerned about disparities in these birth outcomes, as shown in Figure 31. Figure 31. Preterm births and low birthweight births per 100 live births, White non-hispanic Black non-hispanic Asian/Pacific Islander non- Hispanic Hispanic (all races) Preterm births (<37 weeks gestation) Low birthweight (<2500g) Source: NYS Vital Records Upstate University Hospital Community Service Plan Page 87

88 While overall Onondaga County adolescent pregnancy rates are lower in Onondaga County compared to NYS and the overall unintended pregnancy rate is higher in Onondaga County than in NYS (Figure 32), adolescent birth rates are statistically significantly higher as seen in Figure 33. The disparity by highest risk zip code is shown in Table 8. This warrants further analysis and potential intervention. Figure 32. Racial and ethnic disparities in Onondaga County in adolescent pregnancy rates ( ) and Unintended Pregnancy Rate (2011) White non-hispanic Black non-hispanic Hispanic (all races) Adolescent pregnancies per 1,000 females (age 15-17) Source: NYS Vital Recordshttp:// Figure 33. Adolescent birth rates per 1,000females, Percent unintended pregnancies among live births Onondaga County New York State Source: NYSDOH Community Health Assessment Indicators, Family Planning/Natality: Ages Ages Ages Ages Upstate University Hospital Community Service Plan Page 88

89 Table 8. Adolescent Birth Rate per 1,000 Females by Select Zip Codes, Locality Birth rate among ages Onondaga County Source: NYS County/Zip Code Perinatal Data Profile, NYSDOH Bureau of Biometrics and Statistics Breastfeeding Rates: With respect to breastfeeding, the data for Onondaga County show mixed results. As seen in Figure 34, it appears as though delivery hospitals do an excellent job supporting mothers to breastfeed exclusively while in the hospital. Unfortunately, sustaining these efforts appears problematic, particularly among mothers enrolled in WIC. WIC participants are significantly less likely to breastfeed for at least six months compared to their peers throughout NYS. Current quality improvement efforts within WIC were identified to address this issue. Upstate University Hospital Community Service Plan Page 89

90 Figure 34.Breastfeeding in Onondaga County, Onondaga County NYS Breastfeeding for at least 6 months - Mothers in WIC Infants fed any breastmilk in delivery hospital Infants fed exclusively breastmilk in delivery hospital Source: NYSDOH Community Health Assessment Indicators, Maternal and Infant Health: Prevention Agenda Area: Promoting Mental Health and Preventing Substance Abuse Mental Health: According to the Expanded BRFSS Preliminary Report, , 17.4% of Onondaga County adults reported 14 or more days of poor mental health in the past month. This is higher than the NYS rate of 10.3%, and illustrates the importance of having mental health services available to residents of Onondaga County. Suicide and Self- inflicted Injury: As seen in Figure 35, Onondaga County has a higher rate of suicide mortality than NYS, though this difference is not statistically significant. However, a significantly higher rate of self-inflicted injury hospitalizations in the total population and among those age years is seen in Onondaga County compared to NYS. This difference is shown in Table 9. Upstate University Hospital Community Service Plan Page 90

91 Figure 35: Age-adjusted suicide mortality rate per 100,000, Onondaga County NYS U.S Source: Vital Records, NYSDOH Bureau of Biometrics and Health Statistics National data: Table 9. Self-inflicted injury hospitalizations per 10,000, Indicator Self-inflicted injury hospitalizations per 10,000 population Self-inflicted injury hospitalizations per 10,000 population (ages 15-19) Onondaga NYS County Source: NYSDOH County Health Assessment Indicators, Injury, , Binge Drinking: The percent of adults who reported binge drinking in the last month in Onondaga County is 21.9% compared to 14.8% in NYS (Expanded BRFSS Preliminary Report ). The rate of alcohol related motor vehicle injuries and deaths in Onondaga County (47.7 per 100,000) are significantly higher than NYS as a whole (36.2 per 100,000) although it is comparable to other communities outside of the Downstate region. Drug Dependent Newborns: While the newborn drug-related discharge rate is not a priority indicator within the NYS Prevention Agenda, it is a priority indicator for Onondaga County as local rates dramatically exceed the NYS rates. For , the Onondaga County rate was per 10,000 births compared to 64.0 per 10,000 births for NYS. This represents a statistically significant difference and is supported by an increase in self-reporting illegal drug use as seen in Figure 36. Upstate University Hospital Community Service Plan Page 91

92 Figure 36.Percent of births to women with self-reported illegal drug use, Syracuse and Onondaga County, and Syracuse Onondaga County Source: Statewide Perinatal Data System, Onondaga County Bureau of Surveillance and Statistics, 2011 and 2012 data are preliminary. A local analysis of mothers and infants identified with positive drug screens in delivery hospitals between January and May 2012 identified maternal risk factors associated with newborn drug related discharges. These included Medicaid paid birth, black race, lower educational achievement, younger maternal age, decreased paternal involvement, and increased selfreported use of illegal drugs/tobacco/alcohol during pregnancy. Infants born to mothers identified with positive drug screens were more likely to require admission to the Neonatal Intensive Care Unit (NICU) (Figure 37). Of the infants with positive drug screens admitted to the NICU who had positive drug screens, they were far more likely exposed to cannaboids and opiates than to other drugs Upstate University Hospital Community Service Plan Page 92

93 Figure 37.Percent NICU admission, Onondaga County, January May Infants of mothers with positive drug screen Infants with positive drug screen Total birth population Source: Siddiqui S, 2012; Statewide Perinatal Data System; Laboratory Alliance of CNY Prevention Agenda Area: Preventing HIV/STDs, Vaccine Preventable Diseases, and Health Care Associated Infections: A comprehensive review of all of the indicators for this Prevention Agenda Priority Area is seen in Appendix VI. In general, Onondaga County fares very well, particularly with respect to immunization related indicators and to newly diagnosed cases of HIV, when compared to NYS. Unfortunately, Onondaga County has higher than expected rates for Gonorrhea and, as seen in Figure 38, recent trends are alarming. Upstate University Hospital Community Service Plan Page 93

94 Figure 38. Gonorrhea cases per 100,000 population, Onondaga County, Source: NYSDOH Communicable Diseases Electronic Surveillance System (CDESS); U.S. Census Bureau, 2010 Census An analysis of the increase demonstrates that females, ages 15-24, are disproportionately impacted as seen in Figure 39. Furthermore, blacks are overwhelmingly disproportionately represented (data not shown). Upstate University Hospital Community Service Plan Page 94

95 Figure 39: Gonorrhea incidence per 100,000 by age and sex, Onondaga County, Female Male < Age range (years) Source: NYSDOH Communicable Diseases Electronic Surveillance System (CDESS), U.S. Census Bureau, 2010 Census Upstate University Hospital Community Service Plan Page 95

96 APPENDIX III UPSTATE MEDICAL UNIVERSITY STRATEGIC PLANNING REPORT CARD: Upstate University Hospital Community Service Plan Page 96

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