Fiscal Year 2013 Community Benefits Report

LAHEY HOSPITAL & MEDICAL CENTER Fiscal Year 2013 Community Benefits Report Authored by: Gerald MacKillop, Jr., MBA Director, Community Relations, Lahey Health

Table of Contents 3 Massachusetts Attorney General Community Benefit Guidelines 4 Lahey Hospital & Medical Center s Community Benefits Mission Statement 4 Lahey Hospital & Medical Center s Community Benefits Plan 5 Lahey Hospital & Medical Center s Community Benefit Committee Fiscal Year 2013 6 Key Accomplishments for Reporting Fiscal Year 2013 6 Plans for Reporting Fiscal Year 2014 7 Fiscal Year 2013 Community Partners 8 Community Health Needs Assessment Overview 11 Summary of Highlighted Programs for Fiscal Year 2013 11 Lahey Hospital & Medical Center Mini-Grant Program 11 A Matter of Balance 12 Diabetes Self-Management 13 Chronic Disease Self-Management 14 Chronic Pain Workshop 14 Tobacco Treatment / Smoking Cessation 15 You Can Eat Better and Move More 15 My Plate Workshop 16 Torigian Life Center, Peabody Health Fair 16 Cardiovascular Risk Assessment 17 Saint John s Preparatory, Danvers School Health Fair 17 Arthritis Self Management Workshop 18 Low-Dose CT Lung Cancer Screening 19 Lahey Hospital & Medical Center Tuberculosis Program 19 Support Groups 20 Community Outreach Overview Fiscal Year 2013 21 Fiscal Year 2013 Required Financials 22 Massachusetts Attorney General Glossary of Terms 2 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

Massachusetts Attorney General Community Benefits Guidelines The Attorney General s Community Benefits Guidelines for Nonprofit Acute-Care Hospitals and The Attorney General s Community Benefits Guidelines for Health Maintenance Organizations (HMO) include an outline of voluntary principles that encourage Massachusetts hospitals and HMOs to continue and build upon their commitment to addressing health and social needs within their communities. The Guidelines represent a unique, non-regulatory approach that calls upon hospitals and HMOs to identify and respond to the unmet needs of the communities they serve by formalizing their approaches to community benefits planning, collaborating with community representatives to identify and create programs that address those needs and issuing annual reports on their efforts. The Guidelines do not dictate the types of community benefits programs that hospitals and HMOs should provide. They do, however, suggest that hospitals and HMOs tap into their own and their communities particular resources and areas of expertise to target and meet the needs of medically-underserved populations. The hospital and the HMO Community Benefits Guidelines are the result of an extensive process of consultation and partnership between the Attorney General and representatives of the hospital and HMO industries, respectively, and community advocacy groups. These discussions took place at a time of ongoing debate in Massachusetts and around the nation as to whether nonprofit, tax-exempt hospitals were fulfilling their charitable missions. Several Massachusetts hospitals had, on their own initiative, adopted model community benefits guidelines developed by national hospital associations, and the Massachusetts Hospital Association was considering a long-term initiative to produce voluntary guidelines of its own. The resulting Community Benefits Guidelines were the first of their kind to be issued by an Attorney General. The hospital Guidelines were modeled after community benefits guidelines developed by the Kellogg Foundation, the Catholic Hospital Association and the Voluntary Hospital Association, as well as community benefits legislation in several other states. The HMO Guidelines are similar to the hospital Guidelines, and were prompted by recognition of the increased role that HMOs were playing in the healthcare system. Source: Excerpt taken from the Official Website of the Attorney General of Massachusetts. For full guidelines, please go to: http://www.cbsys.ago.state.ma.us/cbpublic/public/hccbnpguide.pdf Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 3

Lahey Hospital & Medical Center s Community benefits Mission Statement Our mission at Lahey Clinic Hospital, Inc., a teaching hospital of Tufts University School of Medicine, is to provide superior healthcare leading to the best possible outcome for every patient. We also reach beyond our own doors through our Community Benefits Initiative, which is committed to improving the health and quality of life of community residents by supporting local organizations aligned with this mission. Through collaborative planning, coalition building and financial support, Lahey Hospital & Medical Center s Community Benefits Initiative strives to serve as a catalyst for positive change within our local communities. Lahey Hospital & Medical Center s Community Benefits Plan Lahey Hospital & Medical Center Lahey Hospital & Medical Centeraffirms its commitment to identifying and serving the health and wellness needs of its community through a Community Benefits Program. The foundation of this program is based upon a collaborative initiative between Lahey Hospital & Medical Center colleagues, community leaders, representatives of community agencies, and community residents. Through collaborative planning and coalition building, Lahey Hospital & Medical Center strives to serve as a catalyst and a leader within the community. Services to improve the health status of community members will be implemented in conjunction with community providers. Through its ongoing Community Benefits Initiative, Lahey Hospital & Medical Center will maintain strong community ties by working toward promoting the health and wellness of the community members we serve. This commitment of offering community benefits services will be in alignment with Lahey Hospital & Medical Center s mission of providing care of the highest quality. 4 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

Lahey Hospital & Medical Center s Community Benefits Committee Fiscal Year 2013 Donna Silva Coordinator, Volunteer and Community Services, Lahey Hospital & Medical Center Jeff Doran Chief Operating Officer, Lahey Hospital & Medical Center, Hospital Division Mary Iodice Manager, Volunteer and Community Services, Lahey Hospital & Medical Center Merle Kushner, LICSW Social Services, Lahey Hospital & Medical Center Lu Shurlan, LICSW Quality Resources, Lahey Hospital & Medical Center Debralee Quinn, RN Nursing Education, Lahey Hospital & Medical Center Karen Myers, PhD. Director, Corporate and Foundation Relations, Lahey Health Margie Doyle Research, Lahey Hospital & Medical Center Gerald MacKillop, Jr., MBA Director, Community Relations, Lahey Health Wayne S. Saltsman, MD, PhD., CMD Section Chief, Geriatrics and Transitions of Care, Lahey Hospital & Medical Center Robert Schneider Chief Operating Officer, Lahey Medical Center, Peabody Thomas Siepka, MS, RPh, FACHE Executive Director, Hospital Services, Lahey Medical Center, Peabody Janet Brown Volunteer, Lahey Hospital & Medical Center Joy Tower Community Outreach Director, Atria Longmeadow Place Jan Hanson Coordinator, CHNA 15 Peg Sallade Coordinator, CHNA 13/14 Marge McDonald Director, Burlington Council on Aging Christine Shruhan Director, Burlington Community Life Center Laura Van Zandt Executive Director, REACH Donna Popkin Director, Billerica Council on Aging Joan Butler Executive Director, Minuteman Senior Services Teri Marciello Director of Elder Services, Buzzelle Senior Center Elizabeth Killeen SHINE Program Director, Minuteman Senior Services Kathy Hassey, RN, BSN, MEd Director, School Health Institute, Northeastern University Jean Beale, MPH Community Linkages Manager, Minuteman Senior Services Susan Carp, MS Executive Director, Arlington Council on Aging Susan Lumenello Director of Public Health, Burlington Board of Health Sharon Cameron Director, Peabody Department of Health and Human Services Andria Nemoda, RN Supervising Nurse, Burlington Board of Health Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 5

Key Accomplishment for Reporting Fiscal Year 2013 The Community Health Needs Assessment (CHNA) and Community Benefit Planning Project were conducted on behalf of Lahey Hospital & Medical Center s Board of Trustees. The project was overseen by Jeffrey Doran, Chief Operating Officer; Mary Iodice, Director of Community and Volunteer Services and Gerald MacKillop, Director of Community Relations, who worked closely with Lahey Hospital & Medical Center s Management Team, other senior staff throughout Lahey Health, and Lahey Hospital & Medical Center s Community Benefit Committee. Lahey Hospital & Medical Center views the CHNA process as an integral part of its commitment to the communities it serves and captured important feedback from community representatives throughout the process. The project began in May 2013 and culminated in a fully-developed Community Benefit Plan. During the process, the community benefits project team interviewed 32 individuals including Lahey Hospital & Medical Center administrative and clinical staff, town officials, health and social service providers and other community stakeholders. The project team also conducted a series of focus groups with community-based providers and public health officials as well as a series of community forums that allowed Lahey Hospital & Medical Center to capture information directly from community residents. The information gathered during these efforts allowed Lahey Hospital & Medical Center to engage the community and gain a better understanding of the health status, healthcare priorities, service gaps and barriers to care of those living throughout Lahey Hospital & Medical Center s community benefits service area. These efforts also greatly informed the strategic planning process as they allowed the project team to develop a menu of possible community responses to the issues identified in the CHNA and to explore community partnerships. Plans for Reporting Fiscal Year 2014 Enhance the infrastructure of the Lahey Hospital & Medical Center community relations department by: hiring a community relations coordinator; engaging Lahey Hospital & Medical Center administrative and clinical staff to raise awareness and promote community benefit activities and their impact; enhancing community linkages and develop and promote health education, prevention and community engagement mechanisms. Engage in a thoughtful and strategic plan regarding elder health priorities: promoting general health and wellness amongst the elderly; enhance programming to help reduce falls in elders and reduce inappropriate hospital readmissions and enhance care transitions. Highlight Lahey Health capabilities in the area of behavioral health: promotion, education and awareness of behavioral health and wellness; increase awareness, screening and advocacy for domestic violence and improve coordination of existing behavioral health services across the community. Promote Access to Care: promotion of Serving Health Information Needs of Everyone (SHINE) and 6 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

expand capacity of SHINE counselors in the community; improve the coordination of services between Lahey Hospital & Medical Center and clinical community partners. Address chronic disease prevalence in the Lahey Hospital & Medical Center primary service area: promote general wellness, behavior change and engagement in primary care; increase healthy living, physical activity and healthy eating and promotion of the Stamford Model to Chronic Disease Self-Management Programs Fiscal Year 2013 Community Partners Professional Fire Fighters of Massachusetts Hanscom Air Force Base Tewksbury Board of Health Peabody Torigian Community Life Center Burlington Council on Aging Arlington Council on Aging Billerica Council on Aging Oracle Middlesex Community College, Lowell Middlesex Community College, Bedford Burlington Council on Aging Billerica Council on Aging Wilmington Council on Aging Woburn Council on Aging Lynnfield Council on Aging Minuteman Senior Services Burlington Community Life Center Community Health Network Area 15 North Shore Community Health Network 13/14 Atria Longmeadow Place Burlington Police Department REACH (Refuge, Education, Advocacy, Change) Domestic Violence Services Network, Inc. North Shore Elder Services Saheli Haven from Hunger Peabody Department of Health and Human Services Melrose Alliance Against Violence HAWC (Healing Abuse Working for Change) Executive Office of Elder Affairs American Cancer Society Massachusetts Department of Public Health Middlesex District Attorney s Office Peabody International Festival Committee North Shore Mall Peabody Chamber of Commerce American Heart Association Massachusetts School Nurse Organization Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 7

Community Health Needs Assessment Overview Lahey Hospital & Medical Center is part of Lahey Health, which brings together not only award-winning hospitals and nationally-recognized physicians, but also a comprehensive network of community-based providers that offer the broad range of health and social services that the community needs to become and stay healthy. Lahey Hospital & Medical Center s integrated outpatient and community-based provider network offers primary care, medical specialty, behavioral health, at-home, skilled nursing and rehabilitation services, as well as operates an assisted living facility, a community-based adult day health program and numerous other community health programs. Lahey Hospital & Medical Center recognizes its role as part of a larger system of care and knows that to be successful it needs to collaborate with its community partners and those it serves. This Community Health Needs Assessment and the associated Community Health Improvement Plan (CHIP) were completed in close collaboration with Lahey Hospital & Medical Center s staff and its health, social service and public health partners, as well as the community at large. This assessment, including the process that was applied to develop the CHIP, exemplifies the spirit of collaboration that is such a vital part of Lahey Hospital & Medical Center s and Lahey Health s vision. This report, along with the associated CHIP, is the culmination of seven months of work. This project was born largely out of Lahey Hospital & Medical Center s commitment to better understand and address the health-related needs of those living in its community benefits service area, which is made up of 13 cities and towns surrounding its hospitals in Burlington and Peabody. The project also fulfills long-standing requirements of the Massachusetts Attorney General s Office and new Federal Internal Revenue Service (IRS) requirements, which mandate that all nonprofit hospitals conduct a community health needs assessment and strategic planning process at least every three years. More specifically, the Commonwealth and IRS regulations require that Lahey Hospital & Medical Center assess community health needs, engage the community, identify priority health issues and create a community health strategy that describes how Lahey Hospital & Medical Center, in collaboration with the community and the local health department, will address the needs and the priorities identified by the assessment. This report summarizes the findings from Lahey Hospital & Medical Center s CHNA and provides the core elements of Lahey Hospital & Medical Center s CHIP, including the major goals, objectives, community health strategies, key action steps, and evaluation metrics that will guide the plan. Lahey Hospital & Medical Center s Community Relations Department, with the full support of Lahey Hospital & Medical Center s Board of Trustees, looks forward to working with health and social service providers, local public officials, other community stakeholders and the community at large to address the issues that arose from the CHNA and to implement the CHIP. The CHNA was conducted in three distinct phases. In Phase I, the Lahey Hospital & Medical Center community benefits project team conducted a preliminary needs assessment that relied heavily on quantitative, secondary health-related data drawn from the Massachusetts Department of Public Health s Massachusetts Community Health Information Profile (MassCHIP) system, data reports from the Centers for Disease Control and Prevention (CDC) and the US Census Bureau s American Community Survey (ACS), as well as other Federal, Commonwealth and local data sources. This data allowed the community benefits project team to better understand the leading causes of 8 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

morbidity and mortality and the associated health-related risk factors. Data collection in Phase I also allowed the project team to refine and target its Phase II efforts on issues of highest concern as well as communities most in need. Data was compiled from these sources at the city-, and town-level whenever possible, which was an essential aspect of the assessment s approach. This targeted approach allowed the project team to highlight areas at greatest risk, understand the unique differences that exist across neighborhoods/towns/cities and identify common themes that could be part of a broad, collaborative, effective strategy. During Phase I, the project team also conducted a series of interviews with Lahey Hospital & Medical Center staff and a representative set of the leading community health stakeholders. These interviews allowed the project team to engage the community and capture qualitative data related to community health needs, community priorities, determinants of health, service gaps, barriers to care and the population groups most at-risk. These interviews were also critical to the development of Lahey Hospital & Medical Center s Community Health Improvement Plan (CHIP) as they provided important information related to Lahey Hospital & Medical Center s strategic response and explored possible partnerships. The culmination of Phase I was a series of meetings with Lahey Hospital & Medical Center s senior staff and thecommunity benefit committee, as well as other key stakeholders, which allowed the community benefits project team to vet its initial findings, capture important feedback and ensure buy-in regarding emerging themes and the range of possible strategic responses. In Phase II, the primary focus was on collecting primary data directly from health and social service providers (including public health officials) and residents through a series of focus groups and community forums. The focus groups captured information from service providers and community health experts, specifically in the areas of chronic disease, elder health, mental health, substance abuse and general wellness. Based on a review of Phase I findings and confirmed by preliminary results from Phase II, chronic disease, behavioral health (mental health and substance abuse) and elder health were identified as key priority areas. The focus groups were geared toward capturing qualitative information that would augment the quantitative data findings as well as on identifying the strategies and programs that would improve health status, promote care coordination, service integration and more effective chronic disease management across these health priority areas. The culmination of Phase II was a series of summary data tables and a summary presentation of key findings, which facilitated a comprehensive, integrated analysis and guided the strategic planning activities in Phase III. Transportation Care coordination and care transitions Primary care / specialty care follow-up In-home safety Depression/isolation Mental health services Chronic disease Hospital readmission Priority 1: Elder Health Priority 4: Wellness Prevention and Disease Management Diabetes, heart disease Cancer Healthy eating / active living / obesity Care management and behavior change Health education and awareness Access for low income Domestic violence Coordination of services Burden of behavioral health in emergency department Priority 2: Behavioral Health Priority 3: Access to Services Primary / medical specialty care Chronic disease management Care coordination and care transitions Transportation / Parking Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 9

In Phase III, Gerald MacKillop, Director of Lahey Health s Community Relations Department, worked with the Community Health Needs Assessment Steering Committee, selected community stakeholders, and Lahey Hospital & Medical Center s senior leadership to: 1) review all of the data compiled, 2) clarify Lahey Hospital & Medical Center s community health priorities, and 3) identify the strategic ideas that would ultimately be included in Lahey Hospital & Medical Center s community health strategy. In Phase III, the project team also developed this report, Lahey Hospital & Medical Center s CHIP, as well as a series of neighborhood snapshots that rudimentarily summarized the CHNA s key findings for a selection of the cities/towns with the highest need in Lahey Hospital & Medical Center s community benefit service area. When these snapshots have been completed and fully vetted they will be shared with cities /town s leadership and ultimately distributed to the community at large. The CHNA s key findings, community health priorities, and the CHIP were approved by Lahey Hospital & Medical Center s Board of Trustees on November 11, 2013. The Community Health Needs Assessment s (CHNA) approach and process provided ample opportunity to vet the quantitative and qualitative data compiled during the assessment. In addition, interview, focus group, and community forum participants were asked what they perceived to be the leading community health priorities. Ultimately, there was little debate that the most significant health-related issue facing the communities surrounding Lahey Hospital & Medical Center were chronic disease and the broader social and economic determinants (e.g., poverty, uninsured and under-insurance, unemployment, food insecurity, violence, health literacy/disease literacy ), which prevent many residents, particularly low income, racial/ethnic minority and older adult residents from maintaining a healthy lifestyle and/or accessing the regular preventive and acute health services they need. In addition to this underlying priority, issues related obesity, lack of physical exercise, poor nutrition, chronic disease, behavioral health, lack of access to care, lack of health education, health/disease literacy and other associated factors were identified as priorities. Finally, issues related to older adult health were also seen as a priority. 10 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

Summary of Highlighted Programs for Fiscal Year 2013 Lahey Hospital & Medical Center Mini-Grant Program Brief Objective or Description: In fiscal year 2013, Lahey Hospital & Medical Center allocated $125,000 in mini-grant funding to local community health, social service and municipal partners to address health disparities identified in the Lahey Hospital & Medical Center community health needs assessment. A request for proposal frames the guidelines and review process of this competitive grant program. Partners: Internal Initiative Detailed Description: The following programs were offered in the community as a result of the funding provided by Lahey Hospital & Medical Center: Community Wellness Programs at the Burlington Council on Aging; Exercise Programs at the Burlington Council on Aging; Senior Computer Literacy at the Burlington Council on Aging; Teen Depression and Suicide Workshops at Burlington High School; A RADical (RAD Rape, Aggression and Defense) Approach to Community Safety at the Burlington Police Department; Sharps Disposal Kiosk at Burlington Town Hall; a Community Health Program at five local council(s) on aging; Exercise programs at the Billerica Council on Aging; Exercise programs at the Arlington Council on Aging; Exercise programs at the Wilmington Council on Aging; REACH community-based advocacy program; Melrose Alliance Against Violence, education and support groups for victims of domestic violence; Healing Abused Women and Children (HAWC), Portuguese Outreach Program; Minuteman Senior Services; Serving Health Information Needs of Everyone (SHINE) counseling; Massachusetts School Nurses Association, Autoimmune Disease training and Saheli, the effect of domestic violence on healthy eating and childhood obesity in the Southeast Asian Population. A Matter of Balance Brief Objective or Description: A Matter of Balance emphasizes practical strategies to reduce fear of falling and increase activity levels for senior citizens. Participants learn to view falls and fear of falling as controllable. They set realistic goals to increase activity, change their environment to reduce fall risk factors and exercise to increase strength and balance. This program has been adapted from the original intervention to be more suitable for community-dwelling older adults by allowing small group sessions to be led by a trained facilitator. (National Council on Aging) Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. This program was also offered at Lahey Medical Center, Peabody. Detailed Description: Age is one of the most fundamental factors in determining scope of need. Cities tend to have more families with young children and young adult professionals than more suburban or rural areas, and the greater Boston area is no exception. Most of the communities in Lahey Hospital & Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 11

Medical Center s service area are suburban in nature and as a result the median age is slightly older than the Commonwealth s median age. The median age for Lahey Hospital & Medical Center s service area would be even older was it not for a handful of very affluent towns with highly respected school districts. These towns tend to have much larger proportions of school-aged children and young, along with the typical older adult populations, which drives down the specific town and regional average. Lahey Hospital & Medical Center s community benefits service area also has a number of towns that defy the typical trend and have high proportions of established, relatively intransient populations of older adults. Diabetes Self-Managment Brief Objective or Description: In fiscal year 2013, Lahey Hospital & Medical Center conducted three, two-week workshops at local Councils on Aging. The workshops were meant to provide teaching and encouragement to participants so they take the right steps to manage their diabetes in an effort to stay healthy and decrease or delay the health risks associated with their disease. Workshops research data results and confirm the empowerment of participants to discover and develop their inherent capacity to be responsible for their own good health, resulting in a healthier, happier life. Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. Detailed Description: There is a growing appreciation for the effects that certain health risk factors, such as obesity, lack of physical exercise, poor nutrition and tobacco use have on health status and the burden of chronic disease. Data on these risk factors is not available at the city/town level however a review of data from the Massachusetts Behavioral Risk Factor Survey System (BRFSS) captured at the county levels shows that large numbers and proportions of the residents in Lahey Hospital & Medical Center s community benefit service area engage in risky behaviors that have an impact on their overall health and well-being. Over the past two decades, obesity rates in the United States have doubled for adults and tripled for children. These trends have spanned all segments of the population, regardless of age, sex, race, ethnicity, education, income, or geographic region. There are certainly segments that have struggled more than others, but no segment has been unaffected. According to data from the Massachusetts BRFSS, nearly 60percent of adults in Middlesex County and 56percent of adults in Essex County are either obese or overweight. Rates for specific demographic, socio-economic and geographic population segments living in Lahey Hospital & Medical Center s community benefits service area are likely dramatically higher, based on Commonwealth data by race/ethnicity and age. Diabetes, hypertension and high cholesterol are widely recognized as the leading risk factors for cardiovascular disease and strokes, which are in turn the leading causes of mortality throughout the United States. Local data is not available to assess the prevalence of these conditions for targeted communities, but if one looks at county, Commonwealth, and national data, the proportions of the population that are impacted by these issues are extreme. In the Commonwealth, 8percent of the population has been told by their doctor at some point in their life that they have diabetes, 29percent has ever been told they have hypertension, and 34percent has ever been told they have high cholesterol. The Middlesex and Essex County rates are slightly lower by a few percentage points across the board, except with respect to the rate of hypertension in Essex County, which is a slightly higher. Nationally, there is 12 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

clear data that show that racial/ethnic minority, low income and older adult populations are the primary drivers of these conditions and face significant disparities. Also of concern is that despite the fact that there are medications that can control and ameliorate the impact of these conditions, large proportions of those with these conditions do not receive the necessary medication. In addition to the County and national data illustrating the impact that these conditions have on the region, nearly all of the interviewees and the focus group and community forum participants cited these issues as among the leading health issues in Lahey Hospital & Medical Center s community benefit service area. Chronic Disease Self-Management Brief Objective or Description: In fiscal year 2013 we conducted three workshops at five Councils on Aging. The workshops were based on the Stamford Model of Chronic Disease Self-Management Program and ran for 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 attended together. Workshops were facilitated by two trained leaders, one or both of whom are non-health professionals with chronic diseases themselves. Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. Detailed Description: Cardiovascular disease (heart disease), cancer and cerebrovascular disease (stroke) are the three leading causes of death in the United States, Massachusetts, and all of the cities/towns in Lahey Hospital & Medical Center s community benefit service area. In addition, diabetes is ranked in the top ten causes across all three of these geographic areas, and asthma and other respiratory diseases have a huge impact on large portions of adults and children. Mental health issues, discussed in more detail below, are chronic conditions for many and are often coupled with other medical conditions. All of these conditions, individually and collectively, have a major impact on people living throughout Lahey Hospital & Medical Center s community benefit service area. All of the chronic conditions share the health risk factors cited above (tobacco use, lack of physical exercise, poor nutrition and obesity/overweightness) as leading factors. It should be noted, once again, that there are major health disparities across all of these conditions among racial/ethnic minority and low-income population segments, as well as among older adults. Rates of illness and death vary by condition.overall, residents in Lahey Hospital & Medical Center s community benefit service area are less likely to have a chronic disease than residents in the Commonwealth on average. However, the majority of cities/towns in the region face disparities across at least a few chronic conditions and a number of cities/towns face a dramatic range of disparities across many conditions compared to the Commonwealth and other cities/towns in their region. Data for this section is gathered through the Massachusetts Hospital Inpatient Discharges database that is available through the Massachusetts Department of Public Health s MassCHIP system. This dataset provides information on hospitalization and mortality rates for the leading chronic diseases or conditions for the targeted communities. Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 13

Chronic Pain Workshop Brief Objective or Description: In fiscal year 2013 we conducted three workshops at five Councils on Aging. Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. Detailed Description: According to a 2011 report by the Institute of Medicine, an estimated 100 million Americans suffer from chronic pain. The U.S. spends up to $635 billion annually to treat chronic pain. This Chronic Pain workshop is an international, evidence based program designed to teach and motivate people with chronic pain to manage their day-to-day pain in order to lead a healthier, happier life while reducing some of the financial burden to our healthcare dollars. This workshop has been extensively researched with significant published results in pain management. Tobacco Treatment / Smoking Cessation Brief Objective or Description: At Lahey Hospital & Medical Center, we are committed to addressing the serious consequences of tobacco use. Our goal is to empower each individual to quit tobacco use and smoking by providing a tobacco-free campus as well as easy access to tobacco treatment. Lahey Hospital & Medical Center offers free drop-in workshops held the 2nd Wednesday of every month from 6:00-7:00 pm at Lahey Hospital & Medical Center, Lobby Conference Room, 4th Floor, 41 Mall Road, Burlington, MA. Come share and receive support on your journey to live tobacco free. Lahey Hospital & Medical Center offers free sessions of the American Lung Association s Freedom From Smoking in both Burlington and Peabody locations. The Freedom From Smoking group includes eight sessions and features a step-by-step plan for quitting smoking/tobacco use. Each session is designed to help tobacco users gain control over their behavior. This format encourages participants to work on the process and problems of quitting both individually and as part of a group. Partners: Oracle, Middlesex Community College Lowell Campus, Middlesex Community College Bedford Campus, Saint John s Preparatory School, Danvers Detailed Description: Tobacco use is the single most preventable cause of death and disease in the United States. Each year, approximately 443,000 Americans die from tobacco-related illnesses. For every person who dies from tobacco use, 20 more people suffer with at least one serious tobacco-related illness, such as chronic airway obstruction, heart disease, stroke, or cancer. The rates of smoking for Middlesex and Essex Counties are slightly lower than the Commonwealth average. Even so, approximately 15percent of residents in these counties are current smokers. Given that tobacco use is still the leading cause of illness and disease in the United States, it is important that work be done to lower these rates even further. 14 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

You Can Eat Better and Move More Brief Objective or Description: We conducted three workshops at five Councils on Aging in fiscal year 2013. Classes meet to educate about healthy nutrition and to promote exercise guidelines and a walking program. A step counter is provided to participants to record their daily walking by keeping a log of their results. The program s goal is to walk 10,000 steps most days. By promoting good nutrition and exercise participants make significant changes that enhance their healthy lifestyle. Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. Detailed Description: There is a growing appreciation for the effects that certain health risk factors, such as obesity, lack of physical exercise, poor nutrition, and tobacco use have on health status and the burden of chronic disease. Data on these risk factors is not available at the city/town level however a review of data from the Massachusetts Behavioral Risk Factor Survey System (BRFSS) captured at the County levels shows that large numbers and proportions of the residents in Lahey Hospital & Medical Center s community benefit service area engage in risky behaviors that have an impact on their overall health and well-being. Over the past two decades, obesity rates in the United States have doubled for adults and tripled for children. These trends have spanned all segments of the population, regardless of age, sex, race, ethnicity, education, income, or geographic region. There are certainly segments that have struggled more than others but no segment has been unaffected. According to data from the Massachusetts BRFSS, nearly 60percent of adults in Middlesex County and 56percent of adults in Essex County are either obese or overweight. Rates for specific demographic, socio-economic and geographic population segments living in Lahey Hospital & Medical Center s community benefits service area are likely dramatically higher, based on Commonwealth data by race/ethnicity and age. Lack of physical fitness and poor nutrition are the leading factors associated with obesity and the leading risk factors associated with chronic diseases, such as heart disease, hypertension, diabetes, cancer, and depression. Good nutrition helps prevent disease, and is essential for healthy growth and development of children and adolescents. Overall fitness and the extent to which people are physically active reduce the risk for many chronic diseases, are linked to good emotional health, and help to prevent disease. Once again, according to Massachusetts BRFSS data, only one in five adults in Middlesex and Essex Counties ate the recommended five servings of fruits and vegetables per day, and one in four adults reported getting no physical activity in the past 30 days. My Plate Workshop Brief Objective or Description: We conducted three workshops at five Councils on Aging in fiscal year 2013. This evidence-based workshop combines a lecture component and hands-on experience focusing on making healthier nutrition choices to improve participant s wellness and independence and to prevent chronic disease development or progression through good nutrition practices. This workshop promotes weight loss and weight management while fighting obesity. Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 15

Detailed Description: Lack of physical fitness and poor nutrition are the leading factors associated with obesity and the leading risk factors associated with chronic diseases, such as heart disease, hypertension, diabetes, cancer, and depression. Good nutrition helps prevent disease, and is essential for healthy growth and development of children and adolescents. Overall fitness and the extent to which people are physically active reduce the risk for many chronic diseases, are linked to good emotional health, and help to prevent disease. Once again, according to Massachusetts BRFSS data, only one in five adults in Middlesex and Essex Counties ate the recommended five servings of fruits and vegetables per day, and one in four adults reported getting no physical activity in the past 30 days. Torigian Life Center, Peabody Health Fair Brief Objective or Description: In Fiscal Year 2013 we hosted a prevention health fair in partnership with the Torigian Community Life Center. Over 240 patrons participated in the offered screenings, educational tables and 30 appointments were booked. During that event, services provided included a cardiovascular risk assessment, blood pressure screening, body composition assessment, osteoporosis risk assessment, bone density screening, balance assessment, falls risk assessment, knee replacement, pain management, prostate risk assessment, breast cancer risk assessment, elder healthy eating, lung cancer rrisk assessment, colorectal risk assessment and counseling for all. Partners: Torigian Community Life Center Cardiovascular Risk Assessment Brief Objective or Description: Lahey Hospital & Medical Center s North Shore Ambulatory Clinic conducted a primary prevention and cardiovascular risk assessment, blood pressure screening and counseling at the City of Peabody s annual International Festival in fiscal year 2013. Partners: City of Peabody International Festival Detailed Description: Cardiovascular disease (heart disease), cancer, and cerebrovascular disease (stroke) are the three leading causes of death in the United States, Massachusetts, and all of the cities/towns in Lahey Hospital & Medical Center s community benefit service area. In addition, diabetes is ranked in the top ten causes across all three of these geographic areas, and asthma and other respiratory diseases have a huge impact on large portions of adults and children. Mental health issues, discussed in more detail below, are chronic conditions for many and are often coupled with other medical conditions. All of these conditions, individually and collectively, have a major impact on people living throughout Lahey Hospital & Medical Center s community benefit service area. All of the chronic conditions share the health risk factors cited above (tobacco use, lack of physical exercise, poor nutrition and obesity/overweightness) as leading factors. It should be noted, once again, that there are major health disparities across all of these conditions among racial/ethnic minority and low-income population segments, as well as among older adults. Rates of illness and death vary by condition and overall residents in Lahey Hospital & Medical Center s community benefit service area are less likely to have a chronic disease than residents in the 16 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

Commonwealth on average. However, the majority of cities/towns in the region face disparities across at least a few chronic conditions and a number of cities/towns face. Saint John s Preparatory School, Danvers Health Fair Brief Objective or Description: In fiscal year 2013 Lahey Medical Center, Peabody, Administration, Ambulatory Clinics, ER and Danvers Physical Therapy all participated in a primary prevention strategic event involving blood pressure screening, body mass index, osteoporosis, balance screening, hand strength assessment, orthopedic MD advisement, ER advisement for concussions, nutrition advisement, tobacco treatment advisement, vision screening and multiple risk factor assessments with on-site education. Partners: St. John s Preparatory High School Detailed Description: There is a growing appreciation for the effects that certain health risk factors, such as obesity, lack of physical exercise, poor nutrition, and tobacco use have on health status and the burden of chronic disease. Data on these risk factors is not available at the city/town level however a review of data from the Massachusetts Behavioral Risk Factor Survey System (BRFSS) captured at the County levels shows that large numbers and proportions of the residents in Lahey Hospital & Medical Center s community benefit service area engage in risky behaviors that have an impact on their overall health and well-being. Over the past two decades, obesity rates in the United States have doubled for adults and tripled for children. These trends have spanned all segments of the population, regardless of age, sex, race, ethnicity, education, income, or geographic region. There are certainly segments that have struggled more than others but no segment has been unaffected. According to data from the Massachusetts BRFSS, nearly 60percent of adults in Essex County are either obese or overweight. Rates for specific demographic, socio-economic and geographic population segments living in Lahey Hospital & Medical Center s community benefits service area are likely dramatically higher, based on Commonwealth data by race/ethnicity and age. Arthritis Self-Management Work Shop Brief Objective or Description: An evidence-based workshop we conduced three times at five Councils on Aging in fiscal year 2013 that teaches and encourages techniques for people with different types of arthritis to live a healthier lifestyle while dealing with the devastating effects of arthritis. The workshop includes appropriate use of medications and exercises that encourage improved quality of life and reduced utilization of medical services. Partners: Burlington Council on Aging, Woburn Council on Aging, Wilmington Council on Aging, Billerica Council on Aging and Lynnfield Council on Aging. Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 17

Low-Dose CT Lung Cancer Screening Brief Objective or Description: Low-Dose CT (LDCT) lung screening is quick and easy and results in a minimal amount of radiation exposure. Most private insurers and the Centers for Medicare and Medicaid Services (CMS) do not currently cover this type of screening, and the majority of hospitals charge a self-pay rate for this exam. However, Lahey Hospital & Medical Center is determined to help bring awareness and accessibility of this testing to all people at high risk and, therefore, is currently offering free LDCT lung screening to individuals who meet the established National Comprehensive Cancer Network (NCCN) high-risk criteria. People qualify for a free LDCT lung screening at Lahey Hospital & Medical Center if they meet the highrisk criteria in one of the following recommended categories: Category 1 Between 55 and 74 years old Currently a smoker or have quit within the past 15 years Have smoked at least a pack of cigarettes a day for 30+ years Category 2 Between 50 and 74 years old Have smoked at least a pack of cigarettes a day for 20+ years Have one additional lung cancer risk factor (not to include secondhand smoke exposure) Lahey Hospital & Medical Center is currently offering LDCT lung screening at absolutely no charge to the patient and has been since January 2012. Please note: While the LDCT lung screening exam is free, any additional testing or evaluation performed as a result of recommendations arising from the LDCT lung screening exam is not free of charge and will be billed to your insurance in the customary fashion. Partners: Massachusetts Firefighters Union; Hanscom Air Force Base; Tewksbury Public Health Department; Peabody Torigian Community Life Center; Burlington Council on Aging; Arlington Council on Aging; Billerica Council on Aging Detailed Description: Cancer is the second leading cause of death in the U.S, the Commonwealth and across all of Lahey Hospital & Medical Center s community benefit service area. While experts have an idea of the risk factors and what causes cancer, more research is needed as there are still many unknowns. The majority of cancers occur in people who do not have any known risk factors. The major known risk factors for contracting cancer are age, family history of cancer, smoking, overweight/obesity, excessive alcohol consumption, excessive exposure to the sun, unsafe sex, exposure to fumes, second hand cigarette smoke and other airborne environmental and occupational pollutants. As with other conditions, there are major disparities in outcomes and death rates across all forms of cancer, which are directly associated with race, ethnicity, income and whether one has comprehensive medical health insurance coverage. Cancer is a major issue in many of the cities/towns within Lahey Hospital & Medical Center s community benefit service area. The Essex County age-adjusted incidence rate and hospitalization rate for cancer (all types) is statistically higher than the Commonwealth s incidence rates. In addition, the incidence, hospitalization, and mortality rates for Cancer (all types) are higher in Billerica, Burlington, Peabody, 18 Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report

and Tewksbury than the rates in both the Commonwealth and the County. Woburn has higher mortality and hospitalization rates than the Commonwealth and the County but not a higher incidence rate. Wilmington has higher incidence and hospitalization rates but not a higher mortality rate. Finally, Stoneham has a higher incidence rate but not higher hospitalization or mortality rates. Lung cancer in both men and women, prostate cancer in men, and breast cancer in women are the main drivers of these high rates. Tuberculosis Clinic Brief Objective or Description: In 1998, The Department of Public Health approved Lahey Hospital and Medical Center s Pulmonary Department as the site for a free tuberculosis treatment outpatient clinic. Lahey treats patients referred by local health departments, healthcare institutions, community shelters and other sources with community linkages for evaluation of patients with suspected tuberculosis. The clinic provides a valuable community benefit and is a resource for approximately 14 communities surrounding Burlington. The TB Clinic will continue to provide the highest quality care to all patients and provide access to those populations at risk for TB. The TB Clinic is available to any resident of the Commonwealth but special consideration is given to more vulnerable individuals who have lack of access to treatment. Detailed Description: Increases in life expectancy during the 20th and 21st centuries are largely due to reductions in infectious disease mortality, as a result of immunization. However, infectious diseases remain a major cause of illness, disability, and even death. Sexually transmitted diseases and pneumonia, particularly in older adults, are among the infectious diseases that have the greatest impact on the population. The assessment captured data on a number of sexually transmitted diseases, including chlamydia, gonorrhea, syphilis, and HIV/AIDS as well as Hepatitis B and C, and pneumonia/ influenza. The hospitalization rate (per 100,000 population) for residents of Billerica, Peabody, Wilmington, and Woburn are all higher than the Commonwealth and the County rates. Support Groups Brief Objective or Description: In Fiscal Year 2013, Lahey Medical Center hosted numerous support group sessions. We offered 18 different types of support groups. We hosted support groups at Lahey Hospital &Medical Center, Lahey Medical Center Peabody and Lahey Outpatient Center, Lexington. Status: Based on the findings of our most recent Community Health Needs Assessment, we will continue to offer a variety of support groups to help educate, support and assist individuals and families who are going through difficult times. Support groups can help to inform, console and lift the spirit all part of the healing process. Partners: Organizational initiative Detailed Description: Support groups include: Head and Neck Cancer; Breast Cancer; GYN Cancers; Lahey Hospital & Medical Center Fiscal Year 2013 Community Benefits Report 19