St. Charles Hospital Community Service Plan 2014-2016 Approved by the Board of Trustees on October 24, 2013 Updated June 9, 2014 200 Belle Terre Road, Port Jefferson, NY (631) 474 6797 stcharles.org
Mission Statement Catholic Health Services of Long Island (CHS), as a ministry of the Catholic Church, continues Christ s healing mission, promotes excellence in care and commits itself to those in need. CHS affirms the sanctity of life, advocates for the poor and underserved, and serves the common good. It conducts its health care practice, business, education and innovation with justice, integrity and respect for the dignity of each person. St. Charles Hospital Service Area St. Charles Hospital is located on the north shore of Suffolk County in the Town of Brookhaven. A not-for-profit hospital with 231 beds, St. Charles is a member of Catholic Health Services. The population in the hospital s primary catchment area is more than 261,000 residents, representing 81% of the hospital s admissions. The hospital s secondary catchment area has more than 200,000 residents and accounts for another 16% of patient admissions. This service area (which has not changed since 2008) comprises underserved and economically challenged communities. St. Charles Hospital s service area is shared with an acute care hospital, John T. Mather Memorial Hospital in Port Jefferson, and a tertiary care hospital, Stony Brook University Medical Center. 2012 St. Charles Hospital discharge data by ethnicity White 9,674 92.3% African American (Black) 523 5.0% Other Race 144 1.4% Asian 129 1.2% Native American 6 0.1% 10,476 100.0% 2012 St. Charles Hospital discharge data by age 0 5 1,883 18.0% 6 13 129 1.2% 14 17 148 1.4% 18 24 471 4.5% 55 64 1,125 10.7% 75 84 1,123 10.7% 35 44 1,084 10.3% 45 54 1,029 9.8% 85+ 642 6.1% 10,476 100.0% St. Charles Hospital has served the residents of the Town of Brookhaven since 1907. St. Charles is a full-service, community hospital and regional rehabilitation center with eight outpatient satellite rehabilitation sites. The 231- bed hospital includes 59 medical/surgical beds, 16 intensive care/critical care beds, 8 pediatric beds, 6 neonatal and 22 maternity beds, 40 alcohol and chemical dependency beds and 80 physical medicine/rehabilitation beds. Ranked among the Best Hospitals by U.S. News & World Report (2013 2014), St. Charles is renowned for high-quality, compassionate care. In 2012, it was 1 of just 3 hospitals in all of Nassau or Suffolk to be named as 1
Top Performers on Key Quality Measures by The Joint Commission, placing St. Charles in the top 18% of more than 3,000 hospitals evaluated. With a rehabilitation program that has achieved the highest level of certification available, St. Charles is the only hospital on Long Island accredited by the Commission on Accreditation for Rehabilitation Facilities for both inpatient and outpatient, adult and pediatric rehabilitation. The pediatric rehabilitation unit has the only inpatient pediatric traumatic brain injury unit on Long Island. St. Charles was the first hospital in New York to introduce computer-assisted orthopedic surgery when performing a total knee arthroplasty and went on to become the first hospital in the region to perform computer-assisted surgery (CAS) on an anterior cruciate ligament and the first on the East Coast to use CAS during a total shoulder replacement surgery. With Joint Commission certification for its total hip and knee replacement program, St. Charles performed more than 500 total joint replacement surgeries in 2012. Due to the growing number of adult and pediatric patients in need of surgical services, an $8 million expansion of an existing operating room suite at St. Charles added 4 operating rooms and features a highly skilled surgical staff, advanced equipment and more space, creating one of the most technologically advanced surgery centers in the area. St. Charles Hospital reported $2.0 million in charity care at cost net of offsetting revenues in 2012. Community service, uncompensated care and other charitable activities provided for the community totaled $10.5 million at cost, and $531 thousand was reported in bad debt at cost net of offsetting revenues in 2012. Public Participation In May 2013, St. Charles Hospital conducted a Community Health Needs Assessment (CHNA). The goal of the CHNA was to improve residents health status, increase their life spans and elevate their overall quality of life; reduce health disparities among residents; and increase accessibility to preventive services for all community residents. The CHNA was a robust, county-wide process involving the Suffolk County Department of Health Services, the Nassau-Suffolk Hospital Council, Stony Brook University Medical Center, Brookhaven Hospital, Peconic Bay Medical Center, Good Samaritan Hospital Medical Center, St. Catherine of Siena Medical Center, Southampton Hospital, John T. Mather Memorial Hospital and the North Shore-LIJ Health System. The work group met on February 14, February 22, April 11, April 29, June 25 and July 30, 2013. St. Charles Hospital worked closely with the Long Island Hospital Network (LIHN), including fellow member hospitals of Catholic Health Services (CHS), as well as with partners in the community including fire departments, libraries, civic organizations, YMCAs, school nurses, youth organizations and churches. The survey was also mailed to various groups of residents in the community, including physicians and business professionals, employees and patients, as well as to all residents living in the 11777 zip code (Port Jefferson, Port Jefferson Station and Belle Terre). The CHNA survey was available for electronic submission via Survey Monkey, which was communicated through the hospital s website with a posting on the home page inviting the public to participate in the survey and providing a direct link to the survey on Survey Monkey. Signs were posted throughout the hospital informing the public of the survey and providing instructions on participation. In addition, the CHNA survey was distributed at a community outreach event, Healthy Sundays, in Riverhead, NY. A total of 18 Hispanic individuals completed the survey. Healthy Sundays is a Catholic Health Services initiative that provides free health screenings and information specifically for underserved and uninsured populations. 2
Suffolk County 2012 Demographics Suffolk County New York Population, 2012 estimate 1,499,273 19,570,261 Population, 2010 (April 1) estimates base 1,493,350 19,378,104 Population, percent change, April 1, 2010 to July 1, 2012 0.4% 1.0% Population, 2010 1,493,350 19,378,102 Persons under 5 years, percent, 2012 5.6% 6.0% Persons under 18 years, percent, 2012 23.1% 21.8% Persons 65 years and over, percent, 2012 14.5% 14.1% Female persons, percent, 2012 50.8% 51.5% White alone, percent, 2012 (a) 85.8% 71.2% Black or African American alone, percent, 2012 (a) 8.2% 17.5% American Indian and Alaska Native alone, percent, 2012 (a) 0.6% 1.0% Asian alone, percent, 2012 (a) 3.7% 8.0% Native Hawaiian and Other Pacific Islander alone, percent, 2012 (a) 0.1% 0.1% Two or More Races, percent, 2012 1.7% 2.2% Hispanic or Latino, percent, 2012 (b) 17.3% 18.2% White alone, not Hispanic or Latino, percent, 2012 70.6% 57.6% Living in same house 1 year & over, percent, 2007-2011 92.6% 88.5% Foreign born persons, percent, 2007-2011 14.2% 21.8% Language other than English spoken at home, percent age 5+, 2007-2011 20.1% 29.5% High school graduate or higher, percent of persons age 25+, 2007-2011 89.5% 84.6% Bachelor's degree or higher, percent of persons age 25+, 2007-2011 32.4% 32.5% Veterans, 2007-2011 89,799 986,313 Mean travel time to work (minutes), workers age 16+, 2007-2011 30.3 31.4 Housing units, 2011 572,995 8,119,364 Homeownership rate, 2007-2011 80.8% 54.8% Housing units in multi-unit structures, percent, 2007-2011 14.0% 50.5% Median value of owner-occupied housing units, 2007-2011 $411,000 $301,000 Households, 2007-2011 496,677 7,215,687 Persons per household, 2007-2011 2.93 2.59 Per capita money income in the past 12 months (2011 dollars), 2007-2011 $36,588 $31,796 Median household income, 2007-2011 $87,187 $56,951 Persons below poverty level, percent, 2007-2011 5.7% 14.5% (a) Includes persons reporting only one race. (b) Hispanics may be of any race, so also are included in applicable race categories. D: Suppressed to avoid disclosure of confidential information F: Fewer than 25 firms FN: Footnote on this item for this area in place of data NA: Not available S: Suppressed, does not meet publication standards X: Not applicable Z: Value greater than zero but less than half unit of measure shown 3
Continued Engagement with Partners and Tracking Progress Long Island Health Collaborative As a result of the CHNA process and with both Nassau and Suffolk counties identifying the same two public health priorities, a collaborative bi-county work group were formed with participants including: hospitals, county health departments, health and welfare organizations, and colleges. Long Island s 24 hospitals Nassau-Suffolk Hospital Council New York State Department of Health Nassau County Department of Health Suffolk County Department of Health Services United Way of Long Island American Lung Association of Northeast Adelphi University Western Suffolk BOCES Cornell University Cooperative Extension YMCA Catholic Charities Healthcare Association of New York State Kaiser Family Foundation Robert Wood Johnson Foundation County Health Rankings & Roadmaps LIHC program inventory HITE site Centers for Disease Control and Prevention (CDC) Institute of Medicine U.S. Department of Health and Human Services National Institutes of Health Healthypeople.gov Unique in New York State, this collaboration will allow for health systems and community partners to be involved in the education, planning and provision of services that goes well beyond clinical care and enters the realm of public health and prevention. Long Island Health Collaborative (LIHC) is a partnership created to support the work group s collective efforts in addressing the selected Prevention Agenda priority and focus areas. This innovative regional effort will culminate in the form of a comprehensive, island wide public awareness campaign. A website, which will be maintained by the Nassau Suffolk Hospital Council, is currently being designed for LIHC. The LIHC website will explain the purpose for LIHC as well as information on population health, the role of reform in the changing landscape of health care and the role of patients and consumers in maintaining their own health. A brief narrative of the focus areas will be found with links to more detailed information and resources as well as an explanation of state and federal mandates which are driving more robust and collaborative community health planning. The site will also include links to helpful resources such as BMI calculators and specific disease risk assessment tools. Additionally, the bi-county work group is creating a universal metric assessment in order to be able to collect reliable and reportable data for the region. The metric will feature four subscales which will dovetail the focus areas. Data will be collected and analyzed by one of LIHC s university partners. Currently, it is anticipated that 4
the metric would be given to program participants in chronic disease management or wellness programs with three or more education sessions. Participants would complete a survey a total of three times: pre-program, immediately post-program and again 3 6 months post-program. Results of the CHNA Identified Five Areas of Community Health Needs: Nutrition/Healthy Eating Obesity/Overweight (Adults and Children) Heart Disease Diabetes High Blood Pressure Assessment and Selection of Public Health Priorities In May 2013, a total of 131 individuals completed the survey. 48.4% of respondents were 50 69 years old, while 19.4% were 70 79 years. 82.4% were non-hispanic and 14.4% Hispanic. 87.1% had health insurance, and 59% of the respondents were female. Individuals from towns responding to the survey included both the primary and secondary service areas, as well as areas surrounding the Rehabilitation Networks: Bayside Centereach Mastic* Medford Ronkonkoma Roosevelt Commack Middle Island Roslyn Coram Hampton Bays Mt. Sinai Oakdale Selden Smithtown Holtsville Lake Grove Patchogue Port Jefferson Sound Beach Stony Brook Manorville Ridge* Wantagh* *Key area with population of underserved and uninsured individuals. Suffolk County Data Compared to New York State and the New York State Prevention Agenda Objectives Prevalence of Chronic Disease in Suffolk County In order to assess the prevalence of chronic disease in Suffolk County, the county data (2008-2009) is compared to New York State (NYS) (2008-2009), as well as to the 2013-2017 NYS Prevention Agenda Objectives (NYSPAO). Coronary heart disease age-adjusted hospitalization rates in Suffolk County are 53 per 10,000 (2009-2011); worse than the NYS average (of 44), and the NYSPAO (48) for the same period. Rates for death from heart disease are higher in Hispanic and Black populations. Black non-hispanics and White non-hispanics have the highest heart disease death rates for the 2000-2009 period (244.5 per 100,000 and 206.6 per 100,000 respectively). Stroke mortality rates for Suffolk County met the NYSPAO at 26.6% (2008-2010) and are significantly better than the state rate of 27.5% and national average of 39. Diabetes prevalence rates in Suffolk County are 9% (2009), which is lower than the NYS average of 10.4% but above the NYSPAO of 5.7%. The short-term complication rate for diabetes is 4.0% (2008-2010) and is also better than the NYS average of 5.8% (2010), thus meeting the NYSPAO for people age 18+ years. 5
Obesity rate for adults (BMI>30) is 21%, which is below the NYS average of 24%, but above the NYSPAO of 15%. Obesity rates for elementary, middle and high school students are in the 3 rd and 4 th quartiles for percent overweight and percent obese for the County Health Indicators (CHI). However, Suffolk County children ages 2-4 years who are enrolled in the WIC program have obesity rates of 22%, well above the NYS average of 14% and the NYSPAO of 11%. Lifestyle issues, including nutrition and physical activity, are major factors in the prevention and management of chronic disease. Approximately 77% of Suffolk County adults report they are engaged in some type of leisure time physical activity, which is above the NYS rate (73%), but below the NYSPAO target of 80%; approximately 1 out of 4 residents in Suffolk County are inactive. Twenty-eight percent of county residents report that they eat 5 or more fruits and vegetables per day, which is above the NYS average (26.8%) but below the NYSPAO target (33%). Mental health and substance abuse The suicide rate (per 100,000) for Suffolk County is 6.8%, lower than the NYS rate (7.5%), but above the NYSPAO of 4.8%. Whites had the highest rate of drug-related hospitalizations, while suicide rates for both Blacks (7.2%) and Whites (6.8%) were more than double the suicide rate of Hispanics (3.3%). Drug-related Suffolk County hospitalizations overall were on par with NYS (26%) and NYSPAO. Prioritization and Rationale for St. Charles Hospital s Selection of Priorities NYSDOH Priority Agenda Items were selected by St. Charles Hospital based on the following criteria as recommended by the Catholic Health Association Assessing and Addressing Community Health Needs Manual: Coordinate hospital and community strategies to ensure the most effective use of resources Give priority to persons who are low-income and disadvantaged Build on existing programs and other community assets when possible Understand root causes of needs being addressed and identify a range of possible interventions Investigate evidence-based approaches to ensure effective use of hospital and community resources For each prioritized need, identify the goal to be achieved, measurable objectives(s), indicators for determining whether objectives were met and evaluation measures Rationale for Selection of Priorities A committee comprising representatives from internal and external stakeholders, including community-based organizations, academic public health experts, health staff from within the facility, Board members and other key stakeholders, met to discuss the results of the CHNA and to identify and prioritize priority health agenda items. The group applied the criteria listed above to these needs in order to prioritize agenda items. In order to address an existing healthy disparity in this community, the committee worked to identify a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage (Disparities 2010, retrieved from healthypeople.gov). Based on the information collected from St. Charles Hospital s CHNA and the criteria used to prioritize and choose agenda items, it was logical to conclude that under the New York State Department of Health s Prevention Agenda Toward the Healthiest State and in the priority area of chronic disease, two community health issues achieved the highest priority and thus were identified for focus at St. Charles Hospital. They are obesity in children and adults and the need for increased access to high-quality chronic disease prevention, care and management. A third focus area, mental health, was identified as it relates to obesity and access to chronic disease prevention and care. 6
Health Disparity As mentioned above, Healthy People 2020 defines a health disparity as a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. (Disparities 2010, retrieved from healthypeople.gov). Diabetes prevalence in adults in Suffolk County is lower than the U.S. and NYS rates. However, it is higher (9.0%) than the Prevention Agenda Objective (5.7%), and the rate of diabetes deaths is increasing in Suffolk County. Many residents are at risk for developing diabetes or have poorly controlled diabetes. Disparities exist in Suffolk County in the areas of diabetes management, care, and education. Priority No. 1: Obesity, Including Co-morbidities of Heart Disease and Diabetes, With a Focus on Nutrition and Exercise Purpose: Introduce and implement initiatives that promote nutrition and reduce adult and childhood obesity. Introduce initiatives and educate the public on the benefits of a healthy lifestyle in order to reduce obesity. Objectives: Explore developing a healthy lifestyle programs for children, adolescents and teens. Develop and implement a healthy lifestyle course hosted at St. Charles Hospital. Expand outreach programs to include offering the expertise of St. Charles clinicians as guest lecturers in the community to speak on health-related topics. Develop a safe walking program. Continue working with the Long Island Health Collaborative (LIHC) by attending regional meetings, accessing the inventory of services and using the universal screening tool as appropriate. Action Plans & Process: Identify individuals at risk for chronic disease, such as diabetes and heart disease, through community health screenings twice a year, provide education and, if a chronic disease is indicated, refer to the patient s primary care physician or, if there is no primary care physician and/or no health insurance, the patient will be referred to Catholic Health Services/Martin Luther King, Jr., Health Center for medical care, management and treatment. Proactively engage at risk patients in preventive lifestyle programs by offering a course with detailed healthy meal planning, including provision of recipes and cooking demonstrations. Identify opportunities to partner with community organizations, including the Suffolk County Department of Health Services and Port Jefferson Village, to drive participation in a minimum of two healthy events each year. Create educational curriculum, to be distributed at health screenings and healthy events, which will address the top health concerns identified in the community: o Nutrition o Exercise Programs o Obesity o Heart Disease o Diabetes St. Charles Hospital clinicians will provide blood pressure and body mass index (BMI) screenings at local 7
parishes as part of the Healthy Sundays program, a Catholic Health Services initiative that provides free preventive health screenings and education to members of medically underserved communities on Long Island. Local parishes include St. John the Evangelist, Riverhead, and Church of the Resurrection, Farmingville. Partner with a school district to pilot a program, ThinkHEALTHY!, for the purpose of preventing childhood obesity and introduce curriculum and programs on healthy eating and exercise. Increase to a total of four, the number of health screenings provided to the community and offer education and resources. Screenings to include: o Blood pressure screenings, four times yearly o Cholesterol screenings, four times yearly o Diabetes screenings, four times yearly o Body Mass Index (BMI) screenings, four times yearly Outcomes: Outcomes for elementary school children will be measured through recording of BMI. School-age children will have their BMI documented at the beginning and end of each school year for the purpose of identifying the number of children achieving a lower BMI. Outcomes for adults will be measured by the number of attendees at community lectures, screenings and health fairs. Additionally, a universal metric assessment tool, created through the Long Island Health Collaborative (LIHC), will be used when applicable to collect reliable and reportable data. Once collected, data will be analyzed by a member organization of LIHC and shared with the bi-county group. It has been determined that the metric will be given to participants in chronic disease program or wellness programs with two or more sessions. Participants complete the metric tool upon commencing, immediately after completing the program and finally, three to six months later. Priority No. 2: Chronic Disease Prevention through Education/Awareness of Preventive Care Purpose: Increase awareness of diabetes risk factors and prevention measures among at-risk populations through free health screenings and educational seminars on healthy lifestyles. Goals: Increase access to diabetes screenings for low income areas. Provide education and counseling on diabetes self-management for patients with diabetes. Decrease number of patients admitted for poorly controlled blood glucose levels/increase number of patients with well-controlled blood glucose levels. 8
Action Plans & Process: St. Charles Hospital will increase screening rates for diabetes by providing a diabetes risk-assessment quiz at health fairs and screenings. At-risk patients will be referred to primary care providers for follow-up. If patients do not have a primary care physician, they will be referred to the Catholic Health Services/Martin Luther King, Jr., Center. St. Charles will also provide evidence-based programs addressing strategies for diabetes prevention to high-risk patients. To reduce disparities, St. Charles will improve access to diabetes management programs for residents of lowincome areas by offering nutrition and diabetes education lectures at local civic organizations, nursing homes, churches, libraries and at St. Charles Hospital. St. Charles will address a health disparity by reducing language and cultural barriers to diabetes care and education by providing diabetes educational services to patients admitted to St. Charles in Spanish as needed and continue to offer interpreter services for many languages, including sign language for those with hearing issues. Registered dieticians will refer appropriate patients admitted to St. Charles to Outpatient Nutrition for counseling and to the Diabetes Education Center at St. Charles Hospital. Partner with Suffolk County Department of Health to offer two16-week Diabetes Prevention Programs each year at St. Charles Hospital. St. Charles Hospital clinicians will provide blood pressure and body mass index (BMI) screenings at local parishes as part of the Healthy Sundays program, a Catholic Health Services initiative that provides free preventive health screenings and education to members of medically underserved communities on Long Island. Local parishes include St. John the Evangelist, Riverhead, and Church of the Resurrection, Farmingville. Address the health disparity of poorly controlled blood glucose management by expanding services offered at the Diabetes Care Center at St. Charles Hospital. The center, recognized by the American Diabetes Association, provides a comprehensive diabetes self-management program for individuals with Type 1, Type 2, pre-diabetes, and gestational diabetes. Catholic Health Services of Long Island is planning a Community Care for Obesity and Diabetes (C.O.D.) screening and referral program for network hospitals including St. Charles. Under this program, certified diabetes educators will implement evidence-based screening, brief intervention and referral to treatment (SBIRT) for Medicaid, Medicare and dually eligible adults accessing care at St. Charles who have a body mass index (BMI) greater than 25 or are pre-diabetic. Patients with BMI>30 will receive individual consultations. Pre-diabetes patients will be referred to the outpatient Diabetes Education Center. Outcomes/Evaluations: Educational material, health counseling and referral to medical resources will be offered to those who screen out of range. The universal screening tool will be used as appropriate. St. Charles will track and measure the rate of short-term diabetes hospitalizations and the number of patients admitted to the hospital with poorly controlled blood glucose levels, with the intent of decreasing hospitalization rates and increasing the number of patients with diabetes whose blood glucose is well controlled. Achieve a 90% or higher compliance rate for an HbA1c level of < 6.5% for all patients admitted to St. Charles with diabetes. 9
Priority No. 3: Mental Health Goal/Purpose: Improve access to mental health programs and resources for members of our community. Action Plan & Process: When a lack of access to mental health resources are identified through the chronic disease prevention priorities, St. Charles Hospital will provide information on and refer to the extensive mental health services available within Catholic Health Services. Explore the development of a post-partum depression support group to reduce post-partum depression in new moms. Expand services for patients admitted with a cancer diagnosis to evaluate for depression. Expand services for patients admitted for medically supervised detoxification to evaluate for depression. Outcomes/Evaluations: St. Charles Hospital will track the number of individuals who are referred to mental health services within the Catholic Health Services system. A psychological screening tool will be developed and used by all care managers/social workers for patients admitted with a cancer diagnosis. When patients are identified as outside of normal range for depression, counselors will be provided on site and a discharge plan of action will be developed. A depression screening will be provided for all patients admitted for medically supervised detoxification. Where needed, counseling will be provided on site for these patients and a discharge plan of action developed. Dissemination of the Plan to the Public St. Charles Hospital will disseminate the Community Service Plan as follows: Mailing to more than 600 physicians, St. Charles s Board of Trustees and the St. Charles Hospital Foundation Board members. Distribution at community events, including health fairs/screenings and other educational events, as well as to prospective nursing students and at recruitment fairs. Mailing to community residents and civic groups upon request. Posting on St. Charles s website. Information included in the hospital s community newsletter, with a circulation of 85,000. In addition, the plan was shared with the public at Adelphi University s fall symposium, Public Health in the Suburbs, Part 2: Medical Centers Meeting Community Health Needs, on Nov. 8, 2013, with extended coverage across the Long Island region through the diocesan website (www.drvc.org) and TV station, Telecare TV (www.telecaretv.org). Next Steps for Priorities For each of the priority areas listed above, St. Charles Hospital will: Identify any related activities being conducted by others in the community that could be built upon. Develop measurable goals and objectives in order to evaluate the effectiveness of the educational interventions. Build support within the community for the identified initiatives through attendance at meetings of Chambers of Commerce, civic organizations, schools, nursing homes and assisted living facilities, as well as market all outreach programs and screenings on social media, hospital 10
Conclusion newsletters and community newspaper calendars. Develop detailed work plans and measurable goals. Address budget and financial implications. St. Charles Hospital will develop a steering committee for the purpose of planning, developing and implementing action plans for the focus areas. Using the hospital s strengths and resources, St. Charles will work to best address the community s health needs and improve the overall health and well-being of the residents of the north shore of Suffolk County. This effort will be a collaborative one, continuing to build on the foundation of the LIHC partnership and forge new partnerships, programs and services to achieve goals of a healthier community. 11