Kaleida Health 2010 One-Year Community Service Plan Update September 2010

2010 One-Year Community Service Plan Update September 2010 1

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Kaleida Health 2010 One-Year Community Service Plan Update September 2010 Kaleida Health hospital facilities include the Buffalo General Hospital, DeGraff Memorial Hospital, Millard Fillmore Gates Circle Hospital, Millard Fillmore Suburban Hospital, Women and Children s Hospital of Buffalo. Kaleida Health also operate long term care facilities at the Deaconess Center, Millard Fillmore Gates, DeGraff Memorial Hospital and Waterfront Healthcare Center. Kaleida Health operates the Visiting Nursing Association of Western New York, Inc., a certified home care agency. Kaleida Health services are guided by a single framework for leadership, governance, shared services, financial infrastructure and information technology. Kaleida Health is a voluntary, integrated delivery system that plays a leading role in providing clinical, outreach, educational and other services for members of our community. We engage with community partners to promote health education and prevention, offering culturally-appropriate language access, and access to care and services for our community regardless of their ability to pay. Mission Statement: No changes from the 2009 CSP submission. Hospital Service Area: No changes from the 2009 CSP submission. Participants and Hospital Role: Community Partners involved in assessing the community health needs: Erie County Department of Health Niagara County Department of Health Reaching 4 Excellence: Regional Institute at University at Buffalo Community Health Foundation of Western and Central New York Kaleida Health Community Health (Consumer) Survey Role of Kaleida Health hospitals in identifying community health needs in selecting prevention agenda priorities: Kaleida Health hospitals leadership team collaborates with our medical staff and community partners to develop plans to address our community s health priorities, based on the community health needs assessments from local county health departments and other organizations. Periodically Kaleida Health supplements these community health needs assessments by focusing on a particular area and conducting our own assessment, as was last published in early 2008. Kaleida Health uses the data from the various assessments to develop community health interventions. During 2009, Kaleida Health leadership was actively involved in collaborative planning with Erie County Department of Health, Niagara County Department of Health, other hospitals, community-based organizations and public schools to develop the 2010-12 Community Service Plan. The 3

Prevention Agenda priorities selected by the Erie County group and the Niagara County group were jointly selected by each respective group, and our hospitals (4 of the 5 are located in Erie County) are active participants in community-based initiatives to address the Prevention Agenda priority. In addition, there are a number of other prevention programs that Kaleida Health provides in response to our community s needs. The table included in this report outlines the various prevention programs offered by Kaleida Health. Do the community partners continue to meet? How frequently? Community partners in Niagara County continue to meet on a regular basis to implement programs and share resources. However, community partners in Erie County have not met regularly regarding the Prevention Agenda priorities since Fall 2009. There have been many challenges in Erie County, including program closures and restructuring by the Erie County Department of Health which took precedence over meeting on community health priorities. In spite of the challenges, there have been collaborative planning meetings with Erie County Department of Health during the past year in response to their announced program closures, and Kaleida Health has provided access to needed services for former Erie County Department of Health patients from their two outpatient primary care clinics and family planning services. There was a seamless transition of patients from Erie County DOH clinics to Kaleida Health clinics throughout 2010. Kaleida Health continues to serve on many community health collaborations and coalitions in Western New York. No changes to the participants and the public notification process occurred after the 2009 CSP submission. Identification of Public Health Priorities: Prevention-Agenda Priorities and Health Improvement Goals: 1. Physical Activity and Nutrition (Erie County): Goals a. Increase consumer knowledge and adoption of healthy lifestyle behaviors by encouraging frequent physical activity and healthy nutrition, leading to improved health status and reduced chronic disease prevalence in resident of Buffalo and Erie County b. Increase the ability to identify risk factors for cardiovascular disease in participants. c. Develop system is (i.e., school-based, faith-based, community-based and primary care based) interventions for early identification and notification of adolescents and adults with high body mass index (BMI), and provide them with information about options and resources to address their problem and the consequences of not addressing their BMI status. 4

d. Implement a social marketing campaign to positively influence voluntary behavior or target population to take action to maximize health. e. Restrict the availability of less healthy foods and beverages in public service venues. 2. Chronic Disease (Diabetes) Prevention and Management (Niagara County): a. Empower participants by increasing access to information and improving knowledge, skill-building techniques and self-care behaviors that lead to positive behavior change and reduction in diabetes prevalence b. Develop and implement pre-diabetes education and offer regularly in community settings. c. Develop community education lectures and public service announcements that emphasize good nutrition, increased physical activity, mental health and risk factors for chronic disease including diabetes. d. Develop and implement a protocol for patients with diabetes entering hospitals to promote referrals for diabetes education class/counseling (SSME), and regular A1C testing. Impact or changes realized to date as a result of the collaborative plan: The scope of the 2010-2012 Community Service Plan has not changed since the plan was written. Update on the Plan of Action: The attached table outlines Kaleida Health s progress to date on prevention agenda priorities and other prevention programs. Dissemination of Report to the Public: The Kaleida Health 2010-2012 Community Service Plan is available to the public by visiting the www.kaleidahealth.org website, which provides access to the plan. There were also hard copies of the report mailed to selective community members/leaders and are available upon request. Copies of the report is available to Kaleida Health employees via the website. By October 2010, the 2010 One-year Community Service Plan Update will be available on the Kaleida Health website. Changes (Actual or Potential) Impacting Community Health, Provision of Charity Care and Access to Services: 5

Kaleida Health continues to be challenged by financial constraints in providing existing community health services. There has been program grant funding cuts this year and overall reimbursement cuts resulting in a need to discontinue programs and close some clinical services such as clinics. We have also scaled back on community health services, such as those offered in school-based health centers, due to state funding reductions. Our salary and supply expenses continue to rise at a time of shrinking grant revenue, thereby hampering our ability to grow and in some cases sustain services. Kaleida Health continues to offer charity care through our Financial Assistance Program, and facilitated enrollment into health insurance plans for eligible patients and community members. Financial Aid Program: There have been no significant changes in the Kaleida Financial Aid Program, which is offered to low income, uninsured and underinsured patients receiving services in a Kaleida Health hospital, emergency room, outpatient facility, and skilled nursing facility. Individuals are notified during intake and registration of the availability of financial assistance, including free care for those meeting income guidelines and asset verification (in accordance with the Federal Poverty Guidelines). Successes in providing financial assistance include assisting patients with applications for Kaleida Health s program, as well as offering facilitated enrollment for individuals at the Kaleida facilities as well as in community-based settings, such as: Ongoing partnerships with community agencies to offer outreach events and health fairs, including information and assistance for eligible participants applying for health insurance enrollment, and offering education to the public about options available for them. Partnering with the NYSDOH and the local health departments to provide information for eligible participants on Children with Special Needs program, Prenatal Care Assistance Program, Family Planning Benefit program, and other financial services for which participants may be eligible to cover the cost of services. Continuing the community hotline (716-859-8979) to assist individuals with applying for financial assistance. The telephone number is posted on our website and in print materials. Automated work queues for facilitated enrollment have been established within our hospital information system to capture automatic referrals in a timely manner. This process improvement includes enhanced reporting to assist in allocating resources where necessary. Challenges related to the provision of financial assistance include the impact of the New York State budget, resulting in reduced reimbursement for care/services rendered for individuals 6

without insurance. There has been limitations placed on providing facilitated enrollment services during non-business hours (weekends, evenings) due to the limited funding available to cover the costs of providing facilitated enrollment. We continue to experience numbers of individuals eligible for free or reduced cost services, however they refuse to apply for coverage, or patients who arrive at our facilities without the documentation necessary to verify income and assets in order to determine coverage levels. Our team of facilitated enrollers continues to educate and offer support for the patients, to the extent possible, within resource limitations. 9/15/10 7

Kaleida Health: Community Service Plan September 2010 Update NYSDOH Prevention Agenda Priority Area 1. Chronic Disease Management: Diabetes Prevention and management (Niagara County) Health Improvement Goals Increase access to information and improve self-management of diabetes Develop community education lectures and public service announcements emphasizing healthy nutrition, physical activity and lifestyle changes to reduce risk factors for chronic disease including diabetes Promote diabetes education referrals for patients entering the hospital Kaleida Health Program/Service or Support for Community-Based Interventions Diabetes Education Classes with Certified Diabetes Educators are offered at DeGraff. Nutrition counseling and education services regularly available at this location. Stay Well Health Promotion Program for Older Adults: A 6-week healthy lifestyle program offered in collaboration with the Niagara County Office for the Aging. Topics emphasize healthy nutrition, physical activity, stress reduction through exercise, and a walking program. 2010 Progress Report Niagara County DOH consumer health education and prevention program materials widely available for use by hospital providers to disseminate to the public. A monthly cable LCTV program reaching a viewing audience of approximately 62,000 households is hosted by the NCDOH. 14 nutrition sites reaching 384 participants. 46% of participants reported weight loss, 27% gained weight, 27% maintained their starting weight; 60% reported lowered blood pressure, 16% increased, 24% maintained their starting blood pressure; 91% of participants increased their activity level, 9% maintained their initial levels. 94% of participants reported high satisfaction with program 8

NYSDOH Prevention Agenda Priority Area 2. Physical Activity and Nutrition (Erie County) Health Improvement Goals Increase consumer knowledge of healthy lifestyle behaviors and ability to identify risk factors for cardiovascular disease Develop interventions and notification of adolescents and adults with high body mass index, and education and resources to address their BMI status Implement a social marketing campaign that encourages healthy lifestyle behaviors Restrict the availability of less healthy foods and beverages in public service venues Kaleida Health Program/Service or Support for Community-Based Interventions Heart Truth CVD prevention program HeartCaring CVD risk reduction program Kaleida Take Control of Your Heart CVD risk reduction community education program School Health Student BMI Surveillance and Nutrition Education and Counseling 2010 Progress Report Conducted 13 Heart Truth consumer information lectures and material distribution contacts, with 2,891 participants Conducted 5 consumer education events with 1,870 participants in total. Conducted 2 train-the-trainer Take Control of Your Heart training sessions, whereby 6 trainees conducted 3 educational workshops for 8 adult and 3 workshops for 35 youth participants on CVD prevention and healthy lifestyles behaviors. Participated in 15 community walks, runs, bicycle events, several golf outings and other programs promoting physical activity in the community Collected and reported to Buffalo Schools baseline data on overweight (BMI > 85 th percentile) children by grade level, June 2010: Pre-K: 36% K: 35% 2 nd grade: 39% 5 th grade: 42% 7 th grade: 42% 10 th grade: 31% Collaborated with Independent Health on the Fitness for Kids challenge in Buffalo schools Collaborated with Univera on the Fun to be Fit program for 2 nd -4 th grade students Participated in the Sister to Sister conference with 220 adolescents participating in nutrition education, healthy food demonstrations Conducted 22 school nutrition classroom presentations on healthy snacks, food pyramid, reducing fat and sugar content in foods and beverages, healthy food choices, etc., reaching over 500 students in middle and high schools. Conducted 325 individual/family nutrition counseling sessions for overweight youth and parents. 9

NYSDOH Prevention Agenda Priority Area Other Kaleida Health Prevention Services: 1. Healthy Mothers, Healthy Babies Health Improvement Goals Early entry into prenatal care (1 st trimester) Kaleida Health Program/Service or Support for Community-Based Interventions Maternal-fetal and high risk obstetric services Outpatient women s health services/ WCHOB 2010 Progress Report Prenatal care in 1 st trimester/ WCHOB 67.7% 2009; 65.4% Jan- May 2010 Prenatal care in 1 st trimester/ Millard Suburban 85.7% in 2009; 86.0% Jan-May 2010 Total visits increased 18% (19,675 in 2008 vs. 23,290 in 2009); 32% increase in colposcopy visits (213 in 2008 vs. 281 in 2009). High patient satisfaction with access to services in one location; new OB appointments within 5 days of call; abnormal pap management; ultrasound and fetal testing on-site; dieticians, social worker and insurance enrollment on site. 2. Access to Quality Health Care: Increase percent of adults with regular health care provider Early stage breast cancer diagnosis 3. Tobacco-use Reduce cigarette smoking Prevention and Smoking in adults Cessation: Reduce cigarette smoking in adults Adult Primary care services Collaboration with Partners for Prevention provides screening and diagnostic mammography and breast ultrasound for underserved women. 100% of Kaleida Health-owned facilities and properties are smoke-free. 15% increase in outpatient volume (2008 vs. 2009) for Family Medicine and Internal Medicine clinics. 2009: 87% increase in number of women receiving screening mammograms, 125% increase in number receiving diagnostic mammograms and 68% increase in number receiving breast ultrasound at BGH. Completed 100% achieved in 2009 10

NYSDOH Prevention Agenda Priority Area Health Improvement Goals Kaleida Health Program/Service or Support for Community-Based Interventions 2010 Progress Report 4. Risk Reduction Increase immunizations to prevent communicable disease Community flu vaccine programs Employee immunization program Flu vaccine educational materials disseminated More than 500 flu vaccine clinics held by VNA, providing 37,200 seasonal flu vaccines, 6,750 H1N1 flu vaccines and 675 pneumonia vaccines for WNY community members since fall 2009. 1,597 seasonal flu vaccines and 1,426 H1N1 flu vaccines distributed to children residing in the City of Buffalo and 1,545 seasonal flu vaccines provided for children in the Kaleida School- Based Health Centers in 2009-10 flu season. 5,690 seasonal flu vaccines and 4,385 H1N1 flu vaccines distributed to Kaleida Health employees during the 2009-10 season. 55 TDAP vaccines administered to employees who may be in contact with infants. 5. Healthy Environment Improve Asthma Self-Care for Children and Adolescents 6. Reduce Incidence of Infectious Disease Screenings for H IV Infection More than 100,000 pieces of educational materials and informational brochures were distributed throughout the community regarding H1N1 and Seasonal Flu prevention during the Fall 2009 campaign. School Asthma Management Program Increased the availability of educational sessions and case management with improvement in documented asthma action plans. 88% of students diagnosed with persistent asthma are prescribed a controller medication, exceeding the goal of 75%. Family Planning Clinic, and Primary Care Clinics HIV counseling and testing available in clinics. Improve treatment PACT Clinic and Community adherence for children and Partnership Council youth living with HIV Treatment adherence for youth living with HIV initiating antiretroviral therapy is >90%. 100% of infants exposed and at risk for transmission tested negative for HIV. Childhood immunization rates for children and youth in PACT clinic is >95% 11

NYSDOH Prevention Agenda Priority Area 7. Community Preparedness Health Improvement Goals Participation in stateapproved emergency preparedness plan Kaleida Health Program/Service or Support for Community-Based Interventions Internal and External Emergency Preparedness 2010 Progress Report Kaleida Health Emergency Management Plan up-to-date and includes assignment of personnel to respond to internal and external emergencies, in coordination with Erie County and NYS Health Departments. 8. Health Equity: Reducing Disparities in Access to Care Community Blood Drives Improve Patient-to- Provider Communication Improve identification of diverse patients 9. Other Community Reduce incidence of Health Outreach, shaken baby syndrome Education and Screening Programs Community Blood Drives in partnership with UNYTS Language Assistance Program Examining Diversity: Collecting Race, Ethnicity and Language Data Training Program. Shaken Baby Education Program Reduce accidental injury Poison Control Program Pediatric Trauma Center Hosted 138 community blood drives during the past year, collecting 1,145 units of blood for distribution in our community. Interpretation services are available for 60 languages; 85,078 patients were assisted with Language Assistance. Computer-based training program developed in 2010 focused on collecting accurate race, ethnicity and language data from the patient s perspective. Training offered continuously for Kaleida Health employees. More than 120,000 commitment statements from parents received since program inception indicating parents commitment to safe handling of their infants. Outreach and educational services were expanded to Upstate NY communities beyond WNY. Educational outreach to parents, child care centers, teachers and child safety organizations. Information is also available at numerous community health and wellness events. Reduce risk of disease and Community and Employer Health injury Screenings and Wellness Programs Ongoing community outreach provides educational programs related to injury prevention, pediatric stabilization and resuscitation. More than 12,000 annual outpatient visits to the Center are due to traumatic and accidental injuries. Kaleida staff participated in 46 community and employer events, resulting in 102,080 outreach contacts in 2009. 250 individuals received laboratory screenings, and 1,200 health insurance referrals were reviewed by Facilitated Enrollers. 12

NYSDOH Prevention Agenda Priority Area 9/15/10 Health Improvement Goals Early identification of children with disabilities Kaleida Health Program/Service or Support for Community-Based Interventions Early Childhood Direction Center 2010 Progress Report Ongoing outreach, consumer education and linkages to community resources for families of children age birth-5, with suspected disabilities. Services to more than 2,000 family contacts in 6 WNY counties annually. 13