community health needs assessment implementation strategy ... · 2013 – 2016 the community health...

Community Health Needs Assessment Implementation Strategy

2013 – 2016

The Community Health Needs Assessment Implementation Strategy was approved by the Washington Adventist Hospital Board of Trustees on September 10, 2013 and was

approved by the Adventist HealthCare Board of Trustees on October 23, 2013.

Washington Adventist Hospital’s Community Health Needs Assessment – Implementation Strategy

Overview/Mission The mission at Washington Adventist Hospital, a member of Adventist HealthCare, is: We demonstrate God’s care by improving the health of people and communities through a ministry of physical, mental and spiritual healing. Adventist HealthCare will be a high performance integrator of wellness, disease management and health care services, delivering superior health outcomes, extraordinary patient experience and exceptional value to those we serve. In keeping with our mission, Washington Adventist Hospital continues its longstanding tradition to bring the community to good health through our robust offering of health and wellness services throughout Montgomery and Prince George's Counties. We have provided the Washington metropolitan area with cutting edge cardiac and vascular procedures for more than 50 years. Washington Adventist Hospital’s Radiation and Oncology program is the first hospital-based facility in Montgomery and Prince George’s Counties, and the first facility in the Washington metropolitan area to be accredited by the American College of Radiation Oncology (ACRO). Washington Adventist Hospital’s Cancer Program has received a three-year accreditation with commendation by the American College of Surgeons Commission on Cancer – only 25 percent of all hospitals in the U.S are accredited, with only a minority receiving accreditation with commendation. Washington Adventist Hospital is proposing to relocate the hospital to property it owns in the White Oak area of Silver Spring along the border of Prince George’s County and Montgomery County. A new 21st century facility, together with the health, wellness, and education programs provided on its current campus, will continue strengthening the region’s health care infrastructure and expanding access to care for all. Priority Population and Target Area Washington Adventist Hospital primarily serves residents of Prince George’s County and Montgomery County, Maryland. Below, Figure 1 shows the percentages of discharges by county for Washington Adventist Hospital: County Percentage

Prince George’s 44.5

Montgomery 40.3

Washington, D.C. 6.4

Other 8.8

Figure 1. WAH discharges by county, 2011.

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Approximately 80 percent of discharges come from our Total Service Area, which is considered Washington Adventist Hospital’s Community Benefit Service Area “CBSA”. Within that area, 60 percent of discharges are from the Primary Service Area and 20 percent of discharges from our Secondary Service Area (see Figure 2). Figure 2. Map of Washington Adventist Hospital’s Primary (purple) and Secondary (orange) Service Areas based on 2011 inpatient discharges Our Community Benefit Service Area (CBSA), covering approximately 80 percent of discharges, includes 1,253,641 people, of which 66.5 percent are minorities (see Figure 3).

2011 Estimates

WHITEBLACK/AF AMER ASIAN

NATIVE HI/PI HISP/LAT

Total Service Area (TSA) 419,958 553,217 1,845 1,338 238,388 33.5% 44.1% 0.1% 0.1% 19.0% Primary Service Area (PSA) 186,853 172,498 885 567 144,409 37.1% 34.2% 0.2% 0.1% 28.7% Secondary Service Area (SSA) 233,105 380,719 960 771 93,979 31.1% 50.8% 0.1% 0.1% 12.5%

Figure 3. Population estimates (2011) by race/ethnicity for Washington Adventist Hospital’s Total Service Area (80% of discharges), Primary Service Area (60% of discharges) and Secondary Service Area (20% of discharges)

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Population demographics are rapidly changing in Montgomery and Prince George’s Counties. We serve one of the most diverse communities in the United States, constantly undergoing the economic, social and demographic shifts that result from an ever-changing, ever-growing population. Prince George’s County is one of the state’s most populous jurisdictions with a population of more than 863,420 residents, making it the third most populated jurisdiction in the Washington metropolitan area.1 Since 2000, it has experienced the second-largest population growth in Maryland, due largely to an increase in Hispanic residents. Every racial/ethnic group has increased its presence in the past decade, except the white population, which has decreased by over 23 percent. Prince George’s County’s foreign-born population has also steadily increased over the last two decades; from 2000 – 2007 it increased at the highest rate in Maryland – 199.9 percent compared to a state average of 70.7 percent.2 Currently, 24 percent of Prince George’s County residents are foreign-born. One fifth of the County’s households speak a language other than English at home, with Spanish as the most frequently spoken language other than English. Over the past decade, Montgomery County has become both the most populous jurisdiction in Maryland and the second largest jurisdiction in the Washington, DC metropolitan area, with almost one million residents (U.S. Census Bureau, 2011). Racial and ethnic diversity has concurrently increased with this drastic increase in population numbers. Non-Hispanic whites now comprise only 49 percent of the population of Montgomery County. For the first time, minorities account for more than half of Montgomery County’s population, making it a “majority-minority” county. The percentage of Hispanics or Latinos in Montgomery County (17 percent) is more than double the percentage of Hispanics or Latinos in the state of Maryland (8 percent), and within Montgomery County, it outnumbers all populations other than non-Hispanic whites (U.S. Census Bureau, 2011). According to the U.S. Census Bureau, Maryland is one of the top ten destinations for foreign-born individuals, and 41 percent of the foreign-born in Maryland reside in Montgomery County.3 Montgomery County’s foreign-born population has gone from 12 percent in 1980 to currently more than 30 percent.4 Immigrants contribute greatly to our community, and our hospital providers are committed to understanding their needs and working to treat them in a culturally competent manner. Washington Adventist Hospital conducted a Community Health Needs Assessment (CHNA) to examine the health status and outcomes among different populations in Montgomery and Prince George’s Counties, with the goal of identifying health disparities, achieving health equity, and improving the health of all groups.

1 2010 Census Summary for Prince George’s County. Prince George’s County Planning Department. http://www.pgplanning.org/Assets/Planning/Countywide+Planning/Research/Facts+Figures/Demographic/2010+Census+Summary.pdf 2 Immigration and the 2010 Census. Maryland Data Center: Census. http://www.census.state.md.us/Immigration%20and%20the%202010%20Census_final.pdf 3 Literacy, ESL and Adult Education. Literacy Council of Montgomery County. http://www.literacycouncilmcmd.org/litadultedu.html 4 Foreign-Born Population of Montgomery County Region, 1950-2000-Census Years. Montgomery Planning. 2000. http://www.montgomeryplanning.org/research/data_library/population/po34.shtm

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Implementation Strategy Development and Adoption Washington Adventist Hospital’s Community Health Needs Assessment was reviewed and approved by the Adventist HealthCare Board of Trustees on April 18, 2013. The Washington Adventist Hospital President’s Council also reviewed the findings of the hospital’s 2013 Community Health Needs Assessment. After discussion, the President’s Council came to a consensus to focus on two areas: Behavioral Health (including mental health and substance abuse), and Influenza among the population served by Washington Adventist Hospital. Washington Adventist Hospital’s Board of Trustees, consisting of leaders from community-based organizations, local safety net clinics, physicians, and health care leaders, reviewed and approved this Implementation Strategy. Why These Priority Areas Were Chosen Based on findings from its Community Health Needs Assessment, Washington Adventist Hospital’s President’s Council decided to focus on the following two areas: Behavioral Health: • The rate of hospital discharges for bipolar disorder has increased for Montgomery County

adults; there was a two-fold increase in readmissions in the past decade. • In Washington Adventist Hospital’s service area, the ZIP code with the highest Emergency

Room rate and hospitalization rate due to alcohol abuse was 20912. Influenza: • In Washington Adventist Hospital’s service area, the ZIP codes with the highest Emergency

Room rates due to immunization preventable influenza and pneumonia included 20901, 20904, and 20912.

Focus Area 1: Behavioral Health Washington Adventist Hospital plans to address behavioral health needs by referring 100 percent of admitted patients with identified conditions of substance abuse and/or chemical dependency, to appropriate resources for intervention and follow-up. We will begin to establish a transitional care plan for discharged patients with bipolar disorder to connect them to a Federally Qualified Health Center or primary care practice that includes integrated behavioral health and home-based case management services, in order to reduce readmission rates. We will also strengthen our outstanding partnership with Victory Towers, a retirement apartment complex for low-income senior citizens, which includes 187 apartment units as well as government-subsidized rentals. Here, we will provide resources to residents regarding alcohol abuse, a common problem in ZIP code 20912, where Victory Towers is located. Goal: Implement strategies to address behavioral health (mental health and substance abuse) needs in the population served by Washington Adventist Hospital.

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Objectives to be completed by end of FY2015: 1. Washington Adventist Hospital will refer 100% of admitted patients with identified

conditions of substance abuse/chemical dependency to appropriate resources for intervention/follow up.

2. Washington Adventist Hospital will establish a transitional care plan for discharged patients with bipolar disorder, to connect them to an FQHC or primary care practice for care that includes integrated behavioral health and home based case management services to reduce readmission rates.

3. Washington Adventist Hospital will provide resources to Victory Towers (low-income senior

apartment complex in ZIP code 20912) regarding alcohol abuse. Objective 1: Goal Implement strategies to address behavioral health needs.

Purpose Address high ER/hospitalization rate due to alcohol abuse.

Accomplishments to Date

On staff physicians with specialties in addiction

Chemical Dependency Therapist on staff

Gaps Patients currently admitted with conditions of substance abuse/chemical dependency are not provided resources for intervention and follow-up. There is no protocol in place for addiction specialists to reach all patients admitted with conditions of substance abuse/chemical dependency.

Objective By FY 2015, Washington Adventist Hospital will refer 100% of admitted patients with identified conditions of substance abuse/chemical dependency to appropriate resources for intervention/follow-up.

Actions Case Management nursing staff to provide resources to patients admitted with conditions of substance abuse/chemical dependency before discharge.

Train additional staff to address chemical dependency.

Evaluation Strategy: Develop a process to use the electronic medical record to monitor whether patients with substance abuse/chemical dependency receive appropriate resources and follow-up care.

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Objective 2: Goal Implement strategies to address behavioral health needs.

Purpose Address high rate of hospital discharges and readmissions for bipolar disorder.


Partial Hospitalization Program (8:30 a.m. - 3:30 p.m.) & Intensive Outpatient Program (4:30 p.m. - 8:00 p.m.), both focused on mental health issues including bipolar disorder; Voluntary Program.

Gaps No programs tailored specifically for bipolar disorder; no specific protocol to track and follow-up with bipolar patients post discharge, i.e. follow-up phone calls, and support groups for bipolar disorder not currently available.

Objective By FY 2015, Washington Adventist Hospital will establish a transitional care plan for discharged patients with bipolar disorder to connect them to an FQHC or primary care practice for care that includes integrated behavioral health and home-based case management services to reduce readmission rates.

Actions Establish a transitional care plan for discharged patients with bipolar disorder.

Connect discharged patients with bipolar disorder to an FQHC for primary care.

Connect discharged patients with resources to help with medication compliance.

Evaluation Strategy: Through the Outpatient Case Management Services, the hospital will track this by following up with discharged patients with bipolar disorder and documenting whether or not they have received adequate follow-up care post-discharge. The referrals can also be tracked through the FQHC on the Washington Adventist Hospital’s campus.

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Objective 3: Goal Implement strategies to address behavioral health needs.

Purpose Address high prevalence Emergency Room visits and hospitalizations due to alcohol abuse in ZIP code 20912.

Gaps No specific programs address alcohol abuse.

Objective By FY 2015, Washington Adventist Hospital will provide resources to Victory Towers (low-income senior apartments) regarding Alcohol Abuse.

Actions Connect family members of residents suffering from alcohol abuse with resources to help address alcoholism.

Provide education and resources to residents dealing with alcoholism.

Evaluation Strategy: Track the resources and services provided to Victory Towers. Evidence-Base: This initiative involves the provision of resources and outreach to low-income seniors who experience high rates of alcohol abuse. The following citations show evidence of similar initiatives that have shown significant reductions in the use of alcohol, medications, and illicit drugs, as well as reduced symptoms of depression among seniors. Citations: Gfroerer, J., Penne, M., Pemberton, M., Folsom, R. (2003). Substance abuse treatment need

among older adults in 2020: The impact of the aging baby-boom cohort. Drug and Alcohol Dependence, 69 (2), 127-135. http://dx.doi.org/10.1016/S0376-8716(02)00307-1.

Schonfeld, L., King-Kallimanis, B. L., Duchene, D. M., Etheridge, R. L., Herrera, J. R., Barry, K. L., & Lynn, N. (2010). Screening and Brief Intervention for Substance Misuse Among Older Adults: The Florida BRITE Project. American Journal of Public Health, 100(1), 108-114. doi: 10.2105/AJPH.2008.149534.

Quijano LM, Stanley MA, Petersen NJ, Casado BL, Steinberg EH, Cully JA, Wilson NL. Healthy IDEAS: A Depression Intervention Delivered by Community-Based Case Managers Serving Older Adults. Journal of Applied Gerontology (April 2007) 26 (2) 139-156. http://jag.sagepub.com/content/26/2/139.short.

Fleming, Michael F. MD, MPH; Manwell, Linda Baier; Barry, Kristen Lawton PhD; Adams, Wendy MD, MPH; Stauffacher, Ellyn A. Brief Physician Advice for Alcohol Problems in Older Adults: A Randomized Community-Based Trial. The Journal of Family Practice. (May 1999) 48 (5): 378-384. http://www.med.wisc.edu/pds/ebm/cases/therapy3/bettyarticle.pdf

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Focus Area 2: Influenza Washington Adventist Hospital plans to implement strategies to address high influenza-related Emergency Room rates. The strategies include partnering with Federally Qualified Health Centers (FQHCs) (e.g., Community Clinics, Inc.), community organizations, churches, senior centers, and county health departments in Montgomery and Prince George’s Counties to provide free vaccinations to residents with the greatest need. We will also partner with “Care For Your Health” physicians to provide vaccine for micro practice patients in the ZIP codes within Washington Adventist Hospital’s primary service area with the highest ER rates due to immunization-preventable influenza and pneumonia. Goal: Implement strategies to address high influenza-related Emergency Room rates in the population served by Washington Adventist Hospital. Objectives to be completed by end of FY2015: 1. Washington Adventist Hospital will partner with local FQHCs and community organizations

to provide free flu shots to residents with a greater need in ZIP codes with highest ER rates due to immunization preventable influenza (20912, 20901 and 20904).

2. Washington Adventist Hospital will partner with Care For Your Health (Dr. Anna Maria Izquierdo-Porrerra) to provide vaccine for micropractice patients.

• Practice located in ZIP code 20904; secondary practice area to be covered including 20901, 20912.

Objective 1: Goal Implement strategies to address high ER rates due to influenza.

Purpose Address high influenza rates in ZIP codes 20912, 20901, and 20904.


Washington Adventist Hospital offers annual low cost & free flu shot clinics from September – January in the hospital and in the community.

Gaps Greater outreach may be needed for low-income residents in target areas.

Objective By FY 2015, Washington Adventist Hospital will partner with local FQHCs to provide influenza vaccinations to residents in ZIP codes with highest ER rates due to preventable influenza (20912, 20901, and 20904).

Actions Provide free flu shots through the FQHCs and community outreach events to residents in the target ZIP codes.

Adjust number of vaccinations each year depending on ER rates.

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Objective 2:

Goal Implement strategies to address high ER rates due to influenza.

Purpose Address high influenza rates in ZIP codes 20912, 20901, and 20904.


Washington Adventist Hospital offers annual low cost & free flu shot clinics from September – January in the hospital and in the community.

Gaps Greater outreach may be needed for low-income residents in target areas.

Objective By FY 2015, Washington Adventist Hospital will partner with Care For Your Health (Dr. Anna Maria Izquierdo-Porrerra) to provide influenza vaccine for micropractice patients. Practice located in ZIP code 20904. Secondary practice areas to be covered include 20901 and 20912.

Actions Provide influenza vaccine to Care for Your Health micropractice.

Evaluation Strategies: Track the number of influenza vaccinations provided at community locations in high-need areas and for micropractice patients. Evidence-Base: This initiative involves providing free and low-cost influenza vaccinations in low-income and underserved areas that have demonstrated high rates of influenza-related Emergency Room use. The following citations show evidence of the effectiveness of vaccination against influenza in healthy adults, among high-risk populations, and the effectiveness of increasing influenza vaccination rates at inner-city health centers. Citations: Nichol, K., Lind, A., Margolis, K., Murdoch, M., McFadden, R., Hauge, M., Magnan, S., &

Drake, M. (1995). The effectiveness of vaccination against influenza in healthy, working adults. The New England Journal of Medicine, 333(14), 889-93. doi: 10.1056/NEJM199510053331401.

Bond, T. (2010). Influenza vaccination in a high-risk population: An evidence-based approach to public health practice. (Doctoral dissertation), Available from Emory University’s Electronic Thesis and Dissertation Repository. Retrieved from http://pid.emory.edu/ark:/25593/7v34t.

Nowalk, M., Zimmerman, R., Lin, C., Raymund, M., Tabbarah, M., Wilson, S., McGaffey, A., Wahrenberger, J., Block, B., Hall DG., Fox DE., & Ricci EM. (2008). Raising adult vaccination rates over 4 years among racially diverse patients at inner-city health centers. Journal of the American Geriatrics Society, 56(7), 1177-1182. doi: 10.1111/j.1532-5415.2008.01769.x.

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Other Areas Addressed by Washington Adventist Hospital Washington Adventist Hospital already addresses and will continue to address other areas of need through existing community health outreach programs, education, and screenings. The following table summarizes highlighted needs identified in the Community Health Needs Assessment and ways in which the hospital addresses those needs, or refers to other sources to address the needs. Disclaimer: This implementation strategy specifies the community health needs that Washington Adventist Hospital has determined to meet in whole or in part and that are consistent with its mission. The hospital reserves the right to amend this implementation strategy as circumstances warrant. For example, certain needs may become more pronounced and require enhancements to the described strategic initiatives. During the three years ending December 31, 2016, other organizations in the community may decide to address certain needs, indicating that the hospital should then refocus its resources to best serve the community.

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Washington Adventist Hospital’s Community Programs Addressing Identified Community Health Needs

Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Cancer

• Breast 15% more white women were diagnosed with breast cancer than black women, while 48% more black women died from breast cancer than white women in Montgomery County. Prince George’s County had a 43% higher death rate of breast cancer than Montgomery County.

Reach uninsured residents of Montgomery County through continued partnership with Mercy Health Clinic, Mobile Med, Mansfield Kaseman Clinic, Pan Asian Clinic, Women’s Cancer Control Program, and Komen Foundation, by providing free early detection screenings and health education outreach.

Washington Adventist Hospital (WAH) will provide free mammogram screenings, navigation, biopsies, ultrasounds, surgeries, and treatment for the uninsured. Encourage prevention & early detection through education at community health fairs, and community locations serving vulnerable populations.

Track and analyze numbers of: mammograms and other screenings provided, breast cancer abnormality findings, and treatment provided. Track number of participants encountered and educated during community outreach.

Cancer • Colorectal

Colorectal cancer is the 2nd leading cause of cancer-related death in U.S. Although the screening for and incidence of colorectal cancer among all races in Montgomery County is relatively comparable, mortality rates were much higher for blacks than whites or other races, indicating that blacks may be getting systematically less or inferior follow-up care post screening.

Reach target populations through continued partnership with Montgomery County Cancer Crusade, Mercy Health Clinic, Mobile Med, Mansfield Kaseman Clinic and Pan Asian Clinic, and provide early detection screenings and community health education/ outreach.

Provide free colonoscopies for target population and refer patients with abnormal findings to Montgomery Cancer Crusades for further treatment. Encourage prevention & early detection through education at community health fairs, and community locations serving vulnerable populations.

Track and analyze numbers of: colonoscopies, treatments and outcomes, as well as community encounters. Continue to monitor local incidence and mortality rates for colorectal cancer.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Cancer (other)

• Lung • Prostate • Cervical • Skin • Oral • Thyroid

General – Prince George’s County has higher mortality rates than the state of Maryland for most cancers. Lung cancer – incidence and mortality rates among black residents of Montgomery County are higher than among white residents. In Prince George’s County, white residents have highest lung cancer incidence rates. Prostate cancer - mortality rate in Prince George’s County is significantly higher than the state of Maryland rate; 93% more black men died of prostate cancer than white men in Montgomery County. Cervical cancer – incidence rate is greatest among Hispanic women (10.2 per 100,000), compared to black women (6.5 per 100,000) or white women (4.9 per 100,000) in Montgomery County. Skin Cancer – White men

Provide free cancer screenings to the community at the annual cancer screening days; provide educational lectures to target populations as well as education to patients at the hospital, and to the community at health fairs and various community locations.

WAH partners with physicians to provide free annual cancer screenings to the community, targeting: breast, prostate, colorectal, oral, skin and thyroid cancer. Additionally, bilingual Cancer Outreach Coordinators encourage prevention and early detection by providing educational presentations and materials to underserved and at-risk populations at community locations. WAH also provides tobacco cessation education and counseling as well as nicotine replacement therapy (NRT) at no cost to eligible patients.

Track and analyze numbers of: cancer screenings, abnormal findings, and treatment provided. Track number of participants encountered and educated through community outreach.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes show the greatest disparity in both incidence and mortality rates compared to county averages. Oral Cancer – Montgomery County’s incidence rate is the lowest among Maryland’s counties. Thyroid Cancer – Montgomery County has the highest incidence rates for thyroid cancer in Maryland, while Prince George’s County has the lowest rates.

Diabetes

Diabetes is 8th leading cause of death in Montgomery County and it disproportionately affects minority populations and the elderly. Diabetes is predicted to rise as these populations continue to increase in Montgomery County. The total health care related costs for the treatment of diabetes runs about $174 billion annually in the U.S., much of that is

Encourage prevention of diabetes through community health education at health fairs, senior and community centers. Ensure that patients at WAH who are diagnosed with diabetes receive appropriate education on how to manage their disease.

WAH will provide inpatient and outpatient services and education for diabetes, and its Center for Advanced Wound Care & Hyperbaric Medicine treats wounds due to complications of diabetes. Provide diabetic education classes. Encourage diabetes prevention through education at community health fairs and community locations.

Track and analyze numbers of participants encountered and educated through inpatient and outpatient diabetes education and through community outreach. Monitor rates of ER visits and hospitalizations due to diabetes.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes spent on hospitalizations and medical care.

Heart Disease and Stroke

Heart Disease – Heart disease was ranked as number one cause of death in U.S. by the CDC. The death rate from heart disease was higher in Prince George’s County than in Maryland. Although on the decline in Maryland and Montgomery County due to improvements in treatment, it remains the leading cause of death in Montgomery County for people over 65 years (whites-30%, blacks-26%, and Hispanics-22%). Stroke – One of the top five leading causes of death in the U.S. Mortality rates in Montgomery County have met the HP 2020 target, but health disparities between racial/ethnic groups persist. Black residents have the highest stroke death rate in the County at 34.4/100,000 compared to whites at 29.8,

Provide free screenings related to cardiovascular health at annual “Love Your Heart” community health fair. Provide strong cardiovascular community outreach, to include the following screenings to community: Lipid Profile, Vertical Auto Profile, Homocysteine, HsCRP, blood pressure, glucose and A1C. Provide free cardiovascular educational materials, blood pressure screenings and body composition screenings (BMI, weight, % body fat, % muscle) at health fairs, churches, senior centers, and various community locations.

WAH will continue to hold its annual “Love Your Heart” screening event to provide free screenings to community members for: blood pressure, cholesterol, glucose, waist circumference, BMI, body composition, and sleep apnea, as well as 1:1 counseling with a clinician. WAH will continue offering Lipid Profile, Vertical Auto Profile, Homocysteine, HsCRP, blood pressure, glucose and A1C screenings, as well as providing free educational lectures to the community. WAH offers the Complete Health Improvement Program (CHIP), which counsels participants on healthy choices regarding diet and weight management.

Track and analyze numbers of screenings and findings from screenings. Track the number of participants encountered and educated through community outreach.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Asian/Pacific Islanders at 19.6, and Hispanics at 14.5.

Obesity According to Healthy Montgomery, 56.1% of County residents are either overweight or obese, and 21% of low-income children ages 2-5 in Montgomery County are overweight compared to 17% in Maryland. In Prince George’s County, 69% of residents are overweight or obese and 48% of children are overweight or obese.

Provide both individual (1:1) and group nutrition counseling, and health education related to exercise and nutrition to the community at a variety of community locations.

Provide 1:1 health education and group presentations about healthy nutrition and the importance of exercise at health fairs, senior and community centers, and faith-based organizations. Provide affordable individual nutrition counseling to the community. WAH also offers the Complete Health Improvement Program (CHIP), which counsels participants on healthy choices regarding diet and weight management.

Track the number of participants encountered and educated through community outreach. Monitor rates of obesity and overweight at the county level.

Influenza

New Initiative for CHNA

Implementation Strategy

(see remainder of report for details

The rate of ER visits due to immunization-preventable pneumonia and influenza was much higher among younger adults (18-24 years old) than among any other adult age group in Montgomery County. Influenza-related death mostly occurs among seniors 65 years and older.

Provide influenza vaccinations to the community throughout the fall flu season in a variety of locations, including locations that have elderly adults with limited mobility (e.g. senior living facilities and housing).

WAH will partner with local FQHCs, physician micropractices, and community organizations to provide free flu shots to residents with a greater need in ZIP codes with highest ER rates. Continue to provide low cost flu shot clinics throughout Montgomery and Prince

WAH will document and track the number of influenza vaccinations provided to community members, and analyze provision of vaccine by variables such as age, ZIP code, and insurance or payment type. Monitor rates of ER visits and hospitalizations due to

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes George’s Counties to children, adults and seniors at community centers, senior centers, faith-based organizations, the hospital, and subsidized apartment complexes.

influenza.

Maternal & Infant Health

Although infant mortality is decreasing, black residents of both Montgomery and Prince George’s Counties continue to experience the highest rates. The adolescent birth rate in Prince George’s County is significantly higher than the state average. Expectant Hispanic and black mothers in Montgomery and Prince George’s Counties are more likely than white mothers to receive late or no prenatal care.

Continue to provide the excellent care to expectant/new mothers, their families, and their infants by providing childbirth classes, infant care classes, breastfeeding classes, as well as a variety of support groups. Continue to collaborate with Montgomery County Maternity Partnership Program to provide prenatal services to low-income and uninsured residents.

In addition to childbirth, breastfeeding, and parenting classes, WAH offers free programs to its patients, such as BEST (Breastfeeding, Education, Support & Togetherness) to promote and support breastfeeding, and Discovering Motherhood support group for new mothers. In partnership with the Montgomery County Maternity Partnership Program, WAH provides prenatal services to low-income and uninsured residents, including: prenatal care, routine lab tests, education/classes and dental screenings. WAH also supports Mary’s Center for Maternal and Child Care,

Continue assessment and evaluation of Maternal and Infant programs through tracking numbers of participants and surveys of participant feedback. Monitor maternal and infant health status in Montgomery County and Prince George’s County.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes which provides culturally and linguistically competent care to low-income, uninsured individuals and families.

Behavioral Health

New Initiative for CHNA

Implementation Strategy

(see remainder of report for details

In Montgomery County 1 in 10 residents has been diagnosed with an anxiety disorder and nearly 17% have been diagnosed with a depressive disorder. The rate of hospital discharges for bipolar disorders in Montgomery County has increased and there was a two-fold increase in readmission rates in the past decade. ZIP code 20912, in which WAH is located, has by far the highest ER and hospitalization rates due to alcohol abuse in Montgomery County.

Implement new strategies to address behavioral health (mental health and substance abuse) needs in the population served by Washington Adventist Hospital.

- WAH will refer 100% of admitted patients with identified conditions of substance abuse/chemical dependency to appropriate resources for intervention/ follow up. - WAH will establish a transitional care plan for discharged patients with bipolar disorder, to connect them to an FQHC or primary care practice for care that includes integrated behavioral health and home based case management services to reduce readmission rates. - WAH will provide resources to Victory Towers (low-income senior apartment complex in ZIP code 20912) regarding alcohol abuse.

- Develop a process to use the electronic medical record to monitor whether patients with substance abuse/chemical dependency receive appropriate resources and follow-up care. - Through the Outpatient Case Management Services, WAH will track this by following up with discharged patients with bipolar disorder and documenting whether or not they have received adequate follow-up care post-discharge. The referrals can also be tracked through the FQHC on Washington Adventist Hospital’s campus. - Track the resources and services provided to Victory Towers.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Senior Health The percentage of Maryland

residents over the age of 60 is expected to increase from 15% in 2010 to 25% by 2030. In Montgomery County, 6.2% of seniors live below the poverty level, with higher percentages among minority seniors and women.

Continue to provide community health outreach programs, education and health screenings to seniors at a variety of locations in the community served by WAH.

WAH offers community health programs for seniors at: Long Branch Community Center, Takoma Park Community Center, Mid-County Community Center, Bowie Senior Center, Victory Towers, Green Ridge House, Springvale Terrace, as well as numerous other subsidized senior apartment complexes. WAH’s community health education and outreach to seniors covers a variety of topics such as: heart health, cholesterol screenings, blood pressure screenings, healthy nutrition, fall prevention, summer safety, disease prevention, cancer screening education, brain health, osteoporosis screenings and bone health, flu and pneumonia shots, education on the importance of exercise, lay person CPR and Basic First Aid instruction.

Track the number of participants encountered and educated through community outreach. Continue to monitor and assess senior health status in Montgomery and Prince George’s Counties to assure needs are being met and addressed.

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Areas of Need Not Directly Addressed by Washington Adventist Hospital & Rationale

Topic Area CHNA Findings* Goal Resources Rationale Asthma Rates of ER visits for

asthma were lower for Montgomery and Prince George’s Counties than for the state of Maryland; however, black residents of both Montgomery and Prince George’s Counties had asthma ER visit rates about 5 times higher than white residents, and hospitalization rates showed a similar trend.

Provide community members with resources on asthma through community outreach.

WAH is in the process of hiring a new pulmonologist to help address this identified need. Montgomery County has established The Asthma Management Program, which focuses on reaching out to Latino Children. This program provides education, support and follow-up care. Additionally, the following organizations provide the community with asthma resources: American Lung Association of Maryland, Asthma and Allergy Foundation of America (Maryland Chapter), and the Maryland Asthma Control Program.

WAH does not currently provide community outreach and educational programs specifically for asthma because asthma prevalence and rates of ER visits in Montgomery County and Prince George’s County are below rates statewide, and because there are other asthma resources available in the County. WAH will continue to monitor trends in asthma to determine whether future reallocation of resources is needed to provide asthma-related community programs.

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Areas of Need Not Directly Addressed by Washington Adventist Hospital & Rationale Topic Area CHNA Findings* Goal Resources Rationale

HIV/AIDS Prince George’s County has the 2nd highest rate of HIV/AIDS prevalence in the region (after D.C.); nearly 88% of people living with HIV/AIDS in Prince George’s County are black. Black residents represent about 16% of Montgomery County’s population, yet 71% of HIV cases diagnosed in 2008 were black residents. While HIV-related deaths in Montgomery County have greatly decreased in the past decade, black residents account for almost 4 out of 5 HIV-related deaths, and had a death rate that was nearly 10 times higher than whites.

Continue to support other organizations that provide services related to HIV and AIDS.

Treatment and support of those with HIV or AIDS is provided by both private and public health care providers. The safety net clinics serving Montgomery County provide diagnostic services and treatment. Montgomery County Health Department provides HIV Case Management (including dental care, counseling, support groups, home care services, education and outreach to at-risk populations), clinical services, lab tests, and diagnostic evaluations. Prince George’s County Health Department provides testing in locations throughout the County, as well as health assessments, physical exams, lab tests, and case management services. Whitman Walker Clinic offers a variety of services. Maryland AIDS Administration educates

WAH does not currently provide community outreach and educational programs for HIV/AIDS due to limited financial resources, and because many HIV/AIDS services are provided by other local organizations. Adventist HealthCare’s Center on Health Disparities led an initiative called Project BEAT IT! (Becoming Empowered Africans Through Improved Treatment of type 2 diabetes, HIV/AIDS, and hepatitis B), which was a grant-funded initiative from U.S. DHHS Office of Minority Health that provided culturally appropriate health education classes to health care providers and the African immigrant community to improve health outcomes related to these chronic and

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public and health care professionals.

infectious diseases. The 20-month grant funded project ended in September 2013.

Social Determinants of Health

• Food Access • Housing Quality • Education • Transportation

Food Access – Montgomery County performs better than state and national baselines with regard to food deserts, while Prince George’s County performs worse than state and national baselines. Housing Quality – 50.8 percent of renters in Montgomery County spend 30% or more of household income on rent. In the area served by WAH, shelters, transitional housing, and motel placements served nearly 8,000 residents (FY2008). Education – The percentage of children who enter kindergarten ready to learn in Montgomery

Partner with and support other organizations in the community that specialize in addressing needs related to food access, housing quality, education, transportation, and other social determinants of health.

Food Access – Manna Food Center is a central food bank in Montgomery County that provides direct food assistance at 14 locations, assisting approximately 5% of Montgomery County residents. In Prince George’s County, Community Support System’s pantry serves over 7,000 people each year. Housing Quality – WAH supports and partners with a local non-profit organization called Interfaith Works, which provides shelter to approximately 744 homeless men and women each night, and has served 135,000 meals through its Homeless Service programs. Additionally, the Montgomery County Coalition for the Homeless

WAH does not directly address many of the social determinants of health because those are not specialty areas of the hospital and WAH does not have the resources or expertise to meet many of these needs. Instead, WAH partners with and supports other organizations in the community that specialize in addressing needs related to food access, housing quality, education, transportation, and other social determinants of health.

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County (74%) and in Prince George’s County (79%) is lower than the state of Maryland baseline (81%). The percentage of students who graduate high school in 4 years is also lower in Prince George’s County (73.3%) than in the state (80.7%). Transportation – Montgomery County ranks in the top quartile of longest commute times among all U.S. counties. The rate of pedestrian injuries on public roads in Montgomery County (44.2/100,000) is higher than the state of Maryland baseline (39.0/100,000).

has shelters and emergency housing as well as programs to provide permanent housing for families. This organization also assists with applying for Medicaid, food stamps, and other entitlement programs, as well as transportation, education completion, and vocational assistance. The Housing Initiative Partnership in Prince George’s County helps low-income residents buy homes, prevents foreclosure, and helps people stay in their homes through tax assistance and loan modification programs. Education – The Housing Initiative Partnership sponsors a ‘Reading is Fundamental’ program encouraging families to read together, has a free library, sponsors summer reading programs, and offers an

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English as a Second Language (ESL) program for adults. Local community colleges offer low-cost higher education opportunities. The Interagency Coalition to Prevent Adolescent Pregnancy works to reduce teen pregnancy – a common reason teenagers drop out of school. Transportation – For community members relying on public transportation, there is a Ride On bus stop located right next to WAH and Ride On Bus 17 will drop off passengers directly at the main entrance to the hospital. WAH also helps to arrange transportation home for many patients upon discharge.

* For complete CHNA findings and sources, please refer to the Washington Adventist Hospital Community Health Needs Assessment (2013-2016)

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community health needs assessment implementation strategy ... · 2013 – 2016 the community health...

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