2013 Comprehensive Three-Year Community Service Plan

Transcription

1 2013 Comprehensive Three-Year Community Service Plan

2 2013 Comprehensive Community Service Plan Prepared to meet the requirements of New York State Public Health Law November 2013 This plan is linked to the NYS Prevention Agenda Comprehensive Community Service Plan

3 Table of contents I. Mission Statement...1 II. Community Served..2 III. Public Participation...4 IV. Assessment and Selection of Public Health Priorities...6 V. Three-Year Plan of Action VI. Dissemination of Plan to the Public VII. Implementation and Tracking...26 VIII. Appendices A. Appendix 1: Key Stakeholder Participants...27 B. Appendix 2: Bassett Medical Center CHNA Stakeholder Session Summary...28 C. Appendix 3: Community Services Plan and County Community Health Assessment Development Process and Community Participation.35

4 I. Mission Statement The Mary Imogene Bassett Hospital (d.b.a. Bassett Medical Center) Bassett Medical Center is an academic medical center that exists to advance the health care of rural populations through: Providing excellence in the continuum of care Educating physicians and other health care professionals Pursuing health research Bassett Medical Center serves as the foundation for the Bassett Healthcare Network and is a 180-bed acute care inpatient teaching facility, located in Cooperstown, New York. It provides 24-hour emergency and trauma care, comprehensive cancer and heart care, dialysis, and most medical and surgical specialties. The Bassett Clinic is located on the same campus as the medical center and provides outpatient primary and specialty care. Bassett maintains a strong academic program through its affiliation with Columbia University College of Physicians and Surgeons, highlighted by the establishment of a Columbia medical school campus at Bassett in The medical center provides postgraduate residency training programs in Medicine and Surgery. The Bassett Medical Group (BMG), which is comprised of a full-time, salaried staff numbering over 400 physicians and other advanced practice clinicians, provides primary and specialty care at the Bassett Clinic and staff Bassett Medical Center in Cooperstown. Bassett physicians and other health professionals also provide preventive, primary and specialty outpatient care at rural health clinics and school-based health centers throughout eight counties. The Bassett Research Institute and the New York Center for Agricultural Medicine and Health conduct research in basic and clinical science, population and public health studies.

5 II. Community Served Bassett Medical Center Service Area Bassett Healthcare Network provides health services in more than 20 communities spanning 5,600 square miles. The map above shows the service area for Bassett Medical Center, which is largely determined by the population centers and counties each of the Network s six affiliate hospitals are located in. Bassett s facilities and its affiliates include: Bassett Medical Center, an acute care inpatient teaching facility in Cooperstown, Otsego County; A.O. Fox Hospital, an acute care hospital in Oneonta, Otsego County; O Connor Hospital, a critical access hospital in Delhi, Delaware County; Cobleskill Regional Hospital, an acute care facility in Cobleskill, Schoharie County; Little Falls Hospital, an acute care facility in Little Falls, Herkimer County; Tri-Town Regional Hospital, a 24/7 emergency care facility in Sidney, Delaware County; the Bassett Clinic, an outpatient primary and specialty care center on the Bassett Medical Center campus in Cooperstown; 30 community based outpatient health centers, 19 school based health

6 centers; two ambulatory surgery centers; Valley Health Services, a residential health care and rehabilitation facility; At Home Care, a certified home care agency; and First Community Care of Bassett, a medical supply company. The service area for Bassett Healthcare Network encompasses eight counties, however the vast majority of its service area is comprised of the counties Bassett Medical Center and its five affiliate hospitals are located in: Otsego County, with a population of 61,917; Delaware County, with a population of 47,559; Herkimer County, with a population of 64,160; and Schoharie County, with a population of 32, 578 (according to 2011 U.S. Census estimates). The service area has a lower percentage of population that is school-age and a higher percentage of older residents compared to the state and national populations. This age structure has a significant impact on the area's economics. The percent of population 65 and older and the median age in the various counties throughout the service area significantly exceed the statewide and/or national figures. The area s overall median age of 42 is older than the statewide median of 38 years and the area s overall percentage of population 65 and older (16.7%) is higher than the statewide percentage (13.7%) and national percentage (13.3%). The older age of the population results in a higher regional chronic disease burden, as the incidence and prevalence of various chronic diseases tends to increase with age, as well as the existence of multiple comorbidities. This also contributes to a higher de facto disability burden. The service area is characterized by long-standing structural unemployment, rather than shorter term employment downturns with good recovery prospects. The area includes parts of Appalachia in the south and runs north into the Mohawk Valley along the old Erie Canal route from Schenectady to Utica, New York. Once populated with prosperous industrial and mill towns, the area s industrial sector has been in economic decline since the post-wwii era and is part of the nation s original Rust Belt. Recent years have also witnessed the accelerated decline in the number of small, family owned and operated farms. Generations of local adults aged 18 to 64 have out-migrated in search of employment opportunities elsewhere, and few new families have in-migrated. The area s aged industrial and commercial infrastructure makes the area less economically competitive as larger capital investment is needed for new business development. Five of the eight counties have unemployment rates that exceed the state and/or national rates. The area also has a much higher rate of small unincorporated business and selfemployed workers. These small family businesses, including nearly all of the area s remaining farms, mean that many owners and workers have limited or no economic fringe benefits, including health insurance and paid time off. Wages and income must, therefore, stretch even further to provide an on-going safety net otherwise provided by larger, corporate employers, unions or even corporate-scale farming and agro-businesses not characteristic of the area. The service area population is comparatively poorer and has fewer economic resources. The U.S. Census imputed percentage of population living in poverty is higher in six of the eight counties than the state and/or national percentage. Median household incomes in the area are well below the statewide and U.S. medians and the population has substantially less economic assets. The median household income in the service area is $43,591, more than $10,000/year below the statewide median and approximately $8,000 below the national median.

7 In 2012, inpatient admissions totaled 12,708 to Bassett Medical Center; emergency department visits totaled 17,503 and 49,565 network wide; outpatient visits totaled 699,970. III. Public Participation This Community Service Plan is informed by Bassett s Community Health Needs Assessment (CHNA). As such, both have taken into account input from persons who represent the broad interests of the community served by Bassett Medical Center. All organizations providing input, including the name and title of those individuals representative of the organization, are listed in Appendix 1. This included input from individuals with expertise in public health, specifically the Otsego County Health Department; community members as users of the local health system; the county Office for the Aging; public school superintendents and college representatives; public health partners such as home care agencies, and public assistance agencies. A) Stakeholder Sessions: In addition to posting of the CHNA on the hospital's website for public viewing and comment, the primary proactive means for receiving community input was through a community-wide stakeholder meeting hosted by Bassett Medical Center on December 7, The purpose of the stakeholder meeting was threefold: 1) to elicit general comments on community health needs and the draft CHNA (which also serves to inform the CSP); 2) to seek community input on the proposed priority health needs; and 3) to seek community input on potential implementation strategies. Sixteen individuals representing 10 area health providers and community services organizations attended the session (see Appendix 1). Additionally, Bassett Medical Center, as well as representatives from Bassett s affiliate hospitals, attended stakeholder sessions sponsored by other health organizations in their respective counties. Bassett Medical Center and affiliate A.O. Fox Hospital, both located in Otsego County, participated in a September 4, 2013 NYS sponsored regional CHA/CSP planning session and an October 4, 2013 CHA planning session sponsored by Heidi Bond and the Otsego County Public Health Department. Out of the October 4 meeting came agreement among all participating agencies that two priority focus areas should be Chronic Disease and Promotion of Mental Health/Prevention of Substance Abuse for Otsego County s CHA and the hospitals CSP. In addition to the process and community participation specifically used in developing the CHNA/ CSP, significant processes and community participation were involved in compiling the Bassett Medical Center Community Service Plan and in development of the various counties' Community Health Assessments for within Bassett s service area, including Otsego County s CHA. These documents were also reviewed and considered as community health needs were identified. Each of these efforts included their own process and methods for identifying community health needs and provided numerous opportunities for community input and participation in reviewing and influencing the selection of priority health needs.

8 B) Outcome of Public Input: In broad terms, public input supported the health priorities identified by the CHNA and that support was reaffirmed in subsequent CSP meetings Bassett participated in as outlined above. During the CHNA stakeholder session last December, several suggestions were made concerning the selected priorities. It was suggested that the access priority be more specific about the type of access to be improved, i.e. primary care, transportation or financial. The decision was made to concentrate on improved access to primary care and to quality dental care. With respect to the chronic care priority, it was suggested that it be expanded to cover diabetes and prostate and skin cancers. A decision was made to concentrate on colorectal cancer screenings as Otsego County is not meeting the state objective with regard to these screenings. Several comments were also received regarding the selected targeted objectives. Suggestions were made that the dental access objective should be focused on children, noting that the number of emergency department visits for cavities among 3-5 year olds since 2005 in Otsego County increased 74 percent. Others, however, supported a continued focus on adults. As a result, the objective includes improving access among both children and adults. It was also suggested that the access objectives be more targeted on population subgroups with the greatest needs, but a good method for doing so was not agreed upon. With respect to the physical activity and good nutrition objective, it was suggested that an obesity objective for children be added using children s body mass index as a measure as Bassett s school-based health centers are tracking this data. Comments on the mental health objective suggested that increasing referrals for services would not necessarily solve the access focus of the objective. While mental health and substance abuse were viewed as high priority issues in each of the stake holder sessions, there was concern over the severe shortage of mental health providers plaguing not just rural NY, but the nation. So while we may improve our screening and referrals for mental health and substance abuse issues, the provider shortage and difficulty recruiting providers to this rural region remains a significant barrier. Lastly, with respect to the chronic disease objectives, it was suggested that focusing on screening 18 year old men and women for human papillomavirus and increasing HPV vaccination rates might have longer term impacts on reducing chronic diseases and this is taken into account in the CHNA/CSP. C) Notification of Sessions: The first CHNA stakeholder session, which served the dual purpose of also informing Bassett s CSP, was sponsored by Bassett. Letters of explanation were sent out inviting individuals representing the broad interests of the community served by Bassett Medical Center to the December 2012 session. The resulting draft CHNAs for each of the six hospitals in the Bassett Healthcare Network, including Bassett Medical Center, were placed on the hospitals websites for public review and comment. The September 4, 2013 regional CSP/Prevention Agenda meeting was a state DOH organized event, and Bassett network hospitals received an invitation to that from HealtheConnections Health Planning. Finally, the October 4, 2013 CSP/CHA meeting

9 was organized by Otsego County Public Health and invitations were ed to health care, public health and other organizations around the region to discuss and determine common top health priorities and objectives. Identifying additional collaborative opportunities related to the agreed upon priorities and objectives is expected to be part of an ongoing discussion with the various community health partners. IV. Assessment and Selection of Public Health Priorities A) Assessment of Public Health Priorities: For the purposes of the 2013 CSP, Bassett Medical Center, A.O. Fox Hospital and the Otsego County Public Health Department considered stakeholder input at the October 2013 Community Health Planning session from individuals representing a broad crosssection of public health agencies and organizations. This input, as well as data from the NYS BRFSS and, USCensus.gov reviewed at this planning session, supported selection of the two common priorities identified by the hospital and LHD: 1) Prevention of Chronic Disease and 2) the Promotion of Mental Health and Prevention of Substance Abuse. As part of the process leading up to the October 2013 county planning session, Bassett also reviewed the Community Service Plans of the counties served by the Bassett Healthcare Network, including Bassett Medical Center s CSP; the Community Health Assessments of the counties within the Bassett Healthcare Network, including Bassett Medical Center s home county, Otsego County, and the current health priorities identified by these documents. In addition, the findings of the Bassett Research Institute s seven county Upstate Health & Wellness Survey were considered. The Bassett Medical Center Community Service Plan was a collaborative process that included the Bassett steering committee, the advisory group, a community focus group session and review of multiple databases. This led to the identification of three priorities from the NYS Prevention Agenda. Each of the following three priorities were among those that rose to the top again in the 2013 CHNA, CHA and CSP discussions at the various stakeholder sessions held in Otsego County by Bassett, Otsego County Public Health and the NYSDOH regional session. Improving Access to Quality Health Care dental health in particular; There is a lack of dental and mental health providers in Otsego County and access to services is limited to only two dental providers in the county who accept Medicaid patients. In 2008, only 66.4 percent of Otsego County adults had visited a dentist in the past year as compared to 70.5 percent for NYS as a whole (4/09 Expanded BRFSS Interim Report). In addition, 67.4 percent of third grade children experienced tooth decay in 2004 compared to 54.1 for NYS the same year (NYS DOH Health Indicators for Tracking Public Health Priority Areas.) Improving Mental Health & Substance Abuse Services; and

10 There are gaps in adult health screenings for substance abuse and mental health issues in Otsego County, and there is a lack of up to date referral information available to primary care providers for mental health services/professionals, support groups and other resources. Over 17 percent of adults in Otsego County were reported as binge drinkers in 2008 (defined as men having 5 or more alcoholic drinks or women having 4 or more alcoholic drinks on one or more occasions within the past month) 4/09 expanded BRFSS interim report) and nearly 7 percent were reported as heavy drinkers (defined as men averaging more than 2 alcoholic drinks per day and women averaging more than 1 alcoholic drink per day within the past month) as compared to state average of 5.4 percent (4/09 Expanded BRFSS Interim Report). Increasing Physical Activity & Good Nutrition Habits. There is a lack of continuity between schools, families and medical providers in obesity prevention, diagnosis and treatment. This is a major concern given that nearly 40 percent of adults in Otsego County were considered overweight in 2008 (body mass index more than 24.9 but less than 30) compared to 34.6 percent for NYS (4/09 Expanded BRFSS Interim Report) The Otsego County Community Health Assessment for was developed in tandem with the Community Service Plans for A.O. Fox Memorial Hospital and Bassett Medical Center. As a result, following the review of a variety of data from the NYS Department of Health and multiple other data sources, there was consensus identification of three Prevention Agenda Priorities. They were: Improving Access to Quality Health Care; The Otsego County Community Health Assessment placed a priority on increasing access to quality health care. This priority should include redefining health care to include dental care, mental health, emergency care, emergency response, alternative and complimentary health care, community outreach by health care providers, at-home visits, transportation, education, and maintenance or follow-up / after-treatment care for chronic disease. Access should be affordable and not limited by SES eligibility guidelines that are too low, health insurance participation or reimbursement, office hours, or transportation in rural areas. Ensure an immediate EMT response when 911 is dialed. Improving Mental Health and Substance Abuse Services; and The Community Health Assessment also identified availability of mental health and substance abuse services as a priority. This priority included: identification of individuals in need of crisis-level intervention and support services; increased numbers of mental health providers; and services that are available for all populations. Additionally,

11 access should not be limited to those with health insurance or who can afford services, or who reside in rural areas. Increasing Physical Activity and Good Nutrition Habits. The assessment identified, as a third priority, increasing physical activity and nutrition interventions to reverse increasing trends in chronic disease in Otsego County. Proactive initiatives to counter childhood and adult obesity should be affordable and accessible, and should include recreational activities that are available in all four seasons and particularly during the summer months for students. Follow-up care is needed for children who are identified as obese and require individualized age/growth specific nutritional guidance from a dietitian and achievable physical activity goals designed to bring them into a healthy weight range. In addition, psychological counseling to bolster self-esteem and counter any presumed or real bias should be provided for children in need. This care should be continuous and coordinated between families, schools and health care providers. Similar services for other family members, including adults, who are identified as obese and need follow-up care, should also be available. Education about the health benefits of physical activity and good nutrition should include information about prevention of chronic disease. The consideration and selection of future health priorities also takes into account findings of the Bassett Research Institute s Upstate Health and Wellness Survey with respect to several health priority areas. The survey provides a primary data source for identifying the health status of residents in a seven county area served by the Bassett Healthcare Network and its affiliate hospitals and other providers (Chenango, Delaware, Herkimer, Madison, Montgomery, Otsego, and Schoharie). The Upstate Health & Wellness Survey, conducted in 2009 by the Bassett Research Institute, consisted of separate surveys covering the topics of: (1) household health, (2) access to health care, (3) child lifestyle and behavior choices, (4) adult lifestyle and behavior choices, and (5) health and health needs of the rural elderly. The survey was designed to provide baseline data to: 1) assess the rural region in terms of 27 priority health indicators established in 2008 by the Commissioner of the New York State Department of Health; 2) Identify key geospatial, social and demographic factors related to living in rural areas that may explain ruralurban health differences; and 3) identify the need for existing and new community health promotion programs throughout the region. The five separate surveys were each designed to meet additional aims. Different sampling frames were used for the five surveys conducted in Three of the surveys (Household Health; Access to Health Care; Child Lifestyle and Behavior Choices) were administered to random samples of households in the seven county study region based on a list of household addresses. The sampling frames for the other two surveys (Adult Lifestyle and Behavior Choices; Health and Health Needs of the Rural Elderly) were derived from a random sample of the roster of participants in a previous Health Census conducted in A random sample of individuals with a BMI value from the 1999 Health Census was selected for the survey on adult lifestyle and behavior choices. The sample for the survey on the rural elderly included all farmers from prior health censuses conducted in 1989 and 1999, who would be at least 50 years of age in 2009, and a random sample of non-farmers from the 1989 or

12 1999 Health Census who met the same age criterion. The random household surveys conducted in each of the seven counties of Bassett's service area are shown in the table below. In total, the survey included 13,226 respondents for the household survey, 1,784 respondents for the access survey and 979 respondents for the child lifestyle and behavioral choices survey. In addition, for the purposes of Bassett s CHNA/CSP, the survey data was re-aggregated along the service area for Bassett Medical Center as defined by zip codes. Household Health Access to Care Child Lifestyle All Respondents Respondents 18+ Primary Respondent Kids 2-18 Region 13,226 11,009 1, Schoharie 1,847 1, Otsego 2,663 2, Montgomery 1,692 1, Madison 1,840 1, Herkimer 1,822 1, Delaware 1,373 1, Chenango 1,989 1, While the overall goal of determining the general health status of Bassett s rural service region remained constant, the 2009 Upstate Health & Wellness Survey expanded on previous efforts by: 1) undertaking an extensive pre-study collaborative planning process with local health departments and the public, 2) collaborating with public health researchers from area universities, and 3) including physical measurements on some participants to confirm the validity of self-reports. In addition to providing descriptive epidemiologic data on the prevalence of health behaviors and conditions, the 2009 survey was designed to test a number of hypotheses in the areas of obesity, aging, health care access, chronic disease, mental health, and other concerns identified by the community. Differences include the following: Improving Access to Quality Health Care Within the service area during 2009, 88.6 percent of adults had at least some form of health insurance (in comparison to the NYSPA and HP2020 goal of 100 percent). The percentage of adults with a primary care provider was 80.6 percent (compared to 96 percent and 95 percent for goals of NYSPA and HP2020, respectively). A larger gap between current status and goal was observed for utilization of dental services 56.3 percent of adults had routine dental care during the previous 12 months, compared to the NYSPA goal of 90.8 percent. Increasing Physical Activity & Good Nutrition Habits.

13 A simple comparison between the NYSPA and HP2020 goals and the Upstate Health and Wellness Survey findings is not possible for physical activity. The report of the survey focused on regular leisure time exercise (3 or more times per week) instead of ever engaging in leisure time physical activity (the more modest goal set by the NYSPA and HP2020). The proportion of adults exercising 3 or more times per week was 33.5 percent; the prevalence was somewhat higher than the corresponding value for the entire region (31.5 percent). The prevalence of obesity in adults was slightly lower in the service area (27.7 percent) than in the region (28.7 percent) and lower than the HP2020 goal (30.6 percent), but well above the NYSPA goal of 23.2 percent. Reducing Chronic Disease The estimates of prevalence for diabetes and hypertension in the Upstate Health and Wellness Survey were 5.8 percent and 21.1 percent; in comparison, the NYSPA goal for diabetes is 5.7 percent and the HP2020 goal for hypertension is 26.9 percent. It should be acknowledged that estimates based on self-reported history of a provider s diagnosis will not include prevalent but undiagnosed cases, which may have led to underestimates from the survey. The estimates from the Upstate Health and Wellness Survey for cancer screening all fall below HP2020 goals. The percentage of women 18 years and older with a Pap smear in the previous 3 years was 73.3 percent (goal 93 percent), the percentage of women 40 years and older with a mammogram in the past 2 years was 68.8 percent (goal 81.1 percent); and the percentage of adults 50 years and older with a colonoscopy in the past 5 years was 55.1 percent (goal 70.5 percent). Levels of cancer screening in the Bassett Healthcare Network service area were similar to levels for the entire seven counties. Reducing Tobacco Use The prevalence of smoking by adult residents of the service area was 16.5 percent, slightly lower than the prevalence for the entire region (17.5 percent) but exceeding the goal of 12 percent set by both the NYSPA and HP2020. Improving the Health of Children Data from the Upstate Health and Wellness Survey on children are not directly comparable to the NYSPA or HP2020 goals. The state and national goals for oral health are presented as prevalence of dental caries in 3 rd grade children. The survey measured the percentage of children 4-18 years of age receiving routine dental care in the past year; this percentage was 80.2 percent in the Bassett Medical Center service area and 76.3 percent in the entire seven counties. The NYSPA and HP2020 goals for child obesity are based on the percentage of children at or above the 95 th percentile for BMI on the 2000 CDC growth charts, while the Upstate Health and Wellness Survey reported the percentage at or above the 85 th percentile (which might be interpreted as a combination of obese and at risk for obesity). This

14 percentage was 34.5 percent for the children in the Bassett Medical Center service area, similar to the percentage for the entire region (34.3 percent). Improving Mental Health The percentage of adults in the service area experiencing 14 or more days with poor mental health in the last month was estimated to be 5.2 percent. This value is below the NYSPA goal (10.1 percent) but should be interpreted with caution, since one key contact typically provided the survey information about all residents of the household. Data collected in this way may be most accurate for well-defined or observable characteristics (e.g. smoking, having a regular primary care provider). Additionally, the trends in patient volumes at Bassett s inpatient and outpatient mental health services indicate increased demand, rather than a decline. B) Selection of Public Health Priorities: The health priorities identified through Bassett s Community Health Needs Assessment, which also served to inform Bassett s Community Service Plan, were selected based upon the application of five criteria.they included: 1. The priority area was identified by at least two of three primary information sources: Bassett Medical Center Community Service Plan ( ), the seven counties' community health assessments ( including Otsego County ) or supported by the findings of the Upstate Health and Wellness Survey; 2. The priority area was consistent with the current and proposed NYS Department of Health Prevention Agenda Areas; 3. The priority area was supported by data showing health status indicators or health needs were below either the averages for New York State or for Bassett's service area based on the Upstate Health and Wellness Survey; 4. The degree of aberration from National Healthy People 2020 goals and/or from NYS Prevention Agenda Objectives; and 5. The priority area was identified and recommended during the CHNA/CHA/CSP public input processes [see appendices]. The application of these criteria resulted in the selection of the following three health priorities for Bassett Medical Center s Community Health Needs Assessment. The health priorities have been stated in terms consistent with the new NYS Health Improvement Plan and guidance issued on December 10, 2012 for the development of the next iteration of hospital community service plans in In addition, at the October 4, 2013 CHA/CSP stakeholder community health planning session organized by Otsego County Public Health, the workgroup (including Bassett Network affiliates Bassett Medical Center and A. O. Fox Hospital), agreed that the top two priority focus areas to be addressed are 1) Preventing Chronic Disease and 2) Promotion of Mental Health and Prevention of Substance Abuse. The decision to focus on Chronic Disease takes into account Bassett Medical Center s continued commitment to expanding primary care access throughout its service region, which is expected to serve as a strategy for also combating chronic disease.

15 NYS Prevention Agenda Priorities Jointly Identified by Hospital & LHD Preventing Chronic Diseases (common to Otsego County s CHA) Disparity: Increase the percentage of adults (50 75 years) with an income of less than $25,000 who receive a colorectal cancer screening based on the most recent guidelines (blood stool test in the past year or a sigmoidoscopy in the past 5 years and a blood stool test in the past 3 years or a colonoscopy in the past 10 years) by 5% by 2017 (NYS Prevention Agenda Objective). Otsego County s median household income $45,334 vs. NYS $56,951 Persons below poverty 16.4% vs. NYS 14.5% [Data Source: US census.gov ] Otsego County adults with an income <$25,000 with colorectal screening 59.4% [Data Source: NYS BRFSS ] Preventing chronic diseases is also the second priority identified through Bassett s CHNA process. It is among the five NYS Prevention Agenda priorities and is one of the two health priorities jointly identified with Otsego County Public Health for the purposes of the LHD s CHA and the hospital s CSP. Selection of this area is a newly established priority for Bassett Medical Center. Reducing chronic disease was also a priority identified in three of seven county community health assessments (Chenango, Herkimer and Fulton) and was also recognized as an important area of concern in Delaware, Otsego and Schoharie. The Upstate Health and Wellness Survey data supports the selection of this priority for Bassett Medical Center, where the reported survey data showed that in the Bassett service area the rates of cancer screening for cervical, breast and colon cancer were significantly below national and New York target levels; at nearly 20 percent below the national goal for 18 year and older women with a Pap smear in the prior three years; over 12 percent below the national goal for women 40 and older with a mammogram in the prior two years; and over 15 percent below the national goal for adults 50 and older with a colonoscopy in the prior five years. The New York State Cancer Registry, 2011 data, also reveals that Otsego County s incidence of colorectal cancer is higher than the New York State rate. The county has also had a higher mortality rate for cancer than the rest of NYS seven of the past 10 years, and a higher mortality rate for common cancers, including lung, prostate and colorectal. This also supports the selection of preventing chronic disease as a health priority. In addition to the focus on cancer screening as a means of preventing chronic disease, a second longer range prevention focus will be on increasing physical activity and good nutrition habits. The Bassett Medical Center Community Service Plan, as well as four of the seven county health departments in their respective Community Health Assessments (Delaware, Fulton, Otsego and Schoharie) identified this as a priority concern. The Upstate Health and Wellness Survey data showed over 34 percent of children in the Bassett service area were obese or at risk for obesity. The survey also showed that obesity among adults in the service area was nearly 28 percent. Additionally, NYS data reveals that in 2009, 62 percent of Otsego County adults reported being obese or overweight, and middle and high school students were more likely to be overweight or obese than elementary students, with 33 percent of middle

16 and high school students being overweight or obese (Source: NYS SPARCS ). Strategies related to this area will include specifically targeting obesity among children and adolescents.. Promoting Mental Health and Preventing Substance Abuse (common to Otsego County s CHA) Promoting mental health and preventing substance abuse is a priority identified through Bassett s new CHNA and is a jointly identified NYS Prevention Agenda Priority in the hospital s CSP and LHD s CHA. This priority was also identified in Bassett Medical Center's Community Service Plan and in three of the seven county community health assessments in the service area (Chenango, Montgomery and Otsego) and also identified as an area of importance by the Delaware County Community Health Assessment. The focus in selecting this priority is to increase training for Bassett Healthcare Network primary care physicians in conducting mental health and substance abuse screenings and providing immediate on-site referral to a social worker to connect patients with the help they need. The rate of drug related hospitalizations has nearly quadrupled since 2001, reaching 29 hospitalizations per 10,000 residents in 2010, an increase that is contrary to the statewide experience. A slightly lower share of Otsego County adults (9.6 percent) reported poor mental health for 14 days or more during the previous month than adults statewide (10.2 percent) in 2009 (Source: NYS SPARKS). However, as these are self-reports, it s expected the incidence is underreported. Trends across the county at mental health intake units show a continuing upward trend in the number of individuals needing mental health services. Therefore, stakeholders agreed in the October 2013 workgroup session that this should be a continued community health priority. In addition to the two health priorities jointly identified with Otsego County Public Health, Bassett, in the CHNA process, identified a third health priority: Improving Access to Quality Health Care Improving access to care is also a priority selected by Bassett Medical Center in its previous Community Service Plan, as well as by six of the seven service area county health departments in their respective Community Health Assessments of In addition, the Upstate Health and Wellness Survey data supports the selection of this priority for Bassett Medical Center, where just over 80 percent of adults reported they had a primary care provider and just over 56 percent reported they had routine dental care in the previous year. The focus in selecting this priority is to specifically improve access to both dental and primary care within the Bassett service area, thereby also positively influencing rates of chronic disease as increased regular primary care visits would be expected to lead to preventive screenings and earlier detection and treatment. A three year plan of action is not included in the CSP for Improving Access to Quality Health Care, as it was not a jointly identified priority with the local health department.

17 V. Three Year Plan of Action Numerous strategies to address the selected community health priorities in this CSP and to achieve targeted objectives related to those priorities were considered. Among others, strategies considered included those identified in Bassett Medical Center s Community Service Plan, in its 2012 Annual Operating Plan, suggestions made by the public and key stakeholders in commenting on the CHNA, and suggested as intervention considerations in the NYS Prevention Agenda Action Plan for Strategies were identified on a Bassett Medical Center service area basis, as well as on a Bassett Healthcare Network wide basis. For the purposes of the 2013 Community Service Plan, the three year plan of action addresses the two NYS Prevention Agenda priorities common to Bassett s CSP and Otsego County s CHA: Preventing Chronic Disease and Promoting Mental Health and Preventing Substance Abuse. As a means to measure progress in addressing the health priorities for Bassett Medical Center and the communities it serves, targeted objectives are identified in each priority area. Objectives were selected based on: goals identified in the hospital's Community Service Plan and stakeholder sessions sponsored by Bassett Medical Center, Otsego County Public Health and the NYSDOH regional CHA/CSP session; the U.S. Department of Health and Human Services, Healthy People year national objectives; and the NYS Department of Health, Health Indicators for Tracking Public Health Priority Areas. Review of these sources allowed for a comparison between service area, state and national rates. A) Goals & Objectives Preventing Chronic Disease [Priority identified with Otsego County Public Health] Goal: Increase screening rates for cardiovascular disease, diabetes and breast/cervical/colorectal cancer, especially among disparate populations Goal: Address and prevent childhood obesity and improve current rates of overweight and obesity in population Bassett serves; expand role of private and public employers in obesity prevention Objective 1.0 : To increase the percentage of women 40 and older in the Bassett Medical Center service area with a mammogram in the past two years from 68.8 percent to 75 percent by 2017 (working toward the NYS Prevention Agenda objective of 81 percent). Performance Indicators: Number of women 40 and older who receive the screening mammogram annually throughout the Bassett network Annual percentage increase in number of women 40 and older who are screened with a goal of achieving a nearly six percent increase by 2017 Number of women referred on for follow-up care Objective 1.1 : To increase the percentage of adults in the Bassett Medical Center service area who receive a colorectal cancer screening based on the most recent guidelines

18 (blood stool test in the past year or a sigmoidoscopy in the past 5 years and a blood stool test in the past 3 years or a colonoscopy in the past 10 years by 5 percent by 2017 (NYS Prevention Agenda Objective).* Performance Indicators: Number of men and women 50 to 75 who receive a colorectal cancer screening annually Percentage increase annually in number of adults who receive screening with goal of a five percent total increase by 2017 Objective 1.2 : To increase the percentage of women 18 and older in the Bassett Medical Center service area with a Pap smear in the prior three years from just over 73 percent to 83 percent by 2017 (working toward the NYS Prevention Agenda objective of 93 percent). Performance Indicators: Number of women 18 and older who received a Pap smear the prior 3 years Percentage of annual increase in the number of women 18 and older who received a Pap smear the prior 3 years, with the goal of achieving a 10 percent increase by 2017 Objective 1.3 : To reduce the rate of cervical cancer by increasing the percentage of young men and women 18 years of age getting the human papillomavirus HPV vaccine in the Bassett Medical Center service area from less than 25 percent to 50 percent by 2017 (as recommended by the Centers for Disease Control & Prevention and the American Academy of Pediatricians). Performance Indicators: Number of young men and women 18 and older who receive the HPV vaccine each year in Bassett s pediatric clinics, including SBH, prime care and women s health clinics Annual percentage increase in number of young men and women receiving the HPV vaccine each year in these clinics, with goal of achieving 50% by 2017 Objective 1.4 : To reduce the rate of obesity among adults in the Bassett Medical Center service area from nearly 28 percent (reported) to 22 percent by 2017 (working toward the NYS Prevention Agenda of 15 percent) Performance Indicators: Number of adult men and women seen in Bassett s primary care clinics with a BMI indicating clinical obesity Percentage reduction annually in number of men and women identified as obese, with a goal of reducing Otsego County s obesity rate to 22 percent by 2017 Objective 1.5 : To increase the percentage of adolescents in the Bassett Medical Center service area getting at least 7 hours of physical activity each week to over 10 percent by 2017 (working toward the Healthy People 2020 Goal of 20 percent). Performance Indicators: Annual number of adolescents in Bassett s SBH program getting at least seven hours of physical activity each week. Percentage increase annually in number of SBH adolescents getting at least seven hours of physical activity each week, with a goal of achieving over 10 percent by 2017

19 *Clinical standards for colorectal screening have been modified to include blood stool and sigmoidoscopy tests and increased from 5 to 10 years for colonoscopies. As a result measurement of this objective will require collection of additional and different data in the future. B) Improvement Strategies Preventing Chronic Disease Cancer Screening Develop and/or improve community, place-based interventions targeted to address the social determinants of health in high-priority vulnerable communities Establish clinical practices that connect patients to self-management education and community resources Expand use of health information technology to remind, provide feedback and incentivize clinicians and health care systems. Support the meaningful use of electronic health records in improving prevention and control of chronic diseases. Community Based & Clinical Strategies: A collaborative strategy between Bassett Medical Center and the Bassett Cancer Institute will be pursued to improve community access to cancer screening services for breast, cervical and colon cancer. A key aspect of the strategy will focus on improving the system of referrals for cancer screening. Development and integration of electronic medical records (EMR) systems will assist in improving referral and tracking of patients receiving cancer screenings. Bassett s EMR, Epic the most commonly installed EMR among health care systems in the country was implemented in the outpatient setting in 2011and expanded to the network s affiliate hospitals in 2013 (except Fox Hospital, which has McKesson), as well as rolled out in the inpatient setting at Bassett Medical Center. Clinical best practices are being woven into Bassett s EMR. So, for patients with chronic conditions for instance, providers can review their care and know immediately if they are meeting clinical best practices or need to adjust in order to do so. All orders pertaining to and impacting patient care are entered into one single location and all patient information is available to providers no matter where they are in the network, whether the hospital setting or outpatient regional clinics across the eight counties Bassett serves. As the system matures and populates data over time, Bassett will be able to track not only patients but an entire practice and/or community with the available data and develop interventions to improve population health. Overweight, obesity and diabetes are examples of chronic conditions Bassett is targeting in order to better manage and improve patient care. A patient portal, MyChart, allows patients to access personal health information, their medical history and track their progress over time. A new feature added late in 2013 will

20 send health and wellness reminders targeted to the patient s specific needs (i.e. colorectal cancer screening, mammography screening, Pap due). A second strategy of Bassett Medical Center specific to reducing cervical cancer will be targeting 18 year old men and women and increasing the percentage in this age group who receive the human papillomavirus (HPV) vaccine in the Bassett Medical Center service area. This is already underway through the School-Based Health Program. Bassett Healthcare Network Strategies: A network wide strategy includes achieving and maintaining medical home status and developing team based models of care. This is an evidencebased approach to tracking chronic conditions and disease in order to measure progress and develop interventions to improve patient outcomes. Within this framework, clinical practices will be pursued to ensure that the cancer screening rates of the targeted objectives are achieved. These models of care will result in a greater focus on wellness and prevention, including identification of patients who are obese or at risk of obesity through BMI screenings and subsequent referrals, another targeted objective related to this priority. Twenty-five of Bassett s primary care health centers across eight counties have achieved level three medical home status, which requires demonstration of meaningful use of the EMR. Key program components required to achieve recognition also include: Written standards for patient access and enhanced communications Appropriate use of charting tools to track patients and organize clinical information Responsive care management techniques with an emphasis on preventive care Use of information technology for care management Use of evidence-based guidelines to treat chronic conditions Systematic tracking of referrals and test results Measurement and reporting of clinical and service performance A second network strategy is the continued support and operation of the Bassett Cancer Institute custom-built medical coach equipped with digital technology for mammography and other cancer screenings, including colorectal and cervical cancer screenings. The cancer screening services of the coach will be targeted to rural areas and includes a partnership with the Cancer Services Program of Otsego, Delaware and Schoharie Counties to also provide free screenings to the uninsured at community-based locations so that individuals don t have to travel long distances to access these preventive screenings. This same partnership exists in Bassett s northern service region with the Cancer Services Program of Herkimer, Madison and Oneida Counties. Impacts and Commitment of Resources: It is anticipated pursuit of these strategies will lead to increases in the percentage of population being screened for specific types of cancers by 2017, including an increase to 75 percent (up from 68.8) of women over forty with a mammogram in the last three years; a 5 percent increase in colon screenings; an increase to 83 percent (up from 73) of women 18 and older receiving cervical cancer screening every three years; and an increase to 50 percent (up from under 25 percent) of 18 year olds receiving the HPV vaccine.

21 In pursuit of these results, Bassett Medical Center will dedicate additional resources to increase monitoring and reporting of cancer screening through its EMR system (see above description of resource commitments); conduct a targeted effort to reach 18 year olds through the resources of the SBH (see above description of resource commitments); continue to allocate annual operating resources of over $260,000 and staffing support of five to the Bassett Cancer Institute mobile medical coach for cancer screening (including two drivers/administrative assistants; an advanced practice clinician; a radiology technician; and a scheduling coordinator); and continue to support medical home model developments throughout the service area (see above description of resource commitments under access to primary care). Obesity Assist and collaborate with community partners on wellness initiatives & referrals School-based health centers actively involved and supported in obesity prevention interventions Use media and health communications to build public awareness, support of and engagement in wellness/healthy lifestyle initiatives Foster collaboration among community-based organizations, the education and businesssectors and clinicians to implement programs that improve access to healthy food, fitness resources and overall wellness resources Expand use of health information technology to remind, provide feedback and incentivize clinicians and health care systems Support the meaningful use of electronic health records in improving prevention of obesity and, therefore, related chronic diseases Develop workplace interventions that address this condition among staff Community & Clinical Based Strategies: Bassett Medical Center will continue to collaborate with local health departments and other community partners to provide early education about the importance of physical activity and nutrition throughout life, including during pregnancy and to prevent chronic disease. Bassett Medical Center will also collaborate with these partners to improve continuity of care between families, schools and primary care providers for the treatment of childhood obesity. In the fall of 2012, the Bassett Research Institute at Bassett Medical Center launched a pilot program targeting childhood obesity through a community-wide program that encourages and supports healthy nutrition and increased physical activity. The program, Let s Go , is an evidence-based approach to promoting community health and reducing childhood obesity that was developed in Maine ( engages schools, worksites, health care providers, and community, preschool and after-school programs in promoting healthy choices for kids: at least 5 fruits and vegetables, 2 hours or less of recreational screen time, at least 1 hour of physical activity, and 0 sugary drinks, more low fat milk and water every day. By bringing together six different sectors of the community to collaborate on implementing and reinforcing healthy behaviors, is truly community-based. While it s initially being piloted in two communities in Bassett s service area, Edmeston and Delhi, the plan is to take what s learned