WINTHROP-UNIVERSITY HOSPITAL

COMMUNITY SERVICE PLAN 2013-2016

Approved by the Board of Directors November 12, 2013

Winthrop-University Hospital 259 First Street Mineola, NY 11501 www.winthrop.org 1-866-WINTHROP

TABLE OF CONTENTS
I.
II. III. IV. V. VI. VII. Mission Statement1 Community Served..2 Public Participation.4 Assessment and Selection of Public Health Priorities.10 Three-Year Plan of Action.18 Dissemination of Plan to the Public.29 Community Engagement and Progress.29

Addendums A. B. C. Supporting the Community.32 Prevention Agenda Outcomes 201336 Winthrop-University Hospital Accomplishments

Attachments 1. 2. 3. 4. 5. Key Informant Interview Questions Community Health Assessment Survey Form English Community Health Assessment Survey Form Spanish Certificate of Translation Community Health Assessment Survey

I. MISSION STATEMENT
It is the mission of Winthrop-University Hospital (referred to as Winthrop or the Hospital) to provide high-quality, safe, culturally competent, and comprehensive healthcare services in a teaching and research environment, which improve the health and well-being of the residents of Nassau County and contiguous county areasbased on a profound commitment to an enduring guiding principle Your Health Means Everything. The Hospitals Community Service Plan is guided by and reflects its mission statement to improve the health and well-being of the residents it serves. Grounded by tradition and committed to the welfare of the community, Winthrop owns the distinction of being Long Islands first voluntary hospital. Founded in 1896, Winthrop has embodied a culture of caring and a commitment to excellence that resonates to this day. Dedicated to the integrity, comfort and well-being of the individual, Winthrop maintains the conviction that a three-pronged approach patient care, medical education and research are essential to the provision of the highest quality of healthcare. Winthrop is a 591-bed, regional healthcare resource offering an extensive range of preventive, diagnostic and clinical medical services through a broad range of primary care and specialized inpatient and outpatient programs. We deliver the highest level of care to newborns, children and adults as evidenced by our respective designations as a NYS Regional Trauma Center and NYS Regional Perinatal Center. The Hospital employs over 6,900 dedicated and caring individuals, including nearly 1,500 nurses; our medical staff includes more than 1,800 full-time and voluntary attending physicians. A number of Winthrops healthcare professionals are actively involved in community service. Many voluntarily provide free-of-charge hospital- and community-based health education lectures, conduct free screenings and attend health fairs all to support the community they serve.

PATIENT CARE
During 2012, Winthrop logged over 70,000 Emergency Department visits, discharged 31,724 inpatients and delivered 4,360 newborns. This included 8,629 inpatient surgical discharges, 590 of which were open-heart operations and an additional 20,428 ambulatory surgical cases. There were over 79,000 visits to community residents by the Hospitals certified Home Health Agency and more than 42,000 visits through its Long Term Homecare Program.

ACADEMIC AND CLINICAL AFFILIATIONS

Winthrop is the Clinical Campus of the Stony Brook University School of Medicine and an affiliated member of the New York-Presbyterian Healthcare System. 1

RESEARCH
Since the highest quality of care is found in settings that nurture education and research, Winthrop is currently building the Research and Academic Center, a 95,000 square-foot, fivestory facility that will house laboratories, academic lecture halls and clinics which will facilitate bench-to-bedside research, cross-fertilization of ideas and access to the most current information available. Fellows, residents and medical students will have the opportunity to learn from leading researchers how to collect data and apply it to provide better care, and scientists and clinicians will share their expertise to improve treatment options for patients.

II. COMMUNITY SERVED

As a large, regional healthcare provider on Long Island, Winthrop s comprehensive approach to healthcare delivery includes the provision of both primary and specialty services to our service area. The Hospitals primary/core service area has historically been Nassau County, specifically, Core Areas A, B, and C (See map below). The secondary service area, represented by Areas D and E, are also considered in the Hospitals strategic planning process for purposes of establishing new programs and services.

Blue: Core A; Green: Core B; Pink: Core C; Purple: Core D; Yellow: Core E

Basic Nassau County Demographics from the Nassau County Department of Health (NCDOH) state that the county has 1.3 million residents; is a suburban community that borders New York City and Suffolk County, with 11.3% of its residents African American and 14.6% Hispanic. Nassau County represents a dichotomy, as health disparities exist within and between townships of varying socioeconomic composition. According to data presented by the NCDOH to the collaborative workgroup January 2013, there are also differences in health status based on race and ethnicity. For example, infant mortality is much higher among African Americans than Caucasians. Latinos have higher rates of teen pregnancies, tuberculosis and deaths from injuries. The causes of these disparities are numerous and complex, and include differences in income, education, housing, and access to healthcare. The following communities have been identified by the NCDOH as select communities, i.e., those that exhibit health disparities and are in Winthrops Core Areas A, B and C: Elmont (11003), Inwood (11096), Freeport (11520), Glen Cove (11542), Hempstead (11550), Uniondale (11553), Long Beach (11561), Roosevelt (11575) and Westbury (11590). Based on an analysis of 2012 discharge data (Table 1), 80.6% of Winthrops discharges are from Nassau County, in core areas A, B and C. Within these areas, 30% of discharges are from select communities (Table 2). In developing the Community Service Plan, the Hospitals workgroup focused on executing the Prevention Agenda priorities in core areas A, B and C, highlighting the particular needs of the select communities with the Hospitals largest percentage of discharges, Core Area A.
Table 1

Discharge Data 2012 (excluding normal newborns) Core Areas A B C Nassau Total D E Other TOTAL Total 17,472 6,953 1,149 25,574 1,560 506 4,084 31,724 % of Total 55.1% 21.9% 3.6% 80.6% 4.9% 1.6% 12.9% 100%

Table 2

Discharge Data 2012 Select Communities (excluding normal newborns) Core Areas A B C TOTAL Total Select Communities 6,217 1,307 143 7,667 % of Total 81% 17% 2% 100% WUH Total 17,472 6,953 1,149 25,574 % of WUH Total 24% 5% .6 % 30%

III. PUBLIC PARTICIPATION

Public participation was organized and solicited through a collaborative process that involved five Nassau County Hospitals (Winthrop-University Hospital, Catholic Health Services, Long Beach Memorial Hospital, North Shore LIJ Health System, and South Nassau Communities Hospital), the Nassau County Department of Health, Adelphi University, and Stony Brook University. Participants and meeting dates are listed throughout this report. During the first meeting, held on January 15, 2013, the collaborative workgroup determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (i.e., the communitys perception of need). The workgroup agreed that in order to be effective, both qualitative and quantitative data should be collected from community organizations and the population-at-large. Two subcommittees Community-Based Organizations (CBOs) and Community-Wide Survey were formed with representation from the five not-for-profit hospitals, academic partners and the Nassau County Department of Health; each subcommittee was charged with developing and implementing the procedures to collect the information.

COMMUNITY-BASED ORGANIZATION KEY INFORMANT INTERVIEW DATA

Subcommittee included:
Adelphi University Hofstra University 1. Professor of Public Health Director of the MPH Program 1.Associate Professor Graduate Director, Master of Public Health & Master of Science in Community, Health Programs 1. Special Projects Representative

Long Beach Medical Center

Nassau County Department of Health

1. Director, Division of Quality Improvement, Epidemiology & Research 2. Epidemiologist 3. Intern 1. Director , Public Health Initiatives 1. Director, Rehabilitation & Community Services 1. Assistant Director, Community Relations

North Shore LIJ Medical Center St. Francis Hospital Winthrop-University Hospital

Interviews with community-based organizations were conducted between March and April of 2013. Representation included:
American Cancer Society Syosset, NY American Diabetes Association Melville, NY American Heart Association Plainview, NY Catholic Charities Hicksville, NY Circulo de la Hispanidad Long Beach, NY FEGS Health & Human Services (Federation of Employment & Guidance Service System) Hempstead, NY Health and Welfare Council of Long Island Hempstead, NY Island Harvest Mineola, NY Jewish Association Serving the Aging (JASA) Long Beach, NY LI GLBT (Gay, Lesbian, Bisexual, Transgender) Garden City, NY Long Island Council of Churches Hempstead, NY Mental Health Association Of Nassau County Glen Cove, NY Perinatal Services Network Uniondale, NY Planned Parenthood Hempstead, NY Massapequa, NY Glen Cove, NY 1. Director of Patient and Family Services 1. Director, Long Island Operations 1. Regional Vice President Field Operations 1. Director of Development and Communications 2. Developer, Information and Referral 1. Executive Director 2. Chief Director of Services and Operations 1. Senior Director 2. Director of HIV Services 3. Vice President, Long Island Operations 1. President and CEO 1. SNAP Outreach Coordinator 1. Director, Long Beach Services 1. Chief Operating Officer and Director of Development for Long Island 1. Director 2. Nassau County Coordinator 1. Director of Special Projects 1. Coordinator 1. Senior Vice President for Health Services, Planned Parenthood of Nassau County

Project Independence Roslyn Heights, NY Sustainable Long Island Farmingdale, NY United Way Deer Park, NY

1. Deputy Commissioner 2. Senior Citizen program Development Specialist 1. Executive Director 1. Senior Vice President

Note: Assessment Methodology is detailed in Section 4.

OUTCOME OF KEY-INTERVIEW PROCESS

The information was analyzed by a consultant, Jessica B. Steier, MPH, Doctoral Candidate. The findings were presented to the committee and CBOs on May 15, 2013.
Participants overwhelmingly reported chronic disease as one of the most pressing health problems; 76.4% of organizations feel it is a priority; 50% feel it is the number one health priority. The most commonly mentioned chronic diseases were diabetes, heart disease and cancer. Obesity was seen as the most important risk factor for chronic conditions; preventing obesity among youth, especially among minority populations, presented a strong theme. Patient education should emphasize prevention versus treatment, with a focus on healthy lifestyles (eating healthy and exercising) There should be increased communication across organizations to ensure visibility of programs and resources available A taskforce with members from various organizations would be helpful to brainstorm additional ideas and solutions Increased patient navigation and case management services would break down barriers to care

Barriers to care:
Inadequate public transportation in the county Language barriers for non-English speaking persons seeking quality health services Lack of awareness of available health resources (e.g. need to update 211 information banks that provide confidential information and referral for help with food, housing, employment, healthcare, etc.) Undocumented immigrant populations not accessing healthcare services due to fear of being reported and LGBT (lesbian, gay, bisexual and transgender) populations not accessing care due to fear of being treated differently Other themes included: the need for more in-home health and mental health services for homebound seniors; heavy reliance on emergency rooms for primary care; and the need for women to play a larger role in helping men access needed health services

INDIVIDUAL SURVEYS SUBCOMMITTEE INCLUDED:

Adelphi University Hofstra University 1. Professor of Public Health, Director of the MPH Program 1. Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community, Health Programs 1. Special Projects Representative 1. Director, Division of Quality Improvement, Epidemiology & Research 2. Epidemiologist 3. Intern 1. Director, Public Health Initiatives 2. Jennifer Ludwin, Health Educator 3. Director, Community Benefit 1. Community Health, Promotion Programs, Marketing & Conference Management 1. Director of Community Education 1. Assistant Director, Community Relations

Long Beach Medical Center Nassau County Department of Health

North Shore LIJ Medical Center

St. Francis Hospital South Nassau Communities Hospital Winthrop-University Hospital

The Nassau County Hospitals, the Nassau County Department of Health (NCDOH) and academic partners collaborated in developing a community-wide survey. The team agreed that the use of a uniform survey distributed widely throughout communities in Nassau County would help ascertain the health perceptions and key concerns of residents, as well as identify service needs and barriers to care. Surveys were widely distributed throughout the community and translated into a certified copy of Spanish (see Public Notification below). Each Nassau County Hospital and NCDOH distributed the survey to community members at events targeting various age groups, diverse populations and communities with health disparities. The survey was distributed between February and April 2013. OUTCOME OF SURVEY Surveys were analyzed by the Department of Health and shared with the committees and COBs on May 15, 2013. The top health concerns for all the respondents and the select communities were the following chronic diseases: cancer, obesity, diabetes and heart disease.

All respondents indicated that health screenings/educational programs on chronic disease especially diabetes and blood pressure were needed, highlighting the importance of routine well care, nutrition and physical activity. Select communities identified substance abuse as an additional high priority health concern. Both the total respondents and the select communities identified healthy food choices, recreational facilities, weight loss programs, clean air and water and job opportunities as items needed to improve the health of the community. All the respondents receive the majority of their health information from health professionals, the internet, television and family/friends. Over 50% of the total respondents and 70% of the select community respondents had a smart phone.

Barriers to Care The top concerns for barriers to medical treatment included: No insurance Lack of ability to pay deductibles and co-pays Fear of discussing health issues Lack of knowledge about the importance of routine medical care

WINTHROPS CULTURAL COMPETENCY COMMITTEE (includes outside agencies and Hospital staff) Meeting 5/21/13
Hempstead Hispanic Civic Association Hempstead, NY BQLI-AHEC (Brooklyn-Queens Long Island Area Health Education Center) Nassau County Department of Health Uniondale, NY Perinatal Service Network, DOH Uniondale, NY Hispanic Counseling Center Hempstead, NY Noticia (Hispanic Newspaper) St. Brigids Church Westbury, NY Winthrop Pediatrics (Hempstead Outpatient Clinic) Hempstead, NY 1. Executive Director

1. LI Program Coordinator 2. Area Health Education Center

1. Commissioner, Nassau County Dept. of Health 1. Director 1. Program Coordinator 1. Sales Director 2. Executive Assistant 1. Director 1. Practice Manager 2. Certified Child Life Specialist

Winthrop Womens Wellness (Hempstead Outpatient Clinic) Hempstead, NY

1. Social Worker 2. Ancillary Practice Manager 3. Nurse Manager 4. Summer Intern 1. Chief Executive Officer 2. Vice President, Womens & Childrens Services 3. Director of Development 4. Manager, Community Training 5. Community Outreach Educator 6. Community Outreach Educator 7. Manager, Community Outreach 8. Director of Pastoral Care 9. Assistant Director, Community Relations 10. Administrative Director, OB/GYN

Winthrop-University Hospital Mineola, NY

During this meeting, Winthrop engaged local community partners to clarify the needs of communities experiencing health disparities. Participants were given a survey representing the Prevention Agenda initiatives and the floor was opened for discussion. Outcome It was determined that obesity and diabetes, along with other chronic diseases such as cancer and heart disease, are the most important conditions to be addressed. Concerns were also raised about mental health issues, drug and alcohol abuse, illegal alien status, domestic violence, womens ignorance about contraception, and asthma. The high cost of food, cultural food issues that undermine health (such as traditional, high fat high carbohydrate diets) and lack of access to affordable, appropriate food were also discussed. The consensus of opinion is that the hospital needs to go into the community, during a weekend or another appropriate time when the underserved are available. CBOs are looking for health screenings and follow-up. Participating agencies offered to act as liaisons by letting their respective populations know that the Hospital will be coming to them. Barriers to Care Mistrust on the part of the community (e.g. fear of the undocumented) Lack of insurance for the working poor Lack of access to care on weekends Language barriers Lack of knowledge about managing conditions

Transportation difficulties (e.g. a single mother taking children on two buses to the Hempstead clinic).

Public Notification
Public notification of our needs assessment and the opportunity to participate was accomplished via the following methods: 1. Surveys were distributed through Survey Monkey, hospital outreach, public libraries, NCDOH Programs and County Agencies, Faith-based organizations, community centers, and via social media platforms. They were available in English and Spanish. 2. The collaborative assessment initiative was announced and explained at various hospital- and community-based organizations; attendees were given an opportunity to discuss issues, but chose to fill our surveys. 3. Surveys were also posted on the Hospitals website and publicized on Facebook . 4. Letters were sent to Winthrops community partners, requesting their assistance in determining needs of their constituents through the Cultural Competency Committee. 5. Two community forums held at Winthrop on September 26 and October 6 were announced in local papers, posted on the Winthrop website, and promoted via social media (Facebook). The forums gave the community additional opportunities to discuss their concerns and learn the outcome of the assessment; both were unattended.

IV. ASSESSMENT AND SELECTION OF PUBLIC HEALTH PRIORITIES

COLLABORATIVE ASSESSMENT PROCESS
The initial CHA/CHIP Community Health Assessment/Community Health Improvement Plan committee met on January 15, 2013 to gain an understanding of the health problems existing in Nassau County. Participants are identified in Section 3, under public participation, but to reiterate, they included: five Nassau County Hospitals (Winthrop-University Hospital, Catholic Health Services, Long Beach Memorial Hospital, North Shore LIJ Health System, and South Nassau Communities Hospital), the Nassau County Department of Health, Adelphi University, and Stony Brook University. Initial information included a preliminary community health assessment data presented by the Nassau County Department of Health comparing Nassau County, NYS and select communities within Nassau County. The objective was to identify and compare rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries (intentional and unintentional), cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. Sources of information 10

included SPARCS data (2008-2010), NYSDOH Vital Statistics, NYS Cancer Registry and the NYSDOH Surveillance System. Data were age-adjusted (direct standardization of rates) based on 2000 U.S. standard population. Key points that were discussed included the following: Largest segment of Nassau County (NC) population consists of adults ages 40-59 Primarily White/Caucasian, but growing minority populations, particularly Hispanics, especially in Hempstead Selected communities within NC have even higher minority populations which contribute to significant health disparities (again, these communities include Roosevelt, Long Beach, Westbury, Uniondale, Hempstead, Inwood, Elmont, Freeport and Glen Cove) Health disparities in the select NC communities exist with rates significantly higher than NC and/or NYS for chronic diseases: cardiovascular disease, respiratory disease (asthma and COPD), diabetes and liver disease For unintentional injuries, particularly Motor Vehicle Accidents, NC is higher than the state and selected communities within NC are higher than NC as a whole; also mentioned were bicycle injuries, pedestrian accidents and submersion (near drowning) Intentional injuries such as, assault, self-inflicted injuries and firearms follow similar patterns as those seen with unintentional injury for both NC and the selected communities Cancer Incidence for males: 1) prostate; 2) lung; 3) colorectal o Death Rates 1) lung; 2) prostate; and 3) colorectal Cancer Incidence for females: 1) breast; 2) lung; 3) colorectal o Death Rates 1) lung; 2) breast; and 3) colorectal Communicable disease rates for TB, syphilis, gonorrhea and Chlamydia are all higher in selected communities vs. NC Causes of death overall: 1) cardiovascular disease (CVD); 2) cancer; 3) respiratory disease; 4) stroke Teen pregnancy and individuals with late or no prenatal care also seen to be significantly higher among selected communities as identified above

The Key-Informant Interview Process for Community-Based Organization is described below. A complete list of participants is in Section III, Public Participation, Key-Interview Process The Community-Based Organizations (CBO) subcommittee was charged with conducting key informant interviews with Nassau Countys health and human services providers. The subcommittee met on January 25, 2013, to develop a list of key community organizations, a pre-interview questionnaire and a CBO interview guide.

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A list of community organizations was compiled based upon recommendations from both the larger Community Health Needs Assessment/Community Health Improvement (CHNA/CHIP) and the CBO subcommittee. Emphasis was placed on groups that addressed one or more of the following populations: minorities/medically underserved, seniors, womens/childrens services, special populations and individuals with disease-specific conditions. A qualitative CBO interview guide was developed and included questions with added prompts regarding New York States Five Prevention Agenda Priorities, significant health problems in the CBOs communities, barriers to care, quality of care, current health services, and recommendations for improving services. A specific interviewer was assigned to each CBO. The interviewers were comprised of representatives from the hospitals, the academic partners and the county health department. All interviewers were required to participate in a training session to ensure consistency across the interviewing process. This training was provided on February 6, 2013, by an Assistant Professor of Preventive Medicine in the Divisions of Evaluative Services and Community Health at Stony Brook University. As a result of the training, modifications were made to the interview guide. A copy of the final CBO interview guide is included as Attachment 1. The group agreed that all interviews should be audio-recorded and transcribed. Transcription duties were shared among the hospitals and health department. Analysis of Interviews The collaborative workgroup hired a consultant to analyze results. Staff from the Nassau County Department of Health interviewed three potential consultants to conduct the qualitative analysis of the key informant interviews. With input from an academic partner, a doctoral candidate in Public Health at CUNY Graduate Center was selected Jessica B. Steier, MPH, DPH Candidate. The hospitals contracted with and paid for the consultant. The consultant coded the key informant transcripts using Atlas TI software. Coding reliability was tested and an analysis was conducted to identify emergent themes. A total of 17 key informant interviews were included in the analysis. The list of participating CBOs is included in section 2, Public Participation. As noted above under Public Participation - Outcomes, the results are: Participants overwhelmingly reported chronic disease as one of the most pressing health problems; 76.4% of organizations feel it is a priority; 50% feel it is the number one health priority. The most commonly mentioned chronic diseases were diabetes, heart disease and cancer. 12

Obesity was seen as the most important risk factor for chronic conditions and preventing obesity among youth, especially among minority populations, was a strong theme. Patient education should emphasize prevention versus treatment, with a focus on healthy lifestyles (eating healthy and exercising). There should be increased communication across organizations to ensure visibility of programs and resources available. A taskforce with members from various organizations would be helpful to brainstorm additional ideas and solutions.

Individual Survey
The Process for the Individual Survey is described below. A list of the committee participants is in Section III, Public Participation, Individual Survey The Nassau County Hospitals and the Nassau County Department of Health collaborated in developing a community-wide survey (see Attachments 2, 3, 4). The team agreed that the use of a uniform survey distributed widely throughout communities in Nassau County would help ascertain the health perceptions and key concerns of residents, as well as identify service needs and barriers to care. The format of the survey was based upon previous community health surveys, including NHANES (National Health and Nutrition Examination Survey) and BRFSS (Behavioral Risk Factor and Surveillance System). The purpose of the survey data was to identify and prioritize pressing health needs in the community, barriers, resources, and health improvement strategies. Multiple choice responses included Prevention Agenda priorities, goals and barriers to health, strategies, and demographic information. Common terminology was used as opposed to public health language to ensure clear communication. The survey, which consisted of six questions, was distributed electronically through Survey Monkey and social media; via paper at hospital outreach programs, public libraries, NCDOH Programs and County Agencies, and other outlets such as faith-based organizations and community centers. In five out of the six questions, individuals were asked to identify up to three main health concerns from a selected list of answers. The purpose of highlighting three was to enable the team to establish a focused group of priorities. Questions were designed to determine the individuals perceptions regarding the biggest ongoing health concerns in their community, their personal health concerns, and what they considered as barriers to treatment. Additionally, respondents were asked to identify what they feel is most needed to improve the health of the community, including health screenings and educational resources. The sixth

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question asked respondents to identify where they get most of their health information: respondents were asked to check all that apply. Demographic information was collected, including the location where respondent received the survey, their sex, age, and zip codes for where they work and live. All surveys were anonymous, and offered in English and Spanish (translation certified by Pacific Interpreters - see Attachment 4). Completed forms were sent to the Nassau County Department of Health for analysis. Descriptive, quantitative data analysis was conducted by inputting answers into Survey Monkey, downloading them into Excel and determining frequencies/percentages. A convenient sample was used to administer the survey in as many locations as possible in an effort to gain a wide representation of the Nassau County population. It reached a broad spectrum of community residents from many different zip codes. According to 2010 US Census estimates, 19% of Nassau Countys population reside in select communities. Out of 1070 surveys returned, 25.8% were from select communities, indicating that there was proportionate representation from populations with health disparities. The survey results were shared with the CHA/CHIP committee and community partners on May 15, 2013. Responses were analyzed according to two separate populations: Nassau County in its entirety and select communities (communities with health disparities). Complete survey results are included as Attachment 5. To summarize, women were the primary respondents, accounting for 72.4% from Nassau County and 79.1% from select communities. Average age for Nassau County respondents was 49; for the select communities, 45. Race distribution identified 65.8% of Nassau County respondents as White/Caucasian, followed by 17.6% as Black/African American; 45.6% in select communities were Black/African American, followed by 34.6% identified as White/Caucasian. A separate question identified 16.4% of respondents in Nassau County and 30.2% in select as Hispanic or Latino. Blood pressure and diabetes screenings were cited as the top priorities in the educational/screening category. Routine well visits were important in both populations; however, exercise and physical activity ranked higher for Nassau County (26.85%) than the select communities (19.3%). The top three ongoing health concerns in the Nassau County population were cancer (44%), obesity (35%) and diabetes (33%). Select communities highlighted diabetes (40.5%), drug and alcohol abuse (38.0%), and cancer (37.2%). Cancer was ranked as the biggest personal health concern for individuals in both populations (35.6% in Nassau County and 37.2% select communities). Other personal health concerns included heart disease and stroke, womens health and diabetes. 14

The survey results indicate that the public is concerned about disease management and prevention, as well as affordable access to quality health care. The significance of obesity was also revealed; healthier food choices were requested, as well as diabetes screenings and more exercise programs. Substance abuse was also cited as a significant health issue. As a result, the following priorities emerged: to increase access to high quality chronic disease preventive care and management; to reduce obesity in children and adults; and to address the issue of substance abuse.

SELECTION OF PRIORITIES
As cited in Section III, the results of both the Key-Informant Interviews and the Individual Surveys were shared with the CHA/CHIP committee and community partners on May 15, 2013. Attendees included:

Adelphi University

1. Professor Public Heath, Director of the MPH Program 1. CHS Vice President Public and External Affairs 1. Project Director 2. Care Coordinator 1. Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community Health Programs 1. Director, Senior Services 1. Special Projects Representative 1. Director, Project Hope 1. Director of Planning and Community Health 2. Public Relations, Marketing and Events Coordinator 1. Director, Division of Quality Improvement, Epidemiology & Research 2. Epidemiologist 3. Intern 1. Secretary 1. Director 1. Director of Communications 1. Quality Assurance Coordinator 1. Representative 1. Community Educator

Catholic Health Services FEGS Health & Human Services (Federation of Employment and Guidance Services) Hofstra University

Jewish Association Service the Aging (JASA) Long Beach Services Long Beach Medical Center Mental Health Association of Nassau County Mercy Hospital

Nassau County Department of Health

Nassau County Lions Club Foundation Nassau County Perinatal Services Network Nassau-Suffolk Hospital Council Nu Health Family Health Centers Planned Parenthood of Nassau County South Nassau Communities Hospital

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St. Francis Hospital

St. Joseph Sustainable Long Island

The Long Island GLBT Services Network (Gay, Lesbian, Bisexual, Transgender Town of North Hempstead Project Independence United Way of Long Island

1. Manager, Community Health Promotion Programs; Emergency Cardiac Care Programs, Marketing & Conference Management 1. Project Manager/Supply Chain Liaison 1. Executive Director 2. Community Planner/ Educational Program Coordinator 1. Chief Operating Officer 2. Director of Programs 1. Deputy Commissioner Department of Services for the Aging 1. Senior Vice President, HIV/AIDS Grant Management 2. Contract Administrator/Quality Manager 1. Assistant Director, Community Relations & Special Projects

Winthrop-University Hospital

Data used to select priorities: At this collaborative meeting with our community partners, the following data was shared: Rates of disease burden and vital statistics data, the rates of disease burden and vital statistics data, including health disparities by age, sex and community: o Chronic disease, Injury, Perinatal Outcomes, Communicable Disease Community-wide survey results: o Normally distributed, represented demographics in the county o Obesity, Chronic Disease (Cardiovascular Disease, Diabetes, Cancer) and Mental Heath emerged as priorities Key Informant Interview process: o Chronic disease overwhelming report o Obesity ranked as most important risk factor o Mental Heath also emerged; reported as important As a result of this meeting, the collaborative group identified the following priorities: Prevent Chronic Disease 1. Reduce Obesity in Children and Adults 2. Increase Access to High Quality Chronic Disease Preventive Care and Management in both Clinical and Community Settings

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In addition, the collaborative group has decided to touch on and promote mental health as well address substance abuse.

RATIONALE In addition to the results of the county-wide assessment and the input we received from our stakeholders at our Cultural Competency Committee meeting on May 21, 2013 (cited above under Public Participation, Section III), Winthrop utilized the following information in identifying obesity and chronic disease as urgent public health improvement priorities: 1. OBESITY (NUTRITION AND HEALTHY WEIGHT) The evidence supporting significant health risks associated with obesity is compelling. As stated in the NYS Prevention Agenda, obesity and overweight are the second leading cause of preventable death in the United States and may soon overtake tobacco as the leading cause of death. By the year 2050, obesity is predicted to shorten life expectancy in the US by two to five years. And, according to the Center for Disease Control, more than one-third of U.S. adults (35.7%) are obese.1 In addition, Healthy People 2020 states that The Nutrition and Weight Status objectives reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. The objectives also emphasize that efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, health care organizations, and communities.2 2. CHRONIC DISEASE According to the Center for Disease Control, chronic diseases are the nations le ading causes of death and disability. Heart disease, stroke, cancer, and diabetes are among the most prevalent, costly, and preventable of all health problems. 3 In statistics stated by the NYS Prevention Agenda, specifically, chronic diseases account for approximately 70% of all deaths in NYS and affect the quality of life for millions of New Yorkers, causing major limitations in daily living for about one in 10 residents. As with obesity, leading a healthy lifestyle (e.g., avoiding tobacco use, being physically active, and eating well) greatly reduces a persons risk for developing chronic disease. Access to high quality care and
1

http://www.cdc.gov/obesity/data/adult.html http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29 http://www.cdc.gov/chronicdisease/overview/index.htm

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affordable prevention measures (including screening and appropriate follow-up) are essential steps in saving lives, reducing disability and lowering costs for medical care. SUMMARY Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer some of the leading causes of preventable death. Therefore, it was determined that Winthrop and our collaborative partners may make the most significant impact on public health by addressing obesity and the most prevalent, preventable chronic conditions in our community. Our goal is to not only improve access to care, but also to encourage individuals to make the behavioral changes needed to lead a healthy lifestyle through an approach that encompasses health interventions and education, public outreach, and strong community partnerships.

V. THREE-YEAR PLAN OF ACTION

FOCUS AREA 1 OBESITY NUTRITION AND HEALTHY WEIGHT A. OBESITY SCREENINGS IN PRIMARY CARE PROVIDER OFFICES
Aligned with Prevention Agenda Goal #1.3 Expand the role of health care and service providers in obesity prevention Goal: Identify children who are obese; reduce BMIs Objective: By December 31, 2106, reduce the percentage of children who are obese in the Winthrop Hempstead Practice (community with health disparities) by 3% Baseline Data Source: Electronic Medical Records (EMR) Performance Measures: BMIs Data Source for Outcome Measures: EMRs, provider feedback. Data will be evaluated biannually Strategy: 5-2-1-0 Program (Promising Practice) The program encourages primary care providers to consistently document BMI, provide lifestyle counseling, develop individual care plans and follow-up measures. During 2013, the identification and counseling of children who are obese (BMI =/>95%) was implemented in the Hempstead Pediatric Clinic, an area suffering health disparities. Children are measured for obesity at every well-child visit beginning at age two. Those who are identified as being obese receive a folder with informational sheets, resources and a personal goal tracker that encouraged documentation document (by coloring for age-appropriate 18

children ) the number of fruits and vegetables, screen time, physical activity and sugary drinks they have each day. They also receive a visual chart, developed by a nutritionist, to clarify portion sizes. Parents are asked to bring their child back within three months for a follow-up visit. Children nine years old and over who are still obese (BMI =/>95%) are sent for lab work which includes cholesterol and liver function testing. Children with abnormal results are then referred to an endocrinologist or a gastroenterologist. Year 2014 Hempstead Practice
Increase the number of individual Care Plans and Obesity Folders distributed to 25% Current Compliance on part of parents to return for follow-up with their obesity folder is poor Increase compliance rate to 25% of patients Current compliance rate of obtaining labs is poor Increase compliance rate to 25%

Year 2015 Hempstead Practice

Increase number of Care Plans and Obesity Folders distributed by 5% Increase compliance rate of parents returning for follow-up appointment by 3% Increase compliance of parents who obtain labs by 5% from year one

Year 2016 Hempstead Practice

Increase number of Care Plans and Obesity Folders distributed by 10% Increase compliance rate of parents returning for follow-up appointment by 5% (from year one) Increase compliance of parents who obtain lab work by 10%

B. CHILDHOOD OBESITY SCREENINGS IN THE COMMUNITY

Aligned with Prevention Agenda Goal #1.3: Expand the role of health care and health service providers and insurers in obesity prevention. Goal: Identify children who are obese (BMI =/>95% ) in communities with health disparities; provide appropriate nutritional counseling Objective: By December 31, 2016, increase the number of children screened by Winthrop at preschool/ childcare centers in communities with health disparities by 20%; provide nutritional counseling based on 5-2-1-0 program Baseline Data: Will be gathered in first year; will include number of children screened, BMIs, and number of participants with BMI=/>95% whose families receive nutritional counseling packets Outcome Measures: Number of children screened, number of children with BMI =/>95%; BMIs at follow-up visits; Number of children returning with completed nutritional counseling packets Data Source for Outcome Measures: BMI Measurement; provider feedback. Data will be evaluated bi-annually.

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Strategy: Bring the 5-2-1-0 Program to the Community (Promising Practice Program) Winthrop will collaborate with its community partners in areas experiencing health disparities, document BMIs, and provide nutritional counseling for families of children identified as being obese Year 2014 Obtain baseline statistics. Pilot obesity screenings and counseling at two early childhood centers in communities experiencing health disparities; healthcare team return in two months for follow-up visits Year 2015 Based on pilot data, evaluate successes and barriers; increase screenings in the community and follow-up visits by 10% Year 2016 Continued expansion of program in community; increase screenings and follow-up visits by 10%

C. BABY-FRIENDLY HOSPITAL
Aligned with Prevention Agenda Goal #1:3: Expand the role of health care and health service providers and insurers in obesity prevention. Goal: Increase the number of babies only receiving breast milk when discharged from Winthrop Objective: By December 31, 2016, 60% of healthy newborns discharged from Winthrop will only receive breast milk Baseline Data: Medical records (on paper) Outcome Measures: Number of babies leaving the hospital who are breastfed Data source for Outcome Measures: Medical records (on paper) Strategy (Evidenced-based program) Winthrop is on a 4-D pathway seeking Baby-Friendly Designation. The pathway phases are: Discovery, Development, Dissemination and Designation. Winthrop has implemented the 10step process: 1. Written breastfeeding policy 2. Training healthcare staff in skills necessary to implement 3. Inform all pregnant women about breastfeeding benefits 4. Help mom initiate breastfeeding 5. Show mothers how to breastfeed 6. Give newborn infants no food or drink other than breast milk, unless medically indicated 7. Practice rooming in 8. Encourage breastfeeding on demand 9. Give no pacifiers or artificial nipples 10. Foster the establishment of breastfeeding support groups 20

Year 2014 50% exclusivity Year 2015 55% exclusivity Year 2016 60% exclusivity In addition to the above focused-initiatives, Winthrop has programs in place that address issues of healthy weight management and nutrition. Our Healthy KIDS program is a comprehensive weight management program for children and teens; we also offer a rigorous Weight Management program that is partially insurance-refundable. In addition, we are a Bariatric Center of Excellence. Winthrop also offers a wide range of community- and hospital-based lectures that support a healthy lifestyle. For further information, please contact 1-866WINTHROP.

FOCUS AREA 2 PREVENTING CHRONIC DISEASE - DIABETES

According to the Nassau County Department of Health, hospitalization from Type 2 Diabetes occurs more than twice as often in the select communities than it does in the rest of Nassau County. And, as noted in Healthy People 2020, effective therapy can prevent or delay diabetic complications. However, almost 25 percent of Americans with Diabetes Mellitus (DM) are undiagnosed, and another 57 million Americans have blood glucose levels that greatly increase their risk of developing DM in the next several years. Few people receive effective preventative care, which makes DM an immense and complex public health challenge.4 Winthrop historically has been a leader in diabetes care. Our Diabetes Education Center, the first diabetes education program in New York State to be accredited by the American Diabetes Association, has been serving as a resource for members of the community since 1970. And, research into the causes and treatment of diabetes has been ongoing and will continue to be a focus in the Research and Academic Center under construction. In addition, the Diabetes Institute has spearheaded over the past few years a hospital-wide education program to teach all patient-care staff from physicians and nurses to pharmacists and social workers how to treat the special needs of patients with diabetes. The result is that Winthrop became the first major teaching hospital in New York State to earn The Joint Commissions Gold Seal of Approval for Advanced Inpatient Diabetes Care. Finally, The Childrens Medical Center at Winthrop has been recognized nationally as an expert in the care and treatment of children with diabetes, providing us with the foundation of services to expand the level of outreach and care to these select communities.

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=8

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Given the significant health disparity in select communities as mentioned above, the fact that diabetes was consistently cited in our community assessment and Winthrops expertise in the area of diabetes management, the Hospital has chosen to prioritize diabetes case findings, prevention and management for Area #2.

A. NATIONAL DIABETES PREVENTION PROGRAM

Aligned with Prevention Agenda Goal # 3.3: Promote culturally relevant chronic disease selfmanagement education Goal: Promote culturally relevant chronic disease self-management education Objective: By December 31, 2016 initiate the National Diabetes Prevention Program and increase by at least 5% each year the number of adults who either meet the diagnostic criteria for pre-diabetes or who have risk factors, and who have participated in at least 9 of the core sessions. Baseline Data: Number of Attendees, number of sessions attended, weight and physical activity minutes along with demographic data will be collected first year Measures: The National Diabetes Prevention Program outcome measures include number of attendees, number of sessions attended, weight and physical activity minutes along with demographic data. Data source for Outcome Measures: Actual participants who start the program and complete at least nine sessions; data will be collected every session Strategy: Evidenced-Based The National Diabetes Prevention Program is a 16-week core program, followed by a once per month post-core program for eight months. 2014 Scale-up Winthrops existing diabetes prevention program to the National Diabetes Prevention Program. We will offer two core program groups and one post-core program during calendar year 2014. 2015 Completion of the second post-core and launch of the Spanish-speaking version. 2016 Continued expansion into communities with health disparities, based on pilot data.

B. DIABETES CASE FINDING & EDUCATION IN HEMPSTEAD (SELECT COMMUNITY WITH HEALTH DISPARITY)
Aligned with Prevention Agenda Goal #3.3 Promote culturally relevant chronic disease selfmanagement education Goal: Increase screening rates for diabetes Objective: By December 31, 2106, increase the number of adults 18 years and older who have been identified at risk for diabetes in a health disparate community by 5% over three years 22

Goal: Promote culturally relevant chronic disease self-management and education Objective: By December 31, 2016, over three years, link at least 25% of those identified as atrisk with culturally relevant patient education services Baseline Data: Will be collected in first year; will include number of participants Outcome measures: The number of people who are identified and attend culturally relevant patient education services Data Source for Outcome Measures: We will document the number of participants in all programs along with post-program satisfaction surveys of those who attend the American Diabetes Association classes. Strategy: Partnering with The Hispanic Counseling Center and the American Diabetes Association, Winthrop will employ the mobile health Winnebago and Spanish-speaking staff to participate in case finding in Hempstead, a select community. Blood pressure and cholesterol results obtained at the screening will be used in the My Health Advisor website to not only assign risk, but also to demonstrate the impact on risk of changes in metabolic parameters. Those participants who present with established diabetes will be referred to the Hispanic Counseling Center which currently hosts classes presented by the American Diabetes Association. The Hispanic Counseling Center serves a diverse population throughout Nassau County. Year 2014 Patients who present with established diabetes will be able to attend the American Diabetes Associations classes that are being offered through the Por Tu Familia and Vivir con diabetes Tipo 2 programs. Those who are identified through My Health Advisor as high-risk for type 2 diabetes will be given diabetes prevention guidelines and Spanish-language literature. Year 2015 Because there are formidable barriers that interfere with community screening linking diabetes diagnostic testing, education and treatment, year 2015 will serve to identify strategies addressing these barriers. In addition, the diabetes prevention program (mentioned above) will be developed for the Spanish-speaking population. Year 2016 Using the data that we obtained in year two, evaluate data and re-evaluate program based on cultural implications

C. PROMOTING CULTURALLY RELEVANT DIABETES EDUCATION TARGETING SOUTH ASIAN INDIAN COMMUNITY
Aligned with Prevention Agenda Goal #3.3 Promote culturally relevant chronic disease selfmanagement education Goal: Promote culturally relevant chronic disease self-management education Objective: By December 31, 2106, increase by at least 5% the number of South Asian IndianAmerican adults with diabetes who have taken a diabetes self-management course

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Baseline Data: Diabetes Education Center statistics Outcome Measures: Number of individuals who attended outreach initiatives. Outcome Date Source: Post-surveys from all who attend the program. Strategy: The South Asian Indian community has a high prevalence of diabetes. Winthrop will target this population through community outreach to educate them about diabetes. Year 2014 Winthrop will build new relationships and work to increase participation in Winthrops Diabetes Education Center established courses. Target 2015 Engage the South Asian Indian population to explore culturally relevant avenues for reinforcing diabetes-specific messages. Target 2016 Support the sustainable infrastructure through clinical community linkages.

COMBINING FOCUS AREAS 1 AND 2 NUTRITION AND HEALTHY WEIGHT (OBESITY) CHRONIC CONDITIONS A. ACTIVE LIVING
Winthrop program based on A New LeafChoices for Healthy Living intervention program Aligned with Prevention Agenda Goal #3.3: Promote culturally relevant chronic disease selfmanagement education Goal: To Increase general knowledge about chronic disease management and encourage a healthy lifestyle that supports the prevention/maintenance of chronic conditions Objective: Targeting the older community, by December 31, 2016, increase by at least 10% the number of adults who have taken a course to promote chronic disease management and the importance of a healthy lifestyle Baseline Data: Will be obtained first year Outcome Measures: Number of individuals who attend and complete program; knowledge gained Outcome Date Source: Pre- and post-surveys Strategy: Targeting the above priorities, as well as the newly developed Healthy People 2020 initiative, Health-Related Quality of Life (HRQoL),5 Winthrop will develop and implement its own program for addressing both general chronic disease and weight management. In evaluating programs and the needs of our community, the Chronic Conditions workgroup combined the identified need of chronic disease management along with the positive feedback
5

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received from specific lectures and programs Winthrop currently offers to the community: Managing Chronic Conditions, Nutrition lectures, and our Exercise/Fall Prevention Classes for seniors. Based on an effective program for older adults, A New LeafChoices for Healthy Living, Winthrops own program, Active Living, will be offered in three sessions and encompass: General Management of Chronic Conditions, Stress Management, Nutrition, and Exercise. Developed by the Director of Winthrops Center for Chronic Conditions and Nurse Navigator from the Center, a registered dietician, physical therapist, a social worker experienced with chronic disease management and registered nurse educators, the program will target older adults with the goal of increasing their knowledge about managing their conditions, improving their weight and balance, and ultimately, reducing healthcare costs. Year 2014 Develop and implement three pilot sessions at Winthrop Year 2015 Evaluate effectiveness and make changes as needed; expand into communities Year 2016 Continued expansion into communities with health disparities, based on pilot data

THE LONG ISLAND HEALTH COLLABORATIVE

In addition to the measures indicated above, Winthrop is actively involved with the Long Island Health Collaborative, an initiative that is moving forward with a three-pronged approach to the Prevention Agenda mandate. It encompasses programming, policy, and public outreach. The Prevention Agenda has asked organizations to help the state meet the goals that it established for the time period 2013 2017. The priority the Collaborative has chosen is Preventing Chronic Disease with a focus on 1) reducing obesity in children and adults, and 2) increasing access to quality preventive programs and chronic disease management programs in clinical and community settings. Additionally, we are incorporating substance abuse prevention/mental health services into our efforts. To help us and the state achieve its Prevention Agenda goals in these focus areas, the LIHC is doing the following: Programming Each member of the collaborative is to collect data on their programs through a pre- and postassessment to determine participants change in health behaviors adopted or learned. The chronic disease prevention/management programs are as varied as the members of the collaborative diabetes, hypertension, obesity, etc. Program offerings are not homogenous, nor are the communities served by these institutions some serve predominately elderly populations, others poorer communities, etc. In order for the Prevention Agenda mandate to maintain relevance for each collaborative member, we decided the best way to approach the 25

situation was to adhere to each members unique programs. In the end, all collaborative members are working toward the same overarching NYS Prevention Agenda goals. Walking we will link with organizational-sponsored walks on LI for 2014 and use the activity of walking (which is cost-free, neutral and feasible for all populations) to promote healthy living behaviors and thus affect positive change in the incidence of chronic disease over time. We will ask our walk partners to provide us with data on either steps walked or numbers of participants. This approach will be repeated in 2015 and 2016. Policy while we continue to promote walking as a healthy behavior and one way to lose weight, keep blood pressure under control, etc., we will work with the regional state transportation office to ensure more of our communities are safe and walkable. We realize this change will take years. Public Outreach we are overlaying our programming and policy efforts with a public awareness campaign that promotes LIHC, the Prevention Agenda, healthier lifestyles and better chronic disease management. We see this component as a key piece to our efforts. Unless the populations we wish to engage know about the various programs and services available to help them lose weight, and develop healthier behaviors, our efforts are futile. The campaigns centerpiece will be an easily navigable website that connects the user with programs, services, and resources in the local communities.

SUPPORTING MENTAL HEALTH AND ADDRESSING SUBSTANCE ABUSE

REFERRALS TO COMMUNITY RESOURCES Winthrop has a solid referral base for community members in need of assistance. The Hospital has a protocol in place for evaluating patients with evidence of behavioral abnormalities who enter the Emergency Department. Evaluated by the Attending Physician, patients with non-psychiatric conditions are diagnosed and treated as appropriate. These patients are provided with a list of community resources for further help. For patients requiring further evaluation, psychiatric consultation is requested by the Emergency Department Attending Physician when appropriate. The Attending Physician, in conjunction with the Psychiatric consultant, will make a decision regarding the hospitalization of psychiatric patients. Two different forms of hospitalization are available involuntary and voluntary. Patients seeking voluntary hospitalization are aided by a social worker in finding proper placement.

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Patients who require involuntary hospitalization must be evaluated by at least two physicians who agree that the patient meets one of the following criteria for involuntary admission: a. Patient is suicidal b. Patient is homicidal c. Patient is incapable of caring for himself or herself. All patients who require psychiatric hospitalization must be transferred to another institution that has the appropriate facilities to treat the individual. SUBSTANCE ABUSE Winthrop has licensed social workers specializing in substance abuse treatment who assist patients with referrals. Acutely intoxicated individuals or those suffering from an overdose that are brought to the Emergency Department or admitted to the Hospital are provided with a consult and assisted with services. Patients who are admitted for another condition, but who are struggling with substance abuse, can request services for referrals and will receive support while hospitalized at Winthrop. Individuals in the community who need assistance with substance abuse and do not require an emergency room visit can call (516) 663-2796. They will be provided with community referrals over the phone.

ADDITIONAL MEASURES
Community Programs - In addition to the focused strategies above, Winthrop has a wide array of community education lectures that provide support for the above initiatives. Evaluation surveys are collected at the end of each lecture and will be monitored for knowledge gained. YouTube Videos - Also, the Winthrop social media educational campaign has a number of videos, including Living with Diabetes. We will track how many views we receive during the years 2014-2016 on all relevant topics. Winthrop Cable Channel The Hospital has developed a channel on cablevision that will deliver health video content and information on community events, beginning late November 2013. We will be able to measure how many times all relevant videos are viewed.

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ADDITIONAL SERVICES OFFERED BY WINTHROP SUPPORTING PREVENTION AGENDA PRIORITIES

Center for Advanced Care of Chronic Conditions
In addition to the above-focused initiatives, Winthrop offers a free service to the community to help individuals with a number of chronic conditions navigate the healthcare system. Winthrops Center for the Advanced Care of Chronic Conditions offers patients a coordinated approach to managing chronic conditions through individualized counseling and a case management approach. As a free service, a nurse navigator customizes a plan of care, coordinates treatment and follow-up care, and promotes awareness of Winthrops various preventive and health screening programs.

Cancer Services
Winthrop also recognizes and supports the publics concern about cancer. As an American College of Surgeons (ACOS) Accredited Cancer Program, Winthrop has a robust program that offers a full complement of inpatient and outpatient services focusing on prevention, diagnosis, treatment, and support all uniquely tailored to meet the highly personal needs of each patient. Furthermore, data has shown that the following cancers maintain the highest incidence on Long Island: breast, prostate, lung and colorectal. Winthrop has assigned an oncology nurse navigator to each of these cancers in an effort to assist patients and their loves ones throughout their cancer journey. Here are highlights of services addressing these issues: Our Breast Health Center, the first nationally accredited site in Nassau County, provides sophisticated diagnostic, treatment and support services to the community. Prostate Cancer is currently being addressed through cutting-edge services such as robotic surgery, cryosurgery, radiation oncology and medical oncology. In addition, support services for patients and their families encompass both educational and support group monthly meetings at the Winthrop Welcome Center. Lung Cancer is the leading cause of cancer death in the United States for both men and women. In addition to our tobacco cessation initiative, low dose CT screening has been shown to reduce Lung Cancer mortality and is now recommended for high risk patients including current or former smokers between the ages of 50-75 with a pack-a-day for 30 years smoking history. Winthrop offers lung cancer screening for these patients who are considered high risk. Colorectal Cancer is being addressed through a collaborative effort of a mutidisciplinary team that includes gastroenterologists, oncologists, surgeons and more. 28

Support services are available through registered dietitians, genetic counselors and licensed social workers. In addition to clinical services, in its continuing efforts to ease the burden of cancer patients and their families, last year Winthrop expanded its staff of social workers, nurse administrators and navigators, specially trained nurses and physician assistants, who help patients with all aspects of their treatment. For more information please call 1-866-WINTHROP.

Center for Cardiovascular Lifestyle Medicine

Given that fact that cardiovascular disease is the number one cause of death in our community, the most advanced levels of diagnostic technology, medical management, interventional cardiology and cardiac surgery available anywhere are in place at Winthrop. Clinicians in the Division of Cardiology also address modifiable risk factors to help their patients stay well. New in 2013, The Center for Cardiovascular Lifestyle Medicine integrates lifestyle practices into the modern practice of medicine both to lower the risk factors for chronic disease and/or if disease is already present serves as an adjunct to its therapy. In keeping with the hospitals mission, the Center for CV Lifestyle Medicine provides high quality, culturally appropriate lifestyle change interventions and promotes healthy behaviors for all patients, as well as the community-at-large, with or at risk of cardiovascular disease while attempting to understand the population determinants of wellness, health, and disease. The Center consists of a nurse-led multidisciplinary team of experts including cardiologists, nurse specialists, research coordinators, an exercise physiologist, behavioral therapist and a registered dietitian. The Center, in partnership with Healthtrax a national leader in preventive healthcare also provides a full complement of cardiac and wellness services, including cardiac risk assessment, lifestyle consultation, patient education, medical screening and counseling. Additional referrals can be coordinated and include services such as cardiac rehabilitation, smoking cessation and diabetes education. For further information, please call 1-866-WINTHROP.

Diabetes Education Center

The oldest program of its kind on Long Island, the Center provides those living with diabetes on a daily basis the up-to-date knowledge, skills and tools people with diabetes need to manage this chronic condition successfully and avoid the many associated complications. The Diabetes Education Center offers individual consultation and a comprehensive diabetes selfmanagement program recognized by the American Diabetes Association. Special nutrition programs including cooking and meal planning classes, as well as a Dining Out with Diabetes program, are also offered. Additional services are available for pregnant women with gestational diabetes based on the latest information regarding diabetes management.

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VI. DISSEMINATION OF THE PLAN TO THE PUBLIC

The Community Service Plan is available to the public through the Winthrop-University Hospital website, www.winthrop.org/communitycsp. Upon request, community members may receive copies of the Plan by mail, at the Hospital information desk or at the Welcome Center, located at 1300 Franklin Avenue, Suite ML-5, Mondays through Friday, 9 AM to 4 PM.

VII. COMMUNITY ENGAGEMENT & PROGRESS

Community Engagement: Community engagement will be maintained through meetings that will be held quarterly with our local partners Winthrops Cultural Competency Committee and a strengthened Community Advisory Board Winthrop will maintain a survey on the website that will request input from the community on current health concerns Evaluation forms at community programs will continue to be utilized as a method of feedback from community members; these forms also request ideas for new programs Social media platforms, Facebook and Twitter, will keep the Hospital and the community connected Many Winthrop administrators and senior staff members participate in communitybased organizations. These interactions will generate feedback for Hospital-based committees Progress: Goals and objectives will be discussed at ongoing meetings with our internal subcommittees and our community partners. All programs will be reviewed; mid-course corrections will be made as necessary during workgroup meetings, scheduled to be held quarterly. Progress will be tracked through CBISA (Community Benefit Inventory for Social Accountability) software, a comprehensive way for Winthrop to measure its impact on the community.

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ADDENDUM

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A. SUPPORTING THE COMMUNITY SERVING SELECT COMMUNITIES

Winthrop demonstrates its commitment to improving access to care for communities with health disparities through the Winthrop Womens Wellness OB/GYN Center in Hempstead. The Center, which opened in April 2010, is designed to provide Comprehensive prenatal services to all Nassau County women and teens in need. Care is provided by a dedicated team of Winthrop healthcare providers who are bilingual in English and Spanish, and the Cyracom phone system is used for translation of any other language. A wide variety of obstetrical and gynecological services are available, as well as on-site risk assessment, psychosocial counseling, postpartum depression screening and referrals, domestic and sexual abuse screening, nutritional and gestational diabetes education, assessment of living conditions and cultural diversity. The site features a Medicaid Enrollment Specialist for uninsured patients; Charity Care Application and selfpay rates are available as well. They participate with NYS Medicaid and many Medicaid Managed Care HMO plans. The Center participates with the Baby Basics Program, which helps put everyone on the same pagefrom physician and staff, to patient and familiesand strengthens the delivery of prenatal care, education and support to vulnerable populations. During 2012, over 900 new patients were seen; there were an additional 1,500 follow up visits. More than 500 new patients were seen with over 5,000 follow-up visits. The Center averages 700 visits per month with approximately 45 new OB patients a month. Financial services were provided to over 600 patients in 2012. The Department of Pediatrics provides ambulatory services at various Long Island locations including Mineola, Hempstead, Bethpage and Commack with offices soon to be opening in Deer Park. The Hempstead Pediatric Practice has grown at a steady substantial rate since opening at its current location in 2007. In 2012 alone, a total of 12,873 patients were treated at the facility. The Hempstead Practice draws patients primarily from the Hempstead community but also serves children, from newborn to age 21, from the surrounding neighborhoods (Elmont, Freeport, Uniondale and Roosevelt). Staffed by five attending physicians, the practice also serves as a teaching setting for Winthrops Pediatric Residency Program. In addition, Winthrops Pediatric Specialty Center in Mineola sends a Pediatric Pulmonologist and an Adolescent Pediatrician to the Hempstead location on a regular basis to allow for easier access to these services.

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Year round, Winthrop Pediatric Associates at Hempstead collaborates with communitybased organizations at Health Fairs and community events so that the parents of Hempstead and the surrounding communities (Freeport, Roosevelt, Uniondale and Elmont Department of Health designated select communities) know that we are available and ready to be of service to them and their children. The physicians and staff also meet with members of the Hagedorn Childrens Center, the Hispanic Counseling Center and the Economic Opportunity Commission to work in partnership to better serve the community. Physicians and staff regularly attend the Hospitals Cultural Competency Committee meetings to stay involved with the Hospitals initiatives. By partnering with the Hispanic Counseling Center, the Pediatric practice is able to provide counseling services to at-risk patients. Children are able to begin sessions at the Pediatric Office, an environment that is familiar to them, and have services at the if continuing session are needed, are transitioned to the Hispanic counseling Center when they are comfortable. Currently, the staff of Hempstead Pediatric Practice is preparing to submit their application to the NCQA for certification as a Patient-Centered Medical Home which will provide focused care on important conditions (asthma and obesity) relevant to the Hempstead pediatric community, in addition to educational opportunities, added community resources, and extended hours of service. The objective is to secure a more involved and empowered patient population. The Hempstead High Health Center (HHHC) is a school-based Health Center, which has been providing services for enrolled students since 1997. The program has significantly increased its staff to accommodate growth in enrollment. In 2012-2013, there were over 5,000 visits to the Center by approximately 1,400 enrolled students. Comprehensive preventive, episodic and confidential healthcare was provided. Winthrop has also implemented specific programs needed by the schools population, including: o Youth support groups in English and Spanish that address common adolescent issues such as acculturation, adolescent adjustment, alternative lifestyles, teen pregnancy and prevention, parenting teens, and violence prevention, including gang violence. o A Positive PPD Chest Clinic that provides students with screening, free chest xray and access to preventive medications. The affected population is able to be compliant with Latent Tuberculosis Treatment Regimen. These individuals might otherwise be lost to follow-up due to lack of insurance and the inability to access the medical health system. Since implementing the program in 2004, the incidence has decreased due to changes in the public healthcare system which has provided students access to healthcare. However, the clinic still serves as a fail-safe for students who test positive. Arrangements are made for those 33

students to have the proper treatment, whether it is through a private healthcare provider or the clinic if insurance currently is not in place.
o

An Asthma Management Program that monitors and tracks students with asthma. This effort is particularly significant in Hempstead, where asthma rates are nearly double those of adjacent neighborhoods. The program was established by the HHHC in 2003 to ensure compliance with medical regimens and provide students with asthma treatment. Collaboration with primary care physicians in the community facilitates treatment that meets current medical standards, trains high school nurses and staff about asthma, and offers accessibility to free medications to those students without health coverage .

ADDITIONAL RESOURCES AT WINTHROP

Winthrop recognizes that a healthy lifestyle prevents or delays the onset of disease. A deep commitment to a healthy lifestyle through health maintenance and wellness is fundamental to the Hospitals Mission. A description of non-prevention agenda initiatives follows: Blood Drives To support the community, each year, Winthrop hosts multiple blood drives to support the Long Island Blood Services. In 2012 employees and community members donated 1,211 pints of blood. Community Education A longstanding tradition, Winthrop continues to offer free Community Wellness Programs on campus as well at the Mineola Community Center. These programs address topics of interest to the community as well as any updates on current health issues and are presented by Winthrop physicians and specialists. Topics during 2012 addressed diabetes, heart disease, stress, anxiety and depression; stroke awareness, memory changes and more. Wellness programs are also offered at various local community centers based on needs discussed by our community partners, such as community-based organizations who represent their constituents, as well as by evaluation of the current trends. Community Training Center The Hospital is an American Heart Association Training Center. The Center provides training in Basic Life Support, PALS and ACLS to community members and to healthcare professionals requiring certifications. Please call (516) 663-4455 for information. Center for Family Dental Medicine During our community assessment, several of our community partners mentioned the need for dental services. New in 2013, our full service, state-of-the-art dental facility serves the 34

communitys patients and allows dentists to complete their residency in a hospital environment. The center offers specialized diagnostic and oral care from preventive measures which range from routine care and cleanings to more complex oral and maxillofacial surgery. As a hospital-based program, we are uniquely positioned to care for medically complex patients, such as those with caner, autoimmune diseases or other medical problems that require advanced treatments. For more information, please call (516) 663-2752. Health Fairs Winthrop participates in community-based health fairs and events. At the fairs, Hospital staff provides blood pressure and asthma screenings, as well as information about a variety of issues, including stroke prevention, diabetes, tobacco cessation, heart health and nutrition. Some of the community-based health fairs Winthrop participated in during 2013 included Senator Hannons Senior Health Fair, Senator Fuschillos Golden Gathering, the Nassau County Health Fair, The Williston Park and Mineola Street Fairs and more. Support Groups Throughout the year, Winthrop coordinates many free support groups that meet periodically, are open to the public and cover a wide range of healthcare topics. Support groups focus on a variety of specific conditions/issues including: bariatric surgery, bereavement, breastfeeding, cancer, cardiac arrest, caregiver, diabetes, dialysis, geriatric, pain management, perinatal bereavement, pulmonary problems, smoking cessation, stroke and trigeminal neuralgia. Winthrop also hosts support groups conducted by Alcoholics Anonymous, Grey Sheet Anonymous, Long Island Celiac Sprue Association and Overeaters Anonymous. Speakers Bureau The Hospital provides speakers at the request of local organizations. Topics are chosen based upon the specific interests of the groups and cover wellness issues such as nutrition, heart health, lung conditions and stroke prevention. Please call 1-866-WINTHROP. Winthrop Welcome Center The Welcome Center at the Winthrop Wellness in Garden City offers written educational material, free lectures and wellness programs. Topics presented are based on the health condition and health information needs of the community. The Center demonstrates Winthrops commitment to improving the health status of the community. Also, Community residents calling the 1-866-WINTHROP number for information are directly linked to clinical departments as well as given referrals to community physicians and services as needed. Winthrop Winnebago Winthrops Winnebago is used to bring health education information and screenings at various locations throughout the community. 35

B. PREVENTION AGENDA OUTCOMES 2012-2013 YEAR FOUR TOBACCO CESSATION

Strategies to Promote Program Participation The results of surveys indicated a preference for group programs offered in the community or workplace. Barriers to attending a program included: cost, time and transportation. Therefore, to encourage participation and to accommodate the publics needs, Winthrop offered Tobacco Cessation Program free- of- charge in various community locations, and workplaces. In addition to Winthrops routine dissemination of tobacco cessation information to inpatients, a program was launched to identify inpatients interested in participating in tobacco cessation programs. A follow-up component with post-discharge patients continues, and 224 postdischarge patients who indicated an interest in upcoming tobacco cessation programs, were contacted by mail. Summary of Efforts to Reduce Tobacco Consumption The Hospitals efforts to reduce adult tobacco consumption in Nassau County included the following: Strengthening education and recruitment efforts to increase enrollment of adult inpatients in Freedom from Smoking upon discharge Raising awareness of Winthrops Tobacco Cessation Program in all relevant Hospital sponsored educational and screening programs Collaborating with community-based organizations and employers to aggressively market and enroll program participants Implementing outreach interventions to follow-up with program participants Tracking and evaluating outcomes for program effectiveness

Program Infrastructure The Tobacco Cessation Program is an interactive four-session workshop offered over a fourweek period. The program is free-of-charge, since cost was identified as a barrier to attendance. A registered nurse is responsible for conducting programs associated with the priorities of the Community Service Plan Agenda. The schedule was extended, new locations were identified, and materials were distributed at numerous sites. Program Outcomes Measurement Tools Database and telephone surveys were completed to document outcomes of program participants who attended three out of four of the workshop sessions. Participants were contacted by telephone approximately eight weeks after the conclusion of the program. 36

Successes A total of 50 people attended eight (8) 4-week tobacco cessation sessions from September 2012 to August 2013. Seventy-Two percent (72%) of all participants attended three or more sessions. Thirteen percent (13%) repeated the entire program more than once. .

Program Outcomes Thirty-Six (36) individuals attended three or more of the tobacco cessation workshops at the Winthrop Welcome Center. Twelve (12) participants out of the twenty (20) who completed surveys no longer smoke; 2 are still smoking although they have decreased the number smoked daily and 2 are still using the e-cigarette. Fifteen (15) (75%) found the program extremely helpful. The following have also been noted: Habits, including everyday activities like drinking coffee, speaking on the telephone, relaxing, and environments where others are smoking and drinking, were the most prevalent barriers to eliminating or reducing tobacco consumption. Several felt addicted or that they just cant quit. Two are using e-cigarettes instead of smoking Four individuals reported quitting after completing the Program, but resuming smoking due to social/environmental influences (stress of Hurricane Sandy). Individuals who quit or significantly reduced their consumption identified the following strategies as helpful in changing their behavior: o A better understanding of how to use anti-smoking medications o Support from the workshop staff o Distraction techniques o Keeping a log of when they smoked and how they felt during and after smoking o Utilization of oral substitutes, such as lollipops or straws o Relaxation and breathing techniques The majority of unsuccessful participants were optimistic about their ability to quit in the future and expressed a willingness to attend a future workshop. Outreach is being conducted to encourage future attendance. Three (3) participants repeated the workshop and have quit smoking. Some of the participants who were unable to quit or significantly reduce their tobacco consumption requested additional support to help them achieve a smoke-free lifestyle specifically, a support group. Three support groups for quitters were offered in 2012-2013. A total of 15 attended, and of the 15, seven no longer smoke. Winthrop is also considering

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developing a program of nutritional and stress management workshops to help these individuals in their quest for a healthier lifestyle. Barriers Other that the common personal barriers mentioned about such as habit, Winthrop successfully circumvented other common barriers to smoking cessation among adults, such as the availability of classes. A trained Health Educator offers the Workshops FREE in the early evening every month at Winthrop. The Workshops are also offered in the community and workplace settings, thus eliminating the barriers of transportation and time.

FALLS PREVENTION
Strategies to Promote Program Participation Outreach to community-based organizations such as local senior groups, libraries and community centers has significantly raised awareness of fall prevention and the importance of balance and strengthening exercises. The fall prevention programs were presented at their local meeting places. Summary of Efforts to reduce falls The Hospitals efforts to reduce the rate of falls resulting in injury to seniors in Nassau County included the following: Raising community awareness of the serious impact of falls Conducting screenings and risk assessments for falls Educating seniors, caregivers and other interested people (target population) about identifying and modifying risk factors and methods of preventing falls Tracking and evaluating outcomes for program effectiveness Going into community-based organizations to offer programs Program Infrastructure The Falls Prevention Program includes an interactive (lecture and exercise) four-week series. The series includes the following classes: What Are the Risks for a Fall, Ways to Prevent Falls, and Balance and Strength Exercise classes. Following completion of the series, participants are invited to continue the program by attending ongoing classes to improve their strength, balance, flexibility and mobility. All the classes are given by a registered nurse educator. Program Outcomes Measurement Tools Database and telephone surveys were utilized. Participants in the program are invited to complete a pre- and post self-assessment tool.

38

Successes In Year Four, the following was accomplished: Additional classes were added to the Falls Prevention program. This included balance/strength exercises at a higher level as the senior progresses, balance assessment and reassessment, demonstration of how to get up from a fall (Be Prepared) and Walking for Strength and Balance. Creation of an inpatient geriatric discharge report, notifying these individuals about upcoming Falls Prevention programs Establishment of a tracking mechanism by creating a database of program attendees and a post-workshop outcomes evaluation tool Collaborating with the Project Independence (aging in place) initiative to offer the four-weeks series at the Yes We Can community center in Westbury, a community experiencing health disparities Overall Participation Winthrops Fall Prevention Program has been, by almost any measure, an outstanding success , with significant growth each year. Participation was as follows: year one, 360; year two, 485; year three, 1100. Due to promotional materials and outreach efforts to the community from September 2012 to August 2013, dyear four of the Prevention Agenda, 127 fall prevention and exercise programs were offered at the Winthrop Welcome Center and out in the community, with more than 1900 participants. Programs included What are the Risks for a Fall, Risks and Tips to Prevent Falls, Exercise & Balance, Walking for Balance and Strength, Be Prepared and Balance Assessment & Reassessment. The breakdown of classes/sessions held is as follows: Eighteen (18) four-week programs were offered the Welcome Center; 264 attended this series. After completion of the four-part program, attendees were encouraged to attend additional balance and strength classes. A total of 55 classes were offered with 1057 attendees Eight (8) off-site four-part programs were offered with 47 attending. Four Walking for Better Balance classes have been added with a total of 70 attendees. Their improvement is evident in the way they move. Sixteen (16) balance/exercise classes were offered in the community with a total of 445 participants. Many continued classes at the Winthrop Welcome Center for follow-up. Feedback from the classes continues to be excellent. All were given information sheets on the exercises to be continued at home for retraining balance and strengthening muscles.

39

Two (2) Be Prepared classes (What to do if you have a fall and how to get up), were offered at the Winthrop Welcome Center, with 25 attendees.

Outcomes: Although attempts were made to reach all participants of the four-week program, (28) followup phone calls were completed. Conversations reported the following: 100% of program participants reported the program increased their knowledge of the risks of falls and fall prevention strategies 75 %reported they had an eye exam and will continue yearly after attending the class 80% completed home assessment, based on materials distributed in the class 85% reported beginning an exercise class 70% have continued attending individual exercise classes more than once with stated improvement in their balance 75% have reviewed their medications with their health care provider 75% carry a prescription drug and medication record in their wallets and encouraged other family members to do the same. 100% want to be contacted about future classes All gave positive feedback on the programs and have promoted the programs among their friends, family and community groups

Balance and Exercise Classes: After completion of the four-part program, attendees were encouraged to attend additional balance and strength classes. As stated above, a total of 55 classes were offered with 1057 attendees. Sixteen (16) classes were offered off-site with 445 attendees. The classes were a huge success. Seventy-one (71) evaluations were completed with the following outcomes: improved balance, increased upper and lower body strength, and demonstrated improved stamina. Forty-four (44) of these participants had a balance assessment and 10 were reassessed after completing the program. Balance Assessment Eight (8) balance assessment sessions were offered. Forty-four (44) seniors were evaluated for balance. Modified Falls Efficacy Scale (MFES) self evaluation revealed the following: Four (4) participants scored 5 and below = high risk for a fall. Out of 44, 12 participants had a score of 10 = very confident in performing everyday activities. Lowest score was 4.7, low confidence in performing everyday activities. A TUG test (Get Up and Go) was also given and the average result was 15.9 seconds = mostly independent. 40

Average age of all participants was 79 years. Average score on MFES was 7.6 = at risk for a fall. All were referred to balance/strength exercise classes. Outcomes: Thirty-Five (35) participants of the above-referenced 44 were contacted to return for a reassessment of balance. At the time of reassessment, the average score for MFES was 9.0; the average score for the TUG test was 13.3. All felt they had improved and will continue to attend balance and exercise classes. A self evaluation on How Fit and Strong Are You? revealed that the average score was 44.0 out of 50+ points = moderate fitness level and room for improvement. Barriers As the popularity of the programs increased, with the space constraint at the Winthrop Welcome Center we have had to turn away prospective participants for our programs. For this reason Winthrop, added more classes and hired another registered nurse to meet the need.

41

WINTHROP-UNIVERSITY HOSPITAL
ACCOMPLISHMENTS
New York Designated Regional Trauma Center NY State Department of Health Stroke Center NY State Department of Health Stroke Center NACHRI Designated Childrens Hospital Long Islands only Fetal Surgery program Regional Perinatal Center National Association of Epilepsy Centers (NAEC) Level-4 Epilepsy Center Hypertrophic Cardiomyopathy (HCM) Center of Excellence Accredited Bariatric Surgery Center of Excellence American College of Surgeons (ACOS) Accredited Cancer Program Accreditations by the National Accreditation Program for Breast Centers (NAPBC) and the National Quality Measures for Breast Centers (NQMBC) First nationally accredited Breast Health Center in Nassau County Breast Imaging Center of Excellence by the American College of Radiology (ACR) First hematology/oncology team on Long Island to be recognized by the Quality Oncology Practice Initiative (QOPI) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO) First CyberKnife Center in the New York Metro Area First Neuroscience Special Care Unit on Long Island American Health Associations (AHA) Get With The Guidelines (GWTG) Gold Achievement Award for Coronary Artery Disease American Heart Association/American Stroke Association Get With The Guidelines (GWTG) Stroke Gold Plus Achievement 2013 American Heart Associations Get With The GuidelinesHeart Failure Gold Plus Quality Achievement Award

First Diabetes Education Center in New York State recognized by the American Diabetes Association in accordance with National Standards for Diabetes Self Management Education and Support First New York State Major Teaching Hospital to be awarded a Gold Seal of Approval for Inpatient Diabetes Care by the Joint Commission First Sleep Disorders Center in Nassau County to be accredited by the American Academy of Sleep Medicine Certified Home Health Agency and Long Term Home Health Care Program named to the Top 100 of the 2013 Home Care Elite Most Wired Hospital by Hospitals & Health Networks Magazine, 2012 and 2013 U.S. News & World Report One of the best regional hospitals in the NY Metro Region with 12 high performing specialties:
Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Ear, Nose and Throat, Gastroenterology & GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology and Neurosurgery, Orthopedics, Pulmonology, Urology

One of the best Childrens Hospitals in the nation with leadership in three pediatric specialties o Diabetes & Endocrinology o Pulmonology o Urology Beckers Hospital Review o Ranked as one of Americas top 70 Cardiac Hospitals in 2013 o Ranked as one of Americas top 100 Cancer Hospitals in 2013 Healthgrades o One of Americas 100 Best Hospitals for Cardiac Care for 2 Years in a Row (2012-2013) o One of Americas 100 Best Hospitals for Cardiac Surgery for 2 Years in a Row (2012-2013) o One of Americas 100 Best Hospitals for Coronary Intervention or 2 Years in a Row (2012-2013) o Ranked among the Top 5% in Nation for Overall Cardiac Services for 4 Years in a Row (2010 2013) o Ranked among the Top 5% in Nation for Cardiology Services for 4 Years in a Row (2010 2013) o Ranked among the Top 5% in Nation for Coronary Interventional Procedure for 5 Years in a Row (2009 2013) o Ranked among the Top 5% in the Nation for GI Medical Treatment in 2013 o Five-Star Recipient for Treatment of Stroke for 2 Years in a Row (2012 2013) o Five-Star Recipient for Treatment of Pneumonia for 6 Years in a Row (2008 2013) o Five-Star Recipient for Treatment of GI Bleed for 10 Years in a Row (2004 2013) o Five-Star Recipient for Treatment of Bowel Obstruction in 2013

ATTACHMENT 1.

KEY INFORMANT INTERVIEW for THE COMMUNITY HEALTH ASSESSMENT Together, Nassau County Department of Health and Nassau County Hospitals are conducting a Community Health Assessment. Today we are trying to get your expert opinion about the health in the community that your organization serves. When we ask a question about the community, we are talking about the community in which your organization serves. Answering the following questions will assist us in identifying the most pressing health needs in your community, and developing goals to meet them. Please share your opinion with us by answering the following questions. Your participation is voluntary, and your responses are confidential. Thank you. Thank you for already completing some basic information about your organization. I would like to expand on it a bit. 1. Can you describe your organization? a. What is your role in the organization b. What specific services does your organization provide? {Ask for explanation if not obvious} c. Who is the target population? d. Do you provide services to minority, low-income, uninsured or other specific populations? What services or programs do you provide specifically for these populations? 2. What are the 3 biggest health problems in the community? {Leave this as open ended, probing for specificity, then follow-up with question 3}.

NYS DOH has identified 5 health issues that health communities could address : 1)Chronic Disease, 2) Healthy and Safe Environment, 3) Healthy Women, Infants and Children 4) Mental Health and Substance Abuse, 5) HIV, STD, Vaccine Preventable Diseases. 3. Of these, can you identify which issue(s) are a priority for your community? a. Is this true for all the populations your serve including minority, low income, or uninsured or other special population you serve? Please expand. 4. What keeps people in the community you serve from addressing the issues you just described? {Ideas could include: transportation, issues of insurance, religion/cultural difference, fear, doctor availability, etc} 5. What should be done to address these barriers? a. Should services be improved? b. What services are needed c. What are some strategies for overcoming these barriers?

There are many reasons or factors that can affect the quality and access of health care. I would like to discuss a few in relation to the community in which your organization serves.

6. What factors can you think of that affect quality and access of health care for your community? a. How does age affect the quality of health care they receive in the community? b. How does gender affect the quality of health care they receive in the community? c. How does race and/or ethnicity affect the quality of health care they receive in the community? d. How does economic security affect the quality of health care they receive in the community? e. How does language affect the quality of health care they receive in the community? {Other factors that should be included?} The health department and hospitals in the area offer services to the surrounding communities. 7. What are some of these services that this community uses? a. What is the communitys feedback about these services? b. What other services/programs do you think the community needs to improve its health? The health department and county hospitals look to improve health care to Nassau County residents. 8. What role would you and your organization be willing to play to improve services and programs? {Look to build partnerships and elicit ideas}

6-12

ATTACHMENT 2.

COMMUNITY HEALTH ASSESSMENT SURVEY

Your opinion is important to us! The purpose of this survey is to get your opinion about health issues that are important in your community. Together, the Nassau County Department of Health and Nassau County hospitals will use the results of this survey and other information to help target health programs in your community. Please complete only one survey per adult 18 years or older. If you have any questions, please contact us at (516) 227-9408. Your survey responses are anonymous. Thank you for your participation.
1. What are the biggest ongoing health concerns in your COMMUNITY? (Please check up to 3) Asthma/lung disease Safety Heart disease & stroke HIV/AIDS & Sexually Transmitted Diseases (STDs) Mental health/ depression/suicide Obesity/weight loss issues Vaccine preventable diseases Womens health & wellness Other (please specify) ________________

Drugs & alcohol abuse Environmental hazards

2. What are the biggest ongoing health concerns for YOU? (Please check up to 3) Asthma/lung Disease Environmental hazards Safety Cancer Child health & wellness Diabetes Drug & alcohol abuse Heart disease & stroke HIV/AIDS & STDs Mental health/ depression/suicide Obesity/weight loss issues Vaccine preventable diseases Womens health & wellness Other (please specify)

________________

3. What prevents people in your community from getting medical treatment? (Please check up to 3) Lack of availability of Unable to pay coCultural/religious beliefs doctors pays/deductibles Dont know how to find doctors Dont understand need to see a doctor Fear (e.g. not ready to face/discuss health problem) Language barriers No insurance Transportation There are no barriers Other (please specify) __________________

4. Which of the following is MOST needed to improve the health of your community? (Please check up to 3) Clean air & water Mental health services Smoking cessation programs Drug & alcohol rehabilitation services Healthier food choices Job opportunities Recreation facilities Safe childcare options Safe places to walk/play Safe worksites Transportation Weight loss programs Other (please specify) _________________

PAGE 1 of 2

5. What health screenings or education/information services are needed in your community? (Please check up to 3) Blood pressure Eating disorders Mental health/depression Nutrition Cancer Emergency preparedness Cholesterol Dental screenings Diabetes Disease outbreak information Drug and alcohol Exercise/physical activity Heart disease HIV/AIDS & STDs Importance of routine well checkups Prenatal care Suicide prevention Vaccination/immunizations Other (please specify) _________

6. Where do you and your family get most of your health information? (Check all that apply) Doctor/health professional Family or friends Health Department Hospital Internet Library Newspaper/magazines Radio Religious organization School/college Television Worksite Other (please specify)

____________

For statistical purposes only, please complete the following: Location where you received this survey: _________________ What is your sex: Male Female

What is your age:_______________ ZIP code or Town where you live: _________________ ZIP code or Town where you work: ___________ What race do you consider yourself? White/Caucasian Black/African American Are you Hispanic or Latino? Yes No What is your highest level of education? K-8 grade Technical school Some high school High school graduate Some college College graduate

Native American Asian/Pacific Islander

Multi-racial Other (please specify) _________________

Graduate school Doctorate Other (please specify) ________________

Do you currently have health insurance? Yes No No, but I did at an earlier time/previous job Do you have a smart phone? Yes No Please return this completed survey to: Nassau County Department of Health Division of Quality Improvement 106 Charles Lindbergh Blvd Uniondale, NY 11553

Or you may fax completed survey to: 516-227-9503

PAGE 2 of 2

ATTACHMENT 3.

ENCUESTA DE EVALUACIN DE SALUD DE LA COMUNIDAD

Su opinin es importante para nosotros! El objetivo de esta encuesta es obtener su opinin sobre problemas de salud que son importantes en su comunidad. El Departamento de Salud del Condado de Nassau y los hospitales del condado de Nassau, en conjunto, emplearn los resultados de esta encuesta y otra informacin para ayudar a disear programas de salud en su comunidad. Le pedimos completar solo una encuesta por adulto mayor de 18 aos. Si tiene alguna pregunta, comunquese con nosotros al (516) 227-9408. Las respuestas de la encuesta son annimas. Gracias por participar.
1. Cules son las mayores inquietudes actuales de salud en su COMUNIDAD? (Por favor marque mximo 3)
Asma/enfermedad pulmonar VIH/SIDA y enfermedades de transmisin sexual (ETS) Salud mental/depresin/suicidio Abuso de alcohol y drogas Peligros ambientales Enfermedad cardaca & derrame cerebral Obesidad/prdida de peso Seguridad Enfermedades prevenibles mediante vacunacin Salud y bienestar de la mujer Otras (por favor especifique) _______________________

2. Cules son las mayores inquietudes actuales de salud para USTED? (Por favor marque mximo 3)
Asma/enfermedad pulmonar Enfermedad cardaca & derrame cerebral VIH/SIDA y ETS Salud mental/depresin/suicidio Obesidad/prdida de peso Seguridad Enfermedades prevenibles mediante vacunacin Salud y bienestar de la mujer Otras (por favor especifique) _________________________

Abuso de alcohol y drogas Peligros ambientales

3. Qu factores impiden que la gente de su comunidad reciba tratamiento mdico? (Por favor marque mximo 3)
Creencias culturales/religiosas No saber cmo encontrar un mdico No entender la necesidad de consultar a un mdico Temor (p. ej., no estar preparado para enfrentar/analizar un problema de salud) Falta de mdicos disponibles Barreras del idioma Falta de seguro Transporte Imposibilidad de pagar copagos/deducibles No hay impedimentos Otros (por favor especifique) _______________________

4. Cules de las opciones siguientes son las que MS se necesitan para mejorar la salud de su comunidad? (Por favor marque mximo 3)
Aire y agua limpios Servicios de rehabilitacin para el abuso del alcohol y las drogas Opciones de alimentacin ms saludables Oportunidades de empleo Servicios de salud mental Instalaciones recreativas Opciones seguras de cuidado infantil Lugares seguros para caminar/jugar Lugares seguros de trabajo Programas para dejar de fumar Transporte Programas para bajar de peso Otro (por favor especifique)

________________________________

PGINA 1 de 2

5.

Qu tipo de evaluaciones de salud o servicios de educacin/informacin se necesitan en su comunidad? (Por favor marque mximo 3) Presin arterial Cncer Colesterol Revisiones odontolgicas Diabetes Informacin sobre brotes de enfermedades Drogas y alcohol Trastornos de la alimentacin Preparacin para emergencias Ejercicio/actividad fsica Enfermedades cardacas VIH/SIDA y ETS Importancia de los controles mdicos peridicos Salud mental/depresin Nutricin Atencin prenatal Prevencin del suicidio Vacunas Otras (por favor especifique) _______

6. Dnde obtienen, usted y su familia, la mayor parte de su informacin de salud? (Marque todo lo que corresponda) Mdico/profesional de la salud Familiares o amigos Departamento de Salud Hospital Internet Biblioteca Peridicos/revistas Radio Organizaciones religiosas Escuela/universidad Televisin Lugar de trabajo Otro (por favor especifique) ________________

Le pedimos que por favor complete la siguiente informacin solo para fines estadsticos: Lugar donde recibi esta encuesta: _________________ Sexo: Masculino Femenino

Edad: _______________ Cdigo postal o ciudad de residencia: _________________ Cdigo postal o ciudad del lugar de trabajo: ___________ Cul es su raza? Blanca/caucsica Negra/afroamericana Es usted hispano o latino? S No Cul es su nivel ms alto de educacin? Hasta 8 grado Preparatoria incompleta Preparatoria completa Escuela tcnica Universidad incompleta Ttulo universitario Cuenta actualmente con seguro mdico? S No No, pero tuve con anterioridad/en mi trabajo anterior Posgrado Doctorado Otra (por favor especifique)_____________ Nativa americana Asitica/islea del Pacfico Multirracial Otra (por favor especifique)___________

Tiene un telfono inteligente? S No O bien, puede enviarla por fax al nmero: 516-227-9503

Por favor, enve esta encuesta una vez completada: Nassau County Department of Health Division of Quality Improvement 106 Charles Lindbergh Blvd

Uniondale, NY 11553

PGINA 2 de 2

Community Health Assessment Survey

Surveys Completed Spanish Surveys Select Comunities 11003 11096 11520 11542 11550 11553 11561 11575 11590 Elmont Inwood Feeport Glen Cove Hempstead Uniondale Long Beach Roosevelt Westbury 40 1 39 13 79 20 24 22 39 1070 75 277

7.0% 25.8% 14.4% 0.4% 14.1% 4.7% 28.5% 7.2% 8.7% 7.9% 14.1%

AgeDistributionofCommunity Surveys,NassauCounty

AgeDistributionofSurveysinthe SelectCommunities

65+ 1829 20% 17% 3045 24% 4664 31%

65+ 1829 16% 25%

4664 39%

3045 28%

Nassau Average Age Median Age Mode 49 50 60

Select Comm 45 44 18

Min Age Max Age Skipped Question

18 98 107

18 98 16

What is your sex: Answer Options Male Female Nassau County Response Response Percent Count 27.6% 279 72.4% 733 answered question 1012 skipped question 58 Select Communities Response Response Percent Count 20.8% 57 79.1% 216 273 4

What race do you consider yourself? Answer Options White/Caucasian Black/African American Native American Asian/Pacific Islander Islander Multi-racial Other (please specify) Nassau County Response Response Percent Count 65.8% 579 17.6% 155 0.6% 5 12 4% 12.4% 109 3.6% 32 3.3% 29 answered question 880 skipped question 190 Select Communities Response Response Percent Count 34.6% 75 45.6% 99 0.5% 1 10.6% 10 6% 23 5.1% 11 3.7% 8 217 60

Are you Hispanic or Latino Answer Options Yes No Nassau County Response Response Percent Count 16.4% 153 83.6% 780 answered question 933 Select Communities Response Response Percent Count 30.2% 75 69.8% 173 248

skipped question
What is your highest level of education? Answer Options K-8 grade Some high school High school graduate Technical school Some college College graduate Graduate school Doctorate Other (please specify)

137

29

Nassau County Response Response Percent Count 1.9% 19 4.2% 42 14.3% 143 3.8% 38 20.3% 203 28.8% 287 22.4% 224 4.3% 43 1.3% 13 answered question 998 skipped question 72

Select Communities Response Response Percent Count 4.4% 12 4.8% 13 16.9% 46 5.1% 14 23.5% 64 26.1% 71 17.6% 48 1.5% 4 0.0% 0 272 5

Do you currently have health insurance? Nassau County Response Response Answer Options Percent Count Yes 86.0% 871 No 10.9% 110 No, but I did at an earlier time/previous job 3.2% 32 answered question 1013 skipped question 57 Select Communities Response Response Percent Count 83.6% 229 14.6% 40 1.8% 5 274 3

Do you have a smart phone? Answer Options Yes No Nassau County Response Response Percent Count 54.3% 548 45.7% 462 Select Communities Response Response Percent Count 79.3% 153 20.7% 40

answered question skipped question

1010 60

193 5

What are the biggest ongoing health concerns in your COMMUNITY? (Please check up to 3) Nassau County Answer Options Asthma/lung disease Cancer Child health & wellness Diabetes Drug & alcohol abuse Environmental hazards Heart disease & stroke HIV/AIDS & Sexually Transmitted Diseases Mental health/depression/suicide Obesity/weight loss issues Safety Vaccine preventable diseases Women's o e s health ea t & wellness e ess Other (please specify) Response Percent 17.1% 44.0% 18.0% 33.0% 31.9% 14.1% 30.8% 12.4% 21.5% 36.0% 16.8% 6.7% 19.6% 2.6% Response Count 178 459 188 344 333 147 321 129 224 375 175 70 204 27 1043 27 Select Communities Response Percent 21.5% 37.2% 20.1% 40.5% 38.0% 12.8% 22.6% 23.7% 20.4% 31.8% 18.2% 6.6% 18.6% 1.1% Response Count 59 102 55 111 104 35 62 65 56 87 50 18 51 3 274 3

answered question skipped question

What are the biggest ongoing health concerns for YOU? (Please check up to 3) Nassau County Response Response Answer Options Percent Count Asthma/lung disease 17.1% 176 Cancer 35.6% 366 Child health & wellness 13.8% 142 Diabetes 27.2% 280

Select Communities Response Response Percent Count 16.4% 44 37.2% 100 17.1% 46 30.9% 83

Drug & alcohol abuse Environmental hazards Heart disease & stroke HIV/AIDS & Sexually Transmitted Diseases Mental health/depression/suicide Obesity/weight loss issues Safety Vaccine preventable diseases Women's health & wellness Other (please specify)

9.5% 20.0% 35.0% 8.1% 14.3% 30.8% 19.5% 6.8% 32.7% 4.1%

98 206 360 83 147 317 200 70 336 42 1028 42

9.3% 16.7% 24.9% 10.8% 12.3% 30.1% 20.1% 5.6% 33.8% 3.0%

25 45 67 29 33 81 54 15 91 8 269 8

answered question skipped question

What prevents people in your community from getting medical treatment? (Please check up to 3) Nassau County Response Response Answer Options Percent Count Cultural/religious beliefs 8.7% 88 Don't know how to find doctors 13.7% 139 Don't understand need to see a doctor 28.6% 290 Fear (e.g. not ready to face/discuss health 41.5% 420 Lack of availability availability of doctors doctors 10.3% 104 Language barriers 16.7% 169 No insurance 58.3% 591 Transportation 16.3% 165 Unable to pay co-pays/deductibles 42.6% 432 There are no barriers 11.6% 118 Other (please specify) 4.3% 44 answered question 1013 skipped question 57

Select Communities Response Response Percent Count 10.6% 29 12.4% 34 30.3% 83 42.3% 116 13.9% 38 23.0% 63 71.2% 195 15.3% 42 50.0% 137 4.0% 11 2.9% 8 274 3

Which of the following is MOST needed to improve the health of your community? (Please check up to 3) Nassau County

Select Communities

Answer Options Clean air & water Drug & alcohol rehabilitation services Healthier food choices Job opportunities Mental health services Recreation facilities Safe childcare options Safe places to walk/play Safe work sites Smoking cessation programs Transportation Weight loss programs Other (please specify)

Response Percent 34.2% 18.8% 46.0% 39.4% 20.8% 21.7% 15.0% 20.5% 5.3% 16.3% 12.3% 30.0% 4.2%

answered question skipped question

Response Count 347 191 466 400 211 220 152 208 54 165 125 304 43 1014 56

Response Percent 33.8% 23.3% 44.7% 40.7% 20.0% 24.7% 20.0% 21.1% 6.2% 14.9% 9.5% 25.8% 2.5%

Response Count 93 64 123 112 55 68 55 58 17 41 26 71 7 275 2

What health screenings or education/information services are needed in your community? (Please check up to 3) Nassau County p p Response Response Answer Options Percent Count Blood pressure 28.5% 272 Cancer 24.5% 234 Cholesterol 20.2% 193 Dental screenings 14.7% 140 Diabetes 28.8% 275 Disease outbreak information 9.3% 89 Drug & alcohol 18.7% 178 Eating disorders 11.7% 112 Emergency prepardness 17.8% 170 Exercise/physical activity 26.8% 256 Heart disease 16.2% 155 HIV/AIDS & STDs 10.5% 100 Importance of routine well check ups 26.1% 249

Select Communities p p Response Response Percent Count 33.3% 88 24.2% 64 23.9% 63 17.8% 47 29.5% 78 9.5% 25 25.8% 68 14.4% 38 17.8% 47 19.3% 51 16.3% 43 17.8% 47 26.9% 71

Mental health/depression Nutrition Prenatal care Suicide prevention Vaccination/immunizations Other (please specify)

18.4% 23.6% 5.3% 6.7% 9.1% 3.5%

176 225 51 64 87 33 954 116

17.0% 21.6% 8.3% 8.3% 9.5% 1.9%

45 57 22 22 25 5 264 13

answered question skipped question

Where do you and your family get most of your health information? (Check all that apply) Answer Options Doctor/health professional Family or friends Health Department Hospital Internet Library Newspaper/magazines Radio Religious organization School/college Television Worksite Other (please specify) Nassau County Response Response Percent Count 77.1% 780 33.8% 342 11.0% 111 17.6% 178 48.7% 493 13.2% 134 33.5% 339 10.1% 10.1% 102 3.4% 34 8.5% 86 37.6% 381 9.9% 100 4.0% 40 answered question 1012 skipped question 58 Select Communities Response Response Percent Count 76.0% 206 34.7% 94 14.4% 39 21.4% 58 47.6% 129 13.3% 36 31.4% 85 7.4% 7.4% 20 4.4% 12 8.9% 24 39.1% 106 8.1% 22 1.1% 3 271 6