Prepared for: Prepared by: Our Lady of Lourdes Memorial Hospital, Inc. Research & Marketing Strategies, Inc. 169 Riverside Drive 15 East Genesee Street, Suite 210 Binghamton, NY 13905 Baldwinsville, NY 13027 www.lourdes.com www.RMSresults.com

Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Implementation Plan Implementation Strategy Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

TABLE OF CONTENTS EXECUTIVE SUMMARY Page Number

Community Service Plan…………………………………………………………………………………..………...….………..….…...……...1 Comprehensive 3 Year Plan Format...... 1 Our Lady of Lourdes Memorial Hospital Mission Statement...... 4

SECTION 1: COMMUNITY HEALTH NEEDS ASSESSMENT 1.1 Primary Service Area ...... 6 1.2 Community Demographics ...... 7 1.3 Community Resources Available to Address Community Health Needs...... 9 1.4 Impact of Prior CHNA Implementation Plan…………………………………….……………..………...... …..…10 1.5 Community Health Need Status ...... 13 1.6 Public Health Priorities: Process for Identifying and Prioritizing Community Health Needs and Services ...... 17 1.7 Process for Consulting with Persons Representing the Community’s Interests……………..………20 1.8 Information Gaps Impacting Community Health Needs Assessment ...... 21

SECTION 2: PUBLIC PARTICIPATION & DISCLOSURE 2.1 Public Participation...... 21 2.2 Public Availability of CHNA to the Public...... 21

SECTION 3: COMMUNITY HEALTH IMPROVEMENT PLAN/IMPLEMENTATION STRATEGY 3.1 Community Health Improvement Plan & Implementation Strategy (CHIP/IS) ...... 23 3.2 Implementation Strategy ...... 23

SECTION 4: FINANCIAL AID PROGRAM ...... 29

SECTION 5: CHANGES IMPACTING COMMUNITY HEALTH/ PROVISION OF CHARITY CARE/ACCESS TO SERVICES……...... 31

SECTION 6: FINACIAL STATEMENT ...... 31

i Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Appendices: 1. Health Care Need Themes Appendix 1.1: Broome County Health Care Needs Themes – Qualitative Research Findings Appendix 1.2: Broome County Health Care Needs Themes – Qualitative and Quantitative Findings Appendix 1.3: Our Lady of Lourdes Memorial Hospital Health Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Categories 2. Health Outcomes and Health Factors 3. FY 17-19 Integrated Strategic, Operational, and Financial Plan 4. New York State Department of Health Prevention Agenda Guidance Letter (November, 2015) 5. Documents and Resources Used in Research 6. Broome County Profile 7. Health Resources Inventory 8. Broome County Indicators for Tracking Public Health Priorities, 2013 - 2018 9. New York Department Of Health (NYDOH) Hospitalizations Due to Falls in Broome County 10. Healthcare Needs Theme Priority Worksheet 11. Community Stakeholder Interviews 12. Community Feedback from DSRIP Activities 13. Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan and Implementation Strategy 14. 2015Community Service Plan 15. Consultant Qualifications

Acronyms: CHNA: Community Health Needs Assessment CHIP: Community Health Improvement Plan IS: Implementation Strategy CSP: Community Service Plan

ii Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

EXECUTIVE SUMMARY

Community Service Plan This three year comprehensive Community Health Needs Assessment (CHNA) reflects the collaborative process between Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes), community organizations and residents. The CHNA demonstrates Lourdes’ current and future commitment both clinically and financially to address the community’s health status by fulfilling its call to provide health care that works, health care that is safe, and health care that leaves no one behind. Lourdes is committed to making our community a stronger, healthier place to live. The plan covers a three year time period from 2016-2018. Annually, Lourdes reports the status on the progress of the CHNA. Changes to and between the Community Health Needs Assessment are documented annually in the Community Service Report. This report is approved by the Board of Directors and made publically available on the website (Appendix 1.1-1.4, and Appendix 14).

Lourdes’ CHNA was a stepped process occurring from September 2015 to August 2016: 1. Identification of community health status themes, September 2015- May 2016; 2. Community health status prioritization, May-July 2016; 3. Development of Community Health Improvement Plan, July-August 2016; 4. Lourdes Board of Directors approval, September 2016; 5. Submission of CHNA/CHIP/IS to the New York State Department of Health, December 30, 2016.

Due to differences in sequencing CHNA and CHIP requests by Ascension Health, the New York State Department of Health, and the Broome County Health Department, the Lourdes CHNA/CHIP maybe updated prior to the NYS Department of Health submission deadline of December 30, 2016, though any updates are not expected to be significant.

Comprehensive 3-Year Plan Format: Community Health Needs Assessment (CHNA), Community Health Improvement Plan/Implementation Strategy (CHIP/IS) The previous 2013-2015 CHNA was used as a basis for the development of the current three year 2016-2018 Community Needs Assessment. In developing the 2016-2018 CHNA, an assessment was completed on the status of the 2013-2015 CHNA community health priorities. Following additional primary and secondary research, two of the 2013-2015 health priorities carried over to the 2016-2018 CHNA (table, page 3, herein). While progress was made by Lourdes and the community in improving health priorities, Lourdes and the community will continue to focus on the priority areas delineated herein (table, page 3, Appendix 1.1-1.4).

The CHNA enhances Lourdes’ services to the community by identifying what services are most desired and needed by area residents. This CHNA is comprised of quantitative and qualitative analysis conducted by Research & Marketing Strategies, Inc. (RMS) to serve as a guide for Our Lady of Lourdes Memorial Hospital for 2016-2018. The plan is a comprehensive assessment of the community’s health needs and Lourdes’ response to community public health priorities. The quantitative research included a review of survey data from the various stakeholder groups. This data had statistical sampling significance. The qualitative work included: In-depth interviews (IDI’s) with community stakeholders as well as a review of focus group results from Medicaid and the uninsured population segments.

During the CHNA research twenty health care needs themes were identified through qualitative (10 themes, Appendix 1.1) and quantitative research (10 themes, Appendix 1.2) Research resulted in the 2016-2018 community health priorities being behavioral health (mental health and substance abuse), obesity (and associated chronic disease) and the health issues associated with lower-income and socially vulnerable populations. The identified community health priorities and implementation strategies which will be implemented to align with the DSRIP Domain 4 efforts. 1 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Health Care Need Themes (1-10) – Qualitative Findings Theme 1: Increase services for mental health, behavioral health, and substance abuse. Theme 2: Affordability of healthcare services is seen as a significant access barrier for many people, particularly those with limited resources. Theme 3: Greater emphasis on preventive care and education regarding “healthy living”. Theme 4: Improve access to healthcare services, by ensuring timely appointments, expanded hours, and greater number of physicians accepting new patients. Theme 5: Communication and care coordination among providers should be significantly improved. Theme 6: Increase emphasis on receiving regular dental care among all segment of the county’s population. Theme 7: Improve transportation resources to and from healthcare service sites. Theme 8: Increase awareness and education of available community-based resources, particularly around identifying specialty care and chronic disease management activities. Theme 9: There needs to be better education and awareness of non-emergent healthcare site alternatives for patients. Theme 10: Conduct assessment of eldercare services available within the County.

Broome County Department of Health (DOH) Themes (11-20) – Quantitative Findings Theme 11: Falls Prevention (reduce inpatient hospitalizations, for those ages 65+) (Abbreviated: Falls Prevention) Theme 12: Decrease the proportion of children and adults who are obese. (Abbreviated: Decrease obesity in children/adults) Theme 13: Increase in cardiovascular disease and diabetes screening, especially among the poor and vulnerable populations (Abbreviated: Increase cardiovascular and diabetes screening) Theme 14: Focus on the poor and vulnerable with special attention to those enrolled in a Medicaid Health Home (Abbreviated: Focus on the poor and vulnerable) Theme 15: Injury Prevention (reduce inpatient hospitalizations and mortality due to injuries). (Abbreviated: Injury prevention) Theme 16: Decrease STD Morbidity (reduce the rate of Chlamydia among men). (Abbreviated: Decrease STD Morbidity) Theme 17: Reduce the rate of adolescent pregnancies. (Abbreviated: Reduce adolescent pregnancies) Theme 18: Reduce the incidence of Cancer of the Lip, Oral Cavity and Pharynx. (Abbreviated: Reduce risk of oral/throat cancer) Theme 19: Increase the proportion of children who receive well child care visits. (Abbreviated: Increase well child care visits) Theme 20: Decrease incidence of high blood levels in children (Abbreviated: Decrease blood lead levels in children)

Community Health Priority Trends The table below shows a comparison of community health priorities identified by Lourdes since 2010. Lourdes’ selected priority areas are supportive of the Broome County Health Department’s Community Health Needs Assessment. The priorities identified align with the DSRIP Domain 4 efforts.

2 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Community Health Priorities Over Time

2013-2017 Broome County Health

Department CHNA Priorities (Note 1) Lourdes adopted these

priorities in Lourdes 2013-2016 CHNA), 2) the Broome County Health 2010-2013 Lourdes Department extended these for the 2016-2018 Lourdes CHNA Health Priorities County through 2018) CHNA Priorities Access to Quality Health Care Healthy and Safe Environment Lourdes determined its 2016- • Increase health care coverage. • Decrease falls among seniors 65+. 2018 CHNA priorities based • Increase access to mental Prevent Chronic Diseases on the community health health/substance abuse services. • Decrease the proportion of need themes and statistical • Increase access to prescription drug children and adults who are obese. analysis identified in the medication. • Increase in cardiovascular disease following pages of this Chronic Disease & Chronic Disease and diabetes screening, especially document. Prevention among the poor and vulnerable Behavioral Health (Mental • Decrease the proportion of children populations. Health & Substance Use) and adults who are obese. Disparate Population Increase access to behavioral • Reduce the prevalence of diabetes • Focus on the poor and vulnerable health (mental health and and reduce diabetes-related with special attention to those substance use).Obesity hospitalizations. enrolled in a Medicaid Health Prevention, Wellness and • Reduce hospitalizations due to heart Home. Chronic Disease failure. Decrease the percentage of children, adolescents and adults who are obese. Socioeconomic Poor and Vulnerable Focus on the poor and vulnerable with special attention to those enrolled in a Medicaid program.

Lourdes’ commitment to addressing community need is reflected in the Lourdes three year Integrated Strategic, Operational, and Financial Plan (“ISOFP”) which is updated annually. (Appendix 3) Measurable outcomes have, are, and will be reported to the community annually on the Lourdes website, regarding Lourdes’ Community Health Improvement Plan through Lourdes’ annual “Community Service Plan” (CSP) Report. Progress on addressing community health priorities will be readily available to the public on Lourdes’ website and through Lourdes’ media venues to educate and build awareness among the public.

The New York State Prevention Agenda 2013-2017 has been extended by the New York State Department of Health to 2018 to align its timeline with other state and federal health care reform initiatives. The Broome County Health Department will be submitting an updated CHNA and Community Health Improvement Plan to the NYS Health Department by December 30, 2016. (Appendix 4) Lourdes will participate in the ongoing assessment of the community’s health status by participating on the Broome County Health Department’s Community Health Assessment Steering Committee. It is the intent of the Steering Committee to meet regularly to review the Community’s Health Improvement 3

Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Plan and Implementation Strategy. Lourdes is also a participant in the Medicaid Delivery System Reform Incentive Payment Program (DSRIP), and the Population Health Improvement Program (PHIP). Data from all these initiatives has been reviewed and incorporated in this final Community Health Improvement Plan and Implementation Strategy.

Lourdes will monitor its own Community Health Improvement Plan and Implementation Strategy internally through existing and new committees to ensure that public health priorities are effectively being addressed.

Our Lady of Lourdes Memorial Hospital Mission Statement

Mission Statement: Reaffirm the hospital’s mission statement that identifies commitment to the community it serves.

Our Lady of Lourdes Memorial Hospital, Inc. (also referred to herein as “Lourdes”, “Lourdes Hospital” or the “Lourdes Health System”) is a community not-for-profit health care system sponsored by Ascension Health. Rooted in the loving ministry of Jesus as healer and in the tradition of the Daughters of Charity of St. Vincent de Paul, Lourdes is committed to serving all persons with special attention to those who are poor and vulnerable. As a Catholic entity, Lourdes is guided by the moral and ethical teachings of the Roman Catholic Church. Lourdes’ Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. Lourdes associates are advocates for a compassionate and just society through their actions and words.

There have been no changes to Our Lady of Lourdes Memorial Hospital’s mission statement, or its core values. Providing community benefit is an important part of Our Lady of Lourdes Hospital’s Mission. It represents a vital link to the community and neighbors. Lourdes’ strength is in rooted in its history and mission. The Mission and work of Lourdes goes on as it has, since 1925.

Central to Lourdes’ services are the core values of Lourdes Hospital:

Service of the Poor – Generosity of spirit, especially for persons most in need; Reverence – Respect and compassion for the dignity and diversity of life; Integrity – Inspiring trust through personal leadership; Wisdom – Integrating excellence and stewardship; Creativity – Courageous innovation; Dedication – Affirming the hope and joy of our ministry.

Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes), located in Binghamton, New York, is a not-for-profit healthcare system serving the residents of Broome County and the surrounding area. Lourdes provides an array of services including: primary care, walk-in, screening and wellness, endocrinology and diabetes, regional cancer care services, outpatient diagnostic services, mobile van services (providing cancer screenings, mammography, dental care), maternal and child care, musculoskeletal services, specialty care, acute care, home healthcare, durable medical equipment, hospice care, youth behavioral health and development, oral health, occupational health services, as well as, health education and outreach programs including “medical missions” in which free care is provided to the community.

4

Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

SECTION 1: COMMUNITY HEALTH NEEDS ASSESSMENT

CHNA Development Process In late 2015, Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes) collaborated with Research & Marketing Strategies, Inc. (RMS) to assist with development of its Community Health Needs Assessment (CHNA). RMS works with delivery systems to conduct community health needs assessments, facilitate clinical integration, assist with payer contracting, establish patient registries, data warehouses and metric dashboards to help systems advance improvements in community population health, and measure satisfaction of the various stakeholder groups. RMS conducted the regional CHNA, for the Medicaid delivery system redesign incentive payment program (DSRIP) which is incorporated and explained in this CHNA.

The RMS team followed a thorough and comprehensive process for assisting hospitals and health care systems with conducting the CHNA to meet the requirements of the IRS statute. Additionally, the RMS team worked with Lourdes to review and incorporate data from existing initiatives already underway through collaborations with county health departments, community based organizations, Care Compass Network (the regional Delivery System Reform Incentive Payment (DSRIP) performing provider system) and healthcare systems. For work related to Lourdes CHNA the CHNA/CHIP/IS process included the following components:

• Demographic, Sociographic and Health Status Profile of Community; • Inventory of Health-related Resources in Community; • In-Depth Interviews with Community Resources/Representatives; • Review of Community Feedback from Consulting Work Associated with DSRIP; • Gap Analysis and Identification of Community Health Needs; • Community Health Needs Prioritization; and • Community Health Improvement Plan (CHIP)/Implementation Strategy (IS).

This CHNA fulfills the requirements of statutes put in place by the Patient Protection and Affordable Care Act (PPACA) that require non-profit hospitals to conduct CHNAs every three years to remain in compliance. The CHNA utilizes input from members of the community in the form of stakeholders and residents from the Lourdes primary service area. RMS worked closely with members of the community and the management team of Lourdes to conduct and compare findings of the assessment.

The objectives of the CHNA process are: • To profile the community in terms of demographic, sociographic, and traditional health-related measures to obtain a clear understanding of the health status of the population served by Lourdes; • To ensure that members of the community are represented in the needs assessment process, including traditionally under-represented and/or vulnerable populations such as the medically underserved, low income, minority populations, as well as populations with chronic disease needs; and • To use information gathered in the CHNA to identify the health needs of the community and to develop a prioritized implementation action plan to address these needs.

Documents and analytic sources informed the identification of health concerns for Broome County residents (Appendix 5). In order to obtain the desired information and meet the objectives of the CHNA, two (2) essential secondary research components were also conducted: (1) a demographic profile of the Lourdes primary service area using the most current data available and (2) an inventory of current services available within the service area to meet the healthcare and wellness needs of residents.

5 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

1.1- 1.2 Community Demographics & Service Area Define the area the hospital uses for community/local health planning for the purposes of the Community Service Plan (CSP). Please include the method used to determine the service area (e.g. zip codes, census data, etc.)

1.1 Primary Service Area

Lourdes is located in Broome County, New York. The hospital is within the city of Binghamton. Broome County represents the population center of the region, known as the Southern Tier of New York State.

Lourdes’ primary service area (PSA) is Broome County. In addition to Broome County, the hospital also serves, to a lesser degree the residents of the surrounding counties immediately around Broome County. However, for the purpose of the CHNA, the hospital’s focus is on Broome County. As of 2015 Broome County had a population of 196,360 individuals.

Method used to determine Service Area The primary service area definition used by Lourdes is consistent with physician needs assessment methodologies based on qualitative standards established by the Internal Revenue Service (IRS) in a variety of General Counsel Memorandums, and was reinforced by its (the IRS’s) private letter ruling with Hermann Hospital and by its Final Revenue Ruling on Physician Recruitment (Revenue Rule 97-21).

6 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

1.2 Community Demographics Community Served –demographics, socioeconomics, community health status Demographic Attributes and healthcare utilization in the market. Sources: Allteryx.com, NYSDOH, Southern Tier Food Bank 2012 (Appendix 6)

2010 Population 200,599 2015 Total Population 196,360 # & % Male: 96,277, 49%

# & % Female: 100,082, 51% 2020 Total Projection 196,204 # & % Male: 96,504, 49.2% # & % Female: 99,699, 50.8% % Change 2015-2020 -0.1%

Avg. Household Income $46,128

Demographics The total population of Broome County decreased slightly (by 2.2%) between 2010 and 2015, from 200,599 to 196,360. The overall population size is expected to remain stable between 2015 and 2020. The population of individuals aged 65 or greater is expected to increase from 33,974 individuals in 2015 to 38,177 individuals in 2020 (a 12.4% increase). The median household income in Broome County rose 5.8% from 2010 to 2015 and is expected to increase by 14.9% from 2015 to 2020. The population of Broome County is predominantly white,

representing 87% or 170,825 individuals. The Black or African American race represents 5.2% or 10,142 of the population.

The next largest population segment is Asian/Native Hawaiian/Other Pacific Islander representing 3.8%, or 7,529 individuals. Race/Ethnicity A small portion, 3.8% or 7,529 individuals are Hispanic or Latino. Noted from Broome County Chamber of Commerce & Head Start, diversity populations impacting healthcare delivery besides Hispanic or Latino are: Asian, Russian, Slovak countries and Indian. There are over 60 languages spoken through the Head Start programs. Socio-economic data: Approximately 17.8% or 33,527 individuals from Broome County live below the poverty level. Socio-economic/Unemployment Among those living in poverty, 24.8% of children in the County are under the age of 18. 47% of children are eligible for the County’s free/reduced

7 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Community Served –demographics, socioeconomics, community health status Demographic Attributes and healthcare utilization in the market. Sources: Allteryx.com, NYSDOH, Southern Tier Food Bank 2012 (Appendix 6) lunch program at area schools. The most likely family unit to be living in poverty is single- mothers with children under the age of 5, where a majority (58%) of these families lives in poverty. There is a strong correlation with poverty & poor health outcomes.

Health Insurance Coverage: Approximately 92% of the Broome County population has some form of health insurance coverage, leaving the remaining 8% (15,581 individuals) uninsured. Only 4.2% (1,646 children) of children under 18 are uninsured, slightly higher than the New York State rate of 4.0%. Broome County’s 11.2% of adults aged 18 to 64 who are without health insurance coverage is less than the State rate of 14.9%. A significant number of “covered NYS individuals” have high deductible coverage, where there is a significant “out of pocket” requirement before coverage begins.

Employment/Unemployment: There is an 8.6% unemployment rate among the population in the labor force in Broome County. This rate was lower than both the New York State unemployment rate of 8.9% and national unemployment rate of 9.2%. The largest occupational category representing nearly 30% of the work force as defined by the government census categories is “Educational services, and health care and social assistance.” The next largest occupational category, for the County, is retail trade representing 13%.

Education: Approximately 2 in 5 persons (37.6%) over the age of 25 have a degree beyond a high school diploma. 43.3% of the population has no education beyond a high school diploma. 10% of the population has never graduated from high school. These education figures for the County have remained consistent for the past 5 years and are expected to remain unchanged through 2020.

8 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

1.3 Community Resources Available to Address Community Health Needs

In order to obtain the desired information and meet the objectives of the CHNA, RMS conducted an inventory of the current services available within the service area to meet the healthcare and wellness needs of residents.

The information below details findings from the inventory of current services available within the Lourdes service area, defined as Broome County, and further expands upon key service.

Health Systems There are two major health systems serving Broome County and the Greater Binghamton region. These two systems are Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes) and United Health Services Inc. (UHS). o The Lourdes system is anchored by its 242-bed hospital providing acute care and emergency care services. Lourdes employs over 140 providers. In addition, Lourdes serves Broome County and the surrounding area through 14 primary care locations of which 4 locations have an integrated walk-in services, 1 independent walk-in clinic on site and adjacent to primary care and specialty care services, Endocrinology & Diabetes Centers of Excellence, outpatient diagnostic services, mobile van services (providing cancer screenings, mammography, dental care), regional cancer care services, musculoskeletal services (including physical, speech, occupational and vestibular therapy, sports medicine spine and joint care) specialty care, home health care and hospice care, durable medical equipment company, youth behavioral health and development, oral health, occupational health services as well as health education and outreach programs. Program descriptions can be found on the hospital website:www.Lourdes.com o UHS operates two acute care hospitals and one long-term care/residential facility in Broome County: Binghamton General Hospital, Wilson Memorial Regional Medical Center, and Ideal Senior Living Center. UHS operates over 30 primary care locations throughout 4 counties and employs over 130 providers, and school based clinics. UHS also operates an acute care hospital in Chenango County and a critical access hospital in Delaware County. www.uhs.net

Providers Based on medical staff development plan (MSDP) research completed in 2014 by AmeriMed Consulting, on behalf of Lourdes, there appears to be need for additional medical providers within Broome County to serve the needs of the population (Appendix 7).

Current recommended additional providers based on need include the following:

Current Need Specialty Recommended Additional Providers Primary Care 19.0 Medical Specialty Care 20.0 Surgical Specialties 7.0 Hospital Based Specialties 9.0 Total Current Need 55.0

9 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

The MSDP also recommended additional providers, based on succession planning for potential physicians, as follows:

Recommended Additional Specialty Providers based on succession Primary Care 19.1 Medical Specialty Care 37.4 Surgical Specialties 37.3 Hospital Based Specialties 0.0 Total Succession Planning Need 93.8

Combined Recommended Specialty Additional Providers Primary Care 38.1 Medical Specialty Care 57.4 Surgical Specialties 44.3 Hospital Based Specialties 9.0 Total Current + Succession Planning Need 148.8

In addition to physician resources, RMS also conducted a review of other healthcare services and resources available to Broome County residents that can help maintain and promote healthy living. These services can be viewed as additional tools available to support and contribute to the overall community health status. A robust list of community services offered in Broome County is in the Community Resource Guide published by the Susquehanna River Region’s 2-1-1 Information and Referral Service and the United Way of Broome County. A complete listing of these agencies can be found in (Appendix 7).

1.4 Impact of Prior CHNA Implementation Plan The 2013-2015 CHNA identified the similar priorities as the current priorities recommended herein (page 3).The impact of this Community Health Improvement Plan/ Implementation Strategy focused primarily on process measures. In some cases it was difficult to determine the impact due to the lack of or delay in New York State data availability. During the 2016-2018 CHNA time frame, Lourdes will leverage a population health data management tool called Optum, to establish baseline outcome measures and impact of interventions for patients seen in the Lourdes Primary Care Network. Below is an overview of the impact by health priority area. Additional information on strategies Lourdes has undertaken to impact these health priority areas and other areas of health concern are found on line in Lourdes’ annual Community Service Plan report at https://www.lourdes.com/about-us/community-service-plan/.

2013-2015 Community Health Priority Areas a. Falls Prevention Falls prevention was part of the New York State “Healthy and Safe Environment” priority area. The goal of this priority area was to decrease falls among seniors, age 65 and older and associated hospital admissions by December 31, 2017. Lourdes committed to offering evidenced based falls prevention programs, providing falls prevention education and screening programs, and integrating falls risk assessments into the primary care setting.

10 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Key Measures Lourdes fulfilled its commitment to the community to add capacity to evidenced based falls prevention programs in Tai Chi for Arthritis instructors, certify home health physical therapists in the OTAGO, and begin falls risk screening assessments in Lourdes primary care practices.

Evaluation of Impact Lourdes trained three associates as instructors in an evidenced based falls prevention program, Tai Chi for Arthritis, and offered the class to twenty participants. Lourdes at Home physical therapists completed certification for a Center for Disease evidenced based falls prevention education program called OTAGO. Falls risk assessments were performed at each home health visit, approximately 49,000 annually. Falls risk assessments were performed as part of the Medicare primary care wellness visits on patients identified by their provider to be as risk for a fall. Pre-operative education on falls prevention was provided for joint replacement patients. Lourdes pharmacists provided education on medications at community falls balance clinics (54 in 2014). Lourdes participated in two Falls Prevention Awareness events. According to the New York State Department of Health SPARCS data, the falls rate for Broome County residents age 65 and older decreased in 2012 from 293.4 to 221 in 2013 and 199 per 10,000 in 2014. Hospital specific data is unavailable. b. Obesity prevention and managing chronic diseases Reducing obesity was part of the New York State “Preventing Chronic Disease” priority area. The goal of this priority area was to reduce obesity in children and adults in Broome County and to increase the screening rates for cardiovascular disease and diabetes, especially among disparate populations.

Key Measures Lourdes’ commitment to this managing obesity was to become a NYS Health Department “Great Beginnings” hospital by adopting breastfeeding policies, to receive a Baby Friendly Hospital Designation by 2017, and to conduct BMI screenings in Lourdes primary care practices. Lourdes’ commitment to managing the chronic diseases associated with obesity were to support the Broome County community partners in addressing the needs of the Medicaid Health Home disparate population; to continue implementing chronic disease standards of care throughout the Lourdes Health System.

Evaluation of Impact Obesity Lourdes achieved Great Beginning’s designation; adopted breast feeding policies, achieved over 80% breast feeding initiation rates, and is on track with receiving Baby Friendly Designation. BMI’s were measured in Lourdes Primary Care practices. From 2014 to 2015, the percent of BMI’s for children age 3-17 increased from 68% to 84%, 24% to 83% for adults age 18-64, and 51% to 91% for adults age 65 and older . Lourdes’ DePaul Pediatric clinic participated in a longitudinal obesity education and prevention study. Through Lourdes Food and Nutrition department, “Fit and Fun Meals”, Superfood of the Month, Action Stations were implemented at the hospital and health food education programs were offered to school aged children. Lourdes Bariatric Surgery program provided nearly 500 surgeries and nearly 3,000 nutritional consults in the first 2 years of the program. The Broome County trend for adults, adolescents and children who are obese increased from 2013-2014.

Chronic Disease Lourdes entered into a collaborative agreement with Catholic Charities to provide clinical services to Catholic Charities Medicaid Health Home clientele. Lourdes hired two nurse case managers to support the needs of Medicaid beneficiaries who had 2 or more chronic diseases. Among the initiatives Lourdes engaged in to prevent cardiovascular disease Lourdes implemented a program called “COACH” – Coordinated Outreach Achieving

11 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Community Health- for Heart Failure and for COPD program respectively in 2014 and 2015; implemented a “T- Time” support group for patients with heart failure and their caregivers – serving nearly 75 persons annually, and increased Lourdes at Homes tele-monitoring capacity from 54 to 74 which resulted in a decrease in readmissions. 100% of monitors are used full time. Lourdes expanded access to diabetes education, prevention, and disease management by increasing the number of endocrinologists, sponsoring annual diabetes teaching days. In 2015 the Lourdes Diabetes Center promoted A1C as the definitive test for diabetes diagnosis. The Optum data management system will allow for pre-diabetics and diabetics to be monitored and managed during the 2016-2018 CHNA period. Additionally, Lourdes began more intentionally champion the health of Lourdes employees by participating in the American Heart Association’s “Fit-Friendly Company Recognition Program”, receiving the Gold Fit award, implementing a “Step it Up Fit Challenge “ program and piloting a wellness and prevention program called EXOS. While age adjusted hospitalization rates for Broome County residents experiencing a heart attack continues to be higher than NYS and the Prevention Agenda target, the rate per 10,000 declined from 18.8 in 2013 to 16.7 in 2014. The Broome County rate of hospitalizations for short term complications of diabetes for ages 6-17 and 18+ was also higher than the NYS average and the Prevention Agenda target. However the rate for those aged 6-17 improved from 2013 to 2014 and worsened for 18+ for the same time period. c. Access to mental health and substance abuse Due to the increased opioid epidemic experienced in Broome County in 2014/2015, Lourdes added improving access to mental health and substance abuse services as a priority area. This is part of the New York State “Accessing Mental Health and Preventing Substance Abuse” priority area. The goal of this priority area was two- fold: first to improve access and coverage to mental health services and second, to use an evidenced based screening tool for the assessment of patients for substance abuse. As such, Lourdes established the goal to increase access to mental health services for adults, to integrate behavioral health in to a primary care practice, to implement an evidenced based suicide screening tool in to a Lourdes Pediatric practice, to recruit additional providers and to implement tele-medicine for psychiatric services.

Key Measures Lourdes increased access to mental health services by receiving approval by the Office of Mental Health in 2015 to expand services to adults at the Lourdes Center for Mental Health, expanded its children’s mental health clinic license in 2014 to the Lourdes Pediatric practice based at the hospital, and implemented a suicide prevention screen in the same practice in conjunction with Behavior Works, a program operated by Lourdes Youth Services and funded by the NYS Office of Mental Health. In 2013 Lourdes was chosen as a pilot hospital to have 124 staff trained in ASIST (Applied Suicide Intervention Skills Training) and SAFE Talk programs in consort with Johns Hopkins Children’s Hospital of Philadelphia and the University of Pennsylvania hospitals to further suicide training programs. During the CHNA period nearly 1700 persons were screened in the hospital or emergency department for alcohol and substance use. Lourdes Youth Services continued to provide services through the Student Assistance Program (SAP), Alcohol and Drug Education Prevention Team (ADEPT) and the Mental Health Juvenile Justice Project (MHJJ). Telemedicine for psychiatric services was researched though not implemented during the CHNA period. Plans to implement this service will occur during the 2016-2018 CHNA.

Evaluation of Impact Lourdes Center for Mental Health provided 42,500 visits over the CHNA time period. The Mental Health Juvenile Justice Project (MHJJ) worked successfully to keep 98% of youth served out of detention and out of home placement. Lourdes received Federal Funding to implement programming geared toward reducing violence, increasing school engagement and performance and improving health outcomes for minority youth. The grant is a collaborative effort between the City of Binghamton, Broome-Tioga BOCES and Lourdes Youth Services. From 2013 to 2014 the Broome County Prevention Agenda metrics had no significant change in age- adjusted percentages of

12 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

adults with poor mental health for 14 or more days in the last month, or in the age adjusted percentage of adults binge drinking during the past month. The age adjusted suicide death rate per 100,000 improved from 2013 to 2014, though based on 2015 local community statistics that number is expected to have increased significantly.

d. Disparate Population Served The disparate population served by Lourdes during 2013-2015 was the poor and vulnerable on Medicaid and the Uninsured. Key measures for this population are the same as for all those for whom Lourdes serves. Lourdes made focused efforts to outreach to the poor and vulnerable.

Evaluation of Impact Key to helping to increase access, Lourdes expanded the number of certified financial counselors from six to eleven, enrolled 4% more persons in the patient financial assistance programs, screened 5,900 persons for eligibility for health coverage which resulted in an average of 94% being enrolled in a health plan. Lourdes continued to provide access to free pharmaceuticals through the Pharmacy Assistance Program and Hope Dispensary, doubled capacity for oral health services, and increased the number service through the mobile oral health and mammography programs. In 2015 Lourdes provided its first “Medical Mission at Home” serving over 200 persons. Over the 3 year CHNA, Lourdes provided over $76.6 million in total Charity Care.

In 2014, New York Governor Andrew Cuomo announced a program to reinvest $8 billion in federal savings generated by Medicaid redesign reforms. The program, Delivery System Reform Incentive Payment (DSRIP), promoted community-level partnerships in New York State and provides financial support to health care providers to implement programs to better meet the needs of their communities and address community health status priorities. During 2014, Lourdes, along with more than 150 partner organizations - including the UHS, Guthrie Corning Hospital, Cayuga Medical Center, Cortland Regional Medical Center, and Schuyler Hospital worked together as a New York State “Performing Provider System” (PPS). The partner organizations included nursing homes, behavioral health and substance abuse programs, social service agencies and similar entities will serve residents in nine counties. In 2015, Lourdes provided leadership in securing additional funding to develop interventions impacting community health status, among which will be the integration of behavioral health in to primary care and cardiovascular disease prevention. The PPS was awarded a potential of $224,540,275.

1.5 Community Health Need Status

Broome County’s health status continues to perform worse in several areas when compared to National, New York State and historical county measures. The information below identifies health need status concerns from varying data sources.

It should be noted that in 2014, Lourdes began working as part of a consolidated health provider team, engaging in work aligned with the New York State Medicaid and uninsured Delivery System Reform Incentive Payment (DSRIP) program for the Southern Tier. This consortium focused on reducing the number of unnecessary emergency room visits, unnecessary admissions and avoidable readmissions by looking for ways to address community health issues by providing greater access to existing services. The community health needs assessment work conducted as part of this work identified perceived community needs. The RMS staff reviewed the Broome County specific research findings and incorporated this into the identified health need themes (Appendix 10).

1.5.a Broome County Health Status Comparison with New York State Health Status The NYS Department of Health Prevention Agenda 2013 is tied to the National Healthy People 2020 goals established by the Federal government. There are five major Prevention Agenda categories defined by the NYS Health Department. Those areas in which Broome County was below the NYS and/or NYS 2018 goals are listed below, by NYS category:

13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

1. Health Disparities a. Percentage of premature deaths (before age 65.)

2. Promoting a Healthy & Safe Environment a. Rate of emergency room visits due to falls per 10,000, ages 1-4. b. Percentage of population with low income and low access to supermarkets or large grocery store. c. Percentage of residents served by community water systems with optimally fluoridated water.

3. Preventing Chronic Disease a. Age-adjusted heart attack hospitalization rate per 10,000. b. Rate of hospitalizations for short-term complications of diabetes per 10,000, ages 6-17.

4. Promoting Healthy Women, Infants, and Children a. The percentage of children who have had the recommended number of well child visits in government sponsored insurance programs. b. The percentage of third grade children with evidence of tooth decay. c. The percentage of unintended pregnancy among live births.

5. Promoting Mental Health and Preventing Substance Abuse a. Age-adjusted percentage of adults with poor mental health for 14 days or more. b. Age-adjusted percentage of adult binge drinking during the past month. c. Age-adjusted suicide death rate per 10,000.

1.5.b: Broome County Health Status Broome County indicators for identifying and tracking public health priority areas for 2013-2018 are available from the New York State Department of Health, (Appendix 6) or at the NYSDOH website: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm [Note: The Prevention Agenda 2013-2017 was extended to 2018 to align its timeline with other state and Federal health care reform initiatives.] (Appendix 4 – NYSDOH Prevention Agenda Guidance letter)

The tracking tool available on the NYSDOH website provides baseline data from 2008-2010 for most of the indicators, with some baseline data from 2011 or 2012, which is used to compare Broome County to NYS and the NYS 2018 Goals.

The research conducted by RMS indicated that Broome County residents are engaging in risky behaviors that impact the overall health status of the County. The table that follows highlights in bold those indicators where Broome County ranks at the bottom quartile of all NYS counties.

Health Indicators: (Appendix Source: NYSDOH: 2011-2013 Incident Rate Data 6) Obesity and Related Indicators • Over two-thirds of Broome County adults are considered overweight or obese (64.1%), higher than New York State (60.5%). • Over one-third (36.0%) of children in Broome County are considered overweight or obese, compared to the New York State (excluding NYC) figure of 33.9%. Tobacco, Alcohol and Other • One of every four adults in Broome County smokes cigarettes (24.0%). Substance Abuse Indicators • Over20% of Broome County adults binge drinks (20.2%). Injury Indicators • Deaths caused by suicide (age adjusted) are higher in Broome County (12.9 per 100,000) than in NYS (8.0) and NYS excluding New York City (9.6).

14 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Health Indicators: (Appendix Source: NYSDOH: 2011-2013 Incident Rate Data 6) • Deaths caused by unintentional injury are higher in Broome County (37.1 per 100,000) than in NYS (25.6) and NYS excluding New York City (30.8). • Hospitalization rates for unintentional injuries are higher in Broome County (68.3 per 10,000) compared to NYS and NYS excluding New York City (both at 62.2). • For both deaths and hospitalizations, Broome County ranks in the 4thquartile (worst or bottom) among all the counties in New York. • Broome County ranks in the 4th quartile (worst or bottom) of counties throughout New York State for self-inflicted injuries 10.4 per 10,000 compared to the state rate of 5.8 per 10,000. • Hospitalizations caused by injuries due to falls are higher in Broome County (38.6 per 10,000) than in NYS (34.7) and NYS excluding New York City (34.9), placing Broome County in the 4th quartile (worst or bottom) among all the counties in New York. However even though the hospitalization age adjusted rate is high, it has been in a steady decline for those 65 years and older. • The rate of hospitalizations caused by falls in the 65 years and older category has decreased from 193.4 per 10,000 in 2012 to 186.0 per 10,000 in 2013.(Appendix 9) HIV/AIDS and Other Sexually • Broome County has low HIV/AIDS and sexually-transmitted diseases (STD) rates Transmitted Infection Indicators compared to NYS and NYS excluding NYC. • The only STD indicator falling within the 4th quartile (worst or bottom) is the Chlamydia rate in the county coming in at 219.6 per 100,000 males. Family Planning/Natality • The teen pregnancy rate per 1,000 for girl’s age 10-14 years in Broome Indicators County is 0.8, falling below the NYS rate of 0.9. However it is higher than the rate for NYS excluding New York City (0.6), putting the county in the 4th quartile (worst or bottom) for this indicator. • The county is also in the 4th quartile (worst or bottom) for teen pregnancy among girls age 15-17, at 20.8 pregnancies per 1,000 compared to 22.4 for the state as a whole and 14.5 for NYS excluding New York City. Cancer Indicators • Cancer of the lip, oral cavity and pharynx incidence rate represents a low number of 12.9 per 100,000 however it is higher than both NYS (10.5) and NYS excluding New York City (11.0). • Incidence rates for other types of cancer, though higher in volume, are generally below the rates for both NYS and NYS excluding New York City. Cardiovascular Disease • Hospitalization rates of adults due to hypertension are 5.5 per 10,000, putting the county into the 4th quartile (worst or bottom) ranking for this measure. • Cardiovascular disease (248.5), other diseases of the heart (195.1), and cerebrovascular disease (34.9) have significantly higher mortality rate in Broome County compared to NYS and NYS excluding New York City. • Congestive heart failure has a lower mortality rate than NYS excluding New York City of 14.2. • Chronic Lower Respiratory Disease Hospitalization rate are lower in Broome County than in NYS but are at a similar rate than in the NYS area without NYC. • Broome County ranks in the 4th quartile (worst or bottom) among NYS

15 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Health Indicators: (Appendix Source: NYSDOH: 2011-2013 Incident Rate Data 6) Counties for hospitalizations associated with cirrhosis of the liver. • Chronic kidney disease has a hospitalization rate per 10,000 of 103.9 which is just slightly higher than NYS as a whole (103.0) and significantly higher than NYS excluding NYC (95.3). • Rates for emergency room visits for patients with chronic kidney disease put Broome County in the 4th quartile (worst or bottom) in the state for this measure. Leading Causes of Death for • Heart Disease Broome County • Cancer • Stroke • Chronic Lower Respiratory Disease • Unintentional Injury (Accidents) Child and Adolescent Health • The percent of children in Broome County receiving government-sponsored Indicators health insurance who have received the recommended number of well child visits is 54.8%. This is significantly lower than the NYS rate of 71.6% and NYS excluding NYC of 70.3%, placing the county in the 4thquartile (worst or bottom) in New York. • The percentages of children who have received lead screening tests are below the percentages of NYS which indicates that children may be at risk for lead poisoning. • The percentage of children born in 2010 who received a lead screening at 9-17 months in Broome County was only 53.6%, compared to 65.0% for NYS. • The percent of children born in 2010 who received at least 2 lead screening tests by 36 months in Broome County was only 37.4%, compared to 55.1% for NYS. • The incidence of confirmed high blood lead level among children ages >72 months in Broome County was 18.8 per 1,000 tested, more than 4 times higher than the state rate of 4.9 children per 1,000 tested. Oral Health Indicators • Approximately 88.5% of 3rd grade children have dental insurance in Broome County. • Four out of every five children in 3rd grade (80.6%) have had at least one dental visit within in the past year. • Slightly more than half (56.7%) of 3rd grade children have had experience with caries (tooth decay) which is higher than NYS excluding NYC (45.4%). No data is available for NYS as a whole. • Seven out of ten (70.1%) of adults have had a dental visit in the past year. • The oral cancer rate for Broome County (12.9 per 100,000) is significantly higher than the rate for NYS (10.5).

1.5.c: Broome County Health Outcomes and Health Factors – Trend Review (Appendix 2) Broome County ranked 56 out of 62 counties in overall health (bottom quartile) and 31 out of 62 counties for factors that influence overall health of the county (table below). The county’s rank for health outcomes has increased (worsened) from 48 in 2013 to 56 in 2016. However, in terms of health factors Broome County showed a slight improvement from 28 in 2015 to 31 in 2016.

16 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Ranking Category: Year Out of 62 NY Counties 2013 2014 2015 2016 Trend (2010 (2011 (2012 (2013 data) data) data) data) Health Outcomes: based on mortality Rank: 48 Rank: 48 Rank: 51 Rank: 56 Getting Worse and morbidity Health Factors: based on behavioral, Rank: 33 Rank: 30 Rank: 28 Rank: 31 Unchanged clinical, social, economic and environmental factors Data source: County Health Rankings & Roadmaps, 2016, University of Wisconsin Population Health Institute; funded by the Robert Wood Johnson Foundation.

Broome County improved its rank (on the list of counties from 2013 to 2015)and continued to show slight improvement in 2016 for health factors (behavior measures), which includes: adult smoking, adult obesity, physical inactivity, excessive drinking, motor vehicle crash death rate, sexually transmitted infections and teen birth rates. Ranking for Broome County was 30th in 2013 and increased to 20th in 2015, dropping to 30th again in 2016. Among the measures included, Broome County is experiencing negative trends in physical inactivity and excessive drinking.

The County saw a decline in ranking in clinical care measures, ranking 15th in 2013, down to 23rd in 2015, but improving its rank to 19 in 2016. Clinical care measures include: uninsured, ratios of primary care providers, dentists, mental health providers, preventable hospital stays, diabetes monitoring, and mammography screenings. Among the measures included, Broome County is has seen a slight negative trends in mammography screenings.

The County has dropped from the high 30s to low 40s of rankings for social and economic factors such as high school graduation rates, college education, unemployment, children in poverty, inadequate social support, children in single- parent households, and violent crime rates. Its rank in 2013 was 38th and in 2016 is 43rd.

Broome County’s ranking for physical environment measures has improved significantly over the past four years, from 52nd in 2013 to 3rd in 2016. Measures for this category include: air pollution, drinking water violations, severe housing problems, driving alone to work, and long commute times when driving alone. It should be noted that in 2013 the category included several different measures that are not included in 2015 and 2016. These changes in measures could account for the significant swing in ranking.

1.6 Public Health Priorities: Process for Identifying & Prioritizing Community Health Needs & Services Hospitals are considered co-conveners of the community assessment process with the local health departments (LHDs) with which they work most closely. Hospitals, LHDs and other community partners (community-based organizations, health care providers, and consumers, etc.) should form a partnership to share and analyze data to identify the two to three Prevention Agenda priorities. This section must describe the criteria by which the priorities were selected, including how data were used to target a community or a segment of the community. Describe whether the priorities selected represent new community initiatives or existing programs that will be supplemented by input and support from community partners.

Process for Identifying Community Health Needs CHNA Development Process In late 2015, Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes) collaborated with Research & Marketing Strategies, Inc. (RMS) to assist with development of its Community Health Needs Assessment (CHNA). RMS works with delivery systems to conduct community health needs assessments, facilitate clinical integration, assist with payer contracting,

17 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

establish patient registries, data warehouses and metric dashboards to help systems advance improvements in community population health, and measure satisfaction of the various stakeholder groups. RMS conducted the regional CHNA, for the Medicaid delivery system redesign incentive payment program (DSRIP) which is incorporated and explained in this CHNA.

The RMS team follows a thorough and comprehensive process for assisting hospitals and health care systems with conducting the CHNA to meet the requirements of the IRS statute. Additionally, the RMS team worked with Lourdes to review and incorporate data from existing initiatives already underway through collaborations with county health departments, community based organizations, Care Compass Network (Delivery System Reform Incentive Payment, DSRIP, performing provider system) and healthcare systems. For work related to Lourdes CHNA the process included the following components: • Demographic, Sociographic and Health Status Profile of Community; • Inventory of Health-related Resources in Community; • In-Depth Interviews with Community Resources/Representatives; • Review of Community Feedback from Consulting Work Associated with DSRIP; • Gap Analysis and Identification of Community Health Needs; • Community Health Needs Prioritization; and • Community Health Improvement Plan (CHIP)/Implementation Strategy.

Additional community health priority sources were reviewed. Each of these sources was also reviewed by Lourdes Hospital.

1. The Prevention Agenda Public Health Priorities – Established by New York State Commissioner of Health for 2013-2018 http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/tracking_indicators.htm

Background The Prevention Agenda identified five priorities for improving health status, reducing health disparities with an increased emphasis on prevention. The Commissioner has asked hospitals, local health departments, and health care and community partners’ work together to bring about measurable progress toward mutually established goals.

The five New York State Prevention Agenda priority categories for 2013-2018 are: Preventing Chronic Diseases; Promote a Healthy and Safe Environment; Promoting Healthy Women, Infants and Children; Promote Mental Health and Prevent Substance Abuse; Prevent HIV/STDs, Vaccine-Preventable Disease and Health Care-Associated Infections.

The county is continuing to focus on existing priorities until 2018. Further information regarding the New York State Department of Health Prevention Agenda Guidance (Appendix 4) or at the following link: http://www.health.state.ny.us/prevention/prevention_agenda/index.htm

2. Community Health Needs Assessments & Public Health Priorities: Lourdes’ 2016-2018 CHNA Lourdes and the Broome County Health Department developed their respective 2013 CHNA’s in tandem and have annually reviewed outcome measures for community health priorities selected in the 2013 CHNA. Information from these prior CHNA’s has been incorporated into the Lourdes and Broome county 2016 CHNA update. Lourdes is participating in a joint Broome and Tioga County CHNA community health priorities update process, which begun in April 2016. The Broome County Health Department Steering Committee has elected to continue to focus on the same community health priorities identified in the 2013-2017 CHNA through 2018 (reference page 2 of this document.)

18 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

3. Public Health Improvement Plan (PHIP) Lourdes actively participates in the Public Health Improvement Plan (PHIP) process during 2015-present. The two priority areas preliminarily selected through the PHIP analysis and prioritization process are to address transportation and mental health/substance abuse. The output of the PHIP planning process is being incorporated in to the updated county health department community health needs assessments which will be submitted to the NYS Department of Health, December 30, 2016.

Prioritization Process The process for identifying and prioritizing the community’s health needs and services was done with facilitation from RMS based upon the information obtained from key community stakeholders as well as quantitative data obtained from the Broome County Health Department.

RMS has developed a tool to assist Lourdes with prioritizing the health themes identified through the CHNA research (Appendix 10). Each priority area, taking into account rating factors or variables below: Fit with Lourdes mission; Availability of staff resources; Availability of financial resources; Community awareness and consensus of the need; Initiatives already underway to address the need; Engagement of multiple community stakeholders; Improvements underway not yet reflected in measurement data; Degree to which failure to address the need will exacerbate the issue; The level of clarity of direction or solutions to the need; The level of impact to the community; Alignment of issue with NYS Prevention Agenda goals.

The goal of the prioritization is to determine which need areas Lourdes will incorporate into its strategic plan and focus on over the next three years. Lourdes and RMS have set the following timeline for the next steps associated with the prioritization of needs and the development of the Community Health Implementation Plan (CHIP).

1. May 2016: Board approval of CHNA document. Posting of CHNA material on the Lourdes website. 2. May - July 2016: Prioritization of Needs. 3. July – August 2016: Selection of Lourdes Health Priorities and the Development of Lourdes Community Health Improvement Plan/Implementation Strategy. 4. September 2016: Board approval of Community Health Improvement Plan/Implementation Strategy; Posting of revised CHNA/CHIP/IS material on the Lourdes website. 5. September-December 2016: Modification of Lourdes CHNA pending Broome County Health Department CHNA update. 6. December 2016: Lourdes CHNA/CHIP provided to NYS Health Department.

19 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

1.7 Process for Consulting with Persons Representing the Community’s Interests

Community input on healthcare needs of the population was received through in-depth interviews conducted with community stakeholders, representing and/or speaking to the healthcare needs of Broome County’s population.

In-depth interviews (IDIs) In-depth interviews were conducted with community stakeholders representing community leaders, health organization administrators, public health stakeholders, social services personnel. Participants provided relevant information regarding the health needs of the community. Each interview was completed with professional-level research staff at RMS (Managers and Analysts).

RMS completed a total of 12 IDIs with community stakeholders. Each interview lasted approximately 20 to 30 minutes. The fieldwork for the telephone IDIs was conducted in December 2015. The list of the interview participants is provided below.

Name Title Organization Nancy Dorfman, MBA Director, Network Contracting Excellus BlueCross BlueShield Emily Hotchkiss, MPH Population Health Coordinator, Rural Health Network of South Central NY Broome and Delaware County Sherriff David Harder Sherriff Broome County Sherriff's Department John Leet General Manager Fox 40 John Berry Executive Director Southern Tier AIDS Program Kim Myers County Legislator, Minority Broome County Legislature Leader Arthur R. Johnson, LCSW Commissioner Broome County Social Services and Mental Health Claudia Edwards Director Broome County Health Department Mary McFadden Supervising Public Health Broome County Health Department Educator Jill Alford-Hammot Program Manager Lourdes Youth Services Brian Picchini President & CEO United Methodist Homes Christopher Ryan, MD Medical Director Broome County Health Department

The majority of the stakeholders listed recommended that Lourdes consider focusing on the following top three community health needs: 1. Behavioral health (mental health and substance abuse) access (66.7%). 2. Access to care for those with limited resources (50%). 3. Access to specialty care services (50%).

Other factors identified as impacting health status were access to home care services, and an aging and impoverished population experiencing poorer health status due to obesity, and chronic illnesses. More information regarding the IDIs can be found in Appendix 11 of this report.

20 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

1.8 Information Gaps Impacting Community Health Needs Assessment

Limitations of timely and integrated data systems make it difficult to know definitively (1) if the selected priorities are the appropriate priorities; and (2) if interventions are impacting the selected priorities. Lourdes is in the process of developing analytic tools to help manage population health. Lourdes will create benchmark data and measurements, as feasible, for those utilizing Lourdes’ services, to monitor the effectiveness of the implementation strategies aimed toward improving health status.

Other information gaps identified by the Broome County CHNA Steering Committee for the 2013-2017 CHNA/CHIP process as well as the 2016 update remain the same. The preliminary Broome County CHNA Steering Committee 2016 update has not found any additional gaps. Existing gaps include: 1. Access to timely community-wide data. 2. Availability and timeliness of limited NYS hospital and ambulatory surgery data through the NYS SPARCS system, lags 9 months to 1 year, and is not available for the community as a whole. 3. Community-wide primary care outcomes and payer data is not publicly available. 4. Lack of a community-wide adopted electronic medical record (EMR). 5. There is an opportunity to work with payers in order to bridge the gaps in real-time health care outcomes data. 6. There is an opportunity to work with Care Compass Network in order to bridge the gaps in health care outcomes data for the Medicaid population as part of the New York State DSRIP program. 7. There is an opportunity to work with payers and community organizations to adopt standardized quality measures to determine community wide opportunities for improvement as well as the ability to measure select quality measures over time.

SECTION 2: PUBLIC PARTICIPATION & DISCLOSURE

2.1 Public Participation Identifies the participants involved in assessing community health needs (e.g. community-based organizations, other health care providers such as community health centers, family planning clinics, physician groups, and home care agencies, facility advisory boards and the public.)

Lourdes recognizes that Public Participation is an important aspect of the CHNA and CHIP/IS. The Broome County Community Health Needs Assessment and the Care Compass Network (DSRIP) CHNA processes are the result of collaboration and serve as a basis for the Public Health Priorities framing Lourdes’ Community Service Plan.

Demonstration of Public Involvement Hi-lights of the public input process include: • In-depth interviews with community stakeholders (Appendix 11); • Online survey administered to area healthcare clinical providers as part of the DSRIP research (Appendix 12); • Online survey administered to area non-clinical providers and community organizations as part of the DSRIP research (Appendix 12); • Online survey administered to community residents as part of the DSRIP research (Appendix 12); • Focus group research conducted among the Medicaid recipients in Broome County (Appendix 12).

21 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy In total, 12 community stakeholders were involved in the process, as well as more than 880 online responses were received and two focus groups representing 24 participants were conducted.

Additional resources used by Lourdes to gather input from the public on an ongoing basis include:

1. Lourdes Patient and Family Advisory Council: The Lourdes Patient and Family Advisory Council, implemented in 2012, are modeled from Ascension Health councils functioning in other states such as Connecticut and Indiana. The purpose of this council is to garner input from the lay public on Community Health Needs and how well Lourdes is accomplishing strategies to address the identified issues.

2. Ongoing Feedback: Lourdes receives formal and informal input on Community Health Needs on an ongoing basis through participation in National, New York State, Regional, County, local community coalitions and agencies, patient and physician satisfaction surveys (findings and results), and the Care Compass Network on- line DSRIP Panel. The Care Compass Network panel is comprised of over 800 persons who are either Medicaid beneficiaries, providers, community based organization representatives or the at large community.

3. Lourdes Associates: Input will continue to be sought on an ongoing basis from nearly 100 organizations/agencies/service groups which over 75 Lourdes Associates serve on to elicit input on community health priorities and interventions, and to ensure that intervention strategies are achieving the desired outcomes, and to identify “new” community needs.

4. Lourdes Committees: • Population Health Committee meetings, held monthly; address community health status, social determinants of health, and input on organizational strategies to address community health needs and priorities. • Healthcare Access and Engagement Committee meetings, held monthly, address access and coverage to health care services, community trends, and identify solutions to access and coverage. • Medical Mission Committee, begun in 2015, oversees the planning and implementation of two Medical Missions annually, designed to deliver health care to the poor and vulnerable. • The Lourdes Board of Directors Population Health Committee is comprised of Board members, Independent Physician and Mid-level Providers along with various members of Hospital Leadership. This committee meets six times per year. Since the last CHNA, the committee has met four times to focus on the population of the community served by Lourdes. This committee will continue to be involved in determining the priorities of the Lourdes CHNA, CHIP/IS.

2.2 Public Availability of the CHNA, CHIP & Implementation Strategy

The Lourdes Hospital 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan and Implementation Strategy and interim Community Service Plan (CSP) Reports will be made available to the public on the Lourdes website in portable document format (pdf) at http://www.lourdes.com/about-us/community-service- plan/. Per Federal and New York State law, Lourdes’ 2016-2018 plan will be made available to the public on the website until a subsequent CHNA is completed. The annual CSP report is approved by the Lourdes Board of Directors. Appendix 14 provides a copy of the most recent Community Service Plan Report.

22 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

SECTION 3: IMPLEMENTATION STRATEGY

Lourdes will ensure that the hospital’s annual three year Integrated Strategic, Operational, and Financial Plan allocates appropriate resources supportive of achieving the Community Health Improvement Plan and Implementation Strategy referenced below and in Appendix 13, in order to improve community health status. Lourdes will continue to participate in the collaborative process of developing and executing the community-wide CHIP/IS. Status updates on Lourdes Community Health Improvement Plan/Implementation Strategy will be made to the Broome County CHNA Steering Committee and to internal Lourdes committees, including but not limited to the Access Committee, Population Health Committee, and Board Population Health Committee which provide oversight for Lourdes’ community benefit.

3.1 Community Health Improvement Plan & Implementation Strategy

Our Lady of Lourdes Memorial Hospital, Inc. is a single hospital, and as such has developed one Community Health Improvement Plan/Implementation Strategy (CHIP/IS). A copy of the CHIP/IS is available on the Lourdes website at www.lourdes.com and in Appendix 13.

New York State requires that hospitals select two health priorities to address, and within one of those to have a measure which addresses the needs of a disparate group.

Lourdes participated in the development of the Broome County CHNA and CHIP/Implementation strategy process. In conjunction with the County process, Lourdes developed a Lourdes CHNA and CHIP/Implementation strategy which was tailored to Lourdes and the residents of Broome County, taking into account Lourdes programs, resources, and the identified community health themes and priorities.

The process by which Lourdes identified the health priorities Lourdes would work on during the 2016-2018 period has been described in Section 1.5,pages 15-17,in Section 2, and further delineated in Section 3, pages 20-27.

3.2 Implementation Strategy: Three Year Plan of Action For the Public Health Priorities identified below, including the 2 to 3 Prevention Agenda priorities, describe the strategies proposed to address them; whether they are new or existing priorities; how they may be addressed by the hospital and community partners and by whom, e.g., a service or program will be implemented within the hospital, a community health center or local health department clinic, an educational effort will be undertaken by local schools, businesses, or health department(s).

Prevention Agenda priorities should be addressed jointly with other community partners performing services or activities within their scope or mission. In the case of hospital public health programs falling outside the Prevention Agenda priorities, the hospital does not need to implement a collaborative approach to address the issue.

The overall goals of the strategies, how the goals will be measured for effectiveness and how these current strategies may be modified to include ongoing input and support from the hospital’s community partners.

23 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Outcomes of Public Input in the Community Service Plan & Assessment Process

2016-2018 Lourdes Public Health Priorities supporting Broome County Public Health Priorities

New York State requires that Hospitals select two health priorities to work on, and within one of those to have a measure which addresses the needs of a disparate group.

Lourdes will continue to collaborate with members of the Broome County Health Department Community Health Needs Assessments Steering Committee to monitor current and develop new initiatives to address Public Health Priorities, which were selected once the Broome County 2013-2018. Lourdes also took into consideration feedback from key community stakeholders and evidence based practices in the development of health priorities. Priority Areas were identified. 1) Obesity – Wellness and Prevention to reduce obesity in children and adults; and Obesity - Chronic Disease to prevent and manage chronic diseases impacted by obesity, such as diabetes and cardiovascular disease; 2) Behavioral Health – Mental Health and Substance Use to improve access and coverage to mental health/behavioral health services. The community health priorities specifically address each of the community health needs identified through the CHNA process. Lourdes will continue to support the Broome County Health Department’s initiatives for falls prevention.

Table 3.2.a: 2013-2018 Broome County Public Health Priorities & 2016-2018 Lourdes Public Health Priorities

NYS Health Lourdes 2016-2018 Priority Area Broome County 2013-2018 Priority Area Department Themes below are categorized according Priority Areas to priority areas Access to Quality Behavioral Health (Mental Health & Increase the age-adjusted percentage of adults who Health Care Substance Use) have a regular health care provider. Services Increase access to Behavioral health Promote Mental (mental health and substance use). Promote mental, emotional and behavioral Health and Goal: Lower Barriers to mental health wellbeing in communities; prevent substance abuse Prevent and substance use services. and other mental, emotional behavioral disorders. Substance Abuse Promoting Obesity Prevention, Wellness & Chronic Increase the percentage of children who have Healthy Disease received full immunization series (ages 19-35 Behaviors Decrease the percentage of children, months). Health and adolescents and adults who are obese. Increase the percentage of children that have well Wellness – Goal: Lower barriers to healthy life style child visits Preventive Care choices. Decrease the percentage of 3rd grade children with untreated tooth decay. Chronic Disease Obesity - Decrease the percentage of children, & Chronic adolescents and adults who are obese. Disease Increase screening rates for cardiovascular disease Prevention and diabetes, especially among the Medicaid Health Home populations. Increase outreach, education, screening(s) through Primary Care practices, and cardiovascular screening programs for patients with cardiovascular disease (CFH, COPD) who may be at risk. Healthy and Safe Reference Table 3.2.b below. Lourdes has Falls prevention - reduce hospitalization rate rates Environment operationalized falls prevention due to falls among seniors (age 65+). initiatives.

24 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy NYS Health Lourdes 2016-2018 Priority Area Broome County 2013-2018 Priority Area Department Themes below are categorized according Priority Areas to priority areas Disparate Socioeconomic Poor & Vulnerable Disparate population is defined as the poor (under Population Focus on the poor and vulnerable with and uninsured). Reduce frequent mental distress special attention to those enrolled in among adults with cardiovascular disease or Medicaid program. diabetes, focusing on those enrolled in the Medicaid Health Home with behavioral health and more than one chronic disease.

Community Health Priorities Not Addressed by Lourdes Following an intensive review of data, input from public health, community and medical staff leadership, Lourdes selected the priorities it would focus on.

Lourdes recognizes that no one organization can address the entire health care needs of the community. Lourdes is conscious of its stewardship of resources to best meet the needs of our community. As such, Lourdes will focus resources in those areas in which Lourdes can impact community health most. Lourdes’ practice is to maximize resources with existing programs, new services planned, to avoid duplication of services, and to establish metrics and tools which foster continuous improvement. Additionally, it was determined that addressing the chronic disease, prevention and wellness and behavioral health (mental health and substance use) combined with Lourdes commitment to serve all persons regardless of disparity, would address the several of the health concerns not selected, as listed in the table below.

Lourdes acknowledges the importance of all identified Broome County health priorities and will continue to work with and support community partners who have demonstrated the expertise, commitment and organizational resources to address priorities for which they are best suited and to address health priority areas not selected to be focused on directly by the community. Additional rationale for health issues Lourdes is not working on is delineated in the table below.

Table 3.2.b Rationale for Broome County Priority Areas Not Addressed by Lourdes

Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by 2016 Goals Lourdes

Improve Health Status & Health Disparities

Percentage of premature deaths • This has not been a worsening trend over the past five years. With the (before age 65), focusing on the development of interventions focusing on identified priority themes, ratio of Black non-Hispanic to Lourdes will sustain continued commitment in their efforts through White non-Hispanics; ratio of development and implementation of programs/services (aligned with Hispanics to White non- Hispanics. interventions) that mitigate health risks, as well as through health care delivery system changes, such as DSRIP program priorities and PCMH Recognition, among others.

• Broome County CHNA process indicated that (1) there was a low number of absolute number of individuals living in Broome County who are part of this disparate group. (2) Other community-wide initiatives targeting education outreaches, and interventions for the

25 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by 2016 Goals Lourdes disparate population around cardiovascular disease, diabetes, cancer, violence, adequate access and health care coverage exist.

• Decision that a greater absolute number of persons could be impacted, some of which would be this disparate group, by focusing on persons in poverty and increasing access and coverage to primary care.

Promote A Healthy and Safe Environment

Rate of hospitalizations due to • With the development of interventions focusing on identified priority falls per 10,000 ages 65+. themes, Lourdes will sustain continued commitment in their efforts through development and implementation of sealant programs (aligned with interventions) that mitigate health risks, as well as through health care delivery system changes, such as DSRIP program priorities and PCMH Recognition, among others.

• Lourdes will be impacting these rates directly through falls prevention initiatives including the implementation of evidence-based program, “Otego” through Lourdes at Home, administering falls risk/prevention questions throughout the Lourdes Primary Care Network, implementation of Tai Chi for Arthritis courses offered at no cost to community members.

• Community resources are currently focused on falls prevention strategies through the Office of Aging, EMS system, and the Broome County Health Department’s evidenced-based strategies. Interventions by these organizations are built in to the Broome County CHNA and CHIP.

• Avoid duplication of resources and community interventions. Rate of emergency room visits due • Rationale for not focusing on ER visits due to falls is that same as to falls per 10,000 ages 1-4. “rate of hospitalizations” above.

• Absolute numbers of individuals affected in Broome County are low.

Preventing Chronic Disease

Age-adjusted heart attack • Lourdes will be impacting these rates through outreach, education, hospitalization rate per 10,000. screening through the Primary Care practices, and cardiovascular screening programs, Lourdes at Home’s tele-medicine program for patients with cardiovascular disease (CHF, CPD) who may be at risk.

• Lourdes selection of obesity as one of the health priorities should impact these rates. With the development of interventions focusing on the identified priority themes, Lourdes will sustain continued commitment in their efforts through development and implementation of programs/services (aligned with interventions) that mitigate health risks,

26 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by 2016 Goals Lourdes as well as through health care delivery system changes, such as DSRIP program priorities and PCMH Recognition.

• Trend has not been worsening.

• Absolute numbers of individuals affected in Broome County are low. • Community resources are currently deployed to address cardiovascular disease prevention, heart attach prevention through the Broome County Health Department, outreach and education by Lourdes and the community, American Heart Association. Rate of hospitalizations fo short- • Address diabetes through obesity interventions is a community-wide term complications of diabetes initiative. per 10,000, ages 6-17. • Lourdes will collaborate with other community partners and organizations to address to improve health outcomes as defined through the Public Health Improvement Plan (PHIP), local health department CHNAs and the DSRIP CHNA. (Appendix 4)

• Current Lourdes initiatives which should impact these rates: Lourdes selection of obesity as one of the health priorities should impact these rates. Lowering the barriers to healthy lifestyle habits will and standardizing provider and patient education will support patient/resident engagement for self-management. Outreach and education through Lourdes Endocrine and Diabetes Center of Excellence, Implementation of the Electronic Medical Record in Lourdes Primary Care Practices, Patient-Centered Medical Home Recognition and associated requirements to monitor and report on A1C’s.

• With the development of interventions focusing on identified priority themes, Lourdes will sustain continued commitment in their efforts through development and implementation of programs (aligned with interventions) that mitigate health risks, as well as through health care delivery system changes, such as DSRIP program priorities and PCMH Recognition, among others.

• Absolute numbers of individuals affected in Broome County are low.

Promoting Healthy Women, Infants, and Children

27 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by 2016 Goals Lourdes Percentage of children who have • Implementation strategies to increase the number of well child visits had the recommended number of is a community-wide initiative led by the Broome County Health well child visits in government Department. The Broome County Health Department will be reaching sponsored insurance programs out to Medicaid managed care companies. (ages 3-6 years of age and 12-21 years of age.) • Lourdes did not select this due to the commitment to continue serving this population through existing programs and interventions such as: 1. Lourdes Primary Care practices serving this population in suburban and rural communities and continues to seek opportunities for collaboration with community organizations utilizing resources. 2. Outreach to enroll children in government sponsored programs. 3. Continued commitment to increase access to children and families who are uninsured and underinsured through existing programs, Lourdes Youth Services, Lourdes programs that work closely with the school systems. 4. Utilization of EMR data will continue to be utilized to identify children within Lourdes practices who have not compliant with well child visits. 5. Implementation of DSRIP projects which link the uninsured to a primary care provider, identify and proactively reach out to non/low-utilizers or health care will reduce barriers to accessing care and receiving well child visits. Percentage of third grade children • Community commitment to continue to operate existing programs: with evidence of tooth decay. Broome County Health Department Dental Sealant Program and interventions through WIC.

• Lourdes will continue to operate programs through the Lourdes Center for Oral Health and the mobile dental van (Dental Clinic serving children and their families who are uninsured, underinsured, or on Medicaid) and outreach through annual Medical Mission events to decrease the percentage of children with tooth decay.

Percentage of unintended • Community commitment continues to operate existing programs, pregnancy among live birth. outreach and education.

Reference herein: Section 1.4, pages 10-14; Section 1.5, page 14

Barriers to Care and/or Gaps in services Services were identified through a variety of methods: focus groups, surveys, Community Service Assessments, the Broome County Health Department CHA Steering Committee, the Care Compass Network Community Health Assessment and on-line Panel group, and qualitative and quantitative analytics. This information was incorporated into the identification and recommendations around Public Health Priorities identified in the 2013-2018 Broome County Health Department’s Community Health Assessment. Additional barriers will be identified in the Broome County Health Department CHNA currently in progress. Comprehensive findings will be detailed in the 2013-2018 Broome County Community Health Assessment document (www.gobroomecounty.com).

28 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy Collaboration of Hospitals Lourdes Hospital and United Health Services Hospitals collaborated in establishing hospital public health priorities. This information was incorporated into the hospital and County Community Service Plans.

Public Input, Sources of Through the BCDOH CHNA Steering Committee and the Public Health Improvement Process (PHIP), Prevention Agenda priorities were addressed jointly with other community partners performing services or activities within their scope or mission.

Broome County Indicators for Tracking Public Health Priority Areas 2013-2016 (Appendix 8) Summarizes key public health issues. Interventions are process and outcomes based and are designed to address health status priorities. Several of the implementation strategies are evidenced based, are recognized nationally, and have previously been successfully deployed by Broome County’s health care systems targeting the particular public health issues.

2016-2018 Community Health Improvement Plan & Implementation Strategy (Appendix 13) The Lourdes Community Health Implementation Plan & Implementation Strategy can be found on the website, www.lourdes.com, which demonstrates Lourdes’ current and future commitment both clinically and financially to address the community’s health status by fulfilling its call to provide health care that works, healthcare that is safe, and health care that leaves no one behind. The Broome County Community Health Improvement Plan 2013-2018 can be found on the website, www.gobroomecounty.com, and identifies the Community’s Public Health Priorities, whether they are existing or new, and how they may be addressed and by whom.

Implementation Strategy Monitoring There will be ongoing input and support from internal Lourdes Committees, the Broome County CHNA Steering Committee Partners, Lourdes Hospital, and United Health Services Hospitals, in the review of selected Community Priorities, the overall goals of the strategies, how the goals will be measured for effectiveness.

Lourdes, in conjunction with the CHNA Steering Committee, will recommend the length of time interventions should be in place before its effectiveness can be determined. The effectiveness of Lourdes CHIP/IS will be monitored by Lourdes and reported to the Broome County Health Department’s CHNA Steering Committee and to Lourdes committees.

SECTION 4: FINANCIAL AID PROGRAM

Describe the hospital’s successes and challenges related to the provision of financial aid in accordance with Public Health Law 2807(k) (9-a).

Do not include the summary of the hospital’s policy or financial data required by Exhibit 50 of the ICR; rather discuss general accomplishments, process improvements and/or best practices related to the hospital’s financial aid program.

Lourdes remains committed to providing the highest quality health care to all who need it particularly care to the poor and vulnerable. Lourdes participates in local, state, and federal public health programs.

Information about Lourdes financial assistance programs are disseminated throughout Lourdes’ locations, 18 Lourdes Physician Network Primary Care Offices, Health Fairs, Community Coalitions, local Employers, and is available to the public and the medical staff at Lourdes. Lourdes provides information to independent physician practices on Lourdes financial assistance programs.

29 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

Among the unique financial assistance programs that Lourdes offers or participates in are: Lourdes Patient Financial Assistance Program (PFAP), prompt pay program, Medicaider, Hope Dispensary, Lourdes Care Plus, Presumptive Eligibility for Prenatal Care, Child Health Plus, Medicaid, Medicaid Managed Care. Lourdes also participates in Health Prevention Initiatives through the Cancer Services Program for Broome, Chenango, and Tioga Counties (CA 10-790-11) and the Star Alliance Initiative (Childhood Obesity). Lourdes administers over $2.3 million annually in grant programs for at risk children and youth. During 2015 Lourdes expanded the Financial Assistance Program to our two retail pharmacy locations. The program provides assistance with prescription co-pays. Patients that qualify under the Lourdes program can receive co-pay assistance based on a sliding scale of 50%, 75% or 100% relief. In April 2016, Lourdes began participating in a program known as 340B which allows safety net hospitals to continue to serve those in need. In spite of the continued national economic crisis, Lourdes will continue to:

1) Expand services to the poor.

2) Provide financial assistance to those in need. Total Charity Care provided in CY 2015 was $23.65 million.

3) Provide financial counselors to assist the uninsured and underinsured in accessing health coverage.

4) Provide access and coverage to pharmaceuticals through Hope Dispensary of the Southern Tier of New York and Lourdes Patient Financial Assistance program. Nearly 2,000 prescriptions totaling nearly $960,000 were provided free to the community.

5) Assist residents in enrolling in insurance plans. In 2015,922 persons were enrolled in a qualified medical insurance plan.

6) Administer assistance through the Patient Financial Assistance Program of the Hospital, which served nearly 7,600 in 2015, a 4% increase from CY 2014.

7) Support its mission through grants. Lourdes administers nearly $2.13 million in grants to serve poor and vulnerable youth.

(Reference Appendix 3: FY 17-18 Integrated Strategic, Operational and Financial Plan)

30 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Needs Assessment, Community Health Improvement Plan, Implementation Strategy

SECTION 5: CHANGES IMPACTING COMMUNITY HEALTH/PROVISION OF CHARITY CARE/ ACCESS TO SERVICES

Describe any changes to the hospital’s operation or financial situation that impacts the care of the community, financial assistance and/or access to health care. This could include, but is not limited to, impending mergers, increasing financial constraints, and key personnel turn over.

Lourdes remains a fiscally strong organization. Lourdes does not anticipate a reduction in services to the community. This report along with the 2015 Community Service Plan (Appendix14) demonstrates Lourdes’ ability to continue to address community need. Additionally, as a member of Ascension Health, Lourdes is actively involved in the Ascension Health 100% Access and Coverage Advocacy Agenda. Lourdes will continue to provide a local and state leadership role for 100% Access and Coverage.

SECTION 6: FINANCIAL STATEMENT

The Department of Health will not require a separate financial statement to be submitted as part of the Community Service Plan. Financial data already reported to the Department through the Institutional Cost Report (ICR) will satisfy the statutory requirement.

Our Lady of Lourdes Memorial Hospitals financial data is available to the New York State Department of Health through the Institutional Cost Report (ICR), and through the annual Community Service Plan report (Appendix13) which is available on Our Lady of Lourdes Memorial Hospital’s website: http://www.lourdes.com/about-us/community-service- plan/.

31 Appendix 1.1 – Broome County Health Care Needs Themes – Qualitative Research Findings

Qualitative Research Online Online Focus Group Care Compass Community Potential Broome County Health Care Provider Community of Medicaid/ Network Stakeholder In- Priority Survey Survey Uninsured Panel depth Categories Needs Priorities Population Interviews Increase services for mental health, behavioral health, and substance √ √ √ √ √ abuse. Providers and community residents feel that services for mental health, behavioral health, and substance abuse are one of the top healthcare needs within Broome County. Barriers include the low number of providers, appointment availability and insurance participation. Affordability of healthcare services is seen as a significant access √ √ √ √ √ barrier for many people, particularly those with limited resources. Affordability extends to both healthcare service attainment Access to and purchasing of health insurance. Quality Health Improve access to healthcare services, by ensuring timely appointments, expanded hours, Care √ √ √ √ √ and greater number of physicians accepting new patients. All stakeholders felt that the availability and access to healthcare services has improved over the past 5 years in Broome County. Key stakeholder IDIs focused on the need for traditional specialty care providers within the community. Communication and care

coordination among providers √ √ √ should be significantly improved. There was a general consensus that communication and care coordination among providers could be significantly improved.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 1 Appendix 1.1 – Broome County Health Care Needs Themes – Qualitative Research Findings

Qualitative Research Potential Focus Group Community Broome County Health Care Needs Online Online Care Compass Priority of Medicaid/ Stakeholder In- Provider Community Network Categories Priorities Uninsured depth Survey Survey Panel Population Interviews Improve transportation resources to and from healthcare service √ √ √ √ √ sites. Improved transportation resources to and from healthcare service sites was identified as a need, especially by the provider stakeholder group. However, the research shows that Broome County transportation resources Access to are better than other surrounding areas surveyed via CHNA DSRIP Quality Health Online survey. Care There needs to be better education and awareness of non-emergent healthcare site alternatives for patients. The majority of online √ √ √ survey and Medicaid focus group respondents believe that the majority of individuals who visit the emergency room could have gone elsewhere. These patients do not have true emergencies. Increase emphasis on receiving regular dental care among all segment of the √ √ √ √ √ Chronic Disease county’s population. A & Chronic significant segment of the County’s population does not Disease receive regular dental care. The key reasons for this seem Prevention to be tied to cost (can’t afford -0 no insurance) and lack of time or fear of such a visit.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 2 Appendix 1.1 – Broome County Health Care Needs Themes – Qualitative Research Findings

Qualitative Research Focus Group Community Potential Broome County Health Care Needs Online Online Care Compass of Medicaid/ Stakeholder In- Priority Provider Community Network Priorities Uninsured depth Categories Survey Survey Panel Population Interviews Greater emphasis on preventive care and education regarding “healthy living”. This need was √ √ √ considered significant by the provider community, but was also identified by the community-at- large. Barriers to adopting and adhering to maintaining a healthy Chronic Disease lifestyle were identified as “lives being too busy”, cost, available & Chronic resources, transportation and lack Disease of focus. Increase awareness and education Prevention of available community-based resources, particularly around identifying specialty care and √ √ √ chronic disease management activities. Online survey respondents were asked their awareness of 211 – both provides and the community-at-large seemed to have low awareness of this Conductservice (~25% assessment awareness). of eldercare services available within the Healthy & Safe √ √ County. Panel respondents believe Environment that there is a community need to enhance what is presently available. Not identified as one of the original 10 themes

Identified as theme upon analysis √ √ √ √ √ Disparate of quantitative analysis

Population Theme 14: Focus on the poor and vulnerable with special attention to those enrolled in a Medicaid Health Home.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 3 Appendix 1.2 – Broome County Health Care Needs Themes – Qualitative and Quantitative Findings Research Methodology Qualitative Research Quantitative Data Our Lady of Lourdes Hospital, NYSDOH Focus Group Care Community Health Health Inc. Prevention Online Online of Medicaid/ Compass Stakeholder Factors, Outcomes, CHNA Identified Agenda Provider Community Uninsured Network In-depth 2016 2016 Priority Areas Items Category Survey Survey Population Panel Interviews (2013 data) (2013 data) NYS DOH Affordability by Improve health those with limited status and √ √ √ √ √ √ resources reduce health disparities Improved access Improve health to Healthcare status and services by reduce health √ √ √ √ √ ensuring timely disparities appointments Access Improve Promote a To transportation healthy and safe resources to and environment √ √ √ √ √ Quality Health from healthcare Care service sites Better education Not directly and awareness of applicable to the non-emergent NYSDOH √ √ √ healthcare site Prevention alternatives for Agenda patients Improve Not directly communication & applicable to the care coordination NYSDOH √ √ √ √ among providers Prevention Agenda

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 1 Appendix 1.2 – Broome County Health Care Needs Themes – Qualitative and Quantitative Findings Research Methodology Qualitative Research Quantitative Data Our Lady of Lourdes Hospital, NYSDOH Focus Group Care Community Health Health Inc. Prevention Online Online of Medicaid/ Compass Stakeholder Factors, Outcomes, CHNA Identified Agenda Provider Community Uninsured Network In-depth 2016 2016 Priority Areas Items Category Survey Survey Population Panel Interviews (2013 data) (2013 data) NYS DOH Decrease STD Prevent Morbidity (reduce HIV/STDs, the rate of vaccine Chlamydia among preventable √ √ men) diseases and healthcare associated Promoting infections Healthy Reduce the rate of Promoting adolescent healthy women, √ √ Behavior pregnancies infants, and children Reduce the Not directly incidence of applicable to the cancer of the lip, NYSDOH √ oral cavity and prevention pharynx agenda Promoting Increase services Promote Mental for mental health, Health & Prevent Mental Health behavioral health, Substance Abuse And Preventing and substance √ √ √ √ √ √ √ √ abuse Substance Abuse

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 2 Appendix 1.2 – Broome County Health Care Needs Themes – Qualitative and Quantitative Findings Research Methodology Qualitative Research Quantitative Data Our Lady of Lourdes Hospital, NYSDOH Focus Group Care Community Health Health Inc. Prevention Online Online of Medicaid/ Compass Stakeholder Factors, Outcomes, CHNA Identified Agenda Provider Community Uninsured Network In-depth 2016 2016 Priority Areas Items Category Survey Survey Population Panel Interviews (2013 data) (2013 data) NYS DOH Increase access Promoting and affordability healthy women, to regular dental infants, and care among all children √ √ √ √ √ √ √ segments of the Health and county’s population Wellness Greater emphasis Not directly on preventive care applicable to the and education NYSDOH Agenda √ √ √ √ √ √ Preventive regarding “healthy care living” Increase the Promoting proportion of healthy women, children who infants, and √ √ receive well child children care visits

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 3 Appendix 1.2 – Broome County Health Care Needs Themes – Qualitative and Quantitative Findings Research Methodology Qualitative Research Quantitative Data Our Lady of Lourdes Hospital, NYSDOH Focus Group Care Community Health Health Inc. Prevention Online Online of Medicaid/ Compass Stakeholder Factors, Outcomes, CHNA Identified Agenda Provider Community Uninsured Network In-depth 2016 2016 Priority Areas Items Category Survey Survey Population Panel Interviews (2013 data) (2013 data) NYS DOH Increase Prevent awareness and chronic disease education of available community-based resources. √ √ √ √ √ √ particularly around identifying specialty care and chronic disease management Chronic activities Disease & Decrease the Prevent chronic Chronic Disease proportion of disease children and √ √ √ √ Prevention adults who are obese Increase in Prevent chronic cardiovascular disease disease and diabetes screening, √ √ √ √ √ √ √ especially among the poor and vulnerable populations

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 4 Appendix 1.2 – Broome County Health Care Needs Themes – Qualitative and Quantitative Findings Research Methodology Qualitative Research Quantitative Data Our Lady of Lourdes Hospital, NYSDOH Focus Group Care Community Health Health Inc. Prevention Online Online of Medicaid/ Compass Stakeholder Factors, Outcomes, CHNA Identified Agenda Provider Community Uninsured Network In-depth 2016 2016 Priority Areas Items Category Survey Survey Population Panel Interviews (2013 data) (2013 data) NYS DOH Falls Prevention Promote a (reduce inpatient Healthy & Safe √ hospitalizations, Environment for those age 65+) Healthy Injury prevention Promote a (reduce inpatient Healthy & Safe & hospitalizations Environment √ √ Safe and mortality due to injuries) Environment Conduct Not directly assessment of applicable to the eldercare services NYSDOH √ √ available within Prevention the County Agenda Focus on the poor Improve health and vulnerable status and with special reduce health attention to those disparities √ √ √ √ √ √ enrolled in a Disparate Medicaid Health Population Home Decrease Not directly incidence of high applicable to the blood lead level in NYSDOH √ √ children Prevention Agenda

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 5 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

In late 2015, Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes) Collaborated with Research & Marketing Strategies, Inc. (RMS) to assist in the development of its Community Health Needs Assessment (CHNA). The CHNA utilizes input from members of the community in the form of stakeholders and residents from the Lourdes Service Area. RMS worked closely with members of the community and the management team of Lourdes to complete the assessment. Objectives of the CHNA process are: (1) To profile the community in terms of demographic, sociographic, and traditional health-related measures to obtain a clear understanding of the health status of the population served by Lourdes; (2) To ensure that members of the community are represented in the needs assessment process, including traditionally under-represented and/or vulnerable populations such as the medically underserved, low income, minority populations, as well as populations with chronic disease needs; and (3) To use information gathered (in the CHNA) to identify the health needs of the community to develop a prioritized community health improvement plan and implementation strategy to address these needs.

The identification of health “need themes” was a culmination of qualitative and quantitative analytical assessments: (1) a demographic profile of the Lourdes primary service area using the most current data available and (2) an inventory of current services available within the service area to meet the healthcare and wellness needs of the residents. There were a total of twenty themes identified through the qualitative and quantitative research in addition to findings from in-depth interviews which were conducted with key community stakeholders, which are as listed:

Qualitative Research: Theme (1-10)

Theme 1: Increase Services for Mental Health: Increase Services for mental Health, behavioral Health, and substance abuse. Theme 2: Affordability of Health Care Services: Affordability of health care services is seen as a significant access barrier for many people, particularly those with limited resources. Theme 3: Greater Emphasis on Preventive Care: Greater emphasis on preventive care and education regarding “healthy living”. Theme 4: Improve Access to Healthcare Services: Improve access to healthcare services, by ensuring timely appointments, expanded hours, and a greater number of physicians accepting new patients. Theme 5: Communication and Care Coordination: Communication and care coordination among providers should be significantly improved. Theme 6: Receiving Regular Dental Care: Increase emphasis on receiving regular dental care among all segments of the county’s population. Theme 7: Improve Transportation: Improve transportation resources to and from healthcare service sites. Theme 8: Increase Awareness of Education Services: Increase awareness and education of available community-based resources, particularly around identifying specialty care and chronic disease management activities. Theme 9: Awareness of Non-emergent Services: There needs to be better education and awareness of non-emergent healthcare site alternatives for patients. Theme 10: Assessment of Eldercare Services: Conduct an assessment of eldercare services available within the County.

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 1 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Quantitative Research: (Theme 11-20) (Data source of quantitative research: Themes 11-14, from 2013-2015/17 Lourdes and Broome County Health Department CHNA; Themes 15-20 from NYSDOH (year) statistics):

Theme 11: Falls Prevention: Reduce inpatient hospitalizations, for those aged 65+. Theme 12: Decrease Obesity in Children/Adults: Decrease the proportion of children and adults who are obese. Theme 13: Increase Cardiovascular and Diabetes Screening: Increase in cardiovascular disease and diabetes screening, especially among the poor and vulnerable populations. Theme 14: Focus on the Poor and Vulnerable: Focus on the poor and vulnerable with special attention to those enrolled in a Medicaid Health Home. Theme 15: Injury Prevention: Reduce inpatient hospitalizations and mortality due to injuries. Theme 16: Decrease STD Morbidity: Reduce the rate of Chlamydia among men. Theme 17: Reduce Adolescent Pregnancies: Reduce the rate of adolescent pregnancies. Theme 18: Reduce Risk of Oral/Throat Cancer: Reduce the incidence of Cancer of the Lip, Oral Cavity and Pharynx. Theme 19: Increase Well Child Care Visits: Increase the proportion of children who receive well child care visits. Theme 20: Decrease Blood Lead Levels in Children: Decrease incidence of high blood levels in children. The following document was designed to assist in identifying and reviewing priorities for the development of the Lourdes Community Heath Implementation Plan (CHIP), which includes the identified themes detailed above in this document. The document format is consistent with the Broome County Health Departments Community Health Assessment Priority Setting tool. The tool compares New York State Department of Health (NYS DOH) Prevention Agenda Priority areas, Broome County Health Assessment (Indicators) priorities and Health Care Need Themes identified through Lourdes Hospital CHNA research conducted Fall 2015/Spring 2016. Themes are detailed based upon Theme Categories which are detailed below.

This document details the Health Care Need Themes which align with the NYSDOH priorities, as well as those identified areas of concern by the CHNA Committee. Priorities are identified as red, yellow and green, and are described below. The priorities not color coded in the document below represent NYS priority areas which are not a Broome County concern. For purposes of reviewing the document, you will see reference to themes that were identified through the qualitative and quantitative research conducted in the fall 2015/spring 2016. The theme number will also be indicated with the abbreviation in the body of the document on the following pages. An abbreviation grid is also provided as reference in this document.

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 2 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

NYS Priority Area 1: Access to Mental Health  Affordability of health care services (Theme 2)  Improve access to healthcare services (Theme 4)  Improve coordination of care and provider communication (Theme 5)  Improve transportation resources (Theme 7)  Increased education and awareness of non-emergent health care services (Theme 9)  Promoting Behavioral health (mental health & substance use) (Theme 1)

NYS Priority Area 2: Promoting Healthy Behavior  Decrease STD Morbidity (reduce the rate of Chlamydia among men) (Theme 16)  Reduce the rate of adolescent pregnancies (Theme 17)  Reduce the incidence of Cancer of the Lip, Oral Cavity and Pharynx (Theme 18)

NYS Priority Area 3 and 4: Chronic Disease & Chronic Disease Prevention  Greater emphasis on preventive care and education regarding “healthy living” (Theme 3)  Increase emphasis on receiving regular dental care among all segments of the population (Theme 6)  Increase the proportion of children who receive well child care visits (Theme 19)  Increase awareness and education of available community-based resources, particularly around identifying specialty care and chronic disease management activities. (Theme 8)  Decrease the proportion of children and adults who are obese (Theme 12)  Increase in cardiovascular disease and diabetes screening, especially among the poor and vulnerable population (Theme 13)

NYS Priority Area 5: Healthy & Safe Environment  Assessment of eldercare services (Theme 10)  Falls Prevention (reduce inpatient hospitalizations, for those 65+) (Theme 11)  Injury Prevention (reduce inpatient hospitalization and mortality due to injuries) (Theme 15)

NYS Priority Area 6: Disparate Population  Increase in cardiovascular disease and diabetes screening, especially among the poor and vulnerable population (Theme 13)  Focus on the poor and vulnerable with special attention to those enrolled in a Medicaid Health Home(MHH) (Theme 14)  Decrease incidence of high blood levels of lead in children (Theme 20)

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 3 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Broom County Indicators are categorized according to color/or no color based upon priority as described: Color Code: Red = Area of High Concern (Low Performance- performing worse than NYS and PA 2018 goal, and in the bottom Quartilein NYS) Yellow = Area of Moderate Concern (Moderate Performance- performing worse than NYS and PA 2018 goal, and not in the bottom quartile in NYS) Green = Area of Low Concern (High Performance- performing better than NYS and PA 2018 goal, and in the top quartileIn NYS) Not Highlighted = Area that are not areas of concern NEW YORK STATE PREVENTION AGENDA – Action Plan Abbreviations ACTION PLAN ABBREVIATION PRIORITY AREA ACTION PLAN HSE-AP Promote a Healthy & Safe Environment Action Plan PCD-AP Prevent Chronic Disease Action Plan HIV-AP, VPD-AP, HCAI-AP Prevent HIV/STDs, Vaccine-Preventable Disease, & Health Care-Associated Infections Action Plan WIC-AP Promote Health Women Infants & Children Action Plan MHSA-AP Promote Mental Health & Prevent Substance Abuse Action Plan

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur IMPROVE HEALTH STATUS & REDUCE HEALTH DISPARITIES Focus Area 1: Improve Health Status and Reduce Health Disparities

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 4 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Improve the Reduce the percentage of Affordability by healthcare services       health status of all premature deaths (before New Yorkers age 65 years) (black & Improve Access to healthcare       Hispanic disparity) services       Reduce the age-adjusted Focus on the poor and vulnerable rate of preventable hospitalizations among adults (black & Hispanic disparity)

Increase the percentage of adults (ages 18-64) with health insurance

Increase the age-adjusted percentage of adults who have a regular health care provider PROMOTE A HEALTHY AND SAFE ENVIRONMENT Focus Area 1: Injuries, Violence and Occupational Health

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 5 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Reduce fall Hospitalization rate d/t falls Falls Prevention  risks among the most (ages 65+) vulnerable populations. ED visits d/t falls (ages 1-4) Injury Prevention   Goal #2: Reduce Assault-related Injury Prevention   violence by targeting hospitalization rate prevention programs [racial/ethnic & income particularly to highest- disparities] risk populations. Goal #3: Reduce ED visits by adolescents Injury Prevention   occupational injury (ages 15-19) for and illness. occupational injuries Focus Area 2: Outdoor Air Quality Goal #1: Reduce # days Air Quality Index Outdoor air quality was not exposure to outdoor (AQI) unhealthy identified as a priority with the air pollutants, with a Lourdes CHNA. focus on burdened communities Focus Area 3: Built Environment

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 6 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Promote % Climate Smart % of climate smart communities healthy lifestyles, Communities was not identified as a priority with sustainability and the Lourdes CHNA. adaptation to climate % commuters using change. alternative modes of Improve transportation resources.       transportation % low-income population with % low-income population access to supermarket was not with low access to identified as a priority with the supermarket Lourdes CHNA. Goal #2: Improve % homes in Healthy Increase awareness of education       home environment. Neighborhood Tracking services Program with fewer asthma triggers Focus Area 4: Water Quality Goal #1: Increase the % residents with optimal Water quality was not identified as percentage of State water fluoridation a priority with Lourdes CHNA.  residents that receive fluoridated drinking water. Goal #2: Reduce [see HSE-AP, p. 11] Water quality was not identified as potential public health a priority with Lourdes CHNA. risks associated with drinking water and recreational water.

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 7 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur PREVENT CHRONIC DISEASES Focus Area 1: Reduce Obesity in Children and Adults Goal #1: Create % children & adolescents Increase awareness of education       community who are obese {WIC & services. environments that public schools] promote and Awareness of non-emergent     support healthy food % adults (ages 18+) who are service. and beverage obese (low income &     choices and physical disability disparity) Decrease obesity in children/adults. activity        Increase cardiovascular and diabetes screening.        Focus on the poor and vulnerable.

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 8 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Prevent [see PCD-AP, p. 6] Increase awareness of education       childhood obesity services through early child care and schools Awareness of non-emergent    services.     Decrease obesity in children/adults.        Increase in cardiovascular disease and diabetes screening.       Focus on poor and vulnerable. Goal #3: Expand the % children (ages 3-17) with Improve access to healthcare      role of health care appropriate assessment for services. and health service weight [commercial & providers and MMC] Awareness of non-emergent    insurers in obesity services. prevention     Decrease obesity for children/adults.       

Increase in cardiovascular disease and diabetes screening.      

Focus on the poor and vulnerable.

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 9 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #4: Expand the [see PCD-AP, p. 8] Decrease obesity in children/adults.     role of public and private employers in Increase in cardiovascular and obesity prevention. diabetes screening.        Focus Area 2: Reduce Illness, Disability and Death Related to Tobacco Use and Secondhand Smoke Exposure Goal #1: Prevent Prevalence of tobacco use Increase awareness and education       initiation of tobacco by high school students service. use by New York youth and young adults, % cigarette smoking among Increase in cardiovascular disease        especially among low adults (& income disparity) and diabetes screening. socioeconomic status (SES) populations # municipalities that restrict Focus on poor and vulnerable.       tobacco marketing Reduce the incidence of Oral/Throat Cancer.

PREVENT CHRONIC DISEASES

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 10 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Promote Utilization of smoking Increase awareness of education       tobacco use cessation benefits in services. cessation, especially managed care among low SES Increase in cardiovascular and populations and diabetes screening.        those with poor mental health Focus on the poor and vulnerable.      

Reduce the incidence of Oral/throat Cancer. 

Goal #3: Eliminate [see PCD-AP, p. 18] Increase awareness of education       exposure to services. secondhand smoke Increase in cardiovascular disease        and diabetes screening.

Focus on the poor and vulnerable.      

Reduce the incidence of Oral/throat  Cancer. Focus Area 3: Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 11 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Increase % adults (ages 50-75) who Greater emphasis on Preventative       screening rates for receive colorectal cancer Care. cardiovascular screening disease, diabetes (& income disparity) Increase of education services.       and breast/cervical/color Decrease obesity in children/adults.     ectal cancer, especially among Increase in cardiovascular disease        disparate and diabetes screening. populations Focus on the poor and vulnerable.      

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 12 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Promote ED visits for asthma Improve access to healthcare use of evidence- (ages 0-4, all ages) services.       based care to % adults (ages 18-85) with manage chronic hypertension that is diseases controlled (& commercial Increase awareness of education vs. MMC, black MMC- services.       enrollee disparities) Hospitalization rate for heart attack % adults (ages 18-85) with Decrease obesity in children/adults.     diabetes that is controlled (& commercial vs. MMC, Increase in cardiovascular disease black MMC-enrollee and diabetes screening.        disparities) Hospitalization rate for short-term DM Focus on the poor and vulnerable.       complications (ages 6-17, 18+) Goal #3: Promote [see PCD-AP, p. 26] Greater emphasis on preventive       culturally relevant care. chronic disease self- management Receiving regular dental care.        education Focus on the poor and vulnerable.      

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 13 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur PREVENT HIV/ STDS, VACCINE-PREVENTABLE DISEASE AND HEALTH CARE-ASSOCIATED INFECTIONS Focus Area 1: Prevent Vaccine-Preventable Diseases Goal #1: Improve % children with Greater emphasis on preventative       childhood and immunization series (ages Care. adolescent 19-35 mos) immunization rates Decrease STD Morbidity.  

Reduce adolescent pregnancies.  

Increase well child care visits.   Goal #2: Educate all [see VPD-AP, p. 18) Greater emphasis on preventive       parents about the care. importance of   immunizations Decrease STD Morbidity.   Reduce adolescent pregnancies.  Increase well child care visits. 

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 14 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #3: Decrease Tdap immunization rate Greater emphasis on preventive       the burden of care. pertussis Decrease STD Morbidity.  

Reduce adolescent pregnancies.  

Increase well child care visits.   Goal #4: Decrease % adults with flu Greater emphasis on preventive       the burden of immunization care. influenza disease (ages 65+) Decrease STD Morbidity.  

Reduce adolescent pregnancies.  

Increase well child care visits.   Goal #5: Decrease % adolescent females with Greater emphasis on preventive       the burden of 3-dose immunization (ages care. disease caused by 13-17) Human Decrease STD Morbidity.   Papillomavirus Reduce adolescent pregnancies.  

Increase well child care visits.   Focus Area 2: Human Immunodeficiency Virus

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 15 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Decrease New diagnosis HIV case rate Increase services for mental health.         HIV morbidity (black and Hispanic disparities) Greater emphasis on preventive care.      

Decrease STD Morbidity.  

Reduce adolescent pregnancies.  

Increase well child care visits   Goal #2: Increase % HIV(+) who are in care Increase services for mental health.         early access to and retention in HIV care Greater emphasis on preventive care.      

Decrease STD Morbidity.  

Reduce adolescent pregnancies.  

Increase well child care visits.   Focus Area 3: Sexually Transmitted Diseases

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 16 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Decrease Gonorrhea case rate (ages Increase services for mental health.         STD morbidity 15-44, M&F) Preventative Care & Education Chlamydia case rate (ages regarding “healthy living”.       15-44 F only) Decrease STD Morbidity (reduce the Syphilis case rate (M&F) rate of Chlamydia among men).  

Reduce the rate of adolescent pregnancies.  

Increase the proportion of children who receive well child care visits.   Focus Area 4: Hepatitis C Virus (HCV) Goal #1: Increase [see HIV-AP, p. 4] Increase services for mental health.         and coordinate HCV prevention and Greater emphasis on preventive       treatment capacity care.

Decrease STD Morbidity.  

Reduce adolescent pregnancies.  

Increase well child care visits.  

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 17 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur PREVENT HIV/ STDS, VACCINE-PREVENTABLE DISEASE AND HEALTH CARE-ASSOCIATED INFECTIONS Focus Area 5: Prevent Health Care-Associated Infections Goal #1: Reduce Hospital-onset CDI rate Prevent Health Care-Associated Clostridium difficile Community-onset CDI rate Infections was not identified as a infections priority with Lourdes CHNA. Goal #2: Reduce Hospital-onset MRSA rate Prevent Health Care-Associated infections caused by Surveillance of MDR Infections was not identified as a multidrug resistant bacteria priority with Lourdes CHNA. organisms Goal #3: Reduce Non-ICU central line Prevent Health Care-Associated device-associated infections Infections was not identified as a infections Non-ICU catheter- priority with Lourdes CHNA. associated UTIs PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN Focus Area 1: Maternal and Infant Health Goal #1: Reduce % preterm births [black, Reduce adolescent pregnancies.    premature births in Hispanic & MMC disparities] New York State [see WIC-AP, p. 6] Increase well child care visits. (Referenced in CHNA as Theme 19) 

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 18 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Increase % infants exclusively Greater emphasis on preventive the proportion of breastfed in hospital [black, care.       NYS babies who are Hispanic & MMC disparities] breastfed [see WIC-AP, p. 16] Increase well child care visits.   Goal #3: Reduce rate Maternal mortality rate Affordability of Health Care       of maternal deaths [racial disparities] Services.       Greater emphasis on preventive care. Focus Area 2: Child Health Goal #1: Increase % children with Improve transportation.       the proportion of recommended # well child NYS children who visits in government Increase well child care visits.   receive insurance comprehensive well (0-15 mos, 3-6 yrs, 12-21 Decrease blood lead levels in   child care in yrs) children. accordance with AAP guidelines % children with health insurance (ages 0-18) [see WIC-AP, p. 29]

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 19 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Reduce the % 3rd grade children with Improve transportation.      prevalence of dental untreated tooth decay caries among NYS (income disparity)[see WIC- Receiving regular dental care.        children AP, p. 38] Focus Area 3: Reproductive, Preconception and Inter-Conception Health Goal #1: Reduce the Adolescent pregnancy rate Affordability of healthcare services. rate of adolescent (ages 15-17) (black/       and unplanned Hispanic disparity) pregnancies in NYS % unintended pregnancy Focus on the poor and vulnerable.       among live births (black, Hispanic & MMC disparities) [see WIC-AP, p. 47] Reduce the rate of adolescent   pregnancies. PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 20 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Increase % women with health Affordability of Health Care utilization of coverage (ages 18-64) Services.       preventive health services among % live births within 24 mos. women of of previous pregnancy [see       reproductive age to WIC-AP, p. 57] Focus on the poor and vulnerable. improve wellness, pregnancy outcomes   and recurrence of Reduce the rate of adolescent adverse birth pregnancies. outcomes PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE Focus Area 1: Promote Mental, Emotional and Behavioral Well-Being in Communities Goal #1: Promote [see MHSA-AP, p. 5, use of Increase services for mental health.         mental, emotional evidence-informed policies and behavioral well- & evidence-based programs Affordability of healthcare services.       being in for healthy development of communities children, youth, and adults] Greater emphasis on preventive       care. Focus Area 2: Prevent Substance Abuse and other Mental Emotional Behavioral Disorders

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 21 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #1: Prevent % youth (gr 9-12) using Increase services for mental health. underage drinking, alcohol on at least 1 day for         non-medical use of past 30 days prescription drugs by youth, and % youth (ages 12-17) using Affordability of healthcare services.       excessive use of non-medical use of alcohol consumption painkillers by adults Greater emphasis on preventive       % adults (ages 18+) binge care. drinking PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE Goal #2: Prevent % adults with ≥ 14 days Increase services for mental health.         and reduce poor mental health occurrences of Affordability of healthcare services.       mental, emotional, % youth (gr 9-12) who felt and behavioral sad or hopeless Greater emphasis on preventive       disorders among care. youth and adults Goal #3: Prevent % youth (gr 9-12) who Increase services for mental health.         suicides among attempt suicide ≥ one time youth and adults in past year Affordability of healthcare services      

Suicide mortality rate Greater emphasis on preventive       care.

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 22 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #4: Reduce Prevalence of cigarette Increase services for mental health.         tobacco use among smoking among adults who adults who report report poor mental health Affordability of healthcare services.       poor mental health Preventative Care & Education re “healthy living”.      

Focus Area 3: Strengthen Infrastructure across Systems Goal #1: Support [see MHSA-AP, p. 23] Increase services for mental health. collaboration among         professionals working in fields of mental, emotional, Improve transportation resources.      and behavioral health promotion and chronic disease prevention, treatment, and recovery

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 23 Appendix 1.3 – Our Lady of Lourdes Memorial Hospital Community Health Needs Assessment Prioritization Process to Align Identified Health Priority Themes with NYSDOH 2016 Prevention Agenda Category

Research Methodology

Qualitative Research Quantitative Research NEW YORK STATE

PREVENTION

- BROOME COUNTY OUR LADY OF LOURDES

AGENDA

INDICATORS CHNA THEMES CATEGORY PRIORITY AREA Health Online Survey Survey NYS NYS DOH (2013 data) Community Community ed Population Network Panel Care CompassCare Health Factors, Online Provider Focus Group of Stakeholder In Outcomes, 2016 2016 (2013 data) Depth Interviews Medicaid/Uninsur Goal #2: Strengthen [see MHSA-AP, p. 23] Increase services for mental health. infrastructure for         mental, emotional, and behavioral health promotion, Improve transportation resources.      and mental, emotional, and behavioral disorder prevention

Our Lady of Lourdes memorial Hospital, Inc. Community Health Needs Assessment 24 Appendix 2: Health Outcomes and Health Factors

Health Outcomes and Health Factors Rankings (62nd Worst – 1st Best) (NYS NYS NYS NYS Broome Rank Broome Rank Broome Rank Brome Rank 2013 of 62) 2014 (of 62) 2015 (of 62) 2016 (of 62) Health Outcomes 48 48 51 56 Length of Life 51 51 51 56 Premature death 6,606 6,606 6,714 6,900

Morbidity 44 43 42 53 Poor or fair health 14% 13% 13% 14% Poor physical health days 3.8 3.6 3.6 3.6 Poor mental health days 3.8 3.7 3.7 3.7 Low birthweight 7.9% 8.0% 8.0% 8.0%

Health Factors 33 30 28 31 Health Behaviors 30 29 20 30 Adult smoking 20% 20% 20% 16% Adult obesity 30% 29% 27% 25% Physical inactivity 24% 24% 21% 24% Excessive drinking 17% 15% 15% 18% Motor vehicle crash death rate 8 8 8 7 Sexually transmitted infections 289 316 362 337 Teen birth rate 23 23 23 22

Clinical Care 15 19 23 19 Uninsured 12% 12% 11% 10% Primary care physicians** 1,245:1 1,221:1 1,254:1 1200:1 Dentists 1,553:1 1,610:1 1,580:1 1540:1 Mental health providers N/A 621:1 552:1 550:1 Preventable hospital stays 62 64 58 62 Diabetic monitoring 87% 87% 85% 87% Mammography screening 67.2% 64.3% 63.7% 65%

** Data should not be compared with prior years due to changes in definition. *Data sets from University of Wisconsin, Population Health Institute, County Health Rankings Injury Deaths Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 2: Health Outcomes and Health Factors

Health Outcomes and Health Factors Rankings (62nd Worst – 1st Best) NYS NYS NYS NYS Broome Rank Broome Rank Broome Rank Broome Rank 2013 (of 62) 2014 (of 62) 2015 (of 62) 2016 (of 62) Health Factors (continued) 33 30 28 31 Social & Economic Factors 38 38 40 43 High school graduation 80% 82% 80% 81% Some college 62.9% 64.1% 63.5% 64% Unemployment 8.5% 8.8% 7.8% 6.6% Children in poverty 24% 24% 25% 24% Inadequate social support 20% 20% N/A N/A Children in single-parent households 37% 37% 39% 38% Income Inequality N/A N/A 4.8 4.8% Violent crime rate 254 246 268 268 Social Associations N/A N/A 11.6 11.8 Injury Deaths N/A 48 52 55

Physical Environment 52 40 22 3 Air pollution-particulate matter days 11.0 11.8 11.8 11.8 Drinking Water Violations 35% 25% 8% No Limited access to healthy foods** 5% 5% 5% NA Severe Housing Problems N/A 15% 16% 15% Driving alone to work N/A 78% 78% 79% Long commute- driving alone N/A 14% 14% 14%

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 3 FY17-19 Integrated Strategic, Operational, and Financial Plan

Lourdes Binghamton, NY

April 13, 2016 Call to Action: Healthcare That Leaves No One Behind

Strategy to address health needs prioritized in the FY17 Strategic Initiatives Ministry’s Community Health Needs Assessment • Develop a Community Health Improvement Plan (CHIP), based on board approval of the FY 2016 CHNA (targeted May 2016), with associate metrics for measuring community health status and improvement. We anticipate the community health priorities will include Obesity prevention & associated chronic disease (diabetes, CVD- COPD, CHF) and mental health/substance abuse. • Standardize evidenced based falls prevention programs throughout the Lourdes Strategy 1: Improve Community Primary Care network (STEADI, Tai chi for arthritis). Health Status • Identifying strategies to maximize the value of dollars spent in order to improve community health status for high risk populations. As appropriate, recommendations will be made regarding budget allocations of community benefit dollars. • Collaborate with other community partners and organizations to address to improve health outcomes as defined through the Public Health Improvement Plan (PHIP), local health department CHNAs and the DSRIP CHNA.

2 November, 2015

Dear Hospital Chief Executive Officers and Local Health Department Commissioners and Directors:

I am writing to update you on New York State’s progress in meeting its Prevention Agenda goals, and to transmit guidance for the next cycle of collaborative community health planning.

As of April 2015, the Prevention Agenda dashboard showed that 16 of the Agenda’s 96 outcome objectives had been met, including the state goal for preventable hospitalizations among adults. In addition to the outcomes that have been met, progress is evident for an additional 22 indicators. There are some areas, such as reducing obesity among adults and reducing pre-term births, where progress is slow.

As you know, the Prevention Agenda 2013-2018 is New York State's health improvement plan; a vision for New York to become the nation’s healthiest state by addressing five health priorities: Prevent Chronic Diseases; Promote a Healthy and Safe Environment; Promote Healthy Women, Infants and Children; Promote Mental Health and Prevent Substance Abuse; and Prevent HIV, Sexually-Transmitted Diseases, Vaccine-Preventable Diseases and Healthcare-Associated Infections. The Prevention Agenda has been the framework for state and local action to improve the health of New Yorkers. It has served as the basis for local community health improvement planning and action by local health departments and hospitals starting since 2013, and has been incorporated into state health care reform initiatives, including the Delivery System Reform Incentive Program (DSRIP) and the State Health Innovation Plan. In December 2014, all of the state’s local health departments and almost 100 percent of hospitals reported implementing interventions to address Prevention Agenda goals.

To achieve our ambitious goals, the continued active participation of the public health and health care communities is essential. I am asking each local health department (LHD) and hospital or hospital system to work together in 2016 to address identified community health priorities tied to the Prevention Agenda. Because many hospitals recently completed a community health needs assessment as part of the DSRIP process, the Department is not asking for a new comprehensive health assessment this cycle. To complete the 2016-18 assessment and planning cycle, each LHD and hospital should:

• collaborate with community partners to review community health data from recently completed health assessments, including updated data on the priority health issues; • identify two Prevention Agenda priorities and one health disparity in the community based on the data; • develop and submit an implementation plan that describes the evidence based interventions being implemented and the process measures being used to track progress toward these priorities; and • demonstrate evidence of collaboration among LHDs, hospitals and community organizations in selecting new or confirming existing priorities and addressing them.

Local health departments and hospitals are encouraged to submit one plan per county that describes the efforts of all participants, or each organization within a county can submit an individual plan. The attached guidance spells out the required information. The completed plan will meet the state’s requirements for an LHD community health assessment and community health improvement plan and a hospital community service plan. The plans are due on December 30, 2016.

I am also asking each hospital involved in DSRIP to work with its partners to ensure that their Prevention Agenda goals and implementation efforts are aligned with DSRIP efforts. Specifically, the projects selected in DSRIP Domain 4 should be tied to countywide efforts to achieve overall Prevention Agenda goals. A hospital’s Prevention Agenda efforts should also be reflected in the community benefit programs, where applicable, described in its Internal Revenue Service Form 990 Schedule H. With the state’s increased focus on prevention, and as more New Yorkers become insured through the New York State of Health, the Health Plan Marketplace, we are expecting that hospitals will increase their investments in the Community Benefit categories of Community Health Improvement and Community Building, whose definitions include the kinds of activities needed to improve the health of communities. The Department’s goal is for each hospital to increasingly align its investments in evidence-based interventions related to the Prevention Agenda.

Local health departments and hospitals can utilize the resources of their regional Population Health Improvement Programs (PHIPs) to assist in the completion of these plans. PHIPs can provide data analysis, convene community stakeholders and/or contribute to the writing of LHD and/or hospital reports. More specific plans for technical assistance on completing the plan will be available in late 2015.

Thank you for your commitment to improve the health of New Yorkers. If you have any questions, please contact Sylvia Pirani, Director, Office of Public Health Practice at [email protected], phone number 518-473-4223.

Sincerely,

Howard A. Zucker, M.D., J.D. Commissioner of Health

Enclosure November 10, 2015 New York State Department of Health

Template New York State 2016 Community Health Assessment and Improvement Plan and Community Service Plan

Cover Page 1. Identify county/counties) or service area covered in this assessment and plan 2. Participating Local Health Department(s) (LHDs) and contact information 3. Participating Hospital/Hospital System(s) and contact information 4. Name of coalition/entity, if any, completing assessment and plan on behalf of participating counties/hospitals Executive Summary (Maximum four double-spaced pages. This report should be posted on your public website(s) and shared with community partners.)

Include succinct statements that answer the following questions: 1. What are the Prevention Agenda priorities and the disparity you are working on with your community partners including the local health department and hospitals for the 2016-2018 period? 2. What has changed, if anything, with regard to the priorities you selected since 2013 including any emerging issues identified or being watched? 3. What data did you review to identify and confirm existing priorities or select new ones? 4. Which partners are you working with and what are their roles in the assessment and implementation processes? 5. How are you engaging the broad community in these efforts? 6. What specific evidence-based interventions/strategies/activities are being implemented to address the specific priorities and the health disparity and how were they selected? 7. How are progress and improvement being tracked to evaluate impact? What process measures are being used?

1 November 10, 2015 New York State Department of Health

Report 1. Provide a short description of the community being served and how the service area has been defined. This could be one county or several counties or parts of several counties. If this is a regional assessment and plan, the plan must describe each county’s health issues and identify the process each county used to identify its priorities and how it will contribute to addressing them. 2. Provide a short summary of health and other data that was reviewed to identify health issues of concern in the community. This could include the Prevention Agenda Dashboard, County Health Rankings and/or other sources of data on demographics and health issues facing the community and the underlying conditions that contribute to their health. 3. Identify the two Prevention Agenda priorities and the health disparity being addressed with community partners including LHDs and hospitals and provide a description of the community engagement process that was used to select or confirm existing priorities.

4. For each of at least two Prevention Agenda priorities, identify the goal(s) and objectives, the interventions/strategies/activities you are or will implement, and process measures with measurable and time-framed targets that will be used to track progress over the three-year period. Interventions should be evidence-based or promising practices. They can include activities currently underway and/or new strategies to be implemented. Process measures must be selected to track progress in implementing the strategies.

For each health priority that is or will be addressed: a) Describe the actions the hospital intends to take to address the health issue and the anticipated impact of these actions b) Identify resources the hospital will commit to address the health need c) Describe the actions the LHD intends to take to address the health need and the anticipated impact of these actions d) Identify resources the LHD will commit to address the health need e) Describe the roles of other participants, stakeholders, other local governmental agencies, or other community based organizations including business, academia, etc. in addressing the priority f) State whether the action(s) will address a health disparity and if so, how.

2 November 10, 2015 New York State Department of Health

To provide this information, use a work plan chart like the one below. The roles and contributions of LHDs and hospitals must be explicitly identified, either on one chart or separate charts for each organization.

Priority/Focus Area:

Goal Outcome Interventions/ Process Partner Partner By When Will Objectives Strategies/ Measures Role Resources action Activities address disparity For some examples of CHIP work plans that include most of these components, see Appendix 1.

5. Briefly describe the process that will be used to maintain engagement with local partners over the next three years, and the process that will be used to track progress and make mid-course corrections.

6. Briefly describe plans for the dissemination of the executive summary to the public and how it will be made widely available to the public including providing the website where it can be located.

3 November 10, 2015 New York State Department of Health

Appendix 1: Examples of Community Health Improvement Plan Work Plans

Seton Health/St. Mary’s Hospital Community Service Plan, see p. 11 http://209.23.127.116/www-setonhealth- org/img/document_files/2013CommunityServicePlanSetonHealth.pdf

Our Lady of Lourdes Memorial Hospital, Inc., see p. 2 https://www.lourdes.com/media/202913/chip20132015.pdf

CVPH Medical Center, see p. 12 http://www.cvph.org/data/files/CVPH%20Community%20Services%20Plan%202013_rev2014.pdf

Delaware County Public Health, see p. 81 http://delawarecountypublichealth.com/wp-content/uploads/2014/12/DelawareCountyCHA- CHIP2013-2017.pdf

Warren County Public Health, see p. 5 http://www.warrencountyny.gov/healthservices/docs/2013hip.pdf

Dutchess County Department of Health, see pp. 23 http://www.co.dutchess.ny.us/CountyGov/Departments/Health/Publications/DutchessCounty_CHIP _2013_2017.pdf

Appendix 2 –Resources  2013 Community Service Plans  2013 LHD Community Health Assessments and Community Health Improvement Plans  Prevention Agenda Dashboard  CHNAs completed for DSRIP by PPSs. These used DSRIP Performance Chartbooks

The Prevention Agenda 2013-2017 lists priority-specific evidence-based interventions:

 Prevent Chronic Disease  Promote Healthy Safe Environment  Promote Healthy Women, Infants and Children  Promote Mental Health and Prevent Substance Abuse  Prevent HIV, STDs Vaccine-Preventable Diseases and Healthcare-Associated Infections

The County Health Rankings Roadmap describes the community health improvement cycle and provides Effective Policies and Programs for Implementation.

The CDC Community Health Improvement Navigator provides hospitals, public health agencies, and other community organizations with evidence-based interventions for implementation.

4 Appendix 5: Documents and Resources Used in Research

QQQualitative and Quantitative Analysis: NYS Southern Tier Rural Performing Provider System (STRIPSS) – Appendix 12 • DSRIP Care Compass Network Panel Survey • DSRIP Community Health Needs Assessment Medicaid Uninsured Focus Groups

Primary and Secondary Resources • Alteryx, Inc. (previously Experian Applied Geographic Solutions) • American Community Survey Conducted by the US Census • New York State Department of Health Data • Broome County Health Department Data • County Health Rankings and Roadmaps from the University of Wisconsin- Population Health Institute Annual Report • Lourdes 2013-2015 CHNA

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Population Trends

2010 2015 2020 2000 Variance Population Estimate Projection Population Total 200,527 200,599 196,360 196,204 -0.1% Male 48.2% 49.0% 49.0% 49.2% 1.8% Female 51.8% 51.0% 51.0% 50.8% -1.6% * Data collected from Alteryx.com Population Age

2000 2010 2015 2020 Age Census Census Estimate Projection 0 to 4 5.60% 5.20% 5.10% 5.10% 5 to 14 13.40% 11.20% 11.10% 10.70% 15 to 19 7.60% 7.80% 7.70% 7.40% 20 to 24 7.20% 8.90% 9.70% 9.10% 25 to 34 11.30% 11.50% 11.40% 12.00% 35 to 44 15.70% 11.10% 10.30% 10.10% 45 to 54 13.40% 15.30% 14.00% 12.20% 55 to 64 9.30% 12.60% 13.50% 13.90% 65 to 74 8.20% 7.80% 8.80% 10.30% 75 to 84 6.10% 5.80% 5.60% 6.10% 85+ 2.20% 2.80% 2.90% 3.10% * Data collected from Alteryx.com

Race/Ethnicity

2000 2010 2015 2020 Census Census Estimate Projection White 91.5% 88.0% 87.0% 86.1% Black or African American 3.3% 4.8% 5.2% 5.3% American Indian and Alaska Native 0.2% 0.2% 0.2% 0.2% Asian/Native Hawaiian/ 2.7% 3.6% 3.8% 4.2% Other Pacific Islander Some Other Race 0.7% 1.0% 1.1% 1.2% Two or More Races 1.6% 2.5% 2.7% 3.1%

Hispanic 2.0% 3.4% 3.8% 4.1% Non-Hispanic 98.0% 96.6% 96.2% 95.9% * Data collected from Alteryx.com

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Household Income 2000 2010 2015 2020 Income Level Census Census Estimate Projection Less than $15,000 19.6% 15.5% 14.7% 12.4% $15,000 to $24,999 15.6% 12.8% 13.0% 11.7% $25,000 to $34,999 14.4% 12.4% 11.3% 10.2% $35,000 to $49,999 17.0% 15.5% 14.5% 13.2% $50,000 to $74,999 17.7% 18.9% 19.0% 19.8% $75,000 to $99,999 8.1% 10.9% 11.6% 12.9% $100,000 to $149,999 5.4% 9.4% 10.1% 12.6% $150,000 or more 2.5% 4.6% 5.7% 7.2%

Median household $35,368 $43,618 $46,128 $53,023 income (dollars) * Data collected from Alteryx.com Per Capita Income Broome Binghamton New York Year County Metro State 2000 18,806 18,753 23,014 2010 25,089 24,882 31,527 2015 24,438 26,438 33,412 2020 29,998 29,936 37,865 Percent Change (2015 – 2020) 13.4% 13.2% 13.3% * Data collected from Alteryx.com Housing Statistics (2015 Estimate) Total Housing Units 89,261 100% Occupied housing units 79,687 89.3% Owner-occupied 51,857 65.07% Renter-occupied 27, 830 34.9% Vacant housing units 9,574 10.7%

Occupied Housing Units (2014 ACS 5 Year Estimates) 79,438 100% Lacking complete plumbing facilities 264 0.3% Lacking complete kitchen facilities 606 0.8% No telephone service available 2,003 2.5% *Data collected from Alteryx.com and American Community Survey www.factfinder.census.gov

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Population Living Below the Poverty Level Percent Below Population Poverty Level All Families 11.6% With related children under 18 years 20.6% With related children under 5 years only 24.5% Married couple families 5.5 % With related children under 18 years 9.2% With related children under 5 years only 9.5% Families with female householder, no husband present 33.1% With related children under 18 years 44.6% With related children under 5 years only 58.3%

All People 17.8% Under 18 Years 24.8% Related children under 18 years 24.0% Related children under 5 years 28.7% Related children 5 to 17 years 22.3% 18 years and over 16.0% 18 to 64 years 18.2% 65 years and over 7.8% *Data collected from American Community Survey www.factfinder.census.gov, 2014 American Community Survey ACS) 5 Year Estimate

Educational Attainment (population age 25 and older) Education 2010 Census 2015 Estimate 2020 Projection No Schooling Completed .9% 1.0% 1.0% Grade K-8 1.6% 1.7% 1.7% Grade 9-12 7.8% 7.9% 7.9% High School Graduate 33.0% 32.7% 32.6% Some College, No Degree 20.0% 19.2% 19.1% Associates Degree 12.4% 12.2% 12.1% Bachelor's Degree 13.5% 14.1% 14.2% Graduate Degree 10.7% 11.3% 11.4% * Data collected from Alteryx.com

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Health Insurance Coverage (2014 ACS 5 Year Estimate) Health Insurance Broome County NY State % of non-institutionalized civilian population 92.0% 89.4% with health insurance coverage

Uninsured by Age Group Under 18 4.2% 4.0% Age 18 to 64 11.9% 14.9% Age 65+ 0.2% 1.0% *Data collected from American Community Survey www.factfinder.census.gov

Vehicles Per Household (2014 ACS 5 Year Estimate) Estimate Percent Number of Vehicles Available 0 Vehicles Available 9,519 12% 1 Vehicle Available 29,487 37.1% 2 Vehicles Available 28,048 35.3% 3 Vehicles Available 12,384 15.6%

Commuting to Work Car, truck or van -- drove alone 68,183 79% Car, truck or van -- carpooled 7,714 8.9% Public transportation 2,677 3.1% Walked 3,578 4.1% Other Means 999 1.2% Worked at Home 3,157 3.7%

Mean travel time to work (minutes) 19 NA *Data collected from American Community Survey www.factfinder.census.gov

Employment Rates (2014 ACS 5 Year Estimate) Employment Broome County New York United States In Labor Force 58.8% 63.5% 63.9% Employed 53.7% 57.7% 57.7% Unemployed 8.6% 8.9% 9.2% Not in Labor Force 41.2% 36.5% 36.1% *Data collected from American Community Survey www.factfinder.census.gov

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Industries of Employment 2014 ACS 5 Year Employment Industry Category Estimate Educational services, and health care and social assistance 29.2% Retail trade 13.0% Manufacturing 11.0% Professional, scientific, and management, and administrative and 8.6% waste management services Arts, entertainment, and recreation, and accommodation and food services 8.6% Construction 5.6% Other services, except public administration 5.4% Finance and insurance, and real estate and rental and leasing 5.0% Public administration 4.5% Transportation and warehousing, and utilities 4.1% Wholesale trade 2.9% Information 1.4% Agriculture, forestry, fishing and hunting, and mining 0.7% *Data collected from American Community Survey www.factfinder.census.gov

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Health Risks & Behaviors 2011-2013 (Lowest) Incidence Rate 4th Broome Upstate NYS Quartile % adults overweight or obese (BMI 25+) 64.1 62.3 60.5 No % of students overweight or obese (85th percentile or higher) 36.0 33.9 N/A No % adults that did not participate in leisure time physical activity in last 30 days 26.8 26.2 27.1 No % adults smoking cigarettes (2013-2014) 24.0 18.0 15.9 No % of adults living in homes where smoking is prohibited 79.3 79.3 80.9 No % of adults that binge drink (2013-2014) 20.2 17.2 17.7 No % of adults eating 5 or more servings of fruit or vegetables daily 27.4 27.7 27.1 No *Data sets from NYS Department of Health

Substance Abuse/Injury/Mental Health Indicators 2011-2013 Rate (Lowest) NYS 4th Broome w/o NYC NYS Quartile Suicide Mortality Rate – Age Adjusted 12.9 9.6 8.0 No Suicide Mortality Rate- 15-19 Years 4.4 6.3 5.4 No Self-inflicted Injury Hospitalization – Age Adjusted 10.4 7.0 5.8 Yes Unintentional Injury Mortality Rate – Age Adjusted 37.1 30.8 25.6 Yes Unintentional Injury Hospitalization Rate – Age Adjusted 68.3 62.2 62.2 Yes Poisoning Hospitalization Rate 13.8 10.9 10.7 No Falls Hospitalization Rate – Age Adjusted 38.6 34.9 34.7 Yes Motor Vehicle Mortality Rate 8.8 8.0 6.0 No Non-Motor Vehicle Mortality Rate 28.3 22.8 19.5 Yes Traumatic Brain Injury Hospitalization Rate 9.3 9.2 9.4 Yes Alcohol Related Motor Vehicle Injuries and Deaths 37.0 44.4 33.3 No Drug-related Hospitalization Rate 14.0 21.0 23.6 No Newborn Drug-related Diagnosis Rate 174.4 123.2 95.0 Yes * Data sets from NYS Department of Health

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

HIV/AIDS and STDs 2011-2013 Incidence Rates (Lowest) NYS 4th Broome w/o NYC NYS Quartile AIDS case rate per 100,000 4.4 4.5 12.2 No HIV case rate per 100,000 5.7 7.9 19.1 No Early Syphilis rate per 100,000 1.2 3.6 14.4 No Gonorrhea rate per 100,000 (All Ages) 51.6 61.1 107.7 No Chlamydia rate per 100,000 (Male, All Ages) 219.6 203.0 336.0 Yes Chlamydia rate per 100,000 (Female, All Ages) 453.2 466.8 672.3 No Pelvic Inflammatory Disease (PID) hospitalization rate per 10,000 women ages 15-44 1.8 2.1 3.0 No * Data sets from NYS Department of Health Pregnancy Indicators 2011-2013 Incidence Rates (Lowest) NYS 4th Broome w/o NYC NYS Quartile Pregnancy Rate Per 1,000 (all pregnancies/female population 15-44 years) 76.8 72.6 87.9 No Teen Pregnancy Rate Per 1,000 10-14 Years 0.8 0.6 0.9 Yes Teen Pregnancy Rate Per 1,000 15-17 Years 20.8 14.5 22.4 Yes Teen Pregnancy Rate Per 1,000 15-19 Years 35.1 28.7 41.3 No * Data sets from NYS Department of Health Cancer Indicators (Age Adjusted Rate/ 100,000) 2010-2012 Incidence Rate (Lowest) NYS 4th Broome w/o NYC NYS Quartile Lip, Oral Cavity and Pharynx 12.9 11.0 10.5 Yes Colon and Rectum 40.1 41.2 41.4 No Lung and Bronchus 58.4 68.6 61.6 No Breast 127.3 133.2 127.2 No Uterine Cervix 6.1 6.7 7.7 No Ovarian 12.3 12.9 12.5 No Prostate 142.1 143.8 145.3 No Melanoma ( mortality per 100,000) 2.1 2.2 2.8 No % of Women 18+ with Pap Smear in past 3 years (2013- 2014) 81.1 76.2 74.2 No % of Women 40+ with Mammography screening in past 2 years (2013 – 2014) 78.1 77.4 77.8 No * Data sets from NYS Department of Health Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Cardiovascular Disease and Stroke Indicators (Age Adjusted)

2011-2013 Mortality Rate (Lowest) NYS 4th Broome w/o NYC NYS Quartile Cardiovascular Disease Mortality Rates 248.5 228.2 228.0 No Disease of the Heart Mortality Rates 195.1 182.8 185.4 No Coronary Heart Disease Mortality Rates 139.8 131.5 146.2 No Congestive Heart Failure Mortality Rates 14.2 16.1 12.0 No Stroke Mortality Rates 34.9 29.8 26.2 No Hypertension Hospitalization Rates (18 and Older) 5.5 5.0 7.4 Yes % of Adults with cholesterol checked in the last 5 years 79.9% 83.2% 83.4% No * Data sets from NYS Department of Health

Hospitalizations for Chronic Conditions (Age Adjusted) 2011-2013 Incidence Rates NYS (Lowest) Broome w/o NYC NYS 4th Quartile Cirrhosis Hospitalization Rates 3.1 2.2 2.5 Yes Diabetes Hospitalization Rates – Primary Diagnosis 13.7 14.2 17.9 No Chronic Lower Respiratory Disease Hospitalization Rates *COPD INCLUDED 28.8 28.6 34.1 No Asthma Hospitalization Rates 10.6 10.9 18.2 No Chronic Kidney Disease Hospitalization Rates 103.9 95.3 103.0 No Chronic Kidney Disease Emergency Rates 120.7 95.1 100.8 Yes * Data sets from NYS Department of Health

Leading Causes of Death (Age Adjusted) Vital Statistics as of March, 2015 NYS Broome NYS w/o NYC Heart Disease Rate per 100,000 203 178 181 Cancer Rate per 100,000 158 160 153 Chronic Lower Respiratory Disease per 100,000 43 36 30 Stroke Rate per 100,000 31 29 25 Unintentional Injury Rate per 100,000 37 31 26 * Data sets from NYS Department of Health

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile

Child and Adolescent Health Indicators (Age Adjusted) 2011-2014 Incidence Rates NYS (Lowest) Broome w/o NYC NYS 4th Quartile % of children born in 2010 who received a lead screening test at 0-8 months (2010-2014) 2.0% 4.2% 3.5% No % of children born in 2010 who received a lead screening test at 9-17 months (2010-2013) 53.6% 53.5% 65.0% No % of children born in 2010 who received at least 2 lead screening tests by 36 months (2010-2013) 37.4% 42.1% 55.1% No Incidence of confirmed high blood lead level per 1,000 tested children aged <72 months 18.8 11.6 4.9 Yes % of children in government sponsored insurance programs with recommended number of well child visits (2013) 54.8% 70.3% 71.6% Yes Hospitalization rate of children 0-4 years for asthma 35.9 30.2 50.5 Yes Hospitalization rate of children 0-4 years for gastroenteritis 9.0 8.6 11.3 No Hospitalization rate of children 0-4 years for otitis media 4.3 2.0 2.5 Yes Hospitalization rate of children 0-4 years for pneumonia 43.2 31.3 39.4 Yes * Data sets from NYS Department of Health

Oral Health Risks & Behaviors

2011-2013 Incidence Rate (Lowest) NYS 4th Broome w/o NYC NYS Quartile % of 3rd Grade children with dental insurance 88.5% 81.8% N/A Yes % of 3rd Grade children with at least one dental visit on the past year 80.6% 83.4% N/A No % of 3rd Grade children with caries (tooth decay) experience 56.7% 45.4% N/A No Age-adjusted % of adults who had a dentist visit within the past year 70.1% 71.5% 69.8% No Oral Cancer – Age adjusted incidence rate per 100,000 12.9 11.0 10.5 Yes * Data sets from NYS Department of Health

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile A Regional Agency 388 Upper Oakwood of Avenue Elmira, New York 14903 A Member P:607.796.6061 of Proudly serving Broome, Chemung, Schuyler, Steuben, F:607.796.6028 Tioga, and Tompkins counties since 1981. www.foodbankst.org

Tompkins Schuyler Steuben Broome Chemung Tioga Broome County Resources Food Bank Member 2012 Demographics of BroomeCounty: Agencies in Broome County: 43 • Population: 190,285 •People living below poverty level: 33,286 (17%) Community Hunger Outreach Warehouse (CHOW) - 23 • Children who qualify for the free and reduced price locations BINGHAMTON school meal program: 13,592 (47%) Carroll St. Ministries Soup •Households receiving public assistance: 2,945 (3.7%) Kitchen Catherine’s Cupboard •Households receiving Social Security: 26,923 (33.5%) Catholic Charities Boys of •Households receiving Food Stamps: 9,256 (11.5%) Courage Catholic Charities Community Food Pantry •% of single female households living below the poverty Loaves and Fishes Food level with children under 5 years: 56.2% Pantry Salvation Army Food 2012 Food Bank Distribution in BroomeCounty: Pantry Salvation Army Rehab • Pounds distributed: 1,924,382 (25% of Food Bank Salvation Army Soup Kitchen total) St. Paul's Emergency Food •Pounds per person in poverty distributed: 58 lbs. Pantry UPC Community Dinner Volunteers of America • Total requests for food: 420,786 (31% of Food Bank YWCA ofBinghamton total) Children: 211,667 DEPOSIT Adults: 183,428 Girl Scouts of NYPENN Pathways Seniors: 25,691 ENDICOTT Catholic Charities 2012 Financial Support & Resources to Broome Mother Teresa's Cupboard County: SOS Shelter •HPNAP* food grants: $200,284 St. Anthony Food Pantry •HPNAP* operating grants: $24,278 HARPURSVILLE •Other Broome County grants received: $10,000 Colesville Community Pantry JOHNSONCITY *HPNAP - The Hunger Prevention & Nutrition Assistance Program Family Enrichment Network Increasing Distribution in Broome County To Meet TheNeed: Pathway of Love Food Pantry WINDSOR Total Pounds of food distributed in 2012: 1,924,382 lbs. Windsor Human Development Total pounds of food needed to meet the need: 7,788,924 lbs. Gap the Food Bank needs to fill to meet the need: 5,864,642 lbs.

Census data taken from American Fact Finder at http://factfinder2.census.gov

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 6: Broome County Profile 2012 Child HungerInitiative The BackPack Program™ provides children who are at risk of hunger with a bag of nutritious, easy to prepare food each Friday during the school year. This programs fills the gap left when children do not have access to the National School Lunch Program on weekends and breaks. Packs are distributed discreetly through participating schools to ensure confidentiality. Started as a pilot program in October, 2005, the BackPack Program™ served 26 sites in the 2011-2012 school year throughout the Food Bank’s six county service area. 2011 BackPack Program™ in Broome County •Number of sites: 6 - Johnson City SchoolDistrict •Locations: - UnionEndicott - Binghamton City SchoolDistrict - Whitney Point Central School - Deposit District - Harpursville Central School District •Number of packs distributed: 11,826 •Number of children served: 441 •Cost of packs distributed: $35,478 ($3.00/pack) •Value of packs distributed: $66,226 ($5.60/pack) 2012 RuralHunger Initiative

Why a Mobile Food Pantry? While hunger exists in both urban and rural areas, rural residents are particularly disadvantaged. Many rural communities can be described as “food deserts” where residents must drive more than 10 miles to the nearest supermarket or food pantry. Rural communities also tend to have a large population of seniors who are more likely than their urban counterparts to live in poverty and require greater access to services.

2011 Mobile Pantry Program in BroomeCounty • Number of distribution sites: 21 •Locations: Binghamton (9 sites), Chenango Bridge, Chenango Forks, Conklin, Deposit, Glen Aubrey, Harpursville, Johnson City (2), Maine, Windsor and Whitney Point (2) •Total number of distributions: 118 •Total pounds distributed: 618,469 lbs. • Total value: $1,026,659 ($1.66/lb.) • People served Households: 11,243 Children: 8,127 Adults: 14,591 Seniors: 5,300

The Food Bank of the Southern Tier is an Accredited Charity of the Better Business Bureau and a proud participant in the Charity Seal Program, which indicates that our organization has met the 20 Standards for Charity Accountability. For more information about the standards, please visit the BBB of Metro New York's website at www.newyork.bbb.org.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 7: Health Resource Inventory

Potential Additional Total FTE’s to Recommended Recruitment evaluate for Current FTEs Additional based on potential in Service Area Providers Succession recruitment PRIMARY CARE 48.1 General/Family Practice 9 5.8 14.8 33.2 Internal Medicine 9 9.3 18.3 21.4 Pediatrics 1 4.0 5.0 102.7 Total Primary Care Needs 19 19.1 38.1

MEDICAL SPECIALTY CARE 2.4 Allergy & Immunology 0 0.8 0.8 13.6 Cardiology 2 5.2 7.2 3.0 Dentistry 0 1.0 1.0 3.7 Dermatology 1 0.8 1.8 5.8 Endocrinology 1 2.8 3.8 8.0 Gastroenterology 2 5.0 7.0 <0.1 Gynecological Oncology 1 0 1.0 5.5 Hematology/Oncology 0 3.6 3.6 2.0 Infectious Diseases 1 1.0 2.0 2.8 Neonatal/Perinatal Medicine 00.80.8 2.0 Nephrology 2 1.0 3.0 6.9 Neurology 1 2.6 3.6 18.5 Obstetrics/Gynecology 2 646.4 848.4 3.1 Occupational Medicine 0 0.1 0.1 0.4 Pain Management 2 0 2.0 0.8 Palliative Medicine 0 0.8 0.8 0.4 Pediatric Allergy/Immunology 0 0 ‐ 1.2 Pediatric Endocrinology 0 0 ‐ 1.0 Pediatric Gastroenterology 0 1.0 1.0 101.0 PditiPediatric PPhitsychiatry 0 0 ‐ 3.0 Physical Medicine & Rehabilitation 0 1.6 1.6 25.8 Psychiatry 21.03.0 7.8 Pulmonary Diseases/Critical Care Medicine 1 1.0 2.0 0.5 Radiation Oncology 1 0 1.0 3.6 Rheumatology 1 0.9 1.9 122.8 Total Medical Specialty Care Needs 20 37.4 57.4

SOURCE: Medical Staff Development Plan, Our Lady of Lourdes Memorial Hospital, AmeriMed Consulting, December 2014

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 7: Health Resource Inventory

Potential Additional Total FTE to Recommended Recruitment Evaluate for Current FTEs Additional based on Potential in Service Area Providers Succession Recruitment SURGICAL SPECIALTY CARE 2.0 Cardiac/Thoracic Surgery 0 2.0 2.0 20.0 General Surgery 06.06.0 3.0 Neurosurgery 1 2.0 3.0 10.7 Oppgyhthalmology 13.74.7 0.8 Oral/Maxillofacial Surgery 1 0 1.0 17.0 Orthopedic Surgery 0 7.0 7.0 4.2 Otolaryngology 2 3.0 5.0 0.9 Pediatric Ophthalmology 0 0 ‐ 6.0 Plastic Surgery 0 4.0 4.0 12.6 Podiatry 0 5.6 5.6 080.8 Urogynecology 1 0 101.0 8.0 Urology 0 4.0 4.0 2.0 Vascular Surgery 1 0 1.0 88 Total Specialty Care Needs 7 37.3 44.3

HOSPITAL BASED SPECIALTIES 8.5 Anesthesiology 0 0 ‐ 11.7 Emergency Medicine 3 0 3.0 11.7 Hospitalists 4 0 4.0 1.8 Intensivists 0 0 ‐ 4.0 Pathology 0 0 ‐ 5.3 Radiology 2 0 2.0

43 Total Hospital Based Specialty Care Needs 9 0 9.0

356.5 TOTAL FTE PHYSICIAN NEEDS 55 93.8 148.8

SOURCE: Medical Staff Development Plan, Our Lady of Lourdes Memorial Hospital, AmeriMed Consulting, December 2014

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 7: Health Resource Inventory

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 7: Health Resource Inventory

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 7: Health Resource Inventory

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 7: Health Resource Inventory

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 4/26/2016 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2018 Appendix 8 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2018

Technical Notes About the Indicators For Tracking Public Health Priority Areas - New York State - 2013-2018

Improve Health Status and Reduce Health Disparities New NYS Data Broome Indicator York Data Links 2018 Years County State Objective 2008- 1. Percentage of premature death (before age 65 years) 20.5 24.3 (Table)(Map) 21.8 2010 2. Ratio of Black non-Hispanics to White non-Hispanics 3.09 2.12 (Table)(Map) 1.87 3. Ratio of Hispanics to White non-Hispanics 2.40 2.14 (Table)(Map) 1.86 2008- 4. Age-adjusted preventable hospitalizations rate per 10,000 - Aged 18+ years 143.8 155.0 (Table)(Map) 133.3 2010 5. Ratio of Black non-Hispanics to White non-Hispanics 1.79 2.09 (Table)(Map) 1.85 6. Ratio of Hispanics to White non-Hispanics 0.44 1.47 (Table)(Map) 1.38 86.0 83.1 7. Percentage of adults with health insurance - Aged 18-64 years 2010 (84.7- (82.9- (Table)(Map) 100 87.3) 83.3) 86.3 83.0 Age-adjusted percentage of adults who have a regular health care provider - Aged 2008- 8. (81.4- (80.4- (Table)(Map) 90.8 18+ years 2009 91.2) 85.5) Promote a Healthy and Safe Environment New NYS Data Broome Indicator York Data Links 2018 Years County State Objective 2008- 9. Rate of hospitalizations due to falls per 10,000 - Aged 65+ years 244.2 204.6 (Table)(Map) Maintain 2010

2008- 591.6 476.8 (Table)(Map) 429.1 10. Rate of emergency department visits due to falls per 10,000 - Aged 1-4 years 2010 https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm 1/5 4/26/2016 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2018 11. Assault-related hospitalization rate per 10,000 2008- 2.7 4.8 (Table)(Map) 4.3 2010 12. Ratio of Black non-Hispanics to White non-Hispanics 6.84 7.43 (Table)(Map) 6.69 13. Ratio of Hispanics to White non-Hispanics 1.54+ 3.06 (Table)(Map) 2.75 14. Ratio of low income ZIP codes to non-low income ZIP codes 1.31 3.25 (Table)(Map) 2.92 Rate of occupational injuries treated in ED per 10,000 adolescents - Aged 15-19 2008- 15. 36.5 36.7 (Table)(Map) 33.0 years 2010 Percentage of population that lives in a jurisdiction that adopted the Climate 16. 2012 23.6 26.7 (Table)(Map) 32.0 Smart Communities pledge 2007- 17. Percentage of commuters who use alternate modes of transportation1 20.5 44.6 (Table)(Map) 49.2 2011 Percentage of population with low-income and low access to a supermarket or 4.8 2.5 (Table)(Map) 2.24 18. 2010 large grocery store2 NA 26.3 19. Percentage of homes in Healthy Neighborhood Program that have fewer asthma 2008- (Table)(Map) 41.0 triggers during the home revisits 2011 Percentage of residents served by community water systems with optimally 20. 2012 75.5 71.4 (Table)(Map) 78.5 fluoridated water Prevent Chronic Diseases New NYS Data Broome Indicator York Data Links 2018 Years County State Objective 24.5 23.2 2008- 21. Percentage of adults who are obese (20.0- (21.2- (Table)(Map) 23.2 2009 29.0) 25.3) NYC: 19.7 2010- (Table)(Map) 22. Percentage of children and adolescents who are obese 18.6 17.6 2012 ROS : 20.3 16.8 16.7

2008- (15.4- (15.1- 23. Percentage of cigarette smoking among adults (Table)(Map) 15.0 2009 25.1) 18.6) 69.0 66.3 Percentage of adults who receive a colorectal cancer screening based on the most 2008- 24. (62.8- (63.5- (Table)(Map) 71.4 recent guidelines - Aged 50-75 years 2009 74.5) 69.1) https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm 2/5 4/26/2016 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2018 25. Asthma emergency department visit rate per 10,000 2008- 45.1 83.7 (Table)(Map) 75.1 2010 75.3 221.4 (Table)(Map) 196.5 26. Asthma emergency department visit rate per 10,000 - Aged 0-4 years 2008- 2010 27. Age-adjusted heart attack hospitalization rate per 10,000 2010 19.5 15.5 (Table)(Map) 14.0 Rate of hospitalizations for short-term complications of diabetes per 10,000 - 28. 2008- 5.8 3.2 (Table)(Map) 3.06 Aged 6-17 years 2010 Rate of hospitalizations for short-term complications of diabetes per 10,000 - 29. 2008- 5.1 5.6 (Table)(Map) 4.86 Aged 18+ years 2010 Prevent HIV/STDs, Vaccine Preventable Diseases and Healthcare-Associated Infections New NYS Data Broome Indicator York Data Links 2018 Years County State Objective Percentage of children with 4:3:1:3:3:1:4 immunization series - Aged 19-35 30. 2011 57.5 47.6 (Table)(Map) 80 months3 Percentage of adolescent females with 3-dose HPV immunization - Aged 13-17 2011 28.9 26.0 (Table)(Map) 50 31. years 75.5 75.0 2008- 32. Percentage of adults with flu immunization - Aged 65+ years (69.4- (71.5- (Table)(Map) 66.2 2009 81.6) 78.5) 2008- 33. Newly diagnosed HIV case rate per 100,000 5.1 21.6 (Table)(Map) 14.7 2010 34. Difference in rates (Black and White) of new HIV diagnoses s59.4 s (Table)(Map) 45.7 35. Difference in rates (Hispanic and White) of new HIV diagnoses 31.1 49.2 (Table) (Map) 22.3 36. Gonorrhea case rate per 100,000 women - Aged 15-44 years 2010 203.4 (Table)(Map) 183.4 37. Gonorrhea case rate per 100,000 men - Aged 15-44 years 2010 22.3* 221.7 (Table)(Map) 199.5 38. Chlamydia case rate per 100,000 women - Aged 15-44 years 2010 1007.9 1619.8 (Table)(Map) 1,458 39. Primary and secondary syphilis case rate per 100,000 males 2010 3.0* 11.2 (Table)(Map) 10.1 40. Primary and secondary syphilis case rate per 100,000 females 2010 1.0* 0.5 (Table) 0.4 Promote Healthy Women, Infants, and Children New NYS Data Broome Indicator York Data Links 2018 Years County State Objective https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm 3/5 4/26/2016 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2018 41. Percentage of preterm births 2008- 10.8 12.0 (Table)(Map) 10.2 2010 42. Ratio of Black non-Hispanics to White non-Hispanics 1.47 1.61 (Table)(Map) 1.42 43. Ratio of Hispanics to White non-Hispanics 0.86 1.25 (Table)(Map) 1.12 44. Ratio of Medicaid births to non-Medicaid births 1.04 1.10 (Table)(Map) 1.00 45. Percentage of infants exclusively breastfed in the hospital 2008- 66.1 42.5 (Table)(Map) 48.1 2010 46. Ratio of Black non-Hispanics to White non-Hispanics 0.80 0.50 (Table)(Map) 0.57 47. Ratio of Hispanics to White non-Hispanics 0.69 0.55 (Table)(Map) 0.64 48. Ratio of Medicaid births to non-Medicaid births 0.73 0.57 (Table)(Map) 0.66 49. Maternal mortality rate per 100,000 births 2008- (Table)(Map) 21.0 2010 Percentage of children who have had the recommended number of well child 56.4 69.9 (Table)(Map) 76.9 50. visits in government sponsored insurance programs4 2011 51. Percentage of children aged 0-15 months who have had the recommended number 87.9 82.8 (Table)(Map) 91.3 of well child visits in government sponsored insurance programs

Percentage of children aged 3-6 years who have had the recommended number of 52. 71.1 82.8 (Table)(Map) 91.3 well child visits in government sponsored insurance programs

Percentage of children aged 12-21 years who have had the recommended number 53. 42.7 61.0 (Table)(Map) 67.1 of well child visits in government sponsored insurance programs 94.4 94.9 54. Percentage of children with any kind of health insurance - Aged under 19 years 2010 (93.1- (94.5- (Table)(Map) 100 95.7) 95.3)

42.3 24.0 2009- 55. Percentage of third-grade children with evidence of untreated tooth decay (38.5- (22.6- (Table)(Map) 21.6 2011 46.1) 25.4) 56. Ratio of low-income children to non-low income children 2.02 2.46 (Table)(Map) 2.21 57. Adolescent pregnancy rate per 1,000 females - Aged 15-17 years 2008- 25.5 31.1 (Table)(Map) 25.6 2010 58. Ratio of Black non-Hispanics to White non-Hispanics 2.91 5.74 (Table)(Map) 4.90 59. Ratio of Hispanics to White non-Hispanics 4.19 5.16 (Table)(Map) 4.10 60. Percentage of unintended pregnancy among live births 2011 36.2 26.7 (Table)(Map) 23.8 61. Ratio of Black non-Hispanics to White non-Hispanics 1.43 2.09 (Table)(Map) 1.90 https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm 4/5 4/26/2016 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2018 62. Ratio of Hispanics to White non-Hispanics 1.40 1.58 (Table)(Map) 1.43 63. Ratio of Medicaid births to non-Medicaid births 1.56 1.69 (Table)(Map) 1.54 88.5 86.1 64. Percentage of women with health coverage - Aged 18-64 years 2010 (86.9- (85.8- (Table)(Map) 100 90.1) 86.4) 2008- 65. Percentage of live births that occur within 24 months of a previous pregnancy 25.3 (Table)(Map) 17.0 2010 18.0 Promote Mental Health and Prevention Substance Abuse New NYS Data Broome Indicator York Data Links 2018 Years County State Objective 10.2 Age-adjusted percentage of adults with poor mental health for 14 or more days in 2008- 12.9 (9.2- 66. (8.7- (Table)(Map) 10.1 the last month 2009 16.7) 11.7) 19.5 18.1 2008- 67. Age-adjusted percentage of adult binge drinking during the past month (14.1- (16.1- (Table)(Map) 18.4 2009 24.8) 20.2) 2008- 68. Age-adjusted suicide death rate per 100,000 8.3 6.8 (Table)(Map) 5.9 2010

* Fewer than 10 events in the numerator, therefore the rate is unstable + Fewer than 10 events in one or both rate numerators, therefore the ratio is unstable s Data do not meet reporting criteria NA Data is not available

1- Alternate modes of transportation include public transportation, carpool, bike, walk, and telecommute 2- Low access is defined as greater than one mile from a supermarket or grocery store in urban areas or greater than ten miles from a supermarket or grocery store in rural areas 3- The 4:3:1:3:3:1:4 immunization series includes: 4 DTaP, 3 polio, 1 MMR, 3 hep B, 3 Hib, 1 varicella, 4 PCV13 4- Government sponsored insurance programs include Medicaid and Child Health Plus

https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm 5/5 Appendix 9: NYDOH Hospitalizations Due to Falls In Broome County

New York State Prevention Agenda Dashboard - State Level

SSetate County Dashboard About This Site Prevention Agenda 2013- Dashboard 2017 County Dashboard Home Data Table Go Back

Select Indicator Rate of hospitalizations due to falls per 10,000 - Aged 65+ years Submit

New York State - Rate of hospitalizations due to falls per 10,000 - Aged 65+ years Data Source: SPARCS data as of December 2014

Data Year(s) Hospitalization PA2017 rate 2008 206.5 204.6 2009 208.8 204.6 2010 198.5 204.6 2011 201.5 204.6 2012 193.4 204.6 2013 186.0 204.6

Questions or comments: [email protected] Revised: April2015

6/3/2015

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Healthcare Need Theme Priority Worksheet As of 5/9/16

INSTRUCTIONS: For each healthcare need theme, review the factors listed below and (for each factor), provide a rating from 0 to 4, with 0 being “Not at all” and 4 being “High” to indicate the level of alignment the factor has with the theme. Circle each appropriate rating number.

Healthcare Need Theme: ______

______

Factor 0 to 4 Rating

Barriers to Success Please sum all of the circled rating figures within this section here:  ______

Not at All High a) Fit with Lourdes Mission 0 1 2 3 4 b) Availability of Staff Resources 0 1 2 3 4

Not at All Completely c) Availability of Financial Resources 0 1 2 3 4 d) Awareness/Consensus of Issue/Problem 0 1 2 3 4

Degree of Impact Please sum all of the circled rating figures within this section here:  ______e) Failure to Address Issue Exacerbates the Problem/Theme 0 1 2 3 4 f) Clarity of Direction or Solution 0 1 2 3 4 g) Impact the Greatest Number in the Community 0 1 2 3 4 h) Alignment with NYS Health Initiatives 0 1 2 3 4

Current Resources/Critical Interest Please sum all of the circled rating figures within this section here:  ______i) Initiative(s) Already Underway by Lourdes 0 1 2 3 4 j) Initiative(s) Already Underway by Community 0 1 2 3 4 k) Multiple Stakeholder Engagement______0 1 2 3 4 l) Milestone Lag in Reporting Known Improvements 0 1 2 3 4

Factor Group Rating Rating 1. TOTAL SCORE for: Barriers to Success 2. TOTAL SCORE for: Degree of Impact Add Rows1 and 2 Sub-total 3. TOTAL SCORE for: Current Resource/Critical Interest ( ) HEALTHCARE NEED THEME PRIORITIZATION SCORE FINAL Subtract Row 3 From Subtotal RATING

At the conclusion of the work organize the Healthcare Need Themes in sequential order from the highest rating to the lowest rating. Those with the higher ratings should be viewed as those Lourdes should consider as high priority.

Healthcare Need Theme Factor Definitions:

Factor Group: Barriers to Success a) Fit with Lourdes Mission – the degree to which addressing the healthcare theme fits with the mission of Lourdes 0 – does not fit with the Lourdes mission 4 – completely aligns with the Lourdes mission b) Availability of Staff Resources – the availability of staff resources to address the healthcare theme (anticipating the staffing needs based on potential solutions to the problem/issue) 0 – there is no staff currently available/no capacity to address the issue 4 – there is appropriate staff available and with capacity to address the issue c) Availability of Financial Resources – the availability of financial resources to address the healthcare theme (anticipating the financial needs based on potential solutions to the problem/issue) 0 – there is no funding source available to cover the anticipated costs to address the issue 4 – there is appropriate funding available to cover the anticipated costs to address the issue d) Awareness/Consensus of Issue/Problem – the level of awareness and agreement in the community that this is a problem that needs to be addressed. 0 – there is no community awareness of the issue and/or no consensus that there is actually a problem associated with this healthcare theme 4 – there is a high level of community awareness of the issue and/or complete consensus that there is actually a problem associated with this healthcare theme

Factor Group: Degree of Impact e) Failure to Address Issue Exacerbates the Problem/Theme – the degree to which not doing anything to address the problem/theme would negatively impact the overall health status of the community 0 – there is no likelihood that if Lourdes does not address the healthcare theme that there would be a negative impact on the overall health status of the community 4 – there is a high degree of likelihood that if Lourdes does not address the healthcare theme that there would be a negative impact on the overall health status of the community

f) Clarity of Direction or Solution – the level of clear direction or solution to address the healthcare theme/problem 0 – there is no clear direction or solution to address the healthcare theme 4 – there is clear direction or solution to addressing the healthcare theme g) Impact the Greatest Number in the Community – the level to which addressing the healthcare theme/problem will impact the overall health status of the community by helping the greatest number of community residents 0 – there will be very minimal impact to the overall health status of the community because very few community residents will be impacted by any efforts to address this healthcare theme/problem 4 – there will be very high impact to the overall health status of the community because many community residents will be impacted by efforts to address this healthcare theme/problem h) Alignment with NYS Health Initiatives – the degree to which addressing the healthcare theme aligns with the NYS Health Initiatives established in the 2013-2018 Prevention Agenda 0 – does not fit with the NYS Health Initiatives established in the 2013-2018 Prevention Agenda 4 – completely aligns with the NYS Health Initiatives established in the 2013-2018 Prevention Agenda

Factor Group: Current Resources/Critical Interest i) Initiative(s) Already Underway by Lourdes – the degree to which there are already initiatives being conducted by Lourdes to address the healthcare theme/issue 0 – there are no initiatives at Lourdes already in place to address the issue 4 – there are extensive initiatives already in place at Lourdes to address the issue j) Initiative(s) Already Underway by Community – the degree to which there are already initiatives being conducted by other community organizations to address the healthcare theme/issue 0 – there are no initiatives throughout the community already in place to address the issue 4 – there are extensive initiatives already in place throughout the community to address the issue k) Multiple Stakeholder Engagement – the degree to which there are multiple stakeholder groups/organizations that are engaged in addressing the healthcare theme/issue 0 – there are no stakeholders in the community currently engaged/available to address the issue 4 – there are many stakeholders in the community currently engaged/available to address the issue l) Milestone Lag in Reporting Known Improvements – the degree to which there are initiatives already making an impact but the improvements are not reflected in the data used to identify the healthcare theme/issue 0 – there is no evidence that any improvements have been made in addressing this healthcare theme beyond what is reflected in the data 4 – there is strong evidence that improvements have been made in addressing this healthcare theme that is not yet reflected in the data

Appendix 11: Community Stakeholder Interviews

The following were the key findings of the stakeholder interviews, focusing on community health needs among the residents of Broome County .

Mental health, behavioral health, and substance abuse access. 11 out of 12 stakeholders identified these services a top healthcare need. These are everyday issues that impact people who are impoverished or in the working class poor. Stakeholders indicated that these services are limited or not available in Broome County and half (7 of 12) felt these services should be a priority to address in the short‐term (within 5 years). Eight of the stakeholders also identified this segment of the population as particularly vulnerable and in need of specific attention from the providers of healthcare services. Finally, when asked to identify 3 priorities for the CHNA, these services were identified by two thirds of the stakeholders (8 of 12 total), as priorities for the community.

Access barriers for people with limited resources. Barriers to access for these populations mentioned by stakeholders include finding providers who will accept Medicaid and/or Medicare patients, finding transportation to healthcare services (regardless of payor status), having programs that are targeted for populations with varied racial or ethnic backgrounds. Stakeholders stated that Broome County residents are burdened by the “everyday” issues that impact people who are impoverished or in the working class poor.

Stakhldkeholders flfelt that t he availlblability and access to services has improve d over t he past 5 years in Broome County. Due to the addition of walk‐in clinics, technology improvements at the hospitals, increased access to primary care services throughout the community, decreases in the number of uninsured, and some specialization within the hospital systems (cancer care at Lourdes). Community health care initiatives have focused on prevention of diseases and promoting healthy lifestyles, increasing access and education to mental health and substance abuse; and addressing transportation issues.

Increase access to specialty services within the County. Several stakeholders mentioned a need for pediatric sub‐specialties, additional cancer care services, cardiac services, neurology and neurosurgical services and consideration for leveraging technology and telemedicine to increase access to specialties unavailable locally. Please include information on the additional themes and reference the appendix Please change to small bullets. Can you clarify for the reader (and me) why there are 4 themes here and 10 mentioned in the E Summary

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 11: Community Stakeholder Interviews Community Health Needs Identified by Stakeholders:

Strong Availability in the Lourdes Primary Service Area: •Primary Care •Basic Specialty Care (cardiology, oncology, radiology, orthopedics and general medical specialties) •Emergency Care •Urgent Care •Other services mentioned as having strong availability by multiple stakeholders included: treatment for Chronic Obstructive Pulmonary Disease (COPD) and diabetes. Additional services mentioned by single respondents included general surgery and OB/Gyn services. One respondent elaborated, saying that many of the services which are highly available are services for which there is a high demand across the entire population, based on common conditions such heart disease, cancer, COPD and diabetes.

Limited Availability in the Lourdes Primary Service Area: •Mental Health •SbstanceSubstance Abu se •Specialty Care (neurology, oncology, allergy, dermatology, urology and cardiology each mentioned once) •Dental Care for lower income residents and those with Medicaid

No Availability in the Lourdes Primary Service Area: •Long Term Substance Abuse Treatment •Pediatric Sub‐specialties mental and substance abuse services for children; pediatric sub‐specialties such as oncology, child neurology and a full neonatal intensive care unit (NICU). •Other services that were identified as not available include any of the highly specialized services which are served by a tertiary care center (agreement was that these services may not be appropriate to have in the County based on the pppopulation size); dialysis services; and an infectious disease ppyhysician ((yonly a nurse practitioner currently available to see patients with HIV). •Stakeholders agreed that priorities for the next 3 to 5 years should focus on the need for more services in mental health and in substance abuse services.

•Other services which were mentioned by individual stakeholders as priorities were urology, infectious disease, and dental care for children. One stakeholder felt that the focus should be on improving technology to be able to access some services through the use of telemedicine rather than trying to bring service providers directly to the area. •Stakeholder’s perception is that Broome County residents travel outside of the region for services not available in the service area such as: cancer treatment (7 mentions), substance abuse treatment (6 mentions), cardiac services (4 mentions), neurology and neurosurgery (5 mentions), pediatric specialty services (3 mentions), child psychiatry (2 mentions), orthopedics, and for other specialized care.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 11: Community Stakeholder Interviews

Perception of Quality and Access to Care in the Lourdes Primary Service Area:

The overall availability and access of healthcare services for residents in Broome County was rated as a 7.2 on a 1‐10 scale by stakeholders. Most believed the county has a fairly strong availability of primary care and hospital services (including emergency and urgent care services). Reasons for not rating the availability of services higher included issues with transportation, inadequate mental health services and lack of some specialty services. The one stakeholder who rated the availability as a “5” indicated that it was because some services are readily available while others are not at all, that the rating is “all over the map” depending on what services you are considering.

•Stakeholders generally agreed that Broome County’s availability and/or access to services was better than other counties in the immediate and surrounding areas, The services which stakeholders felt Broome County had better availability and access than other areas included hospital and emergency services, nursing homes, specialists, trauma, cardiac care, orthopedics, stroke and pediatricians which are the services with strong availability in the area. The services which stakeholders felt that other areas (Syracuse, Rochester, New York City, Buffalo) had better availability and access to the services included cancer care, pediatrics and pediatric sub‐specialties, geriatrics, specialty services, behavioral health, dialysis, cardiac services, and neurosurgery. Non‐Traditional Initiatives that have a positive impact in the community: 1.Falls Prevention Program 2. Community Gardens 3.Health Home Care Management 4.Regional Delivery System Reform Incentive Payment 5.Peer Services in Mental Health and Substance Abuse Treatment 6.Binghamton Metropolitan Transportation Study 7.Drug Awareness Meetings in Schools 8.Programs for Battling Childhood Obesity 9.Community Planning for Walking and Biking Trails 10.Healthy Neighborhood Initiative (lead painting removal) Future Non‐Traditional Initiatives offered by the stakeholders: 1.Alternative Transportation Models 2.Address Substance Abuse Epidemic 3.Find additional recourses for Healthy Food Options within the Community 4.More community‐based behavioral health services 5.More Preventive and Wellness Programs 6.Improved “walkability” of communities

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 11: Community Stakeholder Interviews

 Responses per category during IDI’s conducted by RMS

Thinking about the Community Health Needs Assessment (CHNA) for Lourdes Hospital, if you personally had to choose three items or healthcare services that Lourdes Hospital should pursue for its residents, what would they be? Category Number of Responses Improve Mental Health Services  (7) Improve Substance Abuse Services  (6) Screenings and Services for Chronic Conditions  (5) out in Community Increase Patient Education  Become a Baby Friendly Hospital  Encourage Breast Feeding Friendly Physician Offices  Services for Older Adults with Most Health Issues  Improve Home Care Services  Nurse Navigation Services  Telemedicine Services  Improve Communication Between Providers  Racial and Ethnic Sensitive Programs  Increase Cancer Services  Disease Prevention/Wellness Programs  Childhood Hunger  Raising People Up Out of Poverty 

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

 A Community Needs Assessment (2014 ) conducted as part of the New York State Delivery System Reform Incentive Payment (DSRIP) program identified the same health priorities as the existing research. Key findings from the DSRIP CNA that were used to inform the Lourdes CHNA include:  Key research work informing the community healthcare desires and needs included the DSRIP Community Needs Assessment report completed in mid-December of 2014 and Care Compass Network’s (the Southern Tier’s Performing Provider System). The Panel survey was administered in September2015. Community input was obtained through :  (1) an online survey administered to area healthcare clinical providers ,  (2) an online survey administered to area non-clinical providers and community organizations  (3) an online survey administered to community residents, and  (4) focus group research conducted among the Medicaid recipients in Broome County. In total, more than 880 online responses were received and two focus groups representing 24 participants were conducted.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

 In the DSRIP community needs assessment, providers, organizations and the community-at-large were asked to identify the most pressing needs. The tables below identify the key findings.

Providers Community Organizations Community-at-large

Q51: What is the most pressing Q51: What is the most pressing Q51: What is the most pressing need to improve healthcare for need to improve healthcare for need to improve healthcare for our community? our community? our community? n266; Open-Ended n393; Open-Ended n375; Open-Ended Top 10 Responses n % Top 10 Responses n % Top 10 Responses n %

Access to mental Making healthcare Affordable health 40 15% 74 19% 27 7% health services more affordable care Education/Preventi Increased access to Universal access to 30 11% 70 18% 13 3% on medical services health care Access to medical Access to mental Access to doctors 26 10% 53 14% services health services who accept Medicaid 11 3% insurance Lack of physicians 25 9% Higher quality of Affordable health service from 34 9% Access to mental 15 6% 10 3% care healthcare providers health services Increased healthcare Coordination of care Coordination of 34 9% 10 3% care between 13 5% education between providers providers Access to physicians Lack of physicians 8 2% 29 7% Access to reliable or specialists 8 3% Education/prevention 7 2% transportation Access to reliable 21 5% Access to dental Access to transportation 6 2% 8 3% services specialists Access to community 15 4% Access to reliable Home based support organizations 6 2% 8 3% transportation medical services Practicing preventative Better quality doctors 6 2% Access to dental healthcare 15 4% 6 2% care Effective provider 13 3% communication

 The primary desires/needs seem tied to cost and access to healthcare providers. Mental healthcare and dental care services are areas where there are barriers to care.  The stakeholder groups also discuss the desire for access to reliable transportation so that care can be received.  There is a desire for improved coordination of care between providers.  Increased healthcare education and focus on prevention also surface as needs.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities  The “Open-ended” responses highlighted needs that are reflected in the categories previously noted. These include: o Need for increased access and significant growth in providers who can address mental healthcare, substance abuse and addictive services. o There’s concern that the community needs to address behavior activities tied to obesity, smoking, wellness (exercise), and nutrition. o Several mentioned lack of awareness of community services available, particularly those tied to assisting the uninsured. o Respondents desire greater coordination and a more holistic approach to healthcare. o Education on defining the proper utilization venue for services, including the ER and urgent care sites – Proximity to where they live was a key factor (went to “closest” facility).

 The DSRIP Online study allowed for measuring the perceptions of Broome County specific respondents. Please note that the low percentages in a column indicate that there is an overall rating that is less than good for that particular category.

Q66: Please rate the following healthcare factors among the general population in your county using a scale of 1 to 5 where “5” indicates very good and “1” indicates very poor. Single Response Per Factor; %4-5 by county Community Providers Organizations

Question Broome Broome

n 112 124 The number of healthcare providers available 61% 60% NOTE: The variety of specialty care providers available 34% 41% The highlighted categories indicate Ability for patients to make a timely appointment 24% 27% key need {Score of Healthcare providers that have convenient office hours for 30% or lower} 45% 35% patients Healthcare providers that are accepting new patients 39% 29% The out-of-pocket healthcare costs to patients 9% 14%

Availability of transportation to a healthcare provider practice 18% 18%

Communication among healthcare providers 28% 16% Availability of after-hours and emergency care 43% 44% Availability of community based resources for patients 27% 32% Travel time to healthcare provider locations 49% 48%

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

 Learned that knowledge of available community resources among all the key stakeholder groups regarding availability is lacking. This represents a significant opportunity to improve proper resource utilization. Providers Q72: Does your practice or organization use a community resource directory for patients? n301; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 115 6 8 13 56 9 24 8 15 39 8 Yes 61% 83% - 69% 54% 56% 33% 13% 67% 41% 38% No 16% - 88% 15% 13% 33% 25% 50% 27% 26% 25% 39% Unsure 23% 17% 12% 16% 33% 11% 42% 37% 6% 33% 37%

Q73: Are you aware of the 2-1-1 human resources directory for your area? n301; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 115 6 8 13 56 9 24 8 15 39 8

Yes 25% 50% 25% 46% 41% 33% 33% 38% 33% 72% 13%

No 75% 50% 75% 54% 59% 67% 67% 63% 67% 28% 87%

Q75: Are there enough community resources to support the healthcare needs for your area? n301; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 115 6 8 13 56 9 24 8 15 39 8 Yes 17% 17% 38% 15% 18% 11% 21% 25% - 28% - 83% No 56% 50% 50% 62% 61% 89% 54% 50% 87% 49% 62% Unsure 27% 33% 12% 23% 21% - 25% 25% 13% 23% 38%  Broome Co. providers feel that there are not enough community resources and the majority are unaware of the 2-1-1 resource directory that is available. Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

 Learned that knowledge of existing community resources available among all the key stakeholder groups is lacking. This represents a significant opportunity to improve proper resource utilization.

Community Organizations Q73: Are you aware of the 2-1-1 human resources directory for your area? n441; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 124 8 13 20 94 9 46 17 36 68 6 Yes 65% 63% 62% 60% 60% 11% 39% 88% 58% 96% -

No 35% 37% 38% 40% 40% 89% 61% 12% 42% 4% 100%

Q75: Are there enough community resources to support the healthcare needs for your area? n441; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 124 8 13 20 94 9 46 17 36 68 6 Yes 83% 17% 13% 31% 5% 11% 11% 17% 12% 11% 32% 17% No 61% 50% 15% 75% 55% 89% 57% 77% 61% 47% 50% Unsure 22% 37% 54% 20% 34% - 26% 11% 28% 21% 33%

Community-at-large

Q98: Have you ever dialed 2-1-1? n899; Single Response

Category General Total Medicaid/Uninsured Community Yes 11% 16% 9% No 89% 84% 91%  The primary research also indicated that many residents go to the ED because their condition occurred on the weekend or “after-hours” and they did not know where else they could receive care. They looked to family and friends for advice and these individuals encouraged them to go to the ER as well. The research shows that there is also a desire to match resources with convenience – residents said that they look for care close to their home and where they can easily get in to be seen.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

 Among both the provider community and the general community that there has been an increase in preventive health behavior among Broome County and that most “Sometimes” or “Usually” engage in a preventive health care behavior.

Providers Q78: Over the past 3 years has this preventive behavior among the general population... n111; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 29 3 2 6 23 3 8 3 5 28 1 Increased 52% 67% 50% 50% 30% - 25% - 20% 43% - Decreased 10% - - 17% 4% ------Remained the same 31% 33% 50% 33% 35% 67% 63% 33% 60% 39% 100% Unsure 7% - - - 31% 33% 12% 67% 20% 18% -

Q77: To what extent do patients or residents in the general population engage in preventive health behavior? n111; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 29 3 2 6 23 3 8 3 5 28 1 Never ------Sometimes 65% 100% 100% 67% 52% 67% 75% 67% 60% 75% - Usually 35% - - 33% 26% 33% 25% 33% 20% 21% 100% Always - - - - 4% - - - 20% - - Unsure - - - - 18% - - - - 4% -

 Dental care availability seems to be a service need for Broome county residents, particularly those with Medicaid or who are uninsured. This service was raised by the provider community as well as community survey respondents. Approximately 40% of Broome County survey respondents indicated that they had not had a dental check-up in the past year or couldn’t remember having that check-up. The primary reasons for not having the check-up were that they had no insurance, could not find the time, or could not afford it. About 7% of respondents stated that they could not find a dentist or one that accepted their insurance.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

Community-at-large

Q44: In the past 12 months, have you or a member of your household had a dental check-up? n375; Single Response

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 145 17 30 14 22 13 27 18 52 30 7 Yes 60% 59% 67% 57% 68% 69% 56% 61% 56% 67% 71% No 37% 35% 33% 43% 27% 31% 44% 39% 40% 30% 29% Unsure 3% 6% - - 5% - - - 4% 3% -

Q45: What was the main reason(s) you did not have a dental check-up in the past 12 months? n250; Select All That Apply

Category General Total n Medicaid/Uninsured n Community n

I did not have insurance 31% 33% 28%

I could not afford it 34% 22% 49% I could not find a dentist that took my insurance 13% 16% 10% I do not like going/afraid of the dentist 16% 14% 19%

I did not have the time 12% 13% 11%

The dentist was too far away 4% 7% 2%

I did not have transportation 6% 7% 4% My insurance did not cover check-ups 14% 6% 23% I am healthy and do not need to see a dentist 4% 4% 5%

I did not have childcare 0% - 1% Other(s) 1 14% 15% 12%

Unsure or Refused 4% 6% 3%

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities  Several in the survey felt that transportation in the community “to and from” medical appointments could be an issue and is therefore a need. Providers and Community Organizations identified this as a true need. Not all community residents were sure that this was the case, however 20% of the Southern Tier area community respondents said that there was not adequate transportation for them to visit healthcare providers. Community-at-large

Q91: Is there adequate transportation in the community for you to visit healthcare providers? n209; Single Response Medicaid/Uninsured

Category Broome Cayuga Chemung Chenango Cortland Delaware Schuyler Steuben Tioga Tompkins of None above the n 32 10 28 11 20 10 24 12 30 27 5 Yes 69% 40% 57% 55% 60% 40% 50% 33% 50% 56% 40% No 6% 30% 29% 36% 25% 30% 38% 25% 30% 15% 60% Unsure 25% 30% 14% 9% 15% 30% 12% 42% 20% 29% -

Q91: Is there adequate transportation in the community for you to visit healthcare providers? n899; Single Response Category General Total Medicaid/Uninsured Community Yes 55% 54% 55% No 20% 25% 19% Unsure 25% 21% 26%  Broome County residents do leave the area to obtain healthcare because they could not find a doctor. This is primarily tied to receiving specialty care services. A list of providers and specialties that residents leave the area to receive care are listed on the next page.

Q84: Are there any specialty areas for which you could not find a doctor? n899; Single Response

Category General Community Total n1 Medicaid/Uninsured n1 n1 Yes 33% 20% 26% 18% No 67% 58% 69% Unsure 13% 16% 13%

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

Q85: Which one(s)? n176; Select All That Apply

Category Total Medicaid/Uninsured General Community Psychiatrist 13% 20% 10% Dermatologist (Skin) 21% 16% 22% Neurologist (Brain and Nervous System) 11% 13% 11% Pain Management Specialist 12% 11% 12% Gynecologist (Female) 9% 7% 9% Ophthalmologist (Eye) 6% 7% 5% Sleep Disorders 5% 7% 3% Allergist (Immunologist) 6% 6% 7% Pediatrician (Children) 2% 6% 1% Rheumatologist (Joint Diseases) 9% 6% 10% Adolescent Medicine Specialist 3% 4% 3% Gastroenterologist (Stomach) 5% 4% 6% Addiction Psychiatrist 5% 2% 7% Cardiologist (Heart) 5% 2% 6% Hepatologist (Liver) 1% 2% 1% Obstetrician (Pregnancy) 2% 2% 3% Otolaryngologist (Ear, Nose, and Throat) 3% 2% 3% Pulmonologist (Lung and Breathing) 5% 2% 6% Anesthesiologist 1% - 2% Cardiovascular Surgeon (Heart Surgeon) 2% - 3% Colon and Rectal Surgeon 2% - 3% Endocrinologist (Hormones) 9% - 12% Hematologist (Blood) 3% - 5% Hospitalist (Hospital Care) 2% - 3% Nephrologist (Kidney) 2% - 3% Oncologist (Cancer) 4% - 6% Pathologist (Tissue and Blood Samples) 2% - 3% Sports Medicine 3% - 4% Urologist 2% - 3%

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

Key Slides from the CCN Panel Survey Re: Community Health Needs - 2015 Quantitative Study

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

 According to respondents, the most pressing healthcare issues for the community are access to care (23%), affordability of healthcare (20%), and access to adequate health insurance (11%).

Q1: What is the most pressing healthcare issue for our community? n189; Open-Ended; Multiple Responses; Coded

Top Responses: n %

Access to care 43 23%

Affordability of healthcare 37 20%

Access to adequate health insurance 20 11%

Availability of mental health services 16 8%

Availability of specialty care or chronic disease 16 8% management

Substance abuse treatment 15 8%

Insurance acceptance 9 5%

Elderly care 6 3%

Obesity 5 3%

Transportation 5 3%

Communication between providers 4 2%

Dental care 3 2%

Other1 20 11%

1Other responses include: Don’t know (3), Treatment options, Competent doctors, Economy (2), Health education, High Medicaid population (3), Lifestyles, Patient engagement, Preventative healthcare (2), Nutrition, Repeat non emergent ED visits, N/A (3).

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment AppendixCommunity 12: Community Needs Identification Feedback from Assessment DSRIP Activities

 Among all respondents the two lowest rated healthcare factors (poor) for the general population of the county are ‘the out-of-pocket healthcare costs to patients’ and ‘availability of transportation to a healthcare provider practice.’ Roughly half of the respondents provided a score of 1 or 2 (on a scale of 1 to 5) for these factors, indicating that these are considered poor for the region.

 Among all respondents the two highest rated factors (good) for the general population of the county are the ‘the number of healthcare providers available’ and ‘availability of emergency care services.’ The majority of respondents provided a score of 4 or 5 (on a scale of 1 to 5) for these factors, indicating that these are considered good for the region.

Q2: Please rate the following healthcare factors for the general population in your county. n189; Single Response

Poor Good Factor: % 3 Mean % 1-2 % 4-5

a. The number of healthcare providers available 17% 22% 61% 3.7

m. Availability of emergency care services 17% 20% 63% 3.7 d. Ability for patients to make a timely appointment for 20% 28% 52% 3.5 routine care j. Locations of provider offices 17% 35% 48% 3.5 e. Healthcare providers that have convenient office hours 19% 37% 44% 3.4 for patients i. Travel time to healthcare providers 27% 32% 41% 3.2

l. Availability of after-hours and urgent care services 30% 26% 44% 3.2

f. Healthcare providers that are accepting new patients 27% 37% 36% 3.1

b. The variety of specialty care providers available 37% 28% 35% 3 c. Ability for patients to make a timely appointment for care 34% 31% 35% 3 needed right away n. Availability of support based resources for patients 37% 37% 26% 2.9 k. Communication among healthcare providers about 38% 34% 28% 2.8 patient care g. The out-of-pocket healthcare costs to patients 49% 36% 15% 2.5 h. Availability of transportation to a healthcare provider 53% 24% 23% 2.5 practice  Mean Key: Red = 2.5 or lower, White = 2.6 to 3.4, Green = 3.5 or higher.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunitySurvey Feedback Results from DSRIP Activities  Among Panel Group 1 (Medicaid or Uninsured Community Residents) respondents only, the lowest rated factors remained consistent to the results among all respondents. Less than half of Panel Group 1 respondents provided a score of 1 or 2 (on a scale of 1 to 5) for these factors, indicating that these are considered poor for the region.

 Similarly, the highest rated factors among Panel Group 1 (Medicaid or Uninsured Community Residents) respondents only remained consistent to the results among all respondents. The majority of Panel Group 1 respondents provided a score of 4 or 5 (on a scale of 1 to 5) for these factors, indicating that these are considered good for the region.

Q2: Please rate the following healthcare factors for the general population in your county. n38; Single Response; Medicaid or Uninsured Community Residents (Panel Group 1)

Poor Good Factor: Mean % 1-2 % 3 % 4-5

m. Availability of emergency care services 11% 25% 64% 3.8

a. The number of healthcare providers available 13% 24% 63% 3.7 d. Ability for patients to make a timely appointment for 16% 27% 57% 3.7 routine care e. Healthcare providers that have convenient office hours 14% 37% 49% 3.6 for patients i. Travel time to healthcare providers 16% 33% 51% 3.4

j. Locations of provider offices 19% 30% 51% 3.4

l. Availability of after-hours and urgent care services 19% 35% 46% 3.4 k. Communication among healthcare providers about 30% 38% 32% 3.1 patient care c. Ability for patients to make a timely appointment for care 30% 40% 30% 3 needed right away b. The variety of specialty care providers available 39% 27% 34% 2.9

f. Healthcare providers that are accepting new patients 42% 30% 28% 2.9

n. Availability of support based resources for patients 39% 44% 17% 2.8

g. The out-of-pocket healthcare costs to patients 35% 51% 14% 2.7 h. Availability of transportation to a healthcare provider 47% 23% 30% 2.6 practice  Mean Key: Red = 2.5 or lower, White = 2.6 to 3.4, Green = 3.5 or higher.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: Community Feedback from DSRIP Activities

In addition to the online survey research, the RMS team also reviewed the DSRIP Medicaid audience focus group findings when identifying the area’s healthcare needs. The summary of the focus group research follows on the subsequent pages. Each page defines the general need theme that surfaced through the discussion. These were included in the general need identification.

Key Slides from the DSRIP CHNA Medicaid/Uninsured Focus Groups – Fall 2014

Qualitative Study

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 1 from DSRIP Activities

The emergency room (ER) is viewed by participants as an "always available" option for health and dental care services, and is often visited because of convenience and accessibility. Many participants indicated that they consider the ER as an acceptable location to receive "any type" of medical care, not just when life-threatening healthcare is needed. Key drivers to ER use, identified by the participants, are: (1) its 24/7 access for everyone, (2) ability to always "be seen by a doctor" (3) lack of knowledge as to where else to go to receive care, (4) shortage of other healthcare resources (providers), and (5) no out-of-pocket, up front costs. Other significant drivers also include: ready transportation to the ER, one stop shopping with multiple services available (X-ray, lab, specialists, medications) all under one roof, and the participants have an existing relationship with the provider(s) at the ER.

Selected Comments  The ER is always available. You can go to the ER, but the follow-up is virtually non-existent.  Well, depending on what kind of insurance and stuff you have, there’s not very good availability right in Cortland.  Lack of specialists in the area.  A lack of transportation (to healthcare providers) in the rural areas.  Transportation is a joke. There’s one company around here that was eligible to do Medicaid transports, and there were times where I've had to wait two to three hours after my appointment for the transportation to come back, pick me up and take me home. You always had to be there, they’d pick you up at least an hour early before your appointment. If it was local, you’d be there within 5 to 10 minutes, so you were there at least 45 minutes, 50 minutes early for your appointment, and then still have to wait after the appointment for your ride back home. It just wastes your entire day.  The doctors have a say in how many Medicaid patients they'll accept. “We're not accepting any more Medicaid patients right now” is a common response from doctors.  There is a lack of doctors that will accept Medicaid and Medicare in this county. There are absolutely none that take it.  The transportation of (a) Medicaid (patient), that’s sometimes a month in a advance you gotta book it and that’s not always guaranteed.  Well, it’s one of the things that I know that they won’t turn me away ‘cause I can’t pay.  It’s easier to get into the emergency room than it is to actually get into the doctor. Doctors takes 24+ hours to get in.  Well if it is something that you’re probably going to get admitted to the hospital for, just go to the ER first. If you go to a convenient care, they are just going to transfer you there anyway.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 2 from DSRIP Activities

Participants feel that the majority of patients visiting an ER are there for symptoms/conditions that could be treated at other healthcare venues, and for non-life threatening conditions. The majority of participants acknowledged that the ER is not always the most appropriate place for care, however it may be the only perceived health care provider in the area. A significant majority of participants indicated that they, themselves, had visited an ER with a non-life threatening condition. Some indicated that they know people who went to the ER to obtain medication, receive attention, to obtain a meal, receive mental health care, and/or to get warm and find shelter. Several felt people went there because it (the ER) was most convenient to them.

Selected Comments  You know they – they’re hypochondriacs you know, because I – I used to go when I drank, you know, I’m in recovery and I would get panic attacks you know and I would just run to the emergency room, ‘cause I felt like I was having a heart attack.  I mean, the emergency room is open all night long. The Prompt Care closes, I want to say, at 10 or 11.  Sometimes their (personal) doctors won’t prescribe them what they're looking for, so they go to the ER.  If we don’t think that two days’ waiting is gonna be helpful and we're gonna get worse, then I would choose to go to the ER.  I would've done that same thing if I was without insurance (Medicaid). I would've gone to the emergency room first.  I didn’t know where else to go. Thanksgiving night at 7:30, really no other options.  I went to the ER because…It was 10:00 on a Saturday night, I mean, if I hadn’t been so stubborn and gone to the dentist earlier in the week, but I figured the pain would just eventually go away and it didn’t.  At night it is the only alternative. Yeah. I have three teenagers. You really think they keep normal hours? {laughs}  I saw that there’s an urgent care down on Meadow (Ithaca Group), but I don’t know – I haven’t ever been there.  (I go to the ER…) ‘Cause you can’t get turned away. You can’t get denied care. They will eventually have to see you.  I just use home remedies. If I’m having – My second step is usually I’m gonna have to go to the emergency room to get an antibiotic. I’m waiting three weeks. I’m giving it three weeks to the point where it’s just not gonna work. Can’t afford to go anywhere but the ER.  I tried to go to Guthrie. You have to be a patient at Guthrie. You have to have a doctor over there. A lot of doctors in Guthrie aren’t accepting (Medicaid patients)– Like oh my gosh, I have a sore throat. I feel like I’m gonna die.  Pure laziness, because they don’t want to take them(selves) during the day or through the hours. They think, “Awe, its easier – let’s go to the ER instead.” Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 3 from DSRIP Activities

Participants reported that many times when they called their primary care office before seeking care, they were told to go to the emergency room, even though they knew their condition was not life threatening. Participants indicated that often it was after hours, or they could not get a same-day appointment or they simply got the answering service for their physician. Many participants acknowledged that they were aware they could have gone to a physician, urgent care, walk-in for care but they wanted immediate medical attention and believed that the ER would give them that. In each focus group we asked participants what percentage of people in the ER were there with a non-life threatening condition. The majority of participants said that most were there with non-life threatening conditions. On average, people felt that 75% to 90% of the participants in the ER had non-life threatening conditions.

Selected Comments

 We kind of agreed that we think 80 percent of the time people in the ER don’t probably need to be there.  I believe people need to be educated on that. What constitutes as an emergency and what constitutes as a non-emergency.  (The doctor) Did not listen to me one single bit.  Prefer to go to the one (PCP) that knows the whole deal.  Some of the copays are a little pricey, especially like me, I don’t have a job right now. I’m in the middle of looking for a job. Like if I was going to the doctor I’d have a $75.00 copay. The ER is free.  A lot of them(physician office hours) are like 8:00 to 4:00 or 8:00 to 4:30. My fiancé works 6:00 to 6:00. I work nightshift so I try to sleep during the day, but a lot of times the only time I can go to a doctor was during those hours.  I tried to go to the “free clinic.” I was turned away ‘cause I had insurance (Medicaid). They told me to go to the ER.  I have a specialist that I see. They say when it gets bad enough, “Go to the hospital (ER).” So I go there.  It was the middle of the night, so I knew the doctor’s office wasn’t open, and they’re just gonna tell you to go there anyway because they’re not open, so I went to he ER.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 4 from DSRIP Activities

The responsibility for one's health rests primarily with that individual. Participants said that each individual has the responsibility to stay healthy, but that this is not easy to do. Society is skewed toward unhealthiness, from fast food, to television, to high cost fitness memberships. The participants acknowledged responsibility, but took minimal accountability to be healthy. Many acknowledged that they can’t always stay focused on being healthy. Barriers include time, costs, and entrenched bad habits.

Selected Comments  Ourselves. Or if we're parents and it’s a child, then it’s us, still.  Because ain’t nobody else gonna give a damn.  A constant struggle, you know, this back and forth about eating well, eating right, doing what feels good, or what tastes good—or what’s good for me or what tastes good.  My family keeps me going.  Having somebody to talk to, somebody that you can trust to talk to.  I use Facebook groups a lot, especially for the stuff that’s wrong with me and my fiancé and stuff. I use Facebook groups.  I tried using an online application – Logging into My Fitness Pal. It just became too much.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 5 from DSRIP Activities

Participants perceived that their Medicaid health insurance coverage meant that they were getting "lower quality" care and had more difficulty accessing providers than others (with the exception of the uninsured). They said that participating physicians were limited, particularly in specialty care areas. They feel that they see mid-level providers more frequently than others, and really want to see the doctor. The visit with the doctor is often rushed. The majority of participants felt that the doctor was trying to get them out the door and the doctor doesn't really listen to them. Moreover, the physician was quick to treat with medications rather than other approaches. Selected Comments

 You call, and they say, "No. We don't accept that (Medicaid). Sorry.”  I do think there's plenty of healthcare services, but it's just the insurance – a lot of them don't take Medicaid.  They need more specialists and providers to accept Medicaid and people without insurance.  Sometimes if you go to the emergency room for something, they'll say, "We're not a full something hospital." It makes you feel like they don't care about your health or whatever.  I don't know if there's more, but they just don't get the treatment. People with the insurance can go to the doctor and they can get the treatment and manage their chronic diseases.  It’s a health clinic, not a walk-in clinic. That’s across the street.  I will not see a Cortland doctor. I had one several years ago that nearly kill me.  Dental stuff. I know I had to go—where in the heck was that? Oh, I don't know, at least an hour and a half away to go see a dentist.  I called my primary care and they said “Oh, we can’t get you in for four weeks.”  So then, any time you're really sick or really need to see a doctor, you end up going over to Cayuga Medical, it’s a walk-in place. I'm sitting there waiting three hours, sitting there, you know? I went in, and he goes, “Well, you're already on a water pill. There’s nothing we can do for you.”  I had a doctor tell me everything was in my head years ago, switched to a doctor in Ithaca who ran my blood and said, “Oh my God; how are you even walking?” My B12 level was below 50; it should've been 250 or above.  I think there’s a really high demand in this area for mental health services.  I’ve noticed from being on regular insurance, having my own insurance, then being on Medicaid, you get treated 10 times differently than – you’re not believed if you’re on Medicaid.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 6 from DSRIP Activities

The vast majority of the participants were very supportive of any initiatives that sought to improve access and increase health care services in hopes of decreasing inappropriate ER usage. They stated that there needs to be more health care resources available to them (particularly local resources), better communication and coordination amongst providers, and more access to non-life threatening services. They supported promoting health education regarding where to go for appropriate health care services. They also like the idea of having a navigator to help them with understanding where to go for care.

Selected Comments

 Sometimes it takes five business days for the doctor’s office to get back to the pharmacy.  I thought food pantries (would be a good idea). And pharmacies and whatever , they give flu shots now, that’s not old, that’s kinda new. So I mean, that just seems like a natural progression.  I don't think there’s very good education for—like, health education in general, people don’t know the availability.  Honestly, I think from my own experience more information could be put out there as far as Medicaid. I have had Medicaid for like four years and had no idea that I had Medicaid transportation available to me.  Put a free clinic in this County with extended hours. In the free clinic that I go to, its only open Monday and Thursday evenings between 4:30 and 7:30.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 7 from DSRIP Activities

The actual or perceived lack of access and available physicians, dentists and mental health providers throughout the community was identified as a major reason why the participants go directly to the emergency room for care. Many indicated that they are unaware of which providers within the community will see them when they feel the need to be seen. Individuals stated that they did not know where to go to find resources or if they found a provider, they could not get the healthcare provider to see them within the timeframe that they wanted to be seen. Some also liked the fact the ER has everything under one roof.

Selected Comments  An alternative to an ER needs to be open 24/7.  I think my daughter, my grandchildren, they definitely need more mental health (providers).  I tried to get her in with her primary, but he wasn't available, and the appointment that they gave me was at 3:30 in the afternoon. This was 8:00 in the morning.  No, I think that my primary care would've been the most appropriate place to go, but the availability for me to get in there wasn’t there. It would've been two weeks for me to get into my primary care  Would like a 24 hour clinic that you could go to for things that aren’t necessarily an emergency, but something that you need to be seen for .  They should expand Convenient Care hours to 24 hours a day. I think Convenient Care hours are limited (currently).  Maybe they could have a clinic right at the ER so you don’t go to the ER. You go right to the clinic right there at the same property.  I’m not sure of options for after-hours care. I could drive all the way to Elmira to urgent care, But I still think they close at 7:00 PM. Ithaca is more than 20 miles away. So for me to go to Elmira or Ithaca, its probably a good 45 minutes to an hour. The ER is open 24/7.  The ER gives you a lot of services. You have your lab there, your X-rays there. You have everything – all the services right in that one building. Whereas if you go to your primary care, he’s gonna say I need lab work, go there, I need an Xray, go there.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 8 from DSRIP Activities

Participants wanted a reliable resource (an individual) to help them access providers and direct them where they could/should go to receive appropriate care. When discussed they all embraced the idea of going to the emergency room and then being directed to an urgent care clinic "down the hall" if it meant faster, more appropriate care. They also thought that a nurse help line would be well utilized. Participants indicated that at they do not really know how to navigate the healthcare system on their own and often wait until their situation becomes critical (in their minds) to receive care. Very few of the participants were aware of the 2-1-1 telephone line assistance.

Selected Comments  They should have some kind of fast track program, like when you come in there with a non-emergency, you go to a different spot – your fast tracked.  It’ll be faster than the ER  The ER won’t be the best option because they’re gonna have – they’re gonna get hit by a staff shortage.  Moderator: So one of the other things you’re saying is just give them more knowledge? Participant: Right. Giving alternatives to people.  Like we understand you’re sick and you don’t feel good but this is for emergencies and let me direct you to the closest place that can help you, ‘cause we only deal with life and death issues.  Like somebody with a cold that really doesn’t seem to have really bad symptoms.  Go into triage, and they screen you and decide whether you're an emergency or if you're a Prompt Care person. They're pretty good about that.  Have a hotline to call. If they wonder whether or not they should be going to the emergency room, call a hotline.  So maybe when people show up to the emergency room with a non-life threatening illness somebody like a representative, could be there and say “Oh, I see you have a rash. Let me schedule you an appointment with so-and-so and do it right now right here while you’re here. Can you see Dr. Smith tomorrow?” So that way that person feels taken care of, but they’re not using emergency resources.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 9 from DSRIP Activities

Most participants indicated that they don’t do well or find it difficult in planning scheduled healthcare visits and following preventive activities, unless it was for their children. A number of barriers to engagement were identified. They stated that their lives are too busy, scheduling transportation, or having available copay dollars are all deterrents to being compliant and healthy. Due to transportation issues and not being able to pay the copay, patients try to treat their healthcare symptoms at home, however when these become severe they head to the emergency room because they now need immediate relief.

Selected Comments

 For a fever, certain things that you can’t really take care of yourself at home. That’s when I need to talk with someone or go the Internet.  Send stuff home with the kids, you know, from school. A pamphlet in the mail with what’s available and different examples of reasons to go.  Well, I think the physicians could maybe explain better. I don't think people always finish their medications or—they don’t understand fully what the situation is.  Okay, Bassett has I think a – its not like an urgent care thing, it’s more like by an appointment, where Fox Care is an actual urgent care walk-in. They’re trying to get people to utilize that, but guess what? If I don’t have transportation, I can call an ambulance and I can go to the emergency room. I’ll get a slap for this (using an ambulance) but…  I use the services from Cornell Cooperative Extension and they have a lot of food programs there where you can buy from local farmers and they have groups – and they accept food stamps.  My mom (also on Medicaid) has emphysema and her doctor has told her to do this lung rehab program, but its all the way in Cortland. We can’t do that.  They should remind me of my appointment. Call or send me a text.  I work every day. I can’t get to the doctor during the day. There’s nothing available at night.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 10 from DSRIP Activities

Many participants indicated that they do not like walk-in clinics because they do not always see a physician for their medical visit and the (walk- in) clinic hours typically are not convenient for them. Participants recounted stories regarding having to try and coordinate transportation to go to a clinic. They stated that transportation is difficult, unreliable and inconvenient. It was also reported that it is difficult to obtain appointments that are convenient. Some participants reported that they are happy with receiving their healthcare at a walk-in clinic. They stated that they preferred this venue to the emergency room. Some key clinics touted include Lourdes (Owego); Guthrie (Ithaca); Fox Care –Bassett (Delhi).

Selected Comments

 “Well I have an NP. I haven’t had a regular physician – I want a regular physician, you know.”  “At the walk-ins there is mid-levels – there’s not physicians really that I’m aware of, the one I go to.”  The incompetence. It’s just like how they treat you and they just aren’t open to even learning about other things.  Well, I get into my primary , but it takes a long time. I don’t normally go to the doctor unless I’m sick or have something pressing. But then when I am feeling that way and I feel like I haven’t been there in six months and I’m calling because I don’t want--- I really need to go. They’re going to tell me to wait a week. Then I’m upset.  I want to be able to know that if I am sick, I want to get in tomorrow. You know, if not today.  Now the walk-in clinic that’s on Water Street, if they took Medicaid, which they don’t do or are closed to new Medicaid, they’d see less people at the ER because non-emergent care. They have an X-ray machine, they have everything that they need.  Why are they still going to the ED? ‘Cause you call for an appointment and they constantly say, “we have none available.” So what’s your option?  Accessibility is a problem (at walk in clinics) getting to actually see the doctor. Getting someone to listen to you.  I would definitely use it (a walk-in clinic) 100 times over from – more of us, my kids and my grandkids, if they took Medicaid. I would never go back to the emergency room. They do take Medicaid in North Carolina, but not up here.  Well it comes back to the waiting list or not taking new patients. What’s the deal with that?

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 11 from DSRIP Activities

Communications between physicians and other healthcare providers is not streamlined and does not always go well. Several participants felt that the medical community does not talk with each other. This was particularly true with regard to mental health and the use of pharmaceuticals. Participants expressed concern that physicians order medications and do not always know what else a patient is on and things might interact. There was minimal familiarity with the electronic medical and/or health record concept (EMR/EHR). Participants did not always understand that this could mean streamlined communications, however some did. Several participants were nervous and expressed concerns about privacy with regard to the medical record. They were nervous about keeping the information secure and protected.

Selected Comments

 “(what our healthcare)…doesn’t have and that’s doctors talking to other doctors.”  The doctors do not communicate. Pretty much with me they’ll refer me and they’ll write a note why they referred me and then its up to me to try and backtrack and explain everything that has been going on. And then it’s up to that doctor to believe what I’m saying or not.  Well, so that all the ---all the facilities, there’s gotta be some kind of a system where they can all communicate – where your medical records are accessible no matter where they are. Now, I know a lot of people are afraid of a system like that because if your medical records are accessible anywhere, then you don’t know who might be tapping into ‘em that you don’t want tapping ‘em. But from a medical standpoint, I think accessibility to the patient record is critical.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 12: CommunityTheme Feedback 12 from DSRIP Activities

Cost is a significant driver for participants, determining where they decide to go for care. Many participants indicated that they look to use free clinics or ERs because there is no up-front out of pocket costs. Participants also stated they use a number of sources to find healthcare locations including: on-line, word of mouth, family and friends and provider recommendations. In all of the groups, several participants indicated that they regularly use the web to explore healthcare topics and visit sites such as WebMD and participate in social network groups.

Selected Comments

 I went to the free clinic. I don’t have any insurance, and my husband was taken off his [insurance].  I look online a lot.  Word of mouth.  Daughter, family, friends.  I don’t go to urgent care because, you have to pay $95 just to be seen, like up front.  Bottom line, cost is most important in deciding where to go. What you’re gonna have to pay out of pocket. If you have a co-pay and stuff, then there are some places that are higher than others.  It comes down to money, I guess.  If there is an urgent care center that charges $90 up front 10 minutes away at 11:00 PM and a hospital ER 10 minutes away that charges nothing up-front, I will always choose the ER.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy

Implementation Strategy Narrative Overview Lourdes’ Community Health Needs Assessment/ Community Health Improvement Plan/ Implementation Strategy (CHNA/CHIP/IS) is a stepped process. The associated time frames are listed below: 1. Identification of community health status themes, September 2015- May 2016. 2. Community health status prioritization, May-July 2016. Phase 1 CHNA completed and approved by Our Lady of Lourdes Memorial Hospital’s Board of Directors. 3. Development of Community Health Improvement Plan and Implementation Strategy, July-August 2016; 4. Lourdes Board of Directors approval of CHIP/IS, September 2016. 5. Submission of CHNA/CHIP/IS to the New York State Department of Health, December 30, 2016.

Due to differences in sequencing CHNA and CHIP/IS requests by Ascension Health, the New York State Department of Health, and the Broome County Health Department, the Lourdes CHNA/CHIP/IS may be updated prior to the NYS Department of Health submission deadline of December 30, 2016.

Lourdes’ CHNA, comprised of quantitative and qualitative analysis conducted by Research & Marketing Strategies, Inc. (RMS), serves as a guide for Our Lady of Lourdes Memorial Hospital in addressing community health status from 2016-2018. The plan is a comprehensive assessment of the community’s health needs and Lourdes’ response to community public health priorities. The quantitative research included review of NYSDOH data, Broome County Health Outcomes/Health Rankings data, and prior Broome County Health Department and Lourdes community health priorities. The qualitative work included: In-depth interviews (IDI’s) with community stakeholders as well as review of focus group results from Medicaid and the uninsured population segments, and the venues of public participation mentioned below. This data had statistical sampling significance.

Lourdes recognizes that Public Participation is an important aspect of the CHNA and CHIP/IS process. Hi-lights of the public input process include:

 The Broome County Community Health Assessment steering committee.  In-depth interviews with community stakeholders • 12 community stakeholders were involved in the process,  Online survey administered (more than 800) to area groups as part of the DSRIP research • healthcare clinical providers as part of the DSRIP research; • non-clinical providers • community organizations • community residents  Focus group research (2 focus groups representing 24 participants) conducted among the Medicaid recipients in Broome County.

Additional resources used by Lourdes to gather input from the public on and ongoing basis include: Lourdes Patient and Family Advisory Council, on-going feedback through participation in National, New York State, Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 1 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy Regional, County, local community coalitions and agencies; patient and physician satisfaction surveys, Care Compass Network on-line DSRIP Panel; and Lourdes Associates .

Prioritized Needs Our Lady of Lourdes Memorial Hospital’s Board of Directors preliminarily approved the Lourdes 2016-2018 community health priorities at the May 20, 2016 Board meeting and final community health priorities at the September 15th board meeting. The community health priorities on which Lourdes will focus during 2016-2018 are:

1) Obesity: Chronic Disease and Prevention & Wellness 2) Behavioral Health: Mental Health and Substance Use 3) Disparate population: The socioeconomic poor and vulnerable.

Needs That Will Not Be Addressed Twenty health need theme areas were identified collapsed in to six categories consistent with New York State Health Department guidance. Health theme areas which are not addressed through the Lourdes Community Health Improvement Plan/Implementation Strategy are themes which are being addressed operationally, through other venues/community organizations, or received low rankings based on a prioritization process which addressed barriers to success, degree of impact, and critical resources.

Lourdes will not be including Falls Prevention as a community health priority in 2016-2018 as the strategies associated with this community health issues have been/will continue to be operationalized.

Summary of Implementation Strategy It is expected that the 2016-2018 Community Health Improvement Plan and Implementation Strategy listed below will continue to evolve based on changes in community health status.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 2 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy

Prioritized Need #1: Obesity: Wellness, Prevention & Chronic Disease

Goal: Lower barriers to healthy life style habits.

Action Plan: Priority Need #1: Prevention & Wellness and Obesity Chronic Disease

STRATEGY 1: Ensure Lourdes clinical practices use evidenced based strategies such as a “5210 Be A Healthy Hero”-like program to improve health life style habits and the practitioner population management, adherence to evidenced based treatment guidelines, and the adoption of practices that will improve patient self-efficacy and confidence in self-management.

The Be a Healthy Hero program is designed to daily improve nutrition (5 fruits and vegetables), reduce recreational screen time (2 hours or less), increase physical activity (at least one hour of exercise or play), and no sugary drinks.

BACKGROUND INFORMATION:  Target population: Initially, Lourdes associates, then expanding to Lourdes Network patients, and the community at large. The disparate population that Lourdes will outreach to are Medicaid patients attributed to Lourdes.  Social Determinants of Health which will be addressed: Barriers for low income (Medicaid) patients with cardiovascular disease.  Strategy source: 1) Sutter Heatlh Palo Alto Medical Foundation Nutrition and Fitness Program, “5210 Be A Healthy Hero”: http://www.pamf.org/ynp/5210 2) NYS Department of Health DSRIP Tool Kit, approved metrics which are taken from the Million Hearts Campaign strategies found at http://millionhearts.hhs.gov 3) NYS Department of Health DSRIP Tool Kit, approved metrics which are taken from the Million Hearts Campaign strategies found at http://millionhearts.hhs.gov 4) Approved clinical protocols by the Care Compass Network Clinical Governance and Quality Committee. 5) (Other evidenced base sources per Our Lady of Lourdes Memorial Hospital Inc’s and the Broome County Health Department’s 2013-2017 CHNA/CHIP: 6) http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf 7) http://www.cdc.gov/nccdphp/dnpao/ 8) http://www.thecommunityguide.org/index.html 9) http://www.ama-assn.org/ama1/pub/upload/mm/433/ped_obesity_recs.pdf 10) http://www.uspreventiveservicestaskforce.org/uspstf/uspschobes.htm 11) http://www.aap.org/obesity/index.html 12) NYS Information for Action # 2013-8 13) The Community Guide Cardiovascular Disease Prevention and Control: Clinical Decision-Support Systems (CDSS) 14) The Community Guide Cardiovascular Disease Prevention: Team-Based Care to Improve Blood Pressure Control 15) https://www.cdc.gov/obesity/adult/defining.html

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 3 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy STRATEGY 1: Ensure Lourdes clinical practices use evidenced based strategies such as a “5210 Be A Healthy Hero”-like program to improve health life style habits and the practitioner population management, adherence to evidenced based treatment guidelines, and the adoption of practices that will improve patient self-efficacy and confidence in self-management.

The Be a Healthy Hero program is designed to daily improve nutrition (5 fruits and vegetables), reduce recreational screen time (2 hours or less), increase physical activity (at least one hour of exercise or play), and no sugary drinks. RESOURCES: Hospital (H), NYSDOH, Community Based Organizations (CBO), Care Compass Network (CCN), National best practice org (NBPO)staff, budget

COLLABORATION: Care Compass Network providers and stakeholders (over 135 agencies which include, providers, Broome County Health Department, Catholic Charities, Rural Health Network, Mothers and Babies Perinatal Network, and physician groups (hospitalists, emergency room providers, primary care and obesity specialist providers), University of Rochester,5210).

ACTIONS: 1. By end of FY 2017 Q2, identify an implementation plan which will address standardization of tools: 1) Evidenced Based Strategies: a) Standardized approach to measuring BMI (appropriate scales, HT /WT measurement) b) Ensure Lourdes clinical practices use evidenced based strategies to improve the prevention and management of obesity by improving practitioner adherence to evidenced based guidelines and the adoptions of practices that will improve patient self-efficacy and confidence in self-management. c) Provider education: Behavioral/ Motivational interviewing skills; how to engage patients 2) Lowering financial barriers to food and exercise 3) Nutrition: Food insecurity, cooking classes, linkage to community resources (CHOW), 4) Performance enhancement/ exercise 5) Social determinants: transportation, housing etc. 6) Community resource guide/ navigation 2. By the end of FY 2017 Q2, identify how the 5210 program will be modified for adults and rolled out to Lourdes associates. 3. By the end of FY 2017 Q4, identify how the 5210 program will be provided to Lourdes Network patient and the community at large.

ANTICIPATED IMPACT: Diminished BMI or maintenance of current healthy BMI will be achieved by targeted groups, with the percentage of the target populations to be determined based on baseline metrics.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 4 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy

STRATEGY 2: By 2017 Lourdes will move towards becoming a Baby Friendly Hospital.

BACKGROUND INFORMATION:  Target population: Women delivering newborns at Our Lady of Lourdes Memorial Hospital, Inc. who are eligible to breastfeed.  Social Determinants of Health which will be addressed: low income (Medicaid), transportation, nutrition.  Strategy source: 1) The strategy is informed by the Broome County and NYS Departments of Health; and Ascension Health’s “Baby Friendly Hospital” 2017 initiative. 2) Evidenced base sources per Our Lady of Lourdes Memorial Hospital Inc’s and the Broome County Health Department’s 2013-2017 CHNA/CHIP: http://www.surgeongeneral.gov/library/calls/breastfeeding/index.html http://www.health.ny.gov/prevention/nutrition/wic/breastfeeding/ http://www.health.ny.gov/prevention/obesity/preventing_childhood_obesity.htm https://www.babyfriendlyusa.org/ RESOURCES: Hospital (H), Community Based Organizations (CBO), staff, budget, providers (P),National best practice org (NBPO), New York State Perinatal Association (NYSPA), Baby Friendly USA (BFUSA) COLLABORATION: ACTIONS: 1. Develop plan to become a Baby Friendly hospital a) LOI submitted to BFUSA Q4, 2015 2. Complete 4 phase application process (each phase, avg, 1 year) b) Phase 1: Disclosure c) Phase 2: Development d) Phase 3: Dissemination e) Phase 4: Designation 3. Develop breastfeeding assessment tool for 3, 6, 9 months.

ANTICIPATED IMPACT: 1. By 2018 Q1, Lourdes will make progress toward designation as a baby friendly hospital with 75% of targeted employed providers adopting breastfeeding policies. 2. By 2018 Q1, Lourdes will develop a template to capture timely breast feeding data for initiation and sustainment of breastfeeding which will be used by 75% of the targeted employed providers/practices.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 5 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy

Alignment with Local, State & National Priorities): Long-Term Outcomes for Priority Area#1 Obesity

LOCAL / “HEALTHY PEOPLE 2020” COMMUNITY PLAN: STATE PLAN: (or OTHER NATIONAL PLAN):

By 2020 Q4 100% Lourdes By 2020 Q4 25% reduction in targeted practice sites will PAA, PAR, AER visits for the implement per contract STRIPPS PPS (Care Compass and achieve metrics of an Network) aggregate 25% reduction in PAA, PAR, AER visits

Preventing Chronic Disease Preventing Chronic Disease Prevent Chronic Diseases 1. Focus Area 3: Increase access to high quality chronic disease preventative care and management in both clinical and community settings. a) Goal #1: Increase screening rates for CVD, diabetes, and breast/cervical/colore ctal cancer, especially among disparate populations. b) Goal #2: promote the use of evidence-based care to manage chronic disease c) Goal #3: Promote culturally relevant chronic disease self- management education.

Broome County Health 1. Preventing Chronic HP 2020 Goals: Department 2013-2017 Disease (obesity); 1. At least 70% exclusive CHIP: Preventing Chronic 2. Improving Maternal / Child breast milk; Disease Health (Focus area #1: 2. 82% of hospitals any Focus area: reducing Maternal & Infant Health; breast milk.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 6 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy

LOCAL / “HEALTHY PEOPLE 2020” COMMUNITY PLAN: STATE PLAN: (or OTHER NATIONAL PLAN):

obesity in children & adults Goal: Increase the 3. % of healthy infants also Goal to increase the proportion of babies who being fed formula in the proportion of babies who are breastfed) hospital at <14% are breastfed.

Prioritized Need #2: Behavioral Health – Mental Health and Substance Use GOAL: Lower barriers to mental health and substance use services.

Action Plan: Behavioral Health

STRATEGY 1: Expand access to mental health/behavioral health services by integrating behavioral health into primary care and throughout the Lourdes and community continuum of care: 1) to identify behavioral health diagnosis early, allowing rapid treatment; 2) to ensure treatment of medical and behavioral health conditions are compatible and do not cause adverse effects, 3) De-stigmatize behavioral health diagnosis.

BACKGROUND INFORMATION:  Target population: Patients (ages 18-64 with a Patient Health Questionnaire (PHQ)-9 score of 10 and above) at Lourdes primary care locations that have behavioral health integrated in to primary care.  Social determinants of health/ health disparities which may be addressed: Medicaid patients who are attributed as a Lourdes Medicaid patient; transportation, prescription costs; issues impacting ability for the beneficiary to engage in their care plan.  Strategy source: 1) NYS Department of Health DSRIP Tool Kit, approved metrics which are taken from Project 3.a.i, Integration of Behavioral Health into Primary care. Resources from http://www.integration.samhsa.gov/integrated-care-models. Model 1 selected. 2) Approved clinical protocols by the Care Compass Network Clinical Governance and Quality Committee. Approved screening tools: Behavioral health works, CAGE-AID, GAD-7, PHQ-9, Suicide/Violence, PC-PTSD 3) PCMH 2014 Level 3 standards

RESOURCES: Hospital (H), Community Based Organizations (CBO), staff, budget

COLLABORATION: Care Compass Network providers and stakeholders (over 135 agencies which include, providers, Broome County

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 7 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy STRATEGY 1: Expand access to mental health/behavioral health services by integrating behavioral health into primary care and throughout the Lourdes and community continuum of care: 1) to identify behavioral health diagnosis early, allowing rapid treatment; 2) to ensure treatment of medical and behavioral health conditions are compatible and do not cause adverse effects, 3) De-stigmatize behavioral health diagnosis.

Health Department, Catholic Charities, Rural Health Network, Mothers and Babies Perinatal Network, and physician groups (hospitalists, emergency room providers, and primary care and specialty providers).

ACTIONS: 1) By the end FY 2017 Q1 complete the behavioral health integration in to primary care at the Lourdes Robinson Street practice location. 2) By FY 2017 Q2, expand screening criteria for Lourdes practices that integrate behavioral health into primary car to screen persons ages 18-64 with a Patient Health Questionnaire (PHQ)-9 score of 10 and above. Identify Network primary care sites to implement interventions and begin implementation. 3) By the end of FY 2017 Q2, execute Appendix C contract for 4aiii (behavioral health infrastructure) 4) By end of FY 2017 Q3, develop an implementation plan supportive of integration of: 1. Evidenced based recovery and the medical model 2. A uniformed approach to provider education and patient education 3. The development of tools to engage patients. 4. Addressing social determinants with an emphasis on transportation. 5) By FY 2017 Q4 file certificate of needs for integrated licenses (NYSDOH & Office of Mental Health) Lourdes Network primary care sites & an integrated OMH/OASAS (MH and substance use) license.

ANTICIPATED IMPACT: 1. By 9/30/16 Lourdes will complete pilot site for integrating BH into primary care at the Robinson Street practice and continue with the implementation, achieving a pilot metrics. 2. By FY 2017 Q 4, in Lourdes primary care practices that have integrated behavioral health in to primary care: a) 25% of patients ages 18-64 with a PHQ-9 score of 10 and above will be engaged with a behavioral health consultant (BHC). b) 100% or providers will complete a pre and post-test on evidenced based protocols and 50% achieving an increased knowledge. 3. By FY 2017 Q4, Lourdes will implement 3ai into 2 additional primary care practices, pending budget approval, achieving metrics in II above. 4. By FY 2017 Q4 Lourdes will submit to the NYSDOH, CON applications for integrated BH-Primary Care licenses and one OMH-OASAS integrated license for MH-adolescent substance use disorders. 5. By April 2020, avoidable ER visits with a behavioral health diagnosis for Medicaid beneficiaries attributed to

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 8 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy STRATEGY 1: Expand access to mental health/behavioral health services by integrating behavioral health into primary care and throughout the Lourdes and community continuum of care: 1) to identify behavioral health diagnosis early, allowing rapid treatment; 2) to ensure treatment of medical and behavioral health conditions are compatible and do not cause adverse effects, 3) De-stigmatize behavioral health diagnosis.

Lourdes will decrease by 25%.

Alignment with Local, State & National Priorities Long-Term Outcomes for Priority #2 Behavioral Health- Mental Health & Substance Use

LOCAL / “HEALTHY PEOPLE 2020” COMMUNITY PLAN: STATE PLAN: (or OTHER NATIONAL PLAN):

By FY 2018 Q4: By 2020 Q4 25% reduction in PAA, PAR, AER visits for the 100% Lourdes targeted STRIPPS PPS (Care Compass practice sites will integrate Network) behavioral health in to primary care and achieve metrics.

By end of DSRIP Year 5 (2020), Lourdes primary care sites which have integrated behavioral health will see a 25% reduction in avoidable ER visits for attributed Medicaid beneficiaries with an avoidable behavioral health diagnosis.

100% (14) of submitted CONs approved by FY 2018.

2016-2018 Local Promote Mental Health & Mental Health & Mental community health plans is Prevent Substance Abuse: Disorders currently in process of 1) Focus Area 2: Prevent being updated. Behavioral substance use and other Substance Abuse health has been selected a mental emotional priority area though behavioral disorders. implementation strategies a) Goal 2: Prevent and have not been finalized. reduce occurrences of

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 9 Appendix 13 Our Lady of Lourdes Memorial Hospital, Inc. 2016-2018 Community Health Improvement Plan & Implementation Strategy

LOCAL / “HEALTHY PEOPLE 2020” COMMUNITY PLAN: STATE PLAN: (or OTHER NATIONAL PLAN):

mental, emotional, and behavioral disorders among youth and adults. b) Goal 3: Prevent suicides among youth and adults. 2) Focus Area 3: Strengthen Infrastructure across systems. a) Goal 1: Support collaboration among professionals working in fields of mental, emotional, and behavioral health promotion and chronic disease prevention, treatment and recovery. b) Goal 2: Strengthen infrastructure for mental, emotional, and behavioral health promotion, and mental, emotional and behavioral disorder prevention.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment 10 HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.

2015 Community Service Plan

169 Riverside Drive • Binghamton, NY • 607-798-5111 MESSAGE from the CEO

Dear Friends, 2015 was a year of reflection as Lourdes addressing community health priorities. We took many celebrated 90 years of service. The four steps to address the mental health crisis in our community Daughters of Charity and lay men who by expanding mental health services, hiring additional founded Lourdes in October of 1925 mental health providers, providing suicide intervention could not have envisioned what Lourdes skills training for caregivers, hosting community naloxone would have become over the next 90 trainings to combat the effects of opioid overdose, and years and how many people in this beginning a support group for people who have lost a community would benefit from the care loved one from an overdose. and compassion that was evident on that October day. Our strength is in our history and Mission. It Lourdes holds a deep commitment to increase Veterans’ is our honor to continue their legacy to live in the present access to compassionate, high quality health care. As and engage our future. such, Lourdes Hospice was recognized as a “We Honor Veterans Partner” and in 2016, Lourdes and Ascension Living in the Present. Providing community benefit Health will nationally be accepting the Veterans Choice continues to be an important part of our Mission. It Card, which will allow us to provide services for eligible represents a vital link to our community & neighbors. Veterans outside of the VA. As a leading health care provider, each year we provide To address the falls prevention health priority, Lourdes millions of dollars in charity care & health education associates were certified as Tai Chi instructors and programs to our community. Lourdes is pleased to report provided two 8 week series of classes. Beginner, advanced, to the community the services provided directly or in and seated Tai Chi classes will be available in 2016. collaboration with community agencies during 2015. Lourdes also certified 100% of Lourdes at Home physical These services addressed the community’s health status therapists in a falls prevention program; and focused on priorities of obesity and associated chronic diseases, falls falls prevention as part of Medicare wellness visits. prevention among the elderly, and mental health and substance use. True to our Mission, Lourdes paid particular Beyond the walls of Lourdes, our associates extended attention to those who are poor and vulnerable. our ministry into the community by serving on community boards, participating in community awareness events, In order to improve the health status of the community, providing supplies to elementary schools and participating Lourdes continues to take seriously our stewardship to in food drives. I express my heart felt gratitude to them for provide access and coverage to quality health care living our Mission. services. Increasing access is in large part about removing barriers. One way in which Lourdes accomplished this Lourdes continued to be an active participant in was to take care out into the community in a very different transforming the Medicaid health care delivery system way. We provided our first “Medical Mission at Home” in by working with more than 150 partner organizations. downtown Binghamton where more than 200 persons of Lourdes associates are committed to participate in all ages received free medical care. transformative work to manage our community’s health. Removing financial barriers to care helps provide access to Engaging Our Future. The healthcare needs in our care. These barriers were removed through the efforts of our region continue to grow. To address these changes, we financial counselors, the Hope Dispensary and our charity are transitioning our care model to support managing care policies. This year alone, over 10,000 people were populations of patients. We look forward to continuing to enrolled in Lourdes’ financial assistance program; those partner with the community. Our relationships inspire us who received assistance enrolling in an insurance plan and make our community a stronger, healthier place to live. through the Affordable Care Act increased 30%; and over We invite you to join us as we continue to participate in $961,000 in prescriptions were given to people who would furthering the healing ministry to which we’ve been called. not have been able to receive prescriptions otherwise. This year access to primary and specialty care was expanded through hiring or recruiting to the community Kathryn Connerton twenty-three providers, of which all are critical to President/CEO

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Priorities for the Year

During 2015, Lourdes collaborated with community In addition to these community priorities, Lourdes agencies under the direction of the New York State remains committed to addressing community needs Health Department and County Health Departments in the areas of access to health care by increasing to identify and address public health issues that access to health care coverage and prescription drug and underlying causes and contributing factors to medication, cardiovascular disease, maternal/child/ health status and chronic disease. This report to the adolescent Health and the frail & elderly. Community Community demonstrates how Lourdes has continued and professional outreach and education initiatives to work over the last year to help the Greater were designed to address health priorities. Lourdes will Binghamton community in the following community be updating community health priorities during 2016. health priority areas: Community Health Priorities The following chart provides an overview of some of the programs and services Lourdes offers that impact • Falls Prevention with a focus on helping the elderly. the community’s health status. More information about these programs is available on our website • Access to mental health and substance abuse at www.LOURDES.com. • Obesity prevention and managing associated chronic diseases with a focus on diabetes and reducing hospitalizations due to heart failure.

PROGRAM PERSONS SERVED

Access To Healthcare

Pharmaceutical Access Hope Dispensary 1,212 persons receiving over 1,543 prescriptions, a $332,375 value Pharmacy Assistance Program 311 persons receiving over 420 prescriptions, a $629,286 value

Patient Financial Assistance Program 7,598 enrolled, a 4% increase from last year

Discounted self-pay accounts 11,520

Facilitated Healthcare Coverage Enrollment 1,218 screened with 91% enrolled in a health coverage program. 922 screened for Qualified Health Plans with 85% being enrolled in Medicaid or a QHP.

LECCO – Total Donations 8 Community Agencies which assist with access to $40,000 services and to persons in need

Mobile Mammography 1,729 served 1 Physician Referral Services/Call Center 3,000 persons served

(continued on next page)

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. PROGRAM PERSONS SERVED

Behavioral/Mental Health

Lourdes Center for Mental Health 13,011 visits, a 32% decrease, and over 920 clients

Mental Health Juvenile Justice Project (MHJJ) 64 clients served Detention Alternative After School Program (DAASP) 44 clients served Binghamton Community and Schools Together (BCAST) 169 clients served

Student Assistance Program (SAP) and Alcohol & Drug Persons served: 7,019 Education Prevention Team (ADEPT) Units of service: 3,316

Screening Brief Intervention & Referral to Treatment (SBIRT) 4 trainings, 31 associates

Death from Overdose Recovery & Support Group (DORS) 20 participants

Falls Prevention

Home Health Falls Risk Assessments Over 49,000 visits with falls risk assessments

Tai Chi for Arthritis 3 instructors trained, 20 participants, 16 classes

Frail & Elderly

Hospice 31,532 days of care Volunteers 110 volunteers provided 6,989 volunteer hours; Drove over 36,000 miles to assist patients and families

Palliative Care 2,651 consultations and visits

Maternal/Child/Adolescent Health

DeMarillac Prenatal Program 4,458 visits

DePaul Pediatric Program 10,358 visits

Center for Oral Health 4,778 patients and 14,097 visits Clinic 3,981 patients served and 12,419 visits Mobile Dental Van 486 patients and 1,248 visits Sealant Program 309 patients and 422 visits School Based Sites 18 sites

Community Outreach and Oral Health Education 1,815 persons served at 10 events

Parents And Children Together (PACT) 328 families and 4,021 home visits

2

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. PROGRAM PERSONS SERVED

Mission in Action (Community Outreach)

Community Awareness Events – Over $77,000 in donations Donations raised by Lourdes Associates and the Medical Staff (American Heart Association, American Cancer Society, March of Dimes, Rescue Mission and other events)

Obesity Prevention

Bariatric Services Over 380 procedures, a 28% increase 724 patients receiving 2,571 nutritional consults

Lourdes Primary Care Services Body Mass Index 84% children age 3–17 screened 83% adults age 18–64 screened 91% adults age 65+ screened

Preventing & Managing Chronic Disease

Cancer Breast Cancer Screening 28,984 Screenings 1,729 Mobile Mammography Radiation Therapy Over 6,322 Treatments

Cardiovascular Disease Community Screenings 300 T-Time Classes 72

Diabetes-Endocrinology 13,837 visits, an 11% increase

Home Health 49,339 visits

Infectious Disease/Pneumonia Influenza Vaccines 16,017 persons Over 2,100 health care workers

Women’s Health “Celebration of Women” outreach and education, 225 attended

3

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Overview of Programs & Services

COMMITMENT TO COMMUNITY Both events allowed for enrollment of more than HEALTH STATUS 100 individuals. • Medical Mission at Home. Lourdes provided our Access to Health Care first “Medical Mission at Home” in downtown Increased Health Care Coverage. Binghamton at a location easily accessible to those • Lourdes continues to make a significant impact on most in need. Nearly 200 associates and volunteers healthcare access and coverage to the uninsured by came together, ready to provide care. More than our complement of Financial Counselors that are 200 persons of all ages received free medical care at various locations throughout the hospital and including screenings, dental care, mammograms, offsite locations. All counselors are CAC’s (Certified foot and wound care, pharmacy services, and flu Application Counselors) through the New York shots. Financial counseling for the uninsured and State of Health Marketplace. All Financial underinsured was offered for financial assistance Counselors are able to assist individuals and and marketplace enrollment. Bags of fresh families in enrollment in the Affordable Care Act, vegetables and fruit were provided by CHOW ACA, plans, such as NYS Medicaid, Child Health and personal care items were given to all who Plus, Essential Plans, Qualified Health Plans, and participated. We anticipate offering two Medical the Lourdes Patient Financial Assistance Program. Mission’s at Home in 2016. • The number of persons enrolled in the Patient • Lourdes annual Diversity Fair focused on Financial Assistance program was 7,598, a 4% “Welcoming our New Neighbors.” The intent increase from 2014 to 2015. around the fair was to engage the multiple perspectives, human gifts, skills, experiences, and • Financial Counselors are available at 6 locations. A knowledge of our associates and the patients we full-time financial counselor was placed at Lourdes serve. Vestal a multi-specialty location providing primary care, walk in, specialty care and Retail Pharmacy Increased Access to Primary Care, Prevention and services. Specialty Services. The Financial Counselor team participated in • Lourdes assisted the community in ensuring 2 community enrollment events at 2 different access to primary and specialty care by employing locations, on weekends, with one event occurring at twenty-three providers specializing in cardiology, Lourdes’ first Medical Mission at Home in October, primary care, endocrinology, and vascular disease. and another enrollment at a Lourdes Primary Care All of the providers recruited are important to location that was easily accessible to the public. improving the community’s health status. • Lourdes Center for Mental Health has continued to expand with the need for mental health services in the community. We have implemented an EHR and added additional staff to better meet the needs of the community. The center served 920 clients in 2015. • The Lourdes Student Assistance Program (SAP) 4 and Alcohol and Drug Education Prevention Team (ADEPT) served 2,834 Lourdes associates and local community members on topics including Current Drug Trends, Adolescent Brain Development, Heroin and Prescription Drug, Gambling and Opioid Overdose Prevention.

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. • The Lourdes Detention Alternative After School Program (DAASP) provided services to 37 high risk youth during 2015. Of these youth, 94.5% were successfully kept out of non-secure detention facilities. The Lourdes DAASP program received additional funding from New York State Office of Children & Family Services (OCFS) to expand programming and add a family programming component to encourage continued success in keeping youth out of detention facilities. • Lourdes Youth Services program was selected as one of nine community agencies nationwide, to receive $325,000 per year in Federal funding to implement programming geared toward reducing violence, increasing school engagement and • Oral Health. In 2015 we doubled our capacity to performance, and improving health outcomes for provide oral health to meet the on-going needs of minority youth. This grant is a collaborative effort low income patients as well as to increase access to between the City of Binghamton, Broome-Tioga endodontic services. BOCES and Lourdes Youth Services. The BCAST (Binghamton Community and Schools Together) • Mobile Mammography. The Mission in Motion program serves 45 youth (and their families) mobile mammography provided screening annually. mammography in 64 locations. Of these locations, 22 are rural locations, where residents do not have • Lourdes continued to (1) offer suicide intervention ready access to public transportation to travel to training programs in 2015: ASIST and SAFE Talk receive breast cancer screening services. Services programs for associates; and the Kognito suicide are provided where residents live, work, and play. prevention training program for the medical staff; (2) lead a Lourdes specific Substance Abuse • Palliative Care and Hospice. Lourdes provides the and Mental Health Task Force to better address area’s only palliative care services, and is the only community mental health and substance abuse hospice provider for Broome and Tioga county needs; (3) administer suicide prevention screening residents. Lourdes Hospice provided over 19,500 in a Lourdes Pediatric practice and (4) provide visits to Broome and Tioga Residents. inpatient and emergency department screening Increased Access to Behavioral & Mental Health, for alcohol and substance abuse. Over 850 persons received SBIRT services (Screening, Brief Substance Abuse, and Maternal, Child and Adolescent Intervention & Referral to Treatment). Health Increased Access to Prescription Drug Medication • Lourdes Youth Services provided services to at- risk adolescents through two programs in 2015. • Lourdes increased Pharmaceutical Access in the The Lourdes Mental Health Juvenile Justice Project community through the Dispensary of Hope (MHJJ) worked successfully to keep 98% of the of the Southern Tier. Together with Pharmacy youth served out of detention and out of home Assistance Programs, Lourdes served 1,523 5 placement. This was accomplished by providing persons, filling 1,963 prescriptions, which resulted intensive counseling and case management as well in over $961,000 in free pharmaceuticals to the as providing life skills enhancement groups for the community. Twenty percent of the medications participants. dispensed tied to community health priorities of diabetes, cardiovascular disease, or mental health.

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. The Dispensary of Hope served as an access point for persons being linked to a medical home and to a health insurance plan: 74 persons linked to a medical home; 361 enrolled or referred to an insurance plan (Medicaid, Family Health Plus, Child Health Plus, and Lourdes Patient Financial Assistance Program).

Access to Chronic Disease Prevention Cardiovascular Disease Prevention • Reducing cardiovascular disease was achieved through activities such as participation in the American Heart Association’s Heart Walk to increase community awareness of heart disease, Lourdes piloted a wellness and prevention program and education on reducing cardiovascular disease. for associates, called EXOS which is an American Education is provided to the public on: ways to company founded in 1999 to maximize the reduce the risk of cardiovascular disease, early potential of athletes. identification of these diseases and how to manage symptoms associated with cardiovascular disease in order to maintain a quality life. Obesity Prevention Obesity Prevention, and the treatment of associated • The Cardiovascular Disease Managers at Lourdes chronic diseases such as diabetes and cardiovascular coordinate T-Time, a support group for patients disease is provided throughout the Lourdes system, with Heart Failure and their caregivers. The including primary care, endocrinology, the Lourdes program is offered to the public every other month Diabetes Center, and Lourdes’ Bariatric Surgery at no charge. Topics include: healthy eating at the Program at Lourdes Riverside Surgical. holidays, understanding your medications, and coping with chronic disease. These sessions are • Diabetes Education. Thirty-one providers often led by guest speakers. participated in a professional teaching day. Increased educational focus occurred throughout • In 2015, three hundred community residents were the year on the identification and treatment of screened for cardiovascular disease at community diabetic ketoacidosis and gestational diabetes. The events. Lourdes sponsored a Stroke Awareness day Lourdes Diabetes Center promoted A1C as the in February 2015 to educate the public on early definitive test for diagnosis while continuing to warning signs and offer blood pressure screenings. promote pre-diabetes education. • Lourdes continued to maintain quality standards to • Fit and Fun Meals provided at the Lourdes’ All Spice receive the “Get with the Guidelines” Stroke Gold Café contain a moderate amount of fat, cholesterol, Plus Achievement Award. and sodium. Fit meals include a delicious variety of • Lourdes was welcomed by the American Heart entrees and sides. An Action Station, offers a variety Association to the “Fit-Friendly Company of fresh ingredients, from which health meal 6 Recognition Program” and received Gold Fit options are made while people wait. Superfood of the status. The program recognizes employers Month nutritional benefits and recipes is featured in who champion the health of their employees the cafeteria and on the Lourdes Facebook page. by creating healthy eating options and physical • Newborn and Pediatric health. Supporting a healthy activity programs within the work place, such as start for newborns, patients are encouraged to implementing the “Step it Up Fitness Challenge”. breast feed, as evidenced by a 80% breastfeeding

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. initiation rate. Lourdes is a NYS Department of and participation in Relay for Life and Making Health “New Beginnings Hospital”, and provides Strides Against Breast Cancer as other ways lactation and nutritional consultations to increase overall awareness around Cancer. Lourdes completed its 9th year of CAMP HOPE Cancer Prevention for KIDS to help children learn to cope with their • Lourdes Regional Cancer Center provided outreach loss of a loved one to cancer. Initiatives taken and education information for breast, cervical and by Lourdes to achieve the NYS Department colorectal cancer through the Cancer Services of Health prevention agenda items to increase Program, community health fairs and events, access to cancer prevention services included: and support groups. In 2015, Lourdes expanded maintaining National Accreditation Program several cancer screening programs around lung for Breast Centers (NAPBC) for the Mobile cancer, colorectal cancer, and breast cancer. In Mammography program and the Lourdes Breast an effort to prevent lung cancer, Lourdes also Center. NAPBC accreditation demonstrates a firm provided smoking cessation classes throughout commitment by Lourdes to offer patients every the year. 63.3% of Lourdes primary care patients significant advantage in their battle against breast were screened for breast cancer. Over 1,700 disease. As an NAPBC accredited center, Lourdes mammograms were provided through the commits to ensure patients will have access to Mobile Mammography Van across 64 locations. comprehensive care, a multi-disciplinary team Lourdes associates continued a strong presence approach to coordinate the best treatment options, and information about on-going clinical trials and new treatment options… close to home.

Commitment to Health Care that is Safe Lourdes is committed to providing quality care to everyone we serve. By instituting a number of quality improvement initiatives, Lourdes continues to offer improved community health status. Cardiovascular Disease • Cardiovascular disease, including stroke and heart failure, remains a significant health concern locally and nationally. Lourdes’ commitment to improving community health status around stroke care is evidenced by maintaining its New York State Health Department Stroke Center designation. Lourdes has maintained its Gold Plus award from Get With the Guidelines for exceptional care in the management of patients that present to Lourdes with symptoms of stroke. The award recognizes efficient processes, evidence based care through a multidisciplinary team approach and quality outcomes. 7 • COACH for Heart Failure is a multidisciplinary team that spans the healthcare continuum to improve the coordination of care for this patient population. COACH provides services to patients

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. in the acute care settings, in homes, in primary care and specialty practices. The focus of the program is engagement of persons with heart failure and their caregivers in the management of their chronic disease. Early intervention leads to extended wellness in the community. COACH for COPD began in February, 2015.

Falls Prevention The need to prevent falls in the community is evident trained staff are skilled at helping people prevent by nearly 3,500 persons visiting Lourdes walk-in’s or falls. Persons who may benefit from balance or emergency room upon experiencing a fall. Ways in vestibular treatment are those who experience which Lourdes helps to prevent falls include: balance deficits due to generalized weakness, light headedness, vertigo (spinning sensation) with or • Tai Chi for Arthritis. Lourdes is participating without nausea, difficulty walking in visually busy in a Broome County-wide initiative to reduce environments or on uneven surfaces, post joint community falls. One evidence-based measure replacement, post fracture or sprains, post stroke, for falls reduction is Tai Chi. In 2015, as part neurologic diagnoses such as multiple sclerosis or of the Broome County Better Balance program, Parkinson’s disease, malnutrition, and medication a community-wide collaborative, four Lourdes side-effects. Joint Academy patients are encouraged associates were trained to be Tai Chi for Arthritis to attend Lourdes’ Pre-op Education class where instructors. Tai Chi is a low impact exercise patients and family members learn about safety in program that integrates mind and body through the home including proper use of assistive devices meditative movement, to help improve balance and simple modifications of the home setting such and mobility and reduce pain. Participants commit as installing railings, widening pathways, and to completing two one hour classes per week for removing throw rugs. 8 weeks and to practice what they learn between classes. In 2015 two class series were offered to • Vestibular Therapy is offered at all 4 outpatient twenty persons. Beginner, advanced, and seated tai locations in Binghamton, Endwell, and Vestal. chi classes will be available in 2016. • Primary Care. Falls prevention screenings are • 100% of Lourdes at Home physical therapy staff performed as part of the Medicare primary care received advanced training and certification around wellness visits, and on patients identified by their falls prevention over the last year to help meet the provider to be at risk for a fall. growing needs of the community. Fall prevention • Retail Pharmacy & Medication Management. education along with specific strengthening and Pharmacists discuss falls prevention with patients as balance activities have been incorporated in nearly part of their visit to the pharmacy. Whether filling a all ambulatory patients visits to help decrease falls. new prescription that has a fall risk to it or refilling Lourdes at Home participated in Broome County’s other prescriptions, our pharmacists are aware of “National Fall Prevention Awareness Day” falls risk criteria and utilize that while communicating providing information to the community at the to patients about their prescription use. Oakdale Mall. Lourdes provided over 49,000 home 8 health visits in 2015. Falls risk is assessed at every • Occupational Health. Lourdes focuses on creating a home health visit. safe work environment to prevent associate injury due to slips, trips and falls. On-going communication • Physical Therapy. Lourdes Physical Therapy and guidance is provided through Occupational provides comprehensive evaluation and treatment health services to Lourdes and area businesses on of balance and vestibular disorders. Highly appropriate footware and body mechanics.

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Frail & Elderly Lourdes’ Financial Commitment • Lourdes addressed the needs of the frail and elderly to the Community and their families through many venues, among which were participation in the Aging Futures 2015 CALENDAR YEAR community-wide coalition whose mission is to address the needs of the senior population in the community. Charity Care • Geriatric Services. Lourdes has demonstrated Free Care ...... $7,740,501 commitment to serving the frail and elderly in Community Benefit Programs ...... $15,919,000 all our care settings: primary care, specialty care, Total Charity Care ...... $23,659,501 homecare and hospice, emergency room and Bad Debt ...... $14,387,172 hospital. Our Geriatrics team provides specialty care that focuses on health promotion, prevention and Medicaid Shortfall ...... $7,758,000 treatment of disease, and quality of life in later years. Medicare Shortfall ...... $7,975,000 These providers devote their work solely to working with the frail and elderly through Medicare Wellness visits, care of residents in area nursing homes, and • Lourdes Regional Cancer Center. Lourdes participates the provision of primary care services on site at one in the rapid quality reporting system (RQRS) of the multi-level facilities in our community. through the Commission on Cancer in an effort to • Lourdes at Home provided 47,048 home health visits improve the quality of care to our patients through to Broome County residents. Fifty-two telehealth early reporting on certain quality metrics identified monitors continue to be used at capacity. This by the Commission on Cancer. evidenced based program has decreased Acute • Community Education. Lourdes believes that one Care Hospitalization rates significantly for patients of the hallmarks of Health Care that is safe is to with Congestive Heart Failure (CHF) and Chronic provide a variety of education programs for our Obstructive Pulmonary Disease (COPD) as well community, including cancer, diabetes, issues of as CHF. Lourdes continues to be the only Home aging, and women’s health to name a few. Health Care Agency to service pediatric patients. • Palliative Care and Hospice. Lourdes provides the area’s Patient and Associate Safety. only palliative care services, and is the only hospice • Lourdes adheres to a Universal Influenza provider for Broome and Tioga county residents. Vaccination annually to provide for the safety of all those in our care. • Occupational Health. At Lourdes, we believe that examples of healthy lifestyles should start at “home”. In 2015, Lourdes associates were given the opportunity to participate in a Health Risk Assessment appraisal and education to help associates to successfully engage in managing obesity, diabetes, heart disease and falls prevention. Over 50 associates participated in a healthy life style project, EXOS an integrated model which 9 focuses on mindset, nutrition, movement, and recovery to overall better their health and well being in the workplace. As we experience success in healthy life styles we will share our successes with the comunity.

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Core Values Our Mission SERVICE OF THE POOR Generosity of spirit, especially for persons Rooted in the loving ministry of Jesus as most in need. healer, we commit ourselves to serving all REVERENCE persons with special attention to those who Respect and compassion for the dignity are poor and vulnerable. Our Catholic and diversity of life. health ministry is dedicated to spiritually INTEGRITY centered, holistic care which sustains and Inspiring trust through personal leadership. improves the health of individuals and WISDOM Integrating excellence and stewardship. communities. We are advocates for a CREATIVITY compassionate and just society through Courageous innovation. our actions and our words. DEDICATION Affirming the hope and joy of our ministry.

About Lourdes For 90 years, Lourdes has been a cornerstone mammography services and dental care through of our community, offering resources that have two mobile medical vans, making health care made a difference. With our Catholic faith accessible to rural populations and children tradition, Lourdes Hospital provides the holistic, in need. compassionate care that every patient deserves. Lourdes is also a member of Ascension Health, Lourdes is more than an inpatient acute care the largest, Catholic, nonprofit health system in hospital…we are an outpatient ambulatory the nation with 150,000 associates and 35,000 surgery center…we are a Regional Cancer affiliated providers serving in 1,900 sites of care Center. We provide Palliative Care and Hospice across 23 states and the District of Columbia. Care, an orthopedics program, diabetes care, home health care, and much more. Much has changed in the community and at Reaching beyond the boundaries of our main Lourdes since the Daughters of Charity opened campus, Lourdes has established a network a small 25-bed hospital on Riverside Drive 90 of primary and specialty care physician offices years ago, but one thing remains constant: the at convenient sites throughout the region. The commitment and Mission of caring found here Mobile Mammography and Mobile Dental each and every day. Care programs provide women’s health and

HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Appendix 15: Consultant Qualifications

Company Contact Information: Company Name: Research & Marketing Strategies, Inc. Address: 15 East Genesee Street, Suite 210, Baldwinsville, NY 13027 Phone: (315) 635‐9802 Fax: (315) 720‐1159 Website: www.RMSresults.com President: Mark Dengler CHNA Project Contact: Susan S. Maxsween, MSHA E‐mail Address: [email protected] Company Profile: Research & Marketing Strategies, Inc. (RMS) conducts consulting, market research, and strategic planning activities across a wide spectrum of industry segments. It has dedicated staff with expertise in concentrated fields. Over 60% of RMS’s clients represent the healthcare industry. RMS has a dedicated Healthcare Division that works extensively with healthcare delivery systems. Located in Baldwinsville, NY, the firm provides a full range of custom‐tailored consulting and market research services. RMS works closely with its clients individually to evaluate and understand the business needs and develops the best solution(s) for high quality, actionable results. RMS offers extensive survey, in‐depth interview and focus group research service capabilities to obtain necessary primary research information for its healthcare clients. The RMS team is also well acquainted with secondary healthcare industry resources. RMS has a proven track record for exceeding its clients’ expectations since its inception in 2002. The healthcare industry represents a key client segment served by RMS staff. The firm has a long history working with physician organizations, hospitals, health insurance carriers and healthcare ancillary prov iders. RMS is an approved CAHPS® survey vendor an d wor ks wihith hlhhealthcare system clients in the area of practice transformation and patient‐centered medical home initiatives. Most recently the RMS Healthcare Division has worked with delivery systems to conduct community needs assessments, facilitate continued clinical integration and payor contracting, establish patient registries, data warehouses and metric dashboards to help systems advance improvements in community population health.

Our Lady of Lourdes Memorial Hospital, Inc. Community Health Needs Assessment