MOUNT CARMEL NEW ALBANY 7333 SMITH’S MILL ROAD NEW ALBANY, OHIO 43054 Mountcarmelhealth.Com

MOUNT CARMEL NEW ALBANY 7333 SMITH’S MILL ROAD NEW ALBANY, OHIO 43054 mountcarmelhealth.com

COMMUNITY HEALTH ASSESSMENT AND IMPLEMENTATION PLAN 2013-2016

MOUNT CARMEL NEW ALBANY COMMUNITY HEALTH ASSESSMENT AND IMPLEMENTATION PLAN PAGE 1

Mount Carmel Health System Community Health Needs Assessment Implementation Plans Accepted by the Mount Carmel Health System Board of Trustees as a Component of the Community Benefit Plan and Approved on May 15, 2013

Contents 1. Mount Carmel Health System a. Our Purpose and Overview b. The Community We Serve;Area Demographics

2. Assessment, Methodology and Findings a. Link to the HealthMap 2013 (Franklin County Health Needs Assessment) b. Community Benefit Advisory Board c. Mount Carmel Health Community Benefit System-wide Strategies Goals

3. Facility Specific Overview

4. Community Benefit Reporting (Link to Community Benefit Report)

5. Specific Facility Response to Finding

6. Unaddressed Identified Needs

7. Attachments a. Data Sources b. Anticipated Partners

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Mount Carmel Health System OUR PURPOSE AND OVERVIEW

Mount Carmel Health System was founded in 1886 by two area physicians and the Sisters of the Holy Cross with the mission to help the poor and underserved. Presently a part of CHE- Trinity Health, it is one of the largest Catholic healthcare organizations in the United States.

Located in Columbus, Ohio with a target service area that includes all of Franklin County it serves a population of about 800,000 with 1,350 inpatient beds.We employ more than 8,000 employees, and have 1,500 physicians and nearly 900 volunteers.

MCHS includes Mount Carmel East, Mount Carmel West, Mount Carmel St.Ann’s, Mount Carmel New Albany Surgical Hospital, Diley Ridge Medical Center, and community based ambulatory centers,Women’s Health, Physical Rehab and Cancer.

MCHS exists to improve the health of our communities by providing compassionate care and service to people in time of illness and suffering.

Mission We serve together in Trinity Health, in the spirit of the Gospel, to heal body, mind and spirit, to improve the health of our communities, and to steward the resources entrusted to us.

Vision Inspired by our Catholic faith tradition,Trinity Health will be distinguished by an unrelenting focus on clinical and service outcomes as we seek to create excellence in the care experience. Trinity Health will become the most trusted health partner for life.

Values Respect Social Justice Compassion Care of the Poor and Underserved Excellence

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THE COMMUNITY WE SERVE; AREA DEMOGRAPHICS

Franklin County County Health Rankings and Roadmaps http://www.countyhealthrankings.org/app/ http://www.countyhealthrankings.org/app/ Rank Franklin National (of 88) County Error Margin Ohio Benchmark* Health Outcomes 58 Mortality 56 Premature death 7,870 7,694-8,046 7,457 5,317 Morbidity 64 Poor or fair health 14% 13% - 16% 15% 10% Poor physical health days 3 - 7 3.3 - 4.0 3.6 2.6 Poor mental health days 4 3.6 - 4.3 3.8 2.3 Low birth weight 9.4% 9.2 - 9.5% 8.6% 6.0% Health Factors 41 Health Behaviors 47 Adult Smoking 21% 19 - 23% 22% 13% Adult Obesity 31% 29 - 33% 30% 25% Physical inactivity 25% 23 - 27% 27% 21% Excessive drinking 19% 17 - 21% 18% 7% Motor vehicle crash death rate 9 8 - 9 11 10 Sexually transmitted infections 703 422 92 Teen birth rate 45 44 - 46 38 21 Clinical Care 11 Uninsured 15% 14 - 16% 14% 11% Primary care physicians** 1,065:1 1,348:1 1,067:1 Dentists** 1,317:1 1,928:1 1,516:1 Preventable hospital stays 70 68 - 73 79 47 Diabetic screening 85% 83 - 87% 83% 90% Mammography screening 60% 58 - 62% 63% 73% Social & Economic Factors 52 High school graduation** 83% 78% Some college 69% 61% 70% Unemployment 7.6% 8.6% 5.0% Children in poverty 27% 24 - 29% 24% 14% Inadequate social support 19% 17 - 21% 20% 14% Children in single-parent households 39% 37 - 40% 34% 20% Violent crime rate 537 332 66 Physical environment 46 Daily fine particulate matter 13.5 13.3 - 13.7 13.4 8.8 Drinking water safety 0% 2% 0% Access to recreational facilities 10 10 16 Limited access to healthy foods** 6% 6% 1% Fast food restaurants 59% 55% 27% * 90th percentile, i.e., only 10% are better. ** Data should not be compared with prior years due to change in definition. Note: Blank values reflect unreliable or missing data.

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Area Demographics, continued

Located in Franklin and Licking counties, New Albany contains 2,644 households2.The total population for the village of New Albany, Ohio has more than doubled since 2000 to 18,162, with a forecasted increase of 11.3% by the year 2016.The 2011 demographic distribution is as followed: Race/Ethnicity White - 87.9% Asian - 4.7% Black - 4.2 % Hispanic - 1.7% Other - 1.5% Age Group 18 to 64 Years – 59.8% Under 18 years – 29.7% 65 Years and over – 10.6% The average household income of New Albany is $172,321. 1.8 percent of residents live below poverty level1.

$200,00 14 $180,000 12 $160,000 $140,000 10 $120,000 8 $100,000

$80,000 Millions 6 $60,000 4 $40,000 $20,000 2 $0 0 Median Household Income Total Population

100% 90% 80% 70% 60% 50% 40% Ohio 30% Franklin County 20% 10% New Albany 0% Individuals Living Individuals < 18 High School Below Poverty years Living Graduate Level Below Poverty Level

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HealthMap 2013 Community Needs Index for New Albany, Ohio

Health is not only defined as free of disease; it is something that is affected by education and income, along with other social needs, which are all determinants of health.The Community Need Index (CNI), developed by Catholic Healthcare West (CHW), in partnership with Thomson Reuters, helps organizations gain a better understanding of public health disparities for every zip code in the United States.This information empowers organizations to determine community benefit programming that will better serve its community. It is believed that with the correct resources to meet the needs of the community, unnecessary hospitalizations can be prevented, public health can be improved and the cost of health care can decline.

CHW and Thomson Reuters have identified five socio-economic barriers that assist in quantifying health access to communities: income, education, culture/language, insurance, and housing. Each barrier has been assigned a numerical score between 1 and 5; 1- zip code containing the least amount of socio-economic barriers (low need), 5 – zip code containing the largest amount of socio-economic barriers (high need).The scores are averaged to obtain the final CNI score.The description of how each category was calculated has been italicized.The score for zip code 43054, location of MCNA is in bold.

Income (1) – percentage of elderly, children, and single parents living in poverty. Those with limited income have fewer visits to primary care due to decisions being made between paying a much needed bill or receiving care. Low-income homes may not have insurance, or unable to pay associated costs if they do.

Cultural/Language (3) – percentage of Caucasian/Non-Caucasian and the percentage of adults over the age of 25 with limited English. Those whose primary language is not English may not fully understand their medical situation, be confused on discharge instructions, may not be able to read medication labels or understand self-care instructions for chronic conditions.

Education (1) – percentage of without high school diplomas. Lack of education can often lead to lack of employment and the lack of health insurance.Without health education, the ability to understand medical information or to recognize symptoms may be impacted.

Insurance (1) – percentage of uninsured and the percentage of unemployed. Without health insurance, individuals may forego primary treatment which may lead to hospitalization due to chronic conditions. After hospitalization, those with injuries or chronic conditions may not continue medical care due to costs, which could increase recovery time. If problems persist, the uninsured may have difficulty obtaining health insurance in the future.

Housing (2) – percentage renting housing. Increased use of rental housing is associated with transitory lifestyles, an unstable home and an environment unfavorable to health prevention. Most rental units are sub-standard, in high crime areas, have lower quality schools and limited food choices and less recreational opportunities. Homelessness was not factored in this score.

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Community need index (map showing color coded severity) The final CNI (1.6) - shows correlation between high need and high hospital utilization. Admission rates in high need areas were two times higher than low need areas in regards to pneumonia, congestive heart failure and cellulitis.This may be due to the use of primary care or assistance in managing chronic diseases or conditions. Intercity hardship index The Intercity Hardship Index, calculated every ten years, is a comparative analysis of cities in the United States that have a population of 480,000 or more. It began with 55 cities in 1970 and has grown to include 86 cities that were incorporated in 1990. Six key factors are used to determine the Intercity Hardship Index score from zero to 100.The higher the score, the greater the hardship.The key factors are: Unemployment – percent of civilians 16 years and older who are unemployed Dependency – percent of population under 18 years and over 64 year Education – percent of population 25 years and older who have less than a high school education Income – per capita income Crowded housing – percent of occupied housing units with more than one person per room Poverty – percent of people living below the federal poverty level, adjusted for local cost of living Although the study reflected that cities in the Midwest had a high index score, since the inception of the Intercity Hardship Index, Columbus has always been one of the cities with the least hardship.3

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1970 1980 1990 2000 *Dignity Health Community Needs Index Score 34.8 24.2 22.5 18.6 Index http://cni.chw-interactive.org/ Rank 46 42 78 79 Total # Cities 55 55 86 86

Assessment, Methodology and Findings In 2012 Mount Carmel Health System joined area hospitals and community agencies in performing a community health needs assessment which met the requirement of the Patient Care Protection Affordable Care Act.This assessment was completed and made public January 2013.The document form this assessment is the Franklin County HealthMap 2013: Navigating Our Way to a Healthier Community Together (HealthMap 2013).The collaborative effort was headed by the Central Ohio Hospital Council. The team included representatives from the four hospital systems in Franklin County, public health departments and community stakeholders to identify the health needs of the community. After months of collaboration, eight health indicators emerged:

Access to care High-Risk Chronic Pregnancy Disease

Infectious Unintentional Community Disease Injuries Health

Behavioral Interpersonal High Health Violence Incidence of Cancer

*HealthMap 2013

Link to the HealthMap2013 (Franklin County Health Needs Assessment) The community health needs assessment identified and prioritized health needs consisting of 8 priorities and 140 indicators. Specific information about these indicators can be found in Franklin County HealthMap 2013: Navigating Our Way to a Healthier Community Together.The HealthMap 2013 can be found at http://www.mountcarmelhealth.com

Understanding the prevalence of chronic health conditions, barriers in access to care, and other health issues, all of the central Ohio hospitals involved in this process aligned resources to determine which indicator they could adopt and develop programs, if not already in place, to address any of the eight indicators. MCHS has programs in place to address all eight of these health indicators. MCHS has also chosen to begin a new initiative to address infant mortality.

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Community Benefit Advisory Board The decision to focus resources on infant mortality was decided by Mount Carmel Health System and the Community Benefit Advisory Board with statistics from the Franklin County Health Needs Assessment, HeallthMap2013 supporting this decision.The Mount Carmel Community Benefit Advisory Board members consist of individuals from the community, as well as Mount Carmel Health associates.Together, we work to ensure that community benefit programs are addressing the needs of the community.We have developed a Mount Carmel Health System Community Benefit Ministry Implementation Plan in response to the eight needs identified as priority by the Community Health Needs Assessment HealthMap2013* Mount Carmel Health Community Benefit System-wide Strategies Goals Achieve health equity Ensure equitable provision of care Improve access to health care services Invest in access solutions for those most vulnerable Embrace, celebrate and learn from diversity Enhance the health of the community Expand chronic disease management programs Enhance the health of the community Educate and inform community on healthy behaviors Promote evidence based programs and activities that create health improvement Focus on health needs identified in local community health assessment Promote physical, social and policy activities that create health improvement Advance medical/healthcare knowledge Demonstrate value of community benefit Document metrics and outcomes of all programs Partner with community organizations Give community voice in decisions regarding community benefit strategy and activities Demonstrate a return on investment Maintain and improve knowledge of community health Demonstrate transparency Relieve/reduce the burden of government/other community efforts Although we are looking at identified needs system wide, each facility is focusing on the area surrounding the hospitals with the highest need and or disparities.We are including the determinates of health and reviewing needs from a life course prospective. Determinates of health are factors that contribute to a person's current state of health.“These factors may be biological, socioeconomic, psychosocial, behavioral or social in nature. Scientists generally recognize five determinants of health of a population: Biology and genetics. Examples: sex and age Individual behavior. Examples: alcohol use, injection drug use (needles), unprotected sex, and smoking Social environment. Examples: discrimination, income and gender Physical environment. Examples: where a person lives and crowding conditions Health services. Examples:Access to quality health care and having or not having health insurance.” http://www.cdc.gov/socialdeterminants/Definitions.html

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Life course prospective looks how an individual’s lifestyle choices and health outcomes are affected by their family history. It connects past family social, economic and health history to individual behavior and outcomes in the present. (Bengtson and Allen 1993).We believe this is very important when planning preventative health measures.

Equity in care is also a priority at Mount Carmel Health System. Mount Carmel sponsored leaders to complete an executive disparities leadership program.The Disparities Leadership Program is the first program of its kind in the nation, and is designed for leaders from hospitals, health insurance plans, and other health care organizations who are seeking to develop practical strategies to eliminate racial and ethnic disparities in health care.The program is led by the Disparities Solutions Center at Massachusetts General Hospital (MGH) in Boston, Massachusetts.As a result of our commitment to equity in care Mount Carmel Health has launched a Health Equity committee to develop objectives that are patient-centered and population specific, connecting equity with ongoing hospital initiatives.

FACILITY SPECIFIC OVERVIEW Mount Carmel New Albany In 2007, New Albany Surgical Hospital joined Mount Carmel Health System. Mount Carmel New Albany Surgical Hospital is a specialty hospital focused on inpatient and outpatient orthopedic, neurologic and musculoskeletal care.The hospital features technologically advanced treatments combined with a unique caring and service philosophy tailored for each patient. Its two-story facility includes 117,668 square feet, 60 patient rooms and eight operating rooms. With a commitment to high-quality care, compassionate service and a passion to teach, Mount Carmel New Albany Surgical Hospital conducts and sponsors research in the fields of orthopedic surgery, neurology, neurosurgery, pain management and physical medicine and rehabilitation.The hospital provides educational programs for patients, physicians and healthcare providers; and incorporates research and education into orthopedic and neurologic prevention programs.

Special accreditations and certifications For the sixth straight year, Mount Carmel New Albany Surgical Hospital has received the Summit Award from national healthcare research firm Press Ganey Associates for sustained excellence in patient care. Mount Carmel New Albany is one of only four hospitals in Ohio and 37 in the nation to earn the award in the inpatient category. Just being considered requires a three-year ranking in the 95th percentile for patient satisfaction. Mount Carmel New Albany Surgical Hospital ranks in the 99th percentile.5

Mount Carmel New Albany is one of a select group of hospitals in the United States to receive certification from The Joint Commission for its joint replacement program.The two-year certification requires hospitals to comply with national standards; use appropriate, evidence- based clinical practices; and collect and analyze key performance measures for joint replacement. Both the hospital and its staff met or exceeded each standard during our review by the commission and continue to do so.

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Operation Joint Implant Two surgeons of Joint Implant Surgeons, Inc., have joined with MCHS to launch Operation Joint Implant, a local volunteer medical services program to provide free surgical treatment to the uninsured working poor in central Ohio. Based upon the work of the national organization Operation Walk, which serves patients in developing countries around the world, Operation Joint Implant seeks to identify local patients with no access to life-improving care for arthritis or other debilitating bone conditions affecting the knee and hip.

Community Benefit Reporting (Link to Community Benefit Report) Many of our other programs are highlighted in the Community Benefit Report at this link http://www.mountcarmelhealth.com

Specific Facility Response Plan to Findings The following implementation plan lists each of the eight needs identified by HealthMap 2013. Each need was reviewed for lack of access, awareness or education and then plans were made to meet these needs. All programs will be evaluated yearly with input from the community advisory board.

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Mount Carmel West implementation plan: 2013 – 2015 CHNA IMPLEMENTATION STRATEGY HEALTH ISSUE PLANNING PROFILE Mount Carmel Campus: Mount Carmel New Albany CHNA HEALTH ISSUE: Access to Care CHNA REFERENCE PAGE: Pages 5 & 19 RANKING: 1 Brief Description of Issue: : Emergency departments (EDs) in Franklin County experience higher utilization, when comparing rates per population, than do EDs across the state. Similarly, emergency departments in Franklin County are utilized more often for less severe cases, when comparing rates per population, than EDs across the state. In terms of specific conditions where access to care poses a problem, Franklin County adults have more difficulty in accessing dental care when compared to adults across Ohio. GOAL: To improve access to care in underserved populations. OBJECTIVE: To identify local patients with no access to life-improving care for arthritis or other debilitating bone conditions affecting the knee and hip. STRATEGIES (BY OBJECTIVE): 1. Utilize mobile coach clinic for outreach to underserved populations 2. Increase number of individuals who have coverage and/or access to financial assistance 3. Provide surgical treatment to the uninsured working poor in central Ohio ANTICIPATED OUTCOME(S): 1. Increase access to care through financial assistance and charity care 2. Increase number of individuals who have coverage 3. Increase number of individuals who have surgical treatment KEY PARTNERS: Joint Implant Surgeons, Inc., local anesthesiologists, pharmaceutical programs.

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2013 – 2015 CHNA IMPLEMENTATION STRATEGY HEALTH ISSUE PLANNING PROFILE Mount Carmel Campus: Mount Carmel New Albany CHNA HEALTH ISSUE: Chronic Disease

CHNA REFERENCE PAGE: 6 RANKING: 2 Brief Description of Issue: Chronic diseases – such as heart disease, stroke, cancer, diabetes – are the leading causes of death and disability at the local, state and national levels. According to the Centers for Disease Control and Prevention medical care costs of people with chronic diseases account for more than 75% of total medical care costs in the U.S. In Franklin County, over 60% of all deaths were due to chronic disease. Franklin County has a higher prevalence of both adults and youth diagnosed with asthma when compared to state and national data. Though the prevalence of adults in Franklin County diagnosed with diabetes is slightly less than for adults in the state of Ohio, it is higher than for adults in the U.S. There is also a higher prevalence of obesity in Franklin County adults which can lead to diabetes. GOAL: Improve management of chronic disease, specifically heart failure and diabetes OBJECTIVE: Improve self-management of diabetes and heart failure in partnership with community based organizations and ensuring uninsured individuals have access to health, self-care and prevention education and information on available resources. STRATEGIES (BY OBJECTIVE): 1. Community education through speakers and disease specific and prevention literature 2. Educate community on disease symptoms 3. Provide resource information to improve self-management through Church Partnerships ANTICIPATED OUTCOME(S): 1. Reduction of avoidable admissions as a result of unmanaged diabetes or heart failure. 2. Identification of undiagnosed chronic disease in the community. KEY PARTNERS: Local area churches and pharmaceutical programs.

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2013 – 2015 CHNA IMPLEMENTATION STRATEGY HEALTH ISSUE PLANNING PROFILE Mount Carmel Campus: Mount Carmel New Albany CHNA HEALTH ISSUE: Infectious Disease CHNA REFERENCE PAGE: 7 RANKING: 3 Brief Description of Issue: Incidences of infectious diseases, especially those that are sexually transmitted, more prevalent in Franklin County than in Ohio. Franklin County rates for pertussis and tuberculosis are higher than Ohio rates. The incidence rates for two hospital-acquired infections -- methicillin-sensitive Staphylococcus Aureus (MSSA) and methicillin-resistant Staphylococcus Aureus (MRSA) -- are slightly higher in Franklin County than in Ohio.* GOAL: Reduce instances of infectious diseases. OBJECTIVE: Increase community awareness and prevent the spread of infectious diseases. STRATEGIES (BY OBJECTIVE): 1. Collaboration with the Columbus Public Health Department to educate community regarding flu and pandemics. 2. Look to leadership from the Health Department for prevention of other infectious diseases. 3. Promote prevention, education, and access to vaccinations ANTICIPATED OUTCOME(S): Decrease the cases of preventable infectious diseases through increased use of vaccinations in vulnerable communities. KEY PARTNERS: Columbus Public Health Department, Church Partnerships

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2013 – 2015 CHNA IMPLEMENTATION STRATEGY HEALTH ISSUE PLANNING PROFILE Mount Carmel Campus: Mount Carmel New Albany CHNA HEALTH ISSUE: Interpersonal Violence CHNA REFERENCE PAGE: 9 RANKING: 6 Brief Description of Issue: Individuals in every community, regardless of age, economic status, race, religion, nationality or educational background, are affected by interpersonal violence. The World Health Organization estimates the cost of interpersonal violence in the United States is more than $300 billion per year. In Franklin County, the homicide rate is higher than the Ohio rate. Higher percentages of Franklin County children are in families in need of services, however lower percentages suffer sexual abuse, compared to Ohio data. Franklin County adults have higher percentages of victims who suffer injuries than adults statewide. GOAL: Reduce harmful effects of interpersonal violence and assist victims in recovery. OBJECTIVE: To help victims return to their pre victimization level of functioning STRATEGIES (BY OBJECTIVE): 1. Provide access to education, therapeutic interventions, individual and group support to facilitate recovery with the after effects of a traumatic event 2. Decrease barriers to treatment by providing transportation ANTICIPATED OUTCOME(S): Increase treatment accessibility to victims who are less likely to be able to procure services. KEY PARTNERS: Columbus Police Department, Franklin County City Prosecutes Office, SNARCO, local mental health facilities, Central Ohio Transit Authority.

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Unaddressed Identified Needs All priority needs identified by HealthMap 2013 have been addressed by at least one of Mount Carmel Health System facilities. These needs may not have been addressed by all facilities due to limited resources.

Identified Need: MCNA orAddressed by: 1. Access to Care x 2. Chronic Disease x 3. Infectious Disease x 4. Behavioral Health x MCW, MCSA, DR & resources on pg. 8 of HealthMap 2013 5. High Incidence of Cancer x MCE, MCW, MCSA & resources on pg. 9 of HealthMap 2013 6. Interpersonal Violence x 7. High Risk Pregnancy x MCSA, MCE, MCW & resources on pg. 9 of HealthMap 2013 8. Untentional Injuries x MCE & resources on pg. 10 of HealthMap 2013

X= not addressed by this facility

MCE = Mount Carmel East

MCW = Mount Carmel West

MCSA = Mount Carmel St.Ann’s

MCNA = Mount Carmel New Albany

DR = Diley Ridge

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Attachments Appendix A- Data Sources 1. Klinger, Jeff, Pearsol, Joann. Franklin County Health Map 2013: Navigating Our Way to a Healthier Community Together. 2. Reference: 1. http://quickfacts.census.gov.qfd/states/39/3953970.html 2 www.newalbanyohio.org 3. Montiel, Lisa M., Richard P. Nathan, and David J.Wright. An Update on Urban Hardship. Albany, NY: Nelson A. Rockefeller Institute of Government, State University of New York, 2004. http://www.rockinst.org/pdf/cities_and_neighbrhoods/2004-08- an_update_on_urban_hardship.pdf. 4. Demographics Expert 2.7: 2011 Demographic Snapshot of Zip Code 43054, 2011 Nielson Company, 2012 Thomson Reuters. Accessed 6/13/12. 5. http://Pressganey.com/pressGaneyAwards/Summit/Award/2011_recipients/aspx 6. http://cni.chw-interactive.org/printout.asp

Appendix B – Anticipated Partners MCHS Constituents The Foundation Mission Services Service Line Administration Finance Administration Emergency Department Services Communication and Public Affairs A.V. Lombardi, Jr., MD K.R. Berend, MD Community Constituents American Red Cross Columbus Public Health Department Local Churches Columbus Police Department Franklin County City Prosecutor’s Office SNARCO Local mental health facilities Central Ohio Transit Authority

*** The community health needs and the implementation strategy are based on data supporting the health needs and resources available for a certain period of time.These needs and resources may change and therefore the implementation strategy must also change to remain relevant to the community and hospital system.

MOUNT CARMEL NEW ALBANY