Texas Health Specialty Hospital 2016 Community Health Needs Assessment: Implementation Strategy Report Implementation Strategy Outline 2 Report Contents Appendix Contents • Background I. Project Team – About the Organizations II. Consulting Organization – CHNA Overview – Implementation Strategy Design Process • Implementation Plan – Priority 1: Behavioral Health – Priority 2: Chronic Disease Prevention & Management, including Exercise, Nutrition & Weight – Priority 3: Awareness, Literacy & Navigation Background About Health Resources 4 Mission To improve the health of the people in the communities we serve. Vision , a faith-based organization joining with physicians, will be the health care system of choice. Values • Respect – Respecting the dignity of all persons, fostering a corporate culture characterized by teamwork, diversity and empowerment. • Integrity – Conduct our corporate and personal lives with integrity; Relationships based on loyalty, fairness, truthfulness and trustworthiness. • Compassion – Sensitivity to the whole person, reflective of God's compassion and love, with particular concern for the poor. • Excellence – Continuously improving the quality of our service through education, research, competent and innovative personnel, effective leadership and responsible stewardship of resources.

Your feedback on this report is welcomed and encouraged. Please direct any questions or feedback to: Texas Health Resources System Services Community Health Improvement 612 E. Lamar Blvd., Suite 1400 | Arlington, TX 76011 Email: [email protected] Phone: 682-236-7990 About Texas Health Specialty Hospital 5

Texas Health Specialty Hospital opened in 1989 as a hospital licensed for 15 beds on the campus of Texas Health Harris Methodist Hospital Fort Worth.

Currently, the hospital serves adult patients with medically complex hospital needs, who are anticipated to require 25 days or more in our Long Term Acute Care facility. They typically have needs such as acute and chronic renal failure, prolonged respiratory assistance and wound management requiring complex intervention. This is done using a multidisciplinary team approach, and working closely with patients and families to achieve optimal outcomes. Pathway to ExcellenceTM Texas Health Specialty Hospital has been designated as a Pathway to Excellence HospitalTM. This designation is nationally recognized and is awarded by The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA). Texas Health Specialty Hospital became one of the first hospitals to receive the designation under its new name and affiliation with ANCC. It was formerly known as Nurse FriendlyTM and was awarded by the Texas Nurse's Association (TNA).

This prestigious designation is based upon the confirmed presence in the hospital of 12 standards cited by research and by nurses as exemplifying the kind of nursing practice environment that has a positive impact on patient care, as well as on nurse job satisfaction and retention. An important step in the process is a confidential survey completed by the nursing staff confirming the presence of these elements.

Texas Health Specialty Hospital is located south of Interstate 30 at the corner of Pennsylvania Avenue and Henderson Street, on the campus of Texas Health Fort Worth. It is housed on the fourth floor of the Harris Tower. CHNA & IS Process Overview 6

• In depth interviews and focus groups were conducted with individuals. An online community survey was also distributed to collect input on community health needs, assets, and barriers from community members. Community Input Each form of community input was analyzed, and significant health needs, barriers, and assets/resources Collection & were identified. Analysis

• The Healthy platform was leveraged along with PQI data from The DFW Hospital Council. HCI’s data scoring methodology was used to compare indicator values at national, state, and county levels as well Secondary Data as trends over time and HP2020 targets. HCI’s data scoring methodology was used to compare indicator Analysis values at national, state, and county levels as well as trends over time and HP2020 targets.

• The qualitative (community input/primary data) and quantitative (secondary data) analysis findings were CHNA synthesized to identify significant community health needs. Health needs were considered “significant” if at Data Synthesis & least two of the following data types cited the topic as a pressing health concern: Key Informant/Focus Report Significant Health Group Findings, Survey Findings, Secondary Data Findings. Needs

• Key hospital staff and stakeholders utilized the data analysis and synthesis findings to vote on which significant health needs will be prioritized for implementation strategy development consideration. Prioritization of Participants engaged in multiple rounds of voting and discussion, and considered specific system-wide Significant Health criteria for prioritizing significant health needs. Needs Texas Health Specialty Hospital Priority Health Needs for 2016 CHNA Access to Health Services, Mental Health & Mental Exercise, Nutrition, & Healthcare Navigation, & Disorders Weight Literacy

• Key hospital staff and stakeholders considered the prioritized health needs in developing an implementation strategy. Participants examined current initiatives and resources, discussed potential new programs and IS Implementation partnerships within the community, and considered overall Texas Health strategic planning process to determine which needs to address in the Implementation Strategy. Report Strategy Implementation Strategy Design Process 7

This report summarizes the plans for Texas Health Resources to address the prioritized needs identified in the 2016 Community Health Needs Assessment (CHNA). Texas Health developed a system-wide community benefit strategy to leverage internal and external resources and increase its ability to impact community health needs.

The top prioritized health needs across the system were: 1. Mental Health & Substance Abuse 2. Exercise, Nutrition, & Weight 3. Access to Health Services and Healthcare Navigation & Literacy

From 2017-2019, Texas Health will implement strategies and activities aimed at addressing these areas. Mental Health & Substance Abuse is categorized as Behavioral Health; Exercise, Nutrition, & Weight is grouped under Chronic Disease, which has been a strategic area of focus for Community Health Improvement since the 2013 CHNA; and Access to Health Services and Healthcare Navigation & Literacy is jointly titled Awareness, Health Literacy, & Navigation.

Located on the campus of Texas Health Harris Methodist Hospital Fort Worth, Texas Health Specialty Hospital completed a CHNA in collaboration with Texas Health Fort Worth and will support the implementation strategy of their partner hospital. In accordance with requirements in the Affordable Care Act and IRS 990 Schedule H requirements, this plan was approved by the Texas Health Board of Directors on April 24, 2017. Implementation Plan Priority Area 1: Behavioral Health 9

Priority Area #1: Behavioral Health Mental disorders and substance abuse problems are among the most common forms of disability. Key informants and focus group participants noted the need for more mental health service providers, especially for low-income and uninsured adults and children. The Healthy People 2020 goal Need Statement is to improve mental health and reduce substance abuse through prevention and by ensuring access to appropriate, quality behavioral health services. • Low-income, uninsured/underinsured • African American and Hispanic populations populations • Hispanic women with less than a high school • Zip codes 76104, 76105, 76106, 76110, education Target Populations 76111, 76112, 76114, 76115, 76117, 76119

Increase individuals' awareness of and access to health information and services that are accurate, accessible, and actionable; address social Goals determinants of health by partnering with community organizations. Strategic Alignment Consumer Focus • Texas Health Fort Worth Community • Internal Service Lines Health Improvement Advocate & Staff • Community Partner Organizations/Agencies • System-Level Community Health • Texas Health Buildings Improvement Staff • Partner Organization Locations Resources • Educators and Other Staff • Community Locations • Texas Health Fort Worth Community Health/Community Benefit Budget

Timeline 2017-2019 Priority Area 1: Behavioral Health (cont’d) 10

Priority Area #1: Behavioral Health Anticipated Impact

Strategies Activities Lead Dept / Staff Process Objectives (SMART) Short-Term Intermediate Long-Term Outcomes Outcomes Outcomes (1 year) (1-3 years) (3+ years) 1.1 Explore 1.1.1 Define behavioral • Texas Health Fort • Complete detailed assessment of • Increase • Increase both • Advance opportunities health topic area for Worth Community behavioral health needs and barriers in understanding Texas Health Fort health equity for new strategic Health Advocate primary and secondary service area zip of behavioral Worth and by improving system-wide implementation • System-Level codes health needs community access to behavioral 1.1.2 Collaborate with Community Health • Complete comprehensive inventory of and evidence- capacity to behavioral health System Services and Improvement/ evidence-based behavioral health based address health community other entities to Vice President, community programs and current and behavioral behavioral health services for program(s) determine appropriate Program Directors, potential collaborators health programs needs, targeting underserved system-wide approach Program Manager, • Assess internal resources both internally underserved populations to addressing behavioral Community Health • Improve linkage between internal with Texas populations • Reduce the health needs with Specialists, and Data clinical and community service lines to Health Fort • Increase stigma particular attention to Analyst better address community behavioral Worth staff and capacity to associated evidence-based health needs externally with evaluate with programs and leverage • Identify appropriate behavioral health- community behavioral health behavioral internal and external specific program curriculum partners programs health partnerships to • Pilot program conditions implement • Create training and have Community through community 1.1.3 Collaborate with Health Advocate and educators trained • Partner with Faith Community education System Services and and support other entities to develop Nurses/Community Health Workers, evaluation framework to Behavioral Health service line, community track and report partners and others to implement program impact to both program prioritized to underserved internal and external populations stakeholders

1.1.4 Engage partners • Research behavioral health-focused through behavioral coalitions within Texas Health Fort Worth health coalitions within service areas service areas • Assess appropriate involvement or mobilize community partners in creation of new behavioral health-focused coalition Priority Area 2: Chronic Disease 11

Priority Area #2: Chronic Disease Prevention & Management, including Exercise, Nutrition & Weight Chronic conditions are a significant public health issue and societal cost. However, regular physical activity, a healthful diet, and the maintenance of a healthy body weight can lower a person's risk of several chronic conditions and improve health and quality of life for those already diagnosed. 29% of adults in Tarrant County are obese, and 11% are diabetic. Community survey participants named weight/obesity as the first most pressing health Need Statement need for the community, while diabetes was named as the second, and heart disease was the third. The Healthy People 2020 goal to reduce chronic conditions - such as diabetes and heart disease - and complications from chronic conditions through better prevention, detection, treatment, and education efforts. Source: County Health Rankings • Low-income, uninsured/underinsured • African American and Hispanic populations populations • Hispanic women with less than a high school • Zip codes 76104, 76105, 76106, education Target Populations 76110, 76111, 76112, 76114, 76115, 76117, 76119*

Increase individuals' awareness of and access to health information and services that are accurate, accessible, and actionable; address social Goals determinants of health by partnering with community organizations. Strategic Alignment Consumer Focus, Exceptional Care, Value Creation, Culture of Excellence • Texas Health Fort Worth Community • Internal Service Lines Health Improvement Advocate & Staff • Community Partner Organizations/Agencies • System-Level Community Health • Texas Health Buildings Improvement Staff • Partner Organization Locations Resources • Educators and Other Staff • Community Locations • Texas Health Fort Worth Community Health/Community Benefit Budget

Timeline 2017-2019 Priority Area 2: Chronic Disease (cont’d) 12

Priority Area #2: Chronic Disease Prevention & Management, including Exercise, Nutrition & Weight Anticipated Impact Process Objectives Strategies Activities Lead Dept / Staff Short-Term Intermediate Long-Term (SMART) Outcomes Outcomes Outcomes (1 year) (1-3 years) (3+ years) 2.1 Continue 2.1.1 Hold CDSMP/DSMP • Texas Health Fort • 75% of workshops • 75% of program • 90% of program • 30% decrease implementation of workshops under the Texas Worth Community held between 2017- graduates will graduates will self- in preventable Stanford University's Health program license and Health Advocate 2019 will be held in indicate an increase report "always" or participant Chronic collaborate with community • System-Level zip codes with the towards the total "often" taking healthcare Disease/Diabetes Self- organizations/agencies to hold Community Health highest confidence rate in medications utilization Management workshops under partners' Improvement/ socioeconomic need* self-managing their exactly as related to Programs program licenses; partner with Program Manager • 75% of participants chronic condition prescribed chronic (CDSMP/DSMP) Faith Community enrolled in a • Increase Texas • 60% of DSMP conditions in Nurses/Community Health Partner workshop between Health Fort Worth graduates will self- zip codes with Workers, community partners Organizations: 2017-2019 will and community report an A1C level the highest and others to deliver • Community complete 4 out of 6 capacity to address below 9.0 socioeconomic workshops to underserved Council of Greater sessions ("graduate") the management of need populations Dallas/Area Agency • 90% of program chronic conditions in • 50% decrease on Aging of Dallas graduates between underserved in overall County 2017-2019 will populations preventable • North Central complete both a pre- participant Texas Council of and post-survey healthcare 2.1.2 Collaborate with Texas Governments Area • 10% of program utilization Health Physician Group (THPG) Agency on Aging participants between related to to recommend patients to • Sixty and Better 2017-2019 will be chronic CDSMP/DSMP workshops • Tarrant County patients from THPG conditions Public Health following the 2.1.3 Collaborate with System • United Way of • 50% of program completion of Services to develop evaluation Tarrant graduates will be CDSMP/DSMP plan to track workshop County/Area contacted for follow- participants' sustained Agency on Aging of up evaluation at behavior changes related to Tarrant County various intervals the management of chronic following workshop conditions and self-reported completion biometrics at various intervals following completion of the workshop Priority Area 2: Chronic Disease (cont’d) 13

Priority Area #2: Chronic Disease Prevention & Management, including Exercise, Nutrition & Weight Anticipated Impact Process Objectives Strategies Activities Lead Dept / Staff Short-Term Intermediate Long-Term (SMART) Outcomes Outcomes Outcomes (1 year) (1-3 years) (3+ years) 2.2 Strengthen 2.2.1 Continue implementation of • DSRIP Project • 93% of achievement of • 5% improvement • 10% • 15% Delivery System diabetes education and Lead available dollars for DY6 over baseline in improvement over improvement Reform Incentive management program • Proactively prepare for selected bundle baseline in over baseline Payment (DSRIP) 2.2.2 Continue implementation of anticipated changes to measures selected bundle in selected program congestive heart failure program DSRIP measures bundle measures 2.2.3 Continue implementation of cystic fibrosis program 2.3 Explore 2.3.1 Establish and strenghten • Texas Health • Identify zip codes and • Increase Texas • Increase number • Advance opportunities for partnerships with community Fort Worth communities with Health Fort Worth's of outlets health equity collaboration with groups working to help Community greatest need (i.e., capacity to address supplying fresh by decreasing community partners community members reduce risk Health Advocate limited/no access to food insecurity as a fruits and barriers to to address food for chronic disease and lead fresh fruits and barrier to health vegetables in health by insecurity and healthier lives through the vegetables) Texas Health Fort expanding nutritional needs in consumption of healthful diets • Determine effective Worth access to fresh the community implementation action communities fruits and through the • Establish proof of identified as vegetables implementation of concept and plan for having the food hubs or implementation and greatest need community gardens evaluation 2.3.2 Continue partnership with •HTCC/ • Provide financial and Healthy Tarrant County Executive in-kind support Collaboration (HTCC) on the Director • Support HTCC in the execution of grants and support • Texas Health growth and execution of HTCC's goal to continue diabetes Fort Worth projects prevention and management Community • Serve on Steering efforts in Tarrant County through Health Advocate Committee promotion of healthy retail • Texas Health policies and procedures to leadership to provide increase availability of healthy representation on Board foods of Directors

Priority Area 3: Awareness, Literacy & Navigation 14

Priority Area #3: Awareness, Health Literacy & Navigation 20% of Tarrant County residents lack health insurance, and 17.7% of people residing in Texas Health Fort Worth's service area live below the Federal Poverty Level. But coverage is not the only need. Low health literacy--an individuals' ability to obtain, process, and understand basic health information--has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services. Increased Need Statement access to comprehensive, quality health care services and improved health literacy are part of the Healthy People 2020 goals and objectives and are important measures to improve health equity and quality of life. Sources: County Health Rankings, U.S. Census Bureau • Low-income, uninsured/underinsured • Zip codes 76028, 76108, 76114, 76116, 76132, populations 76133** • Zip codes 76104, 76105, 76106, • African American and Hispanic populations Target Populations 76110, 76111, 76112, 76114, 76115, • Hispanic women with less than a high school 76117, 76119* education

Increase individuals' awareness of and access to health information and services that are accurate, accessible, and actionable; address social Goals determinants of health by partnering with community organizations. Strategic Alignment Consumer Focus • Texas Health Fort Worth Community • Aunt Bertha Platform and Other Technologies Health Improvement Advocate & Staff • Internal Service Lines • System-Level Community Health • Community Partner Organizations/Agencies Improvement Staff • Texas Health Buildings Resources • Educators and Other Staff • Partner Organization Locations • Texas Health Fort Worth Community • Community Locations Health/Community Benefit Budget

Timeline 2017-2019 Priority Area 3: Awareness, Literacy & Navigation (cont’d) 15

Priority Area #3: Awareness, Health Literacy & Navigation Anticipated Impact Lead Dept / Process Objectives Intermediate Strategies Activities Short-Term Outcomes Long-Term Outcomes Staff (SMART) Outcomes (1 year) (3+ years) (1-3 years) 3.1 Continue 3.1.1 Collaborate with • Texas • Disseminate • Increase overall • Increase community • 25% increase in use investment in System Services to Health Fort resources to external utilization of tool capacity to provide of tool by individuals Community Connect raise awareness and Worth stakeholders, • Increase strategic consumers with living in zip codes with Online Resource Guide disseminate Community particularly those utilization with information on the highest information on Health working with particular focus on navigating the socioeconomic need* Community Connect to Advocate underserved underserved healthcare system that • Advance health internal and external • System- populations populations is accurate, accessible equity by improving stakeholders Level • Develop standard • Increase Texas and actionable access to healthcare Community protocols for Health Fort Worth resources for Health utilization and capacity to provide underserved Improvement programmatic consumers with populations /Program integration of tool information on • Improve discharge Manager internally and navigating the planning through externally healthcare system that integration of tool into • Adapt tool to meet is accurate, accessible internal processes the needs of target and actionable populations Priority Area 3: Awareness, Literacy & Navigation (cont’d) 16

Priority Area #3: Awareness, Health Literacy & Navigation Anticipated Impact

Strategies Activities Lead Dept / Staff Process Objectives (SMART) Short-Term Intermediate Long-Term Outcomes Outcomes Outcomes (1 year) (1-3 years) (3+ years) 3.2 Continue 3.2.1 Hold AMOB workshops • Texas Health Fort Worth • 75% of workshops held • 50% of program • 30% decrease • 40% implementation under the Texas Health Community Health between 2017-2019 will be graduates will in overall decrease in of Maine program license and Advocate held in zip codes with the report that they participant healthcare Health's A collaborate with community • System-Level highest socioeconomic need* are "not at all" healthcare utilization rate Matter of organizations/agencies to Community Health or the highest incident rates of concerned that utilization related to falls Balance Fall hold workshops under Improvement/ falls** they will fall in the associated with or fall-related Prevention partners' program licenses; Program Manager • 80% of participants enrolled three months falls or fall- injuries for Program partner with Faith in a workshop between 2017- following the last related injuries older adults (AMOB) Community Partner Organizations: 2019 will complete 5 out of 8 class of participants living in zip Nurses/Community Health • Community Council of sessions ("graduate") • 60% of program following the codes with Workers, community Greater Dallas/Area • 90% of program graduates graduates will completion of high partners and others to Agency on Aging of Dallas between 2017-2019 will report that they AMOB economic deliver workshops to County complete both a pre- and are "absolutely need underserved populations, as • North Central Texas post-survey sure" that they • 30% well as those living in high fall Council of Governments can find a way to decrease in rate areas Area Agency on Aging get up if they fall healthcare 3.2.2 Collaborate with THPG • Sixty and Better • 10% of program participants • 50% of program utilization rate to recommend patients to • Tarrant County Public between 2017-2019 will be graduates will related to falls AMOB workshops Health patients from THPG report that they or fall-related • United Way of Tarrant are "absolutely injuries for 3.2.3 Collaborate with County/Area Agency on • 50% of program graduates sure" that they older adults System Services to develop Aging of Tarrant County between 2017-2019 will be can increase living in zip evaluation plan to track contacted for follow-up physical strength codes with workshop participants' evaluation at various intervals and become the highest sustained behavior changes following workshop steadier on their fall incident related to fall prevention and completion feet rates fear of falling at various • Increase Texas intervals following Health Fort Worth completion of the workshop and community capacity to address the fear of falling and fall prevention in underserved populations Priority Area 3: Awareness, Literacy & Navigation (cont’d) 17

Priority Area #3: Awareness, Health Literacy & Navigation Anticipated Impact Lead Dept / Short-Term Intermediate Strategies Activities Process Objectives (SMART) Long-Term Outcomes Staff Outcomes Outcomes (3+ years) (1 year) (1-3 years) 3.3 Strengthen 3.3.1 Continue • DSRIP Project • 93% of achievement of • 5% • 10% • 15% improvement Delivery System implementation of emergency Lead available dollars for DY6 improvement improvement over baseline in Reform Incentive department (ED) navigation • Proactively prepare for over baseline in over baseline in selected bundle Payment (DSRIP) program anticipated changes to DSRIP selected selected bundle measures program 3.3.2 Continue bundle measures implementation of palliative measures care program 3.3.3 Continue implementation of medication management program 3.3.4 Continue operation of mobile health unit 3.4 Manage and 3.4.1 Continue to address • Texas Health • Provide financial funding to • 70% of • 75% of all • 60% of adults with strengthen operations awareness, literacy and Fort Worth clinic as support for services patients partnered diagnosed of Clinic Connect for navigation through grants Community provided by clinic to referred to all clinics will have hypertension optimal performance awarded to local charitable Health uninsured and underinsured Texas Health- an average wait receiving care in any clinic Advocate patients funded clinics time for next Texas Health-funded • System-Level • Identify patients that meet by hospital available clinic will have a most Community eligibility criteria developed staff will be appointment recent blood pressure Health and agreed upon by Texas seen within 3 that is no more less than 140/90 Improvement/ Health and clinic and contact business days than 7-10 days • 15% decrease in System clinic with requests for • 10% decrease preventable Programs and patient appointments in preventable healthcare utilization Reporting • Patients referred to clinic healthcare by patients referred Director by Texas Health Fort Worth utilization by to all Texas Health- will be seen in the clinic patients funded clinics by within 3 business days of the referred to all hospital staff referral and have access to Texas Health- appropriate clinicians at clinic funded clinics during normal business hours by hospital staff Priority Area 3: Awareness, Literacy & Navigation (cont’d) 18

Priority Area #3: Awareness, Health Literacy & Navigation Anticipated Impact Lead Dept / Process Objectives Intermediate Strategies Activities Short-Term Outcomes Long-Term Outcomes Staff (SMART) Outcomes (1 year) (3+ years) (1-3 years) 3.5 Partner with 3.5.1 Support HTCC's •HTCC/ • Provide financial and • Increase Texas • Increase community • Increase Texas Healthy Tarrant goal to integrate Executive in-kind support Health Fort Worth's capacity to implement Health Resource's County Collaboration policy, systems, and Director • Provide data specific knowledge on and PSE strategies system-wide capacity (HTCC) on the environmental (PSE) • Texas to Texas Health Fort capacity to implement • Increase capacity of to make PSE strategy execution of grants strategies as the grant Health Fort Worth service areas PSE strategies health systems to changes convener for Tarrant Worth • Serve on Steering • Increase collectively gather • Increase quality of County Community Committee generalizable and local primary data for primary data for 3.5.2 Support HTCC's Health • Texas Health knowledge on the CHNAs Tarrant County health goal to increase quality Advocate leadership to provide primary data needs of systems conducting primary data for representation on health systems CHNAs Tarrant County for Board of Directors conducting CHNAs Community Health Needs Assessments (CHNA) and grant applications Appendices 19 The following information can be found in the Appendices: I. Project Team II. Consulting Organization Appendices Appendix I: Project Team 21

• Cheryl Mobley, MHA, MS, FACHE, CPHQ, President, Texas Health Specialty Hospital • Tami Marsland, BSBM, Assistant to the President, Texas Health Specialty Hospital • Catherine Oliveros, MPH, DrPH, Vice President, Community Health Improvement, Texas Health Resources • Jamie Judd, MBA, Program Director, Community Health Improvement, Texas Health Resources • Catherine McMains, MPH, CPH, Community Benefit & Impact Specialist, Texas Health Resources • Michael Thornsberry, MD, Chief Medical Officer, Texas Health Specialty Hospital • Pamela Duffey, MSN, RN, NEA-BC, Chief Nursing Officer, Texas Health Specialty Hospital Appendix II: About Healthy Communities Institute 22

HCI’s mission is to improve the Conduent Healthy Communities Institute (HCI), health, vitality, and environmental formerly a Xerox Corporation, was contracted by sustainability of communities, Texas Health Resources to conduct the 2016 counties, and states Community Health Needs Assessment, support Implementation Strategy development, and to author the CHNA and IS reports. Based in Berkeley, California, HCI provides customizable, web-based information systems that offer a full range of tools and content to improve community health, and developed the Healthy North Texas Platform. To learn more about Healthy Communities Institute please visit: www.HealthyCommunitiesInstitute.com

HCI Project Team & Report Authors Project Manager • Mari Muzzio, MPH Project Support: • Muniba Ahmad • Claire Lindsay, MPH • Rebecca Yae