Initial Report Last Modified: 09/28/2016 1. Hospital Name # Answer Bar Response % 123 Other 0 0% 243 AdCare Hospital 0 0% 244 Addison Gilbert Hospital 0 0% 245 Anna Jaques Hospital 0 0% 246 Arbour Fuller Hospital 0 0% 247 Arbour Hospital 0 0% 248 Arbour HRI 0 0% 249 Athol Memorial Hospital 0 0% 250 Austen Riggs Center 0 0% 251 BayRidge Hospital 0 0% 252 Baystate Franklin Medical Center 0 0% 253 Baystate Mary Lane Hospital 0 0% 254 Baystate Medical Center 0 0% 255 Baystate Noble Hospital 0 0% 256 Baystate Wing Hospital 0 0% 257 Berkshire Health Systems, North Adams Campus of BMC 0 0% 258 Berkshire Medical Center Inc., Berkshire Campus 0 0% 259 Beth Israel Deaconess Hospital - Milton 0 0% 260 Beth Israel Deaconess Hospital - Needham 0 0% 261 Beth Israel Deaconess Hospital - Plymouth 0 0% 262 Beth Israel Deaconess Medical Center 0 0% 263 Beverly Hospital 0 0% 264 Boston Children's Hospital Family and Teen Council 0 0% 265 Boston Medical Center Corporation 0 0% 266 Bournewood Hospital 0 0% 267 Braintree Rehabilitation Hospital 0 0% 268 Bridgewater State Hospital 0 0% 269 Brigham & Women's Faulkner Hospital 0 0% 270 Brigham & Women's Hospital 0 0% 271 Cambridge Health Alliance 0 0% 272 Cape Cod & Island Community Health Center 0 0% 273 Cape Cod Hospital 0 0% 274 Carney Hospital 0 0% 275 Charlton Memorial Hospital 0 0% 276 Clinton Hospital 0 0% 277 Cooley Dickinson Hospital, Inc. 0 0% 278 Dana Farber Cancer Institute 0 0% 279 Dr. Solomon Carter Fuller Mental Health Center 0 0% 280 Edith Nourse Rodgers Memorial Veterans Hospital 0 0% 281 Emerson Hospital 0 0% 282 Fairlawn Rehabilitation Hospital 0 0% 283 Fairview Hospital 0 0% 284 Falmouth Hospital 0 0% 285 Framingham Union Hospital 0 0% 286 Franciscan Hospital for Children 0 0% 287 Good Samaritan Medical Center 0 0% 288 Hallmark Health System 0 0% 289 Harrington Memorial Hospital 0 0% 290 HealthAlliance Hospital, Leominster Campus 0 0% 291 HealthSouth Rehabilitation Hospital of Western Mass 0 0% 292 Hebrew Rehabilitation Center - Boston and Dedham 0 0% 293 Heywood Hospital 0 0% 294 High Point Treatment Center Inc 0 0% 295 Holy Family Hospital & Medical Center 0 0% 296 Holyoke Medical Center 0 0% 297 Kindred Hospital Boston 0 0% 298 Kindred Hospital North Shore 0 0% 299 Kindred Hospital Northeast 0 0% 300 Lahey Hospital and Medical Center 0 0% 301 Lawrence General Hospital 0 0% 302 Lemuel Shattuck Hospital 0 0% 303 Leonard Morse Hospital 0 0% 304 Lowell General Hospital 0 0% 305 Marlborough Hospital 0 0% 306 Martha's Vineyard Hospital 0 0% 307 Massachusetts Ear and Eye Infirmary 0 0% 308 Massachusetts General Hospital 0 0% 309 Massachusetts Hospital Association 0 0% 310 McLean Hospital 0 0% 311 Melrose-Wakefield Hospital 0 0% 312 Mercy Medical Center Campus 0 0% 313 MetroWest Medical Center 0 0% 314 Milford Regional Medical Center 0 0% 315 Morton Hospital & Medical Center, Inc. 0 0% 316 Mount Auburn Hospital 0 0% 317 Nantucket Cottage Hospital 0 0% 318 Nashoba Valley Medical Center 0 0% 319 New England Baptist Hospital 0 0% 320 New England Rehab Hospital at Beverley 0 0% 321 New England Rehab Hospital at Lowell 0 0% 322 New England Rehabilitation Hospital 0 0% 323 New England Sinai Hospital 0 0% 324 Newton-Wellesley Hospital 0 0% 325 North Shore Medical Center 0 0% 326 Norwood Hospital 0 0% 327 NSMC Salem Hospital 0 0% 328 NSMC Union Hospital 0 0% 329 Pembroke Hospital 0 0% 330 Providence Behavioral Health Hospital 0 0% 331 Saint Anne's Hospital 0 0% 332 Saint Vincent Hospital 0 0% 333 Shriners Hospitals for Children Boston 0 0% 334 Shriners Hospitals for Children Springfield 0 0% 335 Signature Healthcare Brockton Hospital 0 0% 336 South Shore Hospital 0 0% 337 Southcoast Hospitals Group Inc., Charlton 0 0% 338 Southcoast Hospitals Group Inc., St. Luke's 0 0% 339 Spaulding Hospital Cambridge 0 0% 340 Spaulding Hospital Rehabilitation Hospital Boston 0 0% 341 Spaulding Rehabilitation Hospital Cape Cod 0 0% 342 St. Elizabeth's Medical Center 0 0% 343 Sturdy Memorial Hospital 0 0% 344 Tewksbury Hospital 0 0% 345 The Meadows of Central Massachusetts 0 0% 346 Tobey Hospital 0 0% 347 Tufts Medical Center 0 0% 348 UMass Memorial Medical Center 1 100% 349 VA Boston Healthcare - Brockton 0 0% 350 VA Boston Healthcare - West Roxbury 0 0% 351 Vibra Hospital of Southeastern Massachusetts 0 0% 352 Vibra Hospital of Western Massachusetts 0 0% 353 Vibra Hospital of Western Massachusetts - Central Campus 0 0% 354 Walden Behavioral Care, LLC 0 0% 355 Western Massachusetts Hospital 0 0% 356 Westwood Lodge Hospital 0 0% 357 Whidden Hospital 0 0% 358 Whittier Rehabilitation Hospital - Bradford 0 0% 359 Whittier Rehabilitation Hospital - Westborough 0 0% 360 Winchester Hospital 0 0% 361 Worcester Recovery Center and Hospital 0 0% Total 1 2. If you selected "Other", please list hospital name: Text Response 3. Which best describes your PFAC? # Answer Bar Response % 1 We are the only PFAC at a single hospital 0 0% 2 We are a PFAC for a system with several hospitals 0 0% 3 We are one of multiple PFACs at a single hospital 0 0% 4 We are one of several PFACs for a system with several hospitals 1 100% 5 Other (please describe): 0 0% Total 1 Other (please describe): 4. Will another PFAC at your hospital also submit a report? # Answer Bar Response % 1 Yes 0 0% 2 No 0 0% Total 0 5. Will another hospital within your system also submit a report? # Answer Bar Response % 1 Yes 0 0% 2 No 0 0% Total 0 6. Staff PFAC Co-Chair Contact: Name and Title: Email: Phone: Ana Mechlin, Patient Experience Project Coordinator [email protected] 774-441-6742 7. Is the Staff PFAC Co-Chair also the Staff PFAC Liaison/Coordinator? # Answer Bar Response % 1 Yes 1 100% 2 No 0 0% Total 1 8. Patient/Family PFAC Co-Chair Contact: Name and Title: Email: Phone: Daniel Wolpert [email protected] 508-868-3752 9. Staff PFAC Liaison/Coordinator Contact (if applicable): Name and Title: Email: Phone: 10. This year, the PFAC recruited new members through the following approaches (check all that apply): # Answer Bar Response % 1 Word of mouth / through existing members 1 100% 2 Promotional efforts within institution to patients or families 0 0% 3 Promotional efforts within institution to providers or staff 1 100% 5 Facebook and Twitter 1 100% 6 Recruitment brochures 1 100% 7 Hospital publications 0 0% 8 Hospital banners and posters 0 0% 9 Case managers / care coordinators 0 0% 10 Patient satisfaction surveys 0 0% 11 Community-based organizations 0 0% 12 Houses of worship 0 0% 13 Community events 1 100% 14 Other 0 0% 15 N/A - we did not recruit new members in FY 2016 0 0% 11. Please describe other recruitment approach: Text Response 12. Total number of staff members on the PFAC: Text Response 7 13. Total number of patient or family member advisors on the PFAC: Text Response 22 14. The name of the hospital department supporting the PFAC is: Text Response Patient Experience 15. The hospital position of the PFAC Staff Liaison/ Coordinator is: Text Response Project Coordinator 16. The hospital provides the following for PFAC members to encourage their participation in meetings (click all that apply): # Answer Bar Response % 11 Parking, mileage, or meals 1 100% 19 Translator or interpreter services 0 0% 20 Assistive services for those with disabilities 0 0% 21 Provision / reimbursement for child care or elder care 0 0% 22 Stipends 0 0% 23 Payment for attendance at annual PFAC conference 1 100% 24 Payment for attendance at other conferences or trainings 0 0% 25 Annual gifts of appreciation 0 0% 26 Conference call phone numbers or "virtual meeting" options 1 100% 27 Meetings outside 9am-5pm office hours 1 100% 28 Other 0 0% 29 N/A - the hospital does not reimburse PFAC members 0 0% 17. Please describe other provision by the hospital for PFAC members: Text Response 18. Our catchment area is geographically defined as (if you are unsure select "don't know"): Text Response Worcester County, MA 19. # Answer Bar Response % 20. Our defined catchment area is made up of the following racial groups (please provide percentages; if you are unsure of percentages please select "don't know"): American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White 0.2% 4% 3.6% .2% 80.7% 21. # Answer Bar Response % 22. What percentage of people in the defined catchment area are of Hispanic, Latino, or Spanish origin? Text Response 9.4% 23. # Answer Bar Response % 24. In FY 2016, the hospital provided care to patients from the following racial groups (please provide percentages): American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Other 0.18% 3.29% 5.51% 0.05% 74.26% 16.71% 25. # Answer Bar Response % 26. What percentage of patients that the hospital provided care to in FY 2016 are of Hispanic, Latino, or Spanish origin? Text Response 10.11% 27. # Answer Bar Response % 28. In FY 2016, the PFAC patient and family advisors came from the following racial groups (please provide percentages): American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Other 10% 80% 10% 29. # Answer Bar Response % 30. What percentage of PFAC patient and family advisors in FY 2016 were of Hispanic, Latino, or Spanish origin? Text Response 10% 31.