Northern Westchester Hospital Community Service Plan 2014 ...

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Northern Westchester Hospital

Community Service Plan

2014 UPDATE

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Northern Westchester Hospital

Community Service Plan 2014 UPDATE All voluntary hospitals in New York State submit a community service plan to the Department of Health annually. This report is a summary of Northern Westchester Hospital’s community service initiatives, plans for program development and collaboration with local healthcare providers and community partners to address New York State’s Prevention Agenda priorities.

Table of Contents Page

I. Mission Statement 3

A. Mission Statement for Northern Westchester Hospital 3 B. Changes to Mission Statement 3 II. Service Area 3 A. Hospital Service Area 3

B. Service Area Used For Community/Local Health Planning For the Purposes of the CSP 3

C. Description of Service Area 3 D. Description of Method(s) Used to Determine Service Area 3 III. Public Participation 3-4 IV. Assessment of Public Health Priorities 4 A. Criteria of Public Health Priorities 4 B. Selected Prevention Agenda Priorities 4 C. Status of Priorities 5 D. Additional Prevention Priorities 5 V. Three-Year Plan of Action – Selected Prevention Agenda Priorities 5-23 VI. Changes Impacting Community Health / Provision of Charity Care / Access to Services 23-24 VII. Dissemination of the Report to the Public 24 VIII. About Northern Westchester Hospital 25 Appendix A: Additional Prevention Agenda Priorities 26-31 Additional NWH Priorities 32-36 Appendix B: Westchester County Health Planning Committee Process Summary 37-38 Appendix C: Map of Community and Region 39 Attachment A: NWH Community & Region Census Data

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I. MISSION STATEMENT A. Mission Statement for Northern Westchester Hospital We provide the highest quality diagnostic and treatment services for our community, while assuring access to a coordinated continuum of healthcare services. We seek to improve and protect the health of individuals in the community through programs that promote healing and wellness.

B. Changes to the Mission Statement There have been no changes to Northern Westchester Hospital’s Mission Statement.

II. SERVICE AREA A. Hospital Service Area Founded in 1916, Northern Westchester Hospital (NWH) is a not-for-profit, 233-bed, all private room facility in Mount Kisco, New York serving residents of Northern Westchester, Putnam and Southern Dutchess Counties in New York and portions of Fairfield County, CT. The hospital offers state-of-the-art care in a warm and nurturing environment for all area residents regardless of their health insurance status or ability to pay for medical care. Northern Westchester Hospital’s ‘Community’ is defined as the ten towns/villages in the immediate radius surrounding the hospital. The hospital’s broader ‘Region’ includes those additional towns/villages located to the north into Putnam County and to the East towards the Hudson River border of Westchester County. The ‘Community’ and ‘Region’ are defined by town lines. (See Appendix C for Community/Region Map)

B. Area Used for Community/Local Health Planning (for purposes of CSP) For purposes of the Community Service Plan, Northern Westchester Hospital focuses primarily on the Hospital’s defined ‘Community.’

C. Description of Service Area Demographic and patient data are captured at the zip code level. The population within the Hospital’s service area has increased 13% since the 2000 U.S. Census. Broken down by age, the most significant growth in population has occurred in the 35-54 age group with a 55.2% increase followed by a 35.4% increase in the Senior population (age 55-64). According to the 2010 U.S. Census, the Hospital’s service area is 74.7% White, 15.2% Hispanic/Latino, and 4.9% Black, 3.6% Asian. The Hispanic/Latino population experienced the greatest spike in growth rate at 96.5%. (See Attachment A for NWH Community & Region Census Data)

D. Method Used to Determine Service Area Northern Westchester Hospital’s service area is determined by zip codes and influenced by the Hospital’s previous participation in the Stellaris Health Network. III. PUBLIC PARTICIPATION NWH serves the community alongside many dedicated community organizations. These organizations, groups and civic leaders along with the NWH Board of Trustees, NWH Cancer Committee, employed staff, volunteers and affiliated physicians are involved in assessing community health needs and contributing their ideas and input towards the development of NWH’s community service priorities. Among the many local organizations that collaborate with NWH are: Neighbor’s Link; Open Door Family Medical Centers; Boys & Girls Club of Northern Westchester; local school districts; NWH President’s Council (which contains representatives from many local businesses); NWH Junior President’s Council; local Chambers of Commerce, Rotaries and civic organizations; local and county police departments; and elected officials.

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Westchester County Health Planning Committee (WCHPC):

Led by the Westchester County Department of Health, a collaborative group comprised of Westchester County hospitals and healthcare providers formed the Westchester County Health Planning Committee in order to advance New York State’s Prevention Agenda.

This Committee met monthly and held a Health Planning Summit inviting appropriate agencies from throughout the county.

(See Appendix B for Westchester County Health Planning Committee Process and Summary)

The Community At-Large: Working with local media, Northern Westchester Hospital conducted a Community Health Survey of community members within the Hospital’s service area. (Survey was conducted in 2013.) The Strategic Planning Committee, Board of Trustees and Senior Management conduct an annual Strategic Planning Retreat to evaluate the hospital’s Strategic Plan, Mission and program development based on the current healthcare environment and needs of the communities served by the hospital.

IV. ASSESSMENT OF PUBLIC HEALTH PRIORITIES A. Criteria of Public Health Priorities County Hospitals and the County Department of Health were required to select two (2) Prevention Agenda Priorities to address together. One of those items is required to address a healthcare disparity. The public health priorities were evaluated using several criteria:

Data – the health of Westchester County’s population was evaluated relative to New York State’s Prevention Agenda indicators and goals to determine where improvement was needed.

Impact – focusing on Obesity in the prevention of Chronic Disease will allow us to impact various health problems: Cancer Prevention, Cardiovascular disease, stroke, and diabetes to name a few. Obesity, heart disease and stroke were identified as top concerns for our community. Breastfeeding has been shown to reduce childhood obesity and provide numerous health benefits for mother and child.

Readiness – Northern Westchester Hospital has existing efforts and partnerships in place to support the chosen priorities.

It’s important to note that the demographics of the Westchester County population served by each hospital vary significantly, specifically in the ability to impact the chosen disparity.

B. Selected Prevention Agenda Priorities The Committee met regularly throughout the year, and working together, selected:

Promoting Healthy, Women, Infants and Children Focus Area 1: Maternal and Infant Health Goal #2: Increase the proportion of NYS babies who are breastfed

Preventing Chronic Diseases Focus Area 1: Reduce Obesity in Children and Adults Disparity: decrease the percent of blacks and Hispanics dying prematurely from heart-related deaths

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C. Status of Priorities Both selected priorities will incorporate many of Northern Westchester Hospital’s existing public health initiatives. These initiatives will be supported by existing, new and modified programs. All will be supplemented by input and support from community partners to varying degrees. As a hospital, we have always focused on 3 key constituencies: 1) Northern Westchester Hospital staff members: more than 1,500 employees. 2) The patients we serve: approximately 145,000 outpatient encounters and over 10,000 admissions in 2014. 3) The community at-large

D. Additional Prevention Priorities Northern Westchester Hospital is committed to ensuring that all members of the community receive access to quality healthcare and actively participate in programs focused on the prevention, diagnosis and treatment of diseases. In addition to the initiatives that support the two selected Priorities, NWH has numerous efforts and ongoing programs that support several priority areas of New York State’s Prevention Agenda. NWH also offers programs that address the needs of the community that are not specifically included in New York State’s Prevention Agenda. (See Appendix A for NWH programs not included under the two Selected Priorities.)

V. THREE-YEAR PLAN OF ACTION – Selected Prevention Agenda Priorities

PRIORITY: Promoting Healthy, Women, Infants and Children Focus Area 1: Maternal and Infant Health Goal #2: Increase the proportion of NYS babies who are breastfed

STRATEGIES: Create an environment around women for initiation and sustaining breastfeeding for at least six months

Create a systematic approach looking at prenatal care providers, hospital policies, support groups to change community environment

Program: Breastfeeding

Description & Purpose: Northern Westchester Hospital’s Lactation Department, in conjunction with the Maternal Child Health Department, recognizes the importance of exclusive and sustained breastfeeding for the health and well-being of the mother/baby dyad. Our mission is to break down barriers that prevent mothers from achieving their breastfeeding goals and to effectively communicate best practices. Ensuring adequate prenatal education and support is essential to successful breastfeeding. We follow the evidence-based “10 Steps to Successful Breastfeeding.” Target Population: All women of child-bearing age in Mt. Kisco, NY and surrounding towns in Westchester County, NY. Goals & Objectives: Short-term:

Exceed the Healthy People 20/20 goal of 81.9% breastfeeding upon discharge target. o Achieved NWH measures in 2012 were 89.9%.

Long-term:

Continued achievement of the evidenced-based gold standard of exclusivity of breastfeeding upon discharge, encouraging rooming in per the CDC mPINC survey. (The Maternity Practices in Infant Nutrition and Care

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(mPINC) Survey is a national survey of infant feeding practices in facilities that provide maternity care services. The Battelle Centers for Public Health Research and Evaluation has conducted this survey for the Centers for Disease Control and Prevention every other year since 2007.)

Increase number of mothers that exclusively breastfeed for 6 months

increase the attendance of the post-partum breast feeding support group Evidenced-Based Strategies/Interventions used to Achieve Objectives: 4th quarter 2012 through 2013

Coalition building: Recruit a breastfeeding champion physician (an Obstetrician and/or Pediatrician) to co-host Lactation Grand Rounds. This can be an effective tool to educate other physicians as well as increase visibility and legitimacy of lactation services available

2013 through 2014

Establishment of community wide Lactation advisory council to provide counseling, referrals and follow up support. Involve lactation consultants, Doula’s, local WIC office. Post yearly calendar for community breast feeding classes.

o Lactation Advisory Council: The Lactation Advisory Council recognizes the importance of exclusive and sustained breastfeeding for the health and well-being of the mother/baby dyad. The mission is to break down barriers that prevent mothers from achieving their breastfeeding goal and to effectively communicate best practices not only to patients, but to other members of the healthcare team. Ensuring the adequate education and support to both the inpatient and outpatient breastfeeding woman is the responsibility of this council.

Lactation Advisory Council Members: Northern Westchester Hospital Maternal Child Health, Nursery/NICU, Maternity, Labor & Delivery, Pediatrics, Lactation Consultants, Lactation Counselors, Prenatal Assistance Care Program; Mount Kisco Medical Group (MKMG) Lactation Consultant, Clinical Coordinator

4th quarter 2013 through 2017

Evaluate community outreach opportunities.

Create content for distribution: blog posts, newsletter articles, public presentations, tips and information for social media.

4th quarter 2012 through 2017

Collaborate with Prenatal Care Providers to create systematic approach on standard of care expectations sharing professional organizations Policy Statements.

Community outreach to educate on benefits of breastfeeding, norms of breast feeding in public, trying to create an environment around women.

2015

Maternal/Child Health department is collaborating with Patient Care Research staff to develop a tool to capture breastfeeding information post hospital discharge through 6 months. Anticipated launch is 2015.

Outcome Measures: At this time, we are able to report 2013 Breastfeeding statistics: Breast feeding upon leaving NWH – 87.8% Exclusive Breast feeding upon leaving NWH – 65.59%

Community Partners: Community businesses, Obstetricians, Pediatricians, WIC, La Leche League, building coalitions and normalizing breastfeeding within the community.

Partner Role

Prenatal Clinic Reaching underserved population

Neighbors Link Reaching underserved population

WIC Reaching underserved population

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Mount Kisco Medical Group Prenatal educational opportunity

Westchester Health OB Prenatal educational opportunity

PEDI Nurse Managers Post-partum educational opportunity

Chambers of Commerce Reaching business community

Program: Accommodation of Breastfeeding Staff Description & Purpose: Recognizing that breastfeeding is an essential aspect of life for mothers and allows for the optimum growth and development of infants, NWH makes available an environment that supports breastfeeding staff.

NWH encourages all staff to have a positive, accepting attitude toward breastfeeding staff. NWH will not tolerate any discrimination and/or harassment of breastfeeding staff. Any incidents of harassment of a breastfeeding staff member will be addressed in accordance with NWH policy of “Discrimination and Harassment.”

NWH policy allows for reasonable break time for staff to express milk at work.

NWH provides a functional, private space with comfortable seating to express breast milk. The location is protected from view, and absent of intrusion from co-workers or the public. The location has access to an electrical outlet for the sole use of an electronic breast pump as well as a sink with hot water and soap for hand washing and cleaning of breastfeeding equipment.

Additionally, expressed breast milk must be labeled with the staff member’s name, date and time and can be stored in the assigned refrigerator.

Target Population: NWH Staff who are breastfeeding Goals & Objectives: Provide an environment which supports and encourages staff who are breastfeeding when they return to work.

PRIORITY: Preventing Chronic Diseases

Focus Area 1: Reduce Obesity in Children and Adults o Disparity: decrease the percent of blacks and Hispanics dying prematurely from heart-related deaths

STRATEGIES: Engage both youth and adults in the community to create awareness, educational opportunities, screening

occasions, and clinical programs that address the obesity epidemic from both a prevention and management standpoint for both chronic disease and cancer.

Create a systematic approach looking at providers, hospital policies, and support groups to change community environment.

Program: Food is Care Description & Purpose: The NWH Kitchen was redesigned to enhance the delivery of patient food services and Cafeteria offerings and to support implementation of a full room service menu for inpatients. Nutritional programs have been instituted to reach NWH staff and visitors as well as patients. The following initiatives have been implemented as part of the NWH Food is Care program. Target Population: NWH Patients, Staff and Visitors Goals & Objectives: Create an environment that promotes and supports healthy food and beverage choices.

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Strategies/Interventions used to Achieve Objectives: Healthy Dining Grab ‘n Go The NWH Healthy Grab n’ Go Station in the NWH Café is a refrigerated unit featuring healthy choices that are easy for employees and visitors to “grab n’ go.” Nutrition Education Starting November 1, 2013, nutritional labels have been placed on items made in our kitchens. Nutritional information labels have been made to provide the following information to customers: Name of product, calories, carbohydrates, sugar, fiber, fat, cholesterol, protein, and sodium. These labels also feature Point-of-Purchase symbols designed to alert customers with special nutritional needs whether or not it is an item that is appropriate for their diet. These symbols include: Gluten-free, vegetarian, vegan, spicy and lactose free. 75% of our offerings in the cafeteria are labeled with nutritional content. Healthy Plate Program The Wellness Committee and the Nutrition Department launched the Healthy Plate Club in the Cafeteria modeled after U.S. government’s ‘MyPlate.’ NWH Registered Dietitians designated a healthy, hot meal selection each week that meets portion control recommendations and provides a healthy meal option. After a staff member purchases 9 Healthy Plates, the 10th Healthy Plate is complimentary. The purpose of this program is to increase staff awareness of healthy choices in our cafeteria; motivate staff to choose healthy selections for meals; and lastly increase servings of fruits and vegetables that staff consumes. Re-Think Your Drink Poster Campaign In conjunction with our new Healthy Grab n’ Go Station, NWH has launched a new campaign for better drink choices in the NWH Café.’ This campaign provides information about the benefits of choosing healthier drinks with less sugar as well as information about how to choose a healthier drink. The information is displayed on posters in the cafeteria and also directly outside the main entrance to the cafeteria. We also have streamlined our drink selection to discontinue use of sugar sweetened beverages and now only offer water, diet and unsweetened products. Healthier Vending Machines Unhealthy choices have been replaced with substitutes that are both tasty and healthy. Customers can even purchase fresh fruit if they choose to. It is the hope that by providing healthier choices in the vending machines, both employees and visitors will have an easier, more convenient way to make smart food decisions, regardless of the time of day. Coffee Bar (located in Front Lobby) Healthier options are provided, as well as several Gluten-Free Items from Local Gluten-Free Bakery “Three Dogs.” In addition, a healthy grab n’ go was placed at the coffee bar. Staff Education Smoothie Cart The smoothie cart was launched in August, 2013. NWH CEO, Joel Seligman and Registered Dietitians provide nutritious smoothies and recipes to hospital staff each month. The goal of this unique smoothie cart is to provide nutritious snacks, an opportunity for education and staff appreciation. National Nutrition Month 2013 Weekly during the month of March, Registered Dietitians provided complementary smoothies and recipes along with a variety of nutrition information to staff and the public. Topics included: How to enjoy more fruits and vegetables, How

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to read a food label, The importance of breakfast, and Everyday healthy eating. RDs also brought healthy snacks around to staff in various departments and patient care areas. Monthly Lunch and Learns All staff are invited to gather monthly to hear a wellness lecture while eating a complimentary healthy meal. A Q & A session follows each lecture. Topics are determined based on aggregated screening and HRA data provided by HealthFitness. 2014 topics included: Deconstructing Popular Diets, Combatting High Cholesterol, Fat Loss: The Healthy Way, The Very Versatile Vegetable, Nutrition and Fitness Applications, Stress and Inflammation, Sun Protection and Melanoma Prevention, Beverages: The Healthy Choice, How to Get a Good Night Sleep, Diabetes and Pre-Diabetes: The Good, the Bad, and the Ugly and Swapportunities. Nutrition Tip of the Month Registered Dietitians have developed a ‘Nutrition Tip of the Month’ to be displayed on NWH’s internal TV screens to staff and visitors. Tips are also posted twice a month on local online media outlets to reach the larger community. Nutrition Corner Launched in first quarter 2014, Registered Dietitians are available once per month in the cafeteria for staff and visitors to stop by to obtain education materials, recipes and answer any nutritional questions. Nutrition Education Videos Projected to launch first quarter 2015: Registered Dietitians will develop a library of Nutrition Education Videos to be offered to patients and their families over the hospital’s health information channel in patient rooms. Future videos may also include food demonstrations and may be available to the public via the hospital’s website. Wellness Corner in the Cancer & Wellness Center Launched in second quarter 2014, a reserved space for outpatients to relax, exercise, research, and learn about healthy cooking. The space is set up with a library, internet access, light exercise equipment and yoga mats, and a healthy food cupboard and cooking cart. A registered dietitian has nutrition and cooking classes weekly. In this same space, if the patient prefers, they can have a one-on-one nutrition consult with the registered dietitian. Community & Staff Outreach Content Creation NWH Registered Dietitians are contributing to NWH Experts’ blog, electronic newsletter (35,000 subscribers), and print newsletter (200,000 distributed). These articles are focused on various nutritional and wellness topics to educate staff and the community on healthy eating practices with corresponding recipes. This content is also shared with our media partners for distribution online and in print. Meatless Monday & Fiber Friday Campaign NWH Registered dietitians have developed a ‘Meatless Monday’ and ‘Fiber Friday’ tip that will be promoted on NWH’s Facebook and Twitter accounts. These tips were published the first Monday and Friday of each month throughout 2014. This campaign is available to all of our constituent groups. Twitter Campaign First quarter 2014: A one-time 30 minute virtual event on Twitter, inviting followers to Ask the Registered Dietitian nutrition related questions. This campaign is available to any individual who follows Chappaqua-Mt. Kisco Patch Blog

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Beginning fourth quarter 2013 - NWH Registered Dietitians created and contributed quarterly nutritional pieces to the Patch (local online media outlet). This blog is available to staff as well as the community. Healthy Recipes Compilation of healthy nutritional recipes for various meals and occasions, available on the Hospital website. NWH Restaurant Partnership The goal is to create a sustainable partnership to allow NWH Registered Dietitians and local restaurants to demonstrate their shared concern and support for community health. The restaurants will offer a minimum of two exclusive healthy dishes incorporating nutritional guidelines that meet the criteria of NWH’s Healthy Plate Program. The partnership would also encourage a more widespread outreach communications program to target individuals, groups, etc. to benefit from and/or contribute to the overall objective. This programs projected launch date is fourth quarter of 2013/first quarter of 2014. PCAP (Prenatal Care Assistance Program) Assess and educate patients through the prenatal care assistance program (PCAP) who are screened and found to be at high nutrition risk. The Diabetes Center @ NWH Our Registered Dietitian Diabetic Educator works in conjunction with Registered Nurse Diabetic Educator to educate patients in different scenarios – Diabetes Self-Management Education classes (DSME), One-on-One Nutrition education as well as support group (RD runs 1-2 support group/year). Pulmonary/Rehab Luncheon Initially ran as a cardiac lunch 1x/month. This luncheon will begin to be offered to all patients who are involved in either cardiac or pulmonary rehab. The goal of this luncheon is to help to encourage an open dialog between the patients and RD to reinforce healthy eating. (Each of the patients as part of their rehab receives 1 (one-on-one) nutrition visit). Bariatric Support Group A nutrition themed monthly group to provided support and ongoing nutrition education to help encourage patients preparing or who have had bariatric surgery make the healthy lifestyle changes necessary for weight loss. Cancer & Wellness Support Group Projected launch date first/second quarter of 2015. This support group will meet weekly to focus on cooking demonstrations and nutritional topics of concern for outpatient cancer and wellness patients. Youth Program Highlights/Nutrition At NWH, we have made it our mission to improve and protect the health of individuals in our community through programs that promote healing and wellness. To that end, we continue to develop “hands-on” programs, including classroom workshops and interactive display programs designed to reach a wider audience. We have also strengthened and broadened our relationships with community partners. New and Up-dated Nutrition Workshops #BetterinBalance Campaign – NWHC’s youth council developed a campaign designed to promote better health choices among children and teens. Programs for elementary to high school students teach practical skills, such as cooking, and include interactive workshops on basic nutrition, food labels, healthy snacking and beverage choices, eating the rainbow (foods from all color groups), and body image.

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• Nutrition 101 and Portion Control • Reasons to Love Labels • Smart Snacking • Eat the Rainbow • Getting Active

Fox Lane Middle School - After School Cooking Club Over the course of the 7 week program students learned to view “snacks” as a nutritional opportunity, and gained practical experience in preparing healthy snacks from scratch. Workshops included:

We Need Plants to Live - Plant Parts Dip and Veggies

Think About Your Drink - Almost Sodas

What’s in that Snack? - Fire Roasted Salsa

Make ½ Your Grains Whole - Chicken Fried Rice

Break Out with Breakfast - Apple Filled Crepes

Exercise – Just Do It! - Fruit Smoothies

Diet & Sports Nutrition - A Better Ade, Fruit with Dips

Program: Community Health Outreach Program (CHOP) Description & Purpose: CHOP’s initiatives and objectives are aligned with the goals of NYS DOH’s Health Improvement Plan: The Prevention Agenda 2013-2017. Phase I includes preventing chronic and vaccine preventable diseases; promoting initiatives that focus on primary and secondary prevention; healthy women, children and infants; and, mental health. Phase II includes promoting access to quality health care and reducing health disparities. Prevent chronic and preventable diseases. CHOP’s programs improve healthcare access and delivery to the growing underserved population in our region through targeted and effective community outreach and education initiatives, and to reduce healthcare disparities between the underserved, and the general public. Prevent chronic and preventable diseases & reduce healthcare disparities. Each year through CHOP, Northern Westchester Hospital provides essential health education and outreach through free health fairs, lectures, screenings, and flu vaccines to individuals in the region. Registered nurses, dieticians and other clinicians (some of whom are bilingual) conduct health screenings and distribute culturally sensitive, bilingual health education materials to community members to reinforce healthcare messages. These programs increase access to high-quality healthcare and minimize healthcare disparities in our underserved, particularly the immigrant Latino population, and the general public. Health screenings include blood pressure, diabetes (glucose), osteoporosis, cholesterol, stroke, and vascular. Medical equipment includes stethoscopes, two types of blood pressure cuffs, six cholesterol machines, one bone ultrasonometer (a portable device to detect osteoporosis) ,and all necessary medical supplies. Bilingual educational brochures that are culturally sensitive are distributed to promote effective follow-up with a primary physician. Bilingual health screening forms contain information about a particular health screening, where NWH staff record the participant’s results and provide recommendations and resources available to help reduce their risks. Target Population: Underserved or economically disadvantaged.

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Goals & Objectives:

Prevent chronic and preventable diseases; promote initiatives that focus on primary and secondary prevention; promote access to quality healthcare and reduce health disparities.

Increase screening rates for blood pressure, diabetes (glucose), cholesterol, stroke, and vascular especially among disparate populations.

Evidenced-Based Strategies/Interventions used to Achieve Objectives:

Screenings, bilingual educational materials.

As part of CHOP, a licensed dietician now works with a nurse at cholesterol or glucose screenings to educate how dietary changes can foster better health.

Outcome Measures / Frequency: Program success is determined using qualitative and quantitative measures. We measure program effectiveness through a database that tracks the number of: events; partner sites; individuals provided education and screening, and education materials distributed. We will obtain anecdotal information from clients, staff and partners on participant demographics, overall program satisfaction and growing demand for education services and screenings. The overall success of CHOP continues! The following highlights accomplishments achieved from September 2013 – September 2014: Prevent chronic and preventable diseases & reduce healthcare disparities.

• Participated in 69 health screening events, health fairs, education & outreach programs, and flu clinics reaching 3000 community members.

• Strengthened partnerships with area community organizations and faith-based organizations. Held 10 health screenings/flu clinics at Neighbor’s Link and 8 at The Community Center of Northern Westchester, reaching a total of 897 individuals (underserved, immigrant Latino population)

• Increased outreach to seniors through health education programs at Heritage Hills, Yorktown Senior Center, New Castle Seniors, Bedford Seniors, Pound Ridge Senior Fair, and Pinecrest Manor. New Castle Seniors, Bedford Seniors and Yorktown Seniors were new partnerships in 2014.

• Continued our active membership in the Latino Providers Network of Northern Westchester. • Continued to provide nutritional counseling by registered dieticians at all community events/screenings to raise

awareness of the link between weight, exercise and diet and a reduction in the risk of developing chronic diseases. In addition, to enhance our nutrition education materials, NWH provides bilingual information on nutrition and food labels and an accompanying food label chart display.

• Developed new bilingual screening forms for blood pressure, cholesterol, osteoporosis, and diabetes/glucose. The forms contain information about a particular health screening, the participant’s results and recommendations and resources to help reduce risk, if appropriate.

Community Partners: NWH registered nurses, dieticians, a bilingual patient navigator, physicians, technologists, and radiologists (some of whom are bilingual) work in collaboration with our Director of Community Health Outreach and over 20 community organizations to conduct flu vaccine clinics and develop and implement health screenings and fairs.

Program: Youth Health Education Description & Purpose: Each year, Northern Westchester Hospital partners with school districts and community based organizations in our service area to conduct health education programs on a variety of topics for all students, from grade school through high school. All of the programs are designed to help children improve their overall health by: (1) introducing facts, principles and techniques in given subject areas, (2) providing strong encouragement for positive behavioral change, and (3) increasing student awareness, interest and confidence about these subjects to encourage maintenance of good health.

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Educational topics include: first aid and safety, healthy snacks/cooking, nutrition and fitness, hand hygiene, tobacco and alcohol awareness, medical careers, healthy relationships, and healthy ways to handle stress. Target Population: Children/Adolescents/Teens - K-12 Goals & Objectives:

A great deal can be achieved in supporting and advancing healthy behavior such as: o Introduce specific important items of knowledge in subject areas: facts, principles and techniques. o Provide strong encouragement to arouse intent for positive behavioral change. o Increase awareness, interest, confidence, and a sense of importance of the subject area for maintaining

good health.

Create community environments that promote and support healthy food and beverage choices and physical activity.

Prevent childhood obesity through early child care and schools. Outcome Measures / Frequency: We use Process Evaluation (monitoring) to determine how many people are served by our programs. We use Outcome Evaluation to determine whether a program has the effect we expect it to have.

To assess the quality and effectiveness of our instruction, a survey, that includes two free response questions, is completed by school faculty or CBO observers at each session. Observer-teachers return the survey at the end of each session. They are asked to evaluate our instructional approach, student reactions, engagement, and motivation.

Periodically, we assess changes in student understanding/appreciation of the subject area, and administer a before and after survey.

We also receive anecdotal feedback from teachers, staff and students, which we use to improve and grow our programs.

September 2013 to September 2014, NWH Health Educators achieved the following: Provided a total of 193 health education programs to 8,224 children in Northern Westchester’s elementary, middle and high schools by way of over 190 interactive programs and/or workshops. Support and advance healthy behavior.

Reached over 1,700 parents and students through panel presentations, with topics ranging from alcohol awareness to stress and nutrition. Increase awareness & support community.

Engaged 2,425 children through tabling events in school cafeterias, farmer’s markets and the hospital’s own annual Teddy Bear Clinic. Support Healthy food and beverage choices & prevent childhood obesity.

Summer 2014, our Registered Dietitian promoted wellness with nutrition workshops at five local camp locations, reaching over 1,000 children. Support Healthy food and beverage choices & prevent childhood obesity.

Expanded on our relationship with Chappaqua , Katonah - Lewisboro and Pleasantville schools to include more programs K- 12, with a focus on nutrition. Support Healthy food and beverage choices & prevent childhood obesity.

Using interactive displays we engaged the public at local events, including races, community fairs and programs run by local organizations – The Wheel of Nutrition, Exercise Dice, Germ Busting, First Aid, and food demos. Support and advance healthy behavior and increase awareness & support community.

Evaluation and Notable Survey Responses

“The nurse that came into my classroom was so kind to the students and answered all of the questions they had. It was a very informative and enjoyable experience.”

“Good reinforcement of WHEN to wash hands and WHY.”

“Blue light/germ activity was very effective and really had an impact on the students.”

“The presenter was extremely informative and encouraging.”

“Students were amazed that even though food labels say ‘healthy,’ you MUST read nutrition labels.”

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“Students were eager to participate and learned from the nutrition BINGO activity.”

“It was great that the students got to practice making 911 calls.”

Community Partners:

Partner Role

Northern Westchester Public School Districts: Bedford Central, Byram Hills Central, Chappaqua Central, Katonah-Lewisboro, Lakeland Central, North Salem Central, Pleasantville Union Free, Somers Central, Yorktown

Receive education / Advise on development

Neighbors Link Receive education / Advise on development

Boys & Girls Club Receive education

Girl Scouts Receive education

Community Libraries Provide use of facility for events

Program: Northern Westchester Local Food System Project

Description & Purpose: The Northern Westchester Local Food System Project is an outgrowth of the Bedford 2020 Coalition – a local grassroots organization formed to implement Bedford, New York’s Climate Action Plan through activities such as local food procurement. The Coalition’s food and agriculture task force was assembled to promote local foods and local farms. Mission: “Build an economically viable, high-quality locally-sourced food system for institutional buyers. This system must be reliable, resilient, responsive and replicable.” To date, the hospital has begun the process of ordering through the aggregator, Red Barn Produce. The Executive Chef is pleased with the very seasonal product, the resulting menu, and the service. The hospital is now taking the steps necessary to continue ordering. However, until other institutions agree to participate in this new local food system, Institutions may only willing to invest in this project if the local product costs are competitive with existing vendor pricing Hyper-Local Farms Five hyper-local farms are interested in participating in the project, and Red Barn Produce is disposed to source from them. None are currently GAP certified, so they may only be able to supply produce to be cooked: Amba Farms, Bedford Hills – organic practices Ryder Farm, Brewster – certified organic JD Farm, Brewster – conventional Meadows Farm, Yorktown – conventional Stuart’s Farm, Somers – conventional There are grants administered by NYS for the USDA, to reimburse costs associated with getting GAP certification, which is helpful to small farms. Sustainable Food Systems will reach out to the 5 hyper local farms with information about this “NYS Good Agricultural Practices/Good Handling Practices Certification Assistance Program.” Target Population: Institutions and local farms in Northern Westchester This is a program that began as a pilot in 2011 Goals & Objectives: Create community environments that promote and support healthy food and beverage choices. Evidenced-Based Strategies/Interventions used to Achieve Objectives:

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A recently released American Farmland Trust report confirms the Northern Westchester Local Food Project is cutting-edge, and has been focusing on the right issues to ensure the project becomes an early success story. The report is called Scaling Up. Strategies for Expanding Sales of Local Food to Public and Private Institutions in New York. Outcome Measures / Frequency : Aligning more institutions with the program Adding more hyper-local farms to the stable of suppliers

Community Partners:

Partner Role

Red Barn Produce of New Paltz, NY GHP certified aggregator/distributor for regional produce to start, and later in the project for hyper-local produce

Flik Independent School Dining (Rippowam Cisqua School and other schools they manage).

Institution

Sustainable Food Systems

Northern Westchester Hospital Institution & Steering Committee.

Bedford 20/20 Steering Committee

Green Schools Coalition of Westchester Steering Committee

Bedford 2020 Coalition Steering Committee

Program: Pediatric Medically Supervised Exercise/Wellness Program Description & Purpose: A Pediatric Medically-Supervised Exercise Program for children and adolescents with lung and breathing disorders. The pediatric program will be a comprehensive program for both patients and their families. This age/developmental individualized program, seeks to enhance physical and social performance, and improve health-related quality of life. The rehabilitation staff will examine, diagnose, treat, and teach participants to prevent, correct and limit physical disability, and illness or disease. To provide a safe and effective exercise program, the availability of nutrition counseling and stress management training and education, and training and education on pulmonary disease. Target Population: Children and adolescents seven years of age and older with a pulmonary disease. Existing program Goals & Objectives: Our goal is to enable any child or adolescent to lead a full and satisfying life within his/her family, school and community. This goal is achieved through the recognition, assessment, treatment and management of symptoms and limitations arising from chronic illness. These goals will be achieved by meeting the following objectives: • To promote and maintain improvement in physical capabilities • To improve body composition • To improve ability to participate in daily activities in home, school, and community • To increase and encourage continued participation in physical education, leisure, and fitness activities at home

and with family and friends • To develop in the individual a perception of well-being • To assist the individual in developing methods to cope with his/her disease • To provide the individual with a better understanding of his/her disease process Evidenced-Based Strategies/Interventions used to Achieve Objectives: The program will include Education and Training, Cardiopulmonary and Resistance training, proper Nutrition, Psychosocial support, and Recreational Therapy to focus on a return to previous activity level. An Exercise Prescription specific for children and adolescents with pulmonary disease (frequency, intensity, time, duration, resistance and flexibility); Nutrition Consultation; Education and Training; and Stress Management Classes.

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Outcome Measures / Frequency: Outcome Measures are tested prior to starting the program and after 32 sessions. 1. Functional Status/Exercise capacity – 6 Minute Walk Test; 2. Cardiopulmonary Exercise test (selected patients) 3. Exercise Challenge Test (selected patients) 4. Dyspnea Measure During 6 Minute Walk Test – Modified Borg Dyspnea Scale; 5. METS (Metabolic Equivalent) – Unit of Energy Expenditure; 6. Strength Test/Fitness Tests – Fitness Gram; 7. Quality of Life Questionnaire; 8. Disease Knowledge Test; 9. BMI Determination. 2014- The program did not develop as we anticipated (very small enrollment) – Unable to capture outcomes (participants failed to report for post outcome measurements). 2015- We will continue to reach out to parents and physicians to increase patient volume. We will stress need for pre and post outcome determinations.

Program: Medically Supervised Exercise/Wellness Program for Adults

Description & Purpose: A Medically-Supervised Exercise Program for individuals with a pulmonary disease. To provide a safe and effective exercise program; the availability of nutrition counseling and stress management training and education; and training and education on pulmonary disease. Target Population: Adults with a Pulmonary Disease Goals & Objectives: Improve patients’ ability to carry out activities of daily living, improve functional level and quality of life. Help patients become less fearful of physical activities and become more active. Alleviate anxiety and depression. Improve mood and self-esteem. Improve body composition and weight. Provide a better understanding of his/her pulmonary disease. Evidenced-Based Strategies/Interventions used to Achieve Objectives: An Exercise Prescription specific for individuals with pulmonary disease (frequency, intensity, time, duration, resistance and flexibility); Nutrition Consultation; Education and Training; and Stress Management Classes. References: American Thoracic Society, American College of Chest Physicians, American College of Sports Medicine, American Association of Cardiovascular and Pulmonary Rehabilitation. Outcome Measures / Frequency: Outcome Measures are tested prior to starting the program and after 36 sessions. 2014 Outcomes - First Quarter (January-March) & Second Quarter (April-June) Outcome Measures / Frequency: 2014 Outcomes - First Quarter

(January-March)

2014 Outcomes - Second Quarter

(April-June)

1. Functional Status/Exercise capacity – 6 Minute Walk Test;

An average score improvement of

34% on the post program 6 Minute

Walk Test (Goal - 40%).

An average score improvement of

25% on the post program 6 Minute

Walk Test (Goal - 40%).

2. Dyspnea Measurement –

Modified Borg Dyspnea Scale

The “Rating of Perceived Exertion”

(patient symptoms) during the 6

An average score improvement of

20% on the post program 6 Minute

Walk Test (Goal – 20%).

An average score improvement of 22

% on the post program 6 Minute

Walk Test (Goal – 20%).

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Minute Walk Test.

3. Quality of Life – St. George’s

Respiratory Questionnaire SGRQ)

An average score improvement of

18% on the post program

questionnaire versus pre-program

questionnaire (Goal – 20%).

An average score improvement of

10% on the post program

questionnaire versus pre- program

questionnaire (Goal – 20%).

4. Patient Retention 80% (Goal – 50%) 86% (Goal – 50%)

5. Change in Upper Body Strength improvement of 51% (Goal - 40%) 41% (Goal - 40%)

6. Change in Lower Body Strength improvement of 37% (Goal - 40%) 45% (Goal - 40%)

7. METS (Metabolic equivalent) - A

unit of energy expenditure during

the 6 Minute Walk Test

improvement of 25% (Goal – 20%) 31%

8. COPD Assessment Test (CAT) –

The CAT is a tool to measure COPD

health status and to quantify the

impact of COPD on one’s life and

the changes over time. It identifies

where COPD affects the patient’s

health and daily life the most.

Outcome not started this quarter.

(Goal – 20%)

10%

9. Psychosocial (Depression

Module): Patient Health

Questionnaire (PHQ-9)

improvement of 50% (Goal – 20%) 52%

Program: NWH Center for Diabetes Description & Purpose: The Center for Diabetes seeks to educate patients and their families about Diabetes and the skills necessary for effective self-management and health promotion. Through an interdisciplinary team approach, the Hospital staff serves both inpatients and outpatients, focusing on the individual teaching needs of each patient and coordinating with the patient, the family, the physician/LIP, and other resources as necessary. Target Population: Patients with a diagnosis of diabetes ( type 1, type 2, or gestational diabetes) or at risk of developing diabetes. Goals & Objectives: To understand the basics of the diabetes disease process and understand acute and long term complications of diabetes. Understand the basics of a balanced diet, including the components of a healthy meal and portion control. Understand the basics of diabetes dietary management including:

What foods affect blood sugar; Portion sizes of carbohydrates; Healthiest types of carbohydrates and foods to limit; Pairing of carbohydrates with protein sources;

Understand the importance of physical activity and exercise in diabetes management, as well as recommended exercise levels. Understand the importance of staying healthy, including checking blood sugar levels, cholesterol and blood pressure regularly, and doing regular self-exams. Understand the importance of maintaining a healthy weight in diabetes management. Gestational diabetes: Understand risk for development of type 2 diabetes in the future. Understand lifestyle interventions postpartum can prevent onset of type 2 diabetes. Understand benefits of breastfeeding on glycemic control and weight management.

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PCC Gestational diabetes program: Added postpartum OGTT prior to insurance cessation to identify women who are either prediabetic or diabetic and counsel/refer accordingly.

It is the standard to have a postpartum OGTT to identify women who continue to have diabetes after pregnancy. The program had referred women back to their Primary care provider for testing but it was felt women did not follow up with this testing. It was also a revised goal/objective to have another educational opportunity for diabetes prevention with sustained lifestyle interventions postpartum.

2015 PLANS Tentative: New Audience: Work with Breast institute to establish an algorithm or treatment plan for people with diabetes and breast cancer. Reinforce importance of good glycemic control to decrease recurrence and promote self- management skills. Evidenced-Based Strategies/Interventions used to Achieve Objectives:

American Diabetes Association Recognized DSMT Site.

American diabetes Association: Clinical Practice Recommendations 2013.

AADE 7 self-care behaviors Outcome Measures / Frequency: ADA requires annual status report and recertification 4 years

o NWH Center for Diabetes received ADA re-recognition status from 4/2014-4/2018. The ADA certificate recognizes the center for diabetes as meeting the national standards for diabetes self- management education.

o Report to NWH quality department quarterly.

Community Partners

Partner: NWH Diabetes advisory committee: endocrinologists from MKMG and Westchester health, podiatrists, inpatient hospitalists, inpatient & outpatient nutritionist, Diabetes educator from Open Door Family Medical Center, one person with diabetes (from the support group), 2 NWH staff nurses, wound care program representative.

Role: Reviews data from the NWH Diabetes Center and advises on proposed changes, provides recommendations for future changes.

Program: Prescription to Wellness ™ Description & Purpose: This program was developed in conjunction with area physicians. For patients who are at risk of becoming obese, developing diabetes, and/ or facing cardiovascular problems, physicians can refer them into this program designed to provide participants practical education and coaching in nutrition and fitness activities. The goal is to help these participants learn healthy behaviors with a goal of preventing the onset of more serious illnesses. Target Population: Patients at risk of becoming obese, developing diabetes, and /or facing cardiovascular problems.

o Offered to NWH staff in 2014 Goals & Objectives: Complete two sessions in 2014 Evidenced-Based Strategies/Interventions used to Achieve Objectives: Baseline respiratory and cardio testing. The tests will be completed at the end of the program for comparative purposes.

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Outcome Measures / Frequency: Outcomes will vary based upon the condition of patients and will be collected at the inception and conclusion of the program.

Community Partners:

Partner Role

Westchester Health Associates Physicians identifying and referring patients

WeeZee World Interactive sensory activity facility

Program: Surgical Weight Loss Support Group Description & Purpose: Support Group for patients who are preoperative or postoperative bariatric surgery. Target Population: Patients who are planning to have or have had bariatric surgery. Goals & Objectives: Provide community and support to the bariatric surgery patient population. Evidenced-Based Strategies/Interventions used to Achieve Objectives: Monthly Support Group - MaryPat Hughes, RD (facilitator):

The Importance of Journaling - research shows people who keep a food and exercise journal are more successful with their weight loss attempts and so I encourage my patients to keep a journal. Bariatric Tool Box - together with the participants a list of important tools for success was developed, ie. water bottle, small utensils and plates, clock, vitamins, sneakers. This tool box discussion helps to reinforce the idea that the surgery is also a tool and not a cure for obesity. The success is dependent on the patients making lifestyle changes and the tools talked about help to make this change possible. Mindful Eating - This topic helps the participants to start to make the transition from an impulsive eater to an intuitive eater. The participants are educated to start to think about eating as a biological necessity as opposed to an emotional response or a physical activity. Common Nutrition Mistakes After WLS - During this session the diet modifications following WLS are discussed to reinforce some of the principles. For example, portion size control; "rule of 30" which refers to avoiding fluid for 30 min before and after meals; eating adequate protein and eating pro 1st, veg 2nd and cho last; encouraging the avoidance of sweets and carbonation.

Outcome Measures / Frequency: Attendance; collected monthly Jan – Aug 2014: 145 attendees

Program: Workplace Wellness Description & Purpose: Our goal at Northern Westchester Hospital is the improvement of our patients’ lives through process-oriented patient-centered care. The outstanding quality care we bring to the community is only possible because of our outstanding staff. We recognize the individuality of our staff and celebrate the diversity of your many interests and experiences that you bring to NWH. When trying to balance the demands of work, home and family, it’s all too often that wellness becomes a lower priority. NWH’s Wellness Committee is an active group who knows the importance of wellness in your work and your life! Wellness is more than just not being sick, it’s fitness of mind, body and spirit. Everyone takes different steps to enhance their health and well-being. Target Population: NWH Staff

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Goals & Objectives: Create community environments that promote and support healthy food and beverage choices and physical activity. To offer a comprehensive worksite wellness program to employees that promotes an environment of organizational and individual responsibility for health, and well-being. Planned Activity: Nutritional Consultations: Staff enrolled in the NWH group health insurance are eligible for up to 12 visits per year. A diagnosis is not required. Onsite consultations are available with a NWH Registered Dietician. The co-payment for onsite consultations is waived. Fitness Reimbursement Program: NWH pays a $100 reimbursement to eligible staff who complete a confidential annual Health Risk Assessment and log their physical activities such as walking, running, or working out at a gym, for at least two times per week for six consecutive months. Wellness Discounts, Promotions, and Events: In an effort to enhance the overall health and well-being of our staff, NWH communicates with local business as well as businesses in the communities in which staff live, to offer discounts and promotions to our staff. These discounts include; Fitness Center discounts, restaurant discounts, and family entertainment discounts. NWH also makes it a point to inform staff of local farmer’s market locations, athletic events such as marathons and walks, and charity based events in the local community. Discount and promotion offerings as well as community events are communicated to staff via electronic newsletter, the Staff Website, Employee Congress meetings, and onsite vendor events. Work/Life Program: available to staff and their immediate family members includes: Confidential Counseling, legal consultations, financial resources, telephonic health and Wellness Coaching, Work/Life Resources E4 Healthcare/Lifescope Tobacco Cessation: Online or with a Tobacco Cessation Coach, Individual Telephone Coaching: Up to one year working with an American Lung Association certified Freedom from Smoking Coach by telephone, In-Person Counseling: Up to 3 sessions of Face to Face counseling with an Addiction Counselor, Virtual Group Sessions: Bi-Monthly by telephone, NRT Therapy: First 4 weeks of Nicotine Replacement Therapy patches will be provided, Materials and Resource Library: Materials sent by email with additional articles, videos, and assessments on the wellnessworklife.com website, Additional Coaching: Unlimited access to Stress Management, Fitness, or Weight Control coaching as needed. Northern Westchester Hospital Tobacco Cessation: FREE Smoking Cessation classes offered to community with free NRT and unlimited counseling • $25 surcharge per pay period deducted from smoking staff member and smoking spouses (only applies if staff member and/or the spouse participate in the NWH medical plan) • Quit Smoking Cold Turkey – offered during the holidays. Staff (and their spouses) can receive a gift card toward the purchase of a holiday turkey for committing to smoking cessation classes. LIVING WELL PROGRAM: $500 Wellness Credit 3 Easy Steps: STEP 1) Onsite Biometric Screening or Alternative Means Screening form completed by physician and faxed to Health Fitness (third party vendor), STEP 2) online Health Risk Assessment and STEP 3) set and meet a Wellness Goal. This can be accomplished by using the HealthFitness Empowered Coaching program or through current NWH Wellness Programs including: Move It to Lose It, Fitness Reimbursement, Weight Watchers at Work, Monthly Lunch and Learns, Registered Dietician counseling, Tobacco Cessation and through a pre-approved “set your own goal” process. Aggregate data reported by HealthFitness is essential to the development of future NWH Wellness Programs to assist our staff to improve their health and enhance their wellness journey.

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Move It to Lose It: Program to encourage staff to be more active and encourage healthy weight loss where appropriate - pedometer based fitness competition. Various prizes from area fitness vendors. RESULTS - 168 staff members competed in 2014 in this 9 week pedometer/percentage of weight loss program. A total of 651.1 lbs. lost and 119,205,248 steps taken. Maintain Don’t Gain: New in Fall of 2013. Weight maintenance program for staff members over the holidays. Available for all staff. Weight Watchers at Work: Hospital discounts offered to staff and their spouses, may attend weekly onsite meeting, may also use the discount toward community Weight Watcher Meetings. Part time and Full time staff who attend 10 out of 12 meetings are eligible for 50% reimbursement from NWH. Monthly Lunch and Learns: Topics are determined based on aggregated screening and HRA data provided by HealthFitness. All staff are invited to gather monthly to hear a wellness lecture while eating a complimentary healthy meal. A Q & A session follows each lecture. Topics covered this year included: Deconstructing Popular Diets, Combatting High Cholesterol, Fat Loss: The Healthy Way, The Very Versatile Vegetable, Nutrition and Fitness Applications, Stress and Inflammation, Sun Protection and Melanoma Prevention, Beverages: The Healthy Choice, How to Get a Good Night Sleep, Diabetes and Pre-Diabetes: The Good, the Bad, and the Ugly and Swapportunities. Healthy Plate: 1) increase staff awareness of healthy choices in our onsite Cafeteria, 2) motivate staff to choose healthy selections for meals and 3) increase consumption of fruits and vegetables. NWH Registered Dieticians designate Healthy Options which may be selected as part of the NWH Healthy Plate Meal. For every nine, $5 Healthy Meal purchased, the tenth meal is FREE. Staff Yoga: 2013 program. Weekly staff yoga classes offered to staff and spouses. Cancer Gold Standard: NWH received re-accreditation in 2014. To earn Cancer Gold Standard accreditation, a facility must establish programs to reduce cancer risk by discouraging tobacco use; encouraging physical activity; promoting healthy nutrition; detecting cancer at its earliest stages when outcomes may be more favorable; and providing access to quality care, including participation in cancer clinical trials. Prescription to Wellness: Offered to NWH staff free-of-charge. For those who are at risk of becoming obese, developing diabetes, and/ or facing cardiovascular problems. This program designed to provide participants practical education and coaching in nutrition and fitness activities. The goal is to help these participants learn healthy behaviors with a goal of preventing the onset of more serious illnesses. American Heart Association Platinum-Level Fit-Friendly Worksite: NWH was recognized in 2014 for taking steps to decrease employee healthcare expenses and increase productivity. Employees are physical activity options in the workplace; Increase healthy eating options at the worksite; Promote a wellness culture in the workplace; Implement at least nine criteria outlined by the American Heart Association in the areas of physical activity, nutrition and culture; Demonstrate measurable outcomes related to workplace wellness. Outcome Measures / Frequency: Biometric screening data collected bi-annually. Objectives are evaluated and modified on an ongoing basis based on aggregate screening results as well as other data. • Program participation

o 219 fitness reimbursement submissions

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o 168 staff members competed in 2014 Move It To Lose It program. A total of 651.1 lbs. lost and 119,205,248 steps taken.

• Successful management of rising healthcare costs demonstrated through reduction in healthcare claims and quantifiable improvement in employee awareness and well-being. Nationally, healthcare costs have risen by 11%-12%. The NWH healthcare plan has increased 5.7%

Community Partners:

Partner Role

Health Fitness To provide confidential screening and coaching services.

Wellness committee (comprised of NWH staff) Represent staff interests when developing wellness programs. Assist in implementation and evaluation/modification.

Community gyms and fitness centers Membership discounts

E4 healthcare/Lifescope Work/Life Program; Smoking Cessation Program

NWH Registered Dieticians Instructors

Weight Watchers Program Partner

PRIORITY: Preventing Chronic Diseases

Focus Area 2: Reduce Illness, disability and Death Related to Tobacco Use and Secondhand Smoke Exposure. o Disparity: decrease the percent of blacks and Hispanics dying prematurely from heart-related deaths

STRATEGIES: Engage adults: staff and community members to create awareness, educational opportunities, and clinical

programs that address smoking cessation.

Create a systematic approach through hospital policies, education and support groups to change community environment.

Program: Live To Be Tobacco Free Smoking Cessation Program Description & Purpose: Program offered to all staff and community members, free of charge, to educate and assist in the process of stopping tobacco use.

Classes are promoted via Hospital website, social media and various community outreach material

Flyers are distributed to the doctors at Mt. Kisco Medical Group and Westchester Health and hospital facilities.

Patients who have indicated they are tobacco users are identified. The cessation program is discussed with them and literature is provided.

Evidenced-Based Strategies/Interventions used to Achieve Objectives :

Monthy, 4-week program o 45-minute Session: Quitting without weight gain. Facilitator: Jennifer Lucas, RRT, NWH o 30-minute Session: Recognizing triggers. Facilitator: Jennifer Lucas, RRT, NWH o 30-minute Session: Hidden dangers of tobacco use. Facilitator: Jennifer Lucas, RRT, NWH

New York State Quitline materials o 20-minute Session: Statistics associated with tobacco use. Facilitator: Jennifer Lucas, RRT, NWH

American Lung Association handout

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Outcome Measures / Frequency: Data is collected monthly by Smoking Cessation Program Coordinator. Follow up letters and phone calls are made to all participants after one month, three months, six months and one year of their participation in the program.

Program: Smoke-free Campus

Description & Purpose: It is the policy of Northern Westchester Hospital to maintain a Tobacco-free campus by prohibiting all use of tobacco products in any form throughout the hospital campus at all times. Target Population: All Hospital Visitors, Staff, Patients, Physicians, and Vendors Goals & Objectives: Improve and enhance the level of health of our patients and community

VI. Changes Impacting Community Health / Provision of Charity Care / Access to Services

As a not-for-profit hospital, Northern Westchester Hospital provides many community benefits including charity care and outreach to the community’s most at-risk patients. Programs include:

Care coordination through the NWH Patient Navigator helps facilitate access to healthcare and resources primarily for patients who are uninsured or underinsured. The Patient Navigator also assists non-English speaking or limited English speaking patients with language translation services to ensure their understanding of complex healthcare issues. The Patient Navigator is a specially trained, culturally sensitive, bilingual healthcare worker who provides support and guidance to patients and their family members. The Patient Navigator helps facilitate access to a variety of healthcare professionals and services at NWH and within the community, including our two (2) medical group partners: Mount Kisco Medical Group and Westchester Health Associates.

The Breast Health Initiative which provides a continuum of free breast health services (including mammography and breast screenings) to uninsured and underinsured women.

The prenatal care assistance program (PCAP) which provides comprehensive care to under-insured and uninsured pregnant women in Westchester and Putnam Counties.

The GI Clinic- which provides access to board certified gastroenterologists for low-income uninsured patients.

The Inpatient Behavioral Health unit continues to be offered as one of our acute care services in order to satisfy unmet needs within our community.

While facing the same financial and resource constraints most hospitals face, Northern Westchester Hospital did not plan or budget reductions to the services it provides or reductions in the amount of financial assistance provided. Positives changes:

Inpatient redesign including Plan of Care to enhance clinical care and patient-centered experiences. 95%+ utilization of electronic order entry Electronic Medical Record Specific recruitment of physicians in needed specialty Continued efforts to be a cost efficient provider Concerns: Lack of clarity of long-term impact of national healthcare reform

Reliance (sustainability) on (of) cost shifting to managed care payers to subsidize governmental reimbursement Continued difficulty in securing access to specialty care for uninsured patients

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Financial Assistance Northern Westchester Hospital believes that a critical component to providing access to all segments of its community is a robust financial assistance program. Adopted by the Board of Trustees, this program includes an active communication plan, guidelines that exceed mandates, and readily available multilingual Financial Counselors. To complement this program, NWH provides a multilingual patient navigator program that assists patients receiving financial assistance at NWH, as well as helping these same patients in securing services provided outside the Hospital. Enhancements to this program focused on educating our front-line registration staff on the importance of informing uninsured patients about this program. In addition, the Hospital’s self-pay billing process includes discussions with patients on the availability of financial assistance.

Corporate Structure Northern Westchester Hospital’s corporate structure changed in 2014, in that Stellaris Health Network was no longer NWH’s corporate parent. This change did not affect the Hospital’s ability or commitment to meet community health needs, charity care and access. In the wake of this change, NWH evaluated new strategic partners – those that shared our mission of providing high-quality diagnostic and treatment services to our community, assuring access to a coordinated continuum of healthcare services and improving and protecting the health of community members through programs that promote health and wellness. In 2014, NWH completed its evaluation of strategic partners. North Shore – LIJ emerged as the preferred partner and the due diligence process was conducted. The NWH and the NS-LIJ Boards approved NWH joining the NS-LIJ Health System as of January 1, 2015.

VII. DISSEMINATION OF THE REPORT TO THE PUBLIC NWH’s annual Community Service Plan will be posted in the ‘About Us’ section of the hospital’s website

(www.nwhc.net). In addition, a link to the CSP will be included in upcoming issues of NWHealth electronic newsletters.

For more information about NWH, visit www.nwhc.net. For referral to a member of the medical staff, call

1.800.4NWH.DOC.

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VII. ABOUT NORTHERN WESTCHESTER HOSPITAL

Designated Planetree Patient-Centered Care Hospital

Northern Westchester Hospital is extremely proud to be one of the first five hospitals in the country to receive the prestigious recognition of Designated Planetree Patient-Centered Care Hospital with Distinction. NWH is also the first hospital in New York State to receive this designation, which is a strong endorsement of the expertise and humanity of the entire staff. Planetree is a non-profit organization that provides education and information in a collaborative community of healthcare organizations, facilitating

efforts to create patient-centered care in healing environments.

Magnet® Recognition

Northern Westchester Hospital has received Magnet® Recognition for excellence in nursing service and the overall quality of care provided to patients and the community. We are proud to be the only Designated Planetree Hospital with Distinction that has achieved Magnet

Recognition in the nation! The Magnet Program is recognized as the gold standard of nursing excellence. Currently, less than 400 of the more than 6,000 U.S. healthcare organizations have received this credential. Magnet Recognition signifies that an organization provides high-quality patient care, promotes nursing excellence and is one of the country’s finest healthcare organizations.

Joint Commission on Accreditation of Healthcare Organizations Northern Westchester Hospital has received accreditation from the Joint Commission, an independent, not-

for-profit organization that evaluates and accredits nearly 18,000 healthcare organizations and programs in the United States. Joint Commission Accreditation is recognized as a symbol of quality that reflects an

organization's commitment to meeting stringent performance standards. Additionally, NWH was recognized as one of the Highest Quality Hospitals in the United States,

and among the Top Performers on Key Quality Measures™ in the Joint Commission’s 2011 annual report. NWH is the only hospital in Westchester County to be recognized as one of the "Highest

Quality Hospitals in the US" and was among only 16 hospitals in NY State to receive this prestigious recognition.

Best Hospitals 2013-2014 U.S. News & World Report

U.S. News & World Report once again lists Northern Westchester Hospital among the "Best Hospitals 2013-14," indicating that NWH is highly proficient in serving the needs of our patients. NWH has been recognized by US News & World Report "Best Regional Hospitals" in five specialties: Urology, Gynecology, Geriatrics, Orthopedics, and Neurology.

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Appendix A Additional Prevention Agenda Priorities

PRIORITY: Preventing Chronic Diseases

Focus Area 3: Increase Access to High-Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings

o Disparity: decrease the percent of blacks and Hispanics dying prematurely from heart-related deaths

Program: NY State Designated Stroke Center / Get With the Guidelines Stroke Gold Performance Achievement Award – The American Stroke Association Description & Purpose: NWH is designated as a Stroke Center by the New York State Health Department, and has received the Get With The Guidelines® Stroke Gold Performance Achievement Award* (GWTG–Stroke) by the American Stroke Association. NWH is also recognized as a recipient of the Target: Stroke Honor Roll by the American Heart Association for improving stroke care. With a stroke, time lost is brain lost, and the Get With The Guidelines–Stroke Gold Plus Quality Achievement Award demonstrates Northern Westchester Hospital's commitment to being one of the top hospitals in the country for providing aggressive, proven stroke care. The award recognizes NWH’s commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations. Target Population: General Population Goals & Objectives: Consistently comply with the requirements in the Get With The Guidelines–Stroke program. These include aggressive use of medications like tPA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol reducing drugs, and smoking cessation. Evidenced-Based Strategies/Interventions used to Achieve Objectives : In order to achieve this prestigious designation, NWH is required to meet stringent guidelines and maintain clinical standards which are reviewed annually by the DOH including:

Following specific protocols designed from evidence-based guidelines established by the American Heart Association and the American Stroke Association

Ensuring the availability of a dedicated Stroke Team including all of the staff in the Emergency Department Caring for You After You Leave NWH: Customized patient education materials, based on patients’ individual risk profiles, are made available just before discharge. The take-away materials are written in an easy-to-understand format and are available in English and Spanish. In addition, the American Stroke Association’s Patient Management Tool provides access to up-to-date cardiovascular and stroke science at the point of care. Planned Activity:

Conduct ongoing staff education specifically focused on stroke care

Monitoring continuous quality improvement efforts

Annual training with the local ambulance departments

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Outcome Measures / Frequency: Percent of Northern Westchester Hospital patients who were eligible ischemic stroke patients have received tissue plasminogen activator, or tPA, within 60 minutes of arriving at NWH (known as ‘door-to-needle’ time). A thrombolytic, or clot-busting agent, tPA is the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reverse the effects of stroke and reduce permanent disability.

Community Partners: Partner Role

NWH Stroke team. Educators. Presenters.

Community EMS / VAC

Program: Acute Stroke Assessment: Time is Brain

Description & Purpose: Annual Stroke symposium. Program Leader: Dr. Akira Todo, Director Stroke Program, NWH Target Population: EMS, VACs, ER Clinical Staff (RNs & MDs) Goals & Objectives:

Educate first responders to recognize patient with potential acute stroke.

Convey importance of rapid stroke assessment.

Present patient care options. Evidenced-Based Strategies/Interventions used to Achieve Objectives : Data, guidelines, recommendations, survivorship stories Outcome Measures / Frequency: Attendance. Satisfaction survey results.

120 attendees in 2014 (slight increase over 2013 attendance)

Community Partners:

Partner Role

Various town/village EMS & VAC Attendees

Northern Westchester Hospital Staff attendees. Presenters.

PRIORITY: Preventing Chronic Diseases

Focus Area 3: Increase Access to High-Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings

Program: GI Clinic AND Community Access Program (CMAP) Description & Purpose: The GI Clinic provides GI consults, endoscopies and colonoscopies to uninsured/underserved patients in our community catchment area. The GI clinic consists of 3 GI doctors and occurs 3 times a month. CMAP provides both surgical and orthopedic consults and surgeries at NWH for patients in our community catchment area. CMAP consists of a general surgeon and an orthopedic surgeon. CMAP occurs twice a month. Target Population: Patients who are uninsured/underserved who live in our catchment area.

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Goals & Objectives: The goal of the clinics is to provide medical access to patients that are uninsured/underserved in our community catchment area. Outcome Measures / Frequency: We Plan to collect numbers of initial patients and procedures done though the clinics on a quarterly basis.

GI CLINIC 1st

Quarter 2014

2nd Quarter

2014

3rd Quarter

2014

Initial Consults 13 17 8

Total Minor Surgery 16 30 6

C-MAP -SURGERY 1st

Quarter 2014

2nd

Quarter 2014

3rd Quarter

2014

Initial Consults 13 19 9

Total Surgery 6 8 5

Community Partners: All of the clinics require the patient to have a primary care physician; we work closely with Mount Kisco Open Door for patient’s referrals.

Partner Role

Mount Kisco Open Door Primary Care providers and referral source

Program: Breast Health Initiative for Underserved Women Description & Purpose: NWH’s Breast Health Initiative for Underserved Women successfully provides a holistic continuum of free, accessible, comprehensive, and timely breast health services, from education and screening to diagnosis, state-of-the-art treatment, and follow-up to underserved (Latina) women in Northern Westchester. Target Population: BHI targets women age 40+ or those at high risk. 90% of our patients live at or below the poverty level and 85% have no health insurance. Goals & Objectives: 1) Increase patient encounters 10% over 2013 – to an estimated 984 in 2014 and 1,082 in 2015; 2) Maintain high-quality patient navigation and retention rate of 85%+; and 3) Rollout of the successful Risk Assessment Pilot Program to all BHI clinic patients and women who attend the BHI educational seminars and assess 100% of all women in these two groups. Evidenced-Based Strategies/Interventions used to Achieve Objectives: Breast cancer is the leading cause of cancer death among Hispanic women in the United States and they are more likely to be diagnosed at a later stage than non –Hispanic women. A lower rate of mammography utilization and delayed follow-up of abnormal screening results likely contributes to this difference. Breast cancer screening (clinical breast exams and screening mammography) promotes early detection and improves outcomes in this population of women.

Planned Activity Timeline Lead Person/Organization

On-site breast clinic monthly BHI Nurse Practitioner & Patient Navigator - NWH

Diagnostics, Surgery & Appointments as needed Patient Navigator & BHI Nurse

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Treatment Practitioner - NWH

Cancer Prevention & Education Outreach Seminars

Twice a year BHI Nurse Practitioner & Patient Navigator - NWH

Breast Cancer Risk Assessment & Reduction

Monthly at breast clinic and education seminars

BHI Nurse Practitioner & Patient Navigator – NWH

Patient Navigation Daily Patient Navigator

Nutrition Program TBD Dietitian & Patient Navigator - NWH

Outcome Measures / Frequency: Yearly measures: Patient Satisfaction Surveys 100% satisfaction rate for courtesy, addressing patient concerns and recommend program to others; 99% satisfaction rate for translation services and 96% satisfaction rate for appointment location ease. Yearly retention rate goal is 85% Yearly encounters goal is 10% more than the previous year. Risk Assessment Program: Our goal is to assess 100% of the women who come to the monthly BHI Clinic at NWH and those we educate at our two community seminars each year. In addition, we track a variety of patient statistics such as number of: screening and diagnostic mammograms; ultrasounds; breast MRI; biopsies; breast surgeon consults; cancer diagnosis; total patient encounters; and total education/outreach encounters.

Community Partners:

Partner Role

Open Door Family Medical Centers Patient Referrals

Hudson Health Plan Patient Referrals

Planned Parenthood Patient Referrals

NYS DOH CSP Patient Referrals

Avon Foundation Grant Provider

Program: Cancer Health and Wellness Program Description & Purpose: Our Cancer Treatment and Wellness Center provides a patient-centered healing environment for individuals receiving cancer treatment (radiation, chemotherapy, infusion services, and Gamma Knife) at NWH. Among the Center’s offerings, the Health and Wellness Program helps high risk individuals, cancer patients and/or cancer survivors access and develop the necessary tools to cope with stressors that occur as a result of a cancer diagnosis and treatment. In addition, the H&W Program provides therapies that have been shown to reduce the risk of cancer recurrence. The Program supports patients by giving them free access to a wide-range of health and wellness modalities. Target Population: Individuals at high-risk of cancer; those diagnosed with cancer and/or those who are finished with active treatment (survivors) who live in Northern Westchester, Putnam and Southern Dutchess Counties in New York AND have a physician who is credentialed at Northern Westchester Hospital. Goals & Objectives: 1) Increase the number of total wellness visits over the prior year;

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2) Help patients manage the stress associated with a cancer diagnosis and treatment; 3) Decrease distress testing scores for patients after they have completed the program; 4) Maintain high patient satisfaction scores. Evidenced-Based Strategies/Interventions used to Achieve Objectives: American Cancer Society, Cancer Facts and Figures, 2012: There is strong scientific evidence that healthy patterns in combination with regular physical activity are needed to maintain a healthy body weight and reduce cancer risk. The Society of Integrative Oncology: Evidence shows the benefit of support groups, supportive/expressive therapy, cognitive-behavioral therapy, and cognitive-behavioral stress management for cancer patients.

Planned Activity Timeline Lead Person/Organization

Health Coach Appointments as needed Nurse Practitioner

Nutrition counseling Appointments as needed Registered Dietician

Physical activity Appointments as needed Exercise Physiologist

Acupuncture and Reiki Appointments as needed Holistic Registered Nurse

Mindful wellness/Counseling Appointments as needed Psychiatrist, Psychologist or Social Worker

Support Groups Monthly Trained Facilitators

Outcome Measures / Frequency: 1) 1596 Wellness visits through August 2014. A 10% increase over total 2013 visits. 2) Distress Management Screening Tool (Quality of Life Assessment): This is administered when a patient enters the Program and when they complete the Program. In 2014, patients’ stress scores dropped an average of 35% after completing the Program. 3) Patient satisfaction surveys are sent out to every patient who has recently completed the program. The surveys are sent out four times a year. In 2014, 100% of the patients responded that the H&W Program helped them manage their stress. In addition, 100% of patients found working with the Health Coach was helpful.

Community Partners:

Partner Role

Physicians Patient Referrals

Cancer Survivors Patient Advisory Council

Volunteers Social worker, Pilates, Yoga, Expressive Writing

American Cancer Society Support Groups

Support Connection, Gilda’s Club Support Groups

Cancer Coalition of Westchester Networking, Support Groups, Programs and Services

American Cancer Society

Look good, Feel Better: co-sponsored with the ACS – monthly meetings held at NWH; NWH provides the cosmetic bags via the ACS and provide wigs for patients undergoing chemo.

Prostate Health: we had a successful lecture series co-sponsored with ACS in 2012-2013.

Patient Navigators at the Cancer Center: Women who are cancer survivors visit patients, give support and help connect patients and their families with resources – i.e. rides for chemo etc.

ACS “Strides Walk” supported by NWH staff.

NWH Cancer Committee meeting attended by ACS representative.

Support Connection

Breast Cancer Support Group – facilitated by Support Connection; hosted by NWH at Chappaqua

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Crossing location.

Support Connection Support-A-Walk – supported by NWH staff.

Bi-annual public education forums – NWH provides speakers for this group. NWH works with representatives from Support Connection in developing each program. - May 2013 : Dr. Karen Arthur, Breast Surgeon, Mary Greco, NP for the Breast Institute, and Nancy Cohen, MS, CGC , Genetic Counselor spoke at our 15th Educational Forum "Breast Health & Cancer Risk: What Can You Do? 30 in attendance.

Gilda’s Club

Support Services – offered free to patients with cancer and their families

NWH Cancer Committee meeting attended by Gilda’s Club representative.

NWH staff participates in Gilda’s Club fundraising events

Hosts monthly Cancer Coalition of Westchester meetings

Cancer Coalition of Westchester

This is a network of many cancer services programs throughout Westchester County: Leukemia and Lymphoma Society, Gilda's Club, American Cancer Society, Support Connection, Westchester Jewish Services, Sole Ryders, NWH, Lawrence Hospital Survivorship NP, Cancer Support Team, St. John's Riverside, MSKCC. The group collaborates on lectures and presentations and shares information regarding programs and services each group provides to the Westchester County community.

PRIORITY: Promote a Healthy and Safe Environment

Focus Area 4: Injuries, Violence and Occupational Health o Goal #1: Reduce fall risks among the most vulnerable populations.

Program: NWH Post-Rehab/Wellness Program Description & Purpose: This program provides an opportunity for individuals who have completed a formal course of PT or OT the opportunity to continue their exercise in a nurturing and supportive environment. Program members are permitted to exercise under our direction/supervision 3X/week. Balance and fall prevention are emphasized. Target Population: Senior citizens who are not comfortable exercising independently in the home or health club setting. Goals & Objectives:

Improve the functional status of our community dwellers

Improve members’ balance

Decrease members’ risks of falling Evidenced-Based Strategies/Interventions used to Achieve Objectives: The Lancet, Volume 366, Issue 9500, Pages 1885 - 1893, 26 November 2005; Prevention of falls and consequent injuries in elderly people. Outcome Measures / Frequency: We track the number of program members on a monthly basis.

30 Members

Implement a satisfaction survey program in 2015.

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Additional NWH Priorities

PRIORITY: Community Education & Support

Program: Presidents Junior Leadership Council Description & Purpose: The PJLC is a youth leadership organization that builds young people’s connections to their community and engages them on issues that matter to them. Council members are liaisons between the hospital and their schools and serve as ambassadors to the community conducting outreach, prevention and wellness programs. Students are empowered to develop projects that are meaningful to them. These projects allow them to work collaboratively to design and produce original programs and materials. This select group of teens also has the opportunity to meet and interact with hospital personnel, explore career opportunities in health and medicine, and gain skills to help prepare them for the challenges and responsibilities they will face as college students and beyond. Mission: The President’s Junior Leadership Council is committed to improving the health, safety, and well-being of adolescents and young adults in northern Westchester County. To accomplish this mission the President’s Junior Leadership Council will:

Act as a liaison and serve as a “voice” between community youth and NWH administration and staff.

Support, advise, and assist NWH administration and staff in their efforts to promote health and wellness. Help identify and prioritize key health issues affecting young people, and develop and implement programs to address these issues. Target Population: Teens The NWH PJLC developed an exciting wellness program, the #BetterinBalance Campaign. The goals of the #BetterinBalance Campaign are to get people talking about food, fitness, and body image. We hope to inspire people to make healthy food choices and feel confident in their own skin. This initiative includes a student designed poster, social media feeds through Twitter and Instagram (@JuniorCouncil, #betterinbalance), and an interactive lesson plan that includes discussions about the basics of healthy nutrition, the connection between a balanced diet and achieving goals, and extreme nature of dieting and its effect on our bodies. Support and advance healthy behavior & food and beverage choices & prevent childhood obesity.

Program: Speaker Series Description & Purpose: The community is offered opportunities to get to know Northern Westchester Hospital’s expert medical staff as its healthcare experts speak on topics that they know best. Attendees learn what the Hospital can do to serve their needs, and how to take control of their family's health and wellness. Attendees enjoy a relaxed atmosphere and can educate themselves on topics that interest them and directly relate to their life.

Health and Wellness Lectures 4 times a year. Target Population: Community members with children in elementary and middle school. Goals & Objectives: To provide the general public with health and wellness information from a respected and trusted source on a variety of topics that are of interest to families with children.

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Outcome Measures / Frequency: Participant surveys are conducted after each lecture to assess satisfaction with the topic and speaker and to determine the level of interest for future lectures. Attendance is also tracked.

In 2014, an average of 42 community members attend each lecture.

Community Partners:

Partner Role

Physicians or healthcare professional Lecturer

Foundation Board Member Volunteer organizer

Essentialmom.com (community blog) Social media and PR / contribution of topic ideas

Volunteers Promotion to garner attendees / serve as hosts

Program: 55+ Community Connection Lecture Series

Description & Purpose: The purpose is to keep community members involved with the Hospital. Target Population: 55+ age group Goals & Objectives: Keep older adults active in their community.

Planned Activity Timeline Lead Person/Organization

Medicare Lecture Doreen/Empire Blue Cross

Financial Savings Lecture Su/Morgan Stanley

Safe Senior Living Brenda/The Kensington

Caregiver Choices Anthon/Comforcare

Outcome Measures / Frequency: Attendance is tracked.

Program: Building Cultural Competency: A Community-Wide Initiative

Description & Purpose: Northern Westchester Hospital, in cooperation with Neighbors Link and the Mount Kisco Police Department, developed a cultural sensitivity training program designed to help achieve the complementary mission of each group and to increase cultural awareness in order to build positive relations with immigrant communities. Target Population: Law enforcement officers Goals & Objectives:

Increase cultural awareness in order to build positive relations with immigrant communities.

Encourage communication and trust between local law enforcement and the immigrant community.

Actively enhance the healthy integration of immigrants in the community.

Planned Activity Timeline Lead Person/Organization

Work with Stamford, CT Neighbors Link to roll out program

4th quarter 2013 – 1st quarter 2014

Neighbors Link & NWH

Initial conversations regarding training with additional towns: Bedford

4th quarter 2013 NWH, Neighbors Link, Town of Bedford Police Department

New Initiative 2015 NWH & Neighbors Link

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Submitted grant proposal in partnership with Neighbors Link in response to RFP to train Westchester County employees

Outcome Measures: Since the program’s inception: 50 Mt. Kisco police officers have participated in the training (2012) 450 Westchester County police officers (2013) 50 Bedford police officer (2014)

Partner Role

Neighbors Link (Mt. Kisco, NY & Stamford, CT) Liaise with, and represent the immigrant community. Collaboration on program development, implementation and evaluation.

Mt. Kisco Police Department Collaboration on program development, implementation and evaluation.

NWH Human Resources and Training staff Provide trainers and original curriculum. Collaboration on program development, implementation and evaluation.

Westchester County Police Department Program participant

Program: Internship and Shadowing Opportunities for the Community Description and purpose: Northern Westchester Hospital supports internship opportunities for engaged students in our community to support and grow health care careers as their primary choice. Internships give students great learning experiences while gaining knowledge of a particular clinical area, insight into the day-to-day responsibilities of support areas and afford the students access to professionals within a hospital setting. Learning objectives for the individual internship are coordinated by referring schools/districts and matched through placement of interns with a corresponding department that can address the stated objectives and goals.

Targeted audience: Anyone with a strong desire to be in healthcare!

Local High School Students

Technical School Students

College Students

Post-Graduate Students

Individuals pursuing a career change Results: Number of Internships Completed at NWH

2011 – 40 interns (11 New Visions)

2012 – 58 interns (12 New Visions)

2013 – 54 interns (12 New Visions)

2014- 52 Interns (13 New Visions Students)

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Interns that became NWH Staff

20 Interns have become staff members

RN’s Laboratory, Human Resources, Support Services Community Partners Bedford, Chappaqua, Armonk, North Salem School Districts, Putnam/ Northern Westchester BOCES, local colleges and universities

Program: The Ken Hamilton Caregivers Center

Description & Purpose: KHCC is dedicated to the support and well-being of the family caregiver, as well as the professional caregiver. Services include counseling by social worker, referrals to community resources, trained caregiver coach volunteers providing support and encouragement to family caregivers. TKHCC provides a place of respite within the hospital for family caregivers to recharge. Provide monthly caregiver support group, as well as bi-monthly perinatal bereavement group open to members of the community free of charge. Target Population: family caregivers of inpatients, out-patients, as well as community members who are caring for a loved one, professional caregivers. Goals & Objectives: To help family caregivers effectively manage the stress associated with caring for a critically ill loved one through supportive counseling, assist with navigating the health care system, provide community resources to family caregivers, provide a place of respite and relaxation to caregivers, regardless of whether they have a loved one hospitalized at NWH. Services are offered free of charge. Evidenced-Based Strategies/Interventions used to Achieve Objectives: Existing Program: Daily Rounding on floors 2 – 3 times, on all inpatient units to provide support and encouragement to family and professional caregivers. Support and respite provided to family caregivers of patients and family caregivers in the community who visit the center. Support groups for caregivers, perinatal bereavement and general bereavement. Results:

Family interactions through September 2014 total 6312, projected to be 8400 through year end 2014.

Recruited and trained 6 new caregiver coaches, bringing total of trained and committed coaches to 30. Replication Program: Materials and guidance for institutions interested in creating and developing a Caregivers Center, dedicated to the needs of the family caregiver. Since its inception, the administration of The Ken Hamilton Caregivers Center has assisted numerous healthcare institutions in replicating the successful model. Results:

Added three new hospitals to our growing list of replicated partners. New hospitals include: Englewood Hospital (NJ), Hospital of the University of Pennsylvania (PA) and Mercy Medical Center (IA).

We now have a total of 10 replicated centers

Held two symposiums for Consortium of Caregivers Centers focused on sharing of best practices and techniques for supporting volunteers

Presented the KHCC replication program at the 2014 Planetree International Conference Community Involvement: Jerri Rosenfeld, Social Worker, presented Advanced Directives to Support Connection group. 2014 Awards:

Marian Hamilton received “Quality of Life” award by Volunteer – NY, a division of United Way

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Marian Hamilton selected by Caregiver Action Network for “Advancing Excellence: Best Practices in Patient and Family Engagement”

Resource Materials: Completed comprehensive handouts for Advanced Directives and Home Health Aides 2015 PLANS: Replication Program:

Continue to pursue new hospitals via Planetree network, Caregiver Action Network and PR efforts

Continue to plan Caregivers Center symposiums focused on identified needs

Continue to recruit and train new volunteer coaches Ongoing Program:

Develop a resource tool detailing recommended online caregiver resources

Maintain ongoing relationships with community resources – WJCS, Cancer Coalition, Support Connection Outcome Measures / Frequency: 1) Family interactions through September 2014 total 6312, projected to be 8400 through year end 2014. 2) Recruited and trained 6 new caregiver coaches, bringing total of trained and committed coaches to 30. 3) Added three new hospitals to our growing list of KHCC replication program partners

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Appendix B: Westchester County Health Planning Team (January – October 2013)

On December 10, 2012 the New York State Health Commissioner Dr. Nirav Shah sent letters to all county health departments and local hospitals requesting within each County the joint collaboration with the development of the community health assessment and health improvement plans required for submission by November 15, 2013. Specifically, Commissioner Shah asked hospitals and local health departments to work together with local community partners on assessing community needs, identifying at least two local priorities, one of which should address a health disparity, and developing a plan to address the identified priorities. To help support and coordinate this collaboration, the Westchester County Department of Health (WCDH) invited all sixteen Westchester County hospitals to attend a kick-off meeting on January 31, 2013. In addition, the three Federally Qualified Health Centers were also invited to attend. The meeting was held at the Westchester County Department of Health (10 County Center Road in White Plains). At the first meeting Sherlita Amler, MD, Westchester County Commissioner of Health, welcomed all participants to the meeting. WCDH provided a brief overview of the prior planning process and the new requirements for both the health department and the hospitals specific to the development of community health assessments and community health improvement plans. The Planning Team supported working collaboratively on this project and during the past ten months has demonstrated its commitment by attendance at monthly meetings, participation in two conference calls and hosting a Health Summit entitled “Working Together Toward a Healthier Westchester.” In addition, the team has shared information, resources and updates through email and phone calls. The team conducted an extensive review of all the health indicators contained in the Prevention Agenda. For each indicator, the team reviewed whether the County was below, meeting or exceeding the state established targets/goals, the estimated number of people affected by each indicator (when available), the County’s overall ranking for the indicator compared to other New York Counties, and the performance range within the State. The team often requested the Westchester County Department of Health to provide additional reports/analysis, including data at a sub-County level to allow a more complete understanding of the problem. In addition to a thorough review of the data, the priorities selected included consideration of priorities that were attainable and that aligned with each agency’s mission and service area. With the diversity and the number of hospitals in the County, it was quite challenging for the team to select its priorities especially when for a number of indicators the data revealed only certain parts of the County being impacted. After careful deliberation and discussions, the following two priorities were selected:

1. Increasing breastfeeding (Focus Area: Promote Healthy Women, Infants and Children) and 2. Decrease the Percentage of Blacks and Hispanics Dying Prematurely from heart related deaths (Focus Area:

Prevent Chronic Disease) The team developed an agency profile that was distributed to community partners. The profile requested each agency to provide general agency information, such as hours of operations, office locations and service areas, as well as to include current activities, training and policies in place to support the selected priorities and any new activities planned. The team also invited community partners to a half-day summit that was devoted to sharing current activities/programs and to discuss what could be done to address the selected health priorities.

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As part of its ongoing commitment to addressing the identified health priorities, the team is planning to continue meeting to review progress in implementing the improvement plans developed by each agency, to work together, when applicable, on planned activities, to discuss barriers to implementation and consider new strategies that could be adopted. The Team is also planning to regularly convene the attendees from the health summit to provide input and support on project implementation.

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Appendix C: MAP OF COMMUNITY AND REGION