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CORTLAND REGIONAL MEDICAL CENTER COMPREHENSIVE COMMUNITY SERVICE PLAN 2013--2015 INTRODUCTION Cortland Regional Medical Center’s Comprehensive Community Service Plan is prepared to comply with New York State Public Health Law, which requires all New York State hospitals produce a Comprehensive Community Service Plan every three years. Cortland Regional Medical Center is proud to utilize this opportunity to demonstrate its commitment to meeting the health care needs of the Cortland community and surrounding area. The New York State Department of Health has set forth the goal of making New York the healthiest state in the nation and has adopted the Prevention Agenda that establishes priorities to help reach that goal. Hospitals and local health departments have been enlisted to engage in collaborative efforts to address these priorities. Cortland Regional Medical Center’s Community Service Plan describes the Medical Center’s participation with community partners to assess community needs and sets forth Prevention Agenda priorities for the local community. These priorities have been established in response to the community needs assessment and in consultation with the Cortland County Health Department. The information contained in this report is intended to inform the community about the process undertaken to identify and prioritize the community’s healthcare needs and the plans Cortland Regional Medical Center has developed to address the most urgent needs. Copies of CRMC’s Community Service Plan are available at local public libraries, in the Medical Center’s in-house library, and from CRMC Administration. Summaries are also made available to community agencies through the Seven Valleys Health Coalition and at locations within the Medical Center. Additionally, this document is posted on the CRMC website at www.cortlandregional.org. CRMC invites public comment on this report, as well as on the organization, its services, and community involvement. Submit comments and inquiries to: Kelly Hirsch, Director of Quality Improvement Cortland Regional Medical Center 134 Homer Avenue, Cortland, New York 13045 ---PAGE BREAK--- 2 OUR MISSION Cortland Regional Medical Center provides quality healthcare with skill and compassion, meeting the lifelong healthcare needs of all citizens of Cortland and the surrounding communities. REAFFIRMATION OF MISSION STATEMENT Cortland Regional Medical Center has long recognized its role as a general community hospital; however, the services provided to the community have changed greatly in the 120 plus years since the hospital was established. The Medical Center’s Mission Statement has, therefore, been updated periodically to reflect those changes. The Board of Trustees initially approved the Medical Center's current Mission Statement in 2003 and reaffirmed that the Mission Statement continues to reflect accurately the Medical Center’s mission in October 2013. CRMC’s mission is stated in succinct and clear terms so that all associated with the organization can easily remember it and rely on it as a touchstone for decision-making. The current Mission Statement reflects the role of Cortland Regional Medical Center as the leading provider of healthcare services in the greater Cortland community. ---PAGE BREAK--- 3 SERVICE AREA HOSPITAL SERVICE AREA Cortland Regional Medical Center is located in the City of Cortland, County of Cortland, in the central region of New York State. The Medical Center is approximately 35 miles south of Syracuse, New York; 40 miles north of Binghamton, New York; and 24 miles northeast of Ithaca, New York. As the only hospital in Cortland County, CRMC is federally designated a sole community hospital. The Medical Center serves all of Cortland County and neighboring parts of seven contiguous counties, including Onondaga, Madison, Chenango, Broome, Tioga, Tompkins, and Cayuga. DESCRIPTION OF SERVICE AREA Cortland Regional Medical Center defines its primary service area as an 18-zip-code area in and around Cortland proper. It accounts for approximately 92% of Cortland Regional Medical Center's total inpatient admissions and approximately 52% market share. Cortland Regional Medical Center is committed to providing quality healthcare services by using available resources to meet the needs of the people who live or work in its service area. ---PAGE BREAK--- 4 PUBLIC PARTICIPATION PARTICIPANTS Cortland Regional Medical Center collaborates with the Cortland County Health Department, SUNY Cortland, and the United Way for Cortland County to maintain an ongoing community needs assessment under the auspices of the Seven Valleys Health Coalition. A Community Assessment Team (CAT) comprised of the Medical Center CEO’s designee and the Cortland County Public Health Director, as well as representatives from each of the other involved organizations, oversees the annual updating of the assessment. The first edition of Cortland Counts: An Assessment of Health and Well Being in Cortland County was released in 2001, and comprehensive assessments have thereafter been conducted every five years. In the years between full assessments, an abbreviated version, the Community Report Card, is published to provide updated highlights of the comprehensive assessment in an “at-a-glance” format. The fourth edition of the comprehensive report was released in September 2013. OUTCOMES A Blue Ribbon Committee (BRC) that includes broad community representation was established in 2002 to review the Cortland Counts assessment in light of data provided by focus groups and citizen surveys conducted by the Community Assessment Team, as well as other community research and feedback. Using both subjective and objective data, the BRC set priorities and developed a Strategic Plan that currently includes four broad tracks: Economic Development, Youth, Housing, and Health. A community organization, or coalition of organizations, is taking the lead to address each broad track: The Cortland County Business Development Corporation is spearheading economic development initiatives. The Cortland Area Communities That Care Coalition (CACTC) is coordinating efforts to improve services and expand opportunities for the youth in the greater Cortland community. Several agencies are involved in addressing the need for better quality, affordable housing. The Seven Valleys Health Coalition, in collaboration with Cortland Regional Medical Center, the Cortland County Health Department, Family Health Network, and other community-based agencies, is directing the focus on community health. The Blue Ribbon Committee meets annually and invites the entire community to participate in redefining priorities and updating the strategic plan. Cortland Counts is a key document that the Medical Center and many community agencies utilize in setting priorities for the continuation of existing services and the development of new/enhanced programs and services. ---PAGE BREAK--- 5 PUBLIC INPUT Providers: A Community Forum was held in January 2013 that included stakeholders representing each of the four Strategic Plan Tracks. Two additional meetings concerning the Health Track were held in February and May to ensure that the health goals had been clearly identified and were being addressed. Community: Focus groups were held during the first six months of 2013. Participants were asked to identify their top three health priorities from the New York State Commissioner of Health’s Prevention Agenda. The focus groups included: ▪ 4-H Teen Council Members ▪ Access to Independence Staff ▪ Cortland County Youth Bureau Students ▪ Loaves and Fishes Clients ▪ Wishing Wellness Center Clients ▪ Leaders of Health and Human Service Agencies ▪ SUNY Cortland Students ▪ Charles Street and Lawrence House Residents ▪ Cortland County Health Department Staff ▪ Cortland Regional Medical Center Staff ▪ Meals on Wheels Recipients ▪ LGBT Community Members ▪ YWCA Model Moms Participants ▪ Homer and Willet Senior Center Participants ▪ Cortland Career Works Participants A voting booth was set up at the Cortland County Chamber of Commerce Business Showcase, and attendees were given tokens with dollar values of $10, $5 and Participants were asked to place their tokens in buckets representing the issues on which they would prefer to see their money spent. Ten dollars represented the highest need. Three hundred and seventy five (375) people provided their input by casting votes. An ongoing goal is to obtain input from a broader cross section of the community, both in data collection and distribution of information. BARRIERS TO CARE/GAPS IN SERVICE Access to Quality Health Care: The surveys revealed residents of Cortland County were concerned about their ability to access high quality specialty and primary care. A shortage of primary care providers and specialists is forcing residents to travel to Syracuse, Binghamton, Ithaca, or further to receive the care they need. Mental Health Services: The inadequacy of mental health and substance abuse services in Cortland was identified as a primary gap in service. Expansion of existing clinics and exploration of partnering with larger medical facilities through telemedicine grant opportunities were proposed as possible solutions. ---PAGE BREAK--- 6 Through the efforts of the Seven Valleys Health Coalition, twice a year, visiting pediatric conduct round table discussions with parents around issues of pediatric mental health. This program has been very successful, and its expansion would be welcome if sufficient funds were available. PUBLIC NOTIFICATION OF OPPORTUNITIES TO PROVIDE INPUT Advertisements were placed in the local newspaper and announcements were distributed via e- mail and LISTSERVS. Public assistance programs were also encouraged to post the notifications and to advise clients of opportunities to participate. Upon evaluation, the process of notifying the public could be improved by placing notices where those residents whose access to healthcare is limited would be more likely to see them. Suggested locations include the County’s Senior Centers, local Food Pantries, Cortland-Chenango Rural Services, and through contact with the faith community. ---PAGE BREAK--- 7 ASSESSMENT OF PUBLIC HEALTH PRIORITIES CRITERIA OF PUBLIC HEALTH PRIORITIES Criteria: Focus groups identified the priority as one of the County’s most significant health issues. County Health Department measures related to health priorities support the public’s subjective opinion, i.e. the priority-specific County measures published in Cortland Counts deviate from state and national benchmarks and Healthy People 2020 Goals. Medical Center internal data supports issues as priorities based on patient volume and utilization of services associated with them. Use of Data: The following were the primary sources of data used to target a population. Community Forum Health Track, Focus Groups, and Community Survey Results– As described above, these activities elicited subjective data regarding health priorities. Issues consistently named “top health priorities” include Access to Quality Healthcare, Healthy Mothers/Healthy Babies, Chronic Disease, Healthy Environment, and Mental Health and Substance Abuse. Cortland Counts 2013: County statistics that deviated most significantly from state, regional, national, and Healthy People 2010 Goals were considered in defining County Public Health Priorities. (See table below.) Indicator Cortland County Upstate NY NYS National Healthy People 2020 Goal Births to Women Receiving 1st Trimester Prenatal Care 74% 70.1% 69.7% 70.2% 77.9% Cigarette Use in Women During Pregnancy 32.8% 25.5% N/A 16.2% 1.4% *Colorectal Cancer Incidence Men Women 50.1 52.9 52.1 40.8 53.3 40.0 52.2 39.3 *Lung/Bronchus Cancer Men Women 108.5 70.5 82.1 64.4 76.3 56.0 74.3 51.9 *Cerebrovascular Disease Mortality Rate 44.9 30.0 26.6 39.1 33.8 *CLRD or COPD Mortality Rate 72.3 36.2 30.5 42.2 98.5 *Cervical Uterine Cancer 4.2 7.4 8.4 7.9 *Prostate Cancer 170.2 169.5 167.3 152.0 * Rate per 100,000 ---PAGE BREAK--- 8 SELECTED PREVENTION AGENDA PRIORITIES Based on data analysis, the Cortland County Health Department and Cortland Regional Medical Center will collaborate on the following public health priorities: Chronic Disease: Focus will be on smoking cessation, with special focus on pregnant women and decreasing disability related to smoking. Additional foci include obesity and efforts to increase screenings for cardiovascular disease, diabetes, and breast, cervical and colorectal cancer. Healthy Mothers/Healthy Babies/Healthy Children: The primary focus will be on increasing the number of babies exclusively breastfeed while in the hospital, while secondarily addressing the disparity between Medicaid and non-Medicaid mothers’ decision to breastfeed. Decreasing the smoking rate among pregnant women will also be addressed. STATUS OF PRIORITIES All priorities represent existing programs either at Cortland Regional Medical Center or the Cortland County Health Department; however, a goal of this project is to increase community awareness of existing programs by involving more community members in the implementation of new initiatives related to identified priorities. ---PAGE BREAK--- 9 THREE-YEAR PLAN OF ACTION STRATEGIES FOR SELECTED PRIORITIES The priorities selected through the collaborative assessment process described in the previous section are all public health issues that have been recognized in the past as priorities for the greater Cortland community and to which CRMC and its community partners have dedicated resources. CHRONIC DISEASE Cortland Regional Medical Center and its community partners will focus on diseases of the lung related specifically to smoking, obesity and screening for diabetes, and breast, cervical and colorectal cancer. These will all be implemented using the most current evidence-based recommendations. Lung Diseases: Pulmonary Rehabilitation Program – Pulmonary Rehabilitation is an exercise program designed for patients with chronic pulmonary obstructive disease (COPD) to increase exercise tolerance and independence in activities of daily living and to decrease and utilization of medical resources. Pulmonary Rehabilitation is the one intervention that studies have found decreases hospitalizations, readmissions, and increases quality of life for COPD patients. Goal: 25% increase in patients referred to pulmonary rehabilitation program. Measurement: Number of patients referred to pulmonary rehabilitation program. Smoking Cessation Initiative – CRMC, in collaboration with the Cortland County Health Department, has undertaken a broad-based campaign against smoking. In spite of these efforts, a growing number of Cortland County women smoke during pregnancy. To address this concern, prenatal providers will be enlisted to participate in an effort to decrease the number of pregnant woman who smoke by providing education about public health referrals and evidenced-based smoking cessation strategies for pregnant women. Goal: 10% reduction in number of Cortland County women who smoke during pregnancy. Measurement: Percent of Cortland County residents who smoke during pregnancy. Obesity: Initiatives to decrease the rate of obesity in Cortland County will be undertaken to include Medical Center staff and the community at large. Promote Increased Physical Activity – There is a perceived lack of awareness among County residents about existing programs to increase physical activity. CRMC will join an effort to publicize these programs. Promote Breastfeeding – Studies show adult obesity is significantly lower among individuals who were breastfeed as infants. Further, breastfeeding success is strongly correlated to having a solid start while in the hospital. Therefore, CRMC will focus its efforts on increasing the rate of exclusive breastfeeding during the hospital stay. ---PAGE BREAK--- 10 Goal: Increase exclusive breastfeeding in the hospital to 80%, as compared with 57.6% in 2010. Measurement: Percent of mother’s delivered at CRMC who exclusively breastfeed their infant while in the hospital. Screening for CV Disease, Diabetes, and Breast, Cervical, and Colorectal Cancer: CRMC Diabetes Services – The Medical Center has been offering a comprehensive range of services to diabetics for more than 20 years. A Registered Nurse who is also a Certified Diabetic Educator (CDE) through the American Diabetes Association coordinates these services. CRMC committed significant financial resources over a two- year period to permit a staff RN to receive the training necessary to become certified. New initiatives will include determining the status of HbA1C testing, lipid testing, dilated eye exams, and nephropathy monitoring in the CDE’s overall evaluation of inpatient diabetics. There will an effort to increase the number of patients receive HbA1C testing during their hospital stay. This will be accomplished by education providers caring for these patients. Goal: Increase number of diabetic patients receiving appropriate HbA1C screening while hospitalized to 50%. Measurement: Number of diabetic patients with HbA1C drawn while inpatient. Breast, Cervical, and Colorectal Cancer Screening – Evidenced-based screening questions will be added to all admission assessments. If individuals have not had appropriate screening, referrals will be made to a provider of the patient’s choice. An informational guide regarding screening recommendations and how to access testing will be developed and placed those in the public areas throughout the Medical Center. Goal: Increase number of patients 50-75 years old with recommended colorectal screening within the last two years from 64.4% to 68%. Measurement: Percentage of adults 50-75 years old who have received the recommended screening for colorectal cancer. HEALTHY MOTHERS/HEALTHY BABIES/HEALTHY CHILDREN Exclusive Breastfeeding While in Hospital – The Medical Center will collaborate with the Cortland County Health Department and obstetrical providers to create an educational series on breastfeeding benefits for each trimester. The disparity of exclusive breastfeeding rates between Medicaid and non-Medicaid mothers will be addressed through this initiative. Goal: Increase exclusive breastfeeding in the hospital to 80% as compared with 57.6% in 2010. Measurement: Percent of mothers delivered at CRMC who exclusively breastfeed while in the hospital. Goal: Decrease discrepancy between numbers of Medicaid mothers who exclusively breastfeed compared to non-Medicaid mothers from .74 to .66. Measurement: Ratios of Medicaid to non-Medicaid mothers who exclusively breastfeed in the hospital. ---PAGE BREAK--- 11 Smoking Cessation – A remarkably high percentage of women in Cortland County smoke cigarettes throughout their pregnancy. The Medical Center will target pregnant women to receive smoking cessation education through collaboration with the Cortland County Health Department and prenatal providers to increase public health referrals and to implement evidenced-based efforts to assist pregnant women with smoking cessation. Goal: 10% reduction in number of Cortland County women who smoke during pregnancy. Measurement: Percent of pregnant Cortland County residents who smoke. Pre-term Birthrate – Lower the preterm birthrate by decreasing smoking during pregnancy, increasing early prenatal care, and providing education to providers about the importance of not performing elective preterm deliveries. Goal: Reduce the percentage of infants delivered prior to 37 weeks from 10.8% to 9.5%. Measurement: Percent of infants delivered prior to 37 weeks. ---PAGE BREAK--- 19 DISSEMINATION OF COMMUNITY SERVICE PLAN PUBLIC INFORMATION Pertinent information regarding Cortland Regional Medical Center’s public health programs, as outlined in its Community Service Plan, will be disseminated to the public in a variety of ways and will include information about the availability of, and instructions for making application for, financial assistance. Pamphlets: A pamphlet summarizing CRMC’s Community Service Plan is being prepared that will highlight the community assessment process, the public health priorities selected for emphasis in the coming three years, the programs available to address these priorities, and information about CRMC’s financial assistance program. Pamphlets will be provided to the member agencies of the Seven Valleys Health Coalition for distribution to their respective clients. Pamphlets will also be made readily available at various locations on the Medical Center’s campuses. Libraries: A copy Cortland Regional Medical Center’s Community Service Plan will be placed in the County’s public libraries, including Cincinnatus, Cortland, Homer, Marathon, and McGraw. A copy will also be available in the Medical Center’s in-house library. Websites: CRMC’s Community Service Plan will be posted on the Medical Center’s website at www.cortlandregional.org and on the website of the Seven Valleys Health Coalition at www.sevenvalleyshealth.org. ENGAGEMENT MAINTENANCE There will be ongoing meetings between the Cortland County Health Department and Cortland Regional Medical Center. These meeting will be held on a basis to start and at least quarterly to monitor the progress of common initiatives. Depending on the initiative, involved community partners will be invited to meetings that involve their respective topic areas or interventions.