Adena Greenfield Medical Center HIGHLAND COUNTY 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGIES. 0 P age

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1 Adena Greenfield Medical Center HIGHLAND COUNTY 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGIES 0 P age

2 ADENA HEALTH SYSTEM Adena Greenfield Medical Center (AGMC) is a part of the Adena Health System. Since 1895, Adena Health System has remained focused on its commitment to provide patients with the best healthcare and personal service. Today, Adena Health System includes three hospitals (Chillicothe, Greenfield and Waverly) and five regional clinics, with a total of 311 beds. Adena provides quality healthcare for the more than 500,000 residents within its 12-county, southern Ohio service region, which includes Adams, Athens, Fayette, Gallia, Highland, Hocking, Jackson, Pickaway, Pike, Ross, Scioto and Vinton Counties. Adena offers its patient s leading edge services in the areas of heart health, cancer diagnosis and treatment, women's health; children's health; and orthopedics. The skilled physicians and medical staff at Adena provide a number of specialty services that are typically found in larger medical centers. These include: open heart surgery; da Vinci robotic surgery; cardiac intervention; cancer care; advanced orthopedic procedures; high level MRI testing; and a Level II pediatric nursery. Progress on the 2013 Community Health Needs Assessment Adena Health System and Adena Greenfield Medical Center completed a community health needs assessment and implementation strategies plan in 2013 for Highland County. The plan identified one primary health need, obesity, and two secondary community health needs: mental and behavioral health; smoking (Figure 1) Highland County Community Health Needs Assessment Community Health Focus and Priorities Focus Health Priorities Strategies Primary Obesity High Blood Pressure Joint/Back Pain Heart Disease Employee Health Initiatives Community Programming Regional Initiatives Secondary Mental/Behavioral Health Stress Depression Drug Abuse Smoking Cancer Chronic Respiratory Disease Figure 1: Adena s 2013 Community Health Needs Assessment Priorities 1 Adena Health System CHNA Implementation Strategies Advocacy Referral Resources Cessation Resources Screening

3 A community health plan was developed around these health priorities using four primary strategies: advocacy; referral; cessation resources; and screening services. Community health programming was then developed around these issues and piloted with Adena Health System employees as part of the employee health and wellness program. Programs were refined and then expanded for implementation into the Highland County community (Figure 2). Employerl Health & Wellness Community Health Impact Ini;a;ve Adena Employee Health & Wellness Plan Figure 2: Adena s 2013 Approach to Community Health Program Development As a result of these efforts, Adena Health System developed multiple programs focused on educating the public on obesity. Advocacy efforts and cessation resources were developed and promoted for mental and behavior health issues, as well tobacco use. Figure 3 provides an outline of the programs that were developed and implemented from 2013 to 2016 for Highland County. Table 1 outlines the actions, progress and outcomes. Primary Health Priority OBESITY Move More Ini;a;ve Healthy Kids Diabetes Expo Secondary Health Priority MENTAL/BEHAVIORAL HEALTH Baby Centered Recovery Secondary Health Priority SMOKING Adena Quit Clinic Lung Cancer Screenings Figure 3: Adena s 2013 Through 2016 Health Priorities Programming For Highland County 2 A dena Health System CHNA Implementation Strategies

4 Table 1: Adena Community Health Needs Assessment Implementation Strategies Actions and Progress Health Priority 2013 Proposed Implementation Strategies 2014 Actions/Progress 2015 Actions/Progress Primary Health Priority Obesity Employee Health Initiatives AHS Community Health Advancement will collaborate with community partners to implement broader scale health and wellness programs, centered around movement, nutrition and wellbeing, previously developed and piloted by the AHS internal employee health and wellness program. In addition, partnerships with local community agencies will be facilitated as part of a diabetes management initiative for high-risk diabetic patients. In 2014, Adena Health System restructured its internal Health & Wellness team to create an evidence-based health and wellness platform by developing and refining programs for health system employees (residents of the service region) that could be implemented on a larger scale in the community. The team successfully created a model built around three components proven to drive improved individual health and wellness: movement; nutrition and wellbeing. The team coordinated programming within these three areas based out of the Adena Regional Medical Center Campus. Programs included a campus based walking program, Weight Watchers at Work, and stress management classes in addition to established offerings including Family Fit and Adena Fit. The programs implemented at the Adena Greenfield Medical Center campus include the walking program and the Adena Fit programs. Employees at the Greenfield location are encouraged to engage in the remainder of the programs at Adena Regional Medical Center. A communication plan was built around the programming to ensure effective communication to employees. In addition, a competitive challenge for employees, Move More Adena, was also coordinated to encourage 90 minutes of activity per week, as well as a venue to market other employee health and wellness offerings. The team successfully engaged more than 35% of the total employee population through these initiatives in In 2015, AHS continued its internal efforts around Employee Health and Wellness (including Greenfield employees) by expanding and implementing evidence-based health and wellness programming built on three different pillars movement, nutrition and well-being. Some programming was also expanded into the greater Ross County Community. The team continued the campus based walking program, Weight Watchers at Work, Adena Fit, and stress management classes. The communication plan developed in 2014 was expanded into social media, representatives from the organization s Health & Wellness committee rounded to departmental meetings, offsite locations and coordinated a Health & Wellness Fair to ensure effective communication to employees. The Move More challenge was kicked off again in May of 2015 with more than 700 Adena employees participating, including Greenfield employees. An initiative improving healthier eating options in the Greenfield cafeteria was also implemented. The overall fruit and vegetable consumption was increased and labeling of fresh serve items was introduced. All of the Health & Wellness Programming again engaged more than 35% of the total employee population through these initiatives in Community Programming AHS Community Health Advancement will collaborate with community partners to implement broader scale health and wellness programs, centered around movement, nutrition and wellbeing, previously developed and piloted by the AHS internal employee health and wellness program. In addition, partnerships with local community agencies will be facilitated as part of a diabetes management initiative for high-risk diabetic patients. AHS Community Health Advancement collaborated with a variety of Highland community partners to coordinate and deliver community program aimed at promoting movement and nutrition. Programs at based or facilitated through the Pike Medical Center included: The Family Fun and Safety night at Greenfield Local Schools. Over 250 children and their families attended the event and were provided health and safety information, a healthy snack, games and prizes. AHS Community Health Advancement again collaborated with a variety of community partners to coordinate and deliver community programs aimed at promoting movement and nutrition. Programs included: The Family Fun and Safety night at Greenfield Local Schools, where over 250 children and their families attended the event and were provided health and safety information, a healthy snack, games and prizes. The Move More challenge was expanded into the community (including neighboring counties) with six local employers (including the second and third largest employers in the region) promoting the challenge to their own employees. While employee participation for Adena employees was down 15% for 2015, participation overall with community involvement was increased by 22% from the previous year. Regional Initiatives AHS will coordinate a Community Health Advancement office to coordinate and implement regional information and awareness campaigns designed to inform the public on the obesity epidemic, its impact on individual health and effective strategies at reducing and controlling weight, specifically movement, nutrition and weight. The Community Health Advancement office was restructured in The Director for the office immediately started with coordination of the Employee Health & Wellness Committee which completed and began execution of its plan in August. In addition, a Corporate Events Coordinator was added to support the director facilitate event set-up and delivery, as well as align health and wellness programming with community events. A community health focus and message, Move More, Eat Better was finalized and set for implementation in The community health focus and message, Move More, Eat Well was finalized and implemented in Banners for approximately 15 community events (county fairs, festivals, senior health fairs, employee health fairs and health expos) were displayed throughout six counties (Fayette, Ross, Highland, Pike, Jackson, and Pickaway) as well brochures and educational information on physical activity and nutrition were distributed. Social media posts on benefits to proper nutrition and fitness were also posted on Facebook throughout the year. There were also two one hour radio programs featuring Adena physicians and representatives aired during P age

5 Health Priority Secondary Health Priorities Mental & Behavioral Health 2013 Proposed Implementation Strategies 2014 Actions/Progress 2015 Actions/Progress Advocacy AHS/ARMC will support a variety of community partners including public health and social services to advocate for expanded access to mental and behavioral health services. This includes participating in Medicaid Expansion efforts to enable patient access to services. AHS/Community Health Advancement will inform legislators and public officials on the lack of mental and behavioral health services within the region, as well as possible strategies to address the need. As one of 3 health system participants in the Strong Start Ohio project (from the Governor s Office of Health Transformation) AHS began delivering prenatal care to pregnant women with addiction issues using a CenteringPregnancy model at the Adena Regional Medical Center Campus. This project provided a monthly opportunity to inform the State of Ohio about barriers to achieving positive birth outcomes, including access to longer-term addiction treatment in southern Ohio. Approximately 10% of the 77 women served through the program in 2014 were from Highland County Ohio. The AHS Director of Community Health Advancement also served on the Southeast Ohio Medicaid Expansion Committee, to participate in efforts to expand Medicaid coverage to the region s residents. This group also informs state government on the need and benefit of affordable health care in southern Ohio. AHS continued its support of multiple community partners in 2015 to advocate for expanded access to mental and behavioral health services. AHS continued delivery of prenatal care to high-risk pregnant women, including those with addiction issues using a CenteringPregnancy model at the Adena Regional Medical Center Campus. A total of 200 women (approximately 10% from Highland County) were served in 2015 with those participating in the program achieving better birth outcomes overall than those opted not to participate. This project provided a monthly opportunity to inform the State of Ohio about barriers to achieving positive birth outcomes, including access to longer-term addiction treatment in southern Ohio and will be reimbursed for in The AHS Director of Community Health Advancement continued participating in the Southeast Ohio Medicaid Expansion Committee, around efforts to expand Medicaid coverage to the region s residents. This group also informs state government on the need and benefit of affordable health care in southern Ohio. Referral Resources AHS/ARMC will continue to operate the regions only acute inpatient, psychiatric unit for insured, uninsured and under insured patients. AHS/ARMC will collaborate with local mental and behavioral health providers to provide referrals to community mental health, behavioral health and material assistance resources. AHS continued to operate the region s only acute inpatient, psychiatric unit for insured, uninsured and under insured patients in 2014 at the Adena Regional Medical Center. AHS Women s & Children s, Primary Care and Pain Management service lines made referrals for patients needing mental and behavioral health services in Pike County to the Adena Counseling Center, Paint Valley Mental Health Center, Adena Women s and Children s CenteringPregnancy program. AHS continued to operate the region s only acute inpatient, psychiatric unit for insured, uninsured and under insured patients in 2015 at the Adena Regional Medical Center (including patients from Highland County). AHS Women s & Children s, Primary Care and Pain Management service lines made referrals for patients needing mental and behavioral health services in Highland County to the Adena Counseling Center, Highland County Community Action, Recovery Council, Paint Valley Mental Health Center, and the Adena Women s and Children s CenteringPregnancy program. Smoking AHS/ARMC will provide financial and human resources to help maintain the local network, a phone and web-based community resource platform that provides updated and on-demand to local social service, material assistance, mental and behavioral health resources. Cessation Resources AHS/ARMC will commit human and financial resources to expanding its opiate addiction program for pregnant women, as well as expanding access to male and non-pregnant women through an Ambulatory Detox program. Screening AHS/ARMC will implement screening tools within its Emergency Department and primary care clinics to assist physicians in identifying patients with mental health or social service needs. Cessation Resources AHS/ARMC will provide financial and human resources to coordinate a smoking cessation program. AHS served a total of 25 women, 8 from Highland County, addicted to opiates as part of its CenteringPregnancy program in In addition, a work team was convened to review community need, demand and opportunities for expansion of current AHS mental and behavioral health opportunities. In 2014, each AHS implemented a screening policy to identify possible mental and behavioral issues with patients presenting in the emergency rooms of Adena Health System hospitals. Along with provider smoking cessation counseling provided to patients self-identified as smokers, AHS has convened a work team to identify additional opportunities to identify and provide intervention to current smokers who are patients of Pike County AHS providers. AHS served a total of 114 women addicted to opiates as part of its CenteringPregnancy program in 2015 (including patients from Highland County). The work team convened to review community need, demand and opportunities for expansion of current AHS mental and behavioral health opportunities also developed relationships with Maryhaven and Compass Community Health to assist with expanding drug addiction support services, including housing, in Ross County. In 2015, AHS continued its screening policy to identify possible mental and behavioral issues with patients presenting in the emergency rooms of Adena Health System hospitals, including the Adena Greenfield Medical Center. The Adena Quit Clinic was piloted at the PACCAR/Kenworth Trucking Company in A total of 45 participants were served as part of the program that utilizes pharmacists, trained in the US Public Health Services 5 A s methodology, to assist tobacco users in cessation. The program will be expanded to Adena employees, including those who live in Highland County, in Screening AHS/Adena Cancer Center offers a free lung screening program to current and former smokers and in identified high-risk groups. Testing identifies the early signs of lung cancer or other disease. AHS Cancer Center provided 194 patients with free lung screenings in 2014, with 13 patients who were identified with early stage lung cancer. AHS Cancer Center provided 662 patients with free lung screenings in 2015 (including patients from Highland County), with 16 patients who were identified with early stage lung cancer. 4 A dena Health System CHNA Implementation Strategies

6 Highland County Health Collaborative To truly improve health through solutions that address social, cultural, and biological determinants of health, Adena physicians and caregivers recognize the need to partner directly with surrounding community. Adena s vision is to be instrumental in helping to create healthy, thriving communities. For this reason, community engagement along with patient care and education is a key strategy in impacting the health of the community. Since 2011, Adena has actively participated in the Highland County Health Collaborative, a community health coalition consisting of seven active local agencies including Highland District Hospital, Adena Greenfield Medical Center, Ohio Department of Job and Family Services, Scioto Paint Valley Mental Health Center, Paint Valley ADAMH Board, FRS Counseling and the Highland County Health Department. This group worked in partnership with Highland County Community Action and The Ohio State University College of Food, Agriculture, and Environmental Sciences from 2015 to 2016 to complete a community health needs assessment (CHNA) that included a community health survey. The assessment was funded through a grant from the Ohio Department of Health. Adena Health System and the Adena Greenfield Medical Center have adopted and used the final CHNA to develop its implementation strategies for to ensure alignment with broader community initiatives in Highland County. Both the 2016 Community Health Needs Assessment and Community Health Improvement Plan are available on the Adena Health System website as this Implementation Strategy. COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) Data Summary As part of the community health needs assessment (CHNA) process, both primary and secondary data to identify priority health areas for the Ross County community. Secondary data was collected on demographics, socio-economic determinants, disease prevalence, in addition to vital statistics data. A public survey and focus groups were also conducted to collect primary data around health behaviors and environmental factors contributing to poor health. This data was then reviewed by health professionals from Highland County and health to determine health priorities. Figure 4 outlines the primary health issues prioritized in order by the Highland County Health Collaborative as part of the CHNA. 5 P age

7 Breast Cancer (47%) Skin Cancer (38%) Top Reported Cancers Top Health Concerns Lack of substance abuse services Illegal drug abuse High smoking rate (27%) Top Mental Health Issues Depression(39%) Anxiety (35%) Figure 4: Highland County Health Collaborative 2016 Community Health Needs Assessment Findings ADENA COMMUNITY HEALTH IMPLEMENTATION STRATEGIES Priorities The Adena Health System and the Adena Greenfield Medical Center utilized the Highland County Health Collaborative CHNA to develop a Implementation Strategies Plan for the Adena Greenfield Medical Center (AGMC). AGMC is dedicated to ensuring the health system s vision of being instrumental in creating healthy, thriving communities. The findings and recommendations from Highland County Health Collaborative assessment will be aligned and tracked by AGMC s Board of Trustees and employees. In addition, it will be shared with local media and AGMC s broad community 6 A dena Health System CHNA Implementation Strategies

8 partner base. This will contribute to awareness about Greenfield and Highland County s health priorities and progress in implementing community health improvement strategies. AGMC utilized the Highland County Health Collaborative CHNA to prioritize its community health programming. Several strategies, based from successes of the community health programming. A total of five strategies were identified to address the health needs based on the capability of AGMC and participating community agencies to address the issue. Figure 5 outlines the 2016 Highland County community health priorities. Figure11: Highland CHNA Health Priorities Figure 5: Highland County CHNA Priorities Adena Greenfield Medical Center aligned its community health strategies and programming with the Highland County Health Collaborative CHNA. Although AHS and AGMC may not be able to fully address all the needs identified, AGMC will contribute, in addition to the Collaborative, to local coalitions and steering committees. This will enable Adena Regional Medical Center to contribute to cross system collaboration, visibility, and health communication. Community health programming will focus on the four areas: addiction; obesity/diabetes; lung and respiratory; depression and anxiety. Although diabetes was not identified in the 2016 assessment as a priority by the Highland County Community, Adena will continue efforts around this issue due to the high number of obese and diabetic patients it provides care. An analysis, based from the report data was compared to current programming ( ) results to establish programing outlines. Based off of current programming success, Adena Greenfield Medical Center will utilize five key strategies to address the five health priority areas. These include infrastructure building, advocacy, education, programming and financial support. Infrastructure development (Table 2) will consist of alignment with other, pertinent coalitions (i.e. Highland County Drug Abuse Prevention and developing task force), as well as partnering with other agencies to develop committees that currently do not exist for obesity and diabetes, respiratory and lung, and mental health. In addition, relationships with partners who may be able to provide services or parts of the continuum that are not currently in existence will also be sought. Community reporting mechanisms to measure the effectiveness of services on the continuum will also be developed. 7 A dena Health System CHNA Implementation Strategies

9 Advocacy will also be a key strategy. Adena Greenfield Medical Center currently has three employees who serve on the Highland County Health Collaborative. Highland County currently has plans to convene a drug task force, which Adena will provide representatives. Adena Greenfield Medical Center will also utilize the Adena Health System marketing and communications department to create public service announcement around each of the five key health issues that be delivered via local radio, newspaper and the Health System s Facebook and Instagram pages which have more than 11,000 followers. Education is another strategy that will be utilized by Adena Greenfield Medical Center. The hospital will provide education on each of the five key issues via Walk With a Doc events to be coordinated on a monthly basis in Greenfield and Hillsboro, Here for Life Education events, as well as bi-yearly health expos. Programming is also another strategy that will be utilized to address the key community health priorities. Adena s Baby Centered Recovery program delivered at the Adena Regional Medical Center will serve pregnant women with addiction issues from the region, including Highland County. The Adena Family Fit program, operated in partnership with the Highland County YMCA, as well as Adena Move More Challenge will be offered to address obesity and diabetes related issues. Adena s Quit Clinic and free lung cancer screenings will be offered to assist in addressing the lung and respiratory issues (related to smoking). All primary care physicians of Adena Health System will begin screening patients for depression and mental health issues in 2017 to help address the depression and anxiety in the community. Adena Health System will also provide financial support to a number of programs and initiatives operated by its community partners in Highland County. This includes drug prevention programs program operated by public schools in Highland County and support of Healthy Kids program operated by the local libraries as part of summer reading. Adena Health System will also support the improvement and expansion of the local directory which will help navigate community members to all health and social services. Table 2 provides a summary of Adena s programs. Tables 3 through 7 provide a breakdown of how the strategies will be utilized for each priority health issue. 8 A dena Health System CHNA Implementation Strategies

10 Table 2: Adena Health System s Summary of Strategies for Top Health Priorities Adena Strategy Addiction (Table 2) Obesity (Table 3) Respiratory (Table 4) Depression (Table 5) Infrastructure Building Align with new Highland County Heroin Task Force Partnership with Maryhaven for services in Ross County Convene a fitness and nutrition committee Develop standard health continuum progress reporting Convene respiratory and lung committee Develop standard health continuum progress reporting Convene a mental health committee / align with ADAMH Board Develop standard health continuum progress reporting Employee Health Initiatives Advocacy Provide Adena representative to with new Highland County Heroin Task Force Public Service Announcements Provide Adena Representative to committee Public Service Announcements Provide Adena Representative to committee Public Service Announcements Provide Adena Representative to committee Public Service Announcements Education Here For Life Education Series Here For Life Education Series Here For Life Education Series Here For Life Education Series Walk With a Doc Walk With a Doc Walk With a Doc Walk With a Doc Diabetes Expos Heart Health Expo Lung Cancer Awareness month Programming Baby Centered Recovery Family Fit Move More Adena Quit Clinic expansion Free Lung Cancer screenings Primary Care Depression Screening Financial Support Drug Prevention Program Healthy Kids Programs Smoking prevention 211 Directory 9 P age

11 Table 3: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Addiction Addiction Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Greenfield Medical Center will begin participation in the new Highland County Heroin Task Force. In addition, AHS will facilitate partnership with Maryhaven to provide individual outpatient therapy, medication assisted treatment and housing for recovering addicts in the region in and around Ross County Ohio, including Greenfield and Highland County. Advocacy Adena Health System and Adena Greenfield Medical Center will continue participation in the new and developing Highland County Heroin Task Force. In addition, the communication and marketing department of Adena Health System will develop public service announcements to increase community awareness and education of drug use and services using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Greenfield. One event will focus on drug addiction, intervention and treatment options. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held twice per month in Highland County and Downtown Greenfield and have approximately in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on addiction symptoms and interventions Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Greenfield Medical Center. Programming Adena Regional Medical Center will continue to deliver the Baby Centered Recovery program. This is a nine month program that provides weekly medication assisted treatment and group counseling to pregnant women with addiction issues by an Adena Social Worker. Approximately 50 women per year from in and around Ross County are served through the program. Financial Support Adena Health System and the Adena Regional Medical Center will provide financial support to drug prevention program in Highland County high schools Anticipated Impact Impact Evaluation It is anticipated that reduction in key health indicators, reported drug and alcohol use and overdose deaths will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower rates of death due to overdose. AHS/AGMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. 10 P age

12 Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported drug and alcohol use. Aggregate data on patient population will be utilized to measure long term, broad based community programming and initiatives, as well County Health Rankings data. Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) AHS/AGMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/AGMC has several community partners, including agencies participating in the Highland County Health Collaborative, that have expressed interest in collaborating on regional initiatives and community programming, including Scioto Paint Valley Mental Health, ADAMH and the Recovery Council. 11 A dena Health System CHNA Implementation Strategies

13 Table 4: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Obesity and Diabetes Obesity and Diabetes Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Greenfield Medical Center will participate with Highland County partners in convening an obesity and diabetes prevention subcommittee. In addition, standard health continuum progress reporting and metrics will be developed for the group. 12 P age AHS Community Health Advancement will continue operation an internal Health & Wellness team to create an evidence-based health and wellness platform by developing and refining programs for health system employees (residents of the service region) that can later be implemented on a larger scale in the community the following year. Advocacy Adena Health System and Adena Greenfield Medical Center will provide a representative to participate on the obesity and diabetes committee. In addition, the communication and marketing department of Adena Health System will develop public service announcements to increase community awareness and education of fitness and nutrition information using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in Greenfield and Hillsboro. One event will focus on obesity related interventions include diet and exercise. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held twice per month in Highland County and Downtown Greenfield and have approximately in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on fitness and nutrition. Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Greenfield Medical Center. Programming Adena Health System and Adena Greenfield Medical Center will begin delivering the Adena Family Fit program at the Highland County YMCA. This is a six week program delivered for two hours once per week to approximately 10 families or people. Dieticians deliver education and cooking tips, while YMCA representatives lead the groups in physical activity. Fitness and proper nutrition are the focus of the program. Adena Health System and Adena Greenfield Medical Center will continue to coordinate the Move More Challenge in Highland County. Approximately 1,000 people participate each year in the 12 week challenge designed to encourage at least 90 minutes of exercise per week. Adena Health System and Adena Regional Medical Center will fund and coordinate a Diabetes Expo and a Heart Health Expo in Highland County in These four hour events have providers and clinicians speak on disease, medication and nutrition management. Community partner provide cooking and fitness demonstrations as well.

14 Financial Support Adena Health System and the Adena Greenfield Medical Center will provide financial support to the Highland County Bookworm/Healthy Kids Summer Challenge. Approximately 1,500 children sign up for the program each summer and are challenged to try healthy activities as part of the reading challenge. Small incentives are provided after challenges are completed. Anticipated Impact Impact Evaluation To develop and refine evidence-based health and wellness initiatives and programming, as well as using health risk assessment tools to measure impact and success rate. By starting with its employees, AHS will have the opportunity for greater success in initiatives delivered on a broad base to community. It is anticipated that reduction in key health indicators, blood pressure, blood glucose and BMI will be seen on engaged populations in the more immediate future (5 years), with the longer term (10 years) effects resulting in lower rates of death due to heart disease. AHS/AGMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) Health Risk Assessment data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Health risk assessment data will evaluate the initiative and programming impact of the internal Health & Wellness program on employees. This will include movement in key obesity related risk factors such as blood pressure, blood glucose, BMI and cholesterol. Aggregate data on patient population will be utilized to measure long term, broad based community programming and initiatives, as well County Health Rankings data. Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) AHS/AGMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/AGMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the YMCA, other local fitness centers, and the local health department. 13 A dena Health System CHNA Implementation Strategies

15 Table 5: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Respiratory and Lung Issues Respiratory and Lung Strategies Infrastructure building Advocacy Education Programming Actions Infrastructure Building Adena Health System and Adena Greenfield Medical Center will participate in convening lung and respiratory sub-committee. In addition, standard health continuum progress reporting and metrics will be developed for the group. Advocacy Adena Health System and Adena Greenfield Medical Center will provide a representative to participate on a lung and respiratory committee coordinated with Highland County partners. In addition, the communication and marketing department of the hospital will develop public service announcements to increase community awareness and education on the dangers of smoking and lung cancer screening events using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Greenfield and Hillsboro. One event will focus on respiratory related interventions including smoking cessation. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held twice per month in Highland County and Downtown Greenfield and have approximately in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 education on smoking cessation and the dangers of smoking. Education and smoking cessation will also be provided to patients who request information by physicians, providers and pharmacists of Adena Health System and Adena Greenfield Medical Center. Programming Adena Health System and Adena Greenfield Medical Center will continue to deliver the Adena Quit Clinic located on the campus of the Adena Regional Medical Center. This is a three month program delivered in 15 minute appointments with a pharmacist every two weeks to approximately people per year. Adena Health System and Adena Greenfield Medical Center will also continue to coordinate free lung cancer screenings (CT scan) for more than700 patients each year at the Adena Cancer Center located on the campus of the Adena Regional Medical Center. Anticipated Impact Impact Evaluation It is anticipated that reduction in key health indicators, reported tobacco use and lung cancer occurrence will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower rates of death due to lung cancer. AHS/AGMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported tobacco use, lung cancer occurrence and death. Aggregate data on patient population will be utilized to measure long term, 14 P age

16 Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) broad based community programming and initiatives, as well County Health Rankings data. AHS/AGMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/AGMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the Highland County Health Department. 15 A dena Health System CHNA Implementation Strategies

17 Table 6: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Depression and Anxiety Depression and Anxiety Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Greenfield Medical Center will participate with local Highland County partners in convening a mental health sub-committee. In addition, standard health continuum progress reporting and metrics will be developed for the group. Advocacy Adena Health System and Adena Greenfield Medical Center will provide a representative to participate on the mental health committee. In addition, the communication and marketing department of the hospital will develop public service announcements to increase community awareness and education on mental health issues using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Greenfield and Hillsboro. One event will focus on depression related interventions. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held twice per month in Highland County and Downtown Greenfield and Hillsboro and have approximately in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on depression and recognizing symptoms. Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Greenfield Medical Center. Programming Adena Health System and Adena Greenfield Medical Center will screen primary care patients starting in Adena provides more than 170,000 primary care visits per year. Referral to counseling and other community resources will be provided as needed. Financial Support Adena Health System and the Adena Greenfield Medical Center will provide financial support to the mental health committee, as well as Scioto Paint Valley Mental Health to support operation and improvement of the directory housed by their organization. This phone directory provides navigation to many healthcare and social services, including mental health resources in a five county area including Highland. Anticipated Impact Impact Evaluation It is anticipated that reduction in key health indicators, poor mental health days and quality of life ratings will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower suicide rates and overdose deaths. AHS/AGMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported poor mental health days and low 16 P age

18 Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) quality of life ratings. Aggregate data on patient population will be utilized to measure long term, broad based community programming and initiatives, as well County Health Rankings data. AHS/AGMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/AGMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the Scioto Paint Valley Mental Health Center, ADAMH, Recovery Council and FRS Services. ADDITIONAL INITIATIVES AND RESOURCES While Adena Health System and Adena Greenfield Medical Center have targeted programs towards many of the significant priority health needs identified in the 2016 CHNA, there are also other initiatives and resources that address these and other health concerns in the community. Unintentional injuries, in general, were not addressed as part of the implementation plan. The primary cause of unintentional injuries in Highland County is automotive accidents and drug overdose deaths. AHS and AGMC did not have the capabilities or resources between 2013 and 2015 to deliver a driver safety campaign. The AGMC does deliver Narcan and resource referrals to those presenting with a drug overdose in its emergency room. Adena Family Medicine - Residency Clinic The Adena Family Medicine - Residency Clinic is a hospital clinic providing affordable, quality health care. The Clinic pairs accessible primary care medical services provided by physician interns and residents of Adena s Graduate Medical Education program, family and internal medicine preceptors and a certified nurse practitioner also providing services to patients in the clinic. For more information, go to: The Clinic at Walmart Chillicothe and Washington Court House In 2012, AHS entered into agreements to enhance access to high quality, affordable health care services in Chillicothe and Washington Court House at local Walmart stores in these respective locations. In each community, Adena opened and maintained a walk-in, retail clinic with extended evening and weekend hours. The clinic and its team specialize in quick, walk-in appointments for cold, flu, sinus infections, immunizations, sports and school physicals. The Washington Court House clinic is located 14 miles from Greenfield. Hope Clinic of Ross County The Adena Health System provides both financial and volunteer resources to the Hope Clinic of Ross County. Hope clinic provides free medical, dental and vision care to uninsured individuals from the 17 A dena Health System CHNA Implementation Strategies

19 surrounding region, including Highland County one evening per week at its location in Chillicothe. More than a dozen Adena nurses and physicians volunteer their time at the clinic. Community Health Programs AHS and AGMC offers community health programs and events in various locations throughout the year to help our community lead healthier lives through wellness education and the prevention of illness and injury. Topics include, but are not limited to the following: cancer; diabetes; heart disease; bone and joint care; childbirth; multiple sclerosis; stroke; and wellness. Following these health seminars, an evaluation form is distributed to request feedback about both the content of the program as well as the speaker. It also asks for other topics of interest and general feedback. Adena Health System and Adena Greenfield Medical Center also provide free and reduced cost breast health screenings and diagnostics for qualifying patients as a grant recipient of Komen Columbus. More than 75 women are provided services through this program each year. AHS coordinated and facilitated the Head to Toe Expo at the Chillicothe Middle School in 2015 which engaged more than 200 community members on orthopedic and neurologic health issues. The event, attended by members of the Highland County community, included a vendor expo that showcased community health partners and Adena Health System services, provided blood pressure checks, diabetes information, and bone density screenings (there was no invasive testing ), as well as offered six concurrent education sessions and featured a celebrity guest speaker. Community Collaborations Adena Health System has three employees who participate as part of the Highland County Health Collaborative. This coalition meets monthly and has six agencies that participate regularly as part of the coalition. Community Events AHS and AGMC also participates in general health fairs/community events, employer health fairs and senior health fairs, often organized by other community organizations. At the general health fairs/community events, Adena provides bone density screenings, Ask the Doctor opportunities, diabetes information, pediatricians - general information, and geriatricians - general information. There is no invasive testing e.g., blood sugar, cholesterol, HIV testing, etc. at any of these events. APPROVAL OF CHNA AND IMPLEMENTATION STRATEGIES The Board of Trustees of the Adena Health System and the Adena Greenfield Medical Center, at its regular meeting on December 1, 2016, approved the adoption of the Community Health Needs Assessment completed in collaboration with the Highland County Health Collaborative. In addition, the implementation strategies outlined by Adena s Director of Community Health Advancement were also approved for Adena Health System and Adena Greenfield Medical Center. 18 A dena Health System CHNA Implementation Strategies

20 19 P age