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Columbia Memorial Hospital Community Service Plan Update 2014-2017


New York State Department of Health (NYSDOH) requires that hospitals and local health departments collaborate with each other and community partners on the development of Community Health Assessment and hospital Community Health Improvement Plans. In keeping with the New York State Improvement Plan, the Prevention Agenda 2013-17, Columbia Memorial Hospital has recognized that collaboration is an essential element for improving population health in our community. Working together to develop a community health assessment and community improvement plan will reduce duplication and assist local health departments to conduct this work in an effective, efficient manner. The development of this document and the assessment has served to meet the requirements of Article 6 and Article 28 of the state public health law. In addition, the Affordable Care Act requires nonprofit hospitals to conduct a periodic community health needs assessment and adopt an implementation strategy to meet the community health needs identified in the assessment. This document is intended to facilitate responses to these requirements and promote collaboration while recognizing the role that the community plays in multi-sector planning and action to address health outcomes.

1. Mission Statement: The mission of Columbia Memorial Hospital is to provide our communities with safe, high quality, comprehensive health care services in a dignified and compassionate environment.

2. Community Definition:Columbia Memorial Hospital (Columbia Memorial) serves Columbia, Greene and parts of northern Dutchess County. For the purposes of this Community Service Plan, the service areas defined herein include the zip codes in Columbia and Greene Counties.

Columbia County is located in the northeastern region of the Mid-Hudson Valley of New York State. It is bordered on the north by Rensselaer County, on the south by Dutchess County, on the east by Berkshire County of the Commonwealth of Massachusetts and on the west by the Hudson River opposite Greene County. Columbia County comprises a total of 643 square miles or 411,520 acres. Based on the U.S. Census, Columbia County's population is 63,096. Columbia County is basically rural in nature and includes the City of Hudson; 18 towns, including Ancram, Austerlitz, Canaan, Chatham, Claverack, Clermont, Copake, Gallatin, Germantown, Ghent, Greenport, Hillsdale, Kinderhook, Livingston, New Lebanon, Stockport, Stuyvesant and Taghkanic, and the four villages of Chatham, Valatie, Kinderhook and Philmont.

Columbia County's local economy is diversified with small private businesses, State and municipal agencies and not- for- profit public service agencies. Many residents of both counties commute to private and public employers in the greater Albany area. Columbia County is also home to a significant community of second home owners from New York City area.

According to the U.S. Census, 15,900 Columbia County residents are under the age of 18, another 36,154 are between the ages of 18 and 65, and 11,042 are over age 65. Columbia County ranks 8th in the State for persons age 65 years and older and first in the state for persons over age 85 years.

Columbia Memorial operates 41 Family Care/ Specialty Centers located throughout Columbia, Greene Counties, and 1 Center in Dutchess County.

Greene County is situated between the mile-wide Hudson River on the east and the Catskill Mountains at the southern and western ends. Greene County is bordered by Albany County to the north, Rensselear County to the northeast, Columbia County to the east, Ulster County to the south, Delaware County to the west and Schoharie County to the northwest. Greene County is rural in nature and covers 658 square miles with a population of 48,954 located in 15 towns and 5 villages which are scattered along the western bank of the Hudson River. Towns include: Ashland, Athens, Cairo, Catskill, Coxsackie, Durham, Greenville, Halcott, Hunter, Jewett, Lexington, New Baltimore, Prattsville, Tannersville and Windham. The Hospital currently operates Family/Specialty Care Centers in Cairo, Catskill, Windham and Coxsackie.

According to the U.S. Census, Greene County has 28,276 resident's age 18-64 years and 2,257 over the age of 65.

Columbia and Greene Counties, substantially rural counties in the Northern region with nearly 115,000 residents in total, are primarily served by Columbia Memorial and its 263 clinically affiliated providers. The affiliated providers include primary and specialty care physicians who practice in solo and group settings and provide care to residents in both counties.



3. Public Participation:

a. In response the New York State's health improvement plan, Columbia Memorial Hospital has developed partnerships with community agencies through a coordinated approach to community service. There are over 50 agencies and organizations working with the hospital to meet the needs of the community, including: The Columbia County Department of Health, Greene County Department of Health, Mental Health Association of Columbia and Greene County, Twin County Recovery Services, Columbia County Department of Human Services, Greene County Mental Health Services, County Sheriff's Departments and other local, law enforcement agencies, Catholic Charities, Greene County Rural Health Network, Columbia County Healthcare Consortium, Columbia Opportunities, Columbia County Medical Society, American Red Cross, public schools in both Columbia and Greene Counties, Columbia Greene Community College, Columbia Greene Network of Healthcare Professionals, Columbia and Greene County businesses, Columbia and Greene County Departments of Social Services, Hudson River HealthCare and others. Columbia and Greene County Departments of Health along with local and regional community agencies have been working and continue to work with Columbia Memorial to develop a comprehensive community service plan.

b.Columbia and Greene County Departments of Health have been working since 2010 on a comprehensive process to identify healthcare priorities through Mobilizing for Action through Planning and Partnerships (MAPP) committees. The process includes the assessment of risks and identification of programs that support the mobilization of a wide range of services. Outcomes from the assessments for both Columbia and Greene Counties have identified key stakeholders and community support systems that address the priorities. Each county developed a list of priorities and formed committees to address the issues identified. Teams of organizations, business leaders, church groups and agencies participated in the assessment process. The MAPP meetings are held bi-monthly in both counties with Columbia Memorial representation on both the Columbia and Greene County teams. Many of the organizations have offices in both counties and currently there are no inpatient hospital services in Greene County.

c.Public notification of this process was accomplished by email, direct mail and telephonic communication. The public input process is ongoing with special attention to barriers to healthcare services within the rural community.

4. Assessment and Selection of Public Health Priorities:

As an extension of Columbia Memorial's involvement with the strategic MAPP process with Columbia and Greene Counties, hospital staff participated in both the Columbia County and Greene County Departments of Health Prevention Agenda Priority Process. Columbia Memorial Hospital staff participated on both county "Leadership Teams", as well as on county- specific Priority Area Work Groups. The Teams/Workgroups reviewed traditional health-related and socio-demographic indicators (see attached Prevention Agenda Indicators for Columbia and Greene Counties, as well as a recently updated indicators file). The Teams/Workgroups also incorporated community and provider input via MAPP-based focus groups and key informant interviews. Priority Area Workgroups from each county not only reviewed this information, but contributed knowledge and expertise, discussed issues, and suggested possible priorities. Columbia Memorial Hospital staff were members of both Columbia and Greene County Leadership Teams that chose the county-specific final Prevention Agenda Priorities. Both Leadership Teams utilized the "Dot Method" for choosing their priorities. Both Columbia and Greene Departments of Health chose Chronic Disease and Mental Health/Substance Abuse as their Prevention Agenda Priority Focus Areas. Columbia Memorial Hospital followed suit and has also chosen Chronic Disease and Mental Health/Substance Abuse as the focus areas for the Hospital's Community Service Plan.

5. Three Year Plan of Action:

The assessment was obtained through the Mobilizing for Action through Planning and Partnership (MAPP) process over a two year period with 44 community partners represented. The full report can be obtained at the Columbia and Greene County Departments of Health. Participants share a community vision and common goals. Over the next three years Columbia Memorial and local departments of health in both Columbia and Greene Counties will focus on the following goals and objectives:

  • Goal: Increase the screening rates for cardiovascular disease, diabetes and breast, cervical and colorectal cancers, especially among disparate populations in Columbia and Greene Counties.
  • Objective: 1aBy Dec 2017, increase the percentage of Columbia and Greene county women, aged 40 years and older, who receive a mammogram in the last 2 years by 10% to 85% in Columbia (baseline 77% EBRFSS 2008-09) and to 87% in Greene (baseline 78.8%).
  • Objective: 1b By Dec 2017, increase the percentage of Columbia and Greene women, 18 years and older, who received cervical cancer screening (PAP test) within the past 3 years by 10% to 91% in Columbia (baseline 87.4% EBRFSS 2008-09) and to 93% in Greene (baseline 84.8%).
  • Objective: 1c By Dec 2017, increase the percentage of Columbia and Greene adults, 50-75 years of age, who received a colorectal screening exam based on most recent guidelines by 10% to 70% in Columbia (baseline 63.7% EBRFSS 2008-09) and to 69% in Greene (baseline 63.0%).
  • Objective: 1dBy Dec 2017, increase the percentage of Columbia and Greene adults, 18 years and older, who had their blood cholesterol checked in the past 5 years by 10% to 87% in Columbia (baseline 79.3% EBRFSS 2008-09) and to 84% in Greene (baseline 76.1%).
  • Measurement: Objectives will be monitored by updated EBRFSS data. Baseline screening rates will be collected by Columbia Memorial Hospital's (Columbia Memorial) Family Care Center's (FCC) electronic medical records (EMR). Baseline will be collected in 2014 and monitored over 3 years.
  • Activities:Beginning in 2014, and through the 3 year period, coordinate with the Columbia and Greene Departments of Health in publicizing Columbia Memorial's screening activities via county health department clinics, community events and health fairs.
  • Measurement: The number of community events/health fairs offering screening information will be monitored along with the number of Columbia and Greene Health Department clients receiving screening materials or referred for screening tests as well as the number of referred individuals receiving appropriate screening tests will be monitored.
    • During 2014, work with the FCC's in Columbia and Greene counties to build computerized screening alerts, utilizing EMRs.
  • Measurement: The number of screening referrals and actual screenings will be monitored.
    • During 2014, and through the 3 year period, Columbia Memorial and its FCCs will collaborate with Columbia-Greene Cancer Services Program to promote early screening for those individuals who are uninsured or underinsured. The Columbia-Greene Cancer Services Program will canvas a list of uninsured/underinsured by phone or at Program Sites and make appropriate referrals to the Columbia Memorial FCCs. Screenings will be offered free of charge or at reduced rates to eligible individuals.
  • Measurement: The number of referrals from Cancer Services Program receiving appropriate screening will be monitored.
  • GOAL 2: Reduce childhood obesity rates by increasing the percent of mothers who breastfeed their infants.
    Objective 1. By December 2017 increase the percent of healthy infants at Columbia Memorial that are fed exclusively breast milk to 50% (baseline 37.4%, 2012) and those fed any breast milk to 80% (baseline 61.2%).
    Measurement: Objective will be monitored using NYSDOH Vital Statistics data and/or Columbia Memorial Hospital records.
    Activities:

    • Through the 3 year period, Columbia Memorial will continue to participate on the Columbia-Greene Breastfeeding Coalition and assist in collaborative efforts to support breastfeeding, including distribution of educational materials at Family Care Centers, during prenatal hospital tours, and at sponsored events.

    Measurement: The number of Columbia Memorial staff with membership on the Columbia Greene Breastfeeding Coalition; breastfeeding educational materials available at prenatal clinics, during prenatal hospital tours, and at sponsored events will be measured.

    • Columbia Memorial will provide breastfeeding information in maternity pre-registration and discharge packets.

    Measurement: 100% of maternity patients will receive breastfeeding information.

    • Train nurses to become certified lactation counselors.

    Measurement: There will be an increase in the number of Certified Lactation Counselors at Columbia Memorial.

    • Columbia Memorial staff will be trained on the importance of breastfeeding and lactation support.

    Measurement: The number of staff receiving training will be measured.

    • Nurses/lactation counselors will visit each maternity patient and provide breastfeeding education and support.

    Measurement: The number of maternity patients receiving visits; number of prenatal and postpartum lactation counselor consultations will be measured.
    GOAL 3: Reduce the smoking prevalence of Columbia and Greene county residents.
    Objective 1: By December 2017, decrease the prevalence of smoking in adults 18 years and older to 21% in Columbia County (baseline 24.7% EBRFSS 2008-09), and to 21% in Greene County (baseline 24.3%)
    Measurement: Objective will be monitored by updated EBRFSS data, by Columbia Memorial Hospital records and by FCC’s electronic medical records.
    Activities:

    • Through the 3 year period, Columbia Memorial will continue to participate with Columbia and Greene County Departments of Health and the Rip Van Winkle Tobacco Free Action to promote policies and implement programs which aim to decrease availability and visibility of tobacco products.

    Measurement: Columbia Memorial staff will attend Tobacco Coalition meetings; distribution of anti-smoking materials at FCC sites.

    • Columbia Memorial will target hospital patients with heart disease, pneumonia, COPD, or other conditions adversely affected by smoking, and provide both educations materials and referral to NY QUITS Smoking Hotline.

    Measurement: The number of patients receiving educational counseling; number referred to NY QUITS (baseline to be collected in 2014).

    • Columbia Memorial will continue the internal and external promotion of Smoking Cessation Programs through various marketing methods and encourage enrollment by tobacco users who are interested in quitting.

    Measurement: The number of participants in Smoking Cessation Programs sponsored by Columbia Memorial and its FCCs; number of individuals referred to NY QUITS will be monitored (baseline to be collected in 2014).
    GOAL 4: Promote evidence-based care and provide culturally relevant chronic disease self-management programs within Columbia and Greene Counties.
    Columbia Memorial lost funding for its Diabetes Prevention/Diabetes Self-Management Programs
    Objective 1: During the 3 year period, Columbia Memorial will search for funding opportunities in order to offer evidence-based chronic disease prevention and self-management initiatives.
    Measurement: Funds identified; programs implemented.

Promote Mental Health/Prevent Substance Abuse:

  • Goal: Promote mental, emotional and behavioral well-being in communities.
  • Objective 1: By December 2017, reduce the number of adults with "poor mental health days" ;by 10% to 9% in Columbia (baseline 10.1% EBRFSS 2008-09) and to 9% in Greene (baseline 10.0%).
  • Measurement: Objective will be monitored by updated EBRFSS data.
  • Activities:

    • By December 2017, increase the number of primary care offices located in Greene County with cross-disciplinary collaborations on topics related to behavioral health symptomology and treatment.  During 2014 20% primary care offices (FCC) will have instituted cross-disciplinary collaborations. It is expected that the number of sites will be expanded to 30% in both counties between 2015 and 2017.

    Measurement: The number of primary care offices in Greene and Columbia County offering cross-disciplinary collaborations; the number of patients seen by mental health providers at these sites will be tracked and the number of referrals for mental health services will be tracked.
    GOAL 2: Prevent substance abuse through early identification and adequate societal support systems.
    Objective 1: By December 2017, reduce the drug-related hospitalization rate by 10% to 19.0/10,000 in Columbia (baseline 21.1/10,000, EBRFSS 2009-11) and to 26.0/10,000 in Greene (baseline 28.7/10,000).
    Measurement: Objective will be monitored using annual hospital inpatient records (SPARCS).
    Activities:

    • By December 2014 identify appropriate substance abuse screening tools for use in primary care office sites.

    Measurement: Screening tools will be reviewed and identified for implementation.

    • By December 2017 increase the number of primary care offices utilizing substance abuse screening tools and making appropriate service referrals.

    Measurement: The number of primary care office sites utilizing substance abuse screening tools; number of patients screened; number of referrals will be measured.

    • Through the 3 year period, Columbia Memorial staff will continue to serve on the Columbia-Greene Controlled Substance Task Force and Workgroups.

    Measurement: Columbia Memorial staff membership on Task Force and appropriate Workgroups will be measured.

    • During 2014, Columbia Memorial's Pain Management Committee will work with the Task Force's Practice Guidelines Committee to develop and implement education programs for providers, focused on pain management and management of narcotics.

    Measurement: Practice guidelines will be developed; education programs offered and the number of prescribers attending programs will be measured.

    • During 2014, Columbia Memorial will coordinate with Task Force partners for the provision of resources for a community program to dispose of unwanted medications. The program will be in collaboration with local law enforcement agencies.

    Measurement: Community programs developed and implemented; amount of medication collected will be monitored.

6. Dissemination of the Report to the Public:

This Community Service Plan will be available for public via the Columbia Memorial Hospital website: columbiamemorial.com.


7. Columbia Memorial's Administration with support from its Department of Community Health Services will be responsible to ensure engagement with local partners over the next three years of this plan. Data will be collected to track progress and address barriers to successful implementation. Columbia Memorial and its clinically affiliated partners are committed to implementing a comprehensive plan that delivers high-quality preventative care and improved management of disease for all population segments.

This report fulfills the requirements of the federal statute established within the Patient Protection and Affordable Care Act (PPACA) requiring that non-profit hospitals conduct community health needs assessments every three years.