Community Health Needs Assessment Implementation Strategy

2013 – 2016

The Community Health Needs Assessment Implementation Strategy was approved by the Shady Grove Adventist Hospital Board of Trustees on September 26, 2013 and was approved by the Adventist HealthCare Board of Trustees on October 23, 2013.

Shady Grove Adventist Hospital’s Community Health Needs Assessment – Implementation Strategy

Overview/Mission Shady Grove Adventist Hospital is a 319-licensed bed acute care facility located in Rockville, Maryland. Opened in 1979, the hospital has since added a four-story patient tower, including private rooms – 48 for new moms and their babies – and a high-tech surgery department for inpatients and outpatients. The mission of Shady Grove Adventist Hospital, a member of Adventist HealthCare, is: We demonstrate God’s care by improving the health of people and communities through a ministry of physical, mental and spiritual healing. Adventist HealthCare will be a high performance integrator of wellness, disease management and health care services, delivering superior health outcomes, extraordinary patient experience and exceptional value to those we serve. In keeping with our mission, Adventist HealthCare continues its longstanding tradition to bring the community to good health through our robust offering of health and wellness services throughout Montgomery, Prince George's and Frederick counties. Our facilities and programs served the community with approximately 650,000 encounters in 2012 as we provide care across the continuum to those whom we are privileged to serve. Priority Population and Target Area This Implementation Strategy will address health needs among the primary population served by Shady Grove Adventist Hospital, covering a geographic area including approximately 80% of patient discharges. Shady Grove Adventist Hospital primarily serves residents of Montgomery County, Maryland. Below, Figure 1 shows the percentages of discharges by county for Shady Grove Adventist Hospital: County Percentage Montgomery 88.2% Frederick 4.6% Prince George’s 2.0% Other 5.2% Figure 1. SGAH discharges by county, 2011

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Approximately 80 percent of discharges come from our Total Service Area, which is considered Shady Grove Adventist Hospital’s Community Benefit Service Area “CBSA” (see Figure 2). Within that area, 60 percent of discharges are from the Primary Service Area including the following ZIP codes/cities: 20874 – Germantown, 20878 – Gaithersburg, 20850 – Rockville, 20877 – Gaithersburg, 20886 – Montgomery Village, 20879 – Gaithersburg, and 20876 – Germantown. We draw 20 percent of discharges from our Secondary Service Area including the following ZIP codes/cities: 20852 – Rockville, 20854 – Potomac, 20906 – Silver Spring, 20871 – Clarksburg, 20872 – Damascus, 20855 – Derwood, 20851 – Rockville, 20853 – Rockville, 20882 – Gaithersburg, and 20841 – Boyds (see Figure 2).

Figure 2. Map of Shady Grove Adventist Hospital’s Primary and Secondary Service Areas based on 2011 inpatient discharges

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Our Community Benefit Service Area (CBSA), covering approximately 80 percent of

discharges, includes 560,158 people, of which approximately 41.6 percent are minorities (see

Figure 3).

2011 Estimates

WHITE

BLACK/

AF AMER ASIAN

NATIVE

HI/PI

HISPANIC/

LATINO

Community Benefit

Service Area (CBSA) 327,337 78,533 90,689 574 94,240

58.4% 14.0% 16.19% 0.1% 16.8%

Primary Service Area

(PSA) 157,673 47,038 53,508 350 52,979

53.7% 16.0% 18.22% 0.1% 18.0%

Secondary Service Area

(SSA) 169,664 31,495 37,181 224 41,261

63.7% 11.8% 13.95% 0.1% 15.5%

Figure 3. Population estimates (2011) by race/ethnicity for Shady Grove Adventist Hospital’s

Total Service Area (80 percent of discharges), Primary Service Area (60 percent of discharges)

and Secondary Service Area (20 percent of discharges)

Population demographics are rapidly changing in the state of Maryland, particularly among

residents living in Montgomery County. We serve one of the most diverse communities in the

United States, constantly undergoing the economic, social and demographic shifts that result

from an ever-changing, ever-growing population. Over the past decade, Montgomery County has

become both the most populous jurisdiction in Maryland, the second largest jurisdiction in the

Washington, D.C. metropolitan area, and the 42nd

most populous county in the nation, with the

residents totaling almost one million (U.S. Census Bureau, 2011). Racial and ethnic diversity has

concurrently increased with this drastic increase in population numbers. Non-Hispanic whites

now comprise only 49 percent of the population of Montgomery County, a decrease of more than

20 percent over the last two decades. For the first time, minorities account for more than half of

Montgomery County’s population, making it a “majority-minority” county. The percentage of

Hispanics or Latinos in Montgomery County (17 percent) is more than double the percentage of

Hispanics or Latinos in the state of Maryland (8 percent), and within the County, it outnumbers

all populations other than non-Hispanic whites (U.S. Census Bureau, 2011).

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According to the U.S. Census Bureau, Maryland is one of the top ten destinations for foreign-born individuals, and 41 percent of the foreign-born in Maryland reside in Montgomery County.1 The County’s foreign-born population has gone from 12 percent in 1980 to currently more than 30 percent.2 Immigrants contribute greatly to our community, and our hospital providers are committed to understanding their needs and working to treat them in a culturally competent manner. As racial and ethnic minority populations become increasingly predominant, concerns regarding health disparities grow – persistent and well-documented data indicate that racial and ethnic minorities still lag behind nonminority populations in many health outcomes measures. These groups are less likely to receive preventive care to stay healthy and are more likely to suffer from serious illnesses, such as cancer, diabetes, and heart disease. Implementation Strategy Development and Adoption Shady Grove Adventist Hospital’s Community Health Needs Assessment was reviewed and approved by the Adventist HealthCare Board of Trustees on April 18, 2013. The Shady Grove Adventist Hospital Executive Council also reviewed the findings of the hospital’s 2013 Community Health Needs Assessment. After discussion and consideration of community input from the CHNA survey, in which the majority of respondents cited chronic diseases and affordability of health care as major problems affecting the health of their community, the Executive Council came to a consensus to focus on two areas: Lung Cancer in the Asian population served by Shady Grove Adventist Hospital, and Diabetes among uninsured patients in Shady Grove Adventist Hospital’s service area. Shady Grove Adventist Hospital’s Board of Trustees, consisting of leaders from community-based organizations, local safety net clinics, physicians, and health care leaders, reviewed and approved this CHNA Implementation Strategy. Why These Priority Areas Were Chosen Based on findings from its Community Health Needs Assessment, the hospital chose to focus one new initiative on Lung Cancer in the Asian population it serves. Compared to hospitals nationally, Shady Grove Adventist Hospital has a higher incidence of lung cancer patients in the Asian population (9.9 percent compared to only 1.83 percent nationally).

                                                            1 “Literacy, ESL and Adult Education.” Literacy Council of Montgomery County. http://www.literacycouncilmcmd.org/litadultedu.html 2 “Foreign-Born Population of Montgomery County Region, 1950-2000-Census Years.” Montgomery Planning. 2000. http://www.montgomeryplanning.org/research/data_library/population/po34.shtm

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The other priority area that Shady Grove Adventist Hospital decided to focus on is diabetes among Montgomery Cares (uninsured) patients. Diabetes is the 8th leading cause of death in Montgomery County and it disproportionately affects minority populations and the elderly, so it is predicted to rise as these populations continue to increase. The total health care and related costs for the treatment of diabetes runs about $174 billion annually in the U.S. and much of that is spent on hospitalizations and medical care. Focus Area 1: Lung Cancer among Asian Population Goal: Improve the early screening and detection of lung cancer among the Asian population served by Shady Grove Adventist Hospital to improve their 5-year survival rate. Objectives to be completed by end of FY2015:

1. Shady Grove Adventist Hospital will provide four annual lung cancer screening days targeted specifically to the Asian community.

2. Shady Grove Adventist Hospital will collaborate with Asian physicians, physicians serving the Asian community, and with community organizations to increase awareness of lung cancer screening programs.

3. Shady Grove Adventist Hospital will create a multi-disciplinary physician approach to the review of all suspicious lung nodules.

Strategies include: • Early detection screening program. • Provide a routine follow-up process for identified lung nodules. • Provide smoking cessation literature in top Asian languages spoken by Shady Grove

Adventist Hospital’s patient population. • Collaborate with community-based outpatient imaging centers to share data on lung cancer

population and effective screening programs. • Community outreach to Asian population, partnering with Montgomery County DHHS’

Asian American Health Initiative and Pan Asian Clinic to raise awareness.

Evaluation Strategies: • Track the percent of lung cancer diagnoses at Shady Grove Adventist Hospital in the Asian

population compared to all hospitals in the U.S. through the CDC’s National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS).

• Record the number of people screened at each lung cancer screening event. Track individuals with an abnormal test result, and record all follow-up.

• Track the number of flyers distributed and the number of physicians who were targeted about the lung cancer screenings.

• Ensure that all screened individuals receive feedback and communication as to their recommendation.

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Collaborative Partners Include: • Montgomery County DHHS Asian American Health Initiative • Pan Asian Clinic • Shady Grove Radiology, Germantown outpatient imaging center • Lung Cancer Alliance • Asian physicians, physicians serving the Asian community in Shady Grove Adventist

Hospital’s service area and Shady Grove Adventist Hospital Thoracic Services physicians  

Evidence-Base: This initiative involves targeted outreach and health screening for a cultural group that is experiencing a disparity in a particular health outcome, in this case lung cancer. There is evidence that culturally targeted and tailored interventions are more effective in reducing health disparities than interventions that are not culturally tailored or targeted. Additionally, there is evidence that patient navigation programs increase rates of cancer screening, particularly among minority populations. Citations: Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, Richter JM, Atlas SJ. (2009). A culturally tailored navigator program for colorectal cancer screening in a

community health center: a randomized, controlled trial. Journal of General Internal Medicine, 24 (2), 211-217.

Robinson-White 2010 – Robinson-White S, Conroy B, Slavish KH, Rosenzweig M. Patient navigation in breast cancer: A systematic review. Cancer Nursing. 2010;33(2):127-40

Phillips 2010 – Phillips CE, Rothstein JD, Beaver K, et al. Patient navigation to increase mammography screening among inner city women. Journal of General Internal Medicine. 2010;26(2):123-9

Donaldson 2012 – Donaldson EA, Holtgrave DR, Duffin RA, et al. Patient navigation for breast and colorectal cancer in 3 community hospital settings: An economic evaluation. Cancer. 2012;118(19):4851-9.

Glick 2012 – Glick SB, Clarke AR, Blanchard A, Whitaker AK. Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: A systematic review. Journal of General Internal Medicine. 2012;27(8):1016-32.

Naylor 2012 – Naylor K, Ward J, Polite BN. Interventions to improve care related to colorectal cancer among racial and ethnic minorities: A systematic review. Journal of General Internal Medicine. 2012;27(8):1033-46.

Jandorf 2005 – Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH. Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Journal of Urban Health. 2005;82(2):216-24.

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Focus Area 2: Diabetes among Montgomery Cares (Uninsured) Patients Goal: Among known diabetic patients in the Montgomery Cares Program within Shady Grove Adventist Hospital’s service area, improve the percent who receive the recommended number of hemoglobin A1C screenings each year. Objectives to be completed by end of FY2015:

1. Shady Grove Adventist Hospital will integrate Montgomery Cares Program participants to Adventist HealthCare’s Health Information Exchange (HIE) Program through Ambulatory Care EMR Support (ACES).

2. Shady Grove Adventist Hospital will conduct a quarterly review of hemoglobin A1C data with Montgomery Cares Program providers and collaborate in offering interventions for improved compliance with recommended screening frequency.

3. Shady Grove Adventist Hospital will start providing diabetes education classes free of charge to the uninsured as part of the intervention for improved compliance with recommended screening frequency.

Strategies include: • Collaborate with Mobile Medical Care, Inc., Mercy Health Clinic, Muslim Community

Clinic, Kaseman Mansfield Clinic, Community Clinics Inc., and Pan Asian Clinic to provide hemoglobin A1C screenings free of charge, track the data, analyze trends, and provide appropriate interventions.

• Collaborate with Shady Grove Adventist Hospital Foundation to provide funding for uninsured patients to access outpatient diabetes education classes.

• Work with safety net clinics and Shady Grove Adventist Hospital Wound Care Center to get referrals of Montgomery Cares (uninsured) patients to the diabetes education classes.

Evaluation Strategies: • In collaboration with the Primary Care Coalition, we will be able to track and measure the

percentage of patients getting the recommended number of hemoglobin A1C screenings. • These reports can be automated through the use of the Clinical Decision Support tools built

into the electronic health record. • Provide diabetes education classes free of charge to the uninsured; track the numbers of

uninsured served and any changes in their hemoglobin A1C.  

Collaborative Partners Include: • Ambulatory Care EMR Support (ACES) program / Center for Connected Health • Montgomery Cares Program • Partner Safety Net Clinics and Community Centers: Mercy Health Clinic, Mobile Medical

Care, Inc., Muslim Community Center Medical Clinic, Proyecto Salud, The People’s Community Wellness Center, Chinese Culture and Community Services Center, Chinese

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Culture and Community Services Center, Care for Your Health and the Mansfield Kaseman Clinic. The Teen and Young Adult Health Connection (TAYA) of Silver Spring will also be participating.

 

Evidence-Base: This initiative involves partnering with local safety net clinics that offer primary care, or a medical home, to uninsured residents of Montgomery County. Through this partnership and a shared Health Information Exchange (HIE), Shady Grove Adventist Hospital helps ensure that uninsured patients have coordinated care between the clinic that serves as their medical home and the hospital where they receive care and educational programs. The following citations show evidence that medical homes increase preventive care and screening, and improve chronic disease management. Citations: Alexander J a, Bae D. Does the patient-centered medical home work? A critical synthesis of

research on patient-centered medical homes and patient-related outcomes. Health Services Management Research. 2012; 25(2):51-9.

Hoff T, Weller W, DePuccio M. The patient-centered medical home: A review of recent research. Medical Care Research and Review. 2012;69(6):619-44.

Amiel JM, Pincus HA. The medical home model: New opportunities for psychiatric services in the United States. Current Opinion in Psychiatry. 2011; 24(6):562-8.

Nutting PA, Miller WL, Crabtree BF, et al. Initial lessons from the First National Demonstration Project on practice transformation to a patient-centered medical home. Annals of Family Medicine. 2009; 7(3):254-60.

There is also evidence regarding the effectiveness of community diabetes self-management programs:

Citation: Klug C, Toobert DJ, Fogerty M,.Healthy Changes for living with diabetes: an evidence-based community diabetes self-management program. Diabetes Education. 2008 Nov-Dec;34(6):1053-61.

Other Areas Addressed by Shady Grove Adventist Hospital Shady Grove Adventist Hospital already addresses and will continue to address other areas of need through existing community health outreach programs, education, and screenings. The following table summarizes highlighted needs identified in the Community Health Needs Assessment and ways in which the hospital addresses those needs, or refers to other sources to address the needs.

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Shady Grove Adventist Hospital’s Community Programs Addressing Identified Community Health Needs

Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Cancer

• Breast 15% more white women were diagnosed with breast cancer than black women, while 48% more black women died from breast cancer than white women.

Reach uninsured residents of Montgomery County through continued partnership with Mercy Health Clinic, Mobile Med, Mansfield Kaseman Clinic, Pan Asian Clinic, Women’s Cancer Control Program, and Komen Foundation, by providing free early detection screenings and health education outreach.

Shady Grove Adventist Hospital (SGAH) will provide free mammogram screenings, navigation, biopsies, ultrasounds, surgeries, and treatment for the uninsured. Encourage prevention & early detection through education at community health fairs, and community locations serving vulnerable populations.

Track and analyze numbers of: mammograms and other screenings provided, breast cancer abnormality findings, and treatment provided. Track number of participants encountered and educated during community outreach.

Cancer • Lung

New Initiative for

CHNA Implementation

Strategy (see remainder of report for

details)

Compared to hospitals nationally, SGAH has a higher incidence of lung cancer patients in the Asian population (9.9% compared to 1.83% nationally).

Improve the early screening and detection of lung cancer among the Asian population served by SGAH to improve their 5-year survival rate, through targeted early detection screening programs, and community outreach to Asian populations (partnering with DHHS-Asian American Health Initiative, and Pan Asian Clinic).

Provide 4 annual lung cancer screening days targeting the Asian community. Collaborate with Asian physicians, physicians serving the Asian community, and with community organizations to increase awareness of lung cancer screenings. Create a multi-disciplinary physician approach to review all suspicious nodules. Encourage prevention and early detection through

Track and analyze numbers of: lung cancer screenings, abnormal findings, follow-up, and treatment provided. Track number of participants encountered and educated through community outreach.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes community health education.

Cancer • Colorectal

Colorectal cancer is the 2nd leading cause of cancer-related death in U.S. Although the screening for and incidence of colorectal cancer among all races in Montgomery County is relatively comparable, mortality rates were much higher for blacks than whites or other races, indicating that blacks may be getting systematically less or inferior follow-up care post screening.

Reach target populations through continued partnership with Montgomery County Cancer Crusade, Mercy Health Clinic, Mobile Med, Mansfield Kaseman Clinic and Pan Asian Clinic, and provide early detection screenings and community health education/ outreach.

Provide colonoscopies for target population and refer patients with abnormal findings to Montgomery Cancer Crusades for further treatment. Encourage prevention & early detection through education at community health fairs, and community locations serving vulnerable populations.

Track and analyze numbers of: colonoscopies, treatments and outcomes, as well as community encounters. Continue to monitor incidence and mortality rates for colorectal cancer to ensure Montgomery County meets or exceeds the Healthy People 2020 target for decreasing colorectal cancer-related deaths.

Cancer (other) • Prostate • Cervical • Skin • Oral • Thyroid

Prostate cancer - mortality rate in Montgomery County is 46% higher than the Maryland rate; 93% more black men died of prostate cancer than white men (Healthy Montgomery, 2012). Cervical cancer – incidence rate is greatest among Hispanic women (10.2 per 100,000), compared to black women (6.5 per 100,000) or white

Provide free cancer screenings to the community at the annual cancer screening days; provide educational lectures to target populations as well as education to the community at health fairs and various community locations.

SGAH partners with physicians to provide free annual cancer screenings to the community, targeting: breast, prostate, colorectal, oral, skin and thyroid cancer. Additionally, bilingual Cancer Outreach Coordinators encourage prevention and early detection by providing educational presentations and materials to underserved and at-risk populations at

Track and analyze numbers of: cancer screenings, abnormal findings, and treatment provided. Track number of participants encountered and educated provided through community outreach.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes women (4.9 per 100,000) in Montgomery County. Skin Cancer – White men show the greatest disparity in both incidence and mortality rates compare to the Montgomery County average. Oral Cancer – Montgomery County’s incidence rate is the lowest among Maryland’s counties. Thyroid Cancer – Montgomery County has the highest incidence rates for thyroid cancer in Maryland.

community locations.

Diabetes

New Initiative for CHNA

Implementation Strategy

(see remainder of report for

details)

Diabetes is 8th leading cause of death in Montgomery County and it disproportionately affects minority populations and the elderly. Diabetes is predicted to rise as these populations continue to increase in Montgomery County. The total health care related costs for the treatment of diabetes runs

Reach target populations through partnership with safety net clinics and community organizations to provide health education and early detection screenings. Encourage prevention of diabetes through community health education at health fairs, senior and community centers. Collaborate with Shady Grove Adventist Hospital Foundation

SGAH will integrate Montgomery Cares Program participants (uninsured) to Adventist HealthCare’s Health Information Exchange (HIE) Program through Ambulatory Care EMR Support (ACES) – AHC is taking the lead to bring 8 partner safety net clinics onto the exchange, including Mobile Med,

SGAH will conduct a quarterly review of hemoglobin A1C data with Montgomery Cares Program providers and collaborate in offering interventions for improved compliance with recommended screening frequency. Monitor/report/track the patients’ data from the

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes about $174 billion annually in the U.S., much of that is spent on hospitalizations and medical care.

to provide funding for uninsured patients to receive outpatient diabetes education classes from an RN/Certified Diabetes Educator. Improve the % of known uninsured diabetic patients who receive the recommended number of hemoglobin A1C screenings within the SGAH’s service area through partnership with the Montgomery Cares Program.

Mercy Health Clinic, Muslim Community Clinic, Kaseman Mansfield Clinic, Community Clinics Inc., and Pan Asian Clinic. SGAH will collaborate with these clinics to provide free hemoglobin A1C screenings, track the data, analyze trends, and provide appropriate interventions. SGAH will start to provide outpatient diabetes education classes free of charge to the uninsured as part of the intervention for improved compliance with recommended screening frequency. Encourage diabetes prevention through education at community health fairs and community locations.

EHRs by December 2013. Stage all 8 clinics to be connected to our Health Information Exchange by Summer of 2014. SGAH will start to provide diabetes classes to the uninsured patients of Montgomery County, measuring initial and final hemoglobin A1C.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Heart Disease and Stroke

Heart Disease – Heart disease was ranked as number one cause of death in U.S. by the CDC. Although on the decline in Maryland and Montgomery County due to improvements in treatment, it remains the leading cause of death in the County for people over 65 years (among whites 30%, blacks 26%, and Hispanics 22%). Stroke – One of the top five leading causes of death in the U.S. Mortality rates in Montgomery County have met the HP 2020 target, but health disparities between racial/ethnic groups persist. Black residents have the highest stroke death rate in the County at 34.4/100,000 compared to whites at 29.8, Asian/Pacific Islanders at 19.6, and Hispanics at 14.5.

Provide free screenings related to cardiovascular health at annual “Love Your Heart” community health fair. Provide strong cardiovascular community outreach, to include the following screenings to community: Lipid Profile, Vertical Auto Profile, Homocysteine, HsCRP, blood pressure, glucose and A1C. Provide free cardiovascular educational materials, blood pressure screenings and body composition screenings (BMI, weight, % body fat, % muscle) at health fairs, churches, senior and community centers around the County.

SGAH will continue to hold its annual “Love Your Heart” screening event to provide free screenings to community members for: blood pressure, cholesterol, glucose, waist circumference, BMI, body composition, and sleep apnea, as well as 1:1 counseling with a clinician. SGAH will continue offering Lipid Profile, Vertical Auto Profile, Homocysteine, HsCRP, blood pressure, glucose and A1C screenings, as well as providing free educational lectures to the community. SGAH will continue its “Healthy Choices Program” in Damascus to provide women of low socio-economic status information and support to assist them in making healthier choices for themselves and their children.

Track and analyze numbers of screenings and findings from screenings. Track the number of participants encountered and educated through community outreach.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Obesity According to Healthy

Montgomery, 56.1% of County residents are either overweight or obese, and 21% of low-income children ages 2-5 in Montgomery County are overweight compared to 17% in Maryland.

Provide both individual (1:1) and group nutrition counseling, and health education related to exercise and nutrition to the community at a variety of community locations.

Provide 1:1 health education and group presentations about healthy nutrition and the importance of exercise at health fairs, senior and community centers, and faith-based organizations. Continue implementing the “Healthy Choices Program” for low-income women. Provide affordable individual nutrition counseling to the community. Begin new initiative: nutrition and fitness challenge program in collaboration with Dawson’s Market (local natural foods market) – SGAH will provide 40 participants with free body composition screenings and related health education twice a week for 12 weeks.

Track the number of participants encountered and educated through community outreach. Monitor rates of obesity and overweight at the county level. For Dawson’s Market Challenge, track results of participants’ body composition screenings over the course of 12 weeks to assess any changes (e.g. weight loss, improved BMI, etc.), and document any changes they have made with regard to nutrition and fitness over the course of the program.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes Influenza Incidence of influenza in

Montgomery County for the 2011-2012 flu season was very low; however the rate of ED visits due to immunization-preventable pneumonia and influenza was much higher among younger adults (18-24 years old) than among any other adult age group.

Provide influenza vaccinations and to the community throughout the fall flu season in a variety of locations, including locations that have elderly adults with limited mobility (e.g. senior living facilities and housing).

Continue to provide low cost flu shot clinics throughout Montgomery County to children, adults and seniors at community centers, senior centers, faith-based organizations, the hospital, and subsidized apartment complexes. SGAH will continue its partnership with WTOP radio to provide hundreds of free flu shots to the community at large.

SGAH will document and track the number of influenza vaccinations provided to community members, and analyze provision of vaccine by variables such as age, ZIP code, and insurance or payment type.

Maternal & Infant Health

Montgomery County has a relatively low infant mortality rate of 4.3 deaths per 1000 births; however, the infant mortality rate is much higher among black residents at 10.7 deaths per 1000 births.

Continue to provide the excellent care to expectant/new mothers, their families, and their infants by providing childbirth classes, infant care classes, breastfeeding classes, as well as a variety of support groups. Continue to collaborate with Montgomery County Health Department to provide prenatal services to low-income and uninsured residents.

In addition to childbirth, breastfeeding, and parenting classes, SGAH offers free programs to its patients, such as BEST (Breastfeeding, Education, Support & Togetherness) to promote and support breastfeeding, and Discovering Motherhood support group for new mothers. In partnership with Montgomery County Health Department, SGAH also provides prenatal services to low-income and uninsured residents, including: prenatal

Continue assessment and evaluation of Maternal and Infant programs through tracking numbers of participants and surveys of participant feedback. Monitor maternal and infant health status in Montgomery County.

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Focus Area CHNA Findings* Goal Action Evaluation of Outcomes care, routine lab tests, classes and dental screenings.

Senior Health The percentage of Maryland residents over the age of 60 is expected to increase from 15% in 2010 to 25% by 2030. In Montgomery County, 6.2% of seniors live below the poverty level, with higher percentages among minority seniors and women.

Continue to provide community health outreach programs, education and health screenings to seniors at a variety of locations in the community served by SGAH.

SGAH offers community health programs for seniors at: Damascus Senior Center, Gaithersburg Up-County Senior Center, Rockville Senior Center, Revitz House, as well as numerous subsidized senior apartment complexes. SGAH’s community health education and outreach to seniors covers a variety of topics such as: heart health, cholesterol screenings, blood pressure screenings, healthy nutrition, summer safety, disease prevention, cancer screening education, brain health, osteoporosis screenings and bone health, flu and pneumonia shots, education on the importance of exercise, lay person CPR and Basic First Aid instruction.

Track the number of participants encountered and educated through community outreach. Continue to monitor and assess senior health status in Montgomery County to assure needs are being met and addressed.

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Areas of Need Not Directly Addressed by Shady Grove Adventist Hospital & Rationale

Topic Area CHNA Findings* Goal Resources Rationale Asthma Rates of ED visits for

asthma were lower for Montgomery County than for the state of Maryland; however, black Montgomery County residents had an asthma ED visit rate about 5 times higher than white residents, and hospitalization rates showed a similar trend.

Provide community members with resources on asthma through community outreach.

Montgomery County has established The Asthma Management Program, which focuses on reaching out to Latino Children. This program provides education, support and follow-up care. Additionally, the following organizations provide the community with asthma resources: American Lung Association of Maryland, Asthma and Allergy Foundation of America (Maryland Chapter), and the Maryland Asthma Control Program.

SGAH does not currently provide community outreach and educational programs specifically for asthma because asthma prevalence and rates of ED visits in Montgomery County are below rates statewide, and because there are other asthma resources available in the County. SGAH will continue to monitor trends in asthma to determine whether future reallocation of resources is needed to provide asthma-related community programs.

HIV/AIDS Blacks represent about 16% of the Montgomery County population, yet 71% of HIV cases diagnosed in 2008 were black residents. While HIV-related deaths in the County have greatly decreased in the past decade, black residents account for almost 4 out of

Continue to support other organizations that provide services related to HIV and AIDS.

Treatment and support of those with HIV or AIDS is provided by both private and public health care providers. The safety net clinics serving Montgomery County provide diagnostic services and treatment. Montgomery County Health Department provides HIV Case

SGAH does not currently provide community outreach and educational programs for HIV/AIDS due to limited financial resources. Adventist HealthCare’s Center on Health Disparities led an initiative called Project BEAT IT! (Becoming

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Areas of Need Not Directly Addressed by Shady Grove Adventist Hospital & Rationale Topic Area CHNA Findings* Goal Resources Rationale

5 HIV-related deaths, and had a death rate that was nearly 10 times higher than whites.

Management (including dental care, counseling, support groups, home care services, education and outreach to at-risk populations), clinical services, lab tests, and diagnostic evaluations. Maryland AIDS Administration educates public and health care professionals.

Empowered Africans Through Improved Treatment of type 2 diabetes, HIV/AIDS, and hepatitis B), which was a grant-funded initiative from U.S. DHHS Office of Minority Health that provided culturally appropriate health education classes to health care providers and the African immigrant community to improve health outcomes related to these chronic and infectious diseases. The 20-month grant funded project ended in September 2013.

Behavioral Health

In Montgomery County 1 in 10 residents has been diagnosed with an anxiety disorder and nearly 17% have been diagnosed with a depressive disorder. The rate of hospital discharges for bipolar disorders in Montgomery County has

Continue to provide behavioral health referrals to Adventist Behavioral Health, whose main hospital campus is next to the campus of Shady Grove Adventist Hospital.

Four hospitals in Montgomery County provide inpatient/outpatient behavioral health care: Adventist Behavioral Health, MedStar Montgomery, Suburban Hospital, and Washington Adventist Hospital. In addition to

SGAH does not provide behavioral health services because these services are already provided by the neighboring specialty care hospital within its hospital system, Adventist Behavioral Health. In addition to Adventist

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Areas of Need Not Directly Addressed by Shady Grove Adventist Hospital & Rationale Topic Area CHNA Findings* Goal Resources Rationale

increased and there was a two-fold increase in readmission rates in the past decade.

private health care providers, there is an array of additional behavioral health services: Montgomery County Crisis Center, Reginald S. Lourie Center for Infants and Young Children, Children’s National Medical Center – partial hospitalization programs, Psychiatric Rehabilitation Programs for Children, Affiliated Community Counselors Inc., Anxiety and Depression Association of America, Access Team, City of Rockville Youth and Family Services, Community Connections, Mental Health Association, and National Alliance on Mental Illness (NAMI).

Behavioral Health, there are many organizations that provide behavioral health services within the SGAH service area.

Social Determinants of Health

• Food Access • Housing Quality • Education

Food Access – Montgomery County performs better than state and national baselines with regard to food deserts.

Partner with and support other organizations in the community that specialize in addressing needs related to food access, housing quality, education, transportation, and

Food Access – SGAH supports the Meals on Wheels Program and the City of Rockville’s annual Holiday Food Drive.

SGAH does not directly address many of the social determinants of health because those are not specialty areas of the hospital and SGAH does

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Areas of Need Not Directly Addressed by Shady Grove Adventist Hospital & Rationale Topic Area CHNA Findings* Goal Resources Rationale

• Transportation

Housing Quality – 50.8 percent of renters in Montgomery County spend 30% or more of household income on rent. In the area served by SGAH, shelters, transitional housing, and motel placements served nearly 8,000 residents (FY2008). Education – The percentage of children who enter kindergarten ready to learn in Montgomery County (74%) is lower than the state of Maryland baseline (81%). Transportation – Montgomery County ranks in the top quartile of longest commute times among all U.S. counties. The rate of pedestrian injuries on public roads in Montgomery County (44.2/100,000) is higher than the state of Maryland baseline

other social determinants of health.

Housing Quality – SGAH supports and partners with a local non-profit organization called Interfaith Works, which provides shelter to approximately 744 homeless men and women each night, and has served 135,000 meals through its Homeless Service programs. Additionally, the Montgomery County Coalition for the Homeless has shelters and emergency housing as well as programs to provide permanent housing for families. This organization also assists with applying for Medicaid, food stamps, and other entitlement programs, as well as transportation, education completion, and vocational assistance. Education – Local community colleges offer low-cost higher education opportunities. The

not have the resources or expertise to meet many of these needs. Instead, SGAH partners with and support other organizations in the community that specialize in addressing needs related to food access, housing quality, education, transportation, and other social determinants of health.

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Areas of Need Not Directly Addressed by Shady Grove Adventist Hospital & Rationale Topic Area CHNA Findings* Goal Resources Rationale

(39.0/100,000). Interagency Coalition to Prevent Adolescent Pregnancy works to reduce teen pregnancy – a common reason teenagers drop out of school. Transportation – For community members relying on public transportation, there is a Ride On bus stop located right next to SGAH’s main entrance to the hospital. SGAH also helps to arrange transportation home for many patients upon discharge.

* For complete CHNA findings and sources, please refer to the Shady Grove Adventist Hospital Community Health Needs Assessment (2013-2016) Disclaimer: This implementation strategy specifies the community health needs that Shady Grove Adventist Hospital has determined to meet in whole or in part and that are consistent with its mission. The hospital reserves the right to amend this implementation strategy as circumstances warrant. For example, certain needs may become more pronounced and require enhancements to the described strategic initiatives. During the three years ending December 31, 2016, other organizations in the community may decide to address certain needs, indicating that the hospital should then refocus its resources to best serve the community.

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