WINTHROP-UNIVERSITY HOSPITAL

COMMUNITY NEEDS ASSESSMENT 2013

Winthrop-University Hospital 259 First Street Mineola, NY 11501 www.winthrop.org 1-866-WINTHROP

TABLE OF CONTENTS
I.
II. III. IV. V. VI. VII. Introduction1 Community Served..2 CHNA Process, Methodology and Findings..4 Identified Needs.13 Prioritization of Needs...15 Community Assets Identified.19 Conclusion..19

Appendix 1. 2. 3. 4. 5. Preliminary Community Health Assessment Data Community Based Organization Interview Findings Community Surveys & Certificate of Translation Community Health Assessment Survey Results Community Resources

I. Introduction
A provision of the Affordable Care Act requires that not-for-profit hospitals conduct and publish a Community Health Needs Assessment (CHNA) once every three years, and annually report to the IRS the steps it is taking to address the needs it has identified. To complete this requirement and produce the most effective assessment possible, Winthrop-University Hospital collaborated with the Nassau County Department of Health, four other Nassau County Hospitals and academic partners to conduct the assessment. The following report outlines the assessment process, the findings and a prioritization of significant health needs.

ABOUT WINTHROP-UNIVERSITY HOSPITAL

Winthrop-University Hospital is a 591-bed, not-for-profit regional healthcare resource located in the Incorporated Village of Mineola in Nassau County, a suburban community that borders New York City and Suffolk County. Founded in 1896, Winthrop owns the distinction of being Long Islands first voluntary hospital. We offer an extensive ran ge of preventive, diagnostic and clinical medical services through a broad range of primary care and specialized inpatient and outpatient programs. Winthrop delivers the highest level of care to newborns, children and adults as evidenced by our respective designations as a NYS Regional Trauma Center, NYS Department of Health Stroke Center, NYS Regional Perinatal Center and NACHRI Designated Childrens Hospital (National Association of Childrens Hospitals and Related Institutions). Winthrop is also the first nationally accredited Breast Health Center in Nassau County, a Breast Imaging Center of Excellence, an accredited Bariatric Surgery Center of Excellence, a Hypertrophic Cardiomyopathy Center of Excellence, and a Level-4 Epilepsy Center. We are also currently building The Research and Academic Center, a 95,000 square-foot, fivestory facility that will house laboratories, academic lecture halls and clinics which will facilitate bench-to-bedside research, cross-fertilization of ideas and access to the most current information available. Winthrop currently spends $5.8 million on unsubsidized research; our 2014 budgeted unsubsidized expense has been increased to $6.5 million. We have chosen to focus many of our research programs on health issues directly affecting the communities we serve. Diabetes, therefore, is a primary focus, both in the adult and pediatric population. Our work in diabetes has been recognized nationally. Winthrops Diabetes Education Center was the first in New York State to be recognized by the American Diabetes Association in accordance with National Standards for Diabetes Self Management Education and Support. We are also the first New York State Major Teaching Hospital to be awarded a Gold Seal of Approval for Inpatient Diabetes Care by the Joint Commission. The Hospital employs over 6,900 dedicated individuals, including nearly 1,500 nurses; our medical staff includes more than 1,800 full-time and voluntary attending physicians. 1

During 2012, Winthrop logged over 70,000 Emergency Department visits, discharged 31,724 inpatients and delivered 4,360 newborns. This included 8,629 inpatient surgical discharges, 590 of which were open-heart operations; an additional 20,428 ambulatory surgical cases were also performed. There were over 79,000 visits to community residents by the Hospitals certified Home Health Agency and more than 42,000 visits through its Long Term Homecare Program.

MISSION STATEMENT
It is the mission of Winthrop-University Hospital to provide high-quality, safe, culturally competent, and comprehensive healthcare services in a teaching and research environment, which improve the health and well-being of the residents of Nassau County and contiguous county areasbased on a profound commitment to an enduring guiding principle Your Health Means Everything.

ACADEMIC AND CLINICAL AFFILIATIONS

Winthrop is the Clinical Campus of the Stony Brook University School of Medicine and an affiliated member of the New York-Presbyterian Healthcare System.

II. Community Served

Winthrops primary core service area is Nassau County. According to 2012 Population estimates from the U.S. Census Bureau, Nassau County has an estimated population of 1,349,233. The median age of residents is 41.1; 89.9% are high school graduates or have achieved higher education, and a median household income is $95,832 with an estimated 5.2% of individuals below poverty level. 1 Race is reported as: 64.1% white alone, not Hispanic or Latino; 15.3% Hispanic or Latino; 12.2% Black or African American and 8.4% Asian.2 Estimated data from County Health Ranking and Roadmaps from the University of Wisconsin Population Health Institute indicates that although Nassau County is ranked as number 1 in New York State for Health Factors, it is number 8 in Health Outcomes; Health Behaviors are ranked at 3. The unemployment rate is 6.7%, compared with the national benchmark of 5.0%. Approximately 12% of the population is uninsured; the national benchmark is 11%. Primary care physician rates are solid about 675 patients to one doctor, compared to 1,067 patients to one doctor nationally. An estimated 9% of children live in poverty, compared to 14% nationally. Although adult obesity is estimated at 21% in Nassau compared to 25% nationally, physical inactivity affects 23% of our population compared to 21% nationally. Excessive drinking rates are high: 16% compared to national estimates of 7%. Teen birth rate is at 12% compared to 21% nationally.3
1 2

http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml http://quickfacts.census.gov/qfd/states/36/36059.html 3 http://www.countyhealthrankings.org/app/new-york/2013/county/snapshorts/059

There are 12 hospitals within Nassau County and approximately 40 urgent care centers.4 There is no tracking system in New York State to indicate the precise number of healthcare professionals currently practicing. However, in 2013 the New York State Education Department reported the following licensing statistics: 10,067 registered licensed physicians and 1,490 physicians assistants5, 1,562 nurse practitioners6; and 2,153 licensed dentists in Nassau.7 Nassau County represents a dichotomy, as health disparities exist within and between townships of varying socioeconomic composition. There are also differences in health status based on race and ethnicity. For example, infant mortality is much higher among African Americans than Caucasians. Latinos have higher rates of teen pregnancies, tuberculosis and deaths from injuries. The causes of these disparities are numerous and complex, and include differences in income, education, housing, and access to healthcare. Identifying and addressing disparities was one of the collaborative teams public health goals. Winthrops comprehensive approach to healthcare delivery includes the provision of both primary and specialty services to our service area. The Hospitals primary/core service area has historically been Nassau County, in Core Areas A, B, and C (See map below); based on an analysis of 2012 discharge data (Table 1), 80.6% of Winthrops discharges are from this area. Therefore, this was the focus of our assessment.

Blue: Core A; Green: Core B; Pink: Core C; Purple: Core D; Yellow: Core E

4 5

http://www.itriage.com http://www.op.nysed.gov/prof/med/medcounts.htm 6 http://www.op.nysed.gov/prof/nurse/nursecounts.htm 7 http://www.op.nysed.gov/prof/dent/dentcounts.htm

Table 1

Discharge Data 2012 (excluding normal newborns) Core Areas A B C Nassau Total D E Other TOTAL Total 17,472 6,953 1,149 25,574 1,560 506 4,084 31,724 % of Total 55.1% 21.9% 3.6% 80.6% 4.9% 1.6% 12.9% 100%

Within Core Areas A, B and C, 30% of Winthrops discharges are from select communities (Table 2,) i.e., those that are designated by the NCDOH as experiencing health disparities. Although they include Elmont (11003), Inwood (11096), Freeport (11520), Glen Cove (11542), Uniondale (11553), Long Beach (11561), and Roosevelt (11575) Hempstead (11550) and Westbury (11590) in Core Area A are geographically closest to the hospital and provide 24% of our patient population. Significant attention was paid to these areas.
Table 2

Discharge Data 2012 Select Communities (excluding normal newborns) Core Areas A B C TOTAL Total Select Communities 6,217 1,307 143 7,667 % of Total 81% 17% 2% 100% WUH Total 17,472 6,953 1,149 25,574 % of WUH Total 24% 5% .6 % 30%

III. CHNA Process, Methodology and Findings

Winthrop conducted the CHNA in collaboration with Catholic Health Services, Long Beach Memorial Hospital, North Shore LIJ Health System, and South Nassau Communities Hospital. Our academic partners included Adelphi University, Hofstra University and Stony Brook University. Our public health expert was Tavora Buchman, PhD, Director, Division of Quality Improvement, Epidemiology and Research from the Nassau County Department of Health, whose expertise was instrumental in our collaborative process. Dr. Buchman presented preliminary statistical data that identified the most

significant health needs within Nassau County, including health disparities in select

communities. She also organized workgroup meetings, invited academic experts to help develop assessment tools (surveys and key-informant interviews), compiled data, and presented the results to the collaborative group and community partners. Preliminary community health assessment data presented by the Nassau County Department of Health to the collaborative workgroup on January 15, 2013, compared Nassau County, NYS and select communities within Nassau County to identify population health problems and health disparities. This comparison included rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries (intentional and unintentional), cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. Sources of information included SPARCS data (2008-2010), NYSDOH Vital Statistics, NYS Cancer Registry and the NYSDOH Surveillance System. Data were age-adjusted (direct standardization of rates) based on 2000 U.S. standard population (See Attachment 1). The collaborative workgroup determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (i.e., the communitys perception of need). The workgroup agreed that in order to be effective, both qualitative and quantitative data should be collected from community organizations and the population-at-large. Two subcommittees Community-Based Organizations (CBOs) and Community-Wide Survey were formed with representation from the five not-for-profit hospitals, academic partners and the Nassau County Department of Health; each subcommittee was charged with developing and implementing the procedures to collect the information. The following explains and summarizes the results of both processes.
Community-Based Organizations Key Interview Process

The Community-Based Organizations (CBO) subcommittee was charged with conducting key informant interviews with Nassau Countys health and human services providers. The subcommittee met on January 25, 2013, to develop a list of key community organizations and a CBO interview guide. Emphasis was placed on groups that addressed one or more of the following populations: minorities/medically underserved, seniors, womens/childrens services, special populations and individuals with disease-specific conditions. The subcommittee included:

Adelphi University Hofstra University

1. Professor of Public Health Director of the MPH Program 1.Associate Professor Graduate Director, Master of Public Health & Master of Science in Community, Health Programs 1. Special Projects Representative

Long Beach Medical Center

Nassau County Department of Health

1. Director, Division of Quality Improvement, Epidemiology & Research 2. Epidemiologist 3. Intern 1. Director , Public Health Initiatives 1. Director, Rehabilitation & Community Services 1. Assistant Director, Community Relations

North Shore LIJ Medical Center St. Francis Hospital Winthrop-University Hospital

A qualitative CBO interview guide was developed and included questions with added prompts regarding New York States Five Prevention Agenda Priorities (Prevent Chronic Diseases; Promote a Healthy and Safe Environment; Promote Healthy Women, Infants and Children; Promote Mental Health and Prevent Substance Abuses; Prevent HIV, STDs, Vaccine-Preventable Diseases), significant health problems in the CBOs communities, barriers to care, quality of care, current health services, and recommendations for improving services. The interviewers included representatives from the hospitals, the academic partners and the county health department. All interviewers were required to participate in a training session to ensure consistency across the interviewing process. This training was provided on February 6, 2013, by an Assistant Professor of Preventive Medicine in the Divisions of Evaluative Services and Community Health at Stony Brook University. As a result of the training, modifications were made to the interview guide. A copy of the final CBO interview guide is included as Attachment 2. The group agreed that all interviews should be audio-recorded and transcribed. were shared among the hospitals and the Department of Health. Transcription duties

COMMUNITY-BASED ORGANIZATION KEY INFORMANT INTERVIEW DATA

Interviews with community-based organizations were conducted between March and April of 2013. Representation included: American Cancer Society Syosset, NY American Diabetes Association Melville, NY American Heart Association Plainview, NY Catholic Charities Hicksville, NY Circulo de la Hispanidad Long Beach, NY FEGS Health & Human Services (Federation of Employment & Guidance Service System) Hempstead, NY 1. Director of Patient and Family Services 1. Director, Long Island Operations 1. Regional Vice President Field Operations 1. Director of Development and Communications 2. Developer, Information and Referral 1. Executive Director 2. Chief Director of Services and Operations 1. Senior Director 2. Director of HIV Services 3. Vice President, Long Island Operations

Health and Welfare Council of Long Island Hempstead, NY Island Harvest Mineola, NY Jewish Association Serving the Aging (JASA) Long Beach, NY LI GLBT (Gay, Lesbian, Bisexual, Transgender) Garden City, NY Long Island Council of Churches Hempstead, NY Mental Health Association Of Nassau County Glen Cove, NY Perinatal Services Network Uniondale, NY Planned Parenthood Hempstead, NY Massapequa, NY Glen Cove, NY Project Independence Roslyn Heights, NY Sustainable Long Island Farmingdale, NY United Way Deer Park, NY

1. President and CEO 1. SNAP Outreach Coordinator 1. Director, Long Beach Services 1. Chief Operating Officer and Director of Development for Long Island 1. Director 2. Nassau County Coordinator 1. Director of Special Projects 1. Coordinator 1. Senior Vice President for Health Services, Planned Parenthood of Nassau County

1. Deputy Commissioner 2. Senior Citizen program Development Specialist 1. Executive Director 1. Senior Vice President

The collaborative workgroup hired a consultant to analyze results. Staff from the Nassau County Department of Health interviewed three potential consultants to conduct the qualitative analysis of the key informant interviews. With input from an academic partner, a doctoral candidate in Public Health at CUNY Graduate Center was selected Jessica B. Steier, MPH, DPH Candidate. The hospitals contracted with and paid for the consultant. The consultant coded the key informant transcripts using Atlas TI software. Coding reliability was tested and an analysis was conducted to identify emergent themes. The findings were presented to the committee and CBOs on May 15, 2013 and are included as Attachment 3. Participants overwhelmingly reported chronic disease as one of the most pressing health problems; 76.4% of organizations feel it is a priority; 50% feel it is the number one health priority. The most commonly mentioned chronic diseases were diabetes, heart disease and cancer. Obesity was seen as the most important risk factor for chronic conditions; preventing obesity among youth, especially among minority populations, represented a strong theme. 7

Patient education should emphasize prevention versus treatment, with a focus on healthy lifestyles (eating healthy and exercising) There should be increased communication across organizations to ensure visibility of available programs and resources A taskforce with members from various organizations would be helpful to brainstorm additional ideas and solutions Increased patient navigation and case management services would break down barriers to care Barriers to care: Inadequate public transportation in the county Language barriers for non-English speaking persons seeking quality health services Lack of awareness of available health resources (e.g. need to update 211 information banks that provide confidential information and referral for help with food, housing, employment, healthcare, etc.) Undocumented immigrant populations not accessing healthcare services due to fear of being reported and LGBT (lesbian, gay, bisexual and transgender) populations not accessing care due to fear of being treated differently Other themes included: the need for more in-home health and mental health services for homebound seniors; heavy reliance on emergency rooms for primary care; and the need for women to play a larger role in helping men access needed health services

INDIVIDUAL SURVEYS
The Individual Survey Subcommittee agreed that the use of a uniform survey distributed widely throughout communities in Nassau County would help ascertain the health perceptions and key concerns of residents, as well as identify service needs and barriers to care. The subcommittee included: Adelphi University Hofstra University 1. Professor of Public Health, Director of the MPH Program 1. Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community, Health Programs 1. Special Projects Representative 1. Director, Division of Quality Improvement, Epidemiology & Research 2. Epidemiologist 3. Intern 1. Director, Public Health Initiatives 2. Health Educator 3. Director, Community Benefit

Long Beach Medical Center Nassau County Department of Health

North Shore LIJ Medical Center

St. Francis Hospital South Nassau Communities Hospital Winthrop-University Hospital

1. Community Health, Promotion Programs, Marketing & Conference Management 1. Director of Community Education 1. Assistant Director, Community Relations

Surveys were translated into a certified copy of Spanish and widely distributed throughout the county (Attachments 4 & 5). Each Nassau County Hospital and NCDOH distributed the survey to community members at events targeting various age groups, diverse populations and communities with health disparities. The survey was distributed between February and April 2013. It reached a broad spectrum of community residents from many different zip codes. According to 2010 US Census estimates, 19% of Nassau Countys population reside in select communities. Out of 1070 surveys returned, 25.8% were from select communities, indicating that there was proportionate representation from populations with health disparities. OUTCOME OF SURVEY The survey results were analyzed by the NCDOH and shared with the CHA/CHIP committee and community partners on May 15, 2013. Responses were analyzed according to two separate populations: Nassau County in its entirety and select communities (communities with health disparities). Complete survey results are included as Attachment 6. The top health concerns for all the respondents and the select communities were the following chronic diseases: cancer, obesity, diabetes and heart disease. All respondents indicated that health screenings/educational programs on chronic disease especially diabetes and blood pressure were needed, highlighting the importance of routine well care, nutrition and physical activity. Womens and childrens health were also cited as a priority; it should be noted that 72% of respondents were women Select communities identified substance abuse as an additional high priority health concern. Both the total respondents and the select communities identified healthy food choices, recreational facilities, weight loss programs, clean air and water and job opportunities as items needed to improve the health of the community. All the respondents receive the majority of their health information from health professionals, the internet, television and family/friends. Over 50% of the total respondents and 70% of the select community respondents had a smart phone.

Barriers to Care The top concerns for barriers to medical treatment included: No insurance Lack of ability to pay deductibles and co-pays Fear of discussing health issues 9

Lack of knowledge about the importance of routine medical care As noted above, the results of both the Key-Informant Interviews and the Individual Surveys were shared with the CHA/CHIP committee and community partners on May 15, 2013. Attendees included:
Adelphi University 1. Professor Public Heath, Director of the MPH Program 1. CHS Vice President Public and External Affairs 1. Project Director 2. Care Coordinator 1. Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community Health Programs 1. Director, Senior Services 1. Special Projects Representative 1. Director, Project Hope 1. Director of Planning and Community Health 2. Public Relations, Marketing and Events Coordinator 1. Director, Division of Quality Improvement, Epidemiology & Research 2. Epidemiologist 3. Intern 1. Secretary 1. Director 1. Director of Communications 1. Quality Assurance Coordinator 1. Representative 1. Community Educator 1. Manager, Community Health Promotion Programs; Emergency Cardiac Care Programs, Marketing & Conference Management 1. Project Manager/Supply Chain Liaison 1. Executive Director 2. Community Planner/ Educational Program Coordinator 1. Chief Operating Officer 2. Director of Programs 1. Deputy Commissioner Department of Services for the Aging

Catholic Health Services FEGS Health & Human Services (Federation of Employment and Guidance Services) Hofstra University

Jewish Association Service the Aging (JASA) Long Beach Services Long Beach Medical Center Mental Health Association of Nassau County Mercy Hospital

Nassau County Department of Health

Nassau County Lions Club Foundation Nassau County Perinatal Services Network Nassau-Suffolk Hospital Council Nu Health Family Health Centers Planned Parenthood of Nassau County South Nassau Communities Hospital St. Francis Hospital

St. Joseph Sustainable Long Island

The Long Island GLBT Services Network (Gay, Lesbian, Bisexual, Transgender Town of North Hempstead Project Independence

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United Way of Long Island

Winthrop-University Hospital

1. Senior Vice President, HIV/AIDS Grant Management 2. Contract Administrator/Quality Manager 1. Assistant Director, Community Relations & Special Projects

At this collaborative meeting with our community partners, the following data was shared and presented by the Department of Health:

Rates of disease burden and vital statistics data, including health disparities by age, sex and community: o Chronic disease, Injury, Perinatal Outcomes, Communicable Disease Community-wide survey results: o Normally distributed, represented demographics in the county o Obesity, Chronic Disease (Cardiovascular Disease, Diabetes, Cancer) and Mental Heath emerged as priorities Key Informant Interview process: o Chronic disease overwhelming report o Obesity ranked as most important risk factor o Mental Heath also emerged; reported as important The following preliminary priorities emerged as a result of this collaborative effort:
Prevent Chronic Disease 1. Reduce Obesity in Children and Adults 2. Increase Access to High Quality Chronic Disease Preventive Care and Management in both Clinical and Community Settings

In addition, the collaborative group decided to touch on and promote mental health as well address substance abuse.

WINTHROPS CULTURAL COMPETENCY COMMITTEE

In addition to the collaborative process, Winthrop engaged local community partners in a discussion on May 21, 2013 to clarify the needs of their communities, validate the findings and discuss solutions. Representation included:

Hempstead Hispanic Civic Association Hempstead, NY

1. Executive Director 11

BQLI-AHEC (Brooklyn-Queens Long Island Area Health Education Center) Nassau County Department of Health Uniondale, NY Perinatal Service Network, DOH Uniondale, NY Hispanic Counseling Center Hempstead, NY Noticia (Hispanic Newspaper) St. Brigids Church Westbury, NY Winthrop Pediatrics (Hempstead Outpatient Clinic) Hempstead, NY Winthrop Womens Wellness (Hempstead Outpatient Clinic) Hempstead, NY

1. LI Program Coordinator 2. Area Health Education Center

1. Commissioner, Nassau County Dept. of Health 1. Director 1. Program Coordinator 1. Sales Director 2. Executive Assistant 1. Director 1. Practice Manager 2. Certified Child Life Specialist 1. Social Worker 2. Ancillary Practice Manager 3. Nurse Manager 4. Summer Intern 1. Chief Executive Officer 2. Vice President, Womens & Childrens Services 3. Director of Development 4. Manager, Community Training 5. Community Outreach Educator 6. Community Outreach Educator 7. Manager, Community Outreach 8. Director of Pastoral Care 9. Assistant Director, Community Relations 10. Administrative Director, OB/GYN

Winthrop-University Hospital Mineola, NY

These concerns were clarified by Winthrops community partners: It was determined that obesity and diabetes, along with other chronic diseases such as cancer and heart disease, are the most important conditions to be addressed. Concerns were also raised about mental health issues, drug and alcohol abuse, asthma, illegal alien status, domestic violence, and womens ignorance about contraception, The high cost of food, cultural food issues that undermine health (such as traditional, high fat high carbohydrate diets) and lack of access to affordable, appropriate food were also discussed. 12

The consensus of opinion is that the hospital needs to go into the community, during weekends or another appropriate times when the underserved are available. CBOs are looking for health screenings and follow-up. Participating agencies offered to act as liaisons by letting their respective populations know that the Hospital will be coming to them. Barriers to Care were similar. Mistrust on the part of the community (e.g. fear of the undocumented) Lack of insurance for the working poor Lack of access to care on weekends Language barriers Lack of knowledge about managing conditions Transportation difficulties (e.g. a single mother taking children on two buses to the Hempstead clinic).

IV. Identified Needs

In addition to the survey, key-informant interview process and discussions with our partners, Winthrop also researched the top causes of death in Nassau County during 2011 (see below). They were: heart disease, cancer, CLRD (Chronic Lower Respiratory Disease, i.e., asthma, COPD), stroke and unintentional injury. 8

500

Top Causes of Death, Nassau County 2011

Average Rate per 100,000 Population

http://www.health.ny.gov/statistics/leadingcauses_death/deaths_by_county.htm 13

The Leading Causes of Premature Death in Nassau County (before age 75) were slightly different cancer was number one and heart disease two, unintentional injury came in third, followed by CRLD and stroke.

Leading Causes of Premature Death Nassau County (Before Age 75)

250 200 150 100 50 0 Average Rate per 100,00 Population

The above information is in alignment with our assessment; the health conditions cited as the leading causes of death were recognized as the top concerns by the community we serve. In addition, according to the Center for Disease Control, chronic diseases are the nations leading causes of death and disability. Heart disease, stroke, cancer, and diabetes are among the most prevalent, costly, and preventable of all health problems. 9 Leading a healthy lifestyle (e.g., avoiding tobacco use, being physically active, and eating well) great ly reduces a persons risk for developing chronic disease. Access to high quality care and affordable prevention measures (including screening and appropriate follow-up) are essential steps in saving lives, reducing disability and lowering costs for medical care. Therefore, the assessment identified public health priorities that are aligned with national, state and community health concerns. The most significant needs identified are as follows: Reduce Obesity in Children and Adults The prevention and management of chronic disease: o diabetes o heart disease o cancer o lung conditions o stroke Mental health and substance abuse Women and Childrens Health Unintentional Injuries (Falls) Dental Services

http://www.cdc.gov/chronicdisease/overview/index.htm

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V. Prioritization of Needs
The process included a discussion with our community partners, an examination of resources and the feasibility of the success of possible interventions. The following criteria were utilized in determining the prioritization of needs: SPARCS data (2008-2010), NYSDOH Vital Statistics, NYS Cancer Registry and the NYSDOH Surveillance System Winthrops Admissions Data The severity of the public health need Results from Community Survey and Key Informant Interviews from CBOs Resources both hospital and community-based Health disparities within our core market area New York State Prevention Agenda Priorities Priorities of Healthy People 2020 Feedback from Winthrops leadership team, many of whom sit on the boards of local organizations Informal discussions with Winthrops healthcare providers

RANKING
Winthrop ranked priorities based on the burden, scope and urgency of the health need, health disparities in select communities and the importance the community placed on addressing the needs. Priorities are as follows: 1. Reduce obesity in children and Adults The evidence supporting significant health risks associated with obesity is compelling: obesity and overweight are the second leading cause of preventable death in the United States and may soon overtake tobacco as the leading cause of death. By the year 2050, obesity is predicted to shorten life expectancy in the US by two to five years. Obesity-related condition include heart disease, stroke, type 2 diabetes and certain types of cancer all identified by our assessment as public health priorities. Therefore, it was determined that Winthrop may make the most significant impact on public health by addressing obesity. 2. Diabetes There are significant disparities with select communities that were identified in our report from the NCDOH (see chart).

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Hospitalization from Type 2 Diabetes occurs more than twice as often in the select communities than it does in the rest of Nassau County. Given the significant health disparity in select communities, the potential complications that lead to heart disease, stroke, eye problems, amputations and more, the emphasis the public placed on diabetes in our assessment and Winthrops expertise in the area of diabetes management, the Hospital has chosen to prioritize and address diabetes case findings, prevention and management.

3. Asthma Asthma poses a health disparity in Nassau County, as illustrated by the accompanying chart. Interventions that focus on proper management can impact healthcare costs and the long-term effects on our countys fourth leading cause of death.

4. Cardiovascular Disease, Including Stroke The number one killer of adults both nationally and within Nassau County. Interventions such as cholesterol screenings, public education, and the benefits of a healthy lifestyle will be addressed by the Hospital.

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5. Women and Childrens Health Perinatal outcomes in select communities are poor (See charts). Winthrop has a Womens Wellness Clinic in Hempstead to address access and barriers to care and will make this a priority.

6. Cancer Identified as a priority by our community, Prostate, Lung, Breast and Colon Cancer have the highest incidence of occurrence in Nassau County. Winthrop currently has a broad spectrum of cancer services that include diagnosis, treatment and support. We will work with 17

community partners on public education efforts that will emphasize the importance of reducing risk factors and seeking appropriate screenings. 7. Mental Health & Substance Abuse Identified as a significant health problem by our community, we have limited resources in this field. However, we have a referral system in place and will address the issue through public education efforts. 8. Unintentional Injuries (Falls) Falls in the elderly are a significant risk factor for hospitalization, loss of quality of life and death. We will continue to address this issue through public education that addresses risks and balance exercises.

9. Dental Care In conducting the assessment, Winthrop noted the link between the lack of routine dental care and complications with diabetes, and other systemic diseases10. For example, oral health is considered to be a public health opportunity by the New York State Department of Health11, due to its link with diabetes. The action notes: Because chron ic periodontal inflammation has been identified as a potential risk factor for poor glycemic control, routine dental care may help prevent complications from diabetes. This will be addressed through education and free screenings.

10 11

http://www.webmd.com/oral-health/features/oral-health-the-mouth-body-connection?page=2 http://www.health.ny.gov/statistics/prevention/injury_prevention/information_for_action/docs/20118_ifa_report.pdf

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VI. Community Assets Identified

The collaborative effort identified a number of strong community assets (Attachment 9), including the other four hospitals and their community programs, an adequate number of primary care physicians, health clinics, and community-based organizations.

VII. CONCLUSION
Our assessment revealed that Nassau County has the resources necessary to support health, yet there are communities experiencing significant health disparities. It is also notable that an estimated 46 percent of deaths in New York State are attributable to modifiable risk factors. Tobacco use, poor diet, lack of physical activity, and alcohol consumption are the most common behaviors linked to preventable deaths. Because of this, Winthrop will work with community partners to improve outcomes by stressing the importance of a healthy lifestyle, seeking appropriate clinical services and treatment, and improving access to care. In addition, our county-wide assessment led to an initiative called the Long Island Collaborative, a coalition of Nassau and Suffolk County Hospitals, community-based organizations and businesses that will focus on improving the health of residents, primarily by focusing on reducing obesity and managing and preventing chronic conditions. The collaborative effort will also address mental health. This initiative is moving forward with a three-pronged approach that will encompasses programming, policy, and public outreach. It is hoped that this collaborative effort will make a positive impact on population health.

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