community health needs assessment (chna) summary eastern

Community Health Needs Assessment (CHNA) Summary

Eastern Long Island Hospital (ELIH), a leading provider of healthcare services to the communities on the North Fork and Shelter Island, conducted a Community Healthcare Needs Assessment (CHNA) in cooperation with the Suffolk County Department of Health Services and other Suffolk County hospitals. The purpose of the assessment is to help identify healthcare needs, resources as well as gaps in service, and establish priorities to meet these needs. The assessment is summarized below and complete details are available in the attached report.

Methodology

A primary assessment initiated by ELIH and conducted by an independent healthcare industry group focused on the needs identified in the prime service area of the Hospital. This process included one-to-one, in-person interviews, telephone interviews, focus groups and an online survey tool completed by 45 community leaders from health/welfare organizations; local schools; clergy; businesses; and government organizations.

In collaboration with the Suffolk County Department of Health Services (SCDHS) a second, county-wide survey was conducted with the assistance of the Nassau Suffolk Hospital Council (NSHC) engaging ELIH and area hospitals jointly and surveying both community-based organizations and individuals. Organizations completed an online survey tool, while SCDHS facilitated collection and analysis from individuals.

Results

Similar issues rose to the top in both reports, identifying – health promotion and disease prevention- as key concerns voiced by the community. Specifically chronic health issues- such as heart disease, high blood pressure and diabetes were highlighted in relationship to being overweight, poor nutrition and lack of exercise. Aging in place resources, transportation access and other age related issues dominated the local report where 65+ issues further challenge managing chronic disease in ELIH’s service area.

Priorities for Healthcare Improvement in the Eastern Long Island Hospital Service Area

Focused on preventing chronic disease and reducing obesity (Prevention Agenda 2013-2017), ELIH is actively forging a path and collaborating with strategic partners in the implementation of an action plan. Formation of a work group, known as, the Long Island Health Collaborative (LIHC) will help Long Islanders understand why prevention and primary care are important, why each patient must play a more active role in his/her own health, what resources and services are available here on Long Island, and how these resources and services can be accessed. A website to engage Long Islanders and showcase regional resources is part of the implementation process.

COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN

PREPARED BYALVAREZ & MARSAL

AND IMPLEMENTATION PLAN PRESENTED MAY 21, 2013ELIH STRATEGIC PLANNING COMMITTEE

APPROVED JUNE 20 2013 HEALTHCARE INDUSTRY GROUPAPPROVED – JUNE 20, 2013ELIH BOARD OF TRUSTEES

ELIH COMMUNITY NEEDS ASSESSMENTAND IMPLEMENTATION PLANAND IMPLEMENTATION PLAN

I. Introduction.…..………....………………………………..1

Table of Contents

II. Implementation Plan• Introduction.…………………………………………………..4• Key Action Plans....………………………………………….6• Obesity Actions 8Obesity Actions………………………………………………8• Diabetes Actions..………………………………………….11• Non-Priority Issues……….……………….………………..14

III. Review and Approval.………………...…………….....15

IV. Appendix…….....................................................................16• ELIH Service Area Statistics..............……………………17• Health Status Profiles..…………………………………….26• Community Identified Issues and Actions……….………34 • Key Issues and Priorities...…….………………….………38• ELIH Lifestyle Coach Program.....………………………..46• RSVP Living Healthy Workshop...…………..…….……..50

I. INTRODUCTION

ELIH Community Health Needs Assessment: Purpose and Charge

Each year ELIH has developed a community health assessment and community service plan as part of its commitment to service area residents. ELIH’s commitment is reflected in its mission and vision:

ELIH Mission: To provide essential healthcare services to the communities of the North fork and Shelter Island and critical access to specialty services.

ELIH Vision: To be a regional leader committed to an East End Healthcare system that ensures excellence compassion education and improved health of the communityensures excellence, compassion, education and improved health of the community.

New for 2013, the federal (Accountable Care and IRS) and New York State Health Department guidelines require an expanded Community Health Needs Assessment (CHNA) process and Implementation Plan. ELIH’s process includes:( ) p p p

Coordination with Suffolk County Health Department & the Nassau Suffolk Hospital Council

Assessment of service area issues and priorities using a variety of community inputAssessment of service area issues and priorities using a variety of community input approaches

Evaluation of North Fork and Suffolk County health statistics with disparity focus

Development of an Implementation Plan with specific measureable outcomesDevelopment of an Implementation Plan with specific measureable outcomes

Completion of CHNA with ELIH’s Strategic Planning Committee and Board guidance 2

I. INTRODUCTION: FOCUS ON IMPLEMENTATION

LEADERSHIP IS THE CAPACITY TO TRANSLATE VISION INTO REALITY

Warren Bennis

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II. IMPLEMENTATION-INTRODUCTION

ELIH will cooperate with area wide hospitals and Suffolk County to target specific i i i d h i di d

Principles To Guide Action Plans and Execution:• Effective solutions to priority health problems will require strengthening the primary care

priorities around chronic disorders.

Effective solutions to priority health problems will require strengthening the primary care provider role as integrator in chronic disease management.

• Access to integrated population health data is a foundation for the prevention and management of Chronic Disease …. and improved health status.management of Chronic Disease …. and improved health status.

• Integrating individual roles across health & non-health organizations is required to improve health status of North Fork and Shelter Island.

• ELIH action plans will include special focus on populations of disparity, particularly Seniors.

• Building Community ownership in self-directed and provider coached “be well” management programs is a foundation for successful community health status improvement over time.p og a s s a ou da o o success u co u y ea s a us p o e e o e e

• Healthcare is on the cusp of a digital revolution with transforming impacts on the healthcare continuum, provider community and our service area residents.

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II. IMPLEMENTATION: INTRODUCTION-CHRONIC DISEASE FOUNDATION

• Chronic diseases are among the leading causes of death, disability and rising health care costs in New York State (NYS). Specifically, they account for approximately 70 percent of all deaths in NYS. The prevalence increases dramatically by age:

Preventing Chronic Conditions is a key foundation for ELIH’s Implementation Plan

# of Chronic Age GroupsConditions 0‐19 20‐44 45‐64 65+1 or More 7% 17% 43% 73%2 or More 27% 40% 68% 91%

• Costs associated with chronic diseases and their major risk factors consume more than 75 percent of our nation’s spending on health care.

• However, chronic diseases are also among the most preventable. Three modifiable risk behaviors - lack of

Medical Economics, 2006, Robert Wood Johnson, 2010

, g pphysical activity, unhealthy nutrition, and tobacco use are largely responsible for the incidence, severity and adverse outcomes of chronic disease, including Obesity and Diabetes.

• If the major risk factors for chronic disease were eliminated, at least 80 percent of all heart disease, stroke and type 2 diabetes would be prevented and more than 40 percent of cancer cases would be avoidedand type-2 diabetes would be prevented, and more than 40 percent of cancer cases would be avoided.

• Reducing these key modifable risk behaviors tied to Obesity and Diabetes will also benefit overall chronic disease prevention.

• In addition, because of high incidence and mortality among Seniors in ELIH service area, addressing these health disparities is a focal point for the ELIH’s chronic disease action plan.

5Source: New York State 2013-2017 Prevention Plan, 2013

II. IMPLEMENTATION: KEY ACTION PLANS

ELIH f i l d f h i di iELIH’s Implementation Plan include two key areas with special focus on a target disparity group, the Senior of the North Fork and Shelter Island:

ELIH focuses on inter-related areas of chronic disease prevention

• Prevent Chronic Disease: Reduce Obesity adult population

• Prevent Chronic Disease: Increase access to quality preventive care and management.

• Specifically Diabetes: Pre-Diabetic & Type 2 diabetes & well adult chronic disease management

• Non-priority Issues include: home aide support, maternal & child health, primary care, and mental health The action plans focus on three inter-related components:

• Develop Infrastructure as a foundation for all priorities and actions

• Collaborate with continuum providers and community organizations

• Deliver specific new ongoing programs for prevention of chronic disorders, e.g. obesity and diabetes

• Facilitate service access for Hispanic population

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II. IMPLEMENTATION: OBESITY OVERVIEW

Obesity and over weight conditions have become a leading health risk across ELIH’s i S ff lk C d N Y k S

Obesity service area, Suffolk County and New York State

• Obesity has reached epidemic proportions in New York State and across the nation. Obesity and overweight are currently the second leading preventable cause of death in the United States and may soon overtake tobacco as the leading cause of death.

• Failing to win the battle against obesity will mean premature death and disability for an increasingly large segment of New York residents. Without strong action to reverse the obesity epidemic, for the first time in our history children may face a shorter lifespan than their parentsfirst time in our history children may face a shorter lifespan than their parents.

Obesity Prevalence• The percentage of New York State adults who are overweight or obese increased from 42% in

1997 to 60% in 2008. The percentage of obese adults in New York State more than doubled from 10% in 1997 to 25% in 200810% in 1997 to 25% in 2008.

• Obesity among children and adolescents has tripled over the past three decades. Currently, a third of New York's children are obese or overweight.

• Health care to treat obesity-related illnesses and conditions cost the United States an estimated $150 billion and New York State more than $7.6 billion every year.

• Overweight and obesity cause serious health problems, including* Type 2 diabetes *Heart disease *High cholesterol

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Type 2 diabetes Heart disease High cholesterol* High blood pressure *Several forms of cancer *Asthma

Source: New York State Health Department, Department of Chronic Disease, 2012

II. IMPLEMENTATION: ACTION PLANS-OBESITY

NY State Health Department has also endorsed Obesity as a core Focus Area in its Ch i Di P i i f 2013 201

• ELIH priority action plan for Obesity was selected based on community leader surveys, interviews and area-wide statistics.

Chronic Disease Priority for 2013-2017

• Significant state and national evidence of increasing obesity among all age groups and its role in major debilitation diseases further demonstrates Obesity as a major health priority for ELIH’s service area.

• Additionally, NY State has selected Obesity as a major Chronic Disease Focus Area: Reduce Obesity in Children and Adults. ELIH’s plan will focus on reducing obesity among adults. ELIH will also focus on one disparity population:

The significant senior disparity population of North Fork, particularly those with independent living circumstances, fixed low incomes and limited access resources

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II. IMPLEMENTATION PLAN: ELIH PRIORITY-OBESITY

• Obesity Goal: * Reduce % adults overweight from 58% to 55% By 2017Obesity Objectives: * Increase adult exercise in last 30 days: From 78% to 83%Obesity Objectives: Increase adult exercise in last 30 days: From 78% to 83%

* Increase ave. two fruits & vegetables daily: from 25% to 30%1

# ELIH Focus: Reducing Obesity in Adults‐Specific Focus On yr1 yr2 yr3 Resources Targetg y pOne Disparity Population‐ Seniors In Coordination with NY State Obesity Focus, 2013‐2017

1 Develop an ELIH staffed “Lifestyle Coach Program”‐nationally recognized and NY State trained Quality Technical Assistance

X NY State 2 classesrecognized and NY State‐ trained Quality Technical Assistance Program (QTAC). See Diabetes Action Plan, #2 for details

QTAC yr. 1; 1 followingyears

2 Exercise/Fitness Access: Continue to operate ELIH GYM for ongoing X X ELIH monthlyweight reduction and fitness classes for North Fork residents, with special emphasis on Seniors; develop fitness class for seniors

services classes / yr. 3

3 Nutritional Access Options: Evaluate & coordinate outreach options for diet information with Cornell’s “Food & Nutrition‐

X Cornell ‘sFNEC

BRFFS‐TBD

Education in Communities” (FNEC) Department.

9ELIH Community Health Needs Assessment: Priority Implementation Actions, 2013

Sources: 1. NY State Obesity BRFFS Statistics, 2010

II. IMPLEMENTATION: DIABETES OVERVIEW

Incidence and Prevalence • Between 1999 and 2009, the prevalence of diagnosed diabetes in adults in New York State (NYS)

increased from 5 7% to 8 9% During the same years the prevalence of obesity in adults increased from

Dual epidemics of diabetes and obesity are on the rise among New York State adults.

increased from 5.7% to 8.9%. During the same years, the prevalence of obesity in adults increased from 7.4% to 24.6%.

• Because obesity is a leading risk factor for diabetes,1 the increase in obesity prevalence translates to nearly one million additional New Yorkers being at higher risk for developing diabetes.2

Public health importance: • The total cost of diabetes in NYS was estimated at $12.9 billion in 2007, including $8.7 billion in diabetes-

related medical expenditures and $4.2 billion attributed to lost productivity costs.3

• NYS ranks second among states in adult obesity-related medical expenditures, with total spending estimated at nearly $7.6 billion.4

• The risk of developing diabetes can be reduced by 58% in adults diagnosed with pre-diabetes through th t dif ti d h i l ti it h l i d lt hi d i t i d t i ht lprograms that modify eating and physical activity, helping adults achieve and maintain modest weight loss

(5-7%).5

References1. Ford ES, Williamson DF, Liu S. Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol 1997; 146(3):214-22. 2. New York State Behavioral Risk Factor Surveillance System, 20093. American Diabetes Association. Diabetes Cost Calculator. Available at: http://www.diabetesarchive.net/advocacy-and-legalresources/cost-of-diabetes.jsp3. American Diabetes Association. Diabetes Cost Calculator. Available at: http://www.diabetesarchive.net/advocacy and legalresources/cost of diabetes.jsp4. Office of the State Comptroller. Preventing and reducing childhood obesity in New York. Oct 2008; 1-4.5. The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 3936. http://www.health.state.ny.us/prevention/prevention_agenda/chronic_disease/diabetes.htm

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II. IMPLEMENTATION: ACTION PLANS-DIABETES

NY State Health Department has also endorsed chronic disease preventive care and management

• ELIH’s priority action plan for Diabetes was selected based on community leader surveys, interviews and area-wide statistics.

as a core Focus Area in its Chronic Disease Priority for 2013-2017

• Significant state and national trends provide evidence of the health care and economic impacts from Diabetes among ELIH’s high percentage of seniors.

• Additionally, NY State has selected a major Chronic Disease Focus Area: Increase access to high-quality chronic disease preventive care and management in both clinical and community settings.

• As part of its action plan, ELIH will focus on Diabetes prevention and promote use of evidence-based care to manage chronic diseases. ELIH will also focus on one disparity population:

The significant senior disparity population of North Fork, particularly those with independent living circumstances, fixed low incomes and limited access resources

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II. IMPLEMENTATION PLAN: ISSUE PRIORITY-DIABETES• Diabetes Objective: Reduce Diabetic Hospitalization Rate to NY State Rate

T t P l ti S i• Target Population: Seniors

ELIH Focus:

Process Indicators:AIC TestLipids

• Initiate ELIH LifestyleCoach Program

• Facilitate Access

Access

LipidsBMIEyes

Outcome

Facilitate Access

• Facilitate use of screenings

Access Indicators

Self Management

Outcome Indicators • Facilitate education

& consultation for Seniors: DSME

Management Indicators • Promote coordination

mechanism across continuum & CBOs

12ELIH Community Health Needs Assessment: Priority Implementation Issues, 2013

II. IMPLEMENTATION PLAN: ISSUE PRIORITY-DIABETES

• Diabetes Goal: * Reduce % adults overweight: from 58% to 55-% by 20171

Diabetes Objectives * Reduce Diabetic Admissions Among Residents 18 and above fromDiabetes Objectives: * Reduce Diabetic Admissions Among Residents 18 and above from 4.0/10,000* population to 3.6/10,000* population, by 2017.

# ELIH concentration on Diabetes & related chronic disease preventive care; special focus Seniors

Yr1 yr2 Yr3 Resources Target

In Coordination with NY State Focus Area: To Increase access to high‐quality chronic disease preventive care…g q y p

1 Infrastructure: ELIH to assist its PCPs & PHO to coordinate NCQA certification process in Diabetes Medical Management.

X X X NY State Chronic Disease & MDs

CertifiedMDs

2 ELIH Lifestyle Coach Program: ELIH to develop program in coordination with NY Quality Technical Assistance Center(QTAC) &

X X X NY State QTAC 16 week classes Q y (Q )

NY State Diabetes Prevention Program; developed by CDC standards program and NIH’s documented program success.

operational

3 Infrastructure: ELIH to facilitate chronic disease self management programs with Suffolk Co. RSVP organization and CBO’s.

X X X RSVP – “Living Healthy

workshops in place p g g

Demonstrate program success to future “expansion” partners (#4)y

Workshops” yr.1

13ELIH Community Health Needs Assessment: Priority Implementation Actions, 2013

Sources: 1. NY State BRFFS, 20132. NY.Gov, NY State Health Department, Suffolk County Health Indicators, June, 2013, * Age-adjusted rate, NY State

II. IMPLEMENTATION PLAN: NON-PRIORITY ISSUES

• Objectives: * Strengthen primary care geo coverage over timeObjectives: Strengthen primary care geo. coverage over time* ELIH continues its ongoing preventive health actions for aging

in place, falls prevention, smoke free campus policies, and suicide prevention

# Activities/Steps: Non‐Priority ELIH Issues yr1 yr2 yr3 Resource Target

ELIH Key Non‐Priority Support Issues: ELIH IS NOT LEAD FOR IMPLEMENTATION; SUPPORT ONLY

1 Provide continuing accommodations for MCH‐perinatal services X X X ELIH space Hispanic1 Provide continuing accommodations for MCH‐perinatal services by area MCH providers ( Southampton, others).

X X X ELIH space Hispanic access

2 Continue to refer Seniors to home health programs for care management support & coordination with Health Plans.

X X X In‐ kind support

Seniorreferrals

3 M i l i i d f i h i i ELIH M di l3 Monitor evolving succession needs for primary care physicians as practicing physicians retire on North Fork & Shelter Island.

x x ELIH Medical staff reports

4 Continue to provide ELIH as a smoke free campus x x x ELIH continue

5 Continue to provide ELIH’s balance program in support of Falls x x x ELIH Program5 Continue to provide ELIH s balance program in support of Falls prevention among seniors

x x x ELIH Programcontinues

6 Continue to raise awareness for suicide prevention and promote ‘safeTalk’ training

x x x Response, NYS OMH

Coalition

7 Strengthen relationships with CBOs/providers serving the x x x HRHC Access

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7 Strengthen relationships with CBOs/providers serving the Hispanic population

x x x HRHC Access

ELIH Community Health Needs Assessment: Priority Implementation Actions, 2013

III. REVIEW AND APPROVAL

Completion of the ELIH plan achieves compliance with both the New York State C it S i Pl d th F d l C it H lth N d A t

REVIEWED:

Community Service Plan and the Federal Community Health Needs Assessment requirements. Additionally, the plan will help better position ELIH strategically in the eastern Long Island healthcare market

REVIEWED: ELIH Strategic Planning Committee - May 21, 2013

APPROVED:

ELIH Board of Trustees – June 20, 2013

Next Steps:

• Provide community access to the “CHNA / CSP” using ELIH website

• Strategic planning committee to monitor implementation steps monthly

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Appendix Demographics &Demographics &

Health Status Profiles

IV. SERVICE AREA STATISTICS: AREA SERVED / POPULATION TRENDS

ELIH’s service area will grow about 3% by 2017, a little faster than Suffolk County overall 2% N bl 2 % f ELIH’ i 6 d 13 6% i S ff lk

Area Served & Population Trends

Service area of 24,000 in 2012 grows to 25,000 by 2017, a moderate 3% increase

at 2%. Notably, 25% of ELIH’s service area are age 65+ compared to 13.6% in Suffolk.

Service area of 24,000 in 2012 grows to 25,000 by 2017, a moderate 3% increase

– Most service area increase projected for Greenport (199), Mattituck (236)& Shelter Island (130);

Service area population while <2% of Suffolk County (2012: 1 513 442) is unique– Service area population, while <2% of Suffolk County (2012: 1,513,442), is unique with an overall high age 65+% at 24% compared with Suffolk at 14%

Service Area 2012 2017 2012‐2017Community Zip Code Population Population Growth %Community Zip Code Population Population Growth %Cutchogue 11935 3,305 3,212 ‐3%East Marion 11939 954 1,021 7%Greenport 11944 4,363 4,561 5%Laurel 11948 1 082 1 101 2%Laurel 11948 1,082 1,101 2%Mattituck 11952 4,970 5,205 5%Orient 11957 705 685 ‐3%Peconic 11958 671 777 16%Southold 11971 5 867 5 899 1%

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Southold 11971 5,867 5,899 1%Shelter(s) 11964/65 2,388 2,518 5%Total 24,304 24,979 3%

Source: Pinpoint Demographics, 2013

ELIH Service Area: N th F k d Sh lt I l dNorth Fork and Shelter Island

IV. SERVICE AREA STATISTICS: KEY DEMOGRAPHIC FEATURES

ELIH’s service area is characterized by its large senior population which is a leading f i d i i i i h l h d d i h l h i i

Key Demographic Feature: Senior PopulationSeniors make up almost 25% of the overall service area compared to Suffolk County at

factor in determining priority health needs and preventive health community actions

13.6% age 65+, nearly twice the percentage in Suffolk County and New York State as well.

This important factor does reflect the presence of retirement and long term care communities in Greenport. However, each of the North Fork & Shelter Island communities have significantly greater % of seniors than in Suffolk County overallhave significantly greater % of seniors, than in Suffolk County overall.

Service Area 2012 2012 2017Zip Code Age 65+ Age 65+ % Age 65+ %Cutchogue 739 22% 23%Cutchogue 739 22% 23%East Marion 314 33% 34%Greenport 1,200 28% 30%Laurel 208 19% 19%M ttit k 943 19% 19%Mattituck 943 19% 19%Orient 230 33% 32%Peconic 133 20% 18%Southold 1,512 26% 25%

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Shelter(s) 679 28% 29%Total 5,958 25% 25%

Source: Pinpoint Demographics, 2013


Key Demographic: Senior Population increases concentration in Greenport

For example, I8% of service area population and 20% of the age 65+ live in Greenport:

ELIH’s service area is characterized by its large senior population

– Greenport increases its concentration of service area seniors to 22% by 2017

– And Greenport holds a significant 36% share of age 85+ in service area… growing to 41% of total age 85+ populationg p p

Including the “graying” 55-64 population to the 65+ senior population reveals:

– Greenport and Mattituck, both with a little less than 1/5 of service area’s age 55+ population grow 9% by 2017population, grow 9% by 2017.

– Southold with almost ¼ of total service area population as well as age 55+, loses about 1% of its 55+ population by 2017

Bottom line: total growth is projected at 3% age 65+ at 3% and age 55+ at 4 5%:Bottom line: total growth is projected at 3%, age 65+ at 3% and age 55+ at 4.5%:

Age Group 2012 2017 % Change55‐64 3,619 3,864 7%65‐74 2,785 2,731 ‐2%

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75‐84 2,043 2,040 0%85+ 1,130 1,373 22%Total 9,577 10,008 5%

The significant minority populations make up 14% of the service area; Hispanic population comprise 12% and African American population accounts for an additional 2% f l i d i G


Key Demographic Features: Minority / Ethnic Populations

Minority populations in ELIH’s service area are concentrated in Greenport Almost

of total service area, concentrated in Greenport

Minority populations in ELIH s service area are concentrated in Greenport. Almost 50% of the small African American population (457) and 53% of the Hispanic population (1288) live in Greenport.

Minority populations in Suffolk County and North Fork communities are at significant y p p y geconomic & health status disparity compared to overall population as detailed on following page and Appendix.

Importantly, health status indicators also demonstrate the health disparity compared t ll l ti i S ff lk C t Thi di it i l d l h lth t t fto overall population in Suffolk County. This disparity includes lower health status for major mortality, morbidity as well as at risk health behaviors, including:

» Diabetic hospitalization rates, falls and accidents, asthma and cervical cancer

» Maternal and child health risk factors for pre-natal care and teen pregnancy

» Overall premature death

» See pages 47-48 for details. p g

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Sources: Pinpoint Demographics, 2013* Hispanic growth estimates based on Pinpoint Demographics and sig. lower local estimates

The African American population is concentrated almost exclusively in Greenport, Mattituck and Cutchogue . The Hispanic population, although often migrant/transient, is concentrated in Greenport


Key Demographic Features: Minority / Ethnic Populations

and includes smaller populations in Southold, Mattituck and Cutchogue.

S i A 2012 % T t l 2012 % T t l 2017 Hi iService Area 2012 % Total 2012 % Total 2017 Hispanic

Zip Code Zip Code African A. Zip Code Hispanic Zip Code Growth *

Cutchogue 11935 63 2% 280 8% Possibly 12%

East Marion 11939 7 1% 44 5% Moderate

Greenport 11944 228 5% 1,288 30% Possibly 39%

Laurel 11948 9 1% 105 10% Low

Mattituck 11952 68 1% 422 8% Low‐Moderate

Orient 11957 8 1% 11 1% Minimal

Peconic 11958 26 4% 80 12% Low

Southold 11971 22 0% 524 9% Possibly 13%

Shelter(s) 11964/65 27 1% 122 5% Minimal

Total 457 2% 2,875 12% Moderate

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Sources: Pinpoint Demographics, 2013* Hispanic growth estimates based on Pinpoint Demographics and sig. lower local estimates

ELIH’s community leader survey is a key foundation for developing priorities and ifi i l I i i h d i di id l d hi


Key Demographic Features: Education Levels

Cutchogue and Southold lead the North Fork with more than 70% of residents holding

specific action plans. Interviews with groups and individuals augmented this process

Cutchogue and Southold lead the North Fork with more than 70% of residents holding Associate college degrees or higher, and 2/5 of Cutchogue residents with advanced graduate degrees.

Conversely, Greenport Mattituck’s populations are among the most diverse reflecting y, p p p g ghigher percentage of younger Hispanic populations and work force.

Not finished Completed Some Associate College GraduateCommunity Zip Code Pop 2012 High School High School College Degree Degree DegreeCutchogue 11935 3,305 6% 12% 10% 9% 20% 42%East Marion 11939 954 11% 26% 17% 5% 25% 15%Greenport 11944 4,363 19% 34% 19% 6% 12% 9%Laurel 11948 1,082 7% 29% 15% 11% 22% 16%Mattituck 11952 4,970 15% 44% 18% 12% 8% 3%Orient 11957 705 2% 21% 21% 28% 14% 14%Peconic 11958 671 16% 27% 19% 4% 25% 10%Southold 11971 5,867 2% 14% 6% 21% 18% 39%Sh l ( ) 11964/65 2 388 11% 33% 20% 5% 20% 11%

23

Shelter(s) 11964/65 2,388 11% 33% 20% 5% 20% 11%Total 24,304 10% 28% 18% 8% 21% 15%Long Island NA 21% 23% 17% 6% 19% 14%

Pinpoint Demographics, 2013

ELIH’s community leader survey is a key foundation for developing priorities and ifi i l I i i h d i di id l d hi


Key Demographic Features: Income

North Fork and Shelter Island are relatively well off in terms of income and protection


North Fork and Shelter Island are relatively well off in terms of income and protection from poverty. Greenport stands out as the least secure community economically, due to presence of the significant low income Hispanic population (30% of Greenport).

This economic profile follows the similar pattern observed in completed education p p plevels across the service area; higher education levels-lower financially at-risk populations.

Service Area 2012 Income IncomeC it P l ti M di HH 50% P tCommunity Population Median HH. <50% PovertyCutchogue 3,305 80,688$ 6.4%East Marion 954 70,140$ 6.2%Greenport 4,363 67,333$ 10.0%Laurel 1,082 70,939$ 1.7%Laurel 1,082 70,939$ 1.7%Mattituck 4,970 85,024$ 1.8%Orient 705 66,270$ 2.4%Peconic 671 78,815$ 6.0%Southold 5,867 70,290$ 2.6%

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Shelter(s) 2,388 73,220$ 2.0%Total 24,304

Pinpoint Demographics, 2013

ELIH’s community leader survey is a key foundation for developing priorities and ifi ti l I t i ith d i di id l t d thi


Key Demographic Features: Seasonal Population & Tourism• Seasonal populations double the local populations during high season Memorial


p p p p g gDay to Labor Day.

• It is assumed, (without county-level profile data available) that this population may have typical health needs of a more affluent population and likely has ongoinghave typical health needs of a more affluent population and likely has ongoing access to health services in home areas.

• However, the prevalence of chronic disease and certain lifestyle risk factors i l di i ht b it d t l h lth bl lik lincluding overweight, obesity and mental health problems are likely.

• Therefore, this seasonal population may in fact avail themselves of key community preventive health services offered and coordinated by ELIH and other service area p yproviders.

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HEALTH STATUS PROFILES: MODEL ELEMENTS

IV. HEALTH STATUS PROFILES: SUFFOLK COUNTY

Suffolk County rates high among all NY rankings for SES and health factors, and d t f h i l i t bidit d li i lmoderate for physical environment, morbidity and clinical care

Suffolk New National Rank InCounty York Benchmark 62 Counties

Health Outcomes 18Mortality 13

Suffolk County Health Assessment

yPremature death/100,000 5,301 5,650 5,317Morbidity 22Poor or fair health past 30 days 12% 15% 10%Poor physical health days past 30 days 3.2 3.5 2.6Poor mental health days past 30 days 3.3 3.4 2.3Low birthweight<2500 gms. 7.6% 8.2% 6.0%Health Factors 8Health Behaviors 14Adult smoking (most days) 18% 18% 13%Adult obesity- BMI>30 26% 25% 25%Physical inactivity adult 23% 25% 21%Physical inactivity- adult 23% 25% 21%Excessive drinking: binge & heavy 18% 17% 7%Motor vehicle crash death rate/100,000 11 7 10Sexually transmitted infections (Chlamdia) 227 516 92Teen birth rate- per 1000 age 15-19 17 25 21Clinical Care 23Clinical Care 23Uninsured < age 65 12% 14% 11%Primary care physicians: pop. to physician 1,359:1 1,222:1 1,067:1Dentists: pop. to dentist 1,390:1 1,414:1 1,516:1Preventable hospital stays: per 1000 Medicare 70 66 47Diabetic screening- per Medicare enrollee 84% 85% 90%

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Source: Robert Wood Johnson, 2013, National County Health rankings & RoadmapsGood feature

Monitor issue

Serious Issue

Mammography screening- % female Medicare 67% 66% 73%

IV. HEALTH STATUS PROFILES: SUFFOLK COUNTY

Suffolk County rates high among all NY rankings for SES and health factors, and moderate for physical environment, morbidity and clinical care, worst in adult social support

Suffolk New National Rank InCounty York Benchmark 62 Counties

Health Factors Continued 8Suffolk County Health Assessment Health Factors, Continued 8Social and Economic Factors 5High school graduation ( in 4 years) 88% 77%Some college 64% 64% 70%Unemployment 7.4% 8.2% 5.0%Children in poverty- under age 18 9% 23% 14%Inadequate social support-% adults 22% 24% 14%Children in single parent households 22% 34% 20%Children in single parent households 22% 34% 20%Violent crime rate- per 100,000 169 391 66Physical Environment 23Daily fine particulate matter- (microgms./cu.M) 10.8 10.9 9.0% % % %% pop. exposed to poor water supply 2% 4% 0%Recreational facilities per 100,000 13 11 16% low income not close to grocery store 4% 2% 1%Fast food restaurants as % total restaurants 48% 45% 27%

28

Source: Robert Wood Johnson, 2013, National County Health rankings & RoadmapsGood feature

Monitor

Serious issue

IV. HEALTH STATUS PROFILES: SUFFOLK COUNTY BEHAVIORAL RISKFACTORS SURVEILLANCE ASSESSMENT SUMMARY, 2013

Suffolk County ratings are poorest for chronic disease,(diabetes, obesity & nutritional

BEHAVIORAL RISK FACTORS‐ 2013MD ACCESS Target Suffolk Co. NY State1

Suffolk County ratings are poorest for chronic disease,(diabetes, obesity & nutritional choices), mental health-related issues, falls and preventive actions for infectious disease

g% Adults with PrimaryPhysician 100% 92.0% 87.0%% Adults 65+ with falls & injuries/3 mo. NA 7.0% 5.0%

Activity/NutritionActivity/Nutrition% Adults Obese 15.0% 21.0% 24.0%% adults with 5 or more fruits & Veg./day 33.0% 26.0% 28.0%% adults leisure activity last Mo. 80.0% 79.0% 79.0%

Chronic DiseaseChronic DiseaseDiabetes 5.7% 9.0% 8.5%Asthma NA 8% 10%

Infectious Diseasel Sh 90 0% 2 0% 6 0%Flu Shots 90.0% 72.0% 76.0%Pneumonia vaccine 90.0% 72.0% 71.0%

Mental Health% adults poor mental health 2wks. /Mo. 7.8% 13.1% 10.9%

29

Source: New York State Health Department, 2013, BRFFS

% adults binge drinking per Mo. 13.4% 21.0% 20.0%

Note: 1. Excludes NY City

IV. HEALTH STATUS PROFILES:SUFFOLK COUNTY HEALTH INDICATORS BY RACE / ETHNICITY, 2008-2010

Si ifi i di i i Hi i l i i ELIH iSignificant economic disparity among growing Hispanic population in ELIH service areaSuffolk County Health Indicators by Race/Ethnicity, 2008-2010

AsianIslander

Disparity Hi iH lth I di t

Non-Hispanic

Hi i T t lWhi Bl k Islander

Population (2010) 1,079,974 109,090 54,383 246,239 1,493,350Percent of Population 72% 7% 4% 17% 100%Median Annual Household Income in US Dollars (2008‐10) 88,435 69,449 90,005 67,066 84,235Percent of Families Below Poverty (2008‐10) 3% 10% 4% 9% 4% Poverty

Hispanics Socio-Demographic Indicators

Health Indicator Hispanic TotalWhite Black

y

Total Mortality per 100,000, Age-adjusted 682 703 238 434 681Percent Premature Deaths (< 75 Years) 36% 62% 62% 62% 39% Premature Years of Potential Life Lost per 100,000, Age-adjusted 4,954 7,884 1,945 4,399 5,113 Death

General Health Indicators

Birth-Related IndicatorsNumber of Births per Year (3 Year Average) 9,792 1,382 720 5,144 17,324 NAPercent Births with Early (1st Trimester) Prenatal Care 84% 58% 73% 58% 73% Prenatal Percent Adequate Prenatal Care (Kotelchuck Index) 76% 48% 66% 51% 65% Prenatal Percent Premature Births (< 37 Weeks Gestation) 11% 19% 11% 13% 12%Percent Low Birthweight Births (< 2.5 Kg) 7% 14% 9% 7% 8%Teen (Age 15-17) Pregnancy Rate per 1,000 8 35 43 16 Pregnancy ( g ) g y p ,Total Pregnancy Rate per 1,000 Age 15-44 Females 62 98 65 137 79 Pregnancy Fertility Rate per 1,000 (All Births/Female Population 15-44) 48 55 57 116 61 Fertility Infant Mortality per 1,000 Live Births 3 11 4 4

InjuryMotor Vehicle-Related Mortality per 100,000, Age-adjusted 10 12 12 10 Vehicle Unintentional Injury Mortality per 100 000 Age-adjusted 33 26 25 32

Injury-Related Indicators

30Source: NY State Health Department, 2013

Unintentional Injury Mortality per 100,000, Age adjusted 33 26 25 32Unintentional Injury Hospitalizations per 10,000, Age-adjusted 70 61 18 86 76 AccidentalPoisoning Hospitalizations per 10,000, Age-adjusted 10 10 1 7 10Fall Hospitalizations per 10,000, Age 65+ Years 230 95 42 265 225 Falls

Good feature Significant issue Major health risk

IV. HEALTH STATUS PROFILES:SUFFOLK COUNTY HEALTH INDICATORS BY RACE / ETHNICITY, 2008-2010

Si ifi i di i i Hi i l i i ELIH iSignificant economic disparity among growing Hispanic population in ELIH service areaSuffolk County Health Indicators by Race/Ethnicity, 2008-2010, ContinuedHealth Indicator White Black Asian Hispanic Total Hispanics

Asthma Hospitalizations per 10,000, Age-adjusted 11 29 3 21 14 AsthmaRespiratory Disease IndicatorsAsthma Hospitalizations per 10,000, Age adjusted 11 29 3 21 14 AsthmaAsthma Hospitalizations per 10,000, Age 0-17 Years 13 36 6 24 19 AsthmaCLRD/COPD Mortality per 100,000, 18+ Years 54 22 6 11 45COPD/CLRD Hospitalizations per 10,000, 18+ Years 42 47 3 34 41Coronary Heart Disease Mortality per 100,000, Age-adjusted 154 160 50 85 154

Coronary Heart Disease Hospitalizations per 10,000, Age-adjusted 54 52 20 55 58Coronary Heart Disease Hospitalizations per 10,000, Age adjusted 54 52 20 55 58Congestive Heart Failure Mortality per 100,000, 18+ Years 29 9 6 4 24Congestive Heart Failure Hospitalizations per 10,000, Age 18+ Years 43 54 7 32 42

DiabetesDiabetes Mortality per 100,000, Age-adjusted 12 23 9 14 13 MortalityDiabetes Hospitalizations per 10,000 (Primary Dx ICD9 250), Age- 12 38 4 22 15 Acute

Diabetes Indicators

Diabetes Hospitalizations per 10,000 (Any Dx ICD9 250), Age-adjusted 173 359 67 294 202 Hosp.Diabetes Short-term Complications Hospitalizations per 10,000, Age 6-18 2 3 NA 2 2Diabetes Short-term Complications Hospitalizations per 10,000, Age 18+ 3 13 1 5 4

CancerLung Cancer Incidence per 100,000, Age-adjusted (2007-09) 79 62 27 25 73.1Colorectal Cancer Mortality per 100 000 Age-adjusted (2007-09) 17 25 6 14 17

Cancer Indicators

Colorectal Cancer Mortality per 100,000, Age-adjusted (2007-09) 17 25 6 14 17Female Breast Cancer Mortality per 100,000, Age-adjusted (2007-09) 23 29 14 12 23Cervix Uteri Cancer Mortality per 100,000, Age-adjusted (2007-09) 1.6 6 NA NA 2Percent Early Stage Colorectal Cancer (2007-09) 46% 42% 59% 48% 46%Percent Early Stage Female Breast Cancer (2007-09) 63% 49% 76% 51% 62%Percent Early Stage Cervical Cancer (2007-09) 45% 33% NA 59% 47% Cervical

31Source: NY State Health Department, 2013

y g ( )Drug A.

Drug-related Hospitalizations per 10,000, Age-adjusted 26 17 2 9 25Suicide Mortality per 100,000, Age-adjusted 7 7 3 3 7

Substance Abuse and Mental Health-Related Indicators

Good feature Significant issue Major health risk

IV. HEALTH STATUS PROFILES: ADULT PREVENTABLE INPATIENTADMISSIONS AS PERCENT OF NY STATE RATES

Statistics appear to indicate that Greenport residents would benefit from significantStatistics appear to indicate that Greenport residents would benefit from significant increase in use of primary care alternatives. .

ELIH Adult % State Rate % State Rate % State Rate % State Rate % State RateService Area Population Zip Codes All Services Acute Circulatory Diabetes RespiratoryGreenport 3,202 11944 132% 111% 155% 103% 143%Southold 4,615 11971 69% 80% 86% 29% 50%Cutchogue 3,111 11935 60% 74% 61% 36% 43%Mattituck 3,593 11952 71% 74% 97% 42% 49%East Marion 821 11939 76% 59% 161% 0% 0%O i t 603 11957 48% 17% 92% 53% 0%Orient 603 11957 48% 17% 92% 53% 0%Shelter Island 1,099 11964 89% 123% 68% 67% 58%Shelter Island Hts. 932 11965 56% 64% 70% 32% 18%Peconic 451 11958 134% 45% 120% 0% 162%Peconic 451 11958 134% 45% 120% 0% 162%Laurel 632 11948 93% 126% 56% 0% 113%Total 19,059 Total 81% 85% 100% 47% 66%Caution


New York State Health Department, Biometrics, 2011

IV. HEALTH STATUS PROFILES: DIABETES AND OBESITY-INCIDENCE AND PREVALENCE

D l id i f di b d b i h i NY S d lDual epidemics of diabetes and obesity are on the rise among NY State adults.

33

Appendix Community IdentifiedCommunity Identified Issues and Actions

IV. COMMUNITY IDENTIFIED ISSUES: LEADER SURVEY HIGHLIGHTS

ELIH’s community leader survey is a key foundation for developing priorities and ifi i l

ELIH surveyed 59 community leaders from six categories from:

» Community health related agencies and associations

specific action plans.

» Community health-related agencies and associations

» City-town-village organizations

» School districts

» Health service organizations & providers

» Faith-based organizations

» Other community leaders» Other community leaders

Community leaders responded well:

» Leaders achieved a 75% response rate with 45 completed surveys

» Leaders who had initial problems accessing survey were persistent and responded well to ELIH follow-up calls/emails; hence an excellent response rate was achieved

35

What Are Your Rankings ( 1‐highest, 5 lowest ) For New York State Prevention Priorities 2013 2017 ?

IV. COMMUNITY IDENTIFIED ISSUES: LEADER SURVEY HIGHLIGHTS

Prevention Priorities ‐ 2013‐2017 ?

25%7%

0%Prevent HIV, STDs, and

i d i f i

2 %

41%

32%

27%

23%

25%

7%14%

Promote healthy women, children, infants

associated infections

23%

25%

25%20%

16%16%

Promote a healthy, safe life style

,

11%9%

14%48%

18%Promote mental health and prevent substance abuse

0%7%

18%23%

52%

0% 10% 20% 30% 40% 50% 60%

Prevent chronic disease

36ELIH Community Leader Survey, February-April , 2013

Ranking: 1st Blue 2nd Purple 3rd Green 4th Red 5th Gold

IV. INTERVIEW FINDINGS: INDIVIDUALS AND GROUPS

ELIH’s issue development process also included interviews and focus groups with health id d i d i i

ELIH also interviewed more than 45 individuals from community, provider and health services areas including area physician practitioners, clinic representatives, nursing , other

providers and community groups and associations.

clinicians and social workers.

Representative from home health, developmental disabilities and skilled nursing were also included in individual interviews and focus groups.

Top issues identified for ELIH service area identified included each of below groupings:

• Chronic disease mgt.: Obesity & Diabetes: overweight, poor nutrition & lack exercise

• Mental health disorders: depression/anxiety dementia meds & drug abuse (seniorsMental health disorders: depression/anxiety, dementia, meds. & drug abuse (seniors & youth) and alcoholism,

• Aging in place resources / Home Care coordination & support: falls prevention,

• Primary care physicians: access patient compliance & follow up; new integrator role• Primary care physicians: access, patient compliance & follow-up; new integrator role

• Maternal & child health support for low income Hispanic community

• Access to transportation for routine health care

• Absence of counseling resources, generally and specific to mental health

37

Appendix Key Issues and PrioritiesKey Issues and Priorities

IV. KEY ISSUES AND PRIORITIES: KEY ISSUES IDENTIFIED

A wide range of community health-related Issues were identified in the community health

A wide range of issues and topics were identified and compiled based on findings from community leader surveys, focus groups, interviews and relevant health

assessment process.

statistics for the service area and Suffolk County.

• Falls among senior population• Mental health disorders

Key Health-Related Issues

• Falls among senior population• Aging in place resources for seniors• Frail elderly• Dementia & Alzheimer's• Primary care access and its evolving role

• Mental health disorders• Depression-anxiety-suicide• Alcoholism & drug abuse• Chronic disease management • Obesity • Primary care access and its evolving role

• Teen pregnancy-Hispanic population• Late trimester pre-natal care • Transportation access for seniors & Hispanics• Access to in home health care coordinators

• Obesity• Overweight population• Diabetes-Type II• Pre-Diabetes• Hispanic Diabetic admissions • Access to in-home health care coordinators

• Access to mental health counseling• Access to Spanish health communications &

translators for community-based counseling• Asthma Pediatrics (Hispanic focus)

• Hispanic Diabetic admissions• Cancers & screenings• Overall premature mortality• Low income population-Hispanic• Poor eating habits

39

• Asthma-Pediatrics (Hispanic focus) • Poor eating habits• Access to healthy nutrition

IV. KEY ISSUES AND PRIORITIES: PRIORITY SETTING APPROACH

ELIH’s selection of issues for action plan development were based on specific criteria as ll id i f NY i i i i f 2013 201

ELIH priorities for Implementation were selected, in large part, based on four criteria:

» Magnitude of the issue or extent to which broad populations are affected

well as consideration of NY state prevention priorities for 2013-2017

» Magnitude of the issue or extent to which broad populations are affected

» Severity of the issue or extent to which issue is life-threatening with possible significant economic and community consequences

ELIH d biliti il bl t h l hi d» ELIH resources and capabilities available to help achieve success, and

» Ability to measure progress over time

The selection of ELIH priorities also took into account the 5 NY State Prevention Priorities for 2013-2017 as outlined below:

» All hospitals are required to address at least one Priority and two focus areas in their Community service plan submissions to the NY State Department of Health.

40

IV. KEY ISSUES AND PRIORITIES: NY STATE CONSIDERATIONS

NY State Health Department’s prevention-oriented priorities for development by health d d h i l d h l l ELIH i i i

New York State Prevention Priorities:

1 Prevent Chronic Diseases:

departments and area hospitals were used to help select ELIH priorities

1. Prevent Chronic Diseases:

3 Focus Areas: Obesity, Preventive care in clinical /community settings, & Tobacco use & secondhand smoke

2 Promote Mental Health & Prevent Substance Abuse:2. Promote Mental Health & Prevent Substance Abuse:

3 Focus Areas: Strengthen Infrastructure across systems, Prevent substance abuse & emotional-behavioral health disorders, and Promote mental, emotional, behavioral health

3 Promote Healthy Women Infants & Children:3. Promote Healthy Women, Infants & Children:

3 Focus Areas: Maternal & infant health, Child health, & Preconception/reproductive health

4. Promote Healthy, Safe Environment:

4 Focus Areas: Injuries, violence & occupational health, Air quality, Built environment, Water quality

5. Prevent HIV, STDs, Vaccine Preventable Diseases & Associated Infections

5 Focus Areas: HIV, STDs, Hepatitis C, Vaccine preventable diseases, & Associated infections

41

IV. KEY ISSUES AND PRIORITIES: ELIH PRIORITIES FOR ACTION PLANS

ELIH will focus on key issues for priority Implementation and will provide leadershipdi i d d l l

Based on the community health issues identified through its assessment and priority setting steps, ELIH has focused on the following priorities for specific action plans:

coordinating and development roles.

» Chronic Disease: with specific focus on

• Reducing Obesity in Adults

I i t hi h lit h i di ti d• Increasing access to high-quality chronic disease preventive care and management (specifically diabetes)

» Disparity Group focus:

• Seniors

42

IV. KEY ISSUES AND PRIORITIES: PRIORITIES & NON-PRIORITIES

P i i d i i l d f l d hi d i l

PRIORITY AREAS: IMPLEMENTATION

NON PRIORITY AREAS

ELIH R l S t Oth L d

Priority and non-priority areas were selected for leadership and supportive roles

ELIH Roles: Lead, Partner & InitiateELIH Roles: Support Other Leaders

CHRONIC DISEASEHomes & Environment

Maternal & Child Health

OthersCHRONIC DISEASE Environment Health

• OBESITY

• Prevention & Management

• Home Support• Falls

• Prenatal• Teen pregnancy

• MDs• Mental Health

RELATED ISSUES:

• Chronic disease management • Nutrition• Eating habits

• Accidents • 1st trimestercare

• Well child

• Smoking• Suicide

prevention• Eating habits• Exercise• Disparity Issues

• Seniors

• Well child p• Infra-

structure• Hispanic

access

43

IV. KEY ISSUES AND PRIORITIES: PRIORITIES AND N0N-PRIORITIES

ELIH will, however, provide specific support for other non-priority community health issues

# Issue/Problem Category Evidence Rationale (see action plans, p. 17) 1 Home-Based Home Health • Community surveys, • ELIH to support existing HH

Support Services Care y y ,

interviews / focus groups

pp gagencies and long-term care resources

2 Perinatal Care –Hispanics

MaternalChild Hlth.

• Suffolk Co. healthstatistics, 2010

• ELIH to continue facilitatingaccess to MCH providers on spa cs C d t stat st cs, 0 0 access to C p o de s osite

3 Dementia Mental & Neurology

• Surveys, & interviews • ELIH provide continuing referrals to neurologists

4 A id t A id t C t h lth ELIH ti it f ll4 Accidents-Falls

Accidents • County health statistics, surveys & interviews

• ELIH continues its falls prevention on-site & supports HH / LTC leaders

5 Pediatric Asthma Pediatrics • County health statistics • ELIH to continue referrals of P d ER/I t T PCPany Peds. ER/Inpt. To PCPs

6 SES Factors:- % poverty- % no H.S. grad

Economic-Social

• Demographic data• NY State Health Dept.

report

• Requires leadership among public governmental depts. ;facilitates access to services

44

- literacy rate under ELIH charity provisions

AppendixELIH LIFESTYLE COACH PROGRAMELIH LIFESTYLE COACH PROGRAM

RSVP‐ LIVING HEALTHY WORKSHOPS

IV. LIFESTYLE COACH: ISSUE PRIORITY- DIABETES• ELIH

LIFESTYLE COACH PROGRAMLIFESTYLE COACH PROGRAM

46

IV. LIFESTYLE COACH: ISSUE PRIORITY- DIABETES• ELIH

LIFESTYLE COACH PROGRAM

47

V. LIFESTYLE COACH: ISSUE PRIORITY- DIABETES• ELIH

LIFESTYLE COACH PROGRAM

48

V. LIFESTYLE COACH: ISSUE PRIORITY- DIABETES• ELIH

LIFESTYLE COACH PROGRAMLIFESTYLE COACH PROGRAM

49

V. RSVP: ISSUE PRIORITY- DIABETES

• RSVP CHRONIC DISEASE SELF MANAGEMENT RESOURCE


V. IMPLEMENTATION PLAN: ISSUE PRIORITY- DIABETES

• RSVP CHRONIC DISEASE SELF MANAGEMENT RESOURCE


community health needs assessment (chna) summary eastern

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