1. Springfield Hospital Act 53 Community Report - 2004 2006 Update

2. Community Needs Assessment Purpose Identify and prioritize the healthcare needs of the service area and for patient populations served, as well as the resources required to meet those needs. Work together collaboratively with key community stakeholders to establish community priorities. Potentially identify other community needs that may be best met by other organizations. Comply with Act 53, Sec. 4, 18 VSA, 9405a, as passed by the Vermont State Legislature.

3. Public Input - 2004 Community Focus Groups Physician Focus Groups Community Key Leaders Legislative Leaders Hospital Board Members

4. Priorities Findings were synthesized from qualitative and quantitative data sources and presented at a meeting of the Community Health Needs Assessment Steering Committee.

5. Community Health- Needs Assessment Steering Committee The Committee was comprised of 25 community members representing a broad cross section of the community, including consumer representatives, agencies, schools, business, government, clergy, health providers, etc. Attendees participated in a group process to prioritize the community’s health needs.

6. Health Improvement Priorities Decrease obesity Decrease substance abuse rates Adult Binge Drinking Youth Substance Abuse Decrease mental illness, depression Adults Youth

7. Health Resource Priorities Expand Chronic Disease Care Initiative Provide Patient Advocacy –Case Management –Service Coordination

8. Health Resource Priorities Increase efforts of Springfield Hospital and area businesses to promote wellness Increase resources for Child Psychiatry and Treatment Services Improve Integration of Primary Care and Mental Health

9. Health Resource Priorities Provide End of Life Care in the Hospital Modernize the Day Surgery and Endoscopy Units Create additional ambulatory space in the Radiology and Emergency Departments

10. Our Response

11. Springfield Hospital - Receives Grant for Chronic Care SPRINGFIELD, VT — Springfield Hospital has been awarded a 3-year grant totaling 150,000 from the Fanny Holt Ames and Edna Louise Holt Fund. This grant will assist the hospital in extending the Chronic Care Model – a national model for collaborative care and quality improvement – to all of its ten medical practices. These practices provided more than 84,000 office visits last year. Springfield Hospital has already been recognized by state health officials for its efforts in this area. Its participation in the state’s Chronic Care Collaborative and Gov. Jim Douglas’s chronic care initiative, especially in the area of diabetes, have made it a model for other hospitals in the state. This new grant will help the hospital’s practitioners provide self-management support to their patients. This includes increasing involvement in chronic care, resulting in better outcomes for patients and reduced cost. It also includes planning for more effective visits and improved clinical information systems in the medical offices. With the help of this grant, Springfield Hospital expects to improve patient relationships by engaging and involving patients in their care, changing the way we think about health care by spreading adoption of best practices, and changing the system of health care reimbursement so that there is sustainable funding for chronic disease care in the future.

12. Chronic Care Model - Expansion December 04-September 05 Number of clinicians involved increased from 1 to 10 over 9 months Number of patients in registries increased from 30 to 283 over 9 months

13. Chronic Care Model Vermont Blueprint for Health Supports changes in 4 key areas: Patient Self-Management Provider Practice Change Community Development Information System Development Springfield Medical Care Systems Focus: Diabetes Pediatric Asthma Obesity

14. Decrease Obesity Improved management of obesity utilizing the Chronic Care Model Self Management Goals being developed with clients based upon Basic Metabolic Index. Community connection through Southern Vermont AHEC PAN (Physical Activity and Nutrition) –Worked with Blue Cross Blue Shield to develop area walking maps –Springfield Pediatric Physician involvement

15. Decrease Obesity Springfield Hospital playing leadership role in creation of the Southern Vermont Recreation Center and will operate the Therapy Pool program in the Center. Employee health benefit redesign for Springfield Hospital providing financial incentive for weight loss and other lifestyle improvements.

16. Mental Health & Substance Abuse Health Resource Priorities Increase resources for outpatient substance abuse and co- occurring disorders treatment Windham Center Participating in state wide Co-occurring training Outpatient substance abuse counselors available Psychiatrist supported substance abuse treatment Relapse Prevention Group

17. Mental Health & Substance Abuse Health Resource Priorities Increase resources for adult psychiatric care Windham Center Partial Hospitalization Program ( PHP) Out patient therapy available Health Care Rehabilitation Services, Robert Wood Johnson Grant.

18. Mental Health & Substance Abuse Health Resource Priorities Increase resources for adult Psychiatric care Windham Center As of Feb 2006, three psychiatrists are available for out-patient services: Dr. William Grass, Dr Ray Abney and Dr. Albert Lorbati.

19. Mental Health & Substance Abuse Health Resource Priorities Improve Integration of Primary Care and Mental Health Springfield Hospital is participating with Health Care and Rehabilitation Services (HCRS) in a Robert Wood Johnson funded program which places a Mental Health resource person in Primary care offices on a weekly basis. Windham Center staff meeting with PCP Offices and providing a “Needs Assessment” to base future integration of support services. HCRS providing counselor support in family practice physician practices to direct resource referrals.

20. Mental Health & Substance Abuse Health Resource Priorities Increase Primary Care Provider’s (PCP) awareness of Co- occurring disorders to assure appropriate referrals. Psychiatry has provided a series of Continuing Medical Education (CME) offerings, on Substance Abuse and Co-occurring disorders Presented By Dr William Grass and Dr Kenneth Minkoff.

21. Facility Redesign Modernize Day Surgery and Endoscopy Units Create additional ambulatory space in the Radiology and Emergency Departments Plan: Accomplish our Critical Access Hospital conversion Currently finalizing Master Facility Planning

22. End of Life Care in the Hospital Portable Hospice Cart – Transforms any hospital room into a hospice room. Private Room – Priority for all patients at the end of life. Palliative Care Orders – Designed to provide comfort and relieve suffering. Active Ethics Committee – provides support to caregivers and families with difficult decisions. Members include physician’s nurses, clergy and community members. All Physicians and clinical staff have completed End of Life education and training. Patient and family information brochure developed to support the concepts of palliative and comfort care.

23. Continued Priorities Mental Health Management –Children Medication Management Depression Obesity Community Connections Continued Chronic Care Model Expansion Complete and execute Master Facility Plan, including emphasis on Day Surgery, Endoscopy, Imaging and Emergency Department areas.