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Community Health Needs Assessment

Implementation Strategy

2013 – 2016

The Community Health Needs Assessment Implementation Strategy was approved by the Adventist Rehabilitation Hospital of Maryland Board of

Trustees on May 5, 2014 and was approved by the Adventist HealthCare Board of Trustees on April 24, 2014.

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Table of Contents

Overview & Mission 3

Priority Population and Target Area 3

Implementation Strategy Development and Adoption 6

Why these Priority Areas were Chosen 6

Focus Area 1: Comprehensive Concussion Care 7

Focus Area 2: Inpatient Rehabilitation Services for Bariatric Patients 10

Other Areas Addressed by Adventist Rehabilitation Hospital of Maryland (ARHM) 13

Areas of Need Not Directly Addressed by ARHM and Rationale 20

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Adventist Rehabilitation Hospital of Maryland’s Community Health Needs Assessment – Implementation Strategy

Overview/Mission

Adventist Rehabilitation Hospital of Maryland, a separate legal entity managed by the Adventist HealthCare Executive Team, is the first and only acute rehabilitation hospital in Montgomery County, Maryland that offers comprehensive rehabilitation programs for brain injuries, spinal cord injuries, stroke, amputation, orthopedic injuries and surgeries, sports-related injuries, work-related injuries, cardiopulmonary conditions, and neurological disorders. Adventist Rehab has two hospital locations: a free-standing fifty-five bed hospital adjacent to Shady Grove Adventist Hospital in Rockville, Maryland and a thirty-two-bed hospital located on the fifth floor of Washington Adventist Hospital in Takoma Park, Maryland. Adventist Rehab also provides outpatient rehabilitation services at both our hospital location in Rockville and our community-based center in Silver Spring, Maryland. Guided by a mission to deliver clinical and service excellence through a ministry of physical, mental and spiritual healing, Adventist Rehab is the only acute hospital in a five-state region to be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) for all four of its specialty programs including stroke, spinal cord injury, brain injury, and amputee. The hospital was also one of the first acute rehab facilities in the nation to earn specialty accreditation for its amputee program.

Priority Population and Target Area

This Implementation Strategy will address health needs among the Community Benefit Service Area served by Adventist Rehabilitation Hospital of Maryland, covering a geographic area including approximately 80% of patient discharges. Adventist Rehabilitation Hospital of Maryland primarily serves residents of Montgomery County, Maryland. Below, Figure 1 shows the percentages of discharges by county for Adventist Rehabilitation Hospital of Maryland.

County Percentage of Discharges

Montgomery 77.6%

Prince George’s 18.3%

Frederick 3.1%

Other 1.0% Figure 1. Adventist Rehabilitation Hospital of Maryland’s discharges by county, 2011

Approximately 80 percent of discharges come from our Total Service Area, which is known as Adventist Rehabilitation Hospital of Maryland’s Community Benefit Service Area “CBSA” (see Figure 2). The CBSA is divided into Primary and Secondary Service Areas. Sixty percent of discharges fall into the Primary Service Area, which includes the following ZIP codes and cities:

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20743 – Capitol Heights, 20782 – Hyattsville, 20783 – Hyattsville, 20814 – Bethesda, 20815 – Chevy Chase, 20817 – Bethesda, 20850 – Rockville, 20852 – Rockville, 20853 – Rockville, 20854 – Potomac, 20855 – Derwood, 20874 – Germantown, 20876 – Germantown, 20877 – Gaithersburg, 20878 – Gaithersburg, 20879 – Gaithersburg, 20886 – Montgomery Village, 20895 – Kensington, 20902 – Silver Spring, 20903 – Silver Spring, 20904 – Silver Spring, 20906 – Silver Spring, 20910 – Silver Spring, and 20912 – Takoma Park. The Secondary Service Area accounts for 20 percent of discharges and includes the following ZIP codes and cities: 20011 – Washington, 20706 – Lanham, 20708 – Laurel, 20722 – Brentwood, 20740 – College Park, 20744 – Fort Washington, 20745 – Oxon Hill, 20747 – District Heights, 20772 – Upper Marlboro, 20774 – Upper Marlboro, 20781 – Hyattsville, 20784 – Hyattsville, 20785 – Hyattsville, 20816 – Bethesda, 20832 – Olney, 20837 – Poolesville, 20851 – Rockville, 20871 – Clarksburg, 20882 – Gaithersburg, 20901 – Silver Spring, 20905 – Silver Spring, 21701 – Frederick, 21702 – Frederick, and 21703 – Frederick.

Figure 2. Map of Adventist Rehabilitation Hospital of Maryland’s Primary Service Area (Purple) and Secondary Service

Area (Orange) Based on 2011 Inpatient Discharges.

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Our Community Benefit Service Area, encompassing 80 percent of all discharges, includes 1,700,889 people, of which approximately 57 percent are racial and ethnic minorities (see Figure 3).

2011 Estimates

White Black/AF American

Native

American Asian Native HI/PI

Hispanic/ Latino

Community Benefit Service Area (CBSA) 730,686

543,963 5,632 155,385 1,495 263,728

43.0% 32.0% 0.3% 9.1% 0.1% 15.5%

Primary Service Area (PSA) 477,393

199,301 3,123 119,338 896 183,830

48.5% 20.3% 0.3% 12.1% 0.1% 18.7%

Secondary Service Area (SSA) 253,293

344,662 2,509 36,047 599 79,898

35.3% 48.1% 0.3% 5.0% 0.1% 11.1% Figure 3. Population estimates (2011) by race/ethnicity for Adventist Rehabilitation Hospital of Maryland’s Community

Benefit Service Area (80 percent of discharges), Primary Service Area (60 percent of discharges) and Secondary Service Area (20 percent of discharges)

Population demographics are rapidly changing in the state of Maryland, particularly among residents living in Montgomery County. We serve one of the most diverse communities in the United States, constantly undergoing the economic, social and demographic shifts that result from an ever-changing and growing population. Over the past decade, with a population of nearly one million people, Montgomery County has become the most populous jurisdiction in Maryland, the second largest jurisdiction in the Washington, D.C. metropolitan area, and the forty-second most populous county in the nation (U.S. Census Bureau, 2011). Racial and ethnic diversity has increased concurrently with the expanding population. Non-Hispanic whites now comprise only 49 percent of the Montgomery County population, a decrease of more than 20 percent over the last two decades. For the first time, minorities account for more than half of Montgomery County’s population with the Hispanic or Latino populations outnumbering all other minority populations (U.S. Census Bureau, 2011). The percentage of Hispanics or Latinos in Montgomery County, currently at 17 percent, is also more than double the total percentage of Hispanics or Latinos in the state of Maryland. As racial and ethnic minority populations have increased, concerns regarding health disparities grow. Persistent, and well-documented data, indicate that racial and ethnic minorities still lag behind nonminority populations in many health outcome measures. These groups are less likely to receive preventive care to stay healthy and are more likely to suffer from serious illnesses, such as cancer and heart disease.

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Implementation Strategy Development and Adoption

Adventist Rehabilitation Hospital of Maryland’s Community Health Needs Assessment was reviewed and approved by the Adventist HealthCare Board of Trustees on October 23, 2013. In order to ascertain the focus areas of this implementation strategy, the Community Health Needs Assessment findings were reviewed by the President’s Council. After discussion and consideration of community input and available resources, both internal and through partnerships, it was determined that the most strategically impactful areas of focus would be: comprehensive concussion care and inpatient rehabilitation services for bariatric patients.

Why these Priority Areas were Chosen

Priority Area 1: Concussion Care

• The CDC estimates there are over 3.8 million sports-related concussions per year in the U.S.

• From 2006-2010, emergency department visits due to a traumatic Brain Injury (TBI) increased by 98 percent for Maryland residents ages 45 and older and by 55 percent for those under the age of 45.1

• Between 2006 and 2010, Montgomery County had the highest percentage of TBI-related emergency department visits in the state of Maryland. During this time Montgomery County also had the fourth highest percentage of TBI related hospital discharges in the state.1

• From 2010-2011, Adventist Rehabilitation Hospital of Maryland (ARHM) had a higher percentage (12.78 percent) of brain injury discharges than the region (11.4 percent) and the nation (10.73 percent).2

Priority Area 2: Inpatient Bariatric Care

• In 2011, Healthy Montgomery identified obesity as one of its six priority areas for Montgomery County.

• According to Healthy Montgomery, 56.1 percent of Montgomery County residents (adults) are either overweight or obese, and 17.1 percent are obese.

• In ARHM’s Community Health Needs Assessment Survey (2012-2013; n=110) 73.6 percent of respondents cited chronic disease as a major problem affecting the health of their community. The chronic disease identified as having the greatest concern was obesity/overweight.

1 Department of Health and Mental Hygiene, 2006-2010. 2 Patient Outcomes Report. Adventist Rehabilitation Hospital of Maryland. 2011.

http://www.adventistrehab.com/app/files/public/213/pdf-ARHM-Patient-Outcomes.pdf

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Focus Area 1: Comprehensive Concussion Care

GOAL: Build a comprehensive concussion screening and treatment program serving community members and student athletes in order to increase the number of persons seeking concussion evaluation and to deliver more consistent care.

Objectives to be completed by the end of 2016: 1. By the end of 2014, provide comprehensive concussion care to at least 60 community

members in need of concussion care services. 2. By the end of the 2013-2014 school year, complete ImPact™ baseline testing for 100% of

student athletes at 13 Montgomery County High Schools. 3. By the end of the 2015-2016 school year, place trainers in 12 of the 25 Montgomery County

High Schools to aide in the development of an injury management and prevention program for student athletes.

Strategies Include:

Increase community outreach to promote pre- and post-concussion care services available at ARHM

Implement ImPact™ baseline testing for each student athlete in 13 of 25 Montgomery County schools every two years

For a minimum of 3 years, maintain and make available ImPact™ test results to students, parents and student’s health care providers at no cost

Provide follow-up testing and analysis for students as needed at a reasonable rate

Provide a set number of retests and analyses at a reduced rate or free of charge for students with economic difficulties

Serve as a resource on concussion education for students, parents and coaches

Train and place athletic trainers in Montgomery County High Schools

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Comprehensive Concussion Care Build a comprehensive concussion screening and treatment program serving community members and student athletes in order to increase the number of persons seeking concussion evaluation and to deliver more consistent care.

Objective 1: By the end of 2014, provide comprehensive concussion care to at least 60 community members in need of concussion care services.

Objective 2: By the end of the 2013-2014 school year, complete ImPact™ baseline testing for 100% of student athletes at 13 Montgomery County High Schools.

Objective 3: By the end of the 2015-2016 school year, place trainers in 12 of the 25 Montgomery County High Schools to aide in the development of an injury management and prevention program for student athletes.

Accomplishments to Date (April 2014)

Established a comprehensive ARHM outpatient concussion clinic in Rockville

Deployed marketing strategy

Established a concussion program steering committee

Identified a concussion care team and established a concussion steering committee

Placed one trainer in a Montgomery County High School (Kennedy) for the 2013-2014 school year.

Gaps being Addressed

There are no providers in Montgomery County, MD offering a full complement of pre- and post-concussive care services and the need appears to be unrealized and unmet.

Currently only 9 of 25 Montgomery County High Schools offer baseline testing to some of their student athletes.

Currently only half of the 25 Montgomery County High Schools have some level of athletic training services.

Actions

Drive quality improvement and assurance through a concussion program steering committee

Identify community groups in need of screening services

Develop, if indicated, an ARHM concussion prevention program

Coordinate scheduling of baseline testing with school personnel

Conduct baseline testing at each of the 13 schools

Coordinate time and location for re-testing and follow-up testing

Complete re-testing, follow-up testing and analyses as needed

Maintain and make available baseline testing results to students, parents and their providers

Develop athletic trainer program

Recruit athletic trainers

Implement program

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Evaluation Strategies:

Track the number of students receiving ImPactTM baseline testing at each school, for each school year

Track the number of re-test and follow-up tests completed

Track the changes in volume of patients seeking concussion care

Track the number and severity of athletic injuries at Kennedy High School Collaborative Partners Include:

Montgomery County Public Schools

Johns Hopkins Medical Center Evidence-Base: This initiative involves establishing a comprehensive concussion care program for the community and partnering with the Montgomery Country public school system to effectively address concussion awareness, prevention and treatment among student-athletes. A similar comprehensive concussion program is cited below which resulted in a substantial increase of youth athletes seeking concussion evaluation and the delivery of more consistent care. Citation:

Wilkins SA, Shannon CN, Brown ST, et al. Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization. J Neurosurg Pediatr. 2014;13(1):82-9.

This initiative also includes ARHM serving as an educational resource for faculty, students, and staff, and placing athletic trainers in schools. Evidence shows that student athletes with increased training and knowledge around concussions are more likely to report symptoms, potentially reducing the risk of further injury and complications. Citations:

Bramley H, Patrick K, Lehman E, Silvis M. High school soccer players with concussion education are more likely to notify their coach of a suspected concussion. Clin Pediatr (Phila). 2012;51(4):332-6. Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, Marshall SW. Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study. J Athl Train. 2013;48(5):645-53.

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Focus Area 2: Inpatient Rehabilitation Services for Bariatric Patients

GOAL: Increase access to, and awareness of acute inpatient rehabilitation services for bariatric patients in the community served by Adventist Rehabilitation Hospital of Maryland.

Objectives to be completed by the end of 2016: 1. By March 2015, complete renovations of 4 patient rooms, bathrooms and main therapy gym

to better and more safely accommodate bariatric patients. 2. By the end of 2016, decrease the average length of stay for bariatric patients at ARHM by 5

percent. Strategies Include:

Establish a bariatric program at ARHM that increases or maintains a patient’s mobility, independent functioning, and strength, and provides a safe environment for staff and patients during high-risk patient handling tasks

Renovate four existing patient rooms to better accommodate bariatric patients including installing permanent ceiling-mounted lift systems

Reconstruct existing bathrooms to include handicapped and bariatric accessible showers

Install ceiling-mounted track systems in the main therapy gym as well as in the occupational kitchen area

Promote new program capabilities to community members and local providers

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Inpatient Bariatric Care Increase access to, and awareness of acute inpatient rehabilitation

services for bariatric patients in the community served by Adventist Rehabilitation Hospital of Maryland.

Objective 1: By March 2015, complete renovations of 4 patient rooms, bathrooms and main therapy gym to better and more safely accommodate bariatric patients.

Objective 2: By the end of 2016, decrease the average length of stay for bariatric patients at ARHM by 5 percent.

Accomplishments to Date (April 2014)

State funding has been acquired for renovations, new equipment needed, and infrastructure growth

Referral sources have been notified of secured funding for renovations, new equipment, and infrastructure growth

Gaps being Addressed There is currently a lack of rehabilitation and continued care discharge options for bariatric patients. ARHM is the only provider of inpatient acute rehabilitation in Montgomery, Frederick and Howard Counties. Renovations, including new equipment, will allow ARHM to double the volume of patients that are served in an environment that is prepared for their unique needs, upholds their dignity and ensures the safety of the staff.

The current lack of proper equipment requires a greater use of resources and time for care, and requires focus to be diverted, at times, to weight management rather than rehabilitation. There is also a lack of equipment to provide rehabilitation services to morbidly obese patients.

Actions Complete remodel planning and design

Acquire new bariatric equipment

Complete renovations and install new equipment

Promote new program capabilities to referral sources and the community

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Evaluation Strategies:

Track the changes in volume of inpatient bariatric patients following the completion of renovations

Track and review changes in the length of stay for bariatric patients before and after the renovation

Collect and review patient satisfaction survey data from inpatient bariatric patients

Track patient Functional Independence Measure (FIM) scores at baseline, during rehabilitation, and at discharge

Track changes in the proportion of patients discharged to sub-acute, acute, and community among bariatric patients

Collaborative Partners Include:

National Lymphedema Network

Cardiac Associates

Shady Grove Adventist Hospital

Washington Adventist Hospital

Suburban Hospital Evidence-Base: This initiative involves increasing access to inpatient rehabilitation services for bariatric patients through the renovation of existing space and acquisition of proper equipment to ensure a safe and effective environment in which rehabilitative care can take place. Studies show that bariatric patients are able to achieve significant functional improvement during rehabilitation but at a slower rate than non-bariatric patients, often requiring a lengthier stay. Evidence suggests that “appropriate facilities and space” and “proper equipment and furnishings” are critical for achieving positive outcomes in a safe and respectful manner for bariatric patients. Citations:

Vincent HK, Seay AN, Vincent KR, Atchison JW, Sadasivan K. Effects of obesity on rehabilitation outcomes after orthopedic trauma. Am J Phys Med Rehabil. 2012;91(12):1051-9.

Slayton S, Williams DS, Newman G. Physical therapy services utilization and length of stay for obese patients following traumatic leg fracture. N C Med J. 2012;73(1):24-8.

Vincent HK, Vincent KR. Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study. Obesity (Silver Spring). 2008;16(1):130-6.

Wignall D. Design as a critical tool in bariatric patient care. J Diabetes Sci Technol. 2008;2(2):263-7.

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Other Areas Addressed by Adventist Rehabilitation Hospital of Maryland (ARHM)

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

Focus Area CHNA Findings* Goal Action Evaluation of Outcomes

General Rehabilitation Compared to the national average, Maryland has higher rates of back surgeries and hip replacements. Among Maryland counties, Montgomery has the second highest number of hospital discharges for hip fractures in adults 65 years and older.

Treat each patient individually and as a whole person addressing both their physical and emotional needs while helping them to achieve the highest level of independence possible and get back to the community as quickly and safely as possible.

ARHM provides a general rehabilitation program that includes four overall diagnostic areas: cardiac, orthopedic, neurological, and medically complex or multi-traumatic.

ARHM’s neuropsychology services include neuropsychological evaluation and behavioral and psychological interventions for patients and their families.

Also offered are Hand Therapy and Upper Extremity services that diagnose upper extremity fractures, dislocations, sprains and strains, nerve injuries, arthritic conditions, and more. The service also provides treatments utilizing progressive exercises, massages, joint mobilizations and stretches.

Average length of stay, discharge to sub-acute, discharge to acute and discharge to community are collected and reported on a quarterly basis.

Overall patient experience outcomes (likelihood to recommend, preparedness to function in the community, emotional needs addressed) are collected and reported on a quarterly basis as well.

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Brain Injury

**New Initiative for CHNA Implementation Strategy**

Montgomery County has the highest percentage of traumatic brain injury (TBI) related emergency department visits in Maryland. Emergency department visits due to TBI have increased by 98 percent for Maryland residents ages 45 and older and by 55 percent for those under the age of 45.

Build a comprehensive concussion screening and treatment program serving community members and student athletes in order to increase the number of persons seeking concussion evaluation and to deliver more consistent care.

Increase community outreach to promote pre- and post-concussion care services available at ARHM. Implement ImPact™ baseline testing for each student athlete in 13 of 25 Montgomery County schools every two years. For a minimum of 3 years, maintain and make available ImPact™ test results to students, parents and students’ health care providers at no cost. Provide follow-up testing and analysis for students as needed at a reasonable rate. Provide a set number of re-tests and analyses at a reduced rate or free of charge for students with economic difficulties. Serve as a resource on concussion education for students, parents and coaches. Train and place athletic trainers in Montgomery County High Schools.

Track the number of students receiving ImPactTM baseline testing at each school, for each school year. Track the number of re-tests and follow-up tests completed. Track the changes in volume of patients seeking concussion care. Track the number and severity of athletic injuries at Kennedy High School.

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Spinal Cord Injury Montgomery County had the fourth highest number of hospital discharges and ambulatory care visits in Maryland for vertebral fracture among adults 65 years and older in 2004. Among Maryland seniors, women had double the rate of hospital discharges and ambulatory visits for vertebral fracture compared to men.

Remobilizing patients and maximizing their independence through therapeutic training.

ARHM offers a Seating and Mobility Clinic to help patients determine the best type of equipment to meet their needs by providing an assessment of their posture, strength, range of motion, skin sensitivity, and movement.

Also offered is a driver rehabilitation program to determine whether it is safe for a patient to continue driving following their injury. For those who require special equipment or adaptive strategies, training is also offered.

Additionally available are an onsite wellness program/ gym membership for outpatients and support groups for patients, family members/caregivers, and friends.



Heart Disease & Stroke Heart Disease: The death rate from coronary heart disease in Montgomery County was significantly lower than the rate for the state of Maryland. However, heart disease was still the leading cause of death for people over the age of 65.

Stroke: While mortality

Heart Disease: Provide tailored care to each individual presenting with a heart condition, weakened endurance level, or requiring post cardiac surgery care.

Stroke: Restore movement, improve speech, teach self-care and home care skills, and improve cognitive and

ARHM provides comprehensive and holistic care focused on meeting the overall medical needs of the individual with its Neuro Rehab and Balance Center.

The Seating and Mobility Clinic at ARHM helps increase mobility and independence following a


Overall patient experience outcomes (likelihood to recommend, preparedness to function in the

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rates for stroke in Montgomery County have met the Healthy People 2020 target, health disparities between racial and ethnic groups still persist.

memory functioning. stroke.

Also offered is “On the Road to Safe Driving” a comprehensive driving evaluation and rehabilitation training program that helps to determine whether it is safe for a client to continue driving following a stroke.

Both inpatient and outpatient treatment for stroke patients includes education and support for patients and their families.

community, emotional needs addressed) are collected and reported on a quarterly basis as well.

Diabetes In Montgomery County, diabetes is the 8th leading cause of death with more than 135 residents dying from the disease each year.

In Montgomery County and across the state of Maryland, diabetes disproportionately affects minority populations and the elderly. It is the 4th leading cause of death for black adult residents, 5th for Hispanics and 6th for Asian/Pacific Islanders.

Montgomery County had 129 hospitalizations due to amputation of a lower extremity attributable to diabetes in 2004.

Assist post-amputee patients to adjust physically and psychologically after the loss of a limb and resume active and productive lives.

ARHM offers a continuum of care from inpatient to outpatient rehab services for amputee patients.

In addition to monthly support groups available at the Rockville and Silver Spring health clinics for amputees, ARHM also offers a peer visitor program to help patients connect with those who have already experienced amputation for support.

Patients are also provided with lifetime follow-up through ARHM’s amputee clinic.



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Cancer

Breast Cancer

Lung Cancer

Colorectal Cancer

Prostate Cancer

Cervical Cancer

Skin Cancer

Oral Cancer

Thyroid Cancer

Overall, cancer mortality rates for Montgomery County are lower than the state target and are lower than any other county in the state.

Breast Cancer: In Montgomery County the mortality rate for black women is higher than for white women. Lung Cancer: Lung cancer is the leading cause of cancer death in Maryland. The incidence and mortality rates in Montgomery County are higher for blacks than for whites. Colorectal Cancer: Although screening and incidence rates are comparable, mortality rates for blacks were higher than whites in Montgomery County. Prostate Cancer: The death rate due to prostate cancer for Montgomery County is 46 percent higher than the Maryland state average and 65 percent higher than the national average. Cervical Cancer: The

Most patients develop lymphedema following surgery and/or radiation therapy for various cancers. ARHM aims to help individuals reduce increased volume resulting from lymphedema, restore mobility, improve cosmesis, prevent infection, and improve quality of life.

ARHM offers Lymphedema Therapy and Lee Silverman Voice Treatment Speech Language and Swallowing Therapy for cancer outpatients.

Overall patient experience outcomes (likelihood to recommend, preparedness to function in the community, emotional needs addressed) are collected and reported on a quarterly basis.

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incidence rate is greatest among Hispanic women as compared to black and white women. Current pap test rates among women in Montgomery County have fallen below the recommended Healthy Montgomery levels. Skin Cancer: Whites have a higher incidence rate than blacks in Montgomery County. Males have higher incidence and mortality rates than females in the county. Oral Cancer: The incidence rate is the lowest among all counties in Maryland. Thyroid Cancer: Montgomery County has the highest incidence rates for thyroid cancer in Maryland.

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Obesity

**New Initiative for CHNA Implementation Strategy**

According to Healthy Montgomery, 56.1 percent of Montgomery County residents (adults) are either overweight or obese, and 17.1 percent are obese.

In ARHM’s Community Health Needs Assessment Survey (2012-2013; n=110) 73.6 percent of respondents cited chronic disease as a major problem affecting the health of their community. The chronic disease identified as having the greatest concern was obesity/overweight.

Increase access to, and awareness of acute inpatient rehabilitation services for bariatric patients in the community served by Adventist Rehabilitation Hospital of Maryland.

Establish a bariatric program at ARHM that increases or maintains a patient’s mobility, independent functioning and strength, and provides a safe environment for staff and patients during high-risk patient handling tasks.

Renovate four existing patient rooms to better accommodate bariatric patients including installing permanent ceiling-mounted lift systems.

Reconstruct existing bathrooms to include handicapped and bariatric accessible showers.

Install ceiling-mounted track systems in the main therapy gym as well as in the occupational kitchen area.

Promote new program capabilities to community members and local providers.

Track the changes in volume of inpatient bariatric patients following the completion of renovations. Track and review changes in the length of stay for bariatric patients before and after the renovation. Collect and review patient satisfaction survey data from inpatient bariatric patients Track patient Functional Independence Measure (FIM) scores at baseline, during rehabilitation, and at discharge. Track changes in the proportion of patients discharged to sub-acute, acute, and community among bariatric patients.

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Areas of Need Not Directly Addressed by Adventist Rehabilitation Hospital of Maryland and Rationale

Focus Area CHNA Findings* Goal Resources Rationale

Asthma In 2009, 12.4 percent of adult residents in Montgomery County were estimated to have been diagnosed with asthma in their lifetime and 7.9 percent reported currently having asthma. Black residents of Montgomery County have an asthma emergency department visit rate about 5 times higher than white residents. Hospitalization rates due to asthma exhibit a similar trend.

Support other organizations that provide services related to asthma.

Refer patients to other Adventist HealthCare entities or community organizations as appropriate.

Montgomery County has established the Asthma Management Program which focuses on Latino children. This intervention program provides education, support and follow-up care.

Other resources include the American Lung Association in Maryland, Asthma and Allergy Foundation of America (Maryland Chapter), and the Maryland Asthma Control Program.

ARHM does not currently directly address Asthma because it is not a specialty area of the hospital. Sufficient resources and expertise are not available to meet these needs. Additional resources are available in the community.

Influenza The incidence of influenza in Montgomery County for the 2011-2012 flu season was very low.

Influenza and pneumonia were ranked as the 4th and 5th leading cause of death among men and women, respectively, in Montgomery County from 2006-2008.

Support other organizations that provide services related to influenza.


Shady Grove Adventist Hospital offers annual flu shot clinics in the Montgomery and Prince George’s County areas beginning in early September and continuing through January. Flu shot clinics are held at community centers, congregations, subsidized apartment complexes, and at Shady Grove Adventist Hospital.

The Montgomery County Health Department has immunization outreach and education services for county residents. An

ARHM does not directly provide influenza services as they fall outside the scope of the hospital as a rehabilitation center. Influenza services are already provided by the acute care hospitals in the Adventist HealthCare System, Shady Grove Adventist Hospital and Washington Adventist Hospital, as well as by several other organizations in ARHM’s service area.

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Annual campaign is offered to residents which includes a Flu Information Line and a “Stay at Home Toolkit”

Other local health care providers, pharmacies, WIC providers, schools, child care providers, and clinics provide flu vaccinations in addition to outreach and education.

HIV/AIDS

Montgomery County has a lower rate of new cases of HIV than the state of Maryland overall and the rate of HIV related deaths decreased by 26 percent between 2004 and 2009. However, there has been a steady increase in the number of Montgomery County residents living with either HIV or AIDS from 1985 through 2008.

Disparities in incidence and mortality rates continue to be prevalent across races in Montgomery County. In 2008, blacks represented about 16 percent of the population, yet they accounted for 71 percent of HIV cases diagnosed that year. Between 2004 and 2009, blacks accounted for

Support other organizations that provide services related to HIV/AIDS.


HIV case management from the Montgomery County Health Department helps to provide dental care, counseling, support groups, and home care services as needed. Education and outreach to at-risk populations is also provided.

The Montgomery County Health Department also provides clinical services, lab tests, and diagnostic evaluations.

Project BEAT IT!, an initiative of the Center for Health Equity and Wellness at Adventist HealthCare, provides culturally appropriate health education classes to health care providers and the

ARHM does not provide HIV/AIDS services as they fall outside the scope of the hospital as a rehabilitation center. HIV/AIDS services are already provided by other entities in the Adventist HealthCare network, as well as by several other organizations in ARHM’s service area.

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4 out of 5 HIV related deaths.

African immigrant community to improve health outcomes related to HIV and other infectious diseases.

The Maryland AIDS administration educates public health care professionals.

Population Health

Maternal and Infant Health

Behavioral Health

Senior Health

Maternal and Infant Health: In Montgomery County, blacks and Hispanics were most likely to receive late or no prenatal care at 7 percent and 6.8 percent respectively, compared to only 2.6 percent of Asians, and 4.6 percent of whites.

Although infant mortality is generally decreasing, blacks continue to experience the highest rates of infant mortality in Maryland as well as in Montgomery County.

Behavioral Health: The rate of hospital discharges for bipolar disorder has increased for Montgomery county adults. There has also been a two-fold increase in readmissions in the past decade. One in 10 Montgomery County

Support other organizations that provide services related to maternal and infant health, behavioral health, and senior health.


Maternal and Infant Health: Shady Grove Adventist offers a full spectrum of services for expectant mothers, new mothers, and infants. Child birth and education classes are offered as well as lactation consultants. Free post-partum support groups are available as well.

The Montgomery County Health Department works with Holy Cross, Washington Adventist, and Shady Grove Adventist to provide prenatal services to low-income and uninsured residents.

To address teen pregnancy, school nurses work in accordance with Maryland state regulations providing Montgomery County Public School (MCPS) students with education

Maternal and Infant Health: ARHM does not provide maternal and infant services as they fall outside the scope of the hospital as a rehabilitation center. A full spectrum of maternal and infant services are already provided by Shady Grove Adventist Hospital, as well as by several other organizations in ARHM’s service area.

Behavioral Health: ARHM does not provide behavioral health services because these services are already provided by a neighboring specialty care hospital within its hospital system, Adventist Behavioral Health. In addition to Adventist Behavioral Health, there are many organizations that provide behavioral health services within the ARHM

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residents has been diagnosed with an anxiety disorder and nearly 17 percent have been diagnosed with a depressive disorder.

Senior Health: In Montgomery County, 6.2 percent of seniors live below the poverty line with higher percentages among minority seniors and women.

In Montgomery County, 12 percent of the population is over age 64 and 87.6 percent of residents over the age of 64 have some type of health insurance. These rates are comparable to the State of Maryland.

Rates of hospitalization for dementia/Alzheimer’s for Montgomery County (9.4%) were lower than rates in Maryland (15.3%) but deaths associated with falls were slightly higher at 7.7 percent compared to 7.3 percent.

and referrals that promote healthy lifestyle choices.

The Teen Parent Support Program provides peer group education on raising children, healthy relationships, and prevention of repeat teenage pregnancy.

Additional services and resources include the WIC program, safety net clinics, mental health care for pregnant women and new mothers at risk for depression, home visitation services to first time parents, and well-baby care programs.

Behavioral Health: Montgomery County Crisis Center providers 24 hour telephone or walk-in services for children and adolescents.

Many additional organizations provide assessment and care services such as: Children’s National Medical Center, Affiliated Community Counselors, Inc., City of Rockville Youth and Family Services, and

service area.

Senior Health: ARHM does not directly provide senior care community outreach services as they fall outside the scope of the hospital as a rehabilitation center. Many older adults and seniors are served by various programs at ARHM, although these not specifically/exclusively offered to seniors. Senior health services are already provided by other entities in the Adventist HealthCare network, as well as by several other organizations in ARHM’s service area.

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Community Connections.

The Mental Health Association and the National Alliance on Mental Illness provide support, education, and advocacy.

Senior Health: The Montgomery County Department of Aging offers nutrition programs, runs community senior centers, and heads several multicultural health initiatives. The Jewish Council for the Aging has an information and referral service, adult day care services, a senior help line, and Connect-A-Ride.

Local community senior centers provide education classes, social activities, and health screenings.

Additionally available are hospital-based programs including support groups, senior resource programs, and a variety of education services. Health promotion services focus on fall prevention, end of life health decisions, and

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overall health issues. Support groups for family caregivers, respite care, and in-home services are also available.

This area also has all levels of care available for seniors such as acute care, skilled nursing care, assisted living facilities, and home health care services.

Social Determinants of Health

Food Access

Housing Quality

Education

Transportation

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

Housing Quality: In Montgomery County, 50.8 percent of renters spend 30 percent or more of their household income on rent. In the areas served by ARHM, shelters, transitional housing, and motel placements served nearly 8,000 residents in 2008.

Education: Montgomery County performs better than the state baseline with regard to percentage of students who graduate high school within 4 years.

While the overall

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

Food Access: Manna Food Center, a central food bank in Montgomery County, provides food assistance directly to individuals from 14 locations across the county. Manna works with local farms and orchards to provide fresh fruits and vegetables to their clients.

Several local food programs deliver boxes of food to their clients, including Germantown HELP and Manna Food Center. Whether they offer delivery, transportation, or programs directed to children in need, these organizations have worked to overcome access challenges to deliver food and other services to those

ARHM does not directly address many of the social determinants of health as they fall outside the specialty areas of the hospital and ARHM does not have the resources or expertise to meet those needs. Instead ARHM supports and partners with other organizations in the community that specialize in addressing needs related to food access, housing quality, education, and transportation.

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graduation rate is higher than the state, there are disparities in graduation rates among racial and ethnic groups.

Transportation: Montgomery County ranks in the top 25 percent of the longest commute times among all counties in the U.S. At 1.4 deaths per 100,000, Montgomery County is close but has not yet reached the Healthy People 2020 pedestrian death rate target of 1.3 deaths per 100,000.

who need it.

Housing Quality: ARHM is a member of Adventist HealthCare, which supports and partners with a non-profit organization in Montgomery County called Interfaith Works that provides assistance to the County’s homeless population. Interfaith Works provides shelter to approximately 744 homeless men and women each night, and has served 135,000 meals through its Homeless Services programs.

An office within the Montgomery County Department of Health and Human Services helps homeless people in the County access medical care.

The Montgomery County Coalition for the Homeless has shelters and emergency housing as well as a program to provide permanent housing for families throughout the county.

Education: Community groups work to reduce the influence of educational

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disparities by offering supplemental education programs for all ages.

Transportation: A number of public transportation options are available in Montgomery County including Ride On, Park and Ride, Metrobus, Metrorail, MetroAccess, Call “N” Ride, AMTRAK, MARC, and taxis. Many of these options offer free of discounted fares for low income individuals.

*For complete CHNA findings and sources, please refer to the Adventist Rehabilitation Hospital of

Maryland’s Needs Assessment (2013-2016)

DISCLAIMER

This implementation strategy specifies the community health needs that Adventist Rehabilitation Hospital of Maryland has determined to meet in whole

or in part and that are consistent with its mission. The hospital reserves the right to amend this implementation strategy as circumstances warrant. For

example, certain needs may become more pronounced and require enhancements to the described strategic initiatives. During the three years ending

December 31, 2016, other organizations in the community may decide to address certain needs, indicating that the hospital should then refocus its

resources to best serve the community.

community health needs assessment implementation ......are either overweight or obese, and 17.1...

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