Community Benefit Implementation Plan Union Hospital of Cecil County Fiscal Years 2013 - 2014

Jean-Marie Donahoo, MPH-HP Community Benefits Coordinator

5/30/2013

2

Introduction Union Hospital’s Community Benefit Implementation Plan outlines how the hospital plans to address the health priorities identified in the most recent Community Health Needs Assessment conducted by Union Hospital for Cecil County. The health needs prioritized are respiratory health, heart disease, and obesity. Each health priority’s implementation objectives, strategies, action steps are prefaced with supporting data, current initiatives underway, and goals. The implementation plan provided for each health priority provides a framework for monitoring impact over the next 3 years (Fiscal Year 2014 – Fiscal Year 2016).

Priority #1: Respiratory Health Analyzing factors and health outcomes associated with respiratory health spans a wide range of variables. In conducting the Community Health Needs Assessment and in addressing patient needs influenced by population health, Union Hospital decided to focus on tobacco cessation to address improving respiratory health in Cecil County.

Data: Tobacco Use In 2011, 23.9% of adults, aged 18 years or older, smoked in Cecil County1. When compared to the rest of the counties in the state, Cecil County ranked fourth out of six counties with the highest adult smoking percentages2. The top six counties were spread out all over the state, but Cecil’s neighboring counties of Kent and Harford each had only 19% of their adult populations that smoked. That’s a 5% difference in smoking rates on either side of Cecil County, covering less than 100 miles with similar geographical and population make-ups. In 2011, in addition to the adult population, 20.5% of Cecil County’s teenagers (aged 13-17 years) smoked3. According to MDQuit, youth (teens included) are more likely to start smoking than those over the age of 21 because they are more susceptible to the affects of advertising, peer influence, curiosity, and environmental cues, like parental smoking4. In addition, there has been an increase in the amount of teens and other youth that use tobacco products due to a recent shift in the marketing of smokeless tobacco products. Flavored cigars, mint-like nicotine gum, nicotine breath mints, and even dissolvable nicotine tongue strips are appealing to youth and teens because they are smokeless, inexpensive and discreet (can be used at any time, indoors or outdoors).

Tobacco Cessation: Current Initiatives Quitting smoking is a very personal, intensive process that requires dedicated guidance to identify state of readiness to quit, address environmental triggers and cues, garner support

1 Maryland Behavioral Risk Factor Surveillance System. (2011). Adults who Smoke [data file]. Retrieved from:

http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 2 County Health Rankings. (2005-2011). Retrieved from:

http://www.countyhealthrankings.org/app/maryland/2013/measure/factors/9/map 3 Maryland Youth Tobacco Survey. (2010). Teens who Smoke [data file]. Retrieved from: http://mdquit.org/tobacco-use/maryland-dhmh-reports 4 MDQuit. (2013). Youth Smoking. Retrieved from: http://mdquit.org/special-populations/youth-smoking

3

through action, and maintain progress. To help Union Hospital assess and address tobacco use in the hospital and in the community, a core team of professionals was formed, known as Union Hospital’s Tobacco Cessation Committee. On this committee there is representation from Cancer Program, Respiratory Care, Community Benefit, Stroke Program, and Cardiology. This committee works on:

Identifying which resources are available in the community for tobacco cessation;

Collaborating with community partners;

Reporting activities to the Cecil County Tobacco Task Force; and

Working on projects that help identify how the patient population, once discharged into the community, are aided in their cessation journeys.

Identification of resources available and collaboration with community partners have been the two largest tasks that the Tobacco Cessation Committee has worked on over Fiscal Years 2012 and 2013. The committee confirms that partnerships are integral to impacting tobacco use in Cecil County. Two partners of Union Hospital’s Tobacco Cessation Committee are the Cecil County Health Department and the Maryland Resource Center for Quitting Use and Initiation of Tobacco (or MDQuit). Promoting Resources from the Cecil County Health Department In working with the Cecil County Health Department, Union Hospital looks at effective ways to refer both in-patients and out-patients, identified as smokers, to the cessation services at the Cecil County Health Department (CCHD). The CCHD has dedicated staff that facilitates the following programs:

“Tools to Be Tobacco Free”. This program is divided into three phases of three, 1-hour sessions designed to help individuals quit and sustain applicable lifestyle and behavioral changes. This program covers topics like, stress management, triggers, setting a quit date, withdrawal, maintenance support, and relapse prevention.

Secondhand Smoke education. Free educational sessions are provided to families regarding protecting children from second-hand smoke. Sessions focus on identifying the dangers of exposure to second-hand smoke.

Private Consultations. CCHD staff meets and talks with individuals about starting and maintaining a tobacco-free life. These sessions are tailored to each individual and are free.

The CCHD also administrates the Community Transformation Grant for Cecil County. Through part of this grant the CCHD is working with Elkton Housing Authority to initiate smoke-free indoor and outdoor spaces. Promoting Resources through MDQuit MDQuit provides several services to help individuals quit using tobacco products. Among them are self-service cessation tools available on their website5, a quit line, and nicotine replacement therapies for eligible participants.

5 www.mdquit.org

4

Goal: Impacting Tobacco Use in Cecil County The goal of the respiratory health implementation plan is to increase the number of contacts and connections made or facilitated among individuals to quit using tobacco products. It has been a difficult undertaking in years past to reduce the overall incidence and prevalence of smoking among adults and teenagers in Cecil County. Smoking percentages have remained constant for more than four years. Due to this difficulty, Union Hospital considers it pertinent to switch the focus from decreasing smoking rates on the whole to increasing the number of face-to-face contacts and connections made with smokers and tobacco users to increase awareness and take a more personalized approach.

Implementation Plan: Tobacco Cessation The following objectives, strategies and action steps have been developed to help increase the number of contacts and connections made and/or facilitated among individuals in Cecil County that want to quit using tobacco products.

Objective 1: Complete the cessation resource assessment by end of May 2013

Strategy: Conduct discharge surveys through Union Hospital’s Respiratory Therapists and Pulmonary Function Testers (PFTs)

Action Step: Complete 50 surveys

Objective 2: Analyze the survey results with MDQuit from June – August 2013

Strategy: Collaborate with MDQuit to produce a report explaining the survey results

Action Step: Post the report online

Action Step: Report results to the Cecil County Tobacco Task Force

Action Step: Meet with Tobacco Cessation Committee to discuss next steps

Objective 3: Increase connections for smokers to available community cessation programs offered by the Cecil County Health Department and MDQuit

Strategy: Continue to offer pamphlets to patients at discharge highlighting CCHD and MDQuit cessation programs

Action Step: Track # of pamphlets distributed

Action Step: Track # of contacts made with those ready to quit

Strategy: Restore the current Union Hospital tobacco cessation website

5

Action Step: Post links to CCHD and MDQuit resources

Action Step: Link self-help tools: the Stages of Change model (TTM) and American Cancer Society’s quit toolkit

Action Step: Include a calendar with dates of Cecil County Tobacco Task Force meetings and upcoming cessation events/activities (i.e., Great American Smoke-Out)

Action Step: Include a “For More Information” contact section to get cessation materials mailed or emailed

Action Step: Track # of users that view the site

Strategy: Emphasize utilization of Fax-to-Assist to increase referrals to MDQuit’s smoking cessation personalized coaching

Action Step: Track # of referrals made by obtaining referral reports from MDQuit and the CCHD

Objective 4: Promote cessation efforts in the community

Strategy: Collaborate with the CCHD to offer free private cessation consultations for the community at the hospital

Action step: Track # of consultations conducted

Strategy: Collaborate with Union Hospital’s Stroke Program to promote cessation counseling

Action Step: Coordinate smoking cessation counseling during stroke risk assessments at community health fairs and other stroke-related events

Action Step: Track # of cessation contacts made

Priority # 2: Heart Disease Heart disease is the number one cause of death in the United States, and it is the number two cause of death in Cecil County (cancer is the number one cause of death). The most common type of heart disease occurring in the United States is coronary artery disease—plaque build-up causing narrowing of the arteries that supply blood to the heart. Coronary artery disease can cause heart attack, heart failure, and arrhythmias. Risk factors associated with heart disease are tobacco smoking, obesity, sedentary lifestyle, high cholesterol, and diabetes. These risk factors are modifiable, meaning that improving lifestyle choices and habits associated with these risk

6

factors can decrease one’s risk of getting heart disease6. These risk factors are also some of the leading causes of Union Hospital’s admission and readmission rates.

Data: Heart Disease From 2009-2011, there were 199.7 deaths per 100,000 population in Cecil County7. When studying Cecil County, the statistics show that there is an increased risk for the development of heart disease for the population based on the following modifiable risk factors:

Tobacco Use. As discussed previously, 23.9% of adults and 20.5% of teenagers in Cecil County smoke. Smoking can damage the functioning of the heart and can damage the structure and functioning of blood vessels. This damage increases the risk for the hardening and narrowing of the coronary arteries8.

Obesity. According to Maryland’s Behavioral Risk Factor Surveillance System (BRFSS) data from 2011, 31.4% of adults in Cecil County were obese (as defined by a body mass index of 30 or greater)9. Higher body fat content can raise blood pressure, raise cholesterol levels, can contribute to insulin resistance and cause poor circulation10.

Sedentary Lifestyle. Physical activity is integral to a healthy lifestyle and reduces the risk for heart disease. The Centers for Disease Control and Prevention recommends that adults get thirty minutes a day of moderate physical activity. For children the recommendation is sixty minutes a day11. According to Maryland BRFSS data from 2012, only 30.2% of the adults in Cecil County participated in moderate physical activity12. Participating in moderate physical activity can improve cardiovascular health and reduce total body fat content.

High Cholesterol. When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart. Together with other substances, it can form plaque that can narrow the arteries. According to Maryland BRFSS data from 2011, 45.5% of adults in Cecil County had high cholesterol13. Thus, almost half of Cecil County’s adult population could be at risk for heart disease. A healthy diet and physical activity can help manage high cholesterol.

6 Healthy Communities Institute. (2013). Age-Adjusted Death Rate due to Heart Disease [data file]. Retrieved

from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 7 Department of Health and Mental Hygiene. (2009-2011). Age-Adjusted Death Rate due to Heart Disease [data

file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 8 National Heart, Lung, and Blood Institute. (2011). How Does Smoking Affect the Heart and Blood Vessels?

Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/smo/ 9 Maryland Behavioral Risk Surveillance System. (2011). Adults Who are Obese [data file]. Retrieved from:

http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 10

American Heart Association. (2013). Obesity Information. Retrieved from: http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/Obesity/Obesity-Information_UCM_307908_Article.jsp 11

Centers for Disease Control and Prevention. (2013). How much physical activity do adults need? Retrieved from: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html 12

Maryland Behavioral Risk Surveillance System. (2010). Adults Engaging in Moderate Physical Activity [data file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 13

Maryland Behavioral Risk Surveillance System. (2011). High Cholesterol Prevalence. [data file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment

7

High Blood Pressure. High blood pressure, or uncontrolled blood pressure, is the number one risk factor for stroke. It can also lead to heart attacks, heart failure, kidney failure, and coronary artery disease. In 2011, 35.2% of the adult population in Cecil County had high blood pressure. Of this percentage about 42% were persons aged 45 – 64 years old and about 69% were persons aged 65 years or older14. High blood pressure can be controlled through lifestyle changes including eating a heart-healthy diet, limiting alcohol intake, avoiding tobacco, controlling weight, and staying physically active.

Diabetes. Diabetes is a condition in which insulin resistance and/or insulin deficiency cause blood glucose to be chronically elevated. This elevated level of glucose can damage blood vessels over time. Individuals with diabetes are 2-4 times more likely to suffer from heart disease or suffer a stroke than individuals without diabetes. According to Maryland BRFSS data from 2011, 11.7% of Cecil County adults had been diagnosed with diabetes, with a majority of adults diagnosed aged 65 years or older15. The American Diabetes Association considers an A1C of 7% or less to be an indicator of well controlled diabetes16.

Modifying lifestyle choices and habits surrounding these risk factors may help to reduce heart disease in Cecil County, as well as other health issues, like tobacco use and obesity.

Preventing Heart Disease: Current Initiatives Reducing the risk for heart disease can be as easy as learning the ABCS (Appropriate Aspirin intake, Blood pressure control, Cholesterol management, and Smoking Cessation). For Community Benefits, blood pressure control, cholesterol management, and smoking cessation are all components of initiatives that are currently being implemented throughout the community. Below please find more information about how blood pressure control and cholesterol management are incorporated into current initiatives (smoking cessation initiatives are discussed in a previous section). Blood Pressure Checks at Elkton Presbyterian Church Union Hospital’s Imaging department coordinates staff volunteers to participate in homeless meal serves at Elkton Presbyterian Church (EPC) in Elkton, MD. This initiative serves two purposes: 1) to help homeless persons get a hot meal and 2) allow homeless persons to have access to knowledge and medical expertise on controlling blood pressure. Hospital staff addresses homeless persons before and after they receive their meals. Meetings are personal, one-on-one interactions where the whole person is considered and take into account personal, and sometimes mitigating, circumstances (barriers to care). Blood pressures are taken and education is given about the difference between high and low blood pressure. Each person

14

Maryland Behavioral Risk Surveillance System. (2011). High Blood Pressure Prevalence [data file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 15

Maryland Behavioral Risk Surveillance System. (2011). Adults with Diabetes [data file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 16

National Diabetes Education Program. (2013). Retrieved from: http://ndep.nih.gov/

8

receives a card with their reading and is encouraged to seek out medical resources in the event that the blood pressure is too high. Union Hospital staff comment that these homeless serves/blood pressure checks are fulfilling both from community service and medical attention perspectives. Staff has also commented that at subsequent homeless serves/blood pressure checks they have encountered persons from previous checks that have maintained their blood pressures according to advice previously received. Preventing Diabetes and Heart Disease Union Hospital’s Dietitians provide free diabetes education at programs and events for youth, adults and seniors in Cecil County. This education emphasizes controlling blood pressure, managing cholesterol, and reducing risk for Type 2 diabetes and heart disease. These educational programs are provided at schools, nursing homes, churches, health fairs and other community events. Educational screenings are often provided at these events to help community members understand their risk for diabetes, heart disease and other diet related chronic illnesses. Stroke Risk Assessments Union Hospital’s Stroke Program, in conjunction with staff nurses from the Emergency Department, provides free stroke risk assessments at nursing homes and at health fairs in the community. These assessments provide an understanding of the risk for stroke based on gender, age, family history, current weight, and systolic blood pressure. While these assessments are quick, they help people identify with the signs and symptoms associated with stroke and instill the value of knowing how some lifestyle choices and habits can increase the risk of stroke. Identifying the Signs and Symptoms of Stroke Union Hospital’s Stroke Program and nursing staff from the Emergency Department educate community groups on the signs and symptoms of stroke through community engagements and other events. Senior staff, from these departments, attends Maryland Stroke Consortium meetings on a regular basis to learn about new techniques for teachable moments and program development on how to identify the signs and symptoms of stroke. Knowledge gained from these meetings is shared in the facility setting as well as with the community. Heart Health Education Union Hospital employed providers are invited to speak at community engagements about heart healthy practices and the importance of heart disease prevention. Presentations are geared toward specific groups, like women, and offer insight into important self-management tools and medical best practices. Union Hospital Dietitians also provide education in the community to help individuals reduce their risk for heart disease though lifestyle changes such as adopting a healthy diet (the Dietary

9

Approaches to Stop Hypertension diet), physical activity, weight management and glycemic control.

Goal: Impacting Heart Disease in Cecil County Cecil County residents continue to show an increase in risk factors associated with heart disease. Addressing these risk factors could potentially reduce the incidence and prevalence of heart disease in Cecil County. However, the goal of this implementation plan for heart disease is to increase awareness by addressing the community about the modifiable risk factors for heart disease and identifying the signs and symptoms of stroke to promote the prevention of heart disease in Cecil County.

Implementation Plan: Heart Disease The following objectives, strategies and action steps address ways to increase awareness surrounding the prevention of heart disease in Cecil County.

Objective 1: Increase the number of blood pressure screenings provided in the community

Strategy: Provide at least 1 additional access point for community members to receive free blood pressure screenings in the community

Action Step: Collaborate with Union Hospital’s Cardio Pulmonary Rehabilitation program and Pulmonary Function Testers (PFTs) to provide education and screenings for the community

Action Step: Track # of participants

Action Step: Track # of abnormal BPs taken

Objective 2: Increase the number of healthy lifestyle events in the community with an emphasis on the prevention of heart disease

Strategy: Provide at least 2 diabetes education/healthy eating opportunities in the community that focus on heart disease prevention and management

Action Step: Work with Union Hospital’s Diabetes Program and other health providers to establish these opportunities in the community. These opportunities may include speaker series, lunch & learns, hands-on demonstrations that focus on heart health, or heart disease prevention for various population groups in Cecil County.

Action Step: Track # of participants

10

Objective 3: Increase the number of stroke education opportunities in the community

Strategy: Collaborate with community partners to provide at least 1 opportunity to receive free stroke risk assessments in the community

Action Step: Track # of participants

Action Step: Track # of abnormal assessments

Strategy: Collaborate with community partner(s) to provide at least 1 stroke education opportunity in the community

Action Step: Coordinate Union Hospital staff and providers to promote awareness for community residents

Action Step: Track # of participants

Objective 4: Increase the number of heart health education opportunities in Cecil County

Strategy: Collaborate with community partner(s) to provide at least 1 heart health education opportunity to promote awareness for community residents

Action Step: Coordinate Union Hospital providers to set-up an activity, such as speaker series, Lunch-n-Learns, or hands-on demonstrations that focus on heart health and heart disease prevention for population groups in Cecil County

Action Step: Track # of participants

Priority #3: Obesity Every year more and more persons are categorized as obese. Obesity is measured as having a body mass index (BMI) of 30 or greater. Several factors can increase obesity: sedentary lifestyle, lack of moderate physical activity, lack of consumption of fresh fruits and vegetables, and poor diet and nutrition. Obesity can also increase the risk for several health problems, like Type 2 diabetes (especially in youth), respiratory health issues, heart disease, poor joint health, high cholesterol, uncontrolled blood pressure, circulatory issues, stroke, and fatigue. Obesity was chosen as a priority in Cecil County because it impacts both youth and adults. Similar to heart disease and tobacco, making healthy lifestyle choices, such as choosing a healthier diet or getting more exercise, may help reduce the risk for obesity.

11

Data: Obesity In 2011, 31.4% of the adult population in Cecil County was obese17. Many factors can lead to obesity but in many cases individuals who are overweight are at the highest risk. Individuals who are overweight have a BMI between 25 and 29.9. Maryland BRFSS data from 2011 showed that 75% of the adult population in Cecil County was overweight or obese18. Overweight individuals are at risk for developing diabetes, heart disease and other health issues. Making healthy lifestyle choices such as exercising and eating right can help overweight individuals maintain healthier weights and reduce the risk of developing related co-morbidities. Data supports the high prevalence of childhood obesity in Cecil County as well. According to the Food Environment Atlas from the US Department of Agriculture, data from 2009-2011 showed that 16.7% of preschool aged children in Cecil County were obese, with a BMI-of-age above the 95th percentile19. Again, there are many factors that can contribute to childhood obesity, but environment and lifestyle choices can certainly influence a child’s tendency to become overweight and even obese. Low-income areas in Cecil County have little access to fresh fruits and vegetables and a higher density of fast food restaurants (in 2009, there were 0.53 restaurants per 1,000 population)20, making it more difficult to access healthy foods. Low-income neighborhoods also contain unsafe outdoor conditions, like lack of proper street lighting, no sidewalks, and few safe playgrounds. These conditions make it more difficult for children to engage in physical activity and increase sedentary behaviors, like increased screen time. Building Healthier Lifestyles: Current Initiatives In partnership with Union Hospital’s Community Benefits program, both Union Hospital’s Dieticians and community partners engage community groups and individuals in a healthy living dialogue. Nutrition Education Union Hospital’s Dietitians provide educational programs to children and adults through health fairs, community cooking demonstrations, worksite wellness programs, school programs and assemblies, and through the school based health centers. Diabetes Education Union Hospital’s Dieticians provide free diabetes education to the community through risk assessments, diabetes management tips and strategies, and events like “Steps to Stop Diabetes,” “Down with Diabetes,” and “Diabetes Alert Days.”

17

Maryland Behavioral Risk Surveillance System. (2011). Adults who are Obese [data file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 18

Maryland Behavioral Risk Surveillance System. (2011). Adults who are Overweight or Obese [data file]. Retrieved from: http://www.uhcc.com/About/Community-Benefit/Community-Health-Needs-Assessment 19

US Department of Agriculture. (2009-2011). Food Environment Atlas. Retrieved from: http://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas.aspx#.UZt4J6Lktn4 20

US Department of Agriculture. (2009-2011). Food Environment Atlas. Retrieved from: http://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas.aspx#.UZt4J6Lktn4

12

Diabetes Screenings Union Hospital’s Dieticians facilitate diabetic eye and foot screenings with community providers free of charge to the community. These screenings provide access to needed physician services and diabetes education. Diabetes Support Group Union Hospital’s Dieticians facilitate a diabetes support group open to the community and free of charge. This support group is facilitated by Jen Noll, RD, LDN, CDE and supported by Caroline Booze, RD, LDN, NASM-CPT. It provides support and educational information for persons with diabetes and their families. Fiscal Year 2013 discussion topics included: “Diabetes and Emotions,” “Carbohydrate Review,” “Protect Your Feet,” and “Problem Solving with Diabetes.” Cecil County Healthy Lifestyles Task Force Union Hospital staff, Cecil County Health Department staff, and other community leaders participate in task force meetings to discuss and support opportunities to engage community members and groups in making healthier lifestyle choices in Cecil County. Past task force discussions have included: addressing food insecurity; supporting the role of free and reduced lunches to facilitate access to regular meals and healthier food options for low-income youth; and the importance of cultivating positive awareness around subsidized food programs in the state of Maryland. This task force also supports and facilitates discussions regarding the Community Transformation Grant’s focus on school wellness policies in Cecil County. Goal: Impacting Obesity in Cecil County As more of the population becomes overweight and obese, it becomes increasingly important to emphasize making healthy lifestyle choices across the age continuum in Cecil County. Consideration of the built environment, as discussed previously, is also an important facet of the obesity prevention equation. However, this implementation plan for obesity will focus primarily on engagement of the community in making healthy lifestyle choices to reduce obesity in Cecil County. Implementation Plan: Obesity In order to help impact obesity in Cecil County, Union Hospital will not only continue to work within the community to emphasize making healthy lifestyle choices, but will also introduce a new project to motivate community members to exercise and re-evaluate current lifestyle behaviors associated with the risk factors for obesity.

Objective 1: Increase availability of obesity prevention activities and programs in the community

Strategy: Provide at least 1 obesity prevention activity in conjunction with Title 1 Elementary Schools, Middle Schools, or current afterschool care programs

Action Step: Collaborate with Cecil County Public Schools or afterschool care programs to establish an in-school or after-school program that addresses increasing

13

physical activity and improving diet

Strategy: Provide at least 1 obesity prevention or worksite wellness program in conjunction with a local business or community group

Action Step: Work with area businesses or community groups to provide an obesity prevention program

Objective 2: Implement the Weight of the Nation program

Strategy: Collaborate with other community organizations to implement the Weight of the Nation program for community members

Action Step: Begin with the following pilot for 1 month: 1) Week 1: Provide the HBO screening of Weight of the Nation 2) Week 2: Provide biometrics screening fair for all established

participants 3) Week 3: Provide a nutrition education/cooking demonstration

presentation for all established participants 4) Week 4: Provide walking opportunities for all established participants

Action Step: Track the following during the pilot: 1) # of participants each week 2) # of locations used 3) # of Union Hospital and community organization staff involved in

coordination 4) # of minutes walked 5) Biometrics

Action Step: Provide a survey to all established participants which solicits feedback about the pilot during the final week

Action Step: Analyze results and determine program feasibility for additional months

Conclusion Impact data per objective will be reported internally and through select community reports throughout Fiscal Year 2014. An impact data summary will be included with the IRS Form 990 Schedule H report for Fiscal Year 2014. Additional strategies and actions steps may be added as needed over the next three years (Fiscal Years 2014 – 2016). Each subsequent year in the 3-year cycle leading up to the next Community Health Needs Assessment will include annual report-outs attached to Form 990 Schedule H reports.