Community Health Needs Assessment RHODE ISLAND HOSPITAL

SEPTEMBER 30, 2019

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Table of Contents I. Introduction 2

A. DescriptionofCHNAPurpose&Goals B. HistoryandMissionofRhodeIslandHospital C. CommitmenttotheCommunity D. RhodeIslandHospital–WhatitDoes

II. RhodeIslandHospital‐DefiningtheCommunityitServes 9

III. Updateon2016CHNAImplementationStrategy 10

IV. AssessmentofHealthNeedsoftheRhodeIslandHospitalCommunity 22

V. IdentificationofRhodeIslandHospitalCommunitySignificantHealthNeeds 28

VI. Conclusion 38A. AcknowledgementsB. ContactInformationAppendices 40

References 52

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I. Introduction

A. Description of CHNA Purpose & Goals Rhode IslandHospital (RIH), located inProvidence,Rhode Island, isa719‐bednonprofitgeneralacutecareteachinghospitalwithuniversityaffiliationprovidingacomprehensiverangeofdiagnosticandtherapeuticservicesfortheacutecareofpatientsprincipallyfromRhodeIslandandsoutheasternMassachusetts.Asacomplementtoitsroleinserviceandeducation,RIH actively supports research.RIH is accreditedby the Joint Commission onAccreditation of Healthcare Organizations and participates as a provider primarily inMedicare,BlueCross,andMedicaidprograms.RIHisalsoamemberofVoluntaryHospitalsofAmerica,Inc.

EffectiveAugust9,1994,RIHandTheMiriamHospital(TMH)ofProvidence,RI(247beds)implementedaplanwhichincludedthecreationofanot‐for‐profitparentcompany,LifespanCorporation.Eachhospitalcontinuestomaintainitsownidentity,aswellasitsowncampusand itsownname.Lifespan, thesolememberofRIHandTMH,has the responsibility forstrategicplanningandinitiatives,capitalandoperatingbudgets,andoverallgovernanceoftheconsolidatedorganization.

InadditiontoRIHandTMH,Lifespan'saffiliatedorganizationsalsoincludeEmmaPendletonBradleyHospital(EPBH),NewportHospital(NH),GatewayHealthcare,Inc.(Gateway),andLifespanPhysicianGroup,Inc.(LPG),aswellasotherorganizationsinsupportofLifespananditshospitals.In2010,thePatientProtectionandAffordableCareAct(PPACA)specifiedrequirementsforhospitals tomaintain recognitionas InternalRevenueCodeSection (IRC)501(c)(3)non‐profit hospital organizations. 1 Among many financial requirements, these regulationsincludearequirementtoconductaCommunityHealthNeedsAssessment(CHNA)atleasteverythreeyearsandtoadoptanimplementationstrategytomeetthecommunityneedsidentifiedintheCHNA.2CHNAsmustutilizequalitativeandquantitativedataandfeedbackfrom key stakeholders and communitymembers to determine themost pressing healthneedsofthecommunitythehospitalserves.Thisgroupincludes,amongothers,membersofthemedicallyunderserved,low‐income,andminoritypopulationsinthecommunitycaredforbythehospitalfacility.CHNAregulationsspecifythataCHNAshouldaddressnotonlyfinancialbarrierstocarebutalso“theneedtopreventillness,toensureadequatenutrition,or to address social, behavioral, and environmental factors that influence health in thecommunity.”3RIHconducted its firstCHNA,datedSeptember30,2013,whichcoveredtheperiod fromOctober 2010 through September 30, 2013, to better understand the individual andcommunity‐level health concerns of the population that it serves. This process and itsresultantfindingswereachievedthroughanefforttoinvolvethecommunityindeterminingits significant health care needs. The CHNA encompassed intensive data collection andanalysis, as well as qualitative research in the form of interviews withmembers of thecommunity and surveys of more than 100 internal and external stakeholders, including

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hospital‐basedphysicians,nurses,socialworkers,administratorsandotherprofessionals,andcommunity‐basedstakeholdersrepresentingconstituenciesservedbyRIH.4The2013reportandimplementationstrategywasdistributedwidelyamongLifespanstakeholders,community partners and the general public. Data collected produced a resultingimplementationstrategytoaddresssignificantneedsspecifictothecommunityservedbyRIH.Progressonthesestrategiesisreportedinthe2016CHNA.Lifespan,onbehalfofRIH,conducteditssecondCHNA,coveringthethree‐yearfiscalperiodfromOctober1,2013 throughSeptember30,2016.Thegoalsof thatCHNAwere to: (1)provideareviewofwhatRIHhasaccomplishedinaddressingthesignificantneedsidentifiedinitsimplementationstrategyincludedinRIH’sinitialCHNA,datedSeptember30,2013;(2)todefinethecommunitythatRIHserves;(3)toassessthehealthneedsofthatcommunitythrough various forms of research, community solicitation, and feedback; (4) to identifywhich of those needs assessed were of most significance to the community; (5) and toprovideanimplementationstrategythatdetailedhowRIHwouldaddressthosesignificantneeds.ThisreportrepresentsthethirdCHNAconductedbyLifespanonbehalfofRIH,coveringthefiscalperiodfromOctober1,2016throughSeptember30,2019.ThegoalsofthisCHNAarethesameasthoseoutlinedabovefor2016.TheimplementationstrategytobepresentedasaresultofthisCHNAwillbeusedorganizationallytoguidehospitalstrategicplanningoverthenextthreeyears(October1,2019throughSeptember30,2022).

B. History and Mission of Rhode Island Hospital As a founding member of the Lifespan health system, RIH is committed to itsmission:Deliveringhealthwithcare.LocatedinProvidence,RhodeIsland,RIHwasfoundedin 1863 to address the medical needs of returning Civil War veterans and the growingcommunityofurbanpoorinanincreasinglyindustrializedRhodeIsland.Ithassincegrowntoencompassacomprehensiverangeofdiagnosticandtherapeuticservices,deliveredina719‐bed,nonprofitacutecareteachinghospital.RIHisthelargestprivate,not‐for‐profithospitalintheState.AstheLevelItraumacenterforsoutheasternNewEngland,theHospitalisdedicatedtobeingonthecuttingedgeofmedicineandresearch.ItalsooperatesHasbroChildren’sHospital(HCH),adivisionofRIHandtheState’sonlyfacilitydedicatedtomedicalpediatriccare.HCHopenedin1994,replacingRIH’sovercrowdedpediatricwingwithalarger,significantlymoresophisticatedfacility.Sinceitsinception, HCH has become a regional hub for pediatric medicine in southeastern NewEngland.PediatricservicesarelocatedontheRIHcampus,inaseparatebuildingfromtheadulthospital.Itoffersawiderangeofprogramsforchildrenandadolescents–fromafull‐service,24‐hourpediatricemergencydepartmenttoadedicatedpediatricimagingcentertoanarrayofspecialtyservices,includingpediatricneurodevelopmentservices,cancercare,andpediatricsurgery.

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A founding teaching affiliate of The Warren AlpertMedicalSchoolofBrownUniversity,RIHwasnamedthemedical school’s Principal Teaching Hospital in 2010.RIHcurrentlysponsorsfiftygraduatemedicaleducationprograms accredited by or under the auspices of theAccreditationCouncil forGraduateMedicalEducation,while also sponsoring another thirty‐fivehospital‐approvedresidencyandfellowshipprograms.RIH serves as the principal setting for these clinicaltraining programs, which encompass the followingdisciplines: anesthesiology; internal medicine andmedicine subspecialties, including hematology andoncology; orthopedics and orthopedic subspecialties;clinical neurosciences and related subspecialties;general surgeryandsurgical subspecialties;pediatricsandpediatric subspecialties, includinghematology andoncology; dermatology; radiologyand radiology subspecialties; pathology; child psychiatry; emergency medicine andemergencymedicinesubspecialties;dentistry;andmedicalphysics.RIHprovidesstipendstoresidentsandphysicianfellowswhileintraining.RIHisaregionalandnationalleaderinmedicaleducation,research,andclinicalcare.InadditiontoservingasthedesignatedLevelITraumaCenterforthestateofRhodeIslandandsoutheasternMassachusetts,RIHprovidesanarrayofmedical/surgicalservicesandbehavioralhealthservicesforadults,adolescents,andchildren.In 2017, Lifespan launched its new shared values that define how services are providedacrossallaffiliates–compassion,accountability,respect,andexcellence– fourwordsthatformtheacronymC.A.R.E.andsuccinctlycapturethesubstanceofitsmission,Deliveringhealthwithcare.ThisacronymservesasRIH’s“true‐north”guide,helpingLifespanbecomethebestplacetoobtaincareandthebestplacetowork.Furthermore,Lifespanidentifiedeightcoreprioritiesthathelpfocusitseffortsonstrategiesthatadvanceitscommitmenttoimprovingthehealthandwell‐beingofthepeopleofRhodeIslandandsoutheasternMassachusetts. ADVANCINGACADEMICS&RESEARCH:Advanceclinicaloperationstotrainthenext

generationofclinicians,aswellasadvanceresearchandthescienceofmedicine. COMMITMENT TO THE COMMUNITY: Enhance corporate visibility; improve the

healthandwellnessofthecommunitiesLifespanserves. COST:Continuetoworktoreducetheoverallcostofcare. PHILANTHROPY: Cultivate community relationships to enhance charitable

contributionsmadetoLifespantoadvancethemissionandvisionoftheorganization. PHYSICIAN PARTNERSHIP: Achieve outstanding collaboration with the system’s

alignedphysicianpartners. QUALITY AND SAFETY: Achieve and maintain top decile performance in quality,

safety,andpatientexperience.

Table 1‐ Rhode Island Hospital Statistics, FY 2018 5

Year founded 1863

Employees 7,781

Affiliated physicians 1,826

Licensed beds 719

Patient Care

Patient discharges 36,912

Emergency department visits 152,328

Outpatient visits 333,546

Outpatient surgeries 13,685

Inpatient surgeries 9,913

Financials ($ in thousands)

Net patient service revenue $1,279,699

Research funding revenue $60,608

Total assets $1,293,953

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VALUE‐BASEDCARE:Continuallyimprovequalityandcontrolcosttodrivethevalueimperative.

WORKFORCE:Recruit,retain,andengagetoptalentthatisalignedwithLifespan’ssharedvaluestoprovideanextraordinarypatientexperience.

C. Commitment to the Community RIHhasalongstandingcommitmenttothemembersofitscommunity,extendingthescopeof the care and resources it provides through programs, conferences, presentations, andsupportgroups.RIHiscommittedtopromotinghealthequityandreducinghealthdisparitiesforitspatients.DuringthefiscalyearendedSeptember30,2018,RIHprovidedmorethan$135.7millionincharity care and other community benefits for its patients, which accounted forapproximately 9.7% of total operating expenses. RIH bills uninsured and underinsuredpatients using the prospectivemethod,whereby patients eligible for financial assistanceunderRIH’sFinancialAssistancePolicyarenotbilledmorethan“amountsgenerallybilled”,defined by the Internal Revenue Code Section §501(r) as the amount Medicare wouldreimburse RIH for billed care (including both the amount thatwould be reimbursed byMedicare,andtheamountthebeneficiarywouldbepersonallyresponsibleforpayingintheformofco‐payments,co‐insurance,anddeductibles)ifthepatientwasaMedicarefee‐for‐servicebeneficiary.6Notably, inadditiontothisfinancialassistanceandsubsidizedhealthservices,RIHprovidedmorethan$1millionincommunityhealthimprovementservicesand

communitybenefitoperations.7RIH also provides many other services to thecommunityforwhichchargesarenotgenerated.These services include certain emergencyservices, community health screenings forcardiac health, diabetes and other diseases,smokingcessation, immunizationandnutritionprograms, health promotion education,community health training programs, patientadvocacy,andforeignlanguagetranslation.The Lifespan Community Health Institute

(LCHI),withamission toensure thatallpeoplecanachieve theiroptimal stateofhealththroughhealthybehaviors,healthyrelationshipsandhealthyenvironments,workswithallLifespanaffiliatestoachievepopulationhealthgoalsandpartnersextensivelywithRIH.Lifespan, through the LCHI and affiliates, coordinates hundreds of programs, events andcommunity service activities that serve between 25,000 and 30,000 southern NewEnglandersannually.Programsareofferedforfreeoratareducedcosttothecommunityand non‐profit organizations.9In partnershipwith community‐based agencies aswell as

Table 2‐ Net Cost of Charity Care and Other Community Benefits, FY 20188

($ in thousands)

Charity care $18,009

Medical education, net $53,262

Research $10,774

Subsidized health services $9,570

Community health improvement services and community benefit operations

$1,023

Unreimbursed Medicaid costs $43,132

Total cost of charity care and other community benefits

$135,770

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hospitalandLifespansystemleadership,LCHIledthedesignanddevelopmentofthe2019CHNA.Community andpatient engagement is a critical component of quality improvement andstrategicplanningforLifespanCorporationanditsaffiliatedhospitals.Lifespanlaunchedawebsite,www.lifespan.org/centers‐services/lifespan‐community‐health‐institute/community‐health‐reports‐and‐resources in the spring of 2016 to describe andpublicizetheCHNAprocess.Thissite,accessiblefromtheLifespanhomepage,ismaintainedandhouseseachhospital’sCHNAreportandimplementationstrategy.Thissitealsoservesas a conduit to link community residents and organizations to RIH’s health‐promotinginitiatives.10

D. Rhode Island Hospital – Notable Achievements October1,2018marked150yearssincethedoorsofRIHofficiallyopenedtopatients.OnOctober 6, 1868, John Sutherland, a 59‐year‐old shoemaker, was the first patient to beadmitted.11Sincethattime,RIHhasintroducedmanyclinical innovationstosoutheasternNewEngland,fromRhodeIsland’sonlykidneytransplantationservicetooneofthenation’sfirstgammaknifesurgicalcenters,offeringintracranialstereotacticradiosurgeryfornon‐invasivetreatmentofbrainlesions.RIHisrecognizedforimprovingaccesstoquality,evidence‐basedclinicalcareforpatientsthrough community partnerships, funding innovative research, and investing inmoderntechnologiesandprograms.RIHhastheuniquepositionofofferingthemostinpatientandoutpatientservicesintheState,meaningittouchesmoreRhodeIslandersthananyotherhospital.Hospitalleadershipandstaffareconstantlystrivingtobetterservetheirpatientsandcommunity.NotableachievementsinclinicalservicesduringthereportingperiodsrepresentingthefiscalyearsendedSeptember30,2017throughSeptember30,2019include12,13: HCHopenedaclinicaldecisionunitadjacenttoitsEmergencyDepartmentduringthe

fiscalyearendedSeptember30,2017forpatientslikelytorequirestaysoflessthan24hours,reducingthewaittimesinthepediatricemergencydepartment.

HCHestablishedtheChildren’sCenterforLiverDiseaseduringthefiscalyearendedSeptember30,2017.

RIHopenedtheLifespanRecoveryCenterduringthefiscalyearendedSeptember30,2017 to help battle the opioid crisis in Rhode Island, providing rapid access totreatmentandsupportduringrecovery.

The department of physical medicine and rehabilitation opened at Rhode IslandHospitalduringthefiscalyearendedSeptember30,2019.

TheLifespanCancerInstituteopenedtheSickleCellMultidisciplinaryClinicatRIHduringthefiscalyearendedSeptember30,2018.Theclinicgivespatientsamedicalhome,helpingtoreduceEmergencyDepartmentvisitsandinpatientadmissions.

InMay2018,ateamofphysiciansandnursesatHCHperformedalife‐changingspinabifidarepaironafetusinhismother’swomb,thefirstprocedureofitskindconductedinRhodeIsland.

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IBMWatsonHealthincludedRIHonthelistof50TopCardiovascularHospitalsforboth2018and2019,thefifthtimeRIHhasreceivedthedistinction.

Healthgrades, an online resource for information about physicians and hospitalsacross the nation, honored RIH and TMH as recipients of the 2018DistinguishedHospitalAwardforClinicalExcellence,joining248otherhospitalsacrossthecountry.

RIH,TMH,andNHwererecognizedfortheirexcellenceinstrokecare.TheAmericanHeart Association/American Stroke Association honored all three hospitals asrecipientsof its “GetWithTheGuidelines”StrokeAchievementAward,alongwithadditionaldistinctions.

NotableachievementsinresearchduringthereportingperiodsrepresentingthefiscalyearsendedSeptember30,2017throughSeptember30,2019include14,15:

ResearchersatRIHandTMHwereawardeda$9.4millionfederalgranttoexplorenew treatments to combat antibiotic‐resistant bacteria, an urgent public healthconcern. The National Institutes of Health (NIH) grant established a Center ofBiomedicalResearchExcellencecalledtheCenterforAntimicrobialResistanceandTherapeuticDiscovery.

AresearchteamatHCHreceiveda$1.8milliongrantfromNIHtostudytheeffectsofenvironmentalexposuresonthehealthanddevelopmentofchildren.

RIHreceivedan$8.8milliongrantfromtheNationalHeart,Lung,andBloodInstitutetodevelopacommunity‐basedpediatricasthmacareprogram.

ThePediatricAnxietyResearchCenter at theBradley/HasbroChildren’sResearchCenterreceiveda$3.4millionawardfromthePatientCenteredOutcomesResearchInstitute to compare patient‐centered (in‐home) and provider‐centered (in‐office)outpatienttreatmentforchildrenwithanxietyandobsessive‐compulsivedisorder.

HCHphysicianMarkZonfrillo,MD,helpedauthorastudythatexaminedtherisingcostofnon‐fatalinjuriesintheUnitedStates—estimatedat$1.9trillionin2013.Thestudyrecommendsriskfactorsthatshouldbeaddressedtoreducetheseinjuries.

LeadersofLifespanandtheLifespanCardiovascularInstitutesignedanagreementwith a delegation from Huazhong University of Science and Technology’s TongjiMedical College and Union Hospital in Wuhan, China. The pact establishes anexchange program centered on cardiovascular research, cardiology,echocardiography,andcardiovascularsurgery.

Notable achievements in safety, quality, and patient‐centered care during the reportingperiodsrepresentingfiscalyearsendedSeptember30,2017throughSeptember30,2019include16,17:

TheHCHMedicinePediatricClinicandthePediatricPrimaryCareClinicreceivedaPatient‐CenteredMedicalHomedesignationfromtheNationalCommitteeforQualityAssuranceduringthefiscalyearendedSeptember30,2017.

TheHCHpediatricintensivecareunitearnedtheSilverBeaconAwardforExcellencefromtheAmericanAssociationofCriticalCareNursesduringthefiscalyearended

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September30,2017,oneofonlysixteenpediatricintensivecareunitsinthecountrytoberecognized.

Forthesecondtime,Lifespan’sfourhospitals:RIH,TMH,EPBH,andNH,achievedTopPerformerstatuson theHealthcareEquality Index(HEI),anationalbenchmarkofhospitals’policiesandpracticesrelatedtoequitableandinclusivetreatmentoftheirLGBTQpatients,visitors,andemployees.

ThethreeeligibleLifespanaffiliates—RIH,TMH,andNH—wereamongfewerthan1,000hospitalsnationwideawardedanAintheLeapfrogHospitalSafetyGradesinOctober 2017 and April 2018. Further, the Leapfrog Group namedRIH as a “TopHospital”,oneof115nationwide.

ThenursesintheCardiothoracicIntensiveCareunitatRIHwererecognizedfortheirexcellence in care and outcomes. The unit received the Silver Beacon designationfromtheAmericanAssociationofCritical‐CareNursesforthethirdtime.

NotablecommunityinvestmentsduringthereportingperiodsrepresentingfiscalyearsendedSeptember30,2017throughSeptember30,2019include18,19:

TheheartwarmingGoodNightLightsritualatHCHmarkeditsthirdanniversaryinDecember2017.NBC’s “TheTODAYShow”andCheerioshonored itscreator,HCHvolunteer Steve Brosnihan, with a Goodness Grant and sent a camera crew todocumentthetradition.

LifespanandTuftsHealthPlanwerefoundingsponsorsofJUMPProvidence,bringingthefirstbike‐shareprogramtoProvidence.

DuringtheannualSeasonofGiving,initiativessuchasfoodandtoydrives,collectionsofwarmouterwear,andgingerbreadhousekitsaleswereorganizedtobrightentheholidaysforRIHneighborsinneed.AnewcollaborationwithOceanStateJobLotinNovember2018yielded50,000poundsoffoodtosupplylocalfoodpantries.

At thebeginningof2018,LCHIexpanded itsConnect forHealthprogramtoservepatientsofRIH’sCenterforPrimaryCareinadditiontopatientsandfamiliesoftheprimarycareclinicatHCH.Theprogramscreenspatients forhealth‐relatedsocialneedsandlinkspatientstothebasicresourcestheyneedtobehealthy.

The Cranston Police Department and the Lawrence A. Aubin, Sr. Child ProtectionCenteratHCHcollaboratedduring the fiscalyearendedSeptember30,2018onacaninecomforttherapyprogramthatisbelievedtobethefirstofitskindinthenation.AnAustralian labradoodlepuppyhelps foster trust in childrenwhoarevictimsofmaltreatment,includingsexualandphysicalabuse.

Duringthesummerof2018,CampDotty,heldonthegroundsofHCH,markedtwentyyears of giving children battling cancer and their siblings the chance to enjoy atraditionalsummercampexperience.CampDottyisfundedbyTheTomorrowFund,anunaffiliatednot‐for‐profitorganization.

DuringthefiscalyearendedSeptember30,2018,RIHbeganparticipatinginProjectSearch,a trainingprogramforpeoplewithdevelopmentaldisabilitieswhichhelpsthempreparetobecomeemployed.UnliketheyouthprogramsatTMHandNH,RIHworkswithadultswhoseagesarebetween21to30.

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II. Rhode Island Hospital – Defining the Community It Serves RIHservespatientsfromthroughoutRhodeIslandandSoutheasternMassachusetts.AbouthalfofRIH’spatientscomefromProvidenceCounty.DuringthefiscalyearendedSeptember30, 2018, 28.6% of RIH patients were from the city of Providence, 12.5% were fromneighboringCranston,and6.8%and5.5%werefromPawtucketandWarwick,respectively.SeeAppendixA.20BecauseRIHishometotheState’sonlyLevelITraumaCenterandoffersmanyspecialtyservices,itattractspatientsfromallovertheregion.RIHislocatedinProvidenceCounty,homeofover636,000residentscovering410squaremiles,andthemostdenselypopulatedcountyinRhodeIsland.ThepopulationofProvidenceCountyisraciallyandethnicallydiverse,andisslightlyyounger,onaverage,thantherestoftheState.21

Table 3‐ Demographics estimates, July 1, 201822 Providence City Providence County Rhode Island

Population estimates 179,335 636,084 1,057,315

% below 18 years of age 22.6% 20.5% 19.4%

% 65 and older 9.6% 15.3% 17.2%

% Non‐Hispanic African American 15.6% 12.3% 8.4%

% American Indian and Alaskan Native 1.3% 1.4% 1.1%

% Asian 6.2% 4.5% 3.6%

% Native Hawaiian/Other Pacific Islander 0.2% 0.3% 0.2%

% Hispanic 42.0% 23.4% 15.9%

% Non‐Hispanic white 34.3% 60.9% 72.0% % Language other than English spoken at home* 49.5% 31.1% 22.0%

% Females 51.8% 51.3% 51.4%

Median household income* $40,366 $52,530 $61,043

% Persons in poverty 26.9% 14.7% 11.6%

Persons per square mile** 9,676.2 1,530.3 1,018.1

% Persons without health insurance 12.5% 6.6% 5.5% *2013‐2017 estimates, **2010

ThemedianhouseholdincomewithinProvidenceCountyis$52,530and14.7%ofresidentsarelivinginpoverty.Morethan18%ofresidentsareforeignborn,and31.1%offamiliesspeakalanguageotherthanEnglishathome.Almost84%ofProvidenceCountyresidentsare high school graduates, and more than 64% of people are active in the workforce.AccordingtotheU.S.Census,6.6%ofresidentsareuninsured.23Thedemographicsof the cityofProvidencediffer from theCounty,withalmost twiceasmany city residents living in poverty. The city population is also made up of a higherproportion of AfricanAmerican (15.6% vs. 12.3%), Asian (6.2% vs. 4.5%), andHispanic(42.0% vs. 23.4%) residents. The median household income in the city ($40,366) issignificantlylowerthanthecountyandstatemedian.Asof2018estimates,therearealmosttwiceasmanyresidentswhoareuninsuredinthecityofProvidencewhencompared to

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Providence County, and more than 2.5 times as many uninsured than the statewidepercentage.24These factors are important to considerwhenplanning for theRIHpatientpopulation. DuringthefiscalyearendedSeptember30,2018,RIHhad31,714adultinpatientdischargesand4,813pediatricinpatientdischarges.AlsointhefiscalyearendedSeptember30,2018,therewere155,157adultoutpatientencounters,81,047pediatricoutpatientencounters,72,250adultemergencydepartment(ED)encounters,and49,756pediatricEDencounters.25Cardiachealth isa significanthealthneed that impactsa largeportionof thecommunityserved by RIH. RIH has handled over 63,000 cardiac encounters and 1,600 cases ofcongestive heart failure during each of the three fiscal‐years covering October 1, 2016throughSeptember30,2019.In2018,85%ofadultandpediatricpatientsatRIHspokeEnglishastheirprimarylanguage,withahigherproportionof inpatientsanda lowerproportionof emergencydepartmentpatients identifying English as their language spoken. The othermost frequently spokenlanguages were Spanish (11%) and Portuguese (1%), followed by Khmer (<1%), CapeVerdeanCreole(<1%),andArabic(<1%)inthefiscalyearendedSeptember30,2018.26 Nineteen percent of the adult and 33% of the pediatric patient population identified asHispanicorLatino.OfthosewhodidnotidentifyasHispanicorLatino,83%identifiedtheirraceasWhiteorCaucasian,11%asBlackorAfricanAmericanand1%asAsian.Table4shows the racial and ethnic breakdown of the patient population in fiscal year endedSeptember30,2018.

III. Update on 2016 CHNA Implementation Strategy RIHconducteditsCHNAdatedSeptember30,2016andtheCHNAimplementationstrategycovering theperiodofOctober1, 2016 throughSeptember30,2019.TheSeptember30,2016CHNA findings reflected significant community input garnered through communityforums,surveysandkeyinformantinterviews.Inaddition,RIHreviewedhospitalutilizationdata and public health trends to inform its selection of implementation priorities.28The

Table 4‐ RIH Patient Population Race27 Total Percent

Hispanic or Latino 68,843 22.7%

White or Caucasian 199,831 66.0%

Black or African American 33,697 11.1%

Asian 4,155 1.4%

American Indian or Alaska Native 404 0.1%

Native Hawaiian or Other Pacific Islander 545 0.2%

Two or More Races 1,340 0.4%

Other/Unknown/Refused 62,965 20.8%

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September 30, 2016CHNA and implementation strategywere distributedwidely amongLifespanstakeholders,communitypartners,andthegeneralpublic.AccesstoCareandHealthLiteracyBelowareactionsRIHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificantneedofaccesstocareandhealthliteracy:

A. Expandaccess tohigh‐qualityprimarycare inpartnershipwithLPGandMetacomMedicalAssociates (MetacomMedical).MetacomMedical plans to establishNCQAPatient‐CenteredMedicalHomequalitystandardsandtoexpandthepracticeintheverynearfuturetomeetthedemandforprimarycare. LPGMetacomMedicalestablishedaPatientCenteredMedicalHome(NCQALevel

3) inMarch2018. Prior to joiningLifespan, thispracticehadachieved level2PCMHstatusin2015butwiththeinfrastructureandsupportofLPG,thispracticewasabletoachieveahigherlevelofdistinction.

PatientswithchronicdiseasessuchasdiabetesandhypertensionhavebenefitedmostbyhavingareadilyavailablePCMHPCPofficewherepatientsaretrackedcloselybyaphysician,nursecaremanager,andpharmacisttoensurethatstaffareadequately controlling their patient’s illnesses. The PCMH guidelines create aframework for managing these patient populations and streamliningworkflows. Inaddition,havingtheabilitytogeneratereliablereportsfromtheelectronicmedicalrecordallowsthepracticetomanagethesediseasestatesinpartnershipwiththephysician.

LPGMetacomMedicalcurrentlyhasover3,000activepatientsinitsprimarycarepractice,aswellasawalk‐inmedicalcenteratthepracticethatservesourpatientpanelandcommunitypatients.Approximatelythirtyprimarycarepatientsareseeneachdayalongwithtwelvetofifteenpatientsatthewalk‐inarea.Afull‐timephysicianwasaddedtothispracticeduringthefiscalyearendedSeptember30,2019 to assist in expanding access to primary care services for the RIHcommunity.

B. Continuecommunity‐basedbiometricscreeningsandfluclinicsforlow‐incomeand

uninsuredresidentsinpartnershipwithLCHItopromoteprimarypreventionwithappropriatereferralstotreatment. Bloodpressurescreenings:FY ‘2017‐(15events,208screened),FY ‘2018‐(26

events,445screened),FY‘2019throughJuly2019‐(39events,580screened); Glucosescreenings:FY‘2017‐(8events,273screened),FY‘2018‐(20events,432

screened),FY‘2019throughJuly2019‐(26events,335screened);and Flu clinics: FY ‘2017‐ (34 clinics, 684 vaccinated), FY ‘2018‐ (45 clinics, 792

vaccinated),FY‘2019throughJuly2019‐(33clinics,647vaccinated).

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C. Continue toprovideoralhealthscreenings tochildren inRhode IslandHeadStart

programs. Partnered with Children’s Friend program, (a Head Start and Pre‐Head Start

program) a relationship in place since 2014. Also provided dental hygiene(cleaningsandfluoride)toallthechildrenscreened,unlessaparentorguardianrefusedthetreatment;

505screeningsduringthefiscalyearendedSeptember30,2018byRIH’sSamuelsSinclairDentalCenter.TheCenterexpectstoperformasimilarnumberinfiscalyear2019.

D. GrowRIH’scollaborationwiththeProvidenceCommunityHealthCenter(PCHC)in

sharingpreventionprogramsacrosspatientpanels.

E. Continuetoimprovetheexistinginterpreterandtranslationservicestobettermeet

theneedsofpatients. Interpreter Services at RIH were reorganized during the fiscal year ended

September30,2019underasystemleadershiprestructuringtoexpediteeffortstostandardizeinterpreterservicepracticesandimproveefficiencyindeliveringinterpretationservicestopatientsandfamiliesacrossLifespan.

Arevisedpolicyoninterpreterservicesforthedeafandhardofhearingwasalsoissued during the fiscal year ended September 30, 2019. The revisions aredesignedtoimprovetimelyaccesstointerpretersandpatientsatisfaction.

F. Strategically expand the reach of the Healthwise health literacy program to

correctional facilities,adultdaycenters, low‐incomeresidentialhousing,andadultlearningcenters. Healthwisewasofferedat seniorcenters,adultdaycenters,anadulteducation

centerandothercommunityagenciesinlow‐incomeareaso thirteenclasses,168participantsduringthefiscalyearendedSeptember

30,2017o twentyclasses,237participantsduringthe fiscalyearendedSeptember

30,2018 RIH did not deliver Healthwise in correctional facilities but did open the

Providence Transitions Clinic at its Center for Primary Care, which providesprimarycareandpatientnavigationforpeoplewhohaverecentlybeenreleasedfromincarceration.

LCHI offered the CDC‐approvedDiabetes Prevention Program (DPP) to PCHCpatients; PCHC providers helped refer into the program. In August 2019, theLCHIpartneredwithPCHC to launchaDPP cohort inSpanish, exclusively forPCHC patients, and held at one of the PCHC clinic sites; twenty‐one patientsenrolled.

LCHI collaborated with PCHC to deliver a week‐long introduction to LCHI’seducationandskill‐buildingprogramsatPCHC’slargestclinicsitein2018.

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G. Continue to provide free lectures at community sites such as community centers,churches,andschoolsontopicsrelatedtohealthaccessandhealthliteracy. The LCHI teaches skill‐building educational courses and facilitates training

delivered by non‐profit partners across the RIH service area, on behalf of theHospital. Healthwise:FY2017‐(13classes,168participants),FY2018‐(20classes,237

students); FinancialLiteracy:FY‘2017‐(2classes,16students),FY‘2018‐(7classes,218

students),FY‘2019throughJuly2019‐(3classes,412students); FoodisMedicine:FY‘2017‐(2classes,10students),FY‘2018‐(4classes,42

students),FY‘2019throughJuly2019‐(9classes,74students); Fooddemonstrations:FY‘2017‐(34events,664participants),FY‘2018‐(23

events, 431 participants), FY ‘2019 through July 2019‐ (2 events, 20participants);

SafeSitter:(31classes,277students),FY‘2018‐(38classes,325students),FY‘2019throughJuly2019‐(17classes,186students);and

Community health lectures: FY ‘2017‐ (23 lectures, 1,048 participants), FY‘2018‐(8lectures,96participants),FY‘2019throughJuly2019‐(30lectures,737participants).

H. Continuetoeducatethecommunityonhospitalcharitycareandfinancialassistancepoliciesandprocedures,sothatthoseinneedreceivequalitymedicalcareregardlessoftheirabilitytopay. The manager of the Lifespan Patient Financial Services (PFS) department

deliveredafreeworkshoponSeptember12,2017whichwasopentocommunityresidents and community‐based organization representatives. The workshopprovidedanoverviewofthePFSdepartment,self‐paymetrics,anexplanationoftheself‐payprocess,anexplanationof thedifferencesbetweencommunity freecareandcharitycareasadministeredbyLifespan,assistanceavailablethroughtheLifespanwebsite, frequentlyaskedquestions,general informationon insuranceconcepts,andresourcesavailablethroughinsurers’websites.

I. Establishan ‘Ask theDoctor’panel to incorporatequarterlyat communityevents,

focusedonaddressingissuesofaccesstocareandhealthliteracy. In lieu of organizing quarterly ‘Ask theDoctor’ panels, a Lifespan internist, Dr.

MarkPaulos, launched theWalkwithaDocwalkingprogram.WalkwithaDocprovidesanopportunityforthegeneralpublictowalkattheirownpaceandhavetheirquestionsansweredbya localphysician.Thegoal is topromotehealthierlifestylesandimprovegeneralhealth.Dr.PauloslaunchedthiswithaninformationsessionatRIH inMay2019;walksbeginatapark inProvidenceandgenerallyoccurtwiceamonthonSaturdaymornings.

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J. DuringthefiscalyearendedSeptember30,2017,HCHopenedaclinicaldecisionunitadjacenttoitsEmergencyDepartmentforpatientslikelytorequirestaysoflessthan24hours,reducingthewaittimesinthepediatricEmergencyDepartment(ED).

TheShortStay/ClinicalDecisionUnitatHCHhasservedapproximately1,300childrenandfamiliesduringthefiscalyearendingSeptember30,2019.

BenefitsoftheUnitinclude:o The elimination of transition/handoffs ensures better continuity of

care and treatment as it eliminates the involvement of an inpatientunit.PatientsafetyandoutcomesareimprovedbecausetheproviderandnurseteamthatarecaringforthepatientintheEDalsooverseetheClinicalDecisionUnit.

o Higher levels of patient/family satisfaction are experienced in thisunit.Patientsandtheirfamiliesareinstate‐of‐the‐artdesignedroomscared for by a dedicated staff that ensures expedited facilitation ofdischarging when appropriate.Discharges are not delayed becauseprovidersareimmediatelyavailabletoinitiatethedischargeprocess,whilenursesareavailabletoprovidedischargeinstructionsinatimelymanner.

o Duringperiodsofhigherpatientvolume,patientswhorequireahigherlevel of care on an inpatient basis have a bed available becauseobservationpatientsarenotadmittedintotheUnit.

HealthyWeightandNutritionBelowareactionsRIHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificanthealthneedofhealthyweightandnutrition:

A. Continue to offer services to adolescents and promote participation in the HCHAdolescent Weight Management Program services. This multidisciplinary teamworkstogethertohelpadolescentsandfamiliesdevelophealthierlifestylesandgaincontrolovertheirweight.Treatmentservicesincludegrouporindividualsessionsonbalanceddietandhealthylifestyle,aswellasmaintenanceandfollowupsupporttokeephealthyhabits. InJune2019,aphysicianfromHCHpiloteda7‐weekSummerSHiNEProgram‐

SummerHEALTHinNutritionandExerciseforadolescentsinherHealthyEatingActive Living Through Hasbro! Program. The program served thirty youthsthroughagroup‐basededucation,exerciseandcookingclassforkidswithweightchallenges.Thephysicianalsomeasuredparents’changesinknowledgethroughapre/post‐test.

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B. Increasethenumberofparticipantsin“FoodisMedicine”classesandbeginofferingclassesinSpanish. TheLCHIbuiltoutademonstrationkitchen in itsoffice thatallowsforhealthy

cookingclasses.ThekitchenwascompletedinJune2017. Food isMedicine is a 4‐week program developed by a research dietician that

teaches residents how to implement a plant based diet through a fun cookingprogramfeaturingextravirginoliveoil,wholegrainandlegumes.Theevidence‐basedprogramteacheshealthyeatingonabudget;theaveragecostperservingis$1.26.LCHIdeliversthisprogramatitsofficeusingitsdemonstrationkitchen.

i. TwoFoodisMedicineclassesfortenindividualsduringthefiscalyearendedSeptember30,2017;

ii. FourFoodisMedicineclassesforforty‐twoindividualsduringthefiscalyearendedSeptember30,2018;

iii. NineFoodisMedicineclassesforseventy‐fourindividualsthruJulyofthefiscalyearendedSeptember30,2019.

LCHI also conducted cooking demonstrations with nutrition education atcommunitylocations,attherequestofcommunitypartners.

i. Twenty‐nine cookingdemonstrations for 501 individuals during thefiscalyearendedSeptember30,2017;

ii. Twenty‐sevencookingdemonstrationsfor451participantsduringthefiscalyearendedSeptember30,2018;

iii. Twocookingdemonstrationsfor20participantsthruJulyofthefiscalyearendedSeptember30,2019.

C. Continuetoprovidefreecommunitylecturesonnutritionandhealthyweight.

“MindfulnessInterventionsforBloodPressure”,November14,2017; “ThePowerofaPlantBasedDiet”,May8,2018; “HungerisaHealthcareIssue”,October9,2018.

D. Considerinstitutingaquarterly‘AsktheTrainer’programattheGerryHouseexercise

facilitiesontheRIHcampus,focusedonaddressingquestionsaboutphysicalactivityrecommendationsandhealthpromotingbehaviors. PeoplecanjointheYMCAandaccessthegymatGerryHouseonthe5thfloorona

dailybasis; TrainersareavailableforconsultationatGerryHouse; YMCAstaffwillmeasurebodymassindexuponrequest.

E. Explorethefeasibilityofdevelopingacommunitygarden.

HCHopenedacommunitygardencalledtheRainbowGardenthatteacheskidstoeatproducethatreflectsthecolorsoftherainbow.Thegardenismaintainedbya pediatrician and patients. The doctors use the produce to teach kids abouthealthyeating.

AdelegationfromLifespanmadeahalf‐daysitevisittotheBostonMedicalCenterto view and learn about their rooftop garden and food pantry, to inform thefeasibilityassessmentofsomethingsimilaronaLifespanaffiliatecampus.

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F. JointheRIHealthcareLocalFoodChallenge,whichencouragesRhodeIslandhospitals

andhealthcenterstopurchaseandprovidelocalsourced,healthyfoodoptionsalongwithconsumereducationintheircafeterias. Basedonunforeseen foodsafetyrequirementsencounteredwhiledetermining

how to implement this typeofprogram inahospital setting,variousobstaclespreventedRIHfrommovingforwardwiththisinitiative.

G. Begin offering the Center for Disease Prevention and Control’s proven effective

DiabetesPreventionProgram,which teachespeopleatriskofdevelopingdiabeteshowtopreventtheconditionthroughdietandexercise. LCHIbecameaCDC‐certifiedDPPproviderandlaunchedthreeyear‐longcohorts

duringthefiscalyearendedSeptember30,2018andonecohortduringthefiscalyearendedSeptember30,2019.

AlsoduringthefiscalyearendedSeptember30,2019.,theLCHIachieved“full”recognition fromtheCDC for itsprovisionof theNationalDiabetesPreventionProgram.

SubstanceUseDisorders

BelowareactionsRIHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificantneedofsubstanceusedisorders:

A. Increase the proportion of people assessed and treated in the RIH emergencydepartmentforasubstanceuserelateddisorder. RIHwas certified as a Level One Trauma Center for Rhode Island Emergency

DepartmentsandHospitalsforTreatingOverdoseandOpioidUseDisorder. RIH offers access to a Certified Peer Recovery specialist in its emergency

department24hoursaday,sevendaysaweek.Additionally,patientshavetheoption of receiving a social work consult to determine clinical needs and linkpatientstotheappropriatetreatmentsetting.

There were 302 hospital contacts in fiscal year ended September 30, 2018resultingin112overdosepatientswhoreceivedpeerrecoverycoachingatRIH.Additionally,patientshavetheoptionofreceivingasocialworkconsultationtodetermineclinicalneedsandlinkpatientstotheappropriatetreatmentsetting.

Significant efforts have been made towards increasing the number of DrugAddiction Treatment Act (DATA)‐waivered physicians in the RIH emergencydepartment,withanemphasisoninitiatingbuprenorphineintheEDsettingwithlinkagetocarefollowingdischarge.

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B. Increase identification and treatment of patients with a substance use disorderduringmedicalinpatientadmissions. RIH Substance Use Consultation Liaison Service recently hired an internal

addictionmedicine physician to provide consult and treatment for individualswithsubstanceusedisordersthatareadmittedtoinpatientmedicine.

Thishasresultedingreateridentification,treatmentinitiation,andlinkagetocareforthisvulnerablepopulation.

C. Asa teachinghospital,RIHwill trainresidents tobecomeapprovedprescribersof

medication‐assistedtreatment,e.g.buprenorphine. InJune2017,RIHopenedafree‐standingRecoveryCenterinProvidenceanda

RecoveryClinic in its Center for PrimaryCare for patientswith substanceusedisorder.Ateachofthesesites,residentsarebeingtrainedtotreatsubstanceusedisorderwithmedication‐assistedtreatment.

D. Continuetoprovidefreecommunitylecturesandconferences,likeParentingMatters

andTemasFamiliares,on topicsrelated tosubstanceabuseprevention, treatment,andmentalhealth. ParentingMattersWorkshoponOctober19,2017,123participants; TemasFamiliaresConferenceonNovember4,2017,42participants; ParentingMattersWorkshoponNovember9,2017,50participants; “UnderstandingtheOpioidEpidemicinRI:TreatmentChallengesandStrategies”

communitylectureonFebruary3,2018; ParentingMattersConferenceonMarch24,2018,240participants; ParentingMattersConferenceinMarch23,2019,196participants; TemasFamiliaresWorkshoponMay4,2019,42participants; “WorkingwithGrievingChildren,TeensandFamilies”communitylectureonJune

11,2019; “CulturalConsiderationswhenWorkingwiththeLatinxPopulation”community

lectureonJuly9,2019.

E. EstablishaCenterofExcellencefortheTreatmentofOpioidUseDisordertoworkincoordinationwiththeRIHemergencydepartment,sothatindividualswillbeabletoreceive initial assessment/initiationof buprenorphine/naloxone in the emergencydepartment,andbeconnectedtoacomprehensivetreatmentprogram. RIH opened the Lifespan Recovery Center (LRC) in June 2017 as a

multidisciplinary, evidence‐based program for the treatment of substance usedisorders,withaspecializationinopioidusedisorder

LRCoffersrapidaccesstotreatmentsuchthatpatientsareadmittedtotreatmentwithin48hoursofcontactingthecenter

LRCprovidescomprehensivetreatmenttoaddressclinicalandsocialneedsofthispopulation,includingcarecoordination/casemanagement,psychotherapy,peerrecovery, family education/support, physical exams, and medicationmanagement

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192peopleweretreatedintheprogramin2017.In2019,561peoplehavebeentreatedintheprogramforeitheranopioidusedisorderoranothersubstanceusedisorder.

F. BeginofferingMentalHealthFirstAidtothegeneralpublicandfirstrespondersin

theRIHservicearea.Behavioralhealthandmentalhealthdisordersoftenco‐occur,soitisimportanttoaddressmentalhealthconcernsasapreventativetechniquewithbehavioral health disorders like substance abuse. Mental Health First Aid is aninnovativeeight‐hourcoursethattrainspeopletorecognizethesignsandsymptomsofcommonmentalhealthdisorders,toprovideimmediateinitialon‐sitehelp,andtoguideindividualstowardappropriateprofessionalassistance. MentalHealthFirstAid(MHFA)consistentlyexpandedthecoursesofferedand

participantsservedduringthereportingperiod.Classesincreasedfromtwenty‐one(302participants)duringthefiscalyearendedSeptember30,2017,tothirty‐three (511participants)during the fiscalyearendedSeptember30,2018,andthendoubledtosixty‐sixclasses(1,062participants)beingheldduringthefiscalyearendedSeptember30,2019.

CardiacHealth

BelowareactionsRIHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificantneedofcardiachealth:

A. LCHI,inconjunctionwithRIH,continuedtoprovidefreebloodpressurescreeningforlowincomeanduninsuredresidents,withappropriatereferralstotreatment. Bloodpressurescreenings:FY ‘2017‐(15events,208screened),FY ‘2018‐(26

events,445screened),FY‘2019throughJuly2019‐(39events,580screened);

B. LCHI,inconjunctionwithRIH,continuedproviding“WorkingHealthy”lecturesthatfocusoncardiachealth. WorkingHealthycontinuedtooffereducationalprogramsaspartofLifespan’s

employeebenefitprogram

C. LCHI,inconjunctionwithRIH,continuedcontinuedtoprovidecommunity‐basedCPR(bothcertifiedandnon‐certified)andAEDtrainingthroughtheCommunityTrainingCenterattheLCHI. CertifiedCPRcourses:FY‘2017‐(84courses,734participants),FY‘2018‐(107

courses, 886 participants), FY ‘2019 through July 2019‐ (97 courses, 705participants);and

Non‐certifiedCPRcourses:FY‘2017‐(23courses,331participants),FY‘2018‐(29courses, 381 participants), FY ‘2019 through July 2019‐ (18 courses, 278participants).

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D. LCHI, in conjunction with RIH, continued to provide free community lectures ontopicsrelatedtocardiachealth. “MindfulnessInterventionsforBloodPressure”,November14,2017; “ThePowerofaPlantBasedDiet”,May8,2018; “HungerisaHealthcareIssue”,October9,2018.

E. ContinuetoprovideservicesthroughtheComprehensiveStrokeCenter(CSC)atRIH.

The award‐winning center cares for over 1,100 patients with stroke or transientischemicattack(TIA)annually.Servicesincludeadedicatedten‐bedinpatientunit,anemergencydepartmentwithadedicatedTIAunit,aneurological intensivecareunit,radiosurgeryandinterventionalneuroradiology,inpatientrehabilitation,andastrokesupportgroup. TheCSC,theonlystrokecenterwithinfortymilesofProvidence,RhodeIsland,is

comprisedoftwentycorephysicianswhomakeupthemultidisciplinarystrokecenterandsixancillary(fourAdvancedPracticeRegisteredNurses(APRN)andone Administrative Assistant) staff. In addition, the CSC includes EmergencyDepartmentstaff,vascularneurologists,interventionalneuro‐radiologists,neuro‐surgeons, neuro‐critical care physicians, vascular surgeons, rehabilitationphysiatrists, PT/OT and speech‐language pathology professionals,speciallytrained stroke nurses on a twenty‐one bed stroke unit, neuro‐critical trainednursesonaneighteenbedNeurologicalCriticalCareUnit (NCCU),nursesonageneral neuroscience unit,and thirty‐seven advanced practice providers whospecialize in neuro‐interventional radiology, stroke neurology, NCCU, andneurosurgery.

NotableachievementsoftheCSCincludebeingRhodeIsland’sfirstandonlyJointCommissioncertifiedComprehensiveStrokeCenter,earningthe2019“GetWiththeGuidelines(GWTG)StrokeGoldPluswithTarget:StrokeHonorRollElitePlus”award,whichrecognizesanaggressivegoalof85%orhighercomplianceincorestandard levels of care as outlined by the American Heart Association andAmericanStrokeAssociationfortwoconsecutivecalendaryearsandadditionally75% compliance in seven out of ten qualitymeasures during a twelvemonthperiod.

TheCSCoffersanewstate‐of‐the‐artVascularInterventionalRadiologysuiteintheEmergencyDepartment,thefirst(andonly)oneinthecountry.

Servicesprovidedby theCSCUnit shouldhelp reducearrival to skinpuncturetimeswhichhaveacriticalimpactonapatient’shealthoutcomes.Researchhasshown that patients who receive mechanical thrombectomy have improvedfunctionalindependenceandreduceddisabilitywhencomparedtothosewhodidnotreceivethisacutestroketreatment.RIHisthefirststrokecentertoproducereal world data demonstrating improved survival with field triage of suspectemergentlargevesselocclusion(ELVO)patientsdirectlytoCSC.

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Cancer

BelowareactionsRIHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificantneedofcancer:

A. ContinuetoprovidepreventativescreeningslikeSee,Test&TreatandSunSmartsforcancersinpartnershipwithLCHI. FiscalyearendedSeptember30,2017SkinCheck(skincancer)screenings:eight

events,509screened; FiscalyearendedSeptember30,2018SkinCheck(skincancer)screenings:nine

events,630screened; Fiscal year ended September 30, 2018 Colon cancer screening: two events,

twenty‐onescreened; FiscalyearendingSeptember30,2019SkinCheck(skincancer)screenings:seven

events,515screened.

B. Continuetoprovidecommunity‐basededucationpro‐gramslikeAvenuesofHealing,tobaccocessationpro‐grams,KickButtsDay,andCancerSurvivorsDayevents. AvenuesofHealingbreastcancerconferencewasdeliveredonOctober21,2017

with124attendees; AvenuesofHealingbreastcancerconferencewasdeliveredonOctober13,2018

with225attendees; Cancer Survivors Day event was held Sunday, September 17, 2017 with 287

participants; Cancer Survivors Day event was held Sunday, September 23, 2018 with 239

participants; Cancer Survivors Day event was held Sunday, September 22, 2019 with 259

participants; FiscalyearendedSeptember30,2017TarWarseducationalsession:oneevent,

eighty‐sixstudents; FiscalyearendedSeptember30,2018TarWarseducationalsessions:twoevents,

eighty‐threestudents; “BreastCancerandAfrican‐AmericanWomen”communitylectureonNovember

1,2016; “80% by 2018 & Beyond” community lecture on colorectal cancer screening

optionsJanuary9,2018; “CTScreeningforLungCancer:HowtoSaveLivesandStopCigaretteSmokingin

RhodeIsland”communitylectureonFebruary12,2019; “Preventable. Treatable. Beatable: Reduce your risk for colorectal cancer”

communitylectureonMarch12,2019.

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C. Improve patient access, patient experience, and communications, includingestablishingaTelephoneTriageCentertoserveas“one‐stopshopping”formedicaloncologyandinfusionpatients. Asinglepointof entryLifespanCancer Institute (LCI) telephone responseand

triagelinewasestablishedduringthefiscalyearendedSeptember30,2017andcontinued throughout the fiscal year ended September 30, 2019, improvingresponsetimesandpatientsatisfactionwithrespecttoaccessingtheironcologyproviders

D. ExpandhoursforOncologyMedicalHome(infusionandsymptommanagement)at

RIH. Facility now offers Saturday hours at RIH (8 am‐2 pm) and will be further

expandinghoursduringthefiscalyearendedSeptember30,2019to8am‐4:30pm.

EastGreenwichsite(underRIHlicense)withnewlyexpandedFridayhours.Thefacility now operatesMonday‐Thursday from 7:30 am‐6:00 pm and on Fridayfrom7:30am‐2:00pm.

Radiation oncologyhas started to providehydration topatients (this is a newserviceinradiationoncology)torespondtosymptommanagementandstandardofcare.

Dr. Dizon, Director of Women's Cancers, LCI, Clinical Director, GynecologicMedicalOncology,andDirectorofMedicalOncologyatRIHreceivedagrantforaprogram called SIMPRO (NCI moonshot initiative‐ Symptom ManagementImplementation of Patient Reported Outcomes) that will unfold over the nextseveralyears.

E. Expandthereachofpsychosocialcare,palliativecare,andsurvivorshipprograms.

In response to demand, added additional hours for social work at the EastGreenwichsite(referencedinD,above).

LCInowhasa full‐timeNursePractitionerwho functionsas theprogrammaticpointperson forsurvivorship.Sheworkswithadvancedpracticeprofessionalsacross the system to ensure we are providing survivorship care plans to allpatientswhorequirecareplans

F. Strengthendisease site expertise through recruitmentand retentionofphysicians

and work with Lifespan Research Department to increase recruitment ofunderservedpopulationstoresearchtrials. On March 21, 2017, Lifespan and the Dana‐Farber Cancer Institute created a

strategic alliance to advance cancer treatment and research. The agreementsupportstheexpansionofclinicaltrials,offersaccessforLifespanphysicianstocancer‐specific disease expertise for complex cases, and creates a program tocoordinatethetreatmentofbonemarrowtransplantpatients,withtransplantsprovided in Boston at Dana‐Farber/Brigham andWomen’s Cancer Center andcare surrounding the transplant in Rhode Island at Lifespan. The two

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organizationsalsoagreed touse thesameclinical trialsmanagementplatform,resultinginbettercarecoordination.

G. Expand community partnerships to reach underserved populations and improveaccessandscreeningthroughpartnersliketheAmericanCancerSociety. PartneredwiththeAmericanCancerSocietyonmanyevents:

o AvenuesofHealing,annuallyo MakingStridesAgainstBreastCancerScreening,annuallyo SkinCheckskincancerscreenings,annuallyo Colorectal cancer awareness activities during the fiscal year ended

September30,2019o LCI’s“RisingAboveCancer”5Kwalk/runandfundraiser,annuallyo NationalCancerSurvivorsDaycelebration,annually

IV. Assessment of Health Needs of the Rhode Island Hospital Community

TheCHNAprocessinvolvedtheintegrationofinformationfromarangeofdatasourcestoidentifythesignificanthealthneedsofthecommunityservedbyRIH,prioritizethoseneeds,and identify resources, facilities and programs to address the prioritized needs. Bothqualitative primary data and secondary quantitative data were gathered to identify thesignificanthealthneedsofthecommunity.Theprimarydatasourcesincludecommunityhealthforums,keyinformantinterviews,andindividualsurveys.Secondarydatasourcesincludenationalandlocalpublicationsofstate‐specificdata.Thesesourcesvary in samplesize,methodofdatacollectionandmeasuresreported,butallarepubliclyavailablesourcesand ineachcase, themostrecentpubliclyaccessibledataispresented.Thedatasourcesaredescribedinmoredetailbelow.CommunityHealthForumsQualitativedatawascollected throughCommunityHealthForums (CHFs) to solicit inputfrom individuals representing the broad interests and perspectives of the community.ParticipantsintheCHFsincludedmembersofthemedicallyunderserved,low‐income,andminoritypopulationsintheRIHservicearea.Communityforumsareastandardqualitativesocialsciencedatacollectionmethod,usedincommunity‐basedorparticipatoryactionresearch.AccordingtoBerg,etal.,thisapproach“endorses consensual, democratic and participatory strategies to encourage people toexamine reflectively their problems or particular issues affecting them or theircommunity.”29TwelveCHFswereheldbetweenApril29andJune12,2019acrosstheRIHservicearea,with261participants.Participantswererecruitedusingsocialmedia,postedflyers,email,andwordofmouth.Locationswereselectedtobeeasilyaccessibleto thepublicandhospital

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patients,andforumswereheldatvarioustimesofthedayonweekdaysandweekends.RIHforumswereheldatcommunitycenters,placesofworship,ahighschool,ahomelessshelter,localnon‐profitagenciesandRIH.Ateachforum,amealwasprovided,alongwithchildcareandinterpretationifrequestedinadvance.AllCHFswereopentothepublicandparticipantswerefullyengagedthroughoutthe90‐minutediscussions.SeeAppendixB.ArepresentativeofRIHservedasahospitalliaisontohelpplanandfacilitatetheCHFs.ThehospitalliaisonwasacriticallinkbetweentheLCHIasthecoordinatingbody,theexpertiseandresourceswithinthehospital,andtheCommunityLiaisonsdescribedbelow.An important and unique component of the CHFs was the involvement of CommunityLiaisons. Six people representing the diverse populations served by RIHwere hired asconsultants to assist with the CHNA. These Community Liaisons helped plan the CHFs,recruitedparticipants,andco‐facilitatedtheforums.AppendixC,containsabio‐sketchforeach of the RIH Community Liaisons. All Community Liaisons were chosen through acompetitiveselectionprocessandcompletedatwo‐hourtrainingpriortoleadingtheCHFs.The training included project planning tips, role‐playing activities, conflict managementstrategies,andlogisticalexpectations.CommunityLiaisonswereresponsibleforidentifyingan accessible venue for each forum, selecting a food vendor and menu that would beappealing to the target audience, and co‐facilitating thediscussion at theCHFwith theirhospitalliaison.EachCHFwastwohoursindurationandfollowedasimilarformatthatbeganwithameal,followedbya90‐minutediscussion,co‐facilitatedbythehospitalandCommunityLiaison.Thediscussiongeneratedconsensusontheparticipants’healthconcerns,theirprioritizationofthoseconcerns,andtheirideasforhowRIHcouldrespondtothoseconcerns.DiscussionbeganwithabriefpresentationofRIH’s2016CHNAprioritiesandexamplesofactivitiesRIHhospitalhasperformed in response.Participantswere invited to share their reactions towhatwaspresentedaswellastheircurrenthealthconcerns.SeeAppendixDforasampleCHF agenda. The input gathered during the CHFs was assessed qualitatively to extractthemesandquantitativelytodeterminethefrequencywithwhichthosethemeswerecited.CommunityLiaisonsalsometwiththeLCHIandthehospitalliaisontodebrieftheforumsand offer their interpretation of the findings to ensure all input was captured and thatprioritieswereappropriatelyranked.Hiring,training,andempoweringcommunitymemberstoserveasCommunityLiaisonsintheCHNAprocessenrichedthequantityandqualityofcommunityinput.ItalsoallowedRIHtobuildrelationshipswithcommunitiesthatmightnototherwisehavebecomeawareoforengagedintheneedsassessmentprocess.IndividualSurveysTobroadenthereachofcommunityinput,surveysweredistributedandcollectedbyLCHIstaffateventstheyattendedinMayandJune2019,suchastheannualPridefestival.ThesurveysaddressedthesamequestionsastheCHFs(SeeAppendixEforthesurvey).FifteenindividualsurveyswerereceivedforRIH.

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KeyInformant InterviewsThedirectoroftheLCHIidentifiedpublichealthandhealthpolicyleaderswhocouldinformthe2019CHNAprocessandhadknowledge,informationorexpertiseaboutthecommunitythatRIHserves.Keyinformantinterviewswereconductedwithstateleaderstosupplementtheotherquantitativeandqualitativedatacollected.Keyinformantsincludethe:

• ActingChiefofStaff,ExecutiveOfficeofHealthandHumanServices,StateofRhodeIslandandPolicyDirector,RhodeIslandChildren’sCabinet

• Director of Policy, Planning, and Research, Executive Office of Health andHumanServices,StateofRhodeIsland

• Director, Health Equity Institute and Special Needs Director, Rhode IslandDepartmentofHealth

• PhysicianLead,HealthEquityInstitute,RhodeIslandDepartmentofHealthWhen crafting theRIH implementation strategy,RIH reflectedupon the key themes thatemerged fromtheseconversations.Thestatewideprioritiesandrecommendationsof thekeyinformantsincluded:incorporatehealthequitytargets;generateandmonitordataonhealthdisparities,especiallybyrace,ethnicityandincome;buildstrategiesthatincorporatethesocialdeterminantsofhealth;gobeyondindividualinterventionstofamily/householdlevel interventions; make investments in early childhood; consider co‐morbidities,especially between behavioral health and chronic diseases; confront racism and bias toimprovecare;providepersonalizedcare;besensitivetomisalignmentswithinhealthcare;andcontinuetoaddresssubstancemisuseandbehavioralhealthconditions.RIH PatientData, 2016‐2018Lifespan’s Planning Department analyzed RIH patient data on patients, discharges, andencountersdisaggregatedbytownofresidence,age,race,ethnicity,andlanguagespokenforfiscal years ended September 30, 2016 through September 30, 2018. This inpatient,outpatient and ED data is important for understanding trends in utilization of hospitalservices.TheCommonwealthFund 2019 Scorecard on StateHealth SystemPerformance –RhodeIsland,201930TheCommonwealthFundScorecardonStateHealthSystemPerformanceidentifiesplaceswhere health care policies are on track and areas that need improvement. Using theScorecard,statescancomparehowtheirperformancestacksupagainstallothers. In themostrecentedition,releasedinJune2019,RhodeIslandwasthestatethat improvedthemost on the health system performance indicators tracked over time; Rhode Islandimprovedon21indicators,worsenedonseven,andhadlittleornochangeon15.RhodeIslandparticularlymadestridesintheareasofcoverageandbehavioralhealth.Thestateuninsuredrateamongadultsdropped from17%in2013 to6% in2017. Inaddition, thepercentageofadultswithanymentalillnessreportinganunmetneeddroppedfrom27%in2010–11to18%in2014–16.Thestatealsosawsignificantreductionsinthepercentageofchildren with unmet mental health needs. The childhood overweight and obesity rateimprovedto31%(vs.36%in2016).However,theprevalenceofadultswhoareoverweightandobeseworsened(31%in2017vs.27%in2016),asdidpreventablehospitalizations

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amongadultsages65+(212.2per1,000Medicarebeneficiaries).At#41,RhodeIslandwasalsoamongthebottom‐rankedstatesfordrugpoisoningdeaths.RhodeIslandKidsCountFactbook,201931Published annually since 1995, The Rhode Island Kids Count Factbook is the primarypublicationofRhodeIslandKidsCount.TheFactbookprovidesastatisticalportraitofthestatusofRhodeIsland'schildrenandfamilies,incorporatingthebestavailableresearchanddata. Information is presented for the state of Rhode Island, each city and town, and anaggregate of the four core cities (cities in whichmore than 25% of the children live inpoverty)‐Providence,CentralFalls,PawtucketandWoonsocket.Ofnote‐threeofthefourcore cities are in the RIH primary service area. The Factbook tracks the progress of 71indicatorsacrossfiveareasofchildwellbeing:Family&Community,EconomicWellbeing,Health,Safety,andEducation.GovernorGinaRaimondo’sOverdosePreventionActionPlan32In2015,RhodeIslandGovernorGinaRaimondoissuedExecutiveOrder15‐14toestablishtheOverdosePreventionandInterventionTaskForceinresponsetothesignificanttollthattheopioidepidemicwas takingonRhode Islanders. Initially, the task force’s goalwas toreduceopioidoverdosedeathsbyone‐thirdwithinthreeyears.Thetaskforcedevelopedastrategicplanwithfourpillars‐prevention,treatment,rescueandrecovery.In2019,thetaskforceissuedanupdatetoitsstrategicplanthatretainedtheoriginalfourstrategypillarsandaddedfivenewcoreprinciplesthatbridgethepillarswhileplacingadditionalemphasisonpreventionandrecovery.Thefivecross‐cuttingpillarsare:(1)IntegratingDatatoInformCrisis Response, (2) Meeting, Engaging and Serving Diverse Communities, (3) ChangingNegativePublicAttitudesonAddictionandRecovery,(4)UniversalIncorporationofHarm‐Reduction, and (5) Confronting the Social Determinants of Health. 33 Rhode Islandexperiencedadeclineinoveralloverdosedeaths,from336in2016to314in2018.34RhodeIslandStateInnovationModel(SIM)TestGrant, 2015‐201935RhodeIslandwasselectedtoparticipateinamulti‐yearStateInnovationModel(SIM)grantintended to “improve health system performance, increase quality of care, and decreasecosts for Medicare, Medicaid and Children’s Health Insurance Program (CHIP)beneficiaries...”RhodeIslandreceiveda$20millionawardinfiscalyearendedSeptember30,2015totestitshealthcarepaymentandservicedeliveryreformmodeloverfouryears.The ultimate goal of the projectwas to achieve the “triple aim” of better care, healthierpeople,andsmarterspending,throughavalue‐basedcarelens.GovernedbyaninteragencyteamandasteeringcommitteeonwhichLifespanwasrepresented,theRhodeIslandSIMprojectdevelopedatheoryofchangethatfocusesmoreonvalueandlessonvolume:IfRhodeIslandSIMmakesinvestmentstosupportprovidersandempowerpatientstoadapttothesechanges,andweaddressthesocialandenvironmentaldeterminantsofhealth,thenwewillimproveourpopulationhealthandmovetowardourvisionofthe“TripleAim.”

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RhodeIslandDepartment ofHealth Strategic Framework36In 2015, Dr. Nicole Alexander‐Scott, Director of the Rhode Island Health Department(RIDOH),issuedtheRIDOHStrategicFramework,thedepartment’sblueprintforreducinghealthdisparitiesandachievinghealthequityinRhodeIsland.Thethreeleadingprioritiesintheframeworkare:(1)AddressthesocialandenvironmentaldeterminantsofhealthinRhode Island, (2)Eliminate thedisparitiesofhealth inRhode Islandandpromotehealthequity,and(3)EnsureaccesstoqualityhealthservicesforRhodeIslanders,includingourvulnerable population. Twenty‐three population health goals are distributed across fivestrategies. The third strategy relates to health care: “Promote a comprehensive healthsystemthatapersoncannavigate,access,andafford.”RIDOH’spopulationhealthgoalsforthisstrategyaretoimproveaccesstocare, includingphysical,oral,andbehavioralhealthsystems;improvehealthcarelicensingandcomplaintinvestigations;expandmodelsofcaredelivery and healthcare payment focused on improved outcomes; build a well‐trained,culturallycompetent,anddiversehealthsystemworkforcetomeetRhodeIsland’sneeds;andincreasepatients’andcaregivers’engagementwithinthecaresystem.RIDOH HealthEquity ZonesTheRIDOHStrategicFrameworkhighlightsthestate’sHealthEquityZones(HEZ),whicharegeographicareasdesignedtoachievehealthequitybyeliminatinghealthdisparitiesusingplace‐basedstrategiestopromotehealthycommunities.37TheRIDOHselectedafirstcohortof11HEZinApril2015(twosubsequentlyceasedthecontractwiththeRIDOHbeforethefirstprojectperiodconcluded)andasecondcohortofthreenewHEZinMay2019.TheHEZare charged with forming community‐led collaboratives, conducting baseline needsassessments,creatingplansofaction,andimplementing&evaluatingthoseplansofaction.TheRIDOHexpectshospitalsandHEZtopartneronclinical‐communitylinkagestoimprovepopulationhealthatlocallevels.38Behavioral RiskFactorSurveillanceSystem –RhodeIsland,2018TheBehavioralRiskFactorSurveillanceSystem(BRFSS)isthenation’spremiersystemofhealth‐relatedtelephonesurveysthatcollectstatedataaboutadultresidentsregardingtheirhealth‐relatedriskbehaviors,chronichealthconditions,anduseofpreventiveservices.Apartnership between the Centers for Disease Control and Prevention and each state’sdepartmentofpublichealth,thesurveyisconductedannuallybyphonetolandlinesandcellphones. 39 Rhode Island’s goal is to interview 5,830 respondents with 55% of thoseinterviewedonacellphone.40TheBRFSScollectsinformationfromRhodeIslandadults(18+years) as part of an effort to address key national health indicators and state priorities.Survey topics include self‐reported health status, health care access, fruit and vegetableconsumption,riskbehaviors,chronicdiseaseburden,andphysicalactivity,amongothers.41KaiserFamilyFoundationStateHealthFacts–RhodeIsland,201942StateHealthFactsisaprojectoftheHenryJ.KaiserFamilyFoundationandprovidesfree,up‐to‐date,andeasy‐to‐usehealthdataforall50states,theDistrictofColumbia,andtheUnitedStates.StateHealthFactsiscomprisedofmorethan800healthindicatorsfromavarietyofpublic and private sources, includingKaiser Family Foundation reports, publicwebsites,governmentsurveysandreports,andprivateorganizations.DatapresentedonStateHealth

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Factsareupdatedoraddedasnewdatabecomeavailable;theupdateschedulevariesfromindicatortoindicator.County HealthRankings–ProvidenceCountyandRI, 201943TheCountyHealthRankings&Roadmapsprogram is a collaboration between theRobertWoodJohnsonFoundationandtheUniversityofWisconsinPopulationHealthInstitute.TheannualCountyHealthRankingsprovidearevealingsnapshotofhowhealthisinfluencedbywherewelive, learn,workandplay.Therankingscomparecountieswithineachstateonmore than 30 health‐influencing factors such as housing, education, jobs, and access toqualityhealthcare.RhodeIslandDepartment ofHealth StatewideHealthInventory,201544TheStatewideHealthInventorystudywasdesignedtoevaluatetheaccessandbarrierstomedical services in the state. The Hospital Survey included information about patients’primaryresidencelocation,insurancesourcesforpatients,censusandvisitdataforfiscalyear 2014, demographics about patients, interpreter services, staffing by specialty andservice category, outpatient specialty clinics and services for calendar year 2014, andinformationtechnology,inadditiontootherdataelements.ThesurveywasinformedbytheCenters for Disease Control and Prevention “National Hospital Care Survey FacilityQuestionnaire”andtheAmericanHospitalAssociation“AHAAnnualSurveyofHospitals.”Findings were reported in the categories of Outpatient Care, Hospitals, Long‐term Care,Facilities&Centers,andPatients&Community.TheRIDOHexpectstocompleteanupdatetotheinventoryin2020.RhodeIslandBehavioralHealthProjectReport, 2015 (TruvenAnalytics)45PreparedfortheRhodeIslandExecutiveOfficeofHealthandHumanServices,DepartmentofHealth,DepartmentofBehavioralHealth,DevelopmentalDisabilities,andHospitals,andtheOfficeoftheHealthInsuranceCommissioner,TruvenAnalyticspublishedfindingsandrecommendationsforimprovingbehavioralhealthinRhodeIslandthroughapublichealthapproach.CriticalNeedIdentificationandPriorityRankingThe CHNA process required RIH to synthesize, interpret and prioritize the varied datacollected. ExistingRIHandLifespan‐specific service line expertise also factored into theselectionandprioritizationprocess.Interpretingandprioritizingallrelevantdatawastheresponsibilityofasteeringcommitteecomprisedof theCommunityLiaisons,RIHLiaison, LCHI leadership,RIH leadership, andLifespan leadership. Representatives of these stakeholder groups met multiple times toanalyzethedata,prioritizethesignificanthealthneeds,andcraftresponsivestrategiesforRIHtoeffectivelyallocateitsresourcestoimprovethehealthstatusofthecommunitiesitserves. During the discussions, the needs were prioritized based on the importanceidentifiedbythecommunity;thescope,severityorurgencyoftheneedasidentifiedbythecommunity and the data; as well as the estimated ability of RIH to provide effectiveinterventions.

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Other health concerns identified during this processwill continue to be considered andevaluatedasopportunities to sharewithotherorganizations thatarebetterequipped torespondtothoseneedsorforfutureRIHstrategies.Theprioritized,significanthealthneedsresultingfromtheRIH2019CHNAprocessare:

Priority1:AccesstoCarePriority2:MentalandBehavioralHealthPriority3:Community‐basedOutreachandEducationPriority4:DiseaseManagement

V. Identification of Rhode Island Hospital Community Significant Health Needs

Basedontheextensivereview,evaluation,anddiscussionofthequalitativeandquantitativedatacollectedthroughtheCHNAprocessconductedonbehalfofRIH,foursignificanthealthneedsfacingthecommunityservedbyRIHhavebeenidentified.Themethodologyusedtodeterminewhichhealthneedsfacingthecommunityhavebeendeterminedtobesignificantand theprocessofprioritizingbyorderof significance to the community isdescribed inSectionIVofthisreport.SectionVfocusesonRIH’sprioritizedsignificanthealthneedsinfurther detail and identifies specific resources, facilities, and programs within thecommunity,includingthoseatRIH,thatarepotentiallyavailabletoaddressthesesignificanthealthneeds.1. AccesstoCare

Accesstohealthservicesimprovesthetimelyuseofpersonalhealthservicestoachievethebest health outcomes. Disparities in access to health services affect individuals andpopulations.Barrierstoservicesinclude:

Lackofavailability Out‐of‐pocketcosts Transportation Languageaccess Lackofinsurancecoverage46

InthelastRIDOHStatewideHealthInventory(2015),whenaskedtorankcommunityhealthissues, the majority of respondents reported that making health care more affordable(79.5%)andincreasingaccesstohealthcare(69.9%)wereofextremeimportance.47Beingabletoaccessandaffordhealthcarewhenneededisafundamentalelementofournation’shealthcaresystem.Healthinsuranceratesareonemeasureofaccesstohealthcare.In2014,theAffordableCareActexpandedaccessformanymillionsofAmericansbycreatinghealth insurance marketplaces and allowing states to expand Medicaid eligibility forresidents.TheuninsuredrateinRhodeIslandin2018was3.7%.48Attheendof2017,

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2.1% of Rhode Island’s children under age 19were uninsured.49According to the 2019CommonwealthFundScorecardonStateHealthSystemPerformance,RhodeIslandranked#3inthenationin2019foraffordabilityandaccessibility.Thisratingisbasedonoverallperformanceandalsopercentchangeonindicatorsrelatedtohealthcareaccess.However,muchimprovementcanstillbemade,especiallyinreducingdisparitiesbyincome,race,andethnicity.IfRhodeIsland’sperformanceimprovedtothesamelevelasthetopperformingstateinthenation,15,625moreRhodeIslandadultsandchildrenwouldbeinsured,33,603feweradultswouldskipneededcarebecauseofcost,and19,890feweremployer‐insuredadultsandelderlyMedicarebeneficiarieswouldseekcareintheEmergencyDepartmentfornon‐emergentorprimary‐care‐treatableconditions.50Adequate access to primary care services is essential to improving population health. Itenables patients to have a source of care that leads to positive health outcomes. As theInstituteofMedicinedefinesit,“primarycareistheprovisionofintegrated,accessiblehealthcareservicesbyclinicianswhoareaccountableforaddressingalargemajorityofpersonalhealthcareneeds,developingasustainedpartnershipwithpatients,andpracticinginthecontextoffamilyandcommunity.”51Withoutprimarycareaccess,patientsmaynotreceiveappropriatecareinatimelymanner.Thescopeofprimarycareincludespreventivecarethatcan help to keep patients healthier in the long term, disease management, and theidentificationofneededbehaviorchangestomaintainhealththroughoutthelifespan.OneoftheRIDOH’sfivestrategiesinitsStrategicFrameworkistopromoteacomprehensivehealthsystemthatapersoncannavigate,access,andaffordwiththeimprovementofaccessto care as one of its twenty‐three population health goals.52Access is difficultwithout astrongPCPbase.Consistentcarealongthecontinuumisalsoimportantaspatientstransitionthroughtheagespectrum.Forexample,consistentlylinkingpostpartumpatientswithaPCPwill ensure that the issues identified during pregnancy than can be indicators of futurehealth‐careproblems(e.g.gestationaldiabetes)areaddressedinatimelymanner.Without a consistent primary care connection, patient care can become fragmented,resultingininconsistenttreatmentandpooroutcomes.Thetotalfull‐timeequivalents(FTE)ofprimarycarephysiciansinthestateofRhodeIslandwas602.7in2014,thelastyearinwhich the RIDOH completed a provider inventory. That figure, according to nationalrecommendations, is10%fewerthanthecurrentdemand.53Increasingaccesstoprimarycarecanimprovelong‐termpopulationhealthoutcomesandhealthequity.AHealthProfessionalShortageArea(HPSA)andMedicallyUnderservedArea/Population(MUA/P) are designations by theHealthResources and ServicesAdministration (HRSA).These designations identify geographic areas with populations in need of primary care,dental,ormentalhealthproviders.ThethreecriteriaforaHPSAthatdetermineitsscoreare:(1)populationtoproviderratio;(2)percentageofthepopulationwhosefamilyincomefallsbelow100%oftheFederalPovertyLevel(FPL);and(3)estimatedtraveltimetothenearestsourceofcareoutsidetheHPSA.Thefirstcriterionholdsthegreatestweightinthescoring.54TherearetenprimarycareHPSAs,tendentalcareHPSAs,andeightmentalhealthHPSAsinProvidenceCounty,suggestingsignificantchallengeswithaccesstocare.55

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AMUA/PdesignationdependsontheIndexofMedicalUnderservice(IMU)score.AnIMUscore is calculated based on: (1) population to provider ratio; (2) percentage of thepopulation whose family income falls below 100% of the FPL; (3) percentage of thepopulationover65yearsofage;and(4)theinfantmortalityrate.TheIMUscorerangesfrom0to100where62orbelowqualifiesasMUAdesignation.ProvidenceCountyhasfiveMUAswithIMUscoresrangingfrom54.2–61.9.56Recruitingprimarycare,dental,andmentalhealthprovidersinRhodeIslandrepresentsachallengeduetotherelativelylowreimbursementandpaymentrateswithinthestate.Duetothephysicianshortage,RhodeIslandisrequiredtocompeteregionallyandnationallyforproviders.Nationally,thereisacurrentandprojectedshortageofPCPs.57Thisshortageisexpected togrowas thepopulationagesand thecorrespondingneed for servicesgrows.Individuals over 65 years‐old seek care from PCPs at twice the rate of the youngerpopulation,whileatthesametime,thesupplyofPCPsisexpectedtodiminishasexistingPCPsretire.58Inaddition,youngerPCPsarenowseekinganimprovedwork‐lifebalancethantheirpredecessorsandwilllikelyseefewerpatientsayear.ThePCPshortageisexacerbatedasinternalmedicineprovidersseekpositionsashospitalistsorchooseasubspecialtyand,therefore,nolongerprovideoutpatientprimarycareinthecommunity.Fewnewphysicianschoose a geriatric primary care subspecialty due to long, expensive training and lowercompensation rates than physicians in other specializations. Hospitals and physicianpracticesareaugmentingthephysiciansupplywithnursepractitioners(NP)andphysicianassistants(PA)integratedintothecareteam.TheHRSAestimatesthatthefulldeploymentofNPsandPAs,wheresupply is increasing, could reduce thephysicianshortagebyover60%.59RIHconsistentlymonitorsitsproviderworkforceandutilizesadvancedpractitionerslikeNPsandPAstoaugmenttheprimarycaremedicaldoctorworkforce.Inaddition,unlikecommunity‐basedPCPs,RIHPCPsacceptMedicaid,increasingaccesstocareforsomeofthemostvulnerableresidents.LinkagewithaPCPcanhelpreducethenumberofEmergencyDepartmentvisitsandlowertherateofhospitalstaysrelatedtoambulatory‐sensitiveconditions,potentiallypreventingtheneed forhospitalization.TimelyPCP interventioncanpreventcomplicationsormoreseveredisease.60In ProvidenceCounty, the rate for ambulatory sensitive conditionswas4,820per100,000MedicarebeneficiariescomparedtothetopU.S.performersof2,765per100,000.ThisratewasalsosignificantlyhigherthantheStateofRhodeIsland,whichalsoperformspoorlyonthismeasureat4,401per100,000.61Additionally,CHFparticipantsidentifiedtheneedforimprovedtimelyaccesstospecialistswithaneedforlocalaccesstobehavioralhealthandcancerspecialties.CanceristhesecondleadingcauseofdeathinRhodeIslandandhadahighermortalityrateinRhodeIsland(154.2per100,000)comparedtotheUnitedStates(152.5)in2017accordingtothemostrecentCDCreports.CancerincidencewasalsohigherinRhodeIsland(458.0)thanintheUnitedStates (437.7).62The shortage of specialists nationwide, while not as critical as the PCPshortagediscussedpreviously, isexpectedtoworsenasthepopulationagesandrequires

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more services and the supply of providers diminishes due to baby boomers enteringretirement.63RIH recognizes themany social determinants of health that often inhibit residents fromaccessingcareavailableintheircommunities.Inparticular,CHFparticipantsnotedlanguageaccess,finances,andhousingasbarrierstocare.Notably,buildingawell‐trained,culturally‐competent,anddiversehealthsystemworkforcetomeetRhodeIsland’sneedsisoneoftheState’stwenty‐threepopulationhealthgoals.64Withadiverseresidentpopulationinwhichalmostathird(31.3%)ofresidentsspeakalanguageotherthanEnglishathome65,RIHhaslongrecognizedtheneedtoprovidelanguageaccesssupportstopatients.RIHcurrentlyhas16 full‐time staff interpreters, seven part‐time interpreters, and four per diem staff. Inadditiontotheseemployees,RIHalsoutilizedcontractedvendorstoprovideinterpretationmorethan2,000timesthroughJuneoffiscalyearendingSeptember30,2019.Still,RIHisincreasingaccessthroughtechnologyandworkforcestrategieswhichwillbelaidoutinitsimplementationstrategywhichwillfollowthisreport.ProvidenceCounty(14.7%ofhouseholds),andtheCityofProvidence(26.9%ofhouseholds)haveasignificantportionofresidentswholiveinpoverty.66Asiswell‐describedinhealthcareandpublichealth literature,povertygetsundertheskin, impactinghealthoutcomesover multiple generations. There are also correlations between poverty andoverweight/obesity, chronic disease prevalence, and life expectancy.67RIH and the LCHIoffertwoprograms‐ConnectforHealth(C4H)andMLPB(formerlyknownasMedicalLegalPartnershipBoston),thatuniquelybridgemedical,communityandsocialdomainstohelppatients achieve a complete state of health. C4H and MLPB screen, refer, and providenavigationsupporttopatientsacrossthesocialdeterminantsofhealthincludinghousing,food, education, employment, transportation, commodities and child care. With theseadditional “teammembers”, providers are better equipped to assess and respond to thehealth‐related social needs of patients. C4H and MLPB give doctors the confidence andbreathing room to ask patients critical but sensitive questions and free hospital socialworkers to focusonmore complexbehavioral health cases.During the fiscal year endedSeptember30,2018,C4HandMLPBservedmorethan1,500patientsandaddressedmorethan3,500needsincludingfood,safehousing,andutilityassistance.Housing affordability and homelessness were significant social factors raised by CHFparticipants as health concerns. As an example, in the city of Providence, 39% ofhomeownersarecostburdened,meaningtheyspendmorethan30%ofincomeonhousingcosts. Among renters in Providence, 57% are cost burdened. 68 Being cost burdenedincreasesthelikelihoodofhomelessnessandtransienceandreducesthelikelihoodthatapersonwillsuccessfullymanagetheirhealthcare. RIH’sownpatientdatareinforcesthis.Themost frequently cited needs among the adult primary care populationwho use theConnect for Health Program (social needs screening and navigation support) at RIH arehousing,food,andutilityassistance.

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RIHwillmaintainitscurrentcommitmenttoprovidinghighquality,comprehensiveprimarycare to vulnerable populations. At the same time, RIH will increase the scope ofinterpretations services by adding more options for live or video interpretation fromqualifiedinterpreters.RIHwillalsocontinueitseffortstomakeiteasierforpatientstoaccessneeded services through offerings like the LCI centralized call center, community‐basededucationandhealthscreeningactivities,andscreeningandnavigationsupportdescribedabovetomitigatehealth‐relatedsocialneeds.Atthesametime,RIHwilltestinterventionstoreducethewaittimesintheED.Waittimeswithspecialistswillcontinuetobemonitoredto ensure timely access and improvementswill bemade ifwait times exceed acceptableranges.2. DiseaseManagementChronic conditions can lead to higher levels of hospital utilization, particularly if notmanaged properly. According to the RIDOH, patients with congestive heart failure arethirteentimesmore likely tobeadmitted to thehospital than theoverallpopulationandthosewithChronicObstructivePulmonaryDisease(COPD)arereadmitted,onaverage,7.5timesmorethantheoverallpopulation.69In2016,RhodeIslandranked46thnationwidefordiabeticadultsages18‐64withoutahemoglobinA1ctest,whichisakeyindicatorofchronicdiseasemanagement.70Asaresultofindicatorslikethese,reducingchronicillnessisoneoftheRIDOH’spopulationhealthgoals.71RIH CHF participants cited nutrition and healthyweight as key health priorities in theircommunities.Ahealthfuldietreducestheriskofmanychronichealthconditions,includingoverweight and obesity, heart disease, high blood pressure, type II diabetes, and somecancers.In2019,RhodeIslandwasranked22nd in thenation foradultwhoareobese.Thirty‐onepercentofRhodeIslandadultsareobese,upfrom27%in2013.72Thecurrentadultdiabetesrateof10.9%isupfrom8.4%in2011.Onapositivenote,3.9%adultsreportedhavingbeendiagnosedwithcoronaryarterydiseasein2018,downfrom4.2%in2011.However,in2017,33.1%ofadults(upfrom28%in2009)reportedbeingdiagnosedwithhypertension.73HeartdiseaseistheleadingcauseofdeathinRhodeIsland,andthestate’smortalityfromheartdiseaseishigherthanthenationalaverage.In2016,15%ofchildrenages2‐17wereoverweightand20%wereobese.Hispanic(45%)andBlack(37%)childrenhadsignificantlyhigherratesofoverweightandobesitythantheirpeers.74Thisdisproportionateburdenofoverweightandobesityonminoritychildrenputsthematgreaterriskforweight‐relateddiseases.Itiswidelyrecognizedthatimprovingupstreamdeterminantsofhealth,suchasincreasingphysicalactivityandhaving financialaccess tonutritious food isnecessary toreduce theincidenceofthesediseases,especiallyastheseincidencesfalldisproportionatelyonlowerincomecommunitiesandracialandethnicminoritypopulations.75Althoughratesofdiet‐relatedmorbidityvariesslightlybydemographiccharacteristics,allsubgroupsareatrisk

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and could benefit from increased access to healthful food and support to achieve andmaintainahealthyweight.“Foodaccess”referstothephysicalandeconomicabilitytomeetone’sdietaryneedsinamannerthat isculturallyappropriateandallowssufficientchoiceof foodgroups.Limitedaccess to supermarkets, supercenters, grocery stores, or other sources of healthy andaffordablefoodmaymakeitharderforsomeAmericanstoeatahealthydiet.Foodinsecurityisdefinedasnothavingaccesstosafeandnutritionallyadequatefood.76ThemagnitudeoffoodinsecurityinRhodeIslandissimilartotheUnitedStateswith12%ofthepopulationlacking access to adequate food. This figure is 13% in Providence County. 77 FederalSupplemental Nutrition Assistance Program (SNAP) participation enrollment expandedsignificantlyoverrecentyears.Ofthe160,272RhodeIslandersenrolledinSNAPinOctober2018,66%wereadultsand34%werechildren.78ManyfamiliesinRhodeIslandhavetroublefeedingtheirfamiliesconsistently,whichmakeseatinghealthyfoodsmuchmoredifficult.In2018,foodpantriesandsoupkitchensprovidedemergencyfoodassistanceto53,000RhodeIslanderseachmonthwhoneededadditionalhelptomeettheirnutritionalneeds.79Benefitsofahealthydietareimmense,especiallyforchildren,whoarestilldeveloping.Ahealthydietalsohelpstolowerstress.80Reducingmorbidityandmortalityfromweightanddiet‐relatedillnesscanbeachievedbycommunities,healthcaresystems,andgovernmentsworkingtogethertodeveloplegislationandlocalinitiativesthatimpactschools,theworkplace,neighborhoods,andhealthcare.81,82Improvingnutritionandweightrequiresamulti‐sectorsolutionandRIH iscommittedtoinvesting in prevention, education, and expansion of clinical and non‐clinical services toRhode Island children and families to improve nutrition and healthy‐weight as well asdecreasingtheimpactofdiet‐relateddisease.Cardiovasculardisease,includingheartdiseaseandstroke,istheleadingcauseofdeathanddisability inRhodeIslandandthecountry. In2017,2,339people inRhodeIslanddiedofheartdiseaseand425peopleinRhodeIslanddiedofstroke.83Riskofheartdiseasecanbereducedbytakingstepstocontrolfactors:

Controlofbloodpressure Loweringofcholesterol Preventionofsmoking Adequateamountsofexercise84

Ingeneral,treatmentforheartdiseaseusuallyincludeslifestylechangessuchaseatingalowfat, low cholesterol diet and exercising regularly. Other treatments include takingmedications to control heart disease and related symptoms or undergoing medicalproceduresorsurgery.85

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TheCardiovascular Institute(CVI)atRIH,TMH,andNHprovideshighqualitydiagnostic,interventional,surgical,andrehabilitativecardiaccare24hoursaday,sevendaysaweek.ComprehensivecardiacservicesareofferedatmultipleCVIlocationsthroughouttheregionandincludecardiacdiagnostictestingandintervention,cardiacrehabilitation,heartfailuremanagement,congenitalheartdiseasemanagement,andprogramsfor lipidmanagement,management of hypertension, and disease prevention. CVI providers create anindividualized treatment plan with each patient and make referrals to specialists asnecessary.Nutritionandphysicalactivitycanhelpcontrolriskfactorsforcardio‐vasculardiseaseandother comorbidities. RIH is committed to expanding access to programs that promotecardiac health through prevention such as screening initiatives, free education andawarenessprograms,andcommunityactivities.RIHwillcollaboratewithLCHIandTMH–whichisnationallyknownforitsweightmanagementandpreventativeservices,toimproveaccesstotheseprogramsintheRIHcommunity.CanceristhesecondleadingcauseofdeathamongRhodeIslanders,andisthefirstamongAsianandPacificIslandersinthestate.86Theage‐adjustedcancerincidenceforRhodeIslandwas450.6per100,000in2016.Thehighestincidencewasforfemalebreastcancer(135.4per 100,000) but the highest mortality was for lung and bronchus cancer (41.6 per100,000).87

InRhodeIslandandtheU.S.overall,annualcountsofcolorectalcancercasesanddeathshavedecreased in the past 25 years, due to improved screening and treatment. Age‐adjustedincidence for colorectal cancer in 2016 was 30.9 per 100,000 with nearly 77% of thepopulationscreened.88Skincancer(alsoknownasMelanomaoftheskin)isthemostcommoncancerintheUnitedStates.Mostcasesofmelanoma,thedeadliestkindofskincancer,arecausedbyexposuretoultravioletlight.Skincancerpreventionstrategiesincludeprotectingskinfromthesunandavoidingindoortanning.89RIHisafoundingpartneroftheLifespanCancerInstitute(LCI),whichgivespatientsaccesstooncologyservicesatRIHandtwoofitsaffiliatedhospitals,TMHandNH.BetweenthethreehospitalswhereLCIoperates,ithastreatedover100,000patientsduringeachofthethreefiscal‐years coveringOctober1, 2016 throughSeptember30, 2019. LCI services are alsoofferedatacommunityclinic,throughvariousservicedeliveryoptions,andavailableclinicaltrials.RIHisactivelyinvolvedinimplementingtheLCI3‐yearactionplan,theRoadmapandparticipatedinLCI’splanningretreatinApril2019.Inaddition,LCIcontinuedtoprovidecommunity‐basedandclinicalservicestopromotecancerprevention,screening,treatment,andsurvivorship.

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RIH will continue to offer an array of education programs, screening activities, patientadvisoryandsupportgroups,andotheroutreachactivitiesforspecialtiesincludingcancer,cardiovasculardisease,weightmanagement,anddiabetes.RIHwillalsocontinuetodeliverhigh quality care as recognized bymaintaining its PCMH recognition and establishing acardiovascular center of excellence that addresses prevention, treatment, rehabilitation,researchandtrainingfocusedoncoordinated,quality,compassionatecardiovascularcare.3. MentalandBehavioralHealth

Substance use disorders occur when the recurrent use of alcohol and/or drugs causesclinicallyandfunctionallysignificant impairment,suchashealthproblems,disability,andfailuretomeetmajorresponsibilitiesatwork,school,orhome.Substanceusedisorderscaninclude use of tobacco, alcohol or other drugs.90Rhode IslandDepartment of BehavioralHealthcare, Developmental Disabilities & Hospitals (BHDDH) and Prevent Overdose RIreportedthattreatmentadmissionsforheroinwereontherisebetween2010‐2014,whileadmissionsforalcoholabuse,otherprescriptiondrugsandmarijuanahaddeclined.91Peoplewithamentalhealthdiagnosesaremorelikelytousealcoholordrugsthanthosenotaffectedbyamentalillness.In2017,18.3%ofadultswithamentalillnesshadasubstanceusedisorderinthepastyear,whilethoseadultswithnomentalillnessonlyhada5.1%rateofsubstanceusedisorderinthepastyear.Foradolescents,agestwelve‐seventeenyears,in2017thepercentwhousedillicitdrugsinthepastyearwashigheramongthosewithaMajorDepressive Episode (29.3%) than those without (14.3%). 92 Addressing substance usetreatmentandpreventioncannotbedonewithoutconsideringmentalhealth.Diagnosingandinterveningonmentalhealthissuesiskeytoprimarypreventionofsubstanceuseandaddiction.93Hospitalsarecrucialtoimprovingearlymentalhealthandaddictiondiagnoses,toincreasingutilizationofthePrescriptionMonitoringProgram(PMP)topreventaddiction,andtoproviding“Medication‐AssistedTreatment”(MAT)andsupportservicestothosewhosurviveoverdose.TheRhode IslandStrategicPlanonAddictionandOverdose reports thatalthoughRhodeIslandhasanelectronicPMPandsomeofthestrongestclinicalguidelinesforthetreatmentof chronic pain in the country, provider participation is low and is often not enforced.Hospital and stateefforts toexpandandenforce theuseof thePMP,alongsideefforts toengagepeoplewhoareaddictedintreatmentwithevidence‐basedmedical therapiesandrecoverysupportcouldmitigatetheepidemicinRhodeIsland.94BecauseofthehighmortalityinRhodeIslandandidentificationofsubstanceusedisorderasatopprioritybyRhodeIslandGovernorGinaRaimondo,therehasbeenasteadygrowthofservicestargetingsubstancemisuseandaddiction.Programsareavailableatarangeofsites:community‐based programs, inpatient detoxification centers, outpatient services, andresidentialprograms.PCPsarestartingtoofferMATandOfficeBasedAddictionTreatmentas an integrated program in their offices. Policy changes have resulted in Narcan beingavailablewithoutaprescriptionandreimbursementavailableforPeerRecoverySpecialists.TrainingprogramsareavailableforPeerRecoverySpecialists.Despitetherangeofemergingservices,theCHFparticipantsstillfeltthataccessisdifficultandabarriertocare.

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Leveraging the expertise at RIH and across the Lifespan system should be beneficial inresponding to theneed in theRIHservicearea.Lifespan remains invested inworking toaddress theoverdoseepidemic.RIHcontinues toparticipateon theGovernor’sOverdosePreventionandInterventionTaskForcewhichissuedastrategicplanin2016andupdatesto the plan in 2019. The Substance Use Disorders Treatment Program at RIH providesconsultationsanddirectcareforpatientswithsubstanceusedisordersand/orwithdual‐diagnosedconditions.RIHalsoprovidesanoutpatientprogramthatcombinesprofessionalcareandself‐helpapproacheswithanemphasisonabstinence,familyparticipation,relapseprevention,andhealthpromotion.RIHwill grow treatment capacityof theLifespanRecoveryCenterandHCH’sEmergencyDepartmentandChildProtectionCenterthroughprogramofferingsandclinicalexpertise.ThroughthepromotionofestablishedLifespanaffiliateserviceslikePediPRN,KidsLinkRI,andGatewayHealthcare,RIHwillraiseawarenessofbehavioralhealthoptionsavailabletothe community. Having established the nation’s first Center of Biomedical ResearchExcellenceonOpioidsandOverdose,RIHexpectstoofferinnovativeresearchandpracticalapplicationsofinterdisciplinaryresponsestotheopioidepidemicwhilecontinuingexistinghigh‐demandeducationalactivitieslikeMentalHealthFirstAidandParentingMatters.4. Community‐basedOutreachandEducation

The need for increased outreach and education is identified in the RIDOH StrategicFrameworkwithtwoofthefivestrategiesaddressingthisinsomeform95: Promotehealthylivingthroughallstagesoflife;and Analyzeandcommunicatedatatoimprovepublic’shealth.ThreeofRhodeIsland’stwenty‐threepopulationhealthgoalsfocused,atleastpartially,ontheneedforOutreachandEducation96: PromotebehavioralhealthandwellnessamongallRhodeIslanders; ImprovehealthliteracyamongRhodeIslandresidents;and Increasepatients’andcaregivers’engagementwithincaresystems.CHFparticipantsstronglysupportedthisneedwithafocuson: Healthliteracy; Healthandwellbeing,prevention;and Healthyfoodchoices.

The CHFparticipants identified the need to focus on the improvement of health literacythroughoutRhodeIslandandtoeliminatethatasabarriertopatients’interactionwiththehealth care system. Peopleneed information they canunderstandanduse effectively tomakethebestdecisionsfortheirownhealthandthehealthoftheirfamilies.Toaccomplishthis,theyneedtofullyunderstandhow,where,andwhentoaccesshealthservices.Stronghealthliteracyhelpspreventandmanagehealthchallengesresultinginimprovedoutcomes.Inhelpingtotargetprograms,thefindingsofRhodeIsland’sSpecialLegislativeCommissiontoStudytheTopicofHealthLiteracy(November2017)97notedthat:

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There is a lack of health literacy among the elderly, individualswith disabilities, andindividualssufferingfrommentalillness;

Certain populations, including Hispanics (14% of RI population), are impactedmoreacutely;and

Improvinghealthliteracyatanearlyagehasadirectimpactonhealthliteracyinlaterlife.

SincetheCommission’sreportwasissued,providersthroughoutRhodeIsland,includingatRIH,havebeendevelopingprogramstoaddresshealthliteracybutthestrongopinionamongtheCHFparticipantsisthatmoreworkisneeded.Additionally,CHFparticipantsindicatedaneed to increaseeducationwithin the community aboutprogramsand services thatRIHofferssothatthepopulationbetterunderstandswhatisalreadyavailableandhowtoaccessthoseservices.Basedon2016data,alargerpercentageofRhodeIslanders(15%)reportpoororfairhealththandoes theoverallUSpopulation (12%).A similar comparison is also true formentalhealth with Rhode Islanders reporting 4.3 poor mental health days in the past monthwhereasacrosstheUnitedStates,3.1dayswerereported.Withregardtophysicalhealth,RhodeIslandersreport3.8daysofpoorphysicalhealthinthepast30dayscomparedto3.0daysforthegeneralU.S.population.ProvidenceCountyisamaincontributortothesehighaveragesinRhodeIsland,where17%oftheadultsintheCountyreportpoororfairhealth,4.4poormentalhealthdaysinthepast30days,and4.0poorphysicalhealthdaysinthepast30days.98TheCHFparticipants’ thirdmost importantoutreach targetwaseducationabouthealthyfoodoptionsandlocations.ObesityisasignificantprobleminRhodeIslandwith31%ofthe2017 adult and child population considered obese or overweight.99Reducing obesity inchildren,teens,andadultsisoneoftheRIDOH’spopulationhealthgoals.100Obesitycausesheartdisease,stroke,somecancers,respiratorydisease,diabetes,andkidneydiseaseandiscausedbypoordietandphysicalinactivity,amongotherfactors.Infact,theCDCreportsthatphysical activity and poor diet are catching up with tobacco use as the second leadingpreventablecauseofdeathintheU.S.RhodeIslandismakinghealthyfoodaccessaprioritythroughtheHEZ,givingRIHtheopportunitytocoordinateoutreacheffortswiththeStateandothercommunity‐basedproviders.TheCHFparticipants felt thatoutreachandeducationshouldbeaccomplished throughavarietyofchannelsandformatstocapturethepopulationwheretheylive,work,prayandplay.A strongprovidernetwork (Priority#1) canalso support thisoutreacheffort. Lesstraditional means of communication should be developed, particularly to reach the“millennial”population(currentlybetweentwenty‐threeandthirty‐eightyearsofage)whoarenowinpositionsasdecision‐makersabout theirhealthandtheir families.Millennialsvaluespeed,consistency,andtransparencysoinformationneedstobetailoredtocapturetheirattention.Millennialsaretechnologyorientedandvaluereceivinginformationthroughtext,socialmedia,mobileapplications,andotheronlinesources.101

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CHFparticipantsencouragedRIHtouseitshealthcareleadershiproletodevelopoutreachprograms throughout the state that promote strategies to improve personal health andwellbeing with a specific focus on adopting behaviors to prevent health problems fromdevelopinglaterinlife.Itiswidelyrecognizedthateasingsocioeconomicstressorsiscriticaltoimprovingpopulationhealthandreducingtheincidenceofdisease.102RIHcanpartnerwith other community‐based providers to create organized outreach and educationprogramsthatcanbeimpactfulonthepopulation’sbehaviors.RIHwill continue to offer thewide array of educational, health literacy, and communityoutreachprogramsitcurrentlyoffersonitsownandinpartnershipwithschools,employers,churches,andcommunity‐basednon‐profits.Atthesametime,RIHwillcontinuetoworktoraiseawarenessabouttheprogramsitofferssothatabroaderswathofthecommunitymayattendtheseprograms.

VI. Conclusion TheCHNAisatoolthatRIHwillusetoaddressthesignificanthealthneedsidentifiedinthisreport. The results of the CHNAwill guide the development of RIH’s community benefitprograms and implementation strategy. RIH’s leadership team, including its Board ofTrustees, members of executive management, and other individuals critical to theorganizational planning process are currently conducting RIH’s implementation strategywhichwill detail action itemplans to covering theperiod fromOctober1, 2019 throughSeptember30,2022.ThisimplementationstrategywillbecompletedandauthorizedbytheRIHBoardofTrusteesconsistentwithIRSrulesandregulations.

A. Acknowledgements

DataandInformationContributorsAdaAmobi,MD,MPH,PhysicianLead,HealthEquityInstitute,RhodeIslandDepartmentofHealthMonicaAnderson,DirectorofCommunityRelationsandCorporateCitizenship,LifespanChristineF.Brown,MHA,FamilyandCommunityLiaisonProgram,BradleyHospitalCancerOversightCommittee,TheLifespanCancer InstituteatRhodeIslandHospital,TheMiriamHospital,andNewportHospitalDeborahGarneau,MA,Director,HealthEquityInstituteandSpecialNeedsDirector,RhodeIslandDepartmentofHealthCommunityHealthInstitute,LifespanMarketingandCommunicationsDepartment,LifespanRhodeIslandKIDSCOUNTKaylaRosen,ActingChiefofStaff,ExecutiveOfficeofHealthandHumanServicesandPolicyDirector,RhodeIslandChildren’sCabinetPamelaMcLaughlin,DirectorofPatientExperience,NewportHospitalJessicaGelinas,Manager,PlanningandAnalysis,Lifespan

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TheresaE.Jenner,MSW,LICSW,CCM,DirectorofClinicalSocialWork,LifespanMartiRosenberg,DirectorofPolicy,Planning,andResearch,ExecutiveOfficeofHealthandHumanServices,StateofRhodeIslandCommunityLiaisonsFeliciaDelgadoShannanHudginsPilarMcCloudMarilenaSantizoClementShabaniKiraWillsCommunityForumHostSitesAmosHouse,Providence,RhodeIslandTheCenter(x2),Providence,RhodeIslandUnitedWayofRhodeIsland,Providence,RhodeIslandBlessedSacramentChurch,Providence,RhodeIslandSt.Patrick’sChurch,Providence,RhodeIslandTheMetSchool,Providence,RhodeIslandInstitutefortheStudyandPracticeofNonviolence,Providence,RhodeIslandSouthsideCulturalCenter,Providence,RhodeIslandSt.MartindePorres,Providence,RhodeIslandCrossroads,Providence,RhodeIslandRIH,Providence,RhodeIsland

B. Contact Information Forinformationregardingthe2019RIHCHNAprocessorfindings,orforinformationonanyof the services or strategies mentioned, please contact the Lifespan Community HealthInstitute.LifespanCommunityHealthInstitute335RPrairieAvenue,Suite2BProvidence,RI02905Phone:401‐444‐8009http://www.lifespan.org

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AppendixARhodeIslandHospitalPatientDemographics:Region,City,&Town,2016‐2018

Region/Town Clusters Adult & Pediatric Inpatients Adult & Pediatric Outpatients 2016 2017 2018 2016 2017 2018

Urb

an C

ore

Reg

ion

Providence, RI:

City of Providence, RI 8,096 8,008 7,626 171,740 173,325 170,600

Providence, RI Subtotal 8,096 8,008 7,626 171,740 173,325 170,600

Cranston/Warwick Cluster:

Cranston, RI 4,852 4,646 4,425 75,085 75,446 73,178

Warwick, RI 2,441 2,354 2,200 32,439 32,426 32,169

West Warwick, RI 697 708 664 10,418 10,262 10,608

Cranston/Warwick Cluster Subtotal 7,990 7,708 7,289 117,942 118,134 115,955

North Providence Cluster:

Central Falls, RI 453 472 538 11,184 11,250 12,271

Johnston, RI 1,035 1,088 1,043 14,480 14,260 14,401

North Providence, RI 408 394 396 7,389 7,339 7,336

Pawtucket, RI 1,523 1,686 1,958 35,473 35,594 40,203

North Providence Cluster Subtotal 3,419 3,640 3,935 68,526 68,443 74,211

Urban Core Region Subtotal 19,505 19,356 18,850 358,208 359,902 360,766

Eas

t B

ay R

egio

n

Barrington Cluster:

Barrington, RI 535 539 461 8,709 8,501 8,164

Bristol, RI 851 844 800 9,118 9,073 8,484

Warren, RI 641 609 580 5,930 5,821 5,540

Barrington Cluster Subtotal 2,027 1,992 1,841 23,757 23,395 22,188

Fall River Cluster:

Fall River, MA 629 711 644 4,039 4,169 3,804

Little Compton, RI 48 41 28 682 665 622

Somerset, MA 114 136 129 1,711 1,557 1,544

Swansea, MA 148 136 173 2,154 2,300 2,335

Tiverton, RI 151 167 206 2,752 2,751 2,849

Fall River Cluster Subtotal 1,090 1,191 1,180 11,338 11,442 11,154

New Bedford Cluster:

Dartmouth, MA 120 134 143 954 860 907

New Bedford, MA 507 653 576 2,186 2,369 2,283

Westport, MA 86 88 80 869 950 889

New Bedford Cluster Subtotal 713 875 799 4,009 4,179 4,079

Newport Cluster:

Jamestown, RI 85 107 65 1,773 1,860 1,832

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Middletown, RI 231 274 237 4,637 4,578 4,586

Newport, RI 311 358 325 5,750 6,007 6,064

Portsmouth, RI 240 220 244 4,582 4,638 4,550

Newport Cluster Subtotal 867 959 871 16,742 17,083 17,032

East Bay Region Subtotal 4,697 5,017 4,691 55,846 56,099 54,453

I-95

Cor

rid

or R

egio

n

Attleboro Cluster:

Attleboro, MA 473 410 534 4,253 4,201 4,523

North Attleboro, MA 215 191 260 2,314 2,254 2,152

Plainville, MA 63 39 56 356 345 344

Wrentham, MA 19 26 18 227 188 194

Attleboro Cluster Subtotal 770 666 868 7,150 6,988 7,213

Cumberland Cluster:

Cumberland, RI 592 740 701 12,338 12,795 12,871

Lincoln, RI 407 478 437 8,097 8,484 8,905

Smithfield, RI 507 484 536 7,750 7,849 7,611

Cumberland Cluster Subtotal 1,506 1,702 1,674 28,185 29,128 29,387

East Prov. Cluster:

Dighton, MA 41 45 49 630 581 688

East Providence, RI 2,398 2,318 2,442 29,980 29,403 29,677

Rehoboth, MA 196 230 252 3,294 3,358 3,254

Seekonk, MA 366 391 345 5,396 5,331 5,446

East Prov. Cluster Subtotal 3,001 2,984 3,088 39,300 38,673 39,065

I-95 Corridor Region Subtotal 5,277 5,352 5,630 74,635 74,789 75,665

Sou

th R

egio

n

Coventry Cluster:

Coventry, RI 736 764 724 11,034 11,302 11,354

East Greenwich, RI 384 457 369 6,876 6,769 6,580

Exeter, RI 82 88 96 1,646 1,549 1,689

North Kingstown, RI 540 581 572 9,071 9,180 9,127

West Greenwich, RI 123 128 122 2,029 1,946 2,026

Coventry Cluster Subtotal 1,865 2,018 1,883 30,656 30,746 30,776

Southern RI Cluster:

Charlestown, RI 138 136 124 1,305 1,252 1,359

Hopkinton, RI 187 154 172 2,105 2,085 2,029

Narragansett, RI 180 178 219 2,689 2,617 2,613

New Shoreham, RI 8 9 19 128 117 143

Richmond, RI 67 59 88 828 907 832

South Kingstown, RI 395 442 428 5,709 5,606 5,703

Westerly, RI 280 301 230 2,604 2,834 2,785

Southern RI Cluster Subtotal 1,255 1,279 1,280 15,368 15,418 15,464

South Region Subtotal 3,120 3,297 3,163 46,024 46,164 46,240

No

rth

NorthWestern MA/RI Cluster:

42

Burrillville, RI 325 346 343 4,795 4,691 4,999

Douglas, MA 5 13 13 112 129 157

Foster, RI 192 138 127 2,317 2,226 2,301

Glocester, RI 143 172 175 2,800 2,938 2,837

Scituate, RI 298 323 366 5,232 5,109 5,379

Uxbridge, MA 10 8 6 228 252 238

NorthWestern MA/RI Cluster Subtotal 973 1,000 1,030 15,484 15,345 15,911

Woonsocket Cluster:

Bellingham, MA 27 15 30 309 288 268

Blackstone, MA 45 45 31 529 605 416

Franklin, MA 29 24 23 251 262 245

Millville, MA 13 8 7 179 148 159

North Smithfield, RI 219 251 258 3,786 3,986 4,207

Woonsocket, RI 860 932 980 12,160 12,548 13,060

Woonsocket Cluster Subtotal 1,193 1,275 1,329 17,214 17,837 18,355

North West Region Subtotal 2,166 2,275 2,359 32,698 33,182 34,266

Oth

er

RI Unknowns:

RI Unknown Residents 1 1 1 1 1 2

RI Unk Res Subtotal 1 1 1 1 1 2

Other:

Other MA & Unknown MA 931 1,044 1,212 7,959 7,972 8,473

CT & Unknown CT 334 310 263 3,672 3,598 3,269

Other States/Unknowns 415 393 358 3,889 3,588 3,503

Other Subtotal 1,680 1,747 1,833 15,520 15,158 15,245

Other Subtotal 1,681 1,748 1,834 15,521 15,159 15,247

Subtotal RI Towns 31,660 31,995 31,325 537,421 539,990 541,546

Subtotal 19 MA Towns 3,106 3,303 3,369 29,991 30,147 29,846

SUBTOTAL RI & 19 MA TOWNS 34,766 35,298 34,694 567,412 570,137 571,392

GRAND TOTAL 36,446 37,045 36,527 582,932 585,295 586,637

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AppendixBRhodeIslandHospitalCommunityHealthForumScheduleMonday,April29,20193:00–5:00PMAmosHouse460PineStreet,Providence,RI02907Saturday,May11,20193:00–5:00PMTheCenter570BroadStreet,Providence,RI02907Thursday,May16,20195:30–7:30PMUnitedWayofRhodeIsland50ValleyStreet,Providence,RI02909Friday,May17,20197:00–9:00PMBlessedSacramentChurch239RegentAvenue,Providence,RI02908Sunday,May19,20192:00–4:00PMSt.Patrick'sChurch244SmithStreet,Providence,RI02908Thursday,May30,201912:00–1:30PMTheMetSchool,LibertyBuilding(openonlytoMetSchoolstudents)325PublicStreet,Providence,RI02905Saturday,June1,201910:00AM–11:30PMTheCenter570BroadStreet,Providence,RI02907Monday,June3,20196:00–8:00PMTheNonviolenceInstitute265OxfordStreet,Providence,RI02905

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Tuesday,June4,201910:00AM–12:00PMSouthsideCulturalCenter393BroadStreet,Providence,RI02907Thursday,June6,201910:00AM–12:00PMSt.MartindePorresCenter160CranstonStreet,Providence,RI02907Friday,June7,201911:00AM–1:00PMCrossroadsRhodeIsland160BroadStreet,Providence,RI02903Wednesday,June12,201911:00AM–12:00PMGeorgeAuditoriumRhodeIslandHospital593EddyStreet,Providence,RI02903

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AppendixCRhodeIslandHospitalCHNACommunityLiaisonProfilesFeliciaDelgado is a Community HealthWorker who was transformed by her previousexperienceinthesex‐for‐payindustry.Tohelpwomenandmencompelledbypovertytosell their bodies, Ms. Delgado founded Esther’s Well in 2013, to direct them towardhealthcareandcommunityresources.Ms.Delgado’sstrategytohelphertargetpopulationisdifferentfrommostcommunityhealthworkers.Sheisaone‐womanenterprise‐seekingout,providingservices,andsecuringhealthcareaccessforindividuals inthesexindustry.Butshealsobattleshealthinequitiesatthesystemiclevelincludingunderemployment,lackofaffordableapartmentrentalsinRhodeIsland,poorwages,andalegalsystemthatimposesmorebarriersthansupportsforpeoplewhosellsex.Also,functionallyilliterate,Ms.Delgadostates, “Mydreamasasurvivorof sexualexploitationand functional illiteracy is toteachothershowtoovercomeobstacles.Obstaclesareonlyopportunitiesforgreatness.”ShannanHudgins,M.A.,M.Div., graduated fromAndoverNewtonTheological School inMay of 2018 following an administrative career in public service in New Hampshire. Amotheroftwoyoungadults,sheleftNHtoworkasaseminaryinternattheRhodeIslandStateCouncilofChurches.NowMinisterforSpecialProjectsattheRISCC,shehasservedasthe education coordinator for the Helen Hudson Foundation in its work to address theunderlyingissuesofhomelessnessinRI.Ms.HudginsiscurrentlycoordinatingtheCouncil’sstudyseriesonwhiteprivilege,MercifulConversationsonRace,andisalsoarepresentativeoftheRISCCinRhodeIsland’sadvancecareplanninginitiativeswithlocalstakeholdersandthenationalorganization,C‐TAC(CoalitiontoTransformAdvancedCare).SheisamemberoftheC‐TACInterfaithandDiversitySteeringCommitteeanditsworkgroup.Ms.HudginsispursuingordinationwithaUCCcongregationinMassachusetts.PilarMcCloud is theCEO& founderofASweetCreationYouthOrganizationwhichwasfoundedinProvidence,RhodeIsland.Ms.McCloudistheformerChairwomanoftheNAACPProvidenceBranch’syouth,highschoolandcollegechapters,andhasbeenanofficerandexecutive board member. Ms. McCloud previously served as the New England AreaConferenceAdvisor for the YouthWorks Committee of theNAACP. Alongwith her socialjusticework,PilaralsoservedontheIntegraMedicaidAccountableEntityGoverningCouncilandisanAmeriCorpsalumna.Marilena Santizo is a registered nurse by profession and graduatedwith a Bachelor ofScienceinNursingfromRhodeIslandCollege.Believingthatgoodhealthcareissomethingthateveryhumandeserves,Ms.Santizoconnectstohercommunitythroughherwork.SheworkedasatelemetrynurseatRogerWilliamsMedicalCenterinProvidenceforfiveyears,duringwhichtimeshewasassignedtobethepreceptorforthenursingstudents.Forthelasteightyearsshehasbeendedicatedtoworkasacommunitynursefortheintegratedcaremanagement team. She helped build this team from scratch, including nurses and

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communityoutreachspecialists.Ms.SantizocurrentlyworksatTuftsHealthPlanwheresheserves children and adult populations. She enjoys her job because it gives her theopportunitytooffereducationtothecommunity.Ms.SantizoisaresidentofEastGreenwichandinherfreetimeshevolunteersattheFrancisDeSaleschurch.Hercommitmentistoworkhardforabettercommunity.ClementShabaniWabenga,aformerrefugeefromtheDemocraticRepublicoftheCongo,resettledinUSAin2014andfoundhomeinRhodeIsland.Heearnedabachelordegreeinsocial work in the Congo and a certificate from the Social and Human Service AssistantProgramatRhodeIslandCollegein2016,withadditionaltrainingsinthehumanrightsfield.Mr.ShabaniiscurrentlyservingasaprojectmanagerforWomen’sRefugeeCare,anon‐profitorganizationassistingrefugeesfromtheGreatLakesRegionofAfrica(Congo,Burundi,andRwanda)livingindistressandexperiencingculturalshocktobegintheprocessofbecomingself‐sufficientandproductivemembersofAmericansociety.Hisprimaryinterestsincludeadvocacy,awareness,andsupportofminorityandunderprivilegedandvoicelesspeople.KiraWillsisaMotivationalSpeakerandCommunicationConsultantfocusingonpersonaldevelopment, community engagement, access and advocacy. Her work in the corporate,nonprofitandeducation industrieshaveprovidedherwithanuncommonperspectiveoncollaborative, strength‐based participation and action. Using the principles ofcommunication,connection,communityandcommitmentsheassistsyouthandadultsinthedevelopment of existing skills while acquiring new skills to increase their personal andprofessionalgrowth.Sheisacommunityadvocateforincreasedaccess,equityandinclusionof underrepresented racial, gender and disabled communities. It is her passion to helppeople from adverse circumstances develop agency, purpose and empowerment forthemselves and the communitieswhere they live. She serves on theProvidence JuvenileHearing Board, Leadership Rhode IslandWomen’s Network aswell as the Rhode IslandCollege President’s Inclusive Excellence Commission. Her top five Clifton Strengths areLearner,Arranger,Activator,ConnectednessandCommunication.

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AppendixC(cont.)

RhodeIslandHospitalCHNACommunityLiaisonPositionDescription

LifespanCommunityHealthInstitute

CommunityHealthNeedsAssessment–CommunityLiaison

PositionDescription

PositionSummary

Whileexcellentcareisourtoppriority,Lifespanalsorecognizesthathealthandwell‐beingismorethantheabsenceofdisease.Wepromoteacultureofwell‐being,inpartachievedbyextendingourexpertiseandservicesintocommunitieswherepeoplelive,learn,work,playandpray.Putsimply,weembraceourmissionofDeliveringhealthwithcare.A demonstration of Lifespan’s mission, the Lifespan Community Health Institute (LCHI)workstoensurethatallpeoplehavetheopportunitiestoachievetheiroptimalstateofhealththrough healthy behaviors, healthy relationships, and healthy environments. The LCHI,often in collaboration with Lifespan affiliates and/or community partners, addresses aspectrumofconditionsthataffecthealth. Oneofourmajorinitiativesin2019istoassisteach of the Lifespan hospitals‐ Rhode Island Hospital/Hasbro Children’s Hospital, TheMiriamHospital,EmmaPendletonBradleyHospital,andNewportHospital,inperformingaCommunityHealthNeedsAssessmentanddevelopingstrategiestorespondtotheidentifiedneedsoverthenextseveralyears.TheLCHIisrecruiting20‐30individualswhowillserveasCommunityLiaisons,helpingtoinfuse community input in the community health needs assessment process. TheCommunityLiaisonisatemporary,part‐timepositionthroughJune2019.Anestimated30‐50hourswillbedistributedoverthecourseof3‐4months.TheCommunityLiaisonreportstotheDirectoroftheCommunityHealthInstituteatLifespan.ThispositionisnotopentocurrentLifespanemployeesanddoesnotconferbenefits.CommunityLiaisonswillbehiredasconsultantsandpaiduponcompletionoftheproject.

Responsibilities

TheCommunityLiaisonwillassistLifespanstaffwithplanningandexecutionofatleasttwocommunity forumsaspartof thecommunityhealthneedsassessmentprocess forRhodeIslandHospital/HasbroChildren’sHospital,TheMiriamHospital,BradleyHospital,and/orNewportHospital.Thegoalofeachforumistoidentifyandprioritizelocalcommunityhealthneeds. The Community Liaison will be responsible for identifying localorganizations/institutions(e.g.neighborhoodassociations,non‐profits,churches,etc.)thatwillbewillingtohostacommunityforum.Further,theCommunityLiaisonwillassistwith

48

recruitment,logistics,facilitation,andinterpretationofeachforum.TheCommunityLiaisonwillbetrainedonexpectedtasksandrelevantdata.Primaryresponsibilitiesinclude:

TeamwithLifespanstaffandotherCommunityLiaisonstocompletetasks. Perform community outreach and recruit strategic partners to participate in the

needsassessmentprocess. Developandmaintainproductiverelationshipswithstakeholders, tocreatebuy‐in

forthecommunityhealthneedsassessmentprocess. Assist with the planning and execution of presentations for small groups and

communityorganizations,includinglogisticsandfollow‐up. Coordinateandsupportotheroutreachactivities,includingpresentationsortabling

atlargepublicevents,listeningsessionsorneighborhoodmeetings. Practiceeffectivecommunicationandreliablefollow‐upwithLifespancontactsand

communitypartners. Trackandcommunicatedetailedinformationregardingsuppliesorothersupports

neededtocompletetasks. Attendallrequiredorientationandcheck‐inmeetings.

QualificationsandCompetencies

The selected Community Liaison must demonstrate the following qualifications andcompetencies:

Trustedcommunitybrokerwithdemonstratedsuccessorganizingcommunityefforts Commitmenttoandinterestincommunityhealth Willingnesstoworkinateamenvironment,aswellastheabilitytocompletetasks

independently Thorough,timelyandreliablecommunicationskills Excellentoralcommunicationaswellasactivelisteningskills Comfortcommunicatingbyemailaswellasinperson Experienceandconfidencewithpublicspeaking Effectivemeetingfacilitation Stronginterpersonalskillsandexperienceworkingwithdiverseaudiences Abilitytoorganizeandleadgroups Willingnesstoshareandleveragepersonalandprofessionalnetworks Detail‐oriented,withexcellenttime‐managementskills Accesstoreliabletransportation Abilitytoworkeveningorweekendhours WorkingknowledgeofMicrosoftOfficesoftware,especiallyWordandPowerPoint

DesiredSkills

Thefollowingskillsarepreferred,butnotrequired: Personalorprofessionalexperienceinapublichealthorrelatedfield(e.g.community

outreachororganizing,healthcare,publicpolicy,communitydevelopment) Experienceinterpretingandexplainingdata Bilingual/BiculturalinSpanishorotherlanguagesspokeninRhodeIsland

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AppendixDRhodeIslandHospitalCHNASampleCommunityHealthForumAgenda

RHODEISLANDHOSPITAL‐2019COMMUNITYHEALTHNEEDSASSESSMENT

CommunityForumWednesday,May22,2019

HostedbyBlackstoneValleyNeighborhoodHealthStation 6:00PM Eat&VisitInformationTable

6:30PM Introductions

6:40PM OverviewofCHNAandprogresssince2016

6:50PM CurrentHealthData

7:00PM Question#1:Doesthisreflectyourhealthconcerns?

What’smissing?

7:20PM Question#2:Howwouldyouprioritizeamongthese

healthconcerns?

7:40PM Question#3:Whatwouldyoulikeforthehospitaltodo

tohelpaddressthesepriorities?

7:55PM Wrap‐Up&Evaluation

Notes:

50

AppendixERhodeIslandHospitalCHNACommunityInputForm

2019CommunityHealthNeedsAssessment‐CommunityInputForm

Lifespanseekstounderstand your health concernsand howourhospitalscanhelprespondto thoseconcerns. The information yousharewillhelpustocompleteaCommunityHealth Needs Assessmentand create anactionplan.Wevalueyourinput! 1. Towhichhospitalserviceareashouldthesecommentsbeattributed?

EmmaPendletonBradleyHospital RhodeIslandHospital/Hasbro

Children’sHospital

NewportHospital TheMiriamHospital

2. Pleasedescribeyoursignificanthealthconcerns.

3. Whatwouldyoulikethehospitaltodoinresponsetoyourconcerns?4. Pleasecommentontheprogressmadeinaddressingthe2016priorities(detailsonreverse).

5. Anyadditionalcommentsorsuggestions?

6. Pleaseshareyourcontactinformationifyouwouldliketoprovideadditionalinformation.Name:____________________________________________________________________________Email:__________________________________________Telephone:________________________

PleasevisitLifespan’sLearningfromourCommunitypage(lifespan.org/our‐community)tolearnmoreaboutthe2019CommunityHealthNeedsAssessments.Thankyouforyourinput!

51

2016CommunityHealthNeedsAssessment

ThePatientProtectionandAffordableCareAct(PPACA)requiresnon‐profithospitalstoconductaCommunityHealthNeedsAssessment(CHNA)everythreeyears.CHNAssolicitfeedbackfrommembersofthecommunitytodeterminethemostpressinghealthneedsinthecommunitythehospitalserves.CHNAsaimtoaddressbarrierstocare,theneedtopreventillness,andthesocial,behavioralandenvironmentalfactorsthatinfluencehealthinthecommunity.Basedontheneedsidentified,eachhospitaldevelopsimplementationstrategiesthatrespondtotheprioritizedneeds.In2016,LifespancompleteditssecondCHNAforeachofitshospitals.

The2016CHNAprocessforeachhospitalidentifiedthefollowingsignificantneeds:

TheMiriamHospital

1.AccesstoCareandHealthLiteracy2.CardiacHealth3.Cancer4.HealthyFoodAccess5.SubstanceUseDisorders

NewportHospital

1.AccesstoCareandHealthLiteracy2.MentalandBehavioralHealth3.SubstanceUseDisorders4.Cancer5.HealthierWeight

RhodeIslandHospital

1.AccesstoCareandHealthLiteracy2.HealthyWeightandNutrition3.SubstanceUseDisorders4.CardiacHealth5.Cancer

BradleyHospital

1.AccesstoServices2.EmergencyDepartmentEvaluation3.Transitionservicesforchildrenwhoageoutofpediatriccare

Foreachhospital,andforeachneed,animplementationplanisincludedintheCHNAreport.Thatimplementationplandescribestheactionstepsthateachhospitalwilltaketomitigatethestatedneedoverthe2017to2020fiscalyears.Pleaserefertothereportsfordetailedimplementationstrategies.

FormoreinformationregardingtheCHNAprocessorfindings,pleasecontactCarrieBridgesFeliz,DirectoroftheLifespanCommunityHealthInstitute,atcbridgesfeliz@lifespan.orgor401‐444‐8009.

LifespanCommunityHealthInstitute335RPrairieAvenue,Suite2B

Providence,RI02905Phone:401‐444‐8009

www.lifespan.org

52

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