raising hope. giving health. together, we make a difference

RAISING HOPE. GIVING RAISING HOPE. GIVING HEALTH. TOGETHER, WE HEALTH. TOGETHER, WE

MAKE A DIFFERENCEMAKE A DIFFERENCE

2012-20132012-2013

YORK HOSPITAL COMMUNITY YORK HOSPITAL COMMUNITY HEALTH CENTERHEALTH CENTER

YHCHC MISSION YHCHC MISSION STATEMENTSTATEMENT

The York Hospital Community Health The York Hospital Community Health Center meets the medical needs of Center meets the medical needs of the underserved by:the underserved by: Providing excellent healthcare Providing excellent healthcare Educating the healthcare providers of Educating the healthcare providers of

the futurethe future Working to improve the health of the Working to improve the health of the

communitycommunity

LORETTA CLAIBORNE BUILDINGLORETTA CLAIBORNE BUILDING

YHCHC VALUESYHCHC VALUES

IInnovation – We will try anything within our nnovation – We will try anything within our means to improve the care of our patientsmeans to improve the care of our patients

EEffectiveness – We make clinical and ffectiveness – We make clinical and operational decisions based on the best operational decisions based on the best information available, including capitalizing information available, including capitalizing on opportunities to provide preventative careon opportunities to provide preventative care

YHCHC VALUESYHCHC VALUES

RRespect – We treat our patients and each espect – We treat our patients and each other as we would want to be treatedother as we would want to be treated Wear name tag at all times while working Wear name tag at all times while working Personal communication is made or received Personal communication is made or received

while not in the presence of a patientwhile not in the presence of a patient Patients are given our undivided attentionPatients are given our undivided attention Patients are asked “how they prefer to be Patients are asked “how they prefer to be

addressed?”addressed?” Health education is provided but the patient’s Health education is provided but the patient’s

right to make an independent choice is right to make an independent choice is respectedrespected

YHCHC VALUESYHCHC VALUES

CCompassion – We provide care that we ompassion – We provide care that we are proud to provide and would be are proud to provide and would be proud to receiveproud to receive Assist patients and their families with Assist patients and their families with

directions if they are confused or lostdirections if they are confused or lost Make sure our body language and our Make sure our body language and our

words communicate kindness and respect.words communicate kindness and respect. TTimeliness – We provide care when our imeliness – We provide care when our

patients want and need to receive care patients want and need to receive care

RAISING HOPERAISING HOPE

OUR PATIENT POPULATIONOUR PATIENT POPULATION

Young, primarily single femalesYoung, primarily single females Poor: Income of </=$21,780 annuallyPoor: Income of </=$21,780 annually 25% Latino/Hispanic;25%Caucasian;24% 25% Latino/Hispanic;25%Caucasian;24%

non-White, non-African-American;14% non-White, non-African-American;14% African-AmericanAfrican-American

12% Spanish-only speakers12% Spanish-only speakers Many access care by walking to our Many access care by walking to our

facilityfacility

GIVING HEALTHGIVING HEALTH

OB/GYN RESIDENT OB/GYN RESIDENT PHYSICIANSPHYSICIANS

OB/GYN RESIDENT OB/GYN RESIDENT PHYSICIANSPHYSICIANS

SERVING THE UNDERSERVEDSERVING THE UNDERSERVEDFY 2010-2011FY 2010-2011

21,778 patient visits, lab services, 21,778 patient visits, lab services, immunizations and other clinical immunizations and other clinical services services

2,664 patients served2,664 patients served 655 obstetrical deliveries655 obstetrical deliveries 157 outpatient surgeries performed157 outpatient surgeries performed

CERVICAL CANCER CERVICAL CANCER PREVENTIONPREVENTION

Cervical cancer is caused by the human Cervical cancer is caused by the human papilloma virus (HPV)papilloma virus (HPV)

HPV is sexually transmitted and often HPV is sexually transmitted and often produces no symptomsproduces no symptoms

The prevalence of HPV in the The prevalence of HPV in the reproductive age population is very reproductive age population is very high: 75% of sexually active adultshigh: 75% of sexually active adults

The pap smear screens for pre-The pap smear screens for pre-cancerous cells caused by the HPV viruscancerous cells caused by the HPV virus

CERVICAL CANCER CERVICAL CANCER PREVENTIONPREVENTION

Virtually all cervical cancers are Virtually all cervical cancers are preventablepreventable

The key to prevention is screening The key to prevention is screening with a pap smearwith a pap smear

Women with abnormal pap smears Women with abnormal pap smears are recommended to undergo are recommended to undergo colposcopycolposcopy

CERVICAL CANCER CERVICAL CANCER PREVENTION INITIATIVEPREVENTION INITIATIVE

Role of colposcopy Role of colposcopy What is colposcopy?What is colposcopy? Where is it done?Where is it done? Who does the procedure?Who does the procedure? How long does it take?How long does it take? When are results available?When are results available?

CERVICAL CANCER CERVICAL CANCER PREVENTION INITIATIVEPREVENTION INITIATIVE

Patients with severely pre-cancerous cells Patients with severely pre-cancerous cells on pap smear screening were referred for on pap smear screening were referred for evaluationevaluation

Many patients fail to follow through with Many patients fail to follow through with these appointmentsthese appointments

By offering comprehensive services on By offering comprehensive services on site, we anticipate better patient site, we anticipate better patient compliance and a reduction in cervical compliance and a reduction in cervical cancercancer

COLPOSCOPECOLPOSCOPE

TREATMENT OF PRE-TREATMENT OF PRE-CANCEROUS CELLSCANCEROUS CELLS

LEEP procedure (Loop electrosurgical LEEP procedure (Loop electrosurgical excision procedure)excision procedure)

Removes pre-cancerous cellsRemoves pre-cancerous cells Currently cannot be performed in our Currently cannot be performed in our

office due to lack of equipment;patients office due to lack of equipment;patients are referred to Gyn Oncologyare referred to Gyn Oncology

Non-compliance rates for evaluation and Non-compliance rates for evaluation and treatment of pre-cancerous cells are high treatment of pre-cancerous cells are high

LEEP MACHINELEEP MACHINE

LEEP ELECTRODESLEEP ELECTRODES

CERVICAL CANCER CERVICAL CANCER PREVENTION INITIATIVEPREVENTION INITIATIVE

By providing comprehensive screening By providing comprehensive screening services to the greatest number of services to the greatest number of women in our patient populationwomen in our patient population

In evaluating and treating these women In evaluating and treating these women with pre-cancerous conditions in a with pre-cancerous conditions in a familiar setting with a health care team familiar setting with a health care team they are comfortable with, cervical they are comfortable with, cervical cancers can be prevented…allowing cancers can be prevented…allowing women to better care for their familieswomen to better care for their families

CASE STUDY- AHCASE STUDY- AH

22 year old woman presented to 22 year old woman presented to YHCHC with abdominal pain for 24 YHCHC with abdominal pain for 24 hourshours

Her pregnancy test was found to be Her pregnancy test was found to be positivepositive

The physical exam was inconclusiveThe physical exam was inconclusive An ultrasound showed a fetus in her An ultrasound showed a fetus in her

fallopian tube and an empty uterusfallopian tube and an empty uterus

CASE STUDY-AH (CONT’D)CASE STUDY-AH (CONT’D)

She was referred for immediate surgery at She was referred for immediate surgery at York HospitalYork Hospital

The patient underwent surgical removal of The patient underwent surgical removal of the fallopian tube and was discharged the fallopian tube and was discharged within 24 hourswithin 24 hours

This was a life-saving procedureThis was a life-saving procedure Her other tube appeared normal and her Her other tube appeared normal and her

chance of a future successful pregnancy is chance of a future successful pregnancy is goodgood

OB AND GYN ULTRASOUNDOB AND GYN ULTRASOUNDSCREENING SCREENING

Pregnant patients in our population Pregnant patients in our population are often uncertain about when they are often uncertain about when they conceivedconceived

Knowledge of their ‘gestational age’ Knowledge of their ‘gestational age’ is key to determining when to screen is key to determining when to screen for various conditions in pregnancyfor various conditions in pregnancy

OB/GYN ULTRASOUND OB/GYN ULTRASOUND SCREENINGSCREENING

Approximately one in five pregnant Approximately one in five pregnant women have threatened women have threatened miscarriages or ectopic gestationsmiscarriages or ectopic gestations

Ectopic pregnancy can be a life Ectopic pregnancy can be a life threatening conditionthreatening condition

A distinction between a ‘viable’ vs. A distinction between a ‘viable’ vs. ‘non-viable’ pregnancy can be made ‘non-viable’ pregnancy can be made by ultrasoundby ultrasound

ECTOPIC PREGNANCYECTOPIC PREGNANCY

Can be life threatening and is one of Can be life threatening and is one of the most frequent causes of the most frequent causes of maternal mortalitymaternal mortality

Often underdiagnosed and patient Often underdiagnosed and patient can present with tubal rupturecan present with tubal rupture

Due to the demographics of our Due to the demographics of our patient population, they often only patient population, they often only seek care when the situation is seek care when the situation is emergentemergent

ECTOPIC PREGNANCYECTOPIC PREGNANCY

Can be diagnosed with an early Can be diagnosed with an early ultrasound and lab studiesultrasound and lab studies

Surgery can be avoided in some Surgery can be avoided in some casescases

Early treatment can preserve future Early treatment can preserve future fertility and prevent emergency fertility and prevent emergency surgical interventionsurgical intervention

PRENATAL COMPLICATIONSPRENATAL COMPLICATIONS

Preterm birth and fetal growth Preterm birth and fetal growth restriction are increased in the restriction are increased in the underserved populationunderserved population

It is imperative to have an accurate It is imperative to have an accurate assessment of the patient’s due dateassessment of the patient’s due date

This is determined by a first trimester This is determined by a first trimester ultrasoundultrasound

FETAL ULTRASOUNDFETAL ULTRASOUND

CASE STUDY: RHCASE STUDY: RH

29 year old female who presented to the 29 year old female who presented to the emergency department by ambulance, emergency department by ambulance, complaining of abdominal pain and complaining of abdominal pain and delivering a preterm fetus at 18 weeks’ delivering a preterm fetus at 18 weeks’ gestationgestation

She required admission to the hospital She required admission to the hospital and underwent surgical evacuation of a and underwent surgical evacuation of a retained placentaretained placenta

CASE STUDY: RH (CONT’D)CASE STUDY: RH (CONT’D)

Patient found to have multiple Patient found to have multiple uterine fibroid tumors as the cause uterine fibroid tumors as the cause for her pregnancy lossfor her pregnancy loss

Within several months of her loss, Within several months of her loss, she was treated with Depo-Lupron, a she was treated with Depo-Lupron, a medication which temporarily shrinks medication which temporarily shrinks the fibroidsthe fibroids

On 2/16/11, she underwent surgical On 2/16/11, she underwent surgical removal of the fibroidsremoval of the fibroids

CASE STUDY: RH (CONT’D)CASE STUDY: RH (CONT’D)

Patient presented to YHCHC on 11/23/11 Patient presented to YHCHC on 11/23/11 and was found to be 10 weeks pregnantand was found to be 10 weeks pregnant

She is undergoing serial ultrasounds to She is undergoing serial ultrasounds to check cervical length due to her history of check cervical length due to her history of preterm laborpreterm labor

She is undergoing careful follow-up for She is undergoing careful follow-up for gestational diabetesgestational diabetes

She currently is doing very well at 25 She currently is doing very well at 25 weeks gestationweeks gestation

ULTRASOUND AT YHCHCULTRASOUND AT YHCHC

Current machine is unable to discern far Current machine is unable to discern far fields, requiring referral to another site for fields, requiring referral to another site for accurate assessment in high risk casesaccurate assessment in high risk cases

Patients may not undergo recommended Patients may not undergo recommended follow-up ultrasound studies due to follow-up ultrasound studies due to transportation and other barrierstransportation and other barriers

This can lead to delays in diagnosis and This can lead to delays in diagnosis and unncessary emergency dept visits and unncessary emergency dept visits and patient emergenciespatient emergencies

TOGETHER, WITH YOUR TOGETHER, WITH YOUR SUPPORT, WE CAN MAKE A SUPPORT, WE CAN MAKE A

DIFFERENCEDIFFERENCE

QUESTIONS?QUESTIONS?