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Community Health Needs Assessment Final Summary Report

February 2013

Backus Health System CHNA Final Report February 2013

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COMMUNITY HEALTH NEEDS ASSESSMENT E X E C U T I V E S U M M A R Y Background Backus Health System led a comprehensive Community Health Needs Assessment (CHNA) to evaluate the health needs of individuals living in the hospital’s service area defined as New London and Windham Counties, Connecticut. The study was conducted between September 2012 and January 2013. Backus Health System engaged Holleran Consulting, a research and consulting firm based in Lancaster, Pennsylvania as its research partner. The purpose of the CHNA was to gather information about local health needs and health behaviors in an effort to ensure hospital community health improvement initiatives and community benefit activities are aligned with community need. The assessment examined a variety of community, household, and health statistics to portray a full picture of the health and social determinants of health in the Backus Health System service area. Research Components

Statistical Secondary Data Profile of New London/Windham Counties Household Telephone Surveys: 401 households in 2012; 1,109

households in 2010 Key Informant Interviews with 49 community stakeholders Focus Group Discussions with healthcare consumers

The CHNA research was reviewed by Backus Health System and its Advisory Task Force. A review of the research findings and a facilitated Prioritization Session was held with community partners to identify priority needs within the community. Backus Health System reviewed feedback from the Prioritization Session, along with its current services and programs, resources and areas of expertise, and other existing community assets, to determine what identified needs it would address, and those it would play a support role in addressing. The following needs were identified by Backus Health System as its priority areas for the following three-year cycle: Community Health Issues

Access to Care Preventative Health, Including Management of Chronic and

Infectious Disease, Respiratory Health, and Obesity Mental Health, Including Substance Abuse


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COMMUNITY HEALTH NEEDS ASSESSMENT HOSPITAL & COMMUNITY PROFILE

Hospital Overview Established in 1893, The William W. Backus Hospital health system includes a not-‐for-‐profit, 213-‐bed hospital in Norwich and numerous off-‐site locations, including several health centers, Backus Home Health Care and the Backus Outpatient Care Center, also in Norwich.

The Outpatient Care Center offers a wide range of services including a weight loss center, diabetes center, arthritis center, physical therapy, radiology, laboratory services, woundcare, a hyperbaric oxygen chamber, anti-‐coagulation clinic, and more.

Backus Health Centers are located in Montville, Ledyard, Colchester and Plainfield, and additional labs for blood draws are available throughout the region.

Backus offers the only trauma center in New London and Windham counties and is the only area hospital with LIFE STAR helicopter services, in partnership with Hartford Hospital. A new Backus Emergency Care Center, offering emergency services 24 hours per day, seven days per week, as well as diagnostic imaging and laboratory services, will open in the summer of 2012.

Backus is accredited as a comprehensive community hospital cancer program, one that offers the best in cancer care close to home for patients.

The health system includes a strong minimally-‐invasive surgery program, offering services from interventional radiology to the da Vinci surgical robot. Backus is the only hospital in New London or Windham counties with robotic capabilities.

The Emergency Department serves more than 60,000 people per year, and consistently receives some of the highest patient satisfaction scores in the nation.

Backus employs 1,800 people.

The Backus Medical Staff includes approximately 300 expert physicians offering a wide range of healthcare services.

Definition of Service Area Backus Health System defines the communities it serves as a primary, secondary and ancillary service area. The Primary Service Area represents approximately 75% of the Hospital’s inpatient discharges. The Secondary Service Area represents approximately 90% of the Hospital’s inpatient discharges.


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Acknowledging that the Backus Health System extends beyond the walls of the Hospital, Backus leaders included an “ancillary” service area encompassing all remaining towns in New London and Windham Counties. Pieces of the Health System, including outpatient health centers, and a full-‐service, 24/7 satellite emergency department, touch patients residing in all towns in Eastern Connecticut.

CHNA Background Backus Health System led a comprehensive Community Health Needs Assessment (CHNA) to evaluate the health needs of individuals living in the hospital’s service area defined as New London and Windham Counties, Connecticut. The CHNA included research from a 2010 CHNA combined with research conducted between July 2012 and January 2013. Backus Health System engaged Holleran Consulting, a research and consulting firm based in Lancaster, Pennsylvania as its research partner. The purpose of the CHNA was to gather information about local health needs and health behaviors in an effort to ensure hospital community health improvement initiatives and community benefit activities are aligned with community need. The assessment examined a variety of community, household and health statistics to portray a full picture of the health and social determinants of health in the Backus Health System service area. The findings from the CHNA were utilized by Backus Health System to prioritize public health issues and develop a Community Health Implementation Strategy. Backus Health System is committed to the people it serves and the communities they live in. Healthy communities lead to lower health care costs, robust community partnerships, and an overall enhanced quality of life.


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Methodology

The CHNA was comprised of both quantitative and qualitative research components, and is a combination of 2010 and 2012 data. A brief synopsis of the research components is included below with further details provided throughout the document:

Quantitative Data: A Secondary Data Profile was compiled in November 2012 to depict population and household statistics, education and economic measures, morbidity and mortality rates, incidence rates, and other health statistics across New London and Windham Counties.

A Statistical Household Telephone Survey was conducted from September to December 2012 with 461 randomly-‐selected community residents, focusing on the ancillary service area. The survey augmented a 2010 study of 1,109 households in the primary and secondary service area. Between the two studies, Backus Health System created a representative sample of the whole of New London and Windham Counties, broken down by its Primary, Secondary, and Ancillary Service Areas. The survey, modeled after the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), assessed health status, health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. The same survey instrument was used in the 2010 and 2013 studies.

Qualitative Data:

Key Informant Interviews were conducted in November 2012 with community representatives. In total, 49 community leaders participated, representing a variety of sectors including public health and medical services, staff and professionals from Federally Qualified Health Centers (FQHC), non-‐profit and social organizations, children and youth agencies, faith-‐based institutions, culturally diverse communities, and the business community. The face-‐to-‐face interviews were conducted by Holleran. Please refer to Appendix A for the detailed list of key informants.

Three Focus Groups were held in December 2012 with 24 healthcare consumers, representing culturally diverse populations, individuals with chronic conditions, and underserved populations within the community. Holleran facilitated all sessions and compiled the reports.

LIMITATIONS OF STUDY: It should be noted that limitations of the research may have prevented the participation of some community members. Language barriers, the use of a random digit landline telephone methodology (vs. including cell phone lines), the lack of an online/ internet survey, and the time lag of secondary data may present some research limitations. Backus Health System sought to mitigate limitations by including representatives of diverse and underserved populations in the qualitative research components.


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Existing Resources to Address Community Health Needs

Research Partner Backus Health System contracted with Holleran, an independent research and consulting firm located in Lancaster, Pennsylvania, to conduct research in support of the CHNA. Holleran has more than 20 years of experience in conducting public health research and community health assessments. The firm provided the following assistance:

1) Collected and interpreted secondary data 2) Conducted, analyzed, and interpreted data from Household Telephone Survey 3) Conducted, analyzed, and interpreted data from Key Informant Interviews 4) Conducted Focus Groups with healthcare consumers 5) Facilitated a Prioritization and Implementation Planning Session 6) Prepared the Final Report and Implementation Strategy

Community engagement and feedback were an integral part of the CHNA process. Backus Health System sought community input through interviews with key community stakeholders, focus groups healthcare consumers, and inclusion of community partners in the prioritization and implementation planning process, as well as members of an advisory task force. Public health and health care professionals shared knowledge and expertise about health issues, and leaders and representatives of non-‐profit and community-‐based organizations provided insight on the community served by Backus Health System including medically underserved, low income, and minority populations. Following the completion of the CHNA research, Backus Health System prioritized community health issues and developed an implementation plan to address prioritized community needs.

The William W. Backus Health System LEARNAlliance for Living Ledge Light Health DistrictAmerican Ambulance Local and State Police DepartmentsBackus Home Health Care Local Fire DepartmentsBethsaida Community Madonna PlaceCatholic Charities Natchaug HospitalChild & Family Agency North East Health DistrictCity of Norwich Reliance HouseCommunity Health Center, Inc. Senior ResourcesConnecticut Community Care Incorporated SouthEastern Council on Alcohol and Drug DependenceDanielson Homeless Shelter SouthEastern Mental Health AuthorityDay Kimball Hospital SouthEastern Regional Action CouncilDepartment of Children & Family St. James ShelterDepartment of Developmental Services St. Vincent DePaul Place Soup KitchenDepartment of Social Services Thames Valley Council for Community ActionGemma Moran Food Bank Uncas Health DistrictGenerations United Community & Family ServicesHospice of SouthEastern Connecticut United WayHospitality Center, Norwich Visiting Nurse Association of SouthEastern ConnecticutLawrence & Memorial Hospital Windham Hospital


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RESEARCH OVERVIEW

Secondary Data Profile A Secondary Data Profile for New London and Windham Counties was created to depict existing demographic and health statistics. Data sources included the U.S. Census Bureau, Centers for Disease Control and Prevention, National Cancer Institute, Connecticut Department of Health and local health departments, Robert Wood Johnson Foundation, among other sources. The profile details data covering the following areas:

Population Statistics Household Statistics Income/Employment Statistics Education Statistics Mortality Statistics Birth Statistics Sexually Transmitted Illness Statistics Injury & Violence Prevention Statistics Communicable Disease Statistics Environmental Health Statistics Health Behaviors Crime Statistics

This section serves as a summary of the key takeaways from the secondary data profile. A full report of all of the statistics is available through Backus Health System.


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Demographics The table below illustrates the age breakdown of residents in Backus Health System’s total service area compared to the state and national proportions. In line with state and national figures the largest percentage of residents are age 45-‐54 at 16.9% of the population with a median age of 39.4. Seventy-‐eight (78) percent of the population is age 18 or older; 13.8 percent of the population is age 65 or older. Table A1 Population by Age (2010)

U.S. Connecticut Backus Total Service Area

n % n % n % Under 5 20,201,362 6.5 202,106 5.7 21,487 5.5 5 – 9 20,348,657 6.6 222,571 6.2 23,181 5.9 10 – 14 20,677,194 6.7 240,265 6.7 24,701 6.3 15 – 19 22,040,343 7.1 250,834 7.0 27,815 7.1 20 – 24 21,585,999 7.0 227,898 6.4 27,738 7.1 25 – 34 41,063,948 13.3 420,377 11.8 46,321 11.9 35 – 44 41,070,606 13.3 484,438 13.5 52,173 13.4 45 – 54 45,006,716 14.6 575,597 16.1 63,765 16.3 55 – 59 19,664,805 6.4 240,157 6.7 26,921 6.9 60 – 64 16,817,924 5.4 203,295 5.7 22,333 5.7 65 – 74 21,713,429 7.0 254,944 7.2 28,217 7.2 75 – 84 13,061,122 4.3 166,717 4.7 17,364 4.5 85 and over 5,493,433 1.8 84,898 2.4 8,061 2.1 Median Age 37.2 40.0 39.4 % 18 years or over 76.0% 77.1% 78.1% % 65 years or over 13.0% 14.2% 13.8%

Source: U.S. Census Bureau, 2010


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The racial breakdown of Backus Health System’s service area residents is primarily White (89.4%). The table below shows the racial breakdown of the Backus Health System service area. The percentage of African American (4.8%) and Hispanic/Latino residents (8.9%) is lower when compared to the state and national comparisons. Table A2 Racial Breakdown (2010) a

Source: U.S. Census Bureau, 2010 a Percentages may equal more than 100% as individuals may report more than one race


n % n % n % White 223,553,265 72.4 2,772,410 77.6 328,961 84.3 Black/African American 38,929,319 12.6 362,296 10.0 18,639 4.8

American Indian/ Alaska Native 2,932,248 0.9 11,256 0.3 3,063 0.8

Asian 14,674,252 4.8 135,565 3.8 12,748 3.3 Native Hawaiian or Other Pacific Islander

540,013 0.2 1,428 0.0 223 0.1

Two or more races 9,009,073 2.9 92,676 2.6 12,728 3.3 Hispanic or Latino (of any race)b 50,477,594 16.3 479,087 13.4 34,524 8.9


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Table A3 below shows the primary language(s) spoken at home. As reflected with the racial breakdown, residents in the Backus Health System speak English only at a higher percentage than the state and nation. Table A3 Language Spoken at Home, 5 Years Old and Older (2010)

Source: U.S. Census Bureau, ACS estimates


Population 5 years old and over 283,833,852 3,340,358 365,995

English only 79.9% 79.4% 87.0%

Language other than English 20.1% 20.6% 13.0%

Speak English less than "very well" 8.7% 8.1% 5.2%

Spanish 12.5% 10.2% 6.1%


Other Indo-European languages 3.7% 7.8% 4.4%


Asian and Pacific Islander languages 3.1% 2.1% 2.2%



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The household statistics display a majority of family households (66%) and married-‐couple families (49%); these figures are comparable to the national and state percentages. Also comparable to national and state figures are the percentage of households with a female householder and no husband present (12%) and the percentage of non-‐family households (34%). The chart below illustrates these statistical household comparisons.

Table A4 Households by Type (2010) U.S. Connecticut Total Service Area

n % n % n %

Total households 116,716,292 100.

0 1,371,087 100.0 150,834

Average household size 2.6 -- 2.5 -- 2.5 --

Average family size 3.1 -- 3.1 -- 3.0 --

Family households 77,538,296 66.4 908,661 66.3 99,491 66.0

Male householder, no wife 5,777,570 5.0 59,675 4.4 7,400 4.9

With own children under 18 yrs. 2,789,424 2.4 26,178 1.9 3,676 2.4

Female householder, no husband 15,250,349 13.1 176,973 12.9 18,108 12.0

With own children under 18 yrs. 8,365,912 7.2 97,651 7.1 10,657 7.1

Husband-wife families 56,510,377 48.4 672,013 49.0 73,983 49.0

Nonfamily households 39,177,996 33.6 462,426 33.7 51,343 34.0

Householder living alone 31,204,909 26.7 373,648 27.3 40,364 26.8

Source: U.S. Census Bureau, 2010


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Figure A1 displays a comparison of Median Household Income of the Backus Health System Total Service, Primary Service, Secondary Service Area, and Ancillary Service compared to the state and national data. As a whole, the total service displays a lower median household income than the state, which is higher than the U.S. The Ancillary Service Area has the highest Median Household Income ($66,516), with the Primary Service Area next highest ($64,369), and the Secondary Service Area reflecting a lower Median Household Income ($61,690).

Figure A1 Median Household Income (2010).


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Figure A2 shows Education Rates in the Total Service Area as compared to the state and nation. While High School graduation rates (88.2%) are on par with the state rates (88.4%), the percent of residents with bachelor’s degrees or higher (27.6%) lags behind the state results (35.2%).

Table A2: Educational Attainment, Population 25 Years and Over (2010)

U.S. Connecticut Total Service

Area

Less than 9th grade 6.2% 4.7% 4.0%

9th to 12th grade, no diploma 8.7% 7.0% 7.8%

High school graduate (includes equivalency) 29.0% 28.6% 33.2%

Some college, no degree 20.6% 17.3% 19.5%

Associate's degree 7.5% 7.3% 7.9%

Bachelor's degree 17.6% 19.9% 15.4%

Graduate or professional degree 10.3% 15.3% 12.2%

Percent high school graduate or higher 85.0% 88.4% 88.2%

Percent bachelor's degree or higher 27.9% 35.2% 27.6%

Source: U.S. Census Bureau, ACS estimates


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Health Statistics

A higher percentage of residents in the Backus Health System service area die from the top three leading causes of death in the Nation (diseases of the heart, cancer, and chronic lower respiratory disease). As illustrated in Table B1, the leading cause of death for residents in Backus Health System service area is elevated above the state or national statistics in the following areas: Heart Disease, 26.1% (compared to 25.1% for CT and 24.6% for U.S.), Cancer, 23.8% (compared to 23.6% for CT and 23.3% for U.S.) and Chronic Lower Respiratory Diseases, 6.1% (compared to 5.0% for CT and 5.6% for U.S.).

Table B1. Top 10 Leading Causes of Death, All Ages (2007 -‐ 2009)

U.S.a Connecticut Total Service

Area

The following are the top 10 leading causes of death in ranking order of the United States.

Diseases of heart 24.6% 25.1% 26.1%

Malignant neoplasms (Cancer) 23.3% 23.6% 23.8%

Chronic lower respiratory diseases 5.6% 5.0% 6.1%

Cerebrovascular diseases (Stroke) 5.3% 5.0% 4.9%

Accidents (Unintentional injuries) 4.8% 4.6% 4.8%

Alzheimer’s disease 3.2% 2.8% 3.4%

Diabetes Mellitus 2.8% 2.2% 2.1%

Influenza and pneumonia 2.2% 2.5% 2.3%

Nephritis, nephrotic syndrome and nephrosis

2.0% 2.0% 1.8%

Intentional self-harm (Suicide) 1.5% 1.0% 1.2%


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As depicted in Table B2, the incidence rate for lung cancer is higher in the Backus Health System service area (78.2) than in Connecticut (74.3) and the Nation (69.6). Additionally, the mortality rate for lung cancer and all cancer sites combined is higher in the Backus Health System service area (55.2 and 204.3 respectively) than in Connecticut (49.9; 192.3), the Nation (52.1; 185.8), and Healthy People 2020 (45.5; 160.6).

Table B2. Cancer Mortality by Site (2007 – 2009)a

Healthy People 2020 U.S. Connecticut Total Service Area

Rate n Rate n Rate n Rate Female breast 20.6 N/A 23.0b 1,488 * 151 * Colorectal 14.5 158,470 17.4 1,734 16.5 190 17.2 Lung 45.5 475,433 52.1 5,252 49.9 607 55.2 Prostate 21.2 85,652 19.0 1,092 * 115 * All Sites 160.6 1,695,955 185.8 20,233 192.3 2,252 204.3

Sources: Center for Disease Control and Prevention, 2009; Connecticut Department of Public Health, 2009; National Cancer Institute, 2005 – 2009 a Crude rates per 100,000 population b Statistic represents 2005-‐2009 data *Crude rates cannot be calculated for aggregated data Related to respiratory health, the annual hospitalization rates for Asthma are higher for both children and adults in the Backus Health System service area (18.5 and 15.1 respectively) than in Connecticut (17.8; 11.1). Table B3 presents the findings. Table B3. Annual Hospitalizations for Asthma (2001 -‐ 2005)a, b

Connecticut Total Service Area

n Rate n Rate

Adults 18 years and over 2,900 11.1 1,793 15.1

Children 0-17 years old 1,500 17.8 708 18.5

Source: Connecticut Department of Public Health, 2001-‐2005 a Crude rates per 10,000 population based on 2000 Census b The towns of Ashford, Brooklyn, Canterbury, Chaplin, Eastford, Franklin, Hampton, Lebanon, North Stonington, Pomfret, Scotland, Sterling, Voluntown, and Woodstock are not included due to insufficient counts


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Turning to Communicable Disease, the Acute Hepatitis C rate is higher in the Backus Health System service area (2.8) compared to Connecticut (1.3), the Nation (0.3), and Healthy People 2020 (0.2). See table B4. The rate of confirmed Lyme disease cases is higher in the Backus Health System service area (82.2) than in Connecticut (56.0) and the Nation (7.3). See table B5. Table B4. Hepatitis Cases (2011)a

Healthy People 2020

U.Sb Connecticut Total Service

Area

Rate n Rate n Rate n Rate Acute Hepatitis A 0.3 1,670 0.5 18 0.5 2 * Acute Hepatitis B N/A 3,350 1.1 19 0.5 2 * Chronic Hepatitis B N/A N/A N/A 351 9.8 36 9.2 Acute Hepatitis C 0.2 850 0.3 47 1.3 11 2.8 Sources: Center for Disease Control and Prevention, 2010; Connecticut Department of Public Health, 2011 a Crude rates per 100,000 population b Statistics represent 2010 data * Rate not calculated for counts less than 5 Table B5. Confirmed Lyme Disease Cases (2011)a

U.Sb Connecticut Total

Service Area

Primary Service

Area

Secondary Service

Area

Ancillary Service

Area Number of cases 22,561 2,006 320 131 75 114 Crude rate 7.3 56.0 82.2 97.9 54.9 95.9 Sources: Center for Disease Control and Prevention, 2010; Connecticut Department of Public Health, 2011 a Crude rates per 100,000 population b Statistics represent 2010 data Health Factors

New London and Windham Counties have more adult smokers (19.0% and 20.0% respectively) than Connecticut (16.0%) and the National Benchmark (14.0%). Windham County has more obese adults and physical inactivity (30.0% and 26.0% respectively) than New London County (24.0%; 23.0%), Connecticut (23.0%; 23.0%) and the National Benchmark (25.0%; 21.0%).

Windham County has a higher motor vehicle crash death rate and teen birth rate (17.0 and 29.0 respectively) than New London County (11.0; 26.0), Connecticut (9.0; 24.0), and the National Benchmark (12.0; 22.0). The patient to primary care physician ratio is greater in New London County (1,098:1) and Windham County (1,333:1) than in Connecticut (729:1) and the National Benchmark (631:1).


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The preventable hospital stays rate is higher in New London County (70.0) and Windham County (75.0) than in Connecticut (63.0) and the National Benchmark (49.0). Nine (9) percent of residents in New London County have limited access to healthy foods. This is in comparison to Windham County (0.0%), Connecticut (5.0%), and the National Benchmark (0.0%). Forty (40) percent of restaurants in Windham County are fast food establishments. This is in comparison to New London County (35.0%), Connecticut (38.0%), and the National Benchmark (25.0%). The following Table C1. Health Behaviors (2012)

National

Benchmarkc Connecticut

New London County

Windham County

Adult smoking 14.0% 16.0% 19.0% 20.0% Adult obesity 25.0% 23.0% 24.0% 30.0% Physical inactivity 21.0% 23.0% 23.0% 26.0% Excessive drinking 8.0% 18.0% 18.0% 17.0% Motor vehicle crash death ratea 12.0 9.0 11.0 17.0

Chlamydia ratea 84.0 346.0 244.0 229.0 Teen birth rateb 22.0 24.0 26.0 29.0

Source: County Health Rankings, 2012 a Rates per 100,000 population b Rates per 1,000 population c National Benchmark represents the 90th percentile and is not an average Table C2. Clinical Care (2012)

National Benchmarka

Connecticut New London

County Windham

County Uninsured adults 12.0% 10.0% 9.0% 11.0% Patient to primary care physician ratio 631:1 729:1 1,098:1 1,333:1

Preventable hospital staysb 49.0 63.0 70.0 75.0 Diabetic screeningc 89.0% 83.0% 84.0% 85.0% Mammography screeningc 74.0% 71.0% 76.0% 71.0%

Source: County Health Rankings, 2012 a National Benchmark represents the 90th percentile and is not an average b Hospitalization rate for ambulatory-‐care sensitive conditions per 1,000 Medicare enrollees c Percent of Medicare enrollees receiving screenings


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Table C3. Physical Environment (2012)

National Benchmarkb Connecticut

New London County

Windham County

Air pollution- particulate matter days 0 4 0 0

Air pollution- ozone days 0 6 4 4 Limited access to healthy foods 0.0% 5.0% 9.0% 0.0%

Access to recreational facilitiesa 16.0 14.0 11.0 12.0

Fast food restaurants 25.0% 38.0% 35.0% 41.0% Source: County Health Rankings, 2011 a Rates per 100,000 population b National Benchmark represents the 90th percentile and is not an average Crime Statistics

The larceny and rape rates in the Backus Health System Hospital service area (1,066.4 and 24.7 respectively) are lower than the national comparison of 2,003.5 and 27.5. However, they are notably larger than in Connecticut (586.6 and 16.8 respectively). Table D1. Crime Offenses (2010)a

U.S Connecticut Total Service Area

n Rate n Rate n Rate Murder 14,748 4.8 132 3.7 6 1.6 Rape 84,767 27.5 599 16.8 77 24.7 Robbery 367,832 119.1 3,554 99.4 147 44.6 Aggravated Assault 778,901 252.3 5,792 162.1 464 137.8 Burglary 2,159,878 699.6 15,158 424.1 1,423 416.2 Larceny 6,185,867 2,003.5 56,705 586.6 3,329 1,066.4 Motor Vehicle Theft 737,142 238.8 6,656 186.2 274 85.2 Arson 56,825 19.6 424 11.9 47 13.1

Sources: Federal Bureau of Investigation, 2010; Connecticut Department of Public Safety Public Safety, 2010 a Crude rates per 100,000 population * Rate not calculated for counts less than 5


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HOUSEHOLD TELEPHONE SURVEY OVERVIEW A household survey was conducted among residents of Backus Health System service area. The telephone survey was based on the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a national initiative, headed by the Centers for Disease Control and Prevention (CDC) that assesses health status and risk factors among U.S. citizens. The following pages illustrate the key findings from the 2012 survey of 401 adults in the Ancillary Service Area and the 2010 study of 1,109 adults in the Primary and Secondary Service Areas. References to the Backus Health System Total Service Area refer to the aggregated results of the Primary, Secondary, and Ancillary Service Areas. A full report of the survey is available from Backus Health System. Areas of Strength The following are areas where Backus Health System residents fare better, or healthier, than the state of Connecticut and/or the Nation as a whole. The Total Service Area is referenced, but only those areas in which all three service areas (Primary, Secondary, and Ancillary) fare better than Connecticut and/or the Nation are included unless otherwise noted. Significant differences among the Primary, Secondary, and Ancillary Service Areas are noted when they exist.

General health status: The proportion of residents in the Total Service Area who reported very good or excellent health in general (57.7%) is higher compared to the Nation (51%) and is in line with the state benchmark.

Health care access: The proportion of residents in the Total Service Area who have health care coverage is greater (90.1%) when compared to the Nation (83.2%) and in line with the state benchmark of 90.6%. Fewer residents in the Total Service Area (11.7%) compared to the Nation (16.8%) reported that cost prohibited them from seeking healthcare when they needed it. However, while the outcomes for all three service areas are more favorable than the Nation, only the Primary and Secondary Service Areas are significantly different than the Nation. All figures for cost prohibitive health care are in line with the state benchmark of 11%. The proportion of residents in the Total Service Area who visited a doctor for a routine checkup within the past year (74.1%) is higher when compared to the Nation (67.9%), and in line with the state (72.8%). However, differences exist by service area. The outcomes for all three service areas are more favorable than the Nation, but only the Ancillary and Primary Service Areas are significantly different than the Nation.

Healthy days: The proportion of residents in the Total Service Area who reported that they felt sad, blue, or depressed on zero days of the past 30 days (65.3%) is higher compared to the Nation (60.8%). All three service areas have more favorable outcomes than the Nation, but only the Ancillary Service Area is significantly different than the Nation.


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Exercise in previous month: A higher proportion of residents in the Total Service Area (83.6%) exercised in the previous month when compared to the state (75.8%) and the Nation (74.4%).

Diabetes and Pre-‐diabetes: Residents in the Total Service Area are more likely to have never been diagnosed with pre-‐diabetes or borderline diabetes (94.5%) when compared to the state (92.1%) and the Nation (91.1%). Related, residents are more likely to have never been diagnosed with diabetes (90.4%) when compared to the state (87.7%) and the Nation (87.2%). However, while the outcomes for all three service areas are more favorable than the state and the Nation for diabetes and pre-‐diabetes, only the Ancillary Service Area is significantly different than the state and the Nation.

Flu Shot: A higher proportion of residents in the Total Service Area (44.7%) had a seasonal flu shot during the past 12 months compared to the Nation (39.9%). However, only the Ancillary and Secondary Service Areas are more favorable than the Nation. The proportion of residents in the Primary Service Area who received a seasonal flu shot during the past 12 months (40.0%) is in line with the National benchmark and is significantly less than the proportion in the Ancillary Service Area (49.1%).

Women’s Preventive Health: Female residents in the Total Service Area are more likely to have had a clinical breast exam (94.3%) compared to females across the Nation (89.8%); however, only the proportion for the Ancillary Service Area is significantly different than the Nation. More women in the Total Service Area (96.8%) also report having had a Pap Test than in Connecticut (93.6%) and the U.S. (93.8%). However, the only significant difference is between the Secondary Service Area and Connecticut.

Men’s Preventive Health: Male residents in the Total Service are more likely to have had a PSA test (62.3%) compared to males across the Nation (53.5%); however, only the Ancillary Service Area is significantly different than the Nation. Likewise, 79% of males have had a digital rectal exam as compared to the Nation (73.4%). All three service areas have more favorable outcomes than the Nation for this factor, but none are significantly different than the Nation.

Colonoscopy Screening: A higher proportion of residents age 50 and over in the Total Service Area reported that they have had a sigmoidoscopy or colonoscopy (75.1%) compared to residents across the Nation (62.0%). However, only the Secondary and Ancillary Service Areas are significantly different than the Nation.

HIV: The proportion of residents in the Total Service Area between the ages of 18 and 64 who have ever been tested for HIV (54.8%) is higher when compared to the state (32.6%) and the Nation (35.9%). In addition, the proportion of residents in the Secondary Service Area who have ever been tested for HIV (59.2%) is higher when compared to the Primary Service Area (49.3%).


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Areas of Opportunity The following are areas where Backus Health System residents in at least one of the three service areas fare worse, or less healthy, than the state of Connecticut and/or the Nation as a whole. Differences between service area outcomes are noted.

Calculated BMI: More residents in the Total Service Area (27.8%) are considered obese when compared to the state (23.3%). In addition, more individuals in the primary (30.4%) and secondary (30.3%) service areas are obese than the Ancillary Service Area (21.3%), and more residents in the Primary Service Area (43.3%) are considered to be overweight than in the Secondary (34.4%) and Ancillary (34.8%) Service Areas.

Depressive disorder: The proportion of residents in the Total Service Area who have been told by a health professional that they have a depressive disorder (18.7%) is higher when compared to the state (16.3%). However, the proportion of residents in the Ancillary Service Area who have been told by a health professional that they have a depressive disorder (14.1%) is lower when compared to the state.

Permanent teeth removal: More residents in the Total Service Area have had their teeth removed because of tooth decay or gum disease than in Connecticut. Specifically, 57.1% report no teeth removed versus 62.3% in the state. Likewise, Total Service Area residents are more likely to report having had six or more but not all teeth removed (10.3% vs. 7.2% for the state) and all of their permanent teeth removed (5.3% vs. 2.6% for the state). Individually, residents in the Ancillary Service Area are more likely to have had their teeth removed than residents throughout Connecticut.

Asthma: The proportion of residents in the Total Service Area who reported having ever been told that they have asthma (19.1%) is higher compared to the state (13.9%) and the Nation (13.5%). However, while the outcomes for all three service areas are less favorable than the state and the Nation, only the outcomes for Ancillary and Secondary Service Areas are significantly different. For those that have asthma, a higher percentage (41.2% in the Total Service Area as compared to 35.6% in the Nation) had an asthma attack in the past 12 months and 21.2% visited an emergency room or urgent care center more than three (3) times because of their asthma. Residents in the Secondary Service Area are more likely to have had an asthma attack in the past 12 months compared to residents in the Ancillary Service Area and the Nation. They are also more likely to have visited an emergency room or urgent care center than residents across the Nation.

Pneumonia shot: A lower proportion of residents in the Total Service Area (31%) had a pneumonia shot during the past 12 months as compared to the state (35.2%). Residents in the Primary Service Area were less likely to receive a pneumonia shot than residents in the Secondary and Ancillary Service Areas, Connecticut, and the Nation.


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Seatbelt use: The proportion of residents in the Total Service Area who always use seat belts when driving or riding in a car (87.7%) is lower when compared to Connecticut (90.0%). In particular, the proportion of residents in the Ancillary Service Area who always use seat belts when driving or riding in a car (86.3%) is lower when compared to Connecticut (90.0%).

Smoking habits: The proportion of residents in the Total Service Area who have smoked at least 100 cigarettes in their entire life is higher (51.1%) when compared to the state (45.3%) and the Nation (45.0%). In addition, the proportion of residents who now smoke every day (29.9%) is higher when compared to the state (21.9%). In particular, residents in the Primary and Ancillary Service Areas are more likely to have smoked at least 100 cigarettes in their life compared to residents across the state and the Nation.

Binge drinking: More residents in the Total Service Area report binge drinking during the past 30 days when compared to Connecticut (66.6% report no days of binge drinking versus 77.6% for Connecticut). In addition, the proportion of residents who participated in binge drinking on two or more occasions during the past 30 days (23.4%) is higher when compared to the state (12.9%).

Health Status

In line with Connecticut and more favorable than the Nation, 86.2% of residents in the combined total service are self-‐report that their general health is very good or excellent. Related, residents in the Ancillary Service Area were more likely than residents in the Primary and Secondary Service area to report that there were “no days” in the last 30 days that their mental and physical health was not good.


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The proportion of residents who have been told by a health professional that they have a depressive disorder (18.7%) is higher when compared to the state (16.3%). However, the proportion of residents in the Ancillary Service Area who have been told by a health professional that they have a depressive disorder (14.1%) is lower when compared to the state.


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Access to Care Residents in the Backus Health System service area are more likely to have health insurance coverage than the U.S. benchmark.

However, residents in the Total Service Area are less likely to report that they have one person they think of as their primary care provider. When comparing the individual service areas, residents in the Ancillary Service are more likely to report one health care provider than residents in the Primary or Secondary Service Areas.


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Residents in the Total Service Area are more likely to have had a routine check-‐up in the last 12 months when compared to Connecticut or U.S. However, differences exist by service area. Residents in the Ancillary Service Area (76.5%) and the Primary Service Area (74.1%) are more likely to have had check-‐up in the last year than the U.S. Benchmark (67.9%).


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Residents in the Secondary Service Area were more likely to seek care at the hospital Emergency Department because they could not get an appointment with a doctor or clinic.

Physical Activity and Overweight Residents in the Total Service Area were more likely to report regular physical activity than the Connecticut and U.S. benchmarks. However, the proportion of obese residents in the Total Service is 27.8% compared to 23.3% in Connecticut, and 27.2% in the U.S.


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A breakdown of Calculated BMI shows that the Primary and Secondary Service Area are more overweight or obese than the Ancillary Service Area.


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Diabetes Residents in the Backus Health System Service Area are less likely to have been told by a health care professional they have diabetes or pre-‐diabetes. However, those residents who report having diabetes are less likely to regularly check their blood sugar levels or feet for sores. They are also less likely to have seen a health care professional for care for their diabetes. In particular, diabetic residents in the Primary and Secondary Service Areas are less likely to properly care for their chronic disease.


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Women’s Health

Women in the Backus Health System Service Area are more likely than women across the U.S. to have had a mammogram in the last 12 months and to have ever had a clinical breast exam. They are also more likely than U.S. or state respondents to have had a Pap test. In particular, women in the Ancillary Service Area are more likely to have had a clinical breast exam and women in the Secondary Service Area are more likely to have had a Pap test.


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Men’s Health

Men in the Backus Health System Total Service Area are more likely to have had a PSA test than the U.S. (62.3% versus 53.5%, respectively) and are in line with the state figure of 81.1%. They are also more likely than the U.S. comparison group to have received a digital rectal exam (79% versus 73.4%). Men in the Ancillary Service Area are more likely to have had a PSA test than men across the Nation.


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Risk Factors A greater percentage of residents in the Backus Health System service area (51.1%) report having smoked at least 100 cigarettes in their lifetime when compared to the state (43.3%) and U.S. (45%). Furthermore, 29.9% of residents report that they still smoke every day, a higher percentage than state residents (21.9%). More people in the Primary and Ancillary Service Areas have smoked at least 100 cigarettes in their lifetime compared to the state and the Nation. Residents in the total service area are also more likely than Connecticut or U.S. residents to report using chewing tobacco, snuff, or snus every day.

Respondents were also asked how often they were exposed to secondhand tobacco smoke. Residents in the Ancillary Service Area were more likely to report being exposed to secondhand smoke at their workplace on one to two of the last seven days. Anecdotal feedback from community leaders suggests this may be related to workers within the casino industry.


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Other risk factors of note include seatbelt use and binge drinking. Residents in the Total Service Area are less likely to always wear a seatbelt when driving or riding in a car (87.7%) when compared to Connecticut (90.0%). In particular, residents in the Ancillary Service Area are less likely to never wear a seatbelt when driving or riding in a car. More residents in the Total Service Area also report binge drinking during the past 30 days when compared to Connecticut (66.6% report no days of binge drinking versus 77.6% for Connecticut). In addition, the proportion of residents who participated in binge drinking on two or more occasions during the past 30 days (23.4. %) is higher when compared to the state (12.9%).


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KEY INFORMANT INTERVIEWS

Face-‐to-‐face interviews were held with 49 key community stakeholders. The questionnaire focused on perceptions of community needs and strengths across three key domains:

Access to care Key health issues and challenges Quality of life

Key Informants included public health experts, representatives of underserved populations, chronic disease conditions, and other special populations. The goal of the research was to better understand leaders’ perception of community health and to uncover health disparities, barriers to accessing health care, and other areas of opportunities, and to gather recommendations and feedback. Among the questions asked of the interviewees was “What do you perceive as the three most significant (most severe or most serious) health issues in the community?” Figure G1 shows the Key Informants’ opinions of key health issues for the Backus Health System. Obesity and Mental Illness were selected most frequently as an issue. Obesity was ranked as the most urgent need, followed by Substance Abuse.

Figure G1: Informant opinions of key health issues for Backus Health System service area.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Obesity Mental Illness Heart Disease Diabetes Substance Abuse

Cancer Domestic/Family Violence/Abuse

of Children

Sexually Transmitted

Diseases

Stroke

Key Health Issues

Percent of respondents selecting the issue Percent of respondents (selecting this issue) who marked it as most urgent


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Strengths It was made clear by numerous Key Informants that Backus Health System is held in high regard in the greater Norwich community. There is a real sense of pride of the local health system. It was also clear that the hospital had improved over the years, was moving in the right direction, and genuinely cared about the community and the health of its residents. The interviews showed a high level of dedication among the community-‐based agency directors and staff. Respondents were glad to share their expertise and offer suggestions to improve the quality of life for their patients and clients. Barriers to Care Key Informants identified cost, transportation, and the lack of health insurance as the three main barriers to care. Additionally, many medical specialists in the Norwich area do not accept Husky (Medicaid) public health insurance, forcing individuals to travel to New Haven or Hartford to seek providers who accept the insurance. Large minority populations including Latino/Hispanic, Chinese, and Haitian, in and around Norwich, present challenges for the healthcare system, community service providers and the public schools to provide culturally competent services. The economic downturn of the nearby casino industry is a likely a contributor to the issue of cost as a barrier to care. Transportation was listed as a barrier to accessing care throughout the study. Key Informants acknowledged that the current transportation infrastructure does not adequately and efficiently aid residents in getting to the health services they need, when they need them. When transportation is a barrier, residents are forced to use more costly health care delivery options, such as the emergency department. It may also impede them from keeping health appointments that could help them prevent disease or better manage chronic conditions. Recommendations for Community Health Improvement Survey respondents saw opportunities for policy change to encourage healthier lifestyles. A greater investment in upstream prevention and more widespread education were at the top of their suggestions. They saw promise in increasing community collaborations, in better engaging the faith community, and in Backus Health System using its good name and reputation as a “convener” to stimulate more community dialogue and advocacy. They see a need for more affordable recreation, more access to fresh fruits and vegetables, more health screenings, and more employee wellness programs. Survey respondents saw opportunities for policy change to encourage healthier lifestyles. A greater investment in upstream prevention and more widespread education were at the top of their suggestions. They saw promise in increasing community collaborations, in better engaging the faith community, and in Backus Hospital using its good name and reputation as a “convener” to stimulate more community dialogue and advocacy. They see a need for more affordable recreation, more access to fresh fruits and vegetables, more health screenings, and more employee wellness programs.


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FOCUS GROUPS

Three Focus Groups were conducted with healthcare consumers December 19-‐20 in Norwich, Connecticut. The groups lasted 90 minutes each. Participants received a $50 Wal-‐Mart gift card in appreciation for their time and participation. In total 24 individuals participated in the group. In consultation with Backus Health System representatives, Holleran created a discussion guide, consisting of 15 questions designed to illicit responses and group discussion around barriers to care, cultural competency, and communication channels. The following section provides a summary of the focus group discussions including key themes and select comments. A full report of the study can be obtained from Backus Health System. Strengths Most participants were aligned with a medical home and see their family doctor regularly. It was acknowledged that area health care providers had made positive inroads to improve multi-‐language communications. The availability, awareness, and success of health improvement programs were consistent throughout the discussion. Partnerships between health providers and social services were seen as positive and an important framework for community health improvement. Health information is distributed widely across the community and participants listed a variety of sources ranging from family and friends to media, community organizations, and their physician. Respondents in the group actively sought out health and wellness opportunities (a tendency that may be elevated due to some participant’s involvement in a health care advisory capacity). Backus Health System was seen as a health leader and recognized for its outreach efforts. A variety of Backus-‐supported services were recognized by the group as examples of programs and services that are working well. Participants encouraged Backus to continue these partnerships and seek out additional opportunities. Opportunities While improvements were noted by the participants, a common theme was the need for continued cultural competency training. Limited access to care due to provider capacity, as well as few specialists accepting Husky Insurance, was discussed. Some participants thought the Husky drug formulary was limited. Participants recommended extending office hours, particularly for primary care providers. Individuals who seek health information are able to access it through a variety of local resources. The library was seen as a free resource to access health information that could be improved by training staff about accessing health information and providing a welcoming environment for all residents. Some in the group saw the variety of health care system options as confusing and disjointed. The opportunity to provide additional health and wellness programs including “integrated medicine,” employee wellness, and physician talks were noted.


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Continued use of a variety of channels to disseminate information was encouraged, as well as the creation of a speakers’ bureau or similar opportunity to tap into experts from across health and human services organizations to provide community education. A specific need for drug and alcohol abuse and gambling awareness was noted. Participants viewed Norwich as a “car community” and observed there were limitations for opportunities to be active, despite several parks and organized activities. Transportation and cost were seen as the biggest barriers to accessing recreational activities. In general, respondents had a positive view of Backus Health System and its work to improve community health. Building on past successes, focus group participants offered a wide variety of ways that Backus can continue to improve its community health efforts. Participants offered suggestions that ranged from improved interaction with physicians to health literacy and cultural competency to using foreign-‐trained professionals to provide services. FINAL RESEARCH CONCLUSIONS

The Backus Health System CHNA provided a comprehensive view of community health needs and an unbiased lens through which the Health System could view community health needs. The methodology included a secondary data profile of New London and Windham Counties, a 1,500-household telephone study (1,109 conducted in 2010; 461 conducted in 2012), 49 key informant interviews, and three focus groups. Holleran collected all data.

The following Key Themes emerged throughout the Community Health Needs Assessment:

Prevalence of Obesity

Prevalence of Respiratory Disease: Asthma/Lung Cancer and Smoking

Less Prevalence of Diabetes, but those diagnosed are less likely to manage their condition well

Access to Care issues exist, specifically, physician/patient ratio, Medicaid health insurance acceptance, and transportation

Increased Cultural Competency is needed in delivering care to ethnic groups

Increased diagnosis of Depression

Need for increased preventative health measures: mammograms, pneumonia shots, seatbelt usage

Need for more widely available Oral Health Care

Need to reduce Preventable Hospitalizations

Increased rates of Lyme Disease, Hepatitis B

Increased Binge Drinking


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PRIORITIZATION OF COMMUNITY NEEDS

Backus Health System hosted a Prioritization Session on January 23, 2013 to identify key community needs. Approximately 25 individuals ranging from Health System representatives, health and human services providers, public health experts, and other community organizations attended the half-‐day session. A list of participants is included in Appendix B. All participants were Key Informants and, as such, had expert knowledge of community health needs.

The meeting began with a research overview followed by facilitated discussion to identify the most pressing community needs. Participants were provided with information regarding the prioritization process, criteria to consider when evaluating key areas of focus, and other aspects of health improvement planning, such as goal setting and developing strategies and measures. Holleran facilitated discussion of overlapping issues, root causes of health, and the ability for regional health and human services providers to effectively address the various needs. After some consolidation and a considerable amount of dialogue, a list of needs was developed by the attendees. The following list was considered the “master list” of needs to be evaluated as potential priority areas for community health improvement activities.

Master list of community priorities (in no particular order) along with brief notes of the discussion for each:

Obesity & Related Chronic Conditions (diabetes mgmt) Respiratory Disease: Asthma/Lung cancer (Smoking) Access to care (physician ratio/insurance, cultural comp, other barriers, hospitalizations) Mental Health: Depression & Anxiety Preventative Health (Mammograms, Pneumonia Shots, oral health, seatbelts) Substance Abuse Built Environment Infectious Disease

Once the master list was compiled, participants were then asked to rate each need based on two criteria. The two criteria included seriousness of the issue and the ability to impact the issue. Respondents were asked to rate each issue on a 1 (not at all serious; no ability to impact) through 5 (very serious; great ability to impact) scale. The ratings were gathered instantly and anonymously through a wireless audience response system. Each attendee received a keypad to register their vote. The following tables reveal the results of the voting exercise.


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Master List Seriousness Rating (average)

Impact Rating (average)

Access to Care 4.46 3.96

Preventative Health 4.08 4.17

Chronic Conditions 4.44 3.79

Respiratory Health 4.04 3.58

Mental Health 4.00 3.25

Infectious Disease 3.13 3.33

Substance Abuse 3.54 2.92

Built Environment 3.46 2.79

The priority area that was perceived as the most serious was Access to Care (4.46 average rating), followed by Chronic Conditions (4.44 average rating). The ability to impact Preventative Health was rated the highest at 4.17, followed by Access to Care with an impact rating of 3.96. The matrix below outlines the intersection of the seriousness and impact ratings. Those items in the upper right quadrant are rated the most serious and with the greatest ability to impact.


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In a planning session following the Prioritization Session, Backus Health System reviewed its internal expertise, existing programs and services, and resources to identify what needs it would play a lead role in addressing and for which needs it would play a supporting role. Backus Health System determined that it was prepared to address the most serious and urgent needs as identified by the research and their community partners:

Access to Care Preventative Health, Including Management of Chronic and Infectious Disease,

Respiratory Health, and Obesity Mental Health, Including Substance Abuse

A separate Implementation Strategy reflects its specific goals and plans to address these identified needs.


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APPENDIX A

Key Informant Participants

Name Title OrganizationGregory Allard Executive Director American Professional ServicesDiana Boisclair Executive Director/Director of Finance Backus Home Health Care & The William W. Backus HospitalMarek Kukulka Executive Director Catholic CharitiesJoAnn Eaccarino Director of School Based Health Centers Child & Family AgencyJohn Wong President Chinese & American Cultural Assistance AssociationDeborah Pennuto Executive Director Encounters of Hope (Encuentros de Esperanza)Estime Jozil Pastor First Haitian Baptist ChurchJudith Gaudet Norwich Site Manager Generations Family Health Center, Inc.Dr. Colleen Casey Norwich Region Medical Director Generations Family Health Center, Inc.Fran Boulay Medial Operations Director Generations Family Health Center, Inc.Carol Mahier Executive Director Hospice, Southeastern ConnecticutSamantha Descombes Registered Nurse Hospice, Southeastern ConnecticutKathy Sinnett, APRN School Nurse Kelly Middle School Based Health CenterBaker Salsbury Director of Health Ledgelight Health DistrictNancy Gentes Executive Director Madonna PlaceSandra Berardy Director of Health Mashantucket Pequot Tribal Nation Department of HealthScott Sjoquist Director of Health Mohegan Tribal Health DepartmentSusan Starkey Director of Health Northeast District Department of HealthRobert Mills Executive Director Norwich Community Development CorporationLee-‐Ann Gomes Assistant Director Norwich Human ServicesBethany DuVal School Nurse Supervisor Plainfield Public SchoolsMyra Ambrogi Director of Health Plainfield Recreation DepartmentBrian Armstrong Executive Director Sensations Charitable FoundationDonna Laroux RN/Supervisor Sheltering Arms/Ross Adult Day CenterMichele Devine Executive Director Southeastern Regional Action CouncilJillian Corbin Executive Director St. Vincent DePaul PlaceMary Guertin Director of Head Start Thames Valley Council for Community ActionDeborah Barrett Health Manager Thames Valley Council for Community ActionDeborah Monahan Executive Director Thames Valley Council for Community ActionDr. Robert Sidman Chief of Emergency Services The William W. Backus HospitalKeith Fontaine Vice President & CAO The William W. Backus HospitalAlice Facente Community Health Nurse The William W. Backus HospitalPaul Sweet First Selectman Town of PlainfieldPatrick McCormack Director of Health Uncas Health DistrictCindy Arpin Public Health Nurse Uncas Health DistrictYolanda Bowes Director, Outreach Services United Community and Family ServicesHeather Gatchek Access to Care Specialist United Community and Family ServicesNancy Cowser Vice President, Planning United Community and Family ServicesMelinda Wilson Finance Analyst United Community and Family ServicesDr. Ramindra Walia Chief Medical Officer & Pediatrician United Community and Family ServicesNancy Holte Nurse Care Coordinator, Primary Care United Community and Family ServicesKelcey Johnson Program Manager, Smiles on the Move United Community and Family ServicesSarah Arlinghause Care Coordinator United Community and Family ServicesFred Fetta Bettor Choice Coordinator United Community and Family ServicesLinda Fooks Customer Service Administrative CoordinatorUnited Community and Family ServicesDiane Manning President & CEO United ServicesDr. Kartik Viswanathan Physician West Side Medical CenterMuralda C.N.A.Cynthia C.N.A.


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APPENDIX B

Prioritization Session Participants

Name Agency

Thomas Reynolds United Way

Nancy Cowser United Community & Family Services

Jillian Corbin St. Vincent DePaul Soup Kitchen

Lee-‐Ann Gomes Norwich Human Services

Kelcey Johnson United Community & Family Services

Yolanda Bowes United Community & Family Services

John Wong Chinese American Cultural Association

Beverly Goulet Norwich Human Services

Gregory Allard American Ambulance

Patrick McCormack Uncas Health District

Cindy Arpin Uncas Health District

Bethany Duval Plainfield School Nurse Coordinator

Kathy Sinnett APRN, Norwich Public Schools

Michele Devine South Eastern Regional Action Council

Deborah Monahan Thames Valley Council for Community Action

David Yovaisis Thames Valley Council for Community Action

Scott Sjoquist Mohegan Sun Tribal Health Director

Dee Boisclair Backus Home Health Care

Sue Starkey Northeast District Department of Health

Robert Mills Norwich Community Development Corporation

Shawn Mawhiney Backus Hospital

Alice Facente Backus Hospital

Lisa Cook Backus Hospital

Janette Edwards Backus Hospital

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