greene county hip 5-31-17 - iowahip/hip progress...exercise during "jump-start" monday...

Greene CountyHealth Improvement Plan Date Updated: May 31, 2017

For additional information, CONTACT:

Name Organization Phone Email

Becky Wolf Greene Co. Medical Center-Public Health 515-386-3228 [email protected]

of 31 Health Improvement PlanGreene County May 31, 2017

Community Priority

Goal #1 By 2021, the rate of childhood obesity in Greene County will decrease.

National Alignment State Alignment

Objective 1-1 By 2021, the rate of childhood obesity in Greene County students (Kindergarten-3rd grade), will decrease by 4%, as evidenced by annual school assessments of BMIs.

Baseline Year2016

Baseline Value

17.25%

Target Year2021

Target Value

13.25%

Strategy 1-1.1 Greene County school nurses will collect and share annual measurement data regarding height, weight, and body mass index (BMI) with Greene County Public Health.

Strategy TypeAddress Social Determinant / Health Inequity

Who's ResponsibleSchool nurses for Greene County school districts (Greene Co. Schools and Paton-Churdan School).

Target Date10/31/2021

Report DateMay 21, 2017

Progress on Strategy

Complete On track✔ Off track No progress

Progress notes: School nurses analyze BMIs annually, but feel BMI results in K-3rd may not accurately reflect childhood obesity due to current body build and "baby weight," etc. Addressing BMI at older age/higher grade level may be more comprehensive and accurate.

Objective 1-2 By 2021, the rate of childhood obesity in Greene County children (ages 4 months-five years) who are served by Greene County Public Health immunization clinics will decrease by 2%, as evidenced by regular assessments of BMIs.

Baseline Year2016

Baseline Value12%

Target Year2021

Target Value10%


Year2017

Value21.3%

Progress on ObjectiveMet, trend in right directionMet, no trend

Met, trend in wrong direction

Not met, trend in right directionNot met, no trend

Not met, trend in wrong direction✔

Progress notes: Implemented process to weigh/measure children and share healthy eating information with parents during child health clinic visits, but it's more realistic to utilize school nurse data to assess BMI in kids K-3rd, especially since the school is providing activities and education. Due to less frequent encounters with children at PH IMMs clinics, the data analysis and response to education would be less reliable. 21.3% = the % of obese students K-3rd in Greene County School District. Education regarding appropriate nutritional choices per age is still important for the four months-five years age range to avoid early onset of obesity.

Strategy 1-2.1 Greene County Public Health nurses will collect measurement data regarding height, weight, and BMI during immunization clinic visits.


Who's ResponsibleGreene County Public Health nurses




Complete On track Off track No progress✔

Progress notes: Strategy not realistic to make a difference; see Objective 1-2.

Strategy 1-2.2 Greene County Public Health nurses will provide education to parents regarding the importance of healthy food choices, portion sizes, and regular activity during


immunization encounters. Strategy TypeCounseling & Education

Who's ResponsibleGreene County Public Health




Complete On track Off track✔ No progress

Progress notes: Developed process of tracking and sharing educational materials, but minimal encounters logged since May 2016. RNs feel challenged to accomplish several tasks per child (immunizations, dental & developmental screenings). Need improved tracking consistency to take credit for work done.

Objective 1-3 By 2021, the number of Greene County community partners who serve families with children (ages 4 months through nine years) and provide education regarding the importance of increased physical activity and decreased screen time (TV, computers, phones, etc.) will reach at least five.

Baseline Year2016

Baseline Value

0

Target Year2021

Target Value

5


Year2017

Value4



Not met, trend in right direction✔

Not met, no trend

Not met, trend in wrong direction

Progress notes: Greene County Community Center offers "Recharge Wednesdays," and local libraries sponsor learning activities during "early-out" Wednesdays. 55 kids registered for "Recharge Wednesdays;" usually 40 show up. Once a month, Greene County school RN teaches a new exercise during "jump-start" Monday sessions. The PE teacher does a lot with prevention, talking about the benefits of healthy choices and daily exercise, reaching approximately 400 students between the two elementary school activities. ISU Extension offers multiple classes targeting healthy eating and limiting screen time. Through grant funding the Community Center plans to develop a Frisbee golf course and walking trail at Daubendiek park within Jefferson city limits. An ISU student is working on a project to connect all parks in Jefferson via a safe and family-friendly walking trail.

Strategy 1-3.1 Educational materials regarding the negative impact of increased screen time will be developed to share with community partners who serve young families.

Strategy TypeCounseling & Education

Who's ResponsibleGreene County Iowa State Extension; Greene County HOPES staff




Complete✔ On track Off track No progress

Progress notes: Greene County HOPES curriculum, which focuses on early brain development and learning behaviors, includes discussions/materials to share with young families regarding this topic. Greene Co. ISU Extension offers four programs to target screen time through healthy activities/behaviors.

Strategy 1-3.2 Educational materials will be distributed to community partners, with the intent of sharing with parents during encounters.








Progress notes: Need to create stock of curriculum to share with community partners for consistent messaging, using materials form HOPES program and ISU Extension.

Objective 1-4 By 2021, the utilization of community educational activities targeting healthy food choices, portion sizes, and physical activity for children will increase from 45 in 2015 to 60 in 2021.

Baseline Year2016

Baseline Value

45

Target Year2021

Target Value

60


Year2017

Value440

Progress on ObjectiveMet, trend in right direction✔

Met, no trend




Progress notes: Greene County Community Center offers "Recharge Wednesdays," and local libraries sponsor learning activities during "early-out" Wednesdays. Once a month, Greene County school RN teaches a new exercise during "jump-start" Monday sessions, and the PE teacher does a lot with prevention, talking about the benefits of healthy choices and daily exercise for a total of 400 students. (Value = total # of children reached through above activities).

Strategy 1-4.1 Develop increased promotional efforts and affordability of registration fees for "Recharge Wednesdays" classes to Greene County children in elementary grade levels.


Who's ResponsibleGreene County Community Center staff

Target DateSep 6, 2017




Progress notes: No cost for for this program; subsidized by cash donations from McFarland Clinic-Jefferson.

Strategy 1-4.2 Libraries in Greene County will offer educational activities to promote healthy food choices, portion sizes, and the benefits of physical activities for elementary-aged children who visit the libraries on Wednesday afternoons.


Who's ResponsibleLocal Greene County librarians

Target DateMay 15, 2018




Progress notes: Libraries are a community gathering place, especially on early-out Wednesdays for kids with working parents, but need to ensure consistency of information offered.

Strategy 1-4.3 Provide information regarding the "Love and Logic" program, which stresses the importance of regular physical activity and healthy food choices, to parents of children attending kindergarten roundup/health clinics each spring.


Who's ResponsibleNew Opportunities, Inc.






Progress notes: Unable to offer "Love and Logic" due to cancellation of kindergarten clinic this spring. Program is promoted in other venues serving families. Next class scheduled for June 2017. Information is shared at coalition and community resource council meetings, and with community partners; and promoted on social media.

Strategy 1-4.4 Provide information regarding the potential negative health risks related to Adverse Childhood Experiences, (ACES), to parents during public health encounters, utilizing the evidence-based curriculum,Growing Great Kids (GGK).


Who's ResponsibleGreene County Public Health HOPES and nursing staff





Progress notes: ACES study is completed with each family enrolled in the Greene County HOPES and 1st Five programs, as a requirement of each program.

Objective 1-5 By 2021, the promotion of healthy food choices offered by various community partners (cafeteria menus, vending machines, grocery stores, restaurants) will increase by 50%.

Baseline Year2016

Baseline Value

5

Target Year2021

Target Value

10


Year2017

Value2




Not met, no trend


Progress notes: Jefferson Hy-Vee provides a basket of fresh fruit near the produce section with signage encourages parents to allow children to grab a piece for free. Cafeteria menu selections at Greene County Medical Center have been revamped to include some healthier options, available to both employees, visitors, and the public. Still need to meet with other community partners regarding healthy menu and vending machine options.

Strategy 1-5.1 Collaborate with local grocery store dietitians to consider offering free fresh fruit and vegetables for children to try during grocery visits with their parents.


Who's ResponsibleLocal Hy-Vee and Fareway dietitians





Progress notes: Jefferson Hy-Vee has a basket of fresh fruit near the produce section; signage encourages parents to have children grab piece for free. Still need to meet with Fareway dietitian to encourage similar strategy.

Strategy 1-5.2 Through increased promotion regarding the benefits of improved eating habits provided by Greene County Public Health, local businesses, employers, and schools will implement an increased number of healthy food choices offered in vending machines.

Strategy TypeLong-Lasting Protective Intervention

Who's ResponsibleLocal business, employers, and Greene County school districts






Progress notes: Meeting with partners will need to be scheduled.

Strategy 1-5.3 Area dietitians to work with owners of restaurants to review kids' menu items with goal of offering healthy side options, such as fruit or veggies with dip, plus milk.

Strategy TypeClinical Intervention

Who's ResponsibleMedical Center and local grocery store dietitians, and restaurant owners





Progress notes: Meeting with dietitians needs to be scheduled.

Strategy 1-5.4 Collect point-of-sale data regarding the purchase of healthy foods at local retailers in Greene County.







Progress notes: Types of food products sold at tobacco point-of-sale locations (2016 data): Of 64% who accepted SNAP, 55% sold whole grain cereal, pasta, brown rice; of 18% who accepted WIC, 91% sold fresh, frozen, or canned fruits/vegetables; of 82% who sold skim or low fat/1% milk, 45% sold lean protein, such as uncooked eggs, lean ground beef, or deli meat; of 27% who sold low fat or fat-free dairy items, such as cheese or yogurt, 27% sold all four types of lean protein, including uncooked eggs, ground beef, whole cuts of meat, and luncheon meat. Source: Iowa Point-of-Sale (POS) Tobacco Audits, 2016, in Greene County, Iowa; IDPH. Published October 2016.

Goal #2 By 2021, access to comprehensive maternal and child health services for low-income population will improve


Objective 2-1 By 2017, the number of contacts with prenatal mothers and children, ages birth to 19, enrolled in the Greene County Public Health Title V-funded Maternal-Child Health (MCH) program, will increase by 15%

Baseline Year2016

Baseline Value798

Target Year2017

Target Value969


Year2016

Value647





Progress notes: OB services and Advanced Women's Clinic at Greene County Medical Center shuttered August 2016, decreasing referral source for prenatals. To increase contacts/service provision, Greene Co. MCH staff met with area providers (Carroll, Boone, Lake City, Ames, Ft. Dodge) who now serve Greene Co. expectant mothers and children, to inform them of available services for families.

Strategy 2-1.1 Increase referrals to the MCH program by strengthening care coordination and outreach with community partners who serve pregnant mothers and children who are low-income.



Who's ResponsibleGreene County Public Health, Advanced Women's Clinic, McFarland Clinic, UnityPoint Clinic, New Opportunities, Inc. (WIC provider)





Progress notes: See Objective 2-1 Progress Notes. Improved care transition efforts have resulted in more referrals from ED and local clinic providers. Recently improved referral tally process to include MCH referrals.

Strategy 2-1.2 Increase referrals to the MCH program by strengthening care coordination and outreach with community partners who serve children who are low-income, to ensure that they receive appropriate services (presumptive eligibility, care coordination, dental screening/education, developmental screenings, lead screenings,social worker and nursing visits)


Who's ResponsibleGreene County Public Health MCH and HOPES staff





Progress notes: See Objective 2-1 Progress Notes. Met with new dentist who opened Jefferson office August 2016. Need to improve process to capture referrals to MCH program. Plan to establish CH medical home with UnityPoint Clinic providers for families to receive comprehensive services as a "one-stop" well-child visit.

Strategy 2-1.3 Improve promotion of the Greene County Maternal-Child Health (MCH) program through community outreach, brochure material development, and use of social media.


Who's ResponsibleGreene County Public Health, Greene County Medical Center Community Relations





Progress notes: See Objective 2-1 Progress Notes. MCH brochure updated and shared during any encounters with families. HOPES and MCH programs provide a reciprocal referral stream to each other. Additional opportunities to increase social media exposure. Packets developed, including updated MCH brochure, and shared with families and providers during encounters.

Objective 2-2 By 2017, as a Title V MCH sub-contractor for Webster County Health Department, the First Five program will be implemented locally to serve Greene County children, birth-five, who may have developmental or behavioral concerns.

Baseline Year2016

Baseline Value

0

Target Year2017

Target Value

20


Year2017

Value33


Met, no trend




Progress notes: Successful program. Referrals to/from HOPES, MCH, local providers, ED, etc.

Strategy 2-2.1 Greene County Public Health will provide information about the benefits and the referral process for the First


Five program to health care providers who serve Greene County children, birth-five.


Who's ResponsibleGreene County Public Health and Webster County Health Department





Progress notes: Because of program importance and the at-risk population in Greene County, will continue outreach to engage/educate all providers who serve families in Greene County. Provider training offered: ACES, autism, benefits of First Five program.

Objective 2-3 By 2021, the number of low birth weight babies will decrease by 2%.

Baseline Year2015

Baseline Value8.8%

Target Year2021

Target Value6.8%


Year2016

Value10%





Progress notes: Greene Co. MCH staff met with area providers (Carroll, Boone, Lake City, Ames, Ft. Dodge) who serve Greene Co. expectant mothers and children to inform them of available services for families. OB service at Greene County Medical Center (GCMC) shuttered August 2016, as did Advanced Women's Clinic. Improved care transition efforts have resulted in increased referrals from ED and local clinic providers. Recently improved referral tally process to include MCH referrals. 100% of all enrolled HOPES and MH expectant clients receive education regarding risks and prevention of low birth weight deliveries. MCH staff are present at monthly WIC clinics to engage with expectant mothers and encourage enrollment in MH and HOPES programs.

Strategy 2-3.1 Increase referrals to the MCH program by strengthening care coordination and outreach with community partners who serve pregnant mothers who are low-income.


Who's ResponsibleGreene County Public Health, Advanced Women's Clinic, McFarland Clinic, UnityPoint Clinic, New Opportunities, Inc. (WIC provider)





Progress notes: Ongoing-See Strategy 2-1.2. Will extend target date to allow for outreach of additional partners.

Strategy 2-3.2 Increase the number of expectant mothers enrolled in Greene County Public Health's Healthy Opportunities for Families to Experience Success (HOPES), an in-home parenting program which reinforces prenatal education, including healthy pregnancy practices, reportable signs/symptoms, and ways to prevent pre-term labor.


Who's ResponsibleGreene County Public Health HOPES staff






Progress notes: Seven prenatals enrolled in HOPES program for 2016. Continue to collaborate with partners to ensure appropriate linkage of community services. Will extend target date due to importance of objective.

Strategy 2-3.3 Encourage all low-income expectant mothers, who are MH and HOPES clients, to enroll in the Women, Children, and Infants (WIC) clinics for nutritional education during pregnancy.


Who's ResponsibleGreene County Public Health MCH and HOPES staff





Progress notes: Each expectant client enrolled in MH and/or HOPES is encouraged to apply for WIC benefits. These clients also receive information about healthy eating habits and how to deal with "morning sickness" during HOPES and MH visits. Will extend target date due to importance of this objective.

Strategy 2-3.4 Offer community education regarding the risks of pre-term labor, preventive health measures (early prenatal care, improved dental care, no smoking/alcohol/drugs, proper nutrition, awareness of reportable pre-term labor signs/symptoms ) and benefits of childbirth education classes.


Who's ResponsibleGreene County Public Health MCH and HOPES staff, Advanced Women's Clinic, WIC/New Opportunities





Progress notes: GCMC OB and Advanced Women's Clinic services shuttered August 2016; expectant moms receiving prenatal care from out-of-county OB/family practice providers; a few offer OB checks at local McFarland Clinic. Local childbirth classes discontinued. St. Anthony's Regional Hospital (Carroll) offers several online courses about childbirth and breastfeeding. HOPES and MCH staff actively seek prenatal referrals from various partners. WIC offers prenatal education/nutritional counseling during monthly Greene Co. clinics.

Objective 2-4 By 2021, the rate of teen births in Greene County will decrease to 30 per year.

Baseline Year2015

Baseline Value

35

Target Year2021

Target Value

30


Year2016

Value37





Progress notes: Need to strengthen collaboration with school counselors and health care providers who serve this group. New Opportunities offers in-school education. HOPES staff participated in annual "Teen Maze" pregnancy prevention program; students from multiple schools rotate through fun, interactive stations. Need to increase access to MH services by offering expectant teens school-based MH services .

Strategy 2-4.1 Utilize HOPES curriculum to educate currently enrolled teen mothers in pregnancy prevention and strategies to


improve self-esteem and self-empowerment. Strategy TypeCounseling & Education






Progress notes: Growing Great Kids, an evidence-based curriculum, focuses on these areas.

Strategy 2-4.2 Promote Community Adolescent Pregnancy Prevention Program and Teen Outreach Program offered by New Opportunities, Inc.







Progress notes: Evidence-based programs are utilized to reach students in both high school and middle school. The Teen Outreach Program (TOP) was implemented into the Health II class for 19 students at Greene County Schools 11/2/16-3/7/17. Lessons related to teen pregnancy include mental health, communication, and relationships. Family members were interviewed for a learning project; students identified family life changes (addiction, teen pregnancy, etc.) and how they wanted to make better self choices. For a class project, students presented information to the middle school students. Teachers stated the high schoolers did a great job with presentations and in sharing personal stories about bullying. "Draw the Line, Respect the Line" was provided to 6th graders in both Paton-Churdan and Greene County School districts. This fall (2017), a Greene County school nurse will offer that program and "Awkward to Awesome" to expand CAPP programming to 5th-8th graders.

Strategy 2-4.3 Establish a Greene County Adolescent Health Coalition to address issues of teen pregnancy.


Who's ResponsibleGreene County Public Health MCH and HOPES staff and New Opportunities, Inc.





Progress notes: Strategy not scheduled yet.

Goal #3 By 2021, access to elderly care (long-term care) will improve


Objective 3-1 By 2021, the Greene County Community Health Needs Survey will note a 5% decrease in respondents who identify improved access to elderly care as a priority health need.

Baseline Year2016

Baseline Value37%

Target Year2021

Target Value32%


Year2016

Value0



Not met, trend in right directionNot met, no trend✔


Progress notes: N/A-Unable to measure until 2021 CHNA Survey data collected.


Strategy 3-1.1 Community partners who serve elders will establish a Greene County Elder Care Coalition.


Who's ResponsibleGreene County long-term care providers





Progress notes: Strategy not scheduled yet; however, a Patient and Family Advisory Council was formed to provide feedback related to improving the patient experience at GCMC, including the long term care (LTC) facility.

Goal #4 By 2021, resources for persons with physical limitations will improve


Objective 4-1 By 2021, the Greene County Community Health Needs Survey will note a 5% decrease in respondents who identify improved access and knowledge of resources to assist those with physical limitations as a priority health need.

Baseline Year2016

Baseline Value26.3%

Target Year2021

Target Value21.3%


Year2016

Value0





Progress notes: N/A-Unable to measure progress until next CHNA Survey in 2021.

Strategy 4-1.1 Increased public promotion of the Greene County Community Resource Guide through social media and outreach with community partners.


Who's ResponsibleGreene County ISU Extension Service





Progress notes: Resource Guide updated and published annually; available on-line. Promotional statements have been issued by ISU Extension. Plans for park trail linkage project will be ADA-compliant.

Strategy 4-1.2 Increased promotion of multiple Greene County Public Health services and community resource expertise through community outreach, social and paper media, and linkage with those who serve persons with physical limitations.


Who's ResponsibleGreene County Public Health; Greene County Medical Center Community Relations; Habitat for Humanity; Jefferson Parks and Rec trails grant project





Progress notes: Information sharing at monthly Community Resource Council meetings. GCMC and PH provided letters of support for proposed park trail linkage project.

Goal #5 By 2021, the rate of heart disease deaths in Greene County will decrease.



Objective 5-1 By 2021, the rate of heart disease mortality in Greene County will decrease by 10.

Baseline Year2013

Baseline Value157

Target Year2021

Target Value147


Year2015

Value174.2





Progress notes: All-ages rate per 100,000 (2013-15 county data), ranking 32nd out of 99 counties.

Strategy 5-1.1 Greene County health care providers will collaborate to provide community education regarding the rate of heart disease deaths in Greene County and offer preventive healthy-heart strategies for residents to improve their health.


Who's ResponsibleGreene County Public Health, Greene County Medical Center Cardiac Rehabilitation, McFarland Clinic, UnityPoint Clinic





Progress notes: Community classes and media materials offered. Active cardiac rehabilitation program offered at medical center. Visiting specialists include cardiologist and vascular surgeon. Supportive of Jefferson Parks and Rec proposed connected park trail project to encourage increased physical activity. Increased number of employers taking advantage of wellness screenings & educational opportunities offered by medical center's occupational medicine department. Because diabetes increases the risk of heart disease, the educational topics dovetail. A major focus is pre-diabetes treatment.

Strategy 5-1.2 Greene County Emergency Preparedness Healthcare Coalition (Public Health, Greene County Medical Center, Greene County EMS) will provide two additional automatic external defibrillators (AEDs) to the Greene County Sheriff's Department, as law enforcement is often the first responder to a sudden cardiac arrest in rural areas.


Who's ResponsibleGreene County Emergency Preparedness Healthcare Coalition





Progress notes: Healthcare Coalition has provided a total of four AEDs in Greene County: Spring Lake park ranger, Sheriff's Dept, Elks Club, and Greene County Fairground. CPR/AED training provided by the Sheriff's Dept. Additional community CPR/AED classes offered for the public and employers. The Jefferson Fire Department officers and Genesis Development (an organization serving special needs residents) have key staff are certified BCLS instructors.

Strategy 5-1.3 Greene County Medical Center will continue to offer cardiopulmonary resuscitation (CPR) classes to the community, schools, and employers each year.


Who's ResponsibleGreene County Medical Center






Progress notes: Ongoing strategy; classes offered on demand. Lucas devices in ED and Greene Co. EMS. HOPES encourages parents to learn infant/child CPR as part of the program curriculum. See Strategy 5-1.2. Future plans include offering a Family & Friends CPR class at the Jefferson Community Center.

Goal #6 By 2021, the rate of diabetes-related deaths in Greene County will decrease


Objective 6-1 By 2021, the rate of diabetes-related deaths in Greene County will decrease to 10 deaths between 2011-2015.

Baseline Year2013

Baseline Value

12

Target Year2021

Target Value

10


Year2010-2014

Value21.46





Progress notes: 10% diabetes prevalence in Greene County; of 173 diabetics who receive monitoring, 96% had a hemoglobin A1c. Age-adjusted mortality rate is per 100,000. Diabetes and pre-diabetes are often under-diagnosed. Diabetes is often a contributor to other leading causes of death.

Strategy 6-1.1 Greene County Medical Center diabetes educators will collaborate with health care providers who serve Greene County residents to provide joint community education regarding the incidence rate, risks/complications, and prevention of diabetes via community outreach, social and paper media, and one-on-one encounters.


Who's ResponsibleGreene County Medical Center diabetes educators and health care providers who serve Greene County residents





Progress notes: Active Diabetes Prevention Program offered by medical center; often covered by health insurance. Diabetes Education Program is accredited with three certified diabetes educators on staff. Simple risk screening tool located on the medical center website and via social media. Medical center lab offers monthly wellness screenings. Visited with area health care providers to educate them on the importance of pre-diabetes screening and referrals, utilizing AMA guidelines. Diabetes Education is part of a statewide task force to increase screening and treatment of pre-diabetes. Outreach and screenings provided to employees of local businesses and industries.

Strategy 6-1.2 Greene County Medical Center emergency room nursing staff will refer all patients seen with diabetes-related issues to Greene County Medical Center Diabetes Education for follow-up.








Progress notes: Need to engage with ED staff regarding importance of prompt referrals to Diabetes Education staff.

Strategy 6-1.3 Diabetes screenings and educations will be offered at various community arenas (health fairs, casino, employers)







Progress notes: Diabetes screenings offered for GCMC and business employees; diabetes prevention program at not cost to GCMC employees. Patient experience video featured Diabetes Education patient.

Goal #7 By 2021, the use of tobacco products by Greene County residents will decrease


Objective 7-1 By 2021, the use of tobacco products by Greene County residents will decrease to 21%.

Baseline Year2015

Baseline Value

23%

Target Year2021

Target Value21%


Year2016

Value17%




Not met, no trend


Progress notes: Adults who smoke, per 2016 County Health Rankings & Roadmaps (State, 19%). Will continue to follow this indicator to ensure positive trending.

Strategy 7-1.1 Education regarding the health risks and strategies to quit smoking (including Quitline information) will be provided to Greene County residents by public health, school nurses/teachers, and health care providers. PH RNs have received dental health/screening training, which includes potential referrals to Quitline, and demonstrates the negative impact smoking has on teeth.


Who's ResponsibleNew Opportunities, Inc. (Tobacco Prevention Program)





Progress notes: Assisted employers to develop tobacco-/nicotine-free workplace policies. Promoted "Ask, Advise, Refer" tobacco cessation and Quitline programs; focused on environmental strategies to address smoking cessation.

Goal #8 By 2021, the perceived issue of gambling addiction in Greene County will decrease


Objective 8-1 By 2021, the Greene County Community Health Needs Survey will note a 5% decrease in respondents who identify gambling addiction as priority health need.


Baseline Year2016

Baseline Value18.3%

Target Year2021

Target Value13.3%


Year2016

Value0





Progress notes: N/A-unable to assess progress until next CHNA Survey in 2021.

Strategy 8-1.1 Information regarding signs and symptoms, risks, and treatment of gambling addiction will be provided via one-on-one encounters, social and paper media, billboards, and community outreach to Greene County residents.


Who's ResponsibleJackson Recovery and Greene County mental health counselors





Progress notes: By law, information about gambling addiction and access to help is available at Wild Rose Casino, Jefferson. TV, radio and media spots air locally. Jackson Recovery area representative regularly attends monthly Community Resource Council meetings. Need to ensure engagement between Jackson Recovery and local mental health counselors.

Goal #9 By 2021, the perceived issue of homelessness (teens and adults) in Greene County will decrease


Objective 9-1 By 2021, the Greene County Community Health Needs Survey will note a 3% decrease in respondents who identify homelessness (teens and adults) as a priority health-related issue.

Baseline Year2016

Baseline Value24.8%

Target Year2021

Target Value21.8%


Year2016

Value0





Progress notes: N/A-Unable to assess objective until 2021 CHNA Survey collected.

Strategy 9-1.1 Homeless or displaced teens in Greene County will receive supportive services enabling them to obtain their high school diploma, while respecting their privacy.


Who's ResponsibleGreene County high school counselors and teachers; Greene County Adopt-A-Family; Greene County Ministerial Association; DHS





Progress notes: Support continues; PH needs to engage with school staff for possible MCH referrals

Strategy 9-1.2 Homeless adults in Greene County will receive supportive services to meet their basic needs of safe housing, health


care, food, and reliable transportation to pursue employment.


Who's ResponsibleGreene County Ministerial Association; DHS, Greene County Christian Action Resource Center (ARC); Greene County Public Health





Progress notes: See Strategy 9-1.1 PH social worker has helped link ED patients to area homeless shelters; local church will donate gas money. Ministerial association will approve emergency vouchers for ARC food pantry.

Goal #10 By 2021, the perceived access to domestic violence and sexual assault services in Greene County will improve


Objective 10-1 By 2021, the Greene County Community Health Needs Survey will note a 3% decrease in respondents who identify domestic violence/sexual assault as a priority health-related issue.

Baseline Year2016

Baseline Value48.2%

Target Year2021

Target Value45.2%


Year2016

Value0





Progress notes: N/A-Unable to assess objective until 2021 CHNA Survey collected.

Strategy 10-1.1 Availability of ACCESS services for Greene County victims of domestic violence/sexual assault will be promoted through visits with entities that may see victims, and increased community outreach with the public, and social/radio/paper media.


Who's ResponsibleGreene County ACCESS staff; Greene County HOPES and MCH programs





Progress notes: ACCESS ongoing; risk assessments included in both maternal-child health social worker and HOPES enrollments.

Goal #11 By 2021, the rate of confirmed child abuse cases in Greene County will be decreased


Objective 11-1 By 2021, the rate of confirmed child abuse cases in Greene County will decrease by 25%.

Baseline Year2014

Baseline Value

4

Target Year2021

Target Value

3


Year2016

Value2




Not met, no trend


Progress notes: Data per DHS Child Maltreatment CY2016: Confirmed or Founded Abuse (Unique Children);


need to continue surveillance for remaining years of HIP, due to seriousness of issue.

Strategy 11-1.1 Greene County Public Health HOPES staff will encourage enrollment in the program through engagement with parents at immunization clinics, MH visits, and WIC clinics, and from referrals by health care providers and ER.







Progress notes: Ongoing strategy

Strategy 11-1.2 Greene County Public Health HOPES staff will meet with DHS staff to encourage referrals of families who have been involved in a potential child abuse investigation.


Who's ResponsibleGreene County Public Health HOPES staff; Greene/Carroll County DHS workers





Progress notes: Some referrals to HOPES but often fragmented.

Strategy 11-1.3 Provide information and encourage participation in the offered "Love and Logic" program, to parents of children attending kindergarten roundup/health clinics each spring. "Love and Logic" is a philosophy of raising and teaching children which allows adults to be happier, empowered, and more skilled in the interactions with children. Love allows children to grow through their mistakes. Logic allows children to live with the consequences of their choices.


Who's ResponsibleNew Opportunities, Inc.; HOPES





Progress notes: HOPES curriculum includes e-parenting, providing role modeling and learning opportunities to hone parenting skills. Information about evidence-based "Love and Logic" program is promoted through community resource council meeting, HOPES visits, partner sharing, and via social media. Next class scheduled for 2017.

Goal #12 By 2021, 100 homes in Greene County will be tested for radon


Objective 12-1 By 2021, 100 homes in Greene County will be tested for radon, facilitated by the Greene County Radon Testing and Awareness Project.

Baseline Year2016

Baseline Value

0

Target Year2021

Target Value100


Year2016

Value111


Met, no trend





Progress notes:

Strategy 12-1.1 Through the Iowa Cancer Coalition, community education and free home radon test kits will be provided to Greene County residents.

Strategy TypeEnvironmental / Policy / Systems Change

Who's ResponsibleGreene County Environmental Health and Greene County Public Health





Progress notes: Program to provide free test kits and mitigation education will continue if local grant funding is obtained through partnership with EH.

Strategy 12-1.2 Information will be shared with Greene County Realtors, home buyers, and landlords regarding the elevated radon levels, the health risks, the needs for testing, and the importance of mitigation.


Who's ResponsibleGreene County Environmental Health and Greene County Public Health





Progress notes: EH Director achieved this strategy.

Goal #13 By 2021, the rate of childhood lead poisoning in Greene County will decrease


Objective 13-1 By 2021, the rate of childhood lead poisoning in Greene County will decrease by 0.14%.

Baseline Year2013

Baseline Value1.64%

Target Year2021

Target Value1.5%

Report Date05/30/2017

Year2015

Value0


Met, no trend




Progress notes: Of 249 tested (40.69% of children ages 12 months-six years), zero confirmed lead poisoning. Will utilize new capillary lead analyzer to screen additional children.

Strategy 13-1.1 80% of Greene County children, ages 12 months-six will be screened annually for lead exposure.


Who's ResponsibleMcFarland Clinic, UnityPoint Clinic, WIC/New Opportunities, Inc.





Progress notes: 249 children tested (40.69%). Children receive lead screenings through WIC visits or primary health care provider. Through MCH program, PH provides home visits and follow-up for any children with elevated lead levels. PH recently obtained capillary lead analyzer and hemocue to reduce need for venous draws on little ones and target any who have missed a screening per age. Will focus on assessing status at each encounter with this age group.


Strategy 13-1.2 Information regarding the health risks of lead poisoning will be provided to families with children higher risk during at least 75% of health encounters (WIC, immunization clinics, HOPES visits, well-child appointments).


Who's ResponsibleWIC/New Opportunities, Inc.; McFarland Clinic; UnityPoint Clinic; Greene County Public Health MCH and HOPES staff





Progress notes: Strategy ongoing and affirmative; strategy revised to reflect at-risk population. Will strengthen with new capillary lead analyzer.

Goal #14 By 2021, the rate of adolescent human papilloma virus (HPV) vaccination will increase


Objective 14-1 By 2021, the rate of adolescent HPV vaccination will increase by 4%.

Baseline Year2015

Baseline Value26.5%

Target Year2021

Target Value30.5%


Year2016

Value38%


Met, no trend




Progress notes: Of 479 adolescents, 13-15 years of age, 180 have received appropriate number of HPV vaccine doses.

Strategy 14-1.1 Greene County Public Health will provide education to 100% of parents of adolescents, who are seen in immunization clinics, regarding the benefits and risks of HPV vaccination.







Progress notes: Staff provide education and encourage vaccination at each immunization opportunity, even if parent declined in past. Extended target date due to need for increased numbers.

Strategy 14-1.2 Greene County Public Health will provide school-based adolescent immunization clinics (including HPV) during school hours and prior to athletic practices.


Who's ResponsibleGreene County Public Health; Greene County school nurses





Progress notes: School-based clinics have been poorly attended despite repeated efforts; will extend target date due to importance of this vaccine.

Strategy 14-1.3 Increased community education and promotion will be provided regarding the benefits of the HPV vaccine,


including the use of community outreach and via social/radio/print media.







Progress notes: Offered "Someone You Love: The HPV Epidemic" Oct. 2016; used school blast notification to encourage parents to attend; zero did so. Extend target date and continue media outreach. Radio interview aired earlier this year by PH Immunization Program Manager.

Goal #15 By 2021, the rate of influenza vaccination for Greene County adults will increase


Objective 15-1 By 2021, the rate of influenza vaccination for adults who have Greene County zip codes and are entered into IRIS will increase by 14%.

Baseline Year2015

Baseline Value30.7%

Target Year2021

Target Value44.7%


Year2016

Value34%




Not met, no trend


Progress notes: Total of 3269 received vaccine/entered in IRIS.

Strategy 15-1.1 Greene County Public Health will provide education regarding the importance of IRIS data entry to all Greene County healthcare providers who offer adult influenza vaccination.


Who's ResponsibleGreene County Public Health and all vaccine providers in Greene County





Progress notes: Local pharmacy now uses software that automatically migrates doses to IRIS; still need to engage other non-clinic providers to enter data into IRIS.

Strategy 15-1.2 Greene County Public Health will annually offer education regarding the benefits of the influenza vaccine and ensure that easy-to-access flu clinics are offered in each community of Greene County.







Progress notes: Multiple community flu clinics offered, plus at PH. Multiple providers now offer vaccination in Greene County. Radio interview, print, and social media messaging provided opportunities to educate the public and dispel myths about the vaccine.


Goal #16 By 2021, the membership of the Greene County Medical Reserve Corp (MRC) will increase


Objective 16-1 By 2021, the membership of the Greene County Medical Reserve Corp (MRC) will increase by 25%.

Baseline Year2015

Baseline Value

15

Target Year2021

Target Value

19


Year2016

Value15





Progress notes: Need to strengthen recruitment efforts.

Strategy 16-1.1 Increased promotion of MRC volunteer activities and opportunities will be provided to the public via community outreach and social media/radio/newspaper.


Who's ResponsibleGreene County Medical Center Community Relations; Greene County Public Health





Progress notes: See Objective 16.1; MRC volunteer did participate in drive-through flu clinic fall 2016. As part of the MRC, GCMC Auxiliary provide volunteer support at monthly wellness screenings, blood drives, and assisting with surgery patients.

Strategy 16-1.2 An educational program, "Cultural Sensitivity During Disasters," will be offered for Greene County MRC members, hospital volunteers, Emergency Management System (EMS), and those involved with emergency preparedness efforts.


Who's ResponsibleGreene County Public Health and MRC





Progress notes: "Cultural Competency in a Disaster Response" offered June 15-16, 2016, sponsored by Greene Co MRC. Total of 13 attended, including MRC members.

Goal #17 By 2021, multiple forms of redundant communication will be in place in Greene County


Objective 17-1 By 2016, at least 30 staff of Greene County Public and Greene County Medical Center will complete training regarding use of the Health Alert Network (HAN) website and 800 MHz radios.

Baseline Year2015

Baseline Value

2

Target Year2016

Target Value

30


Year2016

Value32


Met, no trend




Progress notes: Two sessions of HAN & radio training provided by Tom Boeckmann, IDPH HAN officer,


provided to both medical center and PH staff.

Strategy 17-1.1 HAN training will be provided on-site at Greene County Medical Center by Iowa Department of Public Health (IDPH) staff.







Progress notes: See Objective 17.

Objective 17-2 By 2016, a reliable form of notifying PH and hospital staff via a blast notification system will be in place and tested by a call-down drill.

Baseline Year2015

Baseline Value

0

Target Year2016

Target Value

1


Year2016

Value0





Progress notes: No progress with this strategy. PH staff have practiced two call-down drills via text messaging. Objectives for drills were met each time.

Strategy 17-2.1 The blast notification system will be installed and tested at Greene County Medical Center.


Who's ResponsibleGreene County Emergency Preparedness Healthcare Coalition; Greene County Medical Center Information Technology (IT) Department





Progress notes: See Objective 17-2.

Objective 17-3 By 2017, a reliable weather-alerting system will provide accurate warnings to Greene County Medical Center to prompt patient evacuation.

Baseline Year2016

Baseline Value

0

Target Year2017

Target Value

1


Year2016

Value1


Met, no trend




Progress notes: Weather Call initiated, allowing real-time warnings likely to impact GCMC within 10 mile radius.

Strategy 17-3.1 A weather alert system will be installed for use by medical center staff.


Who's ResponsibleGreene County Emergency Preparedness Healthcare Coalition; Greene County Medical Center IT Department







Goal #18 By 2021, the public perception of personal and family preparedness for disaster events will increase


Objective 18-1 By 2021, the Greene County Community Health Needs Survey will note a 5% increase in respondents who identify personal and family preparedness for disaster events as a priority health-related issue.

Baseline Year2016

Baseline Value17%

Target Year2021

Target Value22%


Year2016

Value0





Progress notes: N/A-Unable to assess until 2021 CHNA Survey.

Strategy 18-1.1 The Greene County Emergency Preparedness Healthcare Coalition will provide at least three community outreach events to encourage personal and family preparedness in the event of a disaster.







Progress notes: Strategy not scheduled yet; PH does offer "Family Preparedness in an Emergency" booklets to HOPES, MCH, immunization clients, to mental health counselors, and to school nurses.

Goal #19 By 2021, Greene County Public Health will demonstrate a coordinated response to mass dispensing clinic


Objective 19-1 By 2021, Greene County Public Health will demonstrate a coordinated response to at least one mass dispensing clinic (actual or exercise).

Baseline Year2016

Baseline Value

0

Target Year2021

Target Value

1


Year2016

Value2


Met, no trend




Progress notes: Drive through flu clinic Oct 2016 at Greene Co. Fairgrounds. Also participated in the qualifying exercise and the SNS exercise with multiple counties in central Iowa.

Strategy 19-1.1 Greene County Public Health will participate in a mass dispensing clinic, as part of the Central Iowa Emergency Preparedness Healthcare Coalition exercises.



Who's ResponsibleGreene County Emergency Preparedness Healthcare Coalition; Greene County Public Health





Progress notes: See Objective 19-1. Greene County HCC members participated in SNS drill in Des Moines, and local tabletop exercise for novel virus epidemic.

Goal #20 By 2021, the public perception of coordinated medical care to prevent gaps in service will improve


Objective 20-1 By 2021, the Greene County Community Health Needs Survey will note a 10% decrease in respondents who identify the need for improved coordination of medical care between providers as a priority health-related issue.

Baseline Year2016

Baseline Value41.4%

Target Year2021

Target Value31.4%


Year2016

Value0





Progress notes: N/A-Unable to assess until 2021 CHNA Survey. Did develop multi-disciplinary care transitions team (PH, ED, Acute hosp, pharmacy) to reduce gaps in patient care from one provider/entity to another. PH offers free transitional care home visit to any discharged ED/hospital patient, and via outside referrals.

Strategy 20-1.1 The Greene County Care Coordination team will engage consistent participation/attendance during monthly meetings from at least one representative of each health care provider serving Greene County residents.


Who's ResponsibleMembers of Greene County Care Coordination team





Progress notes: Monthly meetings not feasible but team still engaged with partners for improved continuity of care.

Strategy 20-1.2 Greene County Public Health will develop a formal "health navigator" program designed to assist healthcare providers and the public to locate various community resources with "just one call" linkage.







Progress notes: PH developed/honed Transitional Care concept in collaboration with GCMC departments who serve patients. Free evaluation visit offered to discharged patients to link to resources and prevent repeat ED or hospital visit.

Strategy 20-1.3 The numbers Greene County Public Health referrals for evaluation visits received from the Greene County Medical Center Emergency Room (ER) will increase by 20%.



Who's ResponsibleGreene County Medical Center ER staff





Progress notes: Post-2016, care transitions team provided education to ED nurses regarding the importance of PH referrals to reduce repeat ED visits or hospital readmissions. Communication tool created to share within the team. Tracking tool created with first three months of data. Target date extended to collect significant data.

Strategy 20-1.4 Greene County Public Health will meet with primary care providers, McFarland Clinic and UnityPoint Clinic, to improve awareness of the many services offered, including care coordination.







Progress notes: Target date extended; meetings with additional primary care providers need to be scheduled.

Goal #21 By 2021, access to transportation for medical appointments will improve


Objective 21-1 By 2021, the number of "missed" medical appointments to Greene County healthcare providers, due to lack of transportation, will decrease by 3% (no previous benchmark).

Baseline Year2016

Baseline Value

0

Target Year2021

Target Value

20


Year2016

Value0





Progress notes: Electronic medical record system (EPIC) must facilitate collection of this specific data; strategy needs to be addressed further.

Strategy 21-1.1 Greene County Public Health will collaborate with Region 12 Western Iowa Transit System (WITS) to develop a voucher program to offset the cost of transportation to medical appointments.


Who's ResponsibleGreene County Public Health; Region 12 WITS





Progress notes: WITS is not an affordable option for many due to cost per mile; GCMC considering possibility of courtesy van for medical appointments, pending appropriate funding to support program. Leaders met with neighboring hospital to learn specifics of their successful service, which utilizes volunteer drivers.

Strategy 21-1.2 Greene County Public Health will educate Medicaid-eligible residents about transportation options sponsored by Iowa's managed care organizations (MCOs).



Who's ResponsibleGreene County Public Health; Greene County Care Coordination members





Progress notes: Level of service and degree of immediacy provided by contracted transportation vendors varies between MCOs. Eligible subscribers not always aware of this option, or doesn't fit their needs.

Strategy 21-1.3 Greene County Public health will develop a simple tracking system to assist healthcare providers in counting "missed" appointments.


Who's ResponsibleGreene County Public Health; Greene County healthcare providers





Progress notes: Electronic medical record (EPIC) has this capability; strategy needs to be addressed further.

Goal #22 By 2021, succession planning for the Greene County Public Health workforce will be completed


Objective 22-1 By 2021, at least three specific succession plans will be in place to meet the anticipated retirement needs of the Greene County Public Health workforce (includes positions of director, office manager, and RN who manages epidemiology cases, health and community education, and emergency prep activities).

Baseline Year2016

Baseline Value

0

Target Year2021

Target Value

3


Year2016

Value1




Not met, no trend


Progress notes: Challenging to find individual(s) with strong position-specific PH background and skills to fill all three positions. Some cross-training in various programs with PH staff to ensure continuity of operations.

Strategy 22-1.1 Identify staff for development into future Public Health leadership roles.


Who's ResponsiblePH Director and Greene County Medical Center Executive Leadership Team






Goal #23 By 2021, access to dental care services will improve


Objective 23-1 By 2021, the Greene County Community Health Needs Survey will note a 10% decrease in respondents that identify access to dental care as a priority health-related need.

Baseline Year2016

Baseline Value26.8%

Target Year2021

Target Value16.8%



Year2016

Value0





Progress notes: N/A-Unable to assess until 2021 CHNA Survey completed. New dental office opened in summer 2016; provider does accept Medicaid and practice is growing. Greene Co. now served by three dentists.

Strategy 23-1.1 Greene County Public Health will assist low-income residents to apply for financial assistance, such as Medicaid, to obtain dental coverage.







Progress notes: While Medicaid-eligible residents receive dental coverage, the ineligible uninsured or under-insured individuals are still left without dental care and cannot afford it, forcing them to seek relief at the ED, which often results in a recommendation to seek dental care. They must travel > an hour for free dental clinic services, which may be limited in meeting their needs.

Strategy 23-1.2 Greene County Public Health will provide information regarding dentist who accept patients with Medicaid.







Progress notes: New dentist in Jefferson accepts Medicaid.

Strategy 23-1.3 Greene County Public Health will provide community education regarding the benefits of preventive dental practices, such as regular brushing, flossing, dental check-ups, nutrition, and fluoridated water.







Progress notes: Promoted through I-Smile MCH program.

Goal #24 By 2021, access to affordable, quality child care will improve.


Objective 24-1 By 2021, Greene County Community Health Needs Survey respondents will identify a 10% improvement in access to affordable child care as a priority health-related need.

Baseline Year2016

Baseline Value41.9%

Target Year2021

Target Value31.9%



Year2016

Value0





Progress notes: N/A-Unable to assess until 2021 CHNA Survey. Early Learning Center in Jefferson has waiting list; registered daycare providers have few open slots. Recent consideration for 2nd daycare center establishment.

Strategy 24-1.1 Improved collaboration between community partners involved with child care, including Child Care Resource and Referral.


Who's ResponsibleEarly Childhood Initiative, Partnership 4 Families Board, Child Care Resource and Referral, Greene County ISU Extension Service





Progress notes: Partner-sponsored "Childcare Provider Appreciation" offered May 2016; included education about healthy snacks, budget-saving meat ideas, and community resources. Despite zero daycare providers attendance for event, collaboration and relationship building occurred.

Goal #25 By 2021, the rate of substance abuse (alcohol and marijuana) in youth in 11th grade will decrease.


Objective 25-1 By 2021, the incidence of binge drinking in 11th graders in Greene County will decrease by 5%.

Baseline Year2014

Baseline Value16%

Target Year2021

Target Value11%


Year2016

Value15%





Progress notes: Source: Iowa Youth Survey-2016 Greene County Results. Teen Outreach Program (TOP) implemented into the Health II class for 19 students at Greene County Schools from 11/2/16-3/7/17. Through curriculum and class projects, students identify family life changes (addiction, teen pregnancy, etc.) prompted them to make better self-choices. "Awkward to Awesome" program will be offered this fall to 5th-8th graders.

Strategy 25-1.1 Expand evidence-based curriculum to all schools in Greene County. Curriculum is offered weekly to students with focus on learning about the dangers of binge drinking, and strategies to respond to peer pressure.









Strategy 25-1.2 Develop a social media web page that offers information and various resources available to teens.







Progress notes: Facebook page aims to reach community adults and parents who may have an indirect impact on teens. Resources can be shared with teens. Website: https://www.facebook.com/New-Opportunities-Prevention-Services-464619410235593/

Objective 25-2 By 2021, the rate of marijuana use by 11th graders in Greene County will decrease by 5%.

Baseline Year2014

Baseline Value21%

Target Year2021

Target Value16%


Year2016

Value8%


Met, no trend




Progress notes: Rate of 8th graders dropped to 1%. Will continue to monitor objective to ensure consistent improvement.

Strategy 25-2.1 Expand evidence-based curriculum to all schools in Greene County. Curriculum is offered weekly to students with focus on learning about the dangers of marijuana, and strategies to respond to peer pressure.








Strategy 25-2.2 Develop a social media web page that offers information and various resources available to teens.







Progress notes: Facebook page aims to reach community adults and parents who may have an indirect impact on teens. Resources can be shared with teens. Website: https://www.facebook.com/New-Opportunities-Prevention-Services-464619410235593/


Goal #26 By 2021, access to mental health services in Greene County will improve.


Objective 26-1 By 2016, at least one member of the Greene County Medical Center Public Health will actively engage with the Greene County Mental Health Coalition.

Baseline Year2016

Baseline Value

0

Target Year2016

Target Value

1


Year2016

Value1


Met, no trend




Progress notes: Social worker is active member of newly formed coalition.

Strategy 26-1.1 Public Health social worker will join the Greene County Mental Health Coalition.


Who's ResponsibleGreene County Public Health social worker





Progress notes: See Objective 26.1

Objective 26-2 By 2019, a mid-level psychiatric provider will offer monthly services at Greene County Medical Center.

Baseline Year2016

Baseline Value

0

Target Year2019

Target Value

1


Year2016

Value0




Not met, no trend


Progress notes: Pending credentialing of provider in mid-2017, Genesis Development will facilitate a medical center-based clinic offering psychiatric services, including medication management; mental health clients currently must travel at least 25 miles for this service.

Strategy 26-2.1 Greene County Medical Center, as a rural affiliate of UnityPoint Health, will recruit a mid-level psychiatric provider to be based in Greene County.


Who's ResponsibleGreene County Medical Center and UnityPoint Health





Progress notes: See Objective 26-2

Objective 26-3 By 2017, Greene County Medical Center will develop a system for providing telemonitoring ( telehealth) to connect mental health patients with one psychiatric provider.

Baseline Year2016

Baseline Value

0

Target Year2017

Target Value

1


Year2016


Value1


Met, no trend




Progress notes: ITP psychiatric telehealth service available 7 days/week until 9PM. Psychiatric provider can assess ED patient, determine need for mental health facility admission, assess psychotropic medications, and facilitate locating a mental health bed if appropriate.

Strategy 26-3.1 Greene County Medical Center, as a rural affiliate, will work with UnityPoint Health to provide a dependable and secure telehealth system.


Who's ResponsibleGreene County Medical Center and UnityPoint Health





Progress notes: See Objective 26-3

greene county hip 5-31-17 - iowahip/hip progress...exercise during "jump-start" monday...

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