Community Health Needs Assessment (CHNA) Written Report · 1 Community Health Needs Assessment (CHNA) Written Report Reading Health System PO Box 16052 Reading, PA 19612 July 1, 2012

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Community Health Needs Assessment (CHNA)

Written Report

Reading Health System

PO Box 16052 Reading, PA 19612

July 1, 2012 – June 30, 2013

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I. General Information

Contact Person: Dick Mable

Date of Written Report: January 2013

Link to Web Site on Which Written Report Was Made Publicly Available:

http://www.readinghealth.org/Community

Date Written Report Made Publicly Available: January 31, 2013

Date Written Report Required to be Made Publicly Available (per Notice 2011-52): N/A

Date of Prior Written Report (if applicable): 2006

Name and EIN of Hospital Organization Operating Hospital Facility: Reading Health System, 23-1352204

Address of Hospital Organization: PO Box 16052 Reading, PA 19612-6052

II. Purpose of CHNA Written Report

This Written Report is being conducted in order to comply with federal tax law requirements set forth in

Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization

described in Code section 501(c)(3) to conduct a community health needs assessment at least once every

three years. The required Written Plan of Implementation Strategy is set forth in a separate written

document. This Written Plan is intended to satisfy each of the applicable requirements set forth in IRS

Notice 2011-52 regarding conducting the Community Health Needs Assessment for Reading Health System.

III. Community Served by Facility (3.03(1) and 3.05)

Description of Community Served by Hospital Facility:

Reading Hospital’s primary service area (“PSA”) consists of the communities in Berks County from which

the Hospital receives approximately 85% of its total inpatient discharges. The primary service area extends

from Fleetwood, Oley and Exeter in the east to Mohnton, Wernersville and Womelsdorf in the west. It

reaches from Hamburg in the north to just above Morgantown in the south. The center of the PSA is the

City of Reading (zip codes 19601 to 19604), which accounts for 23% of the hospital’s inpatient discharges

for the fiscal year ended June 30, 2012.

The secondary service area (“SSA”) consists of the remainder of Berks County, as well as portions of the six

contiguous counties: Montgomery, Chester, Lancaster, Lebanon, Schuylkill, and Lehigh counties. The

hospital receives approximately 12% of its total inpatient discharges from the SSA. In limited

circumstances, the Facility also serves guests and other individuals from outside the service area (3% of

discharges). In 2012, the population of the Total Service Area was 754,141, and the population of the PSA

was 332,598.

Source: PHC4 inpatient data

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Population Demographics

Reading Hospital is committed to providing compassionate, accessible, high quality cost effective health

care to the community without distinction as to race, color, age, creed, handicap, sex, national origin, or

economic status; to promote health; to educate health care professionals and the public; and to participate in

appropriate clinical research.

Source: U.S. Census, 2010 Source: 2012 estimates by Truven Analytics Insurance Coverage Estimates

Principal Functions (e.g., specialty area or targeted disease)

Reading Hospital provides a full spectrum of healthcare services to the community. Core services include

cardiovascular services, cancer services, emergency services, women’s and children’s services, weight

management, surgical services, joints/orthopaedics, and neurological services, among many others. Reading

Health System provides: office-based primary care and specialty care through the Reading Health Physician

Network; comprehensive rehabilitation and transitional care through our 62-bed Rehabilitation Hospital, in-

home nursing care and health services through the Reading Hospital Home Care, continuing care retirement

living through The Highlands at Wyomissing, detoxification, short-term residential care, and outpatient

addiction services through our Drug and Alcohol Center, and Quickcare services that treat non-emergent

health conditions.

The Hospital also provides services that are directed to the underserved population. RHS staffs the Second

Street Health Dispensary, located in the City of Reading, to provide primary care, obstetrical, mental health

services, as well as pharmacy needs, for City residents. In addition, the Hospital maintains daily clinics for

women, children, and adults, as well as operates the Center for Public Health, the community’s primary care

center for individuals with HIV and AIDS.

Health

Overall, Berks County residents are in good health. However, heart disease is the leading cause of death

followed by all forms of cancer (including female breast cancer), and stroke. In addition, many adults suffer

from obesity, high blood pressure, diabetes and untreated mental health conditions. For example:

Nearly one‐third of adults (30.2%) are obese and more than one‐third (35.9%) are overweight;

One‐third of adults (33.4%) have been diagnosed with high blood pressure; this percentage

represents 105,400 adults;

One in seven adults (13.9%) has been diagnosed with diabetes; and

Although 14.6% have been diagnosed with a mental health condition, only 38.5% of those are

receiving treatment for their condition.

Race

White 77%

Black 3%

Latino 16%

Asian 1%

Other 2%

Gender

Male 49%

Female 51%

Age

0-17 24%

18-64 35%

65+ 41%

Insurance Private %

Medicare

%

Medicaid

%

Uninsured

%

North 2012 59% 18% 16% 10%

Northeast 2012 67% 12% 15% 7%

Northwest 2012 61% 18% 16% 7%

South 2012 72% 13% 10% 5%

Southeast 2012 71% 14% 11% 6%

Southwest 2012 74% 14% 8% 5%

PSA 2012 59% 16% 18% 9%

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Residents of the City of Reading, Blacks, and Latinos are in poorer overall health, are more likely to

be obese and are more likely to have diabetes, high blood pressure, or a mental health condition than

other residents, but there are many smaller suburban and rural areas of the County where low income

residents, in particular, are in poor health.

Unmet Needs

There is no County health department in Berks County, Pennsylvania. While many agencies in the County

individually provide services which could be provided by a county health department, there remain unmet

needs that could be filled by a county-wide, coordinated manner by a county health department. In addition,

the following were found as unmet needs:

Access to primary and specialty care for the uninsured and underinsured, including particularly

access to dental and mental health care;

Access to affordable prescription medications;

Access to specialty care for those insured through Medical Assistance;

Transportation to medical care for the low income and Latino migrant worker population;

More affordable mental health and substance abuse services, particularly for children and

adolescents; and

Culturally competent care for the Latino population, including more affordable services for the

uninsured, including more qualified, affordable interpretation services and more bilingual, bicultural

staff.

Description of How Community Served Was Determined:

Reading Health System along with its partners in the needs assessment process determined that the scope of

the community health needs assessment should focus on Berks County, Pennsylvania. Berks County (2010

Pop. 411,500) includes urban, suburban, and rural areas with distinct populations and health resources. For

the purposes of this needs assessment, five geographic subareas of the County, defined by ZIP code clusters,

were identified: the City of Reading and East, West, North, and South Berks County (Map 1). The

boundaries of these smaller areas were determined by the Needs Assessment Steering Committee in

collaboration with PHMC using county geography and population demographics. The City of Reading,

consisting of only three ZIP codes approximately contiguous with its municipal boundaries, was assessed as

a separate area because of the unique socioeconomic and demographic characteristics of its population

compared to other areas of Berks County.

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Map 1

Source: U.S Census, 2010. Prepared by PHMC.

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IV. Process and Methods Used to Conduct the CHNA (3.03(2))

Description of Sources and Dates of Data and Other Information Used in CHNA:

Household Health Survey

The Berks County Household Health Survey was modelled after previous Household Health Surveys

conducted by PHMC in South-eastern Pennsylvania and in Berks, Lancaster, and Schuylkill Counties. The

instrument was designed by PHMC with input from the project Steering Committee. The survey was fielded

by Abt/SRBI between June 20th and August 2nd 2012, and included 1,101 random‐digit dial landline

(1,001) and cell phone (100) respondents using a probability sample across five areas in the county. Within

each randomly selected landline household, the selected respondent was chosen using the last birthday

method. Interviews were conducted in English and Spanish, including an oversample of 101 household of

Latino origin, and averaged 17 minutes in duration. The Berks County survey had an overall AAPOR 3

response rate close to, or better than, comparable surveys at 31.0%. The final data were weighted to reflect

2011 census estimates in two weighting areas: the City of Reading and the remainder of Berks County. This

allowed for estimates of the population represented by each percentage to be calculated.

U.S. Census

This report includes data on the population of Berks County residents along with socio‐demographic and

socioeconomic characteristics for the years 2000, 2010, 2013 and 2018. Data from the 2000 U.S. Census,

the 2010 American Community Survey, and the Nielsen‐Claritas Pop‐Facts Database were also used. The

Nielsen‐Claritas Pop‐Facts Database uses an internal methodology to calculate and project socio‐demographic and socioeconomic characteristics for non‐census years, relying on the U.S. Census, the

Current Population Survey, and the American Community Survey.

Vital Statistics

The most recent information on births, birth outcomes, deaths, and reportable diseases and conditions for

Berks County was obtained from the Pennsylvania Department of Health, Bureau of Health Statistics and

Research. Four year (2005‐2008) annualized average rates for natality and mortality were calculated by

PHMC. Mortality rates were age‐adjusted using the Direct Method and the 2000 U.S. standard million

population. The most recent morbidity information from 2010 was also obtained from the state Department

of Health, and rates were calculated by PHMC. Morbidity information, including information on HIV and

AIDS cases, is not available at the ZIP code level; therefore, rates are presented for the county and the state

only. The denominators for all 2005‐2008 vital statistics rates for the county and state were interpolated

from the 2000 and 2010 U.S. Census. The number of women ages 15‐44 and the number of adolescents ages

14‐19 were also interpolated from the 2000 and 2010 U.S. Census.

Focus Groups

Five focus groups were conducted with Berks County residents between June and September, 2012. A total

of 55 residents participated. Focus groups were used to collect in‐depth information from Berks County

population subgroups that might be at risk for poor health and access to care: Latinos (migrant workers, 18‐64 year olds, and those age 65+); African Americans; and low income older adults aged 65+. All focus

groups were conducted in the City of Reading, although participants were recruited from throughout Berks

Data Source Dates

U.S. Census of Population and Housing 2000, 2010

Claritas, Inc. Pop‐Facts 2013, 2018

Pennsylvania Department of Health 2005‐2008

PHMC Berks County Household Health Survey 2008, 2012

Pennsylvania Health Care Cost Containment Council 2011

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County. Participants were recruited by the Berks Encore Senior Center, Berks Community Health Center,

Reading Area Community College ESL program, and the Keystone Migrant Farmworker Program.

Transportation was provided when necessary, and participants were compensated $50 each for their time

and transportation costs. Focus groups lasted approximately 90 minutes and were guided by a set of written

questions (see Appendix F for the Focus Group Discussion Guide). The focus groups of Latino older adults,

migrant workers, and adults age 18‐64 were conducted in Spanish by a bilingual, bicultural facilitator. All

focus groups were audiotaped. Refreshments were served.

Informational Interviews

Information interviews were conducted with 13 community representatives with knowledge of the health

and health care needs of Berks County residents. Key informants were identified and recruited by the project

Steering Committee working in collaboration with PHMC. Key informants also included individuals with

direct knowledge of special populations in Berks County, including: Latinos, migrant workers, individuals

with HIV/AIDS, the uninsured, pregnant women, older adults, and persons with mental health conditions.

The interviews were conducted by telephone and lasted approximately 45 minutes. The interviews were

guided by questions developed by PHMC in collaboration with the project Steering Committee. The

interviews were conducted between June and September, 2012.

Description of Analytical Methods Applied to Identify Community Health Needs:

Quantitative information from the U.S. Census, Pennsylvania vital statistics, and Berks County Household

Health Survey was analyzed for Berks County as a whole and for the five separate areas within the county

using the Statistical Program for Social Sciences (SPSS). Frequency distributions were produced for

variables for multiple years of data so trends over time could be identified and described. Qualitative

information from focus groups and informational interviews was analyzed by identifying and coding themes

common across groups and individual interviews, and also themes that were unique. This information was

organized into major topic areas related to health status, access to care, special population needs, unmet

needs, and health care priorities.

Description of Information Gaps Impacting Facility's Ability to Assess Community Health Needs:

There were no major gaps in information for this community health needs assessment because quantitative

information for socioeconomic and demographic information, vital statistics, and health status was available

at the ZIP code level for the entire county. These sources also provided information on the Latino population

in Berks County. Information on these populations, and other unmet health care needs, was also supplied in

great detail by informational interviews and focus group discussions with community representatives.

Identity of All Organizations with Which Facility Collaborated to Conduct CHNA:

Reading Health System collaborated with the following organizations to conduct the CHNA: Berks County

Community Foundation, St. Joseph Regional Health Network, and the United Way of Berks County.

Focus Group Location Number of Participants

Older Adults 65+ Berks Encore Senior Center Reading 11

African Americans Berks Community Health Center 9

Latino Older Adults 65+ Reading Area Community College 11

Latino Migrant Workers El Puente Restaurant 12

Latino Adults 18-64 Reading Area Community College 12

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Identity and Qualifications of Third Party Contractors That Assisted in Conducting the CHNA:

The Research and Evaluation Group

Public Health Management Corporation

260 South Broad Street, 18th Floor

Philadelphia, PA 19102

Public Health Management Corporation (PHMC) is a 501(c)(3) non-profit corporation that was founded in

1972 to address problems in the organization and delivery of health and social services. Over the past 40

years, PHMC has grown from a staff of less than 100 to nearly 1,500 employees. PHMC’s Research and

Evaluation Group has more than 20 years’ experience with all of the phases of Community Health Needs

Assessments, collaborating with a wide variety of community partners on all aspects of CHNAs. PHMC

Research and Evaluation staff experience with CHNAs includes extensive research and writing capabilities

in the following areas: study design and implementation; telephone, mail and in-person surveys; health

assessments for communities and special populations; local area analysis; qualitative and quantitative data

collection; focus groups; key informant interviews; analysis of existing records and statistics; observational

studies; database development; mapping/GIS; and practical technical and policy reports.

V. Description of Community Input and Process (3.03(3))

General Explanation of How the Organization Took Into Account Input from Persons Who Represent

Broad Interests of Community:

Description of Input from Persons with Special Knowledge of or Expertise in Public Health (Required):

Description of Input from Government Health or Other Departments or Agencies with Information

Relevant to Community's Health Needs (Required Where Applicable):

Local Department or Agency:

Name Organization Title Expertise Consulted DurationRose Malinowski

Weingartner, MPH

Public Health

Management

Corporation

Research

Associate

Research and

Evaluation

Data Collection &

Analysis

ND

Name Organization Title Expertise Consulted DurationCarolyn Bazik Co-County Wellness

Services

Executive Director HIV and AIDS

Populations

In-person Meetings 3 - 120

minute

meetings

Sheila Bressler Berks County MH/MR Child & Adolescent

Service System

Coordinator

Child Mental Health Telephone Interviews 45 minutes

Dana Eichert Boyertown Area Multi-

Service

Executive Director Health and Social

Service Needs

Telephone Interviews 45 minutes

Ed Michalik, PsyD Berks County MH/MR County

Administrator

Mental Health In-person Meetings 3 - 120

minute

meetings

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Description of Input from Leaders, Representatives, or Members of Medically Underserved, Low-income,

Minority, and Chronic Disease Needs Populations in the Community (Required):

Description of Input from Other Providers of Community Input (Optional):

Name Organization Title Expertise Consulted DurationD. Michael Baxter,

MD

Reading Health System Chair, Department of

Family & Community

Medicine

Family Medicine;

Medically

Underserved


minute

meetings

Peg Bianca Greater Berks Food

Bank

Executive Director Food Insecurity Phone Interview 45 minutes

Diane Bonaccorsi,

MD

Green Hills Medical

Center

Primary Care

Physician

Primary Care In-person Meetings 3 - 120

minute

meetings

Rev. Wayne

Heintzelman

St. Daniel's Lutheran

Church

Pastor Medically

Underserved


minute

meetings

Richard Mable Reading Health System SVP, Community &

Govt Relations

Medically

Underserved


minute

meetings

Louis Mancano, MD Reading Health System Medical Director,

Ambulatory Services

Medically

Underserved

Phone Interview 45 minutes

George A. Neubert,

MD

Reading Health System Chair, Dept. of

Ob/Gyn

Medically

Underserved


Gary Rightmire Berks Community

Health Center

Board Chair Medically

Underserved


minute

meetings

Peter Schnatz, DO Reading Health System Residency Program

Director

Medically

Underserved


Pam Taffera, DO St. Joseph Regional

Health Network

Family Practice

Physician

Medically

Underserved


minute

meetings

Michael Toledo Centro Hispano Executive Director Minority

Populations


minute

meetings

Ivan Torres, Ph.D. PRONTO! Financial

Services

President Minority

Populations


Selina Zygmunt Keystone Farmworker

Health Program

Manager Minority

Populations


minute

meetings

Name Organization Title Expertise Consulted DurationKaren Rightmire Wyomissing

Foundation

President Community

Development


minute

meetings

Pat Giles United Way of Berks

County

Senior Vice President,

Community & Govt

Relations

Community

Development


minute

meetings

Heidi Williamson Berks County

Community Foundation

Vice President,

Grantmaking &

Communications

Community

Development


minute

meetings

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Description of Input from Academic Experts (Optional):

VI. Identification and Prioritization of Community's Health Needs (3.03(4))

Prioritized Description of All the Community Health Needs Identified Through the CHNA:

Name Organization Title Expertise Consulted DurationRebecca Hartman Alvernia University Doctoral Program

Student

Community

Leadership


minute

meetings

Ann Fisher Reading School District Supervisor of School

Health

Minority

Populations


Community Health Need

Categories- Based on Healthy People 2020

Priority AreasBerks

County

City of

Reading

Uninsured Adults 13.3% 23.7%

ED Utilization^ 24.8% 44.1%

Did Not Fill Prescription

Due to Cost 13.7% 23.7%

No Regular Source of

Care 11.8% 18.9%

Female Breast Cancer 24.5 27.3

Lung Cancer 46.7 54.2

Colorectal Cancer 17.6 19.4

Prostate Cancer 6.7 -

Diabetes Diabetes 13.9% 18.9%

Cultural Differences - -

Language Barriers - -

Excellent 21.1% 13.3%

Very Good 31.5% 18.2%

Good 31.4% 35.3%

Fair or Poor 15.9% 32.6%

Heart Disease* 189.3 241.5

High Blood Pressure 33.4% 40.0%

Stroke* 50.7 59.0

Hepatitis B, Chronic 6.6 -

HIV/AIDS 218.7 -

Lyme Disease 8.0 -

Pertussis 6.6 -

Varicella 20.7 -

Chlamydia 302.6 -

Gonorrhea 47.6 -

Birth Rate« 64.2 98.0

Teen Birth Rate» 9.4 28.1

Late or No Pre-Natal

Care 32.8% 50.1%

Low Birth Weight 7.7% 8.8%

Infant Mortality Rate˅ 4.9 5.8

Heart Disease and Stroke

Access to Services

Cancer*

Health Status

Immunization and

Infectious Diseases*

Health Communication

Maternal, Infant, and

Child Health

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Description of Process and Criteria Used to Prioritize Such Health Needs:

The needs assessment was overseen by a Steering Committee of representatives from each of the four

sponsoring organizations. An Advisory Committee of 17 representatives from Berks County community

organizations were appointed by the Steering Committee to provide input from the community. The

Advisory Committee supplied guidance at all stages of the needs assessment process. The steps in the needs

assessment process were: defining the community; identifying existing primary and secondary data and data

needs; collecting primary and secondary data; analyzing data; and preparing a written narrative report.

The following methods were utilized to define community priorities (listed above):

Household Health Survey (phone)

U.S. Census Data

Vital Statistics Data

Community Representatives

o Focus Groups

o Informational Interviews



Priority AreasBerks

County

City of

Reading

Mental Health

Clinical Depression,

Anxiety Disorder, or

Bipolar Disorder 14.6% 21.3%

Do Not Meet

Nutritional Standardsˆ 71.9% 84.8%

Obese 30.2% 35.0%

Overweight 35.9% 35.3%

No Care Due to Cost 21.1% 33.2%

Did Not Visit 30.0% 40.3%

Do Not Exercise 15.6% 23.6%

Free Place to Exercise 59.8% 50.7%

Respiratory Diseases Asthma 15.5% 18.2%

Substance Abuse Binge Drinking 38.4% 47.9%

Tobacco Use Smoking 20.4% 29.3%

˅ Calculated per 1,000 live infant births

Notes: Figures not displayed reflect numbers too small to report

ˆ No. fruits and vegetables consumed in a normal day

Nutrition and Weight

Status

Physical Activity

Oral Health

^Visited ED in past year due to lack of insurance

* Mortality rates calculated per 100,000 population

« Calculated per 1,000 women aged 15-44 years

» Calculated per 1,000 women aged 10-17 years

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VII. Community Facilities and Other Resources (3.03(5))

Description of Existing Health Care Facilities within the Community:

Description of Existing Resources (Other than Facilities) Within the Community:

Name Town State Zip Type

BERKS COUNTY HOSPITALS

Name Town State Zip Type of Hospital

Haven Behavioral Hospital of Eastern PA Reading PA 19601 Behavioral Health Hospital

Wernersville State Hospital Wernersville PA 19565 Psychiatric Hospital

St. Joseph Regional Health Network Reading PA 19605 Hospital

Reading Health System West Reading PA 19611 Hospital

Surgical Institute of Reading Wyomissing PA 19610 Surgical Hospital

Name Town State Zip Type of Center

St. Joseph Regional Health Network Downtown Campus Reading PA 19601 Health Center

Western Berks Free Medical Clinic Robesonia PA 19551 Health Center

Berks Community Health Center Reading PA 19601 Health Center

Keystone Farmworker Health Program Reading PA 19601 Health Center

Planned Parenthood of Northeast Pennsylvania Reading PA 19602 Health Center

Co-County Wellness Services/Berks AIDS Network Reading PA 19603 HIV/AIDS services

Mercy Community Crisis Pregnancy Center Reading PA 19601 Pregnancy Crisis Center

St. Joseph Regional Health Network at Maidencreek Blandon PA 19510 Urgent Care Center

Premier Immediate Medical Care Douglassville PA 19518 Urgent Care Center

Concentra Urgent Care Reading PA 19605 Urgent Care Center

Reading Convenient Care Reading PA 19605 Urgent Care Center

MedExpress Urgent Care - Muhlenberg Reading PA 19605 Urgent Care Center

Advance Urgent Care Reading PA 19608 Urgent Care Center

BERKS COUNTY HEALTH CENTERS AND CLINICS


Abilities In Motion Reading PA 19601 Social Service Agency

ADAPPT Reading PA 19601 Substance Abuse Treatment

Alternative Consulting Enterprises, Inc. Reading PA 19601 Mental Health/Medicaid Provider

American Cancer Socviety Reading PA 19605 Social Service Agency

American Diabetes Association Reading PA 18017 Social Service Agency

American Red Cross Reading PA 19601 Social Service Agency

Arc Advocacy Services Reading PA 19607 Social Service Agency

Autism Society of Berks Wyomissing PA 19610 Social Service Agency

Bailey, Diane, L.P.C. West Lawn PA 19609 Mental Health/Medicaid Provider

BCC Satellite Office Reading PA 19601 Social Service Agency

BCC/ACT Program Reading PA 19601 Social Service Agency

Berks Advocates Against Violence Reading PA 19601 Social Service Agency

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Berks Coalition to End Homelessness Reading PA 19602 Social Service Agency

Berks Counseling Center Reading PA 19601 Social Service Agency

Berks Counseling Center, Inc. Reading PA 19601 Mental Health/Medicaid Provider

Berks County Associate for the Blind Reading PA 19604 Social Service Agency

Berks County Children and Youth Reading PA 19601 Social Service Agency

Berks County Community Foundation Reading PA 19601 Foundation

Berks County Emergency Management Leesport PA 19533 Emergency Services

Berks County Services Center Reading PA 19601 Social Service Agency

Berks Encore- Birdsboro Birdsboro PA 19508 Senior Center

Berks Encore- Fleetwood Fleetwood PA 19522 Senior Center

Berks Encore- Hamburg Hamburg PA 19526 Senior Center

Berks Encore- Mifflin Shillington PA 19607 Senior Center

Berks Encore- Providence House Reading PA 19601 Senior Center

Berks Encore- Wernersville Wernersville PA 19565 Senior Center

Berks Encore-Reading Center Reading PA 19601 Senior Center

Berks Psychiatry, Inc. Reading PA 19602 Mental Health/Medicaid Provider

Berks Women in Crisis Reading PA 19601 Homeless/Emergency Shelter

Berkshire Psychiatric & Behavioral

Health Services, P.C.Reading PA 19601 Mental Health/Medicaid Provider

Beveridge, Lisa, L.S.W. Berks

Counseling Associates, P.C.Wyomissing PA 19610 Mental Health/Medicaid Provider

Big Brothers/Big Sister Reading PA 19601 Social Service Agency

Boyertown Area Multi-Services Center Boyertown PA 19512 Social Service Agency

Boyertown Salvation Army Boyertown PA 19512 Social Service Agency

Cammarano, Denise, L.S.W. Berks

Advocates Against ViolenceReading PA 19601 Mental Health/Medicaid Provider

Center for Mental Health Reading PA 19601 Mental Health

Centro Hispano (Hispanic Center) Reading PA 19601 Social Service Agency

Child & Family Support Services, Inc. Reading PA 19602 Mental Health/Medicaid Provider

Children's Allicance Center Reading PA 19601 Social Service Agency

Children's Home of Reading Reading PA 19601 Substance Abuse Treatment

CHOR Youth & Family Services, Inc. Reading PA 19601 Drug & Alcohol/Medicaid Provider

CHOR Youth & Family Services, Inc. Reading PA 19601 Mental Health/Medicaid Provider

Commonwealth Clinical Group, Inc. Reading PA 19601 Mental Health/Medicaid Provider

Community Prevention Partnership Reading PA 19601 Social Service Agency

Community Skills Program and Rehab, Inc.Wyomissing PA 19610 Social Service Agency

Community Solutions of Pennsylvania Reading PA 19601 Mental Health/Medicaid Provider

CONCERN Professional Services for

Children, Youth & FamiliesWyomissing PA 19610 Mental Health/Medicaid Provider

Concern of Reading Reading PA 19602 Mental Health

Council on Chemical Abuse Reading PA 19601 Substance Abuse Treatment

Creative Health Services, Inc. Birdsboro PA 19508 Substance Abuse Treatment

Creative Health Services, Inc. Birdsboro PA 19508 Mental Health/Medicaid Provider

Danken House Wernersville PA 19565 Homeless/Emergency Shelter

Dayspring Homes, Inc. Reading PA 19611 Homeless/Emergency Shelter

Department of Public Welfare County Assistance OfficeReading PA 19601 Government agency

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DeSantis, Denise, L.C.S.W. Berks

Counseling Associates, P.C. Wyomissing PA 19610 Mental Health/Medicaid Provider

Easter Seals of Eastern PA Reading PA 19611 Social Service Agency

Easy Does It, Inc. Leesport PA 19533 Drug & Alcohol/Medicaid Provider

Ercole, Mario, M.D. Reading PA 19601 Mental Health/Medicaid Provider

Familicare Counseling Center Reading PA 19601 Mental Health/Medicaid Provider

Family First Resource Center Reading PA 19602 Senior Center

Family Guidance Center Wyomissing PA 19610 Drug & Alcohol/Medicaid Provider

Family Guidance Center Reading PA 19601 Mental Health/Medicaid Provider

Family Life Services Topton PA 19562 Substance Abuse Treatment

Family Promise of Berks Reading PA 19601 Homeless/Emergency Shelter

Fischetto, Anthony, Ed.D Shillington PA 19607 Mental Health/Medicaid Provider

Freedom Gate Ministries Reading PA 19602 Substance Abuse Treatment

Gaulin, Ann, M.S., L.M.F.T. Shillington PA 19607 Mental Health/Medicaid Provider

Goodwill Reading PA 19605 Social Service Agency

Greater Reading Mental Health Alliance,

TheShillington PA 19607 Mental Health/Medicaid Provider

Haven Behavioral Hospital of Eastern

PennsylvaniaReading PA 19601 Mental Health/Medicaid Provider

Here and Now Group Reading PA 19602 Social Service Agency

Hill, Alison, Ph.D. Berks Counseling

Associates, P.C. Wyomissing PA 19610 Mental Health/Medicaid Provider

Holcomb Behavioral Health Systems Reading PA 19604 Mental Health/Medicaid Provider

Hope Rescue Mission Reading PA 19601 Homeless/Emergency Shelter

Infante, Olga, M.D. Reading PA 19601 Mental Health/Medicaid Provider

Janjua, Mohammad, M.D. Horizonz,

LLCReading PA 19601 Mental Health/Medicaid Provider

Jewish Community Center of Reading Reading PA 19604 Social Service Agency

Kennedy Senior Center Reading PA 19602 Senior Center

KidsPeace National Centers, Inc. Temple PA 19560 Mental Health/Medicaid Provider

La Casa De la Amistad Reading PA 19601 Senior Center

Laureldale Center Reading PA 19605 WIC Office

Lesniak-Karpiak, Katarzyna, Ph.D. Douglassville PA 19518 Mental Health/Medicaid Provider

Mary's Shelter Reading PA 19602 Homeless/Emergency Shelter

McConaghay, Dean, M.S. Berks

Counseling Associates, P.C.Wyomissing PA 19610 Mental Health/Medicaid Provider

Mental Health Association West Reading PA 19611 Mental Health

Milestones Community Healthcare, Inc. Wyomissing PA 19610 Mental Health/Medicaid Provider

Nagle, Robert, Ph.D. Berks Counseling

Associates, P.C.Wyomissing PA 19610 Mental Health/Medicaid Provider

Namiotka, Mary, L.C.S.W. Leesport PA 19533 Mental Health/Medicaid Provider

National Mentor Healthcare, Inc. dba PA

MentorFleetwood PA 19522 Mental Health/Medicaid Provider

New Directions Treatment Services West Reading PA 19611 Drug & Alcohol/Medicaid Provider

New Directions Treatment Services West Reading PA 19611 Mental Health/Medicaid Provider

New Life Cognitive Behavioral Services,

Inc.Reading PA 19601 Mental Health/Medicaid Provider

New Person Center Reading PA 19601 Substance Abuse Treatment

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NHS Pennsylvania Wyomissing PA 19610 Mental Health/Medicaid Provider

Nicodemus, David, M.A. Reading PA 19607 Mental Health/Medicaid Provider

Office of Mental Health/Developmental DisabilitiesReading PA 19601 Mental Health

Olivet Boy and Girls Club Reading PA 19611 Social Service Agency

Opportunity House Reading PA 19601 Substance Abuse Treatment

Orr, Gerald, M.A. - Berks Counseling

Associates, P.C.Wyomissing PA 19610 Mental Health/Medicaid Provider

Pennsylvania Counseling Services, Inc. Reading PA 19602 Drug & Alcohol/Medicaid Provider

Pennsylvania Counseling Services, Inc. Reading PA 19602 Mental Health/Medicaid Provider

Perez Bentancourt, Mirta, L.P.C. Shillington PA 19607 Mental Health/Medicaid Provider

Progressions Reading PA 19601 Mental Health

Progressions Companies, Inc., The Reading PA 19601 Mental Health/Medicaid Provider

Reading Behavioral Health Center Inc. Reading PA 19602 Mental Health/Medicaid Provider

Reading Center Reading PA 19601 WIC Office

Reading Health System - Ctr. for MH West Reading PA 19611 Mental Health/Medicaid Provider

Reading Health System - Ctr. for MH West Reading PA 19611 Drug & Alcohol/Medicaid Provider

Real Alternatives West Reading PA 19601 Pregnancy Crisis Center

Richard J. Caron Foundation Wyomissing PA 19610 Drug & Alcohol/Medicaid Provider

Rijo, Ana, L.P.C. Seed of Hope, Inc. Reading PA 19601 Mental Health/Medicaid Provider

Royall, Carmen, L.P.C. Horizonz, LLC. Reading PA 19601 Mental Health/Medicaid Provider

Salvation Army Reading PA 19602 Social Services

Salvation Army - Boyertown Corps Boyertown PA 19512 Social Services

Schollenberger, Craig, L.C.S.W. Wyomissing PA 19610 Mental Health/Medicaid Provider

Service Access & Management, Inc. Reading PA 19601 Mental Health/Medicaid Provider

Shillington Center Shillington PA 19607 WIC Office

Signature Family Services West Reading PA 19611 Social Service Agency

Spellman, Pamela, L.C.S.W. Reading PA 19601 Mental Health/Medicaid Provider

Stufflet, Kathryn, L.C.S.W. Wyomissing PA 19610 Mental Health/Medicaid Provider

Tamaqua Salvation Army Tamaqua PA 18252 Social Service Agency

Threshold Rehabilitation Services, Inc. Reading PA 19607 Behavioral Health Services

Threshold Rehabilitation Services, Inc. Reading PA 19607 Mental Health/Medicaid Provider

Treatment Access & Services Center,

Inc.Reading PA 19601 Mental Health/Medicaid Provider

Treatment Access & Services Center,

Inc.Reading PA 19601 Drug & Alcohol/Medicaid Provider

United Way of Berks County Reading PA 19603 Community agency

Veterans Affairs of Berks Leesport PA 19533 Government agency

Wyomissing Foundation Wyomissing PA 19610 Foundation

Yasmeen, Nikhat, M.D. - Reading

PsaychiatryReading PA 19601 Mental Health/Medicaid Provider

YMCA Reading PA 19601 YMCA

Youth Advocate Programs, Inc. Reading PA 19605 Mental Health/Medicaid Provider

16


St. Luke's Lutheran Church Bloomsburg PA 17815 Food Pantry

Pottsville Area Food Pantry Pottsville PA 17901 Food Pantry

Schuylkill Community Action Program Pottsville PA 17901 Food Pantry

Hope Lutheran Church Ashland PA 17921 Food Pantry

Mahanoy Area Food Pantry Mahonoy City PA 17948 Food Pantry

Minersville Area Food Cupboard Minersville PA 17954 Food Pantry

Schuylkill Valley Food Pantry New Philadelphia PA 17959 Food Pantry

New Ringgold Area Food Pantry New Ringgold PA 17960 Food Pantry

Pine Grove Area Food Pantry Pine Grove PA 17963 Food Pantry

Shenandoah Area Food Pantry Shenandoah PA 17976 Food Pantry

Williams Valley Food Pantry Tower City PA 17980 Food Pantry

Tremont Food Pantry Tremont PA 17981 Food Pantry

Tri Valley Food Pantry Valley View PA 17983 Food Pantry

McAdoo Area Food Pantry McAdoo PA 18237 Food Pantry

Nuremberg Area Food Pantry Nuremberg PA 18241 Food Pantry

Tamaqua Area Food Pantry Tamaqua PA 18252 Food Pantry

Tamaqua Primitive Methodist Church Tamaqua PA 18252 Food Pantry

Northern Berks Food Pantry Hamburg PA 19526 Food Pantry

The Rodale Institute Kutztown PA 19530 Food Pantry

St. Benedict's RCC Mohnton PA 19540 Food Pantry

Oley Valley Food Pantry Oley PA 19547 Food Pantry

Spring Valley Church of God Temple PA 19560 Food Pantry

Iglesia Bautista Betania Reading PA 19601 Food Pantry

St. Paul's Lutheran Church Reading PA 19601 Food Pantry

St. James Chapel Reading PA 19602 Food Pantry

Hub of Hope at Reading Moravian Church Reading PA 19604 Food Pantry

St. Ignatius Loyola RCC Reading PA 19606 Food Pantry

Ringtown Valley Food Pantry Reading PA Food Pantry

Ashland Food Pantry Ashland PA 17921 Soup Kitchen/Meal Program

Friend, Inc. Kutztown PA 19350 Soup Kitchen/Meal Program

Harvest Fellowship of Colebrookdale Boyertown PA 19512 Soup Kitchen/Meal Program

Hamburg SDA Church Hamburg PA 19526 Soup Kitchen/Meal Program

Conrad Weiser Pantry Robesonia PA 19551 Soup Kitchen/Meal Program

Hampden Heights SDA Church Temple PA 19560 Soup Kitchen/Meal Program

Bethel AME Church Reading PA 19601 Soup Kitchen/Meal Program

Christ Lutheran Church Reading PA 19601 Soup Kitchen/Meal Program

Circle of Friends Drop In Center Reading PA 19601 Soup Kitchen/Meal Program

City Light Ministry Reading PA 19601 Soup Kitchen/Meal Program

Grace and Hope Mission Reading PA 19601 Soup Kitchen/Meal Program

Holy Cross Memorial Church Reading PA 19601 Soup Kitchen/Meal Program

Holy Spirit Lutheran Church Reading PA 19601 Soup Kitchen/Meal Program

Holy Trinity Church of God Reading PA 19601 Soup Kitchen/Meal Program

BERKS COUNTY FOOD PANTRIES AND SOUP KITCHENS

17


Evangelical Mennonite Church Reading PA 19602 Soup Kitchen/Meal Program

First Unitarian Universalist Reading PA 19602 Soup Kitchen/Meal Program

Greater Berks Food Bank Reading PA 19605 Soup Kitchen/Meal Program

Catholic Charities, Diocese of Allentown Reading PA 19606 Soup Kitchen/Meal Program

Central Park United Methodist Food MinistryReading PA 19606 Soup Kitchen/Meal Program

Bethany Lutheran Church West Reading PA 19611 Soup Kitchen/Meal Program

Calvary Community Center Reading PA 19611 Soup Kitchen/Meal Program

Cluster Outreach Center Temple PA 19560 Soup Kitchen/Meal Program

18

Community Health Needs Assessment (CHNA)

Implementation Strategy

Written Plan

Reading Health System

PO BOX 16052 Reading, PA 19612-6052

July 1, 2012 – June 30, 2013

19

I. General Information

Contact Person: Stephanie Kuppersmith, MPH

Date of Written Plan: May 1, 2013

Date Written Plan Was Adopted by Organization's Authorized Governing Body: May 23, 2013

Date Written Plan Was Required to Be Adopted: June 30, 2013

Authorizing Governing Body that Adopted the Written Plan: Reading Health System Board of Directors

Was Written Plan Adopted by Authorized Governing Body by End of Tax Year in Which CHNA was Made

Available to the Public? Yes

Date Facility's Prior Written Plan Was Adopted by Organization's Governing Body: N/A

Name and EIN of Hospital Organization Operating Hospital Facility: Reading Health System; 23-1352204

Address of Hospital Organization: PO Box 16052 Reading, PA 19612-6052

I. List of Community Health Needs Identified in Written Report

List of Community Health Needs Identified in CHNA Written Report, Ranked by CHNA's Priority:



CHNA Identified

Priority Areas

Berks

County

City of

ReadingPA State U.S.

Healthy

People

2020

Goals

Priority

Ranking

Priority

Potential

Decisions

Birth Rate« 64.2 98.0 88.5 72.5

Teen Birth Rate» 9.4 28.1 29.2 21.0

Late or No Pre-Natal

Care 32.8% 50.1% 29.2% 22.1%

Low Birth Weight 7.7% 8.8% 8.4% 6.0% 7.8%

Infant Mortality Rate˅ 4.9 5.8 7.5 6.2 5.6

Heart Disease* 189.3 241.5 192.1 186.5 100.8

High Blood Pressure 33.4% 40.0%

Stroke* 50.7 59.0 42.2 33.8

Mental Health

Clinical Depression,

Anxiety Disorder, or

Bipolar Disorder 14.6% 21.3% 37.1% 35.8%

30.0

Uninsured Adults 13.3% 23.7% 12.0% 11.0% 0%

ED Utilization^ 24.8% 44.1% Reduce

Did Not Fill Prescription

Due to Cost 13.7% 23.7% 8.0% 9.0%

No Regular Source of

Care 11.8% 18.9% 5.0%

Do Not Meet

Nutritional Standardsˆ 71.9% 84.8%

Obese 30.2% 35.0% 29.0% 25.0% 30.5%

Overweight 35.9% 35.3%

Diabetes Diabetes 13.9% 18.9% 9.5% 9.5% 7.2/1,000 28.0

28.9

28.4

Hig

h P

rio

rity

Maternal, Infant, and

Child Health

Heart Disease and Stroke

Access to Services

Nutrition and Weight

Status

32.1

32.0

20

II. List of Collaborating Organizations

The following organizations were consulted in the development of this implementation plan: Berks County

Community Foundation, Reading Housing Authority, St. Joseph Medical Center, and the United Way of

Berks County.

III. Health Needs Planned to Be Addressed By Facility

Reading Health System convened an internal implementation team comprised of Hospital leadership, as well

as staff from marketing/communications, government relations, patient care and medical care in order to

review the CHNA priorities and define the Hospital’s focus over the next three years. The following is the

result of their findings:



CHNA Identified

Priority Areas

Berks

County

City of

ReadingPA State U.S.

Healthy

People

2020

Goals

Priority

Ranking

Priority

Potential

Decisions

No Care Due to Cost 21.1% 33.2% 11.3%

Did Not Visit 30.0% 40.3% 27.7% 30.3% 51.0%

Hepatitis B, Chronic 6.6 - 0.0

HIV/AIDS 218.7 - 376.5 350.4

Lyme Disease 8.0 -

Pertussis 6.6 - 0.1 0.0

Varicella 20.7 -

Chlamydia 302.6 - 377.0 426.0

Gonorrhea 47.6 - 102.2 100.8

Tobacco Use Smoking 20.4% 29.3% 21.0% 20.6% 12.0% 25.1

Female Breast Cancer 24.5 27.3 27.9% 22.9 20.6

Lung Cancer 46.7 54.2 14.9% 50.6 45.5

Colorectal Cancer 17.6 19.4 18.3 17.0 14.5

Prostate Cancer 6.7 - 27.7% 23.5 21.2

Respiratory Diseases Asthma 15.5% 18.2% 9.9% 8.6% 24.9

Substance Abuse Binge Drinking 38.4% 47.9% 17.0% 7.0% 24.4% 24.4

Cultural Differences - -

Language Barriers - -

Do Not Exercise 15.6% 23.6% 26.0% 21.0% 32.6%

Free Place to Exercise 59.8% 50.7%

Excellent 21.1% 13.3%

Very Good 31.5% 18.2%

Good 31.4% 35.3%

Fair or Poor 15.9% 32.6% 14.0% 10.0%

23.4

23.3

23.0

26.9

26.3

25.0

Notes: Figures not displayed reflect numbers too small to report

ˆ No. fruits and vegetables consumed in a normal day

Low

Pri

ori

ty

Physical Activity

Oral Health

Cancer*

Health Status

Immunization and

Infectious Diseases*

Health Communication

˅ Calculated per 1,000 live infant births

^Visited ED in past year due to lack of insurance

* Mortality rates calculated per 100,000 population

« Calculated per 1,000 women aged 15-44 years

» Calculated per 1,000 women aged 10-17 years

21

Community Health Department at Reading Hospital

Reading Health System will create a new interdisciplinary Community Health Department with staff who

has expertise in community medicine and public health. Their purpose will be to: (1) Work to address the

health needs identified in the CHNA; (2) Coordinate internal community outreach efforts to maximize and

focus efforts on target populations; and (3) Assist in coordinating student placement and research activities

that facilitate the community-based action research of its stakeholders. Department staff will be a constant

presence at community meetings and represent Reading Health System in community organizational

governance structures.

The mission of the Community Health Department will be to improve the health and wellness of Berks

County and abutting communities by mobilizing the resources of Reading Health System and partnering

with community organizations.

In order to fully address the health needs outlined in the 2013 assessment, it will take a consistent, long-term

synergistic effort by multiple stakeholders. To this end, Reading Health System’s Community Health

Department will take the lead in developing and sustaining a community coalition that will convene

stakeholders with broad representation from community organizations and academic institutions.

Berks County Community Coalition

The mission of the Berks County Community Coalition (BCCC) will be to eliminate health disparities in

chronic disease and mental health by reducing risk factors, promoting healthy lifestyles, and applying

evidence-based and culturally appropriate strategies and programs throughout Berks County communities.

Coalition activities will include:

Defining, prioritizing, and developing strategies to address local health issues in cooperation with

community partners, health providers, research institutions and governmental entities;

Developing long-term strategies to address health disparities, with a focus on chronic illnesses

(cancer, diabetes, cardiovascular disease, etc.) and mental health, especially in underserved and

uninsured populations;

Establishing a sustainable capacity and infrastructure that encourages and facilitates community-

based participatory research and training activities focused on eliminating health disparities;

Developing local academic, governmental, and community partnerships to accelerate diffusion and

adoption of evidence-based approaches to prevention and treatment of health conditions;

Advocating for health policies that ensure equality in access to health care and services;

Identifying local, regional, and national resources to develop and implement identified programs that

will improve the delivery of health services to populations with health disparities.

Membership: Private or public organizations interested in the health of Berks County communities will be

asked of their interest to become members of the Community Coalition.

Health priorities identified for the Coalition to focus on (Table 1): Access to Healthcare, Asthma, Binge

Drinking, Obesity, Oral Health, promotion of Physical Activity, and the Teen Birth Rate in the City of

Reading.

22

Table 1.

Primary Priorities: health issues identified as having little or no coordinated effort and programming

PRIORITY: Maternal, Infant, and Child Health Strategy (1): Promote availability of services for pre-natal care

Activity (A): Develop and implement a health communication campaign informing residents of the

importance and availability of pre-natal services

Strategy (2): Promote availability of services for prevention of pregnancy among teens

Activity (A): Develop and implement a health communication campaign promoting availability of

pregnancy prevention services among teens (especially within the City of Reading)

Strategy (3): Promote health education at area schools for pregnancy prevention and access to resources

Activity (A): Work with area School Districts to provide health education to teens on prevention

methods and access to resources to reduce teen pregnancy rates

Reading Health System:

Community Health

Department

Berks County Community

Coalition

Primary Responsibilities:

Maternal, Infant, and Child

Health; Mental Health; and

Obesity

Secondary Responsibilities:

Heart Disease & Stroke;

Diabetes; and Access to

Services

Tertiary Responsibilities:

Cancer; Infectious

Diseases; Tobacco Use;

Health Communication;

and Health Status

Monitoring

Coalition responsibilities: Access to Healthcare- Insurance

Asthma

Binge Drinking

Obesity

Oral Health

Teen Birth Rate (Reading)

Physical Activity

23

Logic Model: Maternal, Infant and Child Health

PRIORITY: Mental Health Strategy (1): Assess feasibility of co-locating primary care and mental health services to better coordinate

patient care

Activity (A): Work with area primary care practices and Center for Mental Health to pilot co-located

services in order to judge feasibility for system-wide roll out

Strategy (2): Assess feasibility of providing case management services through Service Access

Management, Inc., in our Emergency Department

Activity (A): Work with Berks County Service Access Management, Inc., to provide case

management services via telemedicine or hotline in the Emergency Department

Strategy (3): Review Hospital policies and procedures for handling patients with mental health needs

Activity (A): Review, update, and implement revised Hospital policy regarding no-show patients

Activity (B): Review, update, and implement revised Hospital policy regarding patient referrals to

psychiatrists

Outputs

Resources Activities Short-Term Intermediate Long-Term

1 to 3 years 5 to 7 years 10 to 12 years

Strategy (1): Promote

availability of services

for pre-natal care

Community Health

Department; Marketing;

Community

Organizations (TBD)

Develop and implement a

health communication

campaign informing

residents of the

importance and

availability of pre-natal

services

• Development of health

campaign (based on

evidence-based

practices)

• Implementation of

campaign throughout

community

• Acceptance and

promotion of health

campaign by community

organizations

• Increase in

understanding of the

importance of receiving

pre-natal care services

• Increase in util ization

of pre-natal services

• Decrease in women

who have late or no-

prenatal care to 29%


availability of services

for prevention of

pregnancy among teens

Community Health

Department; Marketing;

Community

Organizations (TBD); and

the Community Coalition


health communication

campaign promoting

availability of pregnancy

prevention services

among teens (especially

within the City of

Reading)


campaign (based on

evidence-based

practices)


campaign throughout

community

• Acceptance and

promotion of health


organizations

• Increase in awareness

of the pregnancy

prevention services


of pregnancy prevention

services

• Decrease in teens who

are pregnant in the City

of Reading by 8%


health education at area

schools for pregnancy

prevention and access to

resources

Community Health

Department; Berks

County School Districts

(SDs); Teachers and

Teens

Work with area School

Districts to provide

health education to teens

on prevention methods

and access to resources

to reduce teen pregnancy

rates

• Gain acceptance by

area SDs to allow health

education on teen

pregnancy prevention

• Development of

educational materials

(based on evidence-

based practices)

• Provision of education

materials to Teens

throughout Berks County

• Evaluation of program


of prevention methods

• Increase in knowledge

of prevention methods

and how to access them

• Decrease in the teen

birth rate in the City of

Reading by 7%

Inputs Outcomes- Impact

24

Logic Model: Mental Health

PRIORITY: Obesity Strategy (1): Promote availability of healthy food choices

Activity (A): Perform Food Access and Security Needs Assessment in the City of Reading to

determine access to fresh produce

Activity (B): Develop and implement a Farm to Preschool program at the Hospital’s Children’s

Development Center (i.e. onsite day-care facility)

Activity (C): Increase the proportion of school districts that require schools to make fruits or

vegetables available whenever other food is offered or sold

Activity (D): Promote and support local farmers’ markets in the community

Strategy (2): Promote increased physical activity and exercise

Activity (A) : Health communication campaign to make community members aware of various types

of physical activity and places they can go to exercise, e.g. YMCA, parks, trails, etc.

Activity (B): Work with area school districts to promote physical fitness in schools

Strategy (3): Promote patient-provider education on obesity and cause and effect on chronic diseases

Activity (A): Hold continuing medical education (CME) events for physicians, nurse practitioners,

and nurses to learn how to increase conversations with patients on obesity, BMI, co-morbid

conditions, and promoting healthier lifestyles

Outputs


1 to 3 years 5 to 7 years 10 to 12 years

Strategy (1): Assess

feasibility of co-locating

primary care and mental

health services to better

coordinate patient care

Center for Mental Health;

Family Health Care

Center; Hospital

Administration;

Community Health

Department

Work with area primary

care practices and Center

for Mental Health to pilot

co-located services in

order to judge feasibility

for system-wide roll out

• Hold feasibility study

to: Define location, staff,

services to be provided,

and cost of pilot

• Pilot primary care

services during one of

the mental health clinics

• Evaluate util ization

rate and cost

effectiveness of co-

located services


of primary care services

among patients with

defined mental health

conditions

• Better patient outcomes

• Higher patient

satisfaction scores

Strategy (2): Assess

feasibility of providing

case management

services through Service

Access Management, Inc.,

in our Emergency

Department


Community Health

Department; and Service

Access Management, Inc.

Work with Berks County

Service Access

Management, Inc., to

provide case

management services via

telemedicine or hotline

in the Emergency

Department

• Hold feasibility study

to: Define staff, services

to be provided, and cost

of pilot

• Pilot services provided

in ED

• Evaluate util ization

rate and cost

effectiveness

• Increase in access and

utilization to case

management services by

patients who access care

through the ED


• Higher patient

satisfaction scores

• Better util ization of

physician time

Strategy (3): Review

Hospital policies and

procedures for handling

patients with mental

health needs


Hospital Administration;

Physician panel;

Community Health

Department

Review, update, and

implement revised

Hospital policy regarding

no-show patients

• Updated Hospital

policy regarding no show

patients

• Increase in access to

services


• Higher patient

satisfaction scores


Hospital Administration;

Physician panel;

Community Health

Department

Review, update, and

implement revised

Hospital policy regarding

patient referrals to

psychiatrists

• Updated Hospital

policy regarding

referrals to psychiatrists


specialty care services


• Higher patient

satisfaction scores

Outcomes- ImpactInputs

25

Logic Model: Obesity

Outputs


Community Health Dept.;

The Food Trust; PFHBC

Community Coalition

Perform Food Access and

Security Needs

Assessment in the City of

Reading to determine

access to fresh produce

Completion of the

following:

• Inventory on the food

retail environment;

• Survey of community

members; and

• Survey of local

business owners

• Development of

actionable plan by

Community Coalition

based on results from the

needs assessment

• Definition of funding

sources for implementing

action items

• Acquisition of funding

for action items


fresh produce in the City

of Reading

• Elimination of USDA-

defined Food Desert in

the City of Reading


Child Development

Center; Facilities

Management; Nutrition


Farm to Preschool

program at the Hospital’s

Children’s Development

Center (i.e. onsite day-

care facil ity)

• Development of Farm to

preschool program for

children ages 0-4 at the

CDC (based on evidence-

based practices)

• Increase in knowledge

of what makes up a

healthy diet among

children ages 3-4

• Increase in daily

consumption of fruits

and vegetables by 5%

• Decrease prevalence of

obesity and overweight

in CDC population


School District's

Wellness Committees;

Food Service providers

Increase the proportion

of school districts that

require schools to make

fruits or vegetables

available whenever other

food is offered or sold

• Collaborate with

wellness committees to

assess school's ability to

implement healthier food

options

• Work with 2 SDs to

implement healthier food

options

• Expand reach to

additional 3 SDs

• Increase access to

fresh produce in schools

• 15% of SDs requiring

schools to make fruits or

vegetables available

whenever other foods are

offered or serve



by 7%


Marketing Dept.;

Promote and support

local farmers’ markets in

the community

• Develop marketing

campaign to promote

community farmer's

markets

• Implement campaign


of farmer's markets


of farmer's markets by

5%

• Increase in daily

consumption of fruits

and vegetables by 5%



by 7%

Outcomes- Impact


availability of healthy

food choices

Inputs


Marketing Dept.; and

Community Coalition

Health communication

campaign to make

community members

aware of various types of

physical activity and

places they can go to

exercise, e.g. YMCA,

parks, trails, etc.


campaign (based on

evidence-based

practices)


campaign throughout

community

• Acceptance and

promotion of health


organizations


of places available for

physical activity and

exercise


of community resources

• Increase in physical

activity levels by 10%


Children's Health Center;

Nutrition Services; Area

School Districts; and

Penn State-Berks

Kinesiology Dept.

Work with area school

districts to promote

physical fitness in

schools

• Adoption and

implementation of an

evidence-based practice

model at one school

• Evaluation of program

• Expansion of program

to 3-5 schools


activity levels among

children in grades 1 to 5

by 10%


patient-provider

education on obesity and

cause and effect on

chronic diseases

Academic Affairs Dept.;


Marketing Dept.; and

Health System Physicians

Hold continuing medical

education (CME) events

for physicians, nurse

practitioners, and nurses

to learn how to increase

conversations with

patients on obesity, BMI,

co-morbid conditions,

and promoting healthier

l ifestyles

• Develop CME education

based on evidence-based

practices

• Implement CME

education initiative

• Evaluate education

initiative

• Increase in patient-

provider conversations

about obesity by 3%

• Increase in education

and promotion of healthy

lifestyles by primary care

practices by 5%


activity levels by 5%

• Increase in

consumption of fresh

fruits and vegetables by

5%



by 7%


increased physical

activity and exercise

26

Secondary and Tertiary Priorities: health issues identified as currently having coordinated effort and programming devoted to them

Access to Services ED Utilization

Reading Health System offers three Quickcare Locations (Berkshire Heights, Exeter, and Leesport).

Quickcare facilities are located in high-traffic areas and are open at convenient times. Staffed by Hospital

physicians and ancillary staff, they treat patients with common ailments such as sore throat, ear infections,

or rashes. In addition, they provide immunizations and other simple health check-ups.

In June of 2012, a new Federally Qualified Health Center opened in the City of Reading, called the Berks

Community Health Center. The Health Center had just opened when data collection began on our needs

assessment. We anticipate that the future presence of this facility will aid in reducing unnecessary use of the

Hospital’s Emergency Department (ED). Reading Health System is committed to their success and intends

to promote the Health Center by working with them to expand their service hours, helping them to position

themselves to be integrated into the medical home model with specialists, and aligning them with the Health

System’s ED.

In addition, Reading Health System will look to provide a new access point for patients by establishing a

Health Center within the Hospital’s ED; and support the development of a FQHC in the City of Reading that

would provide Women’s and Children’s services and serve as their medical home, as well as open access

laboratory services to the community.

Did not fill prescription due to cost

In Fiscal Year 2012, Reading Health System provided approximately $85,000 worth of free prescriptions to

patients who needed it. The Health System will continue to offer this service. We are hopeful that with the

opening of the Health Insurance Exchanges in 2014, that fewer patients will need this service in the future.

No regular source of care

While Reading Health System continually examines how it can get in front of the primary care physician

shortage with the increased utilization of Nurse Practitioners and the like, as well as the nursing shortage, we

have found that the community is still struggling with identifying and sustaining a source of primary care.

Reading Health System’s Family Health Care Center has piloted a novel process termed “open access”

which promotes the philosophy of “Do today’s work today.” The process has been found to improve

continuity of care, access, and patient satisfaction. This approach not only applies to patients already in the

practice, but should improve access to new patients as well. In addition, many of our primary care practices

and internal medicine practices provide patients with same-day appointments for urgent matters by holding

open a certain amount of slots each day. Our Family Health Care Center also offers extended hours in order

to provide patients with more options for accessing care.

The Hospital currently offers sub-specialty clinics which provide all patients with access to on-site

specialists in a wide variety of areas including: Arthritis, Cardiology, Dermatology, Endocrinology,

Gastroenterology, Gynourology, Infectious Diseases, Neurology, Podiatry, Pulmonary, Surgical, Trauma,

Cleft Palate, and vision. However, the clinic currently operates on a first come, first serve basis, which often

leaves the most at-risk patients on the door step of the Emergency Department. In order to ensure future

success of this clinic, Reading Health System will convene an internal committee to examine the current

process and will look to establish guidelines and a patient prioritization metric so that the patients at greatest

need will receive care in a timely and efficient manner.

27

Cancer Reading Health System’s McGlinn Family Regional Cancer Center provides comprehensive cancer care

from the time of diagnosis throughout the treatment phase and continues after treatment is completed.

Cancer Center services include:

Early Detection

Screening Programs and Events

The Regional Cancer Center offers free cancer screenings for oral, breast, prostate, skin, and cervical

cancers throughout the year. We also distribute free colorectal cancer screening kits at local health fairs.

The following screening events are held each year:

Breast

Skin

Prostate

Oral

Cervical

Colorectal

Risk Assessment and Genetic Counseling

The Family Risk Assessment Program is targeted toward women who are considered to be at higher than

average risk for developing certain cancers. Through this program, information is being gathered to assist in

cancer research. Program participants are provided with the results, allowing them to make well-informed

medical and lifestyle decisions.

Diagnosis & Treatment (including Clinical Trials)

Reading Hospital’s Regional Cancer Center provides a complete range of treatment options for patients with

most types of cancer. Surgery, chemotherapy, and radiation therapy are the primary therapies used to treat

cancer patients. Clinical trials give cancer patients options that reach beyond standard treatment and provide

a way to discover new therapies to combat cancer. Eligible patients have the opportunity to voluntarily

participate in clinical trials.

Support and Wellness

The following programs and resources are offered to assist patients and their families at every stage of

treatment and recovery:

Breathe Easy Smoking Cessation Course

Caring for the Caregiver

Family Risk Assessment Program

Healing Yoga Classes

Image Recovery Center

Outpatient Social Services

PAWS for Wellness

FLOW – Friendship, Laughter, Openness Workout

Tai Chi

Therapeutic Massage

Breast Cancer Support Services

Psychiatry and Psychology Services

Nutrition Counseling

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Diabetes Diabetes education and management is handled at the Reading Health Physician Network - Endocrinology

and Diabetes Center. Beyond medical management of blood sugars, the Diabetes Center offers a complete

menu of services to anyone with diabetes. Individual education and counseling are crucial for many

diabetics, who need help learning to make decisions about their care, check blood sugars, take medication,

or lose weight.

Services include:

diabetes medical care, including a comprehensive history and physical, and an individualized

treatment plan;

changes in medicine as needed to improve blood sugars;

training in monitoring blood glucose;

insulin pump evaluation, training, and management;

hemoglobin A1C, blood glucose, and urine protein testing on premises;

insulin starts and training in insulin use;

group and individual diabetes education recognized by the American Diabetes Association;

individual meal planning; and

new therapies like continuous glucose monitoring that can look at all blood sugars for 72 hours

In addition, the Diabetes Center offers the following classes:

Multiple Daily Injection Class

Diabetes and You

Diabetes Review Class

Gestational Diabetes Class

Insulin Pump Education

Would An Insulin Pump Be Right For Me?

Pre-Diabetes Group

Pre-Diabetes Support Group

Supermarket Tours

In addition, diabetes is a future initiative under the Hospital’s new Clinical Integration program called

Advancing Wellness. Details of the program are explained under the heart disease category below.

Heart Disease & Stroke The Marlin Miller, Jr. Regional Heart Center provides prevention programs, state-of-the-art diagnostic and

treatment services, and complete cardiac rehabilitation. Our interdisciplinary team approach to heart care

allows us to rapidly mobilize all available resources to treat the patient's heart problems. Our use of

evidence-based treatment guidelines promotes consistency of care and positive patient outcomes.

Community Health Education services include:

Heart to Heart – Lifestyle Education Series

HeartSafe- AED training

Heart Healthy Nutrition

Life After Stroke: Stroke Support Group

CPR classes

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Reading Health System’s- Stroke Center is fully equipped and staffed to provide state-of-the-art rapid

evaluation and treatment for stroke. The Stroke Center’s community health programs including:

Heart Health Education

Go Red- Heart Health

Stroke Awareness

Heart Failure Support Group

In addition, Congestive Heart Failure is one of the Hospital’s strategic priorities and is the catalyst for a new

initiative called Advancing Wellness. Advancing Wellness is a program created to assist patients living with

heart failure, or COPD, and in the future diabetes. The program was developed as a collaboration between

Reading Hospital, Reading Health Physician Network, and local Cardiologists.

Services provided include:

Registered Nurse Care Navigator to coordinate additional care

Collaboration between primary care physicians and specialists to provide complete cardiac

assessment, evaluation, and treatment recommendations for patients diagnosed with heart failure

Expert recommendations to patients on lifestyle changes needed to better manage symptoms and

prevent admission to the hospital

Lab assessment

Rehabilitation programs

Routine follow-up telephone calls with patients by a Care Navigator

Patient medication review and follow-up with a Pharmacist

Patient diet review and follow-up with a Nutritionist

Resources and tools to help patients improve quality of life

Infectious Diseases Reading Health System’s Center for Public Health takes a team approach to promoting the health and

wellness of people diagnosed with HIV. Patients have access to case managers, nutritionists, physicians, and

counsellors. The Center’s staff has over twenty years of experience managing specialty care associated with

HIV. The Center welcomes clients with and without medical insurance.

Center for Public Health services include:

Medical treatment of HIV and AIDS

Primary medical care

Routine gynecological care

Routine immunizations

Nutrition counseling

Case management

Education on medications, laboratory testing, and nutrition

Support groups

Smoking cessation

Routine ophthalmology care

Referral to specialty clinics

Free Rapid HIV testing

Free, confidential screening and treatment of STDs for anyone over the age of 13

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Health Communication Reading Health System is committed to meeting the needs of our patients, including those with diverse

values, beliefs and behaviors. Interpreting services are offered throughout our System to patients who

request it, including in-person and phone interpreters. In Fiscal Year 2012, our Interpreters provided

approximately 9,000 patients with interpreting services. As our minority populations increase in the City of

Reading and throughout Berks County, we will examine expanding these services to meet the increasing

demand.

In addition, Reading Health System will assess cultural competence of our healthcare providers. By being

culturally competent in health care, health care professionals can understand a patient’s diverse values,

beliefs, and behaviors, and customize treatment to meet the patient’s social, cultural and linguistic needs.

Therefore, after an assessment of cultural competence is complete we will develop (based on evidence-based

practices) and implement a cultural competence training program.

Many recent studies have found that cultural competence training shows promise as a strategy for improving

the knowledge, attitudes, and skills of health professionals, and in turn impacts patient care and satisfaction.

Health Status Monitoring As part of its Clinical Integration initiative, Reading Health System has purchased and will be implementing

a population management-based software that will provide the Health System and its providers with a 360-

degree view of patient care, a deep understanding of their own clinical, financial, and infrastructure

strengths and liabilities, extensive expertise and support for improving population management, and an

advantage in risk-based contract negotiations with payers.

Tobacco Use Reading Health System’s Tobacco–Free Wellness Center provides comprehensive tobacco treatment

services that address the physical, emotional and behavioral aspects of tobacco addiction through group and

individual counseling. The Center also assists professionals across the healthcare continuum by sharing best

practices of evidence-based tobacco treatment through consultation and collaboration. Finally, by partnering

with local, regional, and state-wide providers, the Tobacco-Free Wellness Center works to educate the

public on the prevention of smoking, tobacco control policy and the impact of tobacco use on health and

well-being.

IV. Health Needs Facility Does Not Intend to Address

List of Health Needs the Facility Does Not Plan to Address

Reading Health System does not intend to address Access to Healthcare (i.e. insurance), Asthma, Oral

Health, and Substance Abuse (i.e. binge drinking).

Identification and Description of Health Need the Facility Does not intend to meet and Explain Why

Access to Healthcare (i.e. Access to Insurance) The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of

2010 propose to significantly revise established components of our healthcare system, such as: Medicaid and

other government program eligibility criteria; use of technology to improve healthcare quality and delivery;

and creation and administration of Health Insurance Exchanges. Among these, ACA anticipates that a

Health Insurance "Exchange" will be operated in each state as a resource for individuals and small

employers to access health insurance by January 1, 2014. Due to a lack of resources, we are proposing that

this health issue be charged to the community coalition which will encompass a broad range of experts

(including representation of insurers) to deal with this issue. In addition, we will ask the coalition to assess

access to care issues around transportation.

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Asthma Currently, Reading Healthy System does not have the resources to provide community wellness programs

focused on asthma. We are proposing that this health issue be charged to the community coalition which

will encompass a broad range of experts to deal with this issue.

Oral Health While the Hospital is currently planning for a dental residency program, we feel there is a lack of expertise

to solve the problem county-wide. We are proposing that this health issue be charged to the community

coalition which will encompass a broad range of experts to deal with this issue, including the possibility of a

mobile unit.

Substance Abuse (i.e. Binge Drinking) While the Hospital treats patients with drug overdose, we do not have the expertise or resources to hold

prevention programs in this area. We are looking to the Caron Foundation (a national non-profit

organization whose mission is to provide treatment to those affected by alcoholism or other drug addiction)

for future collaborations including grant opportunities where we might share in resources to develop

programming. In addition, this is one of the key health issues that will be charged to the community

coalition to help address.

Documents

Community Health Needs Assessment (CHNA) Written Report · 1 Community Health Needs Assessment (CHNA) Written Report Reading Health System PO Box 16052 Reading, PA 19612 July 1, 2012