C h e s t e r
R i v e r
H e a l t h
S y s t e m
Living Healthy. Getting Healthy. Staying Healthy.
IN THIS ISSUE Living healthy Page 4 Recommended health screenings Page 6 Getting healthy Page 7 Staying healthy Page 9
On the cover: As a healthy living choice, Dorothy Evans, RN, Chester River Hospital Center, walks her dog, Judge.
The secret to go health is teamw
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(Left to right) Brenda Ewing, LPN; Greg Vasas, senior decision support analyst; Diana Nichols, unit health clerk; and Sheila Dixon, registrar, take advantage of the C.R.E.W.S. program by working out in the gym.
... Between doctors, nurses, therapists, medical centers—and you! Working together, we all have a role to play in improving the overall health and well-being of our community. When you think about advances in health care, you
probably think of breakthroughs in medical science, sophisticated technologies, and lifesaving new treatments. And while these advances certainly are exciting, they’re only part of the total wellness picture. “The healthcare industry is realizing that providing care more effectively and keeping people healthy is just as important as offering new treatments and technologies,” says Jim Ross, president and chief executive James E. Ross, president & CEO, officer of the Chester River Chester River Hospital System (left), Health System. “A big part and Dr. Stanley Minken, CMO, of that involves improving Chester River Hospital Center coordination and filling in the service gaps between doctors, hospitals, and other care providers.” With its Comprehensive Community Care program, Chester River Health System is on the leading edge of the movement that’s gaining traction locally and across the nation. In cooperation with the community’s physicians, the health system is advancing the Comprehensive Community Care vision on several fronts by: Promoting screenings and Advocating healthy lifestyles early detection; to keep people from getting Helping patients with chronic disease sick in the first place. manage their conditions to avoid serious complications; and “It’s all about providing the right care, in the right place, with the right care givers,” Mr. Ross says. “It’s a partnership between physicians, patients, the hospital, and all the healthcare providers in the community. We all need to work as a team to improve the community’s health.” The goal of the initiative is simple: to improve the health of the area’s residents both individually and as a whole. One of the factors motivating Chester River to take the lead in promoting Comprehensive Community Care is the region’s aging population and prevalence of chronic disease in the overall population, and among minority groups in particular. For example, one in 10 Kent County residents and one in eight Queen Anne’s County residents are diabetic, according to the 2011 County Health Rankings published by the Robert Wood Johnson Foundation. In addition, 15 percent of Kent County residents report being in poor or fair health, and obesity, smoking, and excessive drinking in both counties are above the national benchmark. “As a total healthcare community, we need to do a better job of educating the public and delivering services when and where they’re needed,” says Dr. Stanley Minken, chief medical officer at the Chester River Hospital Center. “We’re shifting the thrust of health care toward focusing on risk factors and helping people avoid acute illness.”
An Ounce of Prevention Beats a Serving of Fries: Chester River reaches out to promote community wellness
The traditional focus of hospitals HAS BEEN on providing treatment rather
than promoting wellness. But that’s changing. Chester River and many other health systems across America are expanding the hospital’s role to be a wellness leader in addition to a treatment facility. At Chester River, the transformation can be seen in many ways and in many places. The health system is represented at a wide range of community events and fairs, where it offers information on everything from diet and exercise to cancers and chronic diseases. The health system also holds free public seminars and classes throughout the year to provide in-depth education on many health topics. Chester River staff members join with local physicians to provide tips on lowering risk factors for heart disease, coronary artery disease, diabetes, lung disease, and other chronic illnesses. The seminars have been held at Chester
River facilities and also in conjunction with the non-profit Shared Opportunity Service (SOS), which operates the Kent Family Center in Chestertown. The SOS classes have featured presentations on first aid and cardiopulmonary resuscitation, nutrition, and asthma. Another popular program has been the savvy shopper supermarket tours hosted by Mary King, RD, LD, CDE, a certified dietitian and nutritionist.
Working with county health departments
In addition to conducting its own programs, the health system collaborates with the Kent County and Queen Anne’s County health departments to identify health needs and help develop the community’s approaches to improving wellness. It also provides support to specific programs and services. In Kent County, Chester River has been a partner in the Kent on the Move and Get Healthy Kent initiatives. For the Get Healthy Kent employee wellness initiative, funded through a grant from the U.S. Centers for Disease Control and Prevention, the health system participates as one of five employers who have adopted the program, and it provides free lab work for other participating employAmy Holm, executive assistant, Chester River Hospital Center, makes a ers. In its first two healthy lunch choice in the cafeteria at Chester River.
years, the Get Healthy Kent initiative screened more than 500 people for chronic disease risk factors. As a Get Healthy Kent participant, Chester River has worked with the Kent County Health Department to provide employee education and health screenings as well as health coaches for employees with risk factors for developing chronic diseases. By becoming a Get Healthy Kent partner, Chester River also became a “Healthiest Maryland Business,” officially joining hundreds of other Maryland businesses on Governor O’Malley’s recent initiative, a statewide movement to create a culture of wellness— an environment where the healthiest choice is easy.
Practicing what we preach The health system’s in-house wellness programs are key parts of the Comprehensive Community Care initiative in two important ways, says Paula Pouliot, RN, the Chester River employee wellness coordinator. For one, the health system employs about 550 people, making it one of the area’s top two employers, along with Washington College. The second reason is that the programs demonstrate the health system’s commitment to leadership by “practicing what we preach” in regard to staying healthy. “We feel it’s our duty and responsibility to be a role model and set the bar high,” Ms. Pouliot says. “Our employees have many of the same health challenges as the community at large. Many of us need to lose some weight, eat better, and exercise more.” The health system is promoting employee health in many ways. It holds monthly Wellness Wednesday lunch-and-learn seminars, and it recently revamped the menu in the hospital cafeteria, where french fries and similar continued on page 6
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Stretching your food dollar, not your waistline Several times a year, Mary King, RD, LD, CDE, nutrition services coordinator, Chester River Hospital, helps local residents confront one of modern life’s most confusing chores—shopping for groceries. “There are so many choices and so many terms used in food marketing today that it’s hard for consumers to determine what the healthiest choices really are,” says Ms. King, Chester River’s nutrition services supervisor. She conducts small-group grocery store tours that help shoppers cut through the confusion. Her tours emphasize choosing fresh fruits and vegetables, avoiding heavily processed foods, and determining which foods deliver the best value for both nutrition and price. Reading nutrition labels is an important part of her tours, since deciphering the information can tell shoppers the cost-per-unit, identify problematic ingredients, and help them compare products for their relative fat, cholesterol, fiber, and vitamin content. The free store tours, which last about an hour, are advertised in local newspapers and on the radio, so stay alert for the next tour if you would like to become a better grocery shopper.
Mary King, RD, LD, CDE, nutrition services coordinator at Chester River Hospital (right), educates a client about healthy food choices.
high-fat, high-salt items now make only an occasional appearance. Instead, the Healthy Foods for a Healthy You menu features 300calorie entrees, a healthier salad bar, detailed nutritional information, and foods that overall are lower in salt and saturated fat. “The healthy foods initiative is one part of our participation in the Maryland’s Hospitals for a Healthy Environment (H2E) program,” says Scott Burleson, executive vice president of the Chester River Hospital Center. “In addition to providing better food choices for our employees, the cafeteria has become popular with
Scott Burleson, vice president of Chester River Hospital Center, shows Going Green initiative with a reusable Chester River mug.
Paula Pouliot, RN, wellness coordinator at Chester River (left) and Nicole Norris, RN, Kent County Department of Health, discuss their partnership in the Get Healthy Kent program.
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people from the public who appreciate having an affordable alternative to fast-food.” The hospital cafeteria is open to the public from 11:15 a.m. to 1 p.m. on weekdays. Another important aspect of wellness is exercise, and health system employees are now able to use the hospital’s well-equipped cardiac rehabilitation fitness center to work out during non-patient hours. The health system also has incorporated its commitment to employee health in the insurance plan it offers to workers. Employees are offered a policy premium discount to take a health risk assessment and follow through with one-on-one health coaching if they are determined to have significant risk factors. More than 70 percent of employees have taken the assessment.
Getting Healthy Screening Saves Lives: Working with doctors and health agencies for early detection The traditional role of a hospital is
to help sick people get healthy, but hospitalbased treatment can often be more effective— or avoided entirely—if diseases are detected and treated early. From heart disease to cancer, many diseases can be prevented, cured, or controlled if they’re caught early. That’s why the Chester River Health System works with physicians and health agencies to raise awareness of the need for screenings and to make them readily available—sometimes for free. The hospital staff often provides free blood pressure screenings at local fairs and events,
and free prostate screenings are available during National Prostate Awareness Month in September. In addition, diabetes screening was offered at the Kent County Parks and Recreation Community Health Fair in March. People who didn’t meet the fasting requirements for an immediate test were given a voucher to have a free screening performed later. Another major effort to encourage screening takes place in October during National Breast Cancer Awareness month. Last year, the Chester River Hospital Center enlisted pledges from employees to talk to women about breast
cancer and to encourage them to see their doctors about breast cancer screening. Under the direction of Kelly Bottomley, director of radiology, the campaign resulted in 900 local women signing a pledge to get yearly diagnostic mammograms. Overall, the hospital screened 3,400 women for breast cancer last year, or about half of the women living in Kent County. The health system has further broadened its outreach efforts in the African-American community. Spearheaded by Sam Ricketts, the initiative has prompted hundreds of people to sign up and follow through with health screenings. continued on page 9
Infected with a passion for promoting wellness On any given day, Sam Ricketts, RNC, might be found working one-on-one with a family or patient, meeting with physicians, speaking to a church group, or writing a letter to the editor of a newspaper. Rather than being exhausted, however, Ms. Ricketts is energized, because she’s helping to spread what she sees as one of the most powerful forces for wellness there is—knowledge.
Sam Ricketts, RNC
“It’s amazing how many myths and misconceptions are out there about health care and how all the pieces fit together,” says Ms. Ricketts, who represents the health system on the Kent County Health Coalition. “My job is to increase awareness and understanding, not just among patients, but among doctors and public officials and everyone.”
As the community educator for Chester River Home Care & Hospice, Ms. Ricketts is on the leading edge of the health system’s Comprehensive Community Care initiative. One of the most important aspects of her work is reaching out to underserved populations, including the African-American community. Kent County’s minority population is among the least healthy in the state. “I became impassioned about improving health in the minority community after I attended a seminar at Duke University that focused on increasing minority participation in hospice programs,” Ms. Ricketts says. “I realized that it’s not only hospice where we need to improve our outreach, but in all areas of health and wellness.” She took up the cause by contacting leaders in the minority community and attending dinners and gatherings, where she talks about the importance of being screened for cancer, hypertension, and other chronic diseases. “We’ve already had some positive and encouraging results,” Ms. Ricketts says. “There’s still much work to be done, but our initial goal has been to plant the seed and see how much it can grow.”
Surviving skin cancer with prevention and vigilance Skin cancer often can be spotted in the form of an unusual growth or discoloration—if you’re vigilant. Beth Ortiz, RN, was, and it might have saved her life. As a Chester River Hospital Center nurse, Mrs. Ortiz was concerned several years ago by an itchy mole on the back of her shoulder. When she couldn’t schedule an appointment with a dermatologist for six months, she described her problem to a cancer specialist at the hospital. Dr. Gerard O’Connor had a look and was concerned enough to order a biopsy to check for cancer. The test showed that Mrs. Ortiz had Stage III melanoma, the most dangerous form of skin cancer. “The diagnosis was devastating,” she says. “I sat at my desk in tears for a long time.” The news got better, however. Mrs. Ortiz’s vigilance and persistence gave surgeons enough time to stop the cancer before it spread. Now a nurse educator at Delaware Technical & Community College, she continues to receive a total body examination every six months for suspicious growths. No cancer has been found, but Mrs. Ortiz strictly adheres to preventive measures, such as using sunscreen and wearing hats and clothing to cover her skin whenever she’s going to be outdoors. She’s also a strong advocate for taking precautionary measures. She urges everyone to look carefully for early signs of cancer, such as moles that suddenly appear, enlarge, change color, itch, or have an erratic shape. “Don’t waste any time getting to your doctor to have it checked out,” she says. “It could save your life.”
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Beth Ortiz, RN, urges everyone to check their skin carefully for early signs of cancer.
Strong Support from Physicians An essential part of community wellness is the support of physicians—from primary care doctors to specialists—who are partnering with the health system and county health officials to spread the word about the importance of screening and to educate the community about risk factors and warning signs. Dr. Gerard O’Connor, a Chestertown surgeon who works with many cancer patients, has presented information to a variety of community groups on the importance of screening for colon cancer.
“Colon cancer is the third most common cancer in the United States, but for the most part it’s easily treated if it’s found early enough,” Dr. O’Connor says. “The key is to follow the guidelines for receiving a colonoscopy screening. About 90 percent of colon cancer starts with benign polyps, which can be removed during a colonoscopy.” He urges patients to follow through with their primary care physician’s recommendations for having a colonoscopy and to be sure to inform their doctor about any family history of colon cancer, which could indicate a need to begin screening at an earlier age.
Another physician who devotes considerable time and effort to promoting screenings is Dr. Neil Stoddard. A prostate cancer survivor himself, he understands the importance of early intervention, which has made him a leading advocate for prostate cancer screening. Dr. Stoddard speaks frequently in the community about the disease, and he provides free digital rectal screenings at Chester River Hospital Center during its annual National Prostate Health event in September. Free prostate specific antigen (PSA) testing is also offered during the event.
Bridging the gaps: How Chester River is providing follow-up and support services to help patients manage chronic disease Having high-quality healthcare facilities and skilled medical professionals
nearby is reassuring to all members of the community. Yet nobody looks forward to a trip to the hospital (with the exception of expectant mothers), especially if it means being readmitted for the same problem. To help patients manage disease more effectively and transition more smoothly from the hospital or rehabilitation center to home, the Chester River Health System has introduced several programs aimed at preventing problems that could require additional hospitalization.
Taking Charge of Your Heart Clinic One program that’s launching this summer is the Taking Charge of Your Heart Clinic, through which the health system is partnering with cardiologists and primary care physicians
to help heart failure patients track their medications, test results, and weight. The program starts with a 30-minute introduction session for patients who are being transitioned from the hospital or rehabilitation center to home. They receive an initial visit at home from a Chester River Home Care nurse, two follow-up telephone calls, and a second home care visit within 30 days. “Research has shown that there’s much less likelihood of readmission when patients are visited by a home care nurse,” says Mary Jo Keefe, RN, Chester River’s vice president of Patient Care Services. “They’re able to understand much more clearly what the patient’s challenges are and what barriers he or she might have to effectively managing their disease.” The clinic involves cooperation between all components of the health system, including the hospital, the Chester River Manor Nursing
The Taking Charge of Your Heart Clinic launched on July 15 with 17 participating patients identified with congestive heart failure (CHF). Each patient received a program binder, customized with individual goals, list of medications/supplements, and a “patient contract.” The binders will be used to track each individual’s progress through the program. Stay tuned for future updates as these patients learn how to manage living with CHF. The clinical team is currently planning to design similar programs for diabetic patients and COPD patients.
and Rehabilitation Center, and the home care team, Ms. Keefe notes, and it’s available to any patient referred by a physician, whether or nor their participation is covered by insurance or they’re referred from outside the Chester River system.
Coumadin Clinic Coumadin, the trade name of the drug warfarin, is an effective treatment for preventing or treating blood clots in people with cardiac, cardiovascular, and pulmonary diseases. However, failure to take the medication correctly and guard against adverse interactions with certain medications and foods could cause severe side effects, which often land Coumadin patients in the emergency room. Chester River is helping patients avoid those side effects through its new Coumadin Clinic. Staffed by Chester River pharmacists, the clinic at the hospital is currently helping about 50 patients manage their Coumadin regimen. The patients come in once a month (or more often if necessary) for simple finger stick to obtain a drop of blood for testing. The process takes only five to 10 minutes, says
Pharmacist Megan Pulleyn, PharmD, checks patient Sara Joiner-Gagalski’s blood in the Coumadin Clinic.
Becky Schulkowski, PharmD, BCPS, pharmacy director. “The clinic makes it much easier for patients to come in and have their blood checked,” Dr. Schulkowski says. “The pharmacists are able to make adjustments in dosage right there if there’s a problem.”
Coronary artery disease classes Did you know that coronary artery disease (CAD) is the number-one killer of men and women in America? Most people don’t, including victims and their families. That’s just one of many facts learned by participants in Chester River CAD education classes, says Libby Rice, RN, who teaches approximately 150 people a year about CAD risk factors. CAD occurs when cholesterol and plaque build up in the arteries that supply blood to the heart. As a result, blood flow decreases, which can lead to chest pain or heart attack. “In addition to helping patients understand risk factors and manage their disease, the classes really help raise the awareness of family members,” Mrs. Rice says. “They often realize they’re at risk, too, and they all need to eat better, exercise more, and talk to their doctors about possible medications.”
Diabetes counseling and classes It might seem hard at first, but diabetes can be managed successfully—as many people
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can attest. The challenge for the medical community is to make sure that patients and their families know what’s required and have the latest information about the disease, says Chrissy Nelson, RN-CDE, Chester River’s head of diabetes education. Mrs. Nelson provides diabetes management counseling to patients who are referred by the doctors, and she holds four-hour Managing Your Diabetes classes several times a year. In addition, she hosts a support group that meets once a month. A big part of ensuring that diabetics get the support they need to avoid complications is coordination with physicians and within the health system, Mrs. Nelson adds. “We’re doing more networking with Chester River Manor and with Chester River Home Care to discuss which patients are getting ready to go home and might need diabetic counseling,” she reports.
Support groups In addition to special classes and initiatives, Chester River hosts many support groups that provide timely information
for patients with various diseases and allow them to share their experiences with others in the same situation. Groups are currently offered for patients who have suffered from cancer, diabetes, heart disease, prostate cancer, and the loss of a loved one (bereavement). For more information about any of these groups, call Chester River at (410) 778-3300. All of Chester River’s services and initiatives to support patients outside the hospital are designed not only to transition people from inpatient care to their homes, but also to ensure they can remain there and lead active, rewarding lives.
Cindy Parks, sterile processing technician at Chester River Hospital Center, discusses the health risks of smoking with Mary Jo Carpenter, tobacco cessation coordinator at Kent County Health Department. Ms. Parks decided to quit smoking for a 2011 New Year’s resolution. She admits it was difficult, but she says that adding exercise and having a supportive group of family, friends, and co-workers definitely helps. “I feel healthier since I quit smoking on January 2, and I have more energy from working out two or three days each week at C.R.E.W.S.—and it’s free for Chester River employees!”
Being at home is often the best medicine Most people would much rather be at home than in a hospital or rehabilitation facility, but sometimes patients, their family members, and healthcare providers worry that they’ll be able to manage outside of the clinical environment.
Dr. Neil Stoddard (middle), Paul Showalter (right), and Judge Floyd Parks are members of the Prostate Cancer Support Group.
That’s where Chester River Home Care comes in. Home care nurses, social workers, and certified nurses aides are able to provide the care, support, and education that allows patients to recover and manage their diseases in the comfort and familiarity of home. “Our job is to help people return to their homes successfully and remain there by teaching them to manage their disease or condition effectively,” says Cindy Bach, executive director of Chester River Home Care & Hospice. “We’re problem solvers for our patients. By visiting them in their homes, we see what individual challenges our patients face, and we are able to address these concerns on a oneto-one basis in their own environment.” Being in the home lets us identify problems such as home safety issues that, when addressed, can help prevent falls. Removing unsafe throw rugs, assuring proper medication management, or teaching proper use of a walker in the home can help keep our patients safe and out of the hospital. When in the patient’s home, the assessment and teaching process becomes an individualized teaching opportunity from the minute we set foot in the door. Home care staff are becoming even better equipped to help their patients through the use of new laptop computers that allow them to access and update patient medical records on the road. The computers ensure each patient’s important information is at the nurses’ fingertips, and they also support in-home patient education by allowing nurses to show videos on specific disease management issues. “Home care plays a vital role in the integrated vision of Comprehensive Community Care,” Bach notes. “One of our challenges is to increase awareness of our capabilities and to partner effectively with physicians to provide the best-possible care for their patients in the community.”
Support that only a survivor can give In some ways, Paul Showalter and Judge Floyd Parks are unlikely friends. Mr. Showalter is a retired business executive who moved to Chestertown 10 years ago. Judge Parks is a lawyer and retired judge who has been a Kent County resident for more than 40 years. But they also share two characteristics that give them a special bond. Both are prostate cancer survivors committed to helping others who are diagnosed with the disease. Mr. Showalter and Judge Parks are founding members of the Chester River Prostate Cancer Support Group, which meets once a month at the hospital. “For somebody who’s just been diagnosed, there’s a lot of information and several treatment options to consider,” Mr. Showalter says. “It can seem overwhelming. The support group is here to answer questions and help people through what can be a confusing and emotional time.” The support group also helps its members sort through the facts and myths surrounding the side effects of the various treatments. In its first five years, the group has helped dozens of men cope with their diagnosis, and now it’s stepping up its efforts to be even more effective. It has formed three committees to focus on community outreach, schedule speakers, and oversee public relations. The outreach committee will have a special emphasis on spreading the word among African-American men, who have the highest rate of prostate cancer in the world. The group has several AfricanAmerican members, but it’s hoping to reach many more with information about early detection as well as Prostate Cancer post-diagnosis support. Judge Parks says the group wouldn’t have been possible without the support of the Chester River Health System. “The hospital recognizes that groups like ours help expand the role of the hospital as a community health center, as opposed to a place you only go when you’re sick.”
Jeanette Walton, RN, a Chester River Home Care nurse, uses her new laptop to support in-home patient education.
Support Group meets the 4th Monday of the month, 7 p.m.– 9 p.m., Chester River Hospital Conference Center. September is Prostate Cancer Awareness Month and we will offer free screeninGS. Check our local calendar listing in September for more information.
100 Brown Street • Chestertown, MD 21620 (410) 778-3300 • www.chesterriverhealth.org
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Bridges is published by the Marketing & Communications Department of Chester River Health System. The articles published should not be considered specific medical advice, as each individual situation is different. Should you feel a need for medical advice, consult your physician. Entire publication © Chester River Health System 2011. All rights reserved.
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The Case for Community Comprehensive Care Like every aspect of a community—from police protection to helping the needy— health care works best when everybody works together. At Chester River Health System, we call that Comprehensive Community Care, and it’s the focus of this issue of Bridges. Now, more than ever, providing Comprehensive Community Care is imperative for the health and well-being of the people of Kent and Queen Anne’s counties. At the same time that our nation is striving to bring healthcare costs under control, our community is facing many healthcare challenges. Those challenges were evident in the 2011 County Health Rankings released recently by the Robert Wood Johnson Foundation. According to the report, Kent County ranks
2011 County Health Rankings / Selected Data Kent County
Queen Anne’s County National Benchmark
Poor or fair health
Motor vehicle crash death 23 rate (per 1,000 population)
Children in poverty
Health outcomes ranking in Maryland
16th of 24 counties
4th of 24 counties
Health factors ranking in Maryland
13th of 24 counties
7th of 24 counties
Percentage of population aged 65 years and older
Source: Robert Wood Johnson Foundation and University of Wisconsin | Complete report data can be found on the web at countyhealthrankings.org.
16th among Maryland’s 24 counties in health outcomes and 13th in health factors. Queen Anne’s county ranks substantially higher, but the statistics show that it also faces challenges in key areas.
The data underscores the need for us to identify and fill in the gaps that currently exist in our healthcare delivery network. Chester River is committed to being a leader in making that happen.
A quarterly publication from Chester River Health System in Maryland.