International Forum on Quality & Safety in Health Care April 11 th , 2014

1. Using the U.S. National Prevention Guidelines to Operationalize the Transformation of the Health of Populations International Forum on Quality & Safety in Health Care April 11th, 2014 North Shore-LIJ Health System Office of Community and Public Health Long Island, New York, USA jmieres@nshs.edu

2. Introductions Jennifer H Mieres, MD, FACC, FASNC, FAHA Professor of Cardiology & Population Health Hofstra North Shore- LIJ School of Medicine Sr. Vice President, Office of Community and Public Health Chief Diversity and Inclusion Officer Medical Director, Center for Learning and Innovation North Shore -LIJ Health System Stacey E. Rosen, MD, FACC, FACP, FASE Vice President, Women's Health The Katz Institute for Women's Health North Shore - LIJ Health System Associate Professor of Cardiology Hofstra North Shore –LIJ School of Medicine Elizabeth C. McCulloch, MS, PhDc Director, Language Access Services & Performance Improvement Office of Community and Public Health North Shore-LIJ Health System

3. Conflict of Interest We certify that there is no conflict to declare.

4. Transforming the Health of Populations Using the US National Prevention Strategy The National Prevention Strategy and guiding principles. Defining the components needed to achieve quality and safety in patient and community health care. Integration of the National Prevention Guiding Principles into the 17 hospitals of the North Shore-Long Island Jewish Health System. The importance of the tenets of health literacy and language access in patient quality and safety. A population health model: A strategy for women’s health.

5. Transforming the Health of Populations Using the US National Prevention Strategy The National Prevention Strategy and guiding principles. Defining the components needed to achieve quality and safety in patient and community health care. Integration of the National Prevention Guiding Principles into the 17 hospitals of the North Shore-Long Island Jewish Health System. The importance of the tenets of health literacy and language access in patient quality and safety. A population health model: A strategy for women’s health.

6. U. S. National Prevention StrategyVision Working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.

7. The Critical Need for a U.S. Prevention Strategy Chronic Illness ( diabetes, obesity, depression etc) cause Americans to miss 2.5 Billion days of work each year Loss of productivity : $1 Trillion

8. U.S. National Prevention StrategyAmerica’s Plan for Better Health and Wellness

9. Healthy and Safe Community Environments • Clean air and water. • Affordable and secure housing. • Sustainable and economically vital neighborhoods. • Make healthy choices easy and affordable.

10. Clinical and Community Preventive Services • Evidence-based preventive services are effective. • Preventive services can be delivered in communities. • Preventive services can be reinforced by community-based prevention, policies, and programs. • Community programs can promote the use of clinical preventive service (e.g., transportation, child care, patient navigation issues).

11. Empowered People • People are empowered when they have the knowledge, resources ability, and motivation to identify and make healthy choices. • When people are empowered, they are able to take an active role in improving their health, supporting their families and friends in making healthy choices, and leading community change.

12. Elimination of Health Disparities • Health outcomes vary widely based on race, ethnicity, socio-economic status, and other social factors. • Disparities are often linked to social, economic or environmental disadvantage. • Health disparities are not intractable and can be reduced or eliminated with focused commitment and effort.

13. Transforming the Health of Populations Using the US National Prevention Strategy The National Prevention Strategy and guiding principles. Defining the components needed to achieve quality and safety in patient and community health care. Integration of the National Prevention Guiding Principles into the 17 hospitals of the North Shore-Long Island Jewish Health System. The importance of the tenets of health literacy and language access in patient quality and safety. A population health model: A strategy for women’s health.

14. Integrating the Four Guiding Principles of the National Prevention Strategy into a 17 Hospital Network at the NSLIJ Health System

15. Scope of North Shore-LIJ

16. Service Area Demographics Queens is one of the most ethnically diverse regions in the world, populated by residents who represent more than 100 nationalities and speak more than 170 languages1. Source: 1NYS Office of the State Comptroller; U.S. Census, 2010 - Race/Ethnicity Demographics Report prepared by North Shore-LIJ Health System Office of Strategic Planning and Program Development/sk

17. Primary Language Spoken at Home Strategic Market Area: North Shore-LIJ Health System

18. Essential Components for Achieving Excellent Health Outcomes for All Health Literacy & Patient Education Professional Education Language Health Equity = Elimination of Health Disparities Diversity & Inclusion Governance Community Research Humanism = Dignity & Respect Patient Care CulturalCompetence 1-2-13 version Source: Modified from Dr. Marc Nivet’s AAMC: 11/2010

19. Office of Community and Public Health Aligns with the National Prevention Guidelines Mission:Promote health and wellness, prevent and control disease and illness, and enable people to live healthier lives. Community Health Diversity & Inclusion Regulatory Affairs/ Community Benefit Community Engagement Health Literacy & Patient Education Office of Community & Public Health • Katz Institute for Women’s Health Sustainability

20. Transforming the Health of Populations Using the US National Prevention Strategy The National Prevention Strategy and guiding principles. Defining the components needed to achieve quality and safety in patient and community health care. Integration of the National Prevention Guiding Principles into the 17 hospitals of the North Shore-Long Island Jewish Health System. The importance of the tenets of health literacy and language access in patient quality and safety. A population health model: A strategy for women’s health.

21. Language and Communication Access Services Health Literacy & Patient Education Professional Education Language Health Equity = Elimination of Health Disparities Diversity & Inclusion Governance Community Research CulturalCompetence Humanism Patient Care

22. Case ExampleKeep the following in mind… Did the clinician offer and encourage the use of professional interpretation services? Was conflict of interest and the sensitivity of the information interpreted addressed? Were there communication errors between the relative, patient and clinician?

24. Case ExampleKeep the following in mind… Did the clinician offer and encourage the use of professional interpretation services? Was conflict of interest and the sensitivity of the information interpreted addressed? Were there communication errors between the relative, patient and clinician?

25. Why Focus on Limited English Proficiency? • Minority groups are a large and growing population. • Fastest growing demographic. • Accounting for 1/3 of the U.S. Population. • Nearly 25 Million people in the U.S. are defined at Limited English Proficient (LEP). • At risk for adverse events because of language and culture barriers.

26. Why Focus on Limited English Proficiency?

27. Four Point Strategic Approach for Language Access

28. Strategic Approach Impact

29. Transforming the Health of Populations Using the US National Prevention Strategy The National Prevention Strategy and guiding principles. Defining the components needed to achieve quality and safety in patient and community health care. Integration of the National Prevention Guiding Principles into the 17 hospitals of the North Shore-Long Island Jewish Health System. The importance of the tenets of health literacy and language access in patient quality and safety. A population health model: A strategy for women’s health.

30. A Population Health Model: A Strategy for Women’s Health Health Literacy & Patient Education Professional Education Language Health Equity = Elimination of Health Disparities Diversity & Inclusion Governance Community Research CulturalCompetence Humanism Patient Care

31. Biologic Imperative Unique medical needs of women Conditions where women are uniquely affected • Gynecologic disorders • Obstetrics • Breast diseases Conditions where women are affected disproportionately more than men • Osteoporosis • Depression • Gallstone disease Conditions where the manifestation in women is different from men • Heart disease • Lung cancer • Rheumatoid arthritis, other autoimmune conditions

32. Institute of Medicine and Women’s Health • 2001: • Exploring the Biological Contributions to Human Health: Does Sex Matter? • 2010: • Women’s Health Research: Progress, Pitfalls and Promise.

33. The Katz Institute for Women’s Health Vision The Katz Institute for Women's Health strives to be a leader in the delivery of comprehensive, integrated health care and wellness services for women and their families. Mission The mission of the Katz Institute for Women’s Health is to improve the health of women across their life span through exemplary clinical practice, advancement in research, education, community engagement and commitment to health care equality. The Katz Institute promotes the continuum of women’s health by defining the standards of excellence in patient centered women’s health care and empowers women to make informed decisions about their health and wellness.

34. CLINICAL SERVICE • COMMUNITY PARTNERSHIP • EDUCATION & HEALTH LITERACY • RESEARCH Providing exceptional clinical care that is comprehensive, integrated and patient-centered

35. Break the traditional “silo” approach Enhancing care by redefining the health care delivery model Breast Health Ob/Gyn Ob/ Gyn Bone Health Internal Medicine Patient Centric Cancer Heart Health Cardiac Nutrition Imaging Nutrition Integrative Health Behavioral Health Orthopedics Behavioral Health Integrative Health

36. The Continuum of Women’s Health Care • For diseases specific to women • For health maintenance & disease prevention • About how to live with illness • Complete health screening • Community outreach • Quick follow-up • Convenience • Support groups • Quality of life improvements • Holistic care • Child care services • Lifestyle modification • Medical therapy • Radiation therapy • Surgical intervention • Cosmetic reconstruction • Complementary & Alternative Medicine Source: The Edge Briefing on Women’s Health (Sg2 – 2004)

37. CLINICAL SERVICE • COMMUNITY PARTNERSHIP • EDUCATION & HEALTH LITERACY • RESEARCH Engaging and connecting with groups and organizations in our community

38. KIWH Community Membership • Engage women in the community to partner with KIWH in their health and offer “membership” as a brand differentiator Potential membership benefits include: • Invitation to special lectures and events • Participation in wellness activities • Interaction with health system clinical and administrative leadership • Web-based educational newsletters and blogs

39. Partnerships/Collaboration

40. CLINICAL SERVICE • COMMUNITY PARTNERSHIP • EDUCATION & HEALTH LITERACY • RESEARCH Educating patients, providers and the public to create a partnership to optimize health

41. Education & Health Literacy • Educational Opportunities: • Women’s Wellness Series • • Anton News • • Employee Wellness Campaigns • Website • National/Local Organizations: • AHA – Women’s Heart Health Conference • • Girl Scouts – Mother/Daughter Conference • • Long Island Women’s Agenda • Community Groups: • Community Boards • • Libraries/Community Centers

42. Using the National Prevention Guidelines to Operationalize the Transformation of the Health of PopulationsThank You North Shore-LIJ Health System Office of Community and Public Health Long Island, New York, USA jmieres@nshs.edu