How to improve

Making Ulster County the healthiest county in New York State has got to be County Executive Mike Hein’s most well-publicized goal in the area of public health. But Hein, who first set the goal in 2009, has never specifically said how long it will take to achieve that worthy goal.

Ulster County Health and Mental Health Commissioner Dr. Carol Smith supports Hein’s goal. It’s the correct goal, she argues. Being number one should be Ulster County’s aspiration.

The nationwide county health rankings first published by the University of Wisconsin’s Population Health Institute four years ago is widely accepted as the standard for comparing county performance. In 2010 Ulster County ranked 33rd of New York’s 62 counties. In 2011 it dropped to 35th. In 2012 it improved to 29th, and this year its rank slid back down to 31st — the statistical middle of the state pack.

Both at last month’s board of health meeting and at the May 21 meeting for health professionals at Ulster County Community College in Stone Ridge, Smith complained about how this year’s results were skewed by the inclusion of a new category, “drinking water safety,” in which Ulster County was ranked very poorly — probably wrongly, according to her. She also expressed concern about the survey sample size — 500 Ulster County residents had been surveyed.

The ranking system, its research supported financially by the Robert Wood Johnson Foundation, may have its methodological weaknesses, but in the field of American public health it is fast becoming the equivalent of what the Dow Jones Average is on Wall Street — that is, it’s widely followed, and it’s based on the best capsules of comparative data available.

The rankings of surrounding counties suggest the same up-and-down-within-a-narrow-range pattern as Ulster County’s. Neighboring Dutchess County was ranked 11 in health outcomes among the counties in 2010, 13 in 2011, 9 in 2012 and 9 again in 2013. Orange County ranked 21, 19, 20 and 22. Greene County was 59, 60, 52 and 55. Putnam County was ranked 1, 1, 1 and 4 among the counties, and Sullivan County a consistent 61 in all four years. Columbia County was ranked 45 in all years except 2011, when it temporarily moved up to 43.

As can be surmised from these numbers, results vary widely in the mid-Hudson region. What is more important than the rankings derived from the combination of various socio-demographic and medical variables is what they tell us about the pattern of public health care in our counties. What can be most easily improved? Where are structural changes most needed in our fragmented healthcare system? What are the relationships among the institutional players? What investments will yield the highest rate of return in terms of the improvement of overall public health?

The role of the hospitals in the rapidly changing community health systems is one of the big items the state health department is seeking to tackle this year. The county health departments are being required to prepare a four-year community health plan for submission to the state in November.

This is a tough time for people in health care who are comfortable with changing only one thing at a time. Americans are proud of having what we consider to be the best healthcare system in the world. Unfortunately it is by far the most inefficient, fragmented, disorganized and expensive healthcare system in the world as well, leading to our trailing many other nations in terms of outcomes and other results.

Can Ulster measure up?

[wide]Ulster[/wide]With state and federal support in question and Ulster County facing an obesity epidemic, the county health department has its challenges. At a meeting of nearly 100 health professionals entitled “A New Era of Prevention: Assess, Plan and Connect for a Healthier Ulster County” at SUNY Ulster on May 21, Dr. Carol Smith, Ulster’s commissioner of both health and mental health, said her department remained committed to the goal of making Ulster County the healthiest county in the state, as promised by County Executive Michael Hein in 2009.

Education in the schools and workplaces is key to creating “a culture of health and wellness,” she said. The goal is long-term and aspirational: “We may not change everyone in the current generation, but it’s important and achievable for the future.”

In his introductory remarks, Hein applauded the county’s emerging network of rail trails as not only an economic development tool but also as “a huge public-health initiative.” It provides the opportunity to get out and recreate, which will have an impact on obesity and gives inner-city youth access to nature, he said. Gov. Andrew Cuomo has committed $2 million to the trail network, which is already “65 percent built out.” It will eventually connect the Ashokan Reservoir to the Walkway Over the Hudson, the Hurley rail-trail and the Kingston waterfront.

Hein alluded to the planned closing of one of HealthAlliance’s hospitals. “The building is immaterial” to ensuring the quality of health care in the county, he said. Ulster County benefits from access to high-quality care in Albany and New York City.

Smith was appointed commissioner in April 2012. She is a medical internist who holds a master’s degree in public health and has resided in Ulster County for 20 years.

The state health department is requiring county health departments to collaborate with hospitals in preparing community health implementation plans to address county needs through 2017. The plans must be submitted to the state in November.

The state agenda focuses on five areas: preventing chronic diseases: promoting a safe and healthy environment; promoting better health for women, children, and infants; preventing HIV and other infectious diseases; and promoting mental health, including prevention of substance abuse.

Ulster County is focusing on two areas, preventing chronic diseases and promoting mental health. Heart disease, cancer and lung disease are the leading causes of death in Ulster County. (Heart disease is number one for women, followed by cancer and lung disease, while cancer is number one for men, followed by heart disease and lung disease.)

Home is where the health is

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Vassar Brothers Medical Center.
Vassar Brothers Medical Center.

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You’ve heard it for years. You may have even said it yourself: If you’re faced with a major medical issue, head south to New York City or north to Albany for treatment, the implication being that local hospitals lag behind their big-city counterparts in quality.

For decades, Hudson Valley residents seeking special care in fields like cardiology, oncology and orthopedics felt they had travel to New York City or Albany for treatment. But in recent years that trend has begun to diminish, with patients sticking closer to home. That’s no accident.

HealthAlliance of the Hudson Valley is an integrated healthcare system with campus locations in Kingston, Margaretville and New Paltz. Josh Ratner, chief strategy officer for HealthAlliance, said that one of the first goals when consolidation came in 2009 was determining why patients left the area for treatment and what might be done to prevent that from happening.

“We heard about the out-migration to other areas, both north and south,” Ratner said. “It was a priority to understand the environment we were serving so that we could better serve the community. Not only did we look at the data from the state, but also we undertook a community perception survey to go out and quantitatively speak to what the public’s perceptions were at that time so we could better understand how to make some of those changes. It helped us solidify factually why some folks were going outside the community. That became one of the pillars of our strategic plan.”

That plan resulted in a concept that was also pursued by Health Quest, formed through the affiliation of hospitals in Rhinebeck, Poughkeepsie and Carmel. According to Health Quest senior vice-president for strategic planning and business development David Ping, a first step was working with respected physicians in a concerted effort to address the perception of healthcare in the Hudson Valley.

“It started with one program, really,” Ping said. “It started with the desire to make Vassar be a regional referral center for cardiac services. We were able to attract Dr. [Mohan] Sarabu and his team here, and we made sure they had the tools that they needed, the equipment they needed to enable them to practice medicine the way they wanted to practice medicine. Once Dr. Sarabu was established, we moved on to the next thing we wanted to work on, which were oncology services. That was our approach, to take it one program at a time, recruit the best people we could recruit for those programs, have them build the team and then once that’s done start attracting the patients. It was a commitment on the part of Health Quest and Vassar Brothers medical board and the vision of the administrative team to make that happen.”

A healthier region needs to start in school

[wide]health[/wide]Although there have been many educators in my family, I’m not among them. But I do know that the education of a young mind is a multi-faceted thing. More than just reading, writing and ’rithmetic are needed to turn a kid into a happy, healthy and successful adult. Often neglected as a crucial part of education has been teaching kids how to take care of their bodies throughout their lives. A history of inadequate, sometimes optional “gym” classes and cafeteria food that is often neither appealing nor nutritious makes for a health crisis that is improving in bits and pieces here and there, but slowly and with still a long way to go.

A recent conference in New Paltz demonstrated how to find resources for funding and motivating school staff and students to learn how to make big steps to improve student health. The Healthier Hudson Valley Challenge earlier this month at the Ulster BOCES Conference Center in New Paltz featured speakers, panelists and representatives of agencies and corporations offering encouragement to area school administrators and staff, as well as practical information and resources for improving the health of kids in their districts.

The need for leadership

I had to miss the beginning in order to ferry my own child to school, but when I arrived, Mary Joan McLarney, a registered dietician and nutritionist for the U.S Department of Agriculture, was telling the audience about a successful program she was involved with. Components included a parent breakfast every year and a recipe contest for kids.

“It’s about leadership at the school,” she said, and, “This is so broad sweeping because the whole culture shifts.”

In February, President Barack Obama’s administration released nutritional guidelines for snacks sold in schools, to encourage kids to choose fruits, low-fat wholegrain snacks and to limit sugary drinks. The USDA has proposed the Healthy, Hunger Free Kids Act of 2010, with standards for snack foods and beverages sold to kids at school. Too many still offer “junk” food and drinks to any kids with the spare change to buy them.

Better health outcomes

[wide]VBMC[/wide]Vassar Brothers Medical Center (VBMC) is expanding and says it is drawing more patients from other area hospitals, a trend it attributes to its high ratings and comprehensive services.

That was among the messages communicated by President Janet Ready at the hospital’s eighth annual “State of the Hospital” address on April 5 at the Grandview in Poughkeepsie. Ready provided a brief overview of the hospital’s achievements in the past year, which she said reflected its three primary objectives: enhancing patient care, enhancing access to care, and partnering with physicians. Three physicians also spoke at the well-attended early-morning event.

Ready said the hospital has enhanced patient care by expanding staff. In the past year, the hospital has hired 60 new physicians, for a total of 650 doctors, and 37 allied heath practitioners. The new hires include a gynecological oncologist who is an expert in robotic surgery and specialists in vascular medicine and breast surgical reconstruction.

Ready noted that VBMC was ranked in the top five percent of all hospitals in the nation for overall cardiac services, cardiac surgery, coronary interventional procedures, and maternity services. It has among the best outcomes in the state for coronary bypass surgery, according to an August 2012 state health department report. “Our cardiac surgery program ranks number one for coronary bypass grafts and valves in the state,” she said.

Ready noted the numerous partnerships with the medical community in the areas of primary care, pulmonology, thoracic surgery and neurosurgery. She said that 1,000 more patients were referred in 2012 to VBMC from other regional hospitals, nearly 70 percent higher than the previous year.

VBMC’s new Center for Ambulatory Services, opened in mid-July, served 760 patients in its first six months. The center has enabled the hospital to perform more surgeries.