Presence Mercy Medical Center Presence Fox Knoll Presence McAuley Manor Presence Home Care ·...

Presence Mercy Medical Center Presence Fox Knoll

Presence McAuley Manor Presence Home Care

Community Health Needs Assessment Implementation Strategy

2013 - 2016

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Kane County Community 2013 - 2016 Implementation Strategy

Ministry Overview .................................................................................................................... 1

Target Areas and Populations ............................................................................................................ 3

Identification of Community Needs ..................................................................................................... 9

Identifying Community Priorities .................................................................................................................................... 15

Development of the Implementation Strategy ................................................................................... 17

Action Plan with Presence Health’s Involvement in Addressing the Needs .................................... 19

Next Steps for Priorities .................................................................................................................... 37

Priorities Not Being Addressed by Presence Mercy Medical Center ................................................ 38

Implementation Strategy Approval .................................................................................................... 39

Implementation Strategy Communication ......................................................................................... 40

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Provena Health and Resurrection Health Care merged on November 1, 2011 to form a new health system, Presence Health, creating a comprehensive family of not-for-profit health care services and the single largest Catholic health system in Illinois. Presence Health embodies the act of being present in every moment we share with those we serve and is the cornerstone of a patient, resident and family-centered care environment. “Presence” Health embodies the way we choose to be present in our communities, as well as with one another and those we serve.

Building on the faith and heritage of our founding religious congregations, we commit ourselves to these values that flow from our mission and our identity as a Catholic health care ministry:

Honesty: The value of Honesty instills in us the courage to always speak the truth, to actin ways consistent with our Mission and Values and to choose to do the right thing.

Oneness: The value of Oneness inspires us to recognize that we are interdependent,interrelated and interconnected with each other and all those we are called to serve.

People: The value of People encourages us to honor the diversity and dignity of eachindividual as a person created and loved by God, bestowed with unique and personalgifts and blessings, and an inherently sacred and valuable member of the community.

Excellence: The value of Excellence empowers us to always strive for exceptionalperformance as we work individually and collectively to best serve those in need.

Presence Mercy Medical Center (PMMC) has been meeting the health needs of Kane County residents for over 100 years. Founded by the Sisters of Mercy, PMMC continues to carry out its mission of providing “compassionate, holistic care with a spirit of healing and hope in the communities” it serves.

PMMC is a 350-bed facility located in Aurora, Illinois, a growing suburb 40 miles west of Chicago. Consistent with the mission and vision set forth by the founding Sisters of Mercy, PMMC diligently works to meet the needs of the community. This is achieved through a commitment to provide high quality, state-of-the-art, cost-effective care, within a Catholic, culturally sensitive environment, to all members of the community regardless of religious preference.

With over 1,200 employees and a medical staff of over 340 physicians across multiple specialties, PMMC offers a full range of inpatient and outpatient medical services for the Greater Aurora area. In concert with other Presence ministries, PMMC strives to live out its mission of providing compassionate, holistic care with a spirit of healing and hope in the communities it serves.

Presence Fox Knoll Presence Fox Knoll (PFK) is a Senior Living Community in Aurora that includes an 88-unit Independent Living building for persons 65 and older, and a 75 unit, IDPH-licensed Assisted Living building which was formerly St. Joseph Mercy Hospital. Assisted Living services include meals, housekeeping, assistance with activities of daily living and memory care. Social opportunities and spiritual enrichment are available for all Presence Fox Knoll residents.

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Presence McAuley Manor In 1985, Presence McAuley Manor (PMM) began providing short- and long-term skilled nursing care to the Aurora and Fox Valley communities. The ministry has 87 Medicare-certified beds, of which 9 are also certified for Medicaid. The short-term Transitional Care Unit comprises 50% of the population Presence McAuley Manor serves. The services provided at Presence McAuley Manor include 24-hour skilled nursing care, physical, occupational and speech therapy services, as well as spiritual health, art, music and other complementary therapies that address the needs of the entire person. Presence McAuley Manor employs approximately 130 employees and is accredited by The Joint Commission.

Presence Home Care Presence Home Care (PHC) is a ministry of Presence Life Connections and part of the integrated healthcare delivery network of Presence Health. Presence Health includes five acute care hospitals, one long term acute care hospital, 17 long-term care facilities, 9 residential housing ministries, five home health agencies, two hospice agencies, a private duty agency, an intergenerational center, adult daycare centers, pharmacies and clinics. Presence Life Connections ministries are located in Illinois and Indiana. Presence Home Care consists of five home health agencies (Chicago, Elgin, Joliet, Kankakee and Champaign-Urbana), two hospice agencies (Elgin and Champaign/Urbana) and one private duty agency covering all service areas. The average daily census in the home health agencies is approximately 950, of which 75-80% are Medicare recipients, with the remaining being a mix of Medicaid, commercial andself-pay. The average daily census in the hospice agencies is approximately 45, with acomparable distribution in terms of payer sources. Private duty currently has approximately1,500 people subscribed to our patient monitoring system in the home. Presence Home Careemploys approximately 375 employees of which 80% are clinical staff.

This report summarizes the plans for PMMC, PFK, PMM and PHC to sustain and develop new community benefit programs that 1) address prioritized needs from the 2011 Kane County Community Health Needs Assessment (CHNA) conducted by Kane County Health Department and 2) respond to other identified community health needs.


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Kane County

40 miles west of Chicago 515,269 people who reside in

30 municipalities. Median age in Kane is 35.4

years The 2010 U.S. Census reports

the Hispanic population has tripled since 1990 and now stands at 158,390, or 31% of the total population, the highest proportion of Hispanic residents of all Illinois counties.

Aurora, Illinois

Total Population: 197,899 Gender: 51% Female, 49%

Male Ethnicity: 41% Hispanic, 40%

Caucasian, 10% African American, 7% Asian, 2% other

Age Distribution Years: 30-39=17%, 10-19=16%, 20-29=14%, 40-49=14%, 50-51=10%

Median Household Income:61K

Language Spoken: 54%English, 39% Spanish Only

Unemployed: 8.5%

Description of Community Kane County is the fifth largest county in Illinois, with a 2010 population of 515,269. It has grown by 30% since 2000 and by 60% since 1990. Kane County is located 40 miles west of Chicago, within the Chicago Metropolitan Area. Its land area is about 520 square miles, with a population density of about 776.5 people per square mile. It has a small rural area (2.3% of total population), mostly in the western half of the County. Most of its urban population is clustered around the Fox River. Southern Kane makes up about 37% of the Kane County population and comprises seven communities located in the southern third of Kane County by land mass. The largest community in Kane County is Aurora with a population of 197,899.

Primary Service Area PMMC’s service area comprises Aurora, North Aurora and Montgomery, with a total population of 233,097 in its service area. Aurora is the largest municipality which makes up about 85% of the service area with a total population of 197,899. Aurora straddles four counties (Dupage, Kane, Kendall and Will) and is the second largest city in Illinois. It is racially and ethnically diverse, with 44% of the population White, 38% Hispanic and Asian and African Americans comprising 6% and 10% of its population, respectively. Aurora has the second largest Hispanic population in the state.

Demographics Southern Kane County makes up about 37% of the Kane County population, with a 2010 population of 192,259. It comprises seven communities located in the southern third of Kane County by land mass. The largest communities in the Southern Planning Area (SPA) are Aurora, comprising 68% of SPA as a whole, and Batavia which represents 14% of SPA.

Age. The age distribution showed that the SPA is also a younger community, with a third of the population age less than 18 years and 9% under 5 years old. In Aurora, the largest age distribution was 30-39 years (17%), 10-19 (16%), 20-29 (14%), 40-49 (14%), and 50-51 (10%).

Gender. There were more females (51%) residing in Aurora than males (49%).

Population. Kane County has a population of 515,269 people who reside in 30 municipalities. Aurora has a total population of 197,899.


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Ethnicity. Aurora is home to the largest Hispanic community in Illinois outside of Chicago. It is quite racial/ethnically diverse, with 46% of the population White, 42% Hispanic, 9% African American and 2% Asian.

Language Spoken. 54% of Aurora residents speak English and 39% of residents speak Spanish.

Income. The median household income in Aurora is $61,000. Like most other communities, this area was also affected by the economic downturn. All the major municipalities in the service area had their unemployment rates in 2010 increase more than double the rate in 2000. The unemployment rate for Aurora is currently 10.9%.

Poverty Status. Similarly, poverty status in Aurora increased to 13.9%. It is estimated that a one-parent family with a preschooler and school-age child will need at least $60,472 to be self- sufficient in Kane County. Of the 59,663 homes in Aurora, almost a third are renter-occupied, with 47% of the renters spending 35% or more of their income on rent.

Education. About 72% of high school students graduated in the major school districts serving the area (D129 and D131), with a composite ACT score of 17.9.

Target Population. The CHNA revealed that 89% of Kane adult residents reported that they had health insurance coverage compared to 87.8% in 2002. The U.S. Census reported that 86.8% of the total population had health insurance, compared to 86.2% for Illinois, and lower than the Healthy People 2020 goal of 100%. The target population for this Presence Mercy Medical Center is underserved adults in the hospitals primary service area which includes eight Medically Underserved Areas (MUAs).

Gender: 51% Female 49% Male

Race/Ethnicity: 41% Hispanic

Source: Kane County Health Department, 2012. Kane 201-2016 Community Health Improvement Plan. Available: http://kanehealth.com/PDFs/CHIP/CHIP-short.pdf

http://kanehealth.com/PDFs/CHIP/CHIP-short.pdf


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High School Graduates: 21.4%

Total Population: 193,582

Median Household Income: $61K



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Northern Kane County60102 Algonquin 60010 Barrington Hills 60103 Bartlett 60109 Burlington 60110 Carpentersville 60118 East Dundee 60123 Elgin 60136 Gilberts 60140 Hampshire 60142 Huntley 60140 Pingree Grove 60118 Sleepy Hollow 60177 South Elgin 60118 West Dundee

Central Kane County60119 Campton Hills 60119 Elburn 60134 Geneva 60142 La Fox 60151 Lily Lake 60151 Maple Park 60174 St. Charles 60151 Virgil 60184 Wayne

Southern Kane County60504 Aurora 60505 Aurora 60506 Aurora 60507 Aurora 60510 Batavia 60511 Big Rock 60144 Kaneville 60538 Montgomery 60542 North Aurora 60554 Sugar Grove

PMMC Primary Service Area


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Source: Kane County Health Department, 2012. Kane 2012-2016 Community Health Improvement Plan.

Available: http://kanehealth.com/PDFs/CHIP/CHIP-short.pdf


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Secondary Data Sources

2010 U.S. Census Center for Disease

Control and Prevention Illinois Department of

Public Health Illinois Department of

Employment Security Kane County Health

Department Youth Risk Behavior

Survey

Process Used to Identify Community Needs Approach. Kane County approached the 2011 Community Health Needs Assessment differently than in years past. In late 2010, the Kane County Health Department (KCHD) engaged the five hospitals in the county and the INC Board in a formal Community Health Assessment Committee to fund and lead the assessment effort. In early 2011, the Fox Valley United Way and the United Way of Elgin both formally agreed to fund and support the assessment process as well. This partnership allowed all agencies to meet their community assessment requirements and provided an efficient use of assessment and planning resources from all involved agencies.

Indicators and Secondary Data Sources. The assessment included the collection and analysis of the most-up-to-date health, social, economic housing and other data including: 2010 U.S. Census, Centers for Disease Control and Prevention, Illinois Department of Public Health, Illinois Department of Employment Security, Kane County Health Department, Youth Risk Behavior Surveillance Survey, and other Kane County offices and departments. In addition, the assessment included qualitative input directly from residents gathered through focus groups, Community Cafés, Community Meetings and Quality of Kane Open Houses.

Methodology. The assessment partnership funded a comprehensive telephone survey of Kane County residents to collect health status information for over 1,500 adults and the caregivers of over 400 children. The survey questions were created based on the Behavioral Risk Factor Surveillance System survey, allowing the results to be compared with state and national figures. The Northern Illinois University Public Opinion Laboratory was contracted to conduct the phone survey between March and July of 2011. In addition to quantitative data, the department gathered qualitative information from residents about the health of the community through the Quality of Kane Public Meetings, Focus Groups, Community Cafés and Community Meetings. These events provided an opportunity to hear directly from residents about the factors most influencing health in their communities. This information was used to help planners understand the health data collected. Over 200 residents participated in at least one of these events.

Community and Stakeholder Participation. Community and stakeholder input were obtained to determine the needs of the community. The Quality of Kane Public Meetings were held in April, May, and November 2011. These meetings provided community members an opportunity to hear about and provide their input on planning initiatives in Kane County from different planning disciplines: health, land use, and transportation. There were six meetings total, two from each of the three planning areas in the county. The planning areas are defined by the county and are used by all departments.


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Focus groups were a key component in this community health assessment. Use of focus groups provided additional information in a less structured setting. Multiple sessions in different areas during different times ensured that enough information was gathered to identify common themes in all responses. Twelve of the groups consisted of residents recruited by Northern Illinois University Public Opinion Laboratory and were held in the three planning areas (North, Central, South) of the county with four meetings in each area.

Two Community Cafés were held in conjunction with the Strengthening Families organization and used their “Parent Café” model. The model had specially trained parent coordinators who hosted and facilitated the discussion. Three questions were presented at each session, one per table, and participants moved from table to table, building on what was discussed by the prior group. The Strengthening Families Parent Cafés are a valuable part of the community, that help serve as a vehicle to help bring parents together to discuss topics that help keep families strong and children safe by looking at the social-emotional side of health.

For the Community Meetings, the department targeted existing groups to ask another series of questions relating to health, education, and income/employment. This method was effective because it did not require special recruitment of participants; meetings were held during existing meeting times to increase participation.

Type of Meeting Number of Meetings Number of Participants

Quality of Kane Public 8 210Meetings

Community Café 2 10: Spanish-Speaking Session9: English-Speaking Session

NIU Focus Groups 12 88

Community Meetings 6 52

369 Total Participants Table 1: Methods of Qualitative Data Collection

Community and Stakeholder Key Findings. The results of the survey, focus groups, Community Cafés, and Community Meetings were analyzed along with the secondary data collected to identify potential threats to community health.

Community Assets and Resources. As part of the assessment, the department examined the assets in the community: hospitals, physicians, agencies, and partnerships. There are five hospitals in Kane County, (two in Elgin, one in Geneva, and two in Aurora) all of whom work closely with the department on the assessment and many other projects including health access, wellness programs, and the Fit Kids 2020 Plan initiative. Five Federally Qualified Health Centers (FQHC) serve Kane County and together they provided essential health services for 68,943 patients, dental services for 18,976 patients, and mental health services for 6,038 patients in 2010. These centers are crucial in helping vulnerable populations get access to the services they need. There are 46.3 primary care physicians (including pediatricians) per 100,000 population, as compared to the national median of 54.6 per 100,000 population. Kane



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Identified Community Health Needs in Kane County

1. Obesity2. Chronic Disease3. Infant Mortality4. Childhood Lead Poisoning5. Communicable Disease6. Poor Social and Emotional

Wellness

County has 9 pediatricians per 100,000 population as compared to the national median of 4 per 100,000. This is beneficial to the county because of its large population of children under 18. The number of specialist in Kane County is higher (85.8 per 100,000) than the national (31.7 per 100,000) median as well. Finally, dentists in the county per 100,000 is 53.7, higher than the national median of 33. The county does not have a community mental health center; however, there are 20 agencies coordinating the provision of services through the Kane County Mental Health Council.

Key Findings. Analysis of the 2011 Community Health Survey data, secondary data, online survey results, and qualitative data, the Kane County Health Assessment results pointed to six major threats to community health and well-being.

These issues contribute to a lower quality of life for many Kane County residents, as well as increased spending on health care costs. To improve the overall quality of life in

Kane County, the Community Health Improvement Plan (CHIP) recommends four cross-cutting priorities to address these threats. Each priority will be addressed through implementation of one or more evidence-based strategies.

Results of the 2012 Needs Assessment Obesity. The problem of obesity in the United States has reached epidemic levels and Kane County is experiencing equally high rates for adults and children. For adults, obesity is defined as having a Body Mass Index (BMI) equal to or greater than 30. The calculation for BMI uses a person’s height and weight. For children and teens, the calculation is more precise, using height, weight, age, and gender.

The current percentage of adults in Kane County who are overweight (BMI between 25 and 29.9) is 34.5%. Those who are obese make up 29.4% which means, together, 63.9% of Kane County adults are considered overweight and obese. According to the Centers of Disease



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Control and Prevention, being overweight or obese can increase the risk for health problems including heart disease, type 2 diabetes, high blood pressure, cancer, stroke, and osteoarthritis.

Chronic Disease. Chronic diseases such as heart disease, stroke, cancer, diabetes, and arthritis are among the most common, costly, and preventable of all health problems in the U.S. Chronic disease accounts for 80% of all deaths in Kane County. With the rapidly growing older population in the county, these diseases will become more prevalent unless preventative action is taken. Without proper insurance, people are unable to keep their conditions under control and will end up in hospital emergency rooms for issues that could be more effectively managed by regular visits to a physician.

Infant Mortality. In Kane County, there is a disparity in the infant mortality rate when compared by race/ethnicity; the rate is two times higher for African Americans than for Hispanic and white residents. Looking at the current trend, which is improving, it will still take another two generations to close the gap in rates. By implementing various strategies, like increasing the number of African-American women who enter prenatal care in the first trimester, that gap can be closed by 2030.



Childhood Lead Poisoning. Lead poisoning is entirely preventable. Unfortunately, Illinois leads the nation in the percentage of lead poisoned children. Outside of Cook County, Kane County has the highest rate of childhood lead poisoning in the state. Nearly 1,500 children in Kane were documented to have elevated blood lead levels and need to have their homes evaluated for lead hazards and have the lead hazards reduced or eliminated.

Communicable Disease. Vaccines are among the most cost-effective clinical preventive services and are a core component of any preventive services package. Unfortunately, only 56% of 2 year olds in Kane County received the recommended vaccinations in 2010. Outbreaks of communicable disease lead to increased absenteeism in workplaces and schools and increased health care costs. A healthcare system in Kane County working to prevent, identify early, and treat communicable diseases is critical and can help close the gap to reduce the burden of communicable disease.


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Poor Social and Emotional Wellness. Mental disorders are among the most common causes of disability. Mental health plays a major role in people’s ability to maintain good physical health. Mental illness such as depression and anxiety, affect people’s ability to participate in health- promoting behaviors. Southern Kane County had the highest percentage of adults who reported that their mental health was not good.


A key objective of the hospital is to integrate the CHNA findings with the Community Health Improvement Plan and Implementation Strategy. To begin, PMMC looked back at the priorities from the last community benefit plan. An evaluation of the past plan was important in helping determine if what was implemented actually had a positive outcome and people’s lives had improved.

PMMC’s review of current community benefit programs found that the hospital is meeting existing community needs by delivering prevention and management programs and providing advocacy and support to local campaigns and initiatives.

Obesity: Prevention: I’m Reducing Obesity in Children (IROC) Nutrition Program Advocacy and Support: Making Kane County Fit for Kids Partnership Advocacy and Support: Healthy Living Council of Greater Aurora

Chronic Disease: Prevention: A-List: Achieving Good Health Diabetes Prevention Program Management: A1C Achiever Diabetes Program Management: Live Well, Be Well Program Chronic Disease Management Prevention: Community Wellness Program

Poor Social and Emotional Wellness Advocacy and Support: Kane County Mental Health Council Partnership


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PMMC recognizes that priority setting is a critically important step in the community benefit planning process. Decisions around priorities have a pivotal impact upon the effectiveness and sustainability of the endeavor. PMMC worked with the Kane County CHNA Steering Committee to identify priority issues for the county. This allowed PMMC to be actively engaged in the current county assessment to fully understand the health needs of the county residents.

The CHNA steering committee developed the following process for prioritizing the issues that were identified in the assessment:

First, the results of the survey, focus groups, Community Cafés, and Community Meetings were analyzed along with the secondary data collected to identify potential threats to community health. Next, for the first time, the results of the Kane County Community Health Assessment were made available online in a webinar format in October and November 2011. The webinar provided new, updated information on the overall health of the community, a progress report on the last community health improvement plan and nine recommended key opportunities for community health improvement over the next five years. The webinars were available on- demand which allowed people to view them at their own convenience and pace and permitted pausing/restarting at the click of a button. 169 individuals from many different agencies and communities viewed the webinar over a three week period.

Residents, stakeholders, and other interested parties were asked to prioritize the nine recommended key opportunities for community health improvement, provide input on who should be involved in addressing the issues, and comment on what resources are currently available in the community. In addition, members of the Kane County Board of Health and Health Advisory Committee participated in a retreat to review the data and discuss the results. After issues were identified, workgroups were formed for each priority to develop goals and strategies of how to address the issues. The CHNA Steering Committee saw some overlapping strategies under each issue and agreed to structure the workgroups that would work on each issue.

PMMC identified internal resources to serve on the appropriate action items. Staff resources were identified to work collaboratively toward implementation of the objectives, goals and strategies under the health issues that PMMC was best equipped to address.

The Kane County CHNA findings served as tools to use in determining the overall health of the community and identifying the key health issues facing the community.

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The following indicators served as a guide to identify the community priorities:

Size of the Problem. Results were analyzed to provide insight to the size of the current health problems the community is facing.

Seriousness of the Problem. Results were analyzed to assess the seriousness of the current health problems the community is facing. What impact did the current problem have on the individual, family and at the community level? For example, obesity was the number one threat facing Kane County, therefore, implementing interventions aimed at obesity prevention was critical to improving the health of the community.

Economic Feasibility. All community benefit initiatives are an integral component of PMMC’s strategic and financial plans, inclusive of budgeting to provide financial and human resources adequate for successful program implementation.

Disparities. Health disparities exist when inequalities that exist when members from certain population groups do not benefit from the same health status as other groups. PMMC approaches all community benefit initiatives taking into account the disparities that exist in the community. Although health disparities are often identified along racial/ethnic lines, PMMC leadership also considers other disparities such as access to healthcare, socioeconomic status, gender and behavioral factors when identifying community priorities.

Available Expertise. PMMC Leadership has identified internal resources to serve on action teams that will help to move the Health Implementation Strategy Agenda forward within the next three years. These internal resources will offer expertise in the following areas: chronic disease (diabetes, heart disease, stroke), nutrition, obesity, program implementation, development and evaluation, and behavioral health.

Necessary Time Commitment. PMMC’s organizational commitment for implementation of this strategy will be monitored by the Mission Committee of the Board. The Mission Committee will oversee the progress of the Health Implementation Strategy plan. The VP of Mission Services and Director of Community Health are the dedicated resources for implementation of the plan. In addition, implementation of the Health Implementation Strategy will involve time commitment from action teams to move the implementation agenda forward.


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Community Health Assessment Partners

Delnor Hospital Fox Valley United Way INC Board Presence Mercy Medical Center Presence Saint Joseph Hospital Rush-Copley Medical Center Sherman Hospital United Way of Elgin

PMMC’s Implementation Strategy was developed based on the findings and priorities established by the Kane County CHNA and a review of the hospital’s existing community benefit activities.

PMMC served as one of eight partners that participated in the Kane County Community Health Needs Assessment. This provided the opportunity for PMMC to actively provide expertise, input, and financial support.

Partners also involved in this process included the 4 other hospitals in Kane County including Delnor Hospital, Presence Saint Joseph Hospital, Rush-Copley Medical Center, Sherman Hospital, Fox Valley United Way and the United Way of Elgin.

After the health issues were identified in the assessment, meetings involving PMMC leadership (Community Health, Mission Services, Strategy, Faith Community Nursing, Center for Diabetic Wellness) were held to begin identifying current programs and/or interventions that already existed and those that could be developed.

Next, PMMC leadership identified internal resources to serve on the appropriate action teams. After considering staff resources and expertise, staff was matched with the most appropriate objectives, goals and strategies under each health issue within the community. The action teams were assigned to work collaboratively toward implementation of the objectives, goals and strategies under the health issues that PMMC was best equipped to address.

Goals and strategies were set by the VP of Mission Services and the Director of Community Health. Once the goals and strategies were determined, a program proposal was submitted to Senior Leadership identifying the need based on community assessment findings, internal resources with expertise, program goals and objectives, measures of success, evaluation.

PMMC has a highly skilled team of experts in the areas of chronic disease, heart disease, stroke and diabetes. In addition, PMMC has a community outreach team including both the Community Health Nursing department and the Faith Community Nursing department.

The past year has been a time of organizational transition. During 2013, Presence Fox Knoll and Presence McAuley Manor will be evaluating opportunities to partner with community organizations, as well as Presence Mercy Medical Center, to identify specific programs and strategies to focus their efforts in the coming year.


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Based on the CHNA findings, internal resources, and internal expertise the areas of focus for the 2013 Implementation Strategy Plan that PMMC will help to address include:

Kane County Health Threat

Goal / Priority Strategy PSJH Community Partner

Obesity Support HealthBehaviors that Promote Well-Being & Prevent Disease

Increase access to, and consumption of fresh fruits and vegetables

IROC Nutrition Program

Local School Districts

Family Focus

American Cancer Society-

Chronic Disease

Support Health Behaviors that Promote Well-Being & Prevent Disease

Increase Access to High Quality, Holistic Preventive & Treatment Services Across the Health Care System

Focus culturally appropriate outreach and engagement efforts to eliminate racial disparities in health outcomes

Reduce tobacco use and exposure to environmental tobacco smoke.

Increase the proportion of residents of all ages who receive appropriate, evidence-based clinical preventive services

Freedom from Smoking Program

Living Well with Diabetes Program Live Well, Be Well Program

Madrinas Go Red! Heart Disease Awareness Program

Kane County Health Department

Local Physicians

American Heart Association

Poor Social and Emotional Wellness

Increase Access to High Quality, Holistic Preventive & Treatment Services Across the Health Care System

Enhance systems to support the prevention, early identification and evidence-based treatment of mental health conditions.

Kane County Mental Health Services Council Partnership

Kane County Mental Health Services Council

Although some needs are the same as they were identified in 2012 (i.e. obesity, chronic disease) there are also additional areas that were identified by PMMC that are of concern such as language assistance.


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The PMMC Executive Team and Governing Board have a strong commitment to community health initiatives. Community initiatives and activities have ongoing monitoring and evaluation for program effectiveness. The Mission Committee of the Board is actively involved in review of the Health Implementation Strategy Plan to ensure proposed programs are aligned with our mission and with the needs identified in the 2011 Community Health Needs Assessment. The Mission Committee of the Board meets quarterly and as needed.

The first step in this process involves the Director of Community Health submitting the proposed Implementation Strategy to the VP of Mission Services. The plan is then submitted by the VP of Mission Services to the Executive Team for review. Once approved, the plan is then submitted to the Mission Committee of the Board and to the Board of Directors for annual review, feedback and approval. Once approval is received from both boards, the Implementation Strategy is then sent to the System Director of Community Health Strategy for inclusion in a system-wide report, which will be submitted to the Attorney General’s office.

I’M REDUCING OBESITY CHILDREN (IROC) NUTRITION PROGRAM

Program Description I’m Reducing Obesity in Children (IROC) Nutrition program is designed to provide a series of eight 1.0 hour workshops that will emphasize proper nutrition education for parents and children including goal setting and motivation related to healthy behavior issues. The workshops will also provide families with information and resources relevant to the topics covered. Each 8- week session involves parents attending an education workshop presented by a registered dietitian as children concurrently participate in a cooking demonstration activity led by a registered nurse. Children will create and eat some healthy snacks in this hands-on class that introduces little cooks to the kitchen with easy recipes, simple measurements and kitchen safety.

Community Need: Obesity Prevention: I’m Reducing Obesity in Children (IROC) Nutrition Program Aim Statement: Reduce and/or prevent childhood obesity in Kane County by providing nutrition education for children and parents to promote lifelong health eating habits amongst parents and children.

Outcomes Strategy Action Steps Ministry Role Community Partner Role

Evaluation Plan/ Measures of

Success 1. 80% ofprogramparticipants willreport increasedknowledge ofproper nutritionfor children.

Provide nutrition education/cooking workshops for parents and children

Create knowledge questionnaire,

Create education modules,

Schedule education

Financial Supporter

Expertise

Staff Resources

American Cancer Society: Co- Facilitator for workshops and menu planning

Fox Valley Park District:

Knowledge Questionnaire Preprogram and Post program



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workshops with community partners

Provided Use of Space to host workshops

2. Increase thenumber ofchildren whoseBMI wasmaintained ordecreased after6 months.

Provide nutrition education/cooking workshops for parents and children

Create education module on obesity and BMI

Supply BMI charts

Data Collector

Instructing Team

American Cancer Society: Co- Facilitator for workshops and menu planning Fox Valley Park District: Provided Use of Space to host workshops

Body Mass Index (BMI) Charts

Weight and Height Measurements

3. Increasehealthybehaviors inchildren postprogram asevidenced by:

% of childrenwho reportdecreasedsoda and juiceconsumption

% of childrenwho reporteatingbreakfast

% of childrenwho reporteating morefresh fruit andvegetables

%of childrenwho reportwatching TV

% of childrenwho reportmore physicalActivity

Provide nutrition education/cooking workshops for parents and children on healthy behaviors and healthy eating

Provide education to parents on the impact on unhealthy behaviors on children’s health.

Create children’s curriculum; educate children on what healthy behaviors look like.

Create Lifestyle Questionnaire for parents to assess current risk behaviors

Create Wellness Questionnaire to assess current nutrition and physical activity status

Instructing Team

Expertise

Data Collector

American Cancer Society: Co- Facilitator for workshops and menu planning

Fox Valley Park District: Provided Use of Space to host workshops

Wellness Questionnaire

Lifestyle Questionnaire




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4. Increase thenumber offamilies whoreport havingaccess to propernutritioneducation byqualifiedhealthcareprofessionals

Provide access to healthcare professionals for each workshop

Recruit participants

Market the program throughout the community

Inform local healthcare professionals and other agencies about services

Served as main registration center

Budget for Registered Dietitians, Registered Nurses, and Certified Diabetes Educators for instructing team for all workshops

American Cancer Society assisted with recruitment

Fox Valley Park District: assisted with registration and recruitment




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A1C ACHIEVER DIABETES MANAGEMENT PROGRAM

Program Description "Life with Diabetes" is a 2-3 month program that combines diabetes self-management education and medical nutrition therapy concurrently. Patients are referred by their primary healthcare provider to meet with a diabetes educator for an individual initial assessment to determine the plan of care. Patients attend six 1.5 hour sessions and two individual medical nutrition therapy sessions. Healthy behavior goals are selected by the patient and diabetes educator to be re- evaluated midway through the program and upon program completion or as needed. All patients that achieve an A1C of less than 7% become part of the “A 1C Achiever” program which is a patient recognition program that rewards patients for achieving glycemic control.

Community Need: Chronic Disease Management: A1C Achiever Program Aim Statement: The Life with Diabetes Program provides access to diabetes services so that program participants can attain glycemic control (A1C less than 7%) and improve current health status. Participants that achieve glycemic control are recognized A1C Achievers.



Success 60% of program participants will achieve target A1C of less than 7%.

Provide access to Diabetes Self- Management Education services

Provide access to Medical Nutrition Therapy services

Provide access to necessary pharmaceutical agents to control gylcemic levels

Continuous development of Life With Diabetes program curriculum to reflect most updated evidence based approach.

Weekly Clinical Team staffing to monitor patient progress

Work with Physician and pharmacy to provide access for uninsured patients of the CDW

Budget for diabetes services and Instructing Team

Provide assistance for diabetes supplies and pharmaceutical agents

Referrals from local primary care providers for new onset and uncontrolled patients with diabetes

Referrals from Federally Qualified Health Centers

Cosmopolitan Club of Aurora: Contributes to Diabetes Emergency Fund

A1C laboratory results preprogram and post program

A1C Achiever program completion roster



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90% of program participants will report an increase in diabetes self- management knowledge

Provide access to education services

Create diabetes education care plans for patients

Assess knowledge level pre-program and postprogram

Create knowledge questionnaire

Provide accessto diabetes education services for patients

Referrals from local primary care providers for new onset and uncontrolled patients with diabetes


Pre-program and Post-program Knowledge Questionnaire

A-LIST: ACHIEVING GOOD HEALTH DIABETES PREVENTION PROGRAM

Program Description A diabetes screening and education program that focuses to prevent the onset of type 2 diabetes. Established in 2011, the A-List: Achieving Good Health Diabetes Prevention program is an 8-week program that combines diabetes prevention education strategies and medical nutrition therapy concurrently. Participants must have at least one risk factor for type 2 diabetes but must not be diagnosed upon program entry. Participants meet with a diabetes educator for an individual initial assessment to determine the plan of care. Participants will then attend eight 1.5 hour workshops and two individual medical nutrition therapy sessions. Healthy behavior goals are selected by participants and a diabetes educator at the beginning of the program and then to be re-evaluated midway through the program and upon program completion or as needed. All participants that can demonstrate optimal glycemic levels or improved glycemic levels are invited to attend a recognition celebration that rewards them for achieving improved health status.

Community Need: Chronic Disease Prevention: A-List Achieving Good Health Diabetes Prevention Program Aim Statement: Increase participants’ knowledge on prevention strategies and sills to prevent or delay the onset of type 2 diabetes.



Success 80% of program participants will report increased knowledge of diabetes risk factors upon program

Provide access to diabetes prevention education workshops for individuals at risk for type 2

Create type 2 diabetes prevention education modules

Schedule

Provide access to diabetes prevention education services for at- risk

Referrals from local primary care providers for individuals at risk for type 2 diabetes

Pre-program and Post Pro-gram Knowledge Questionnaire



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completion diabetes diabetesprevention workshops throughout the year

Assess current diabetes prevention knowledge

participants

Marketing of program

Budget for instructing team


80% of program participants will report increased knowledge of diabetes prevention strategies upon program completion

Provide access to diabetes prevention education workshops for individuals at risk for type 2 diabetes

Create type 2 diabetes prevention education modules

Schedule diabetes prevention workshops throughout the year

Assess current diabetes prevention knowledge

Provide access to diabetes prevention education services for at- risk participants

Marketing of program

Budget for instructing team



Post Program Evaluation

80% of program participants will report having access to proper nutrition and diabetes education by qualified healthcare professionals

Provide access to healthcare professionals for each workshop

Recruit participants

Market the program throughout the community

Inform local healthcare professionals and other agencies about services


Dunham Fund awarded funding to deliver program

Post Program Evaluation

80% of program participants will

Provide access to diabetes

Create 6-month follow up

Budget for Registered

Dunham Fund awarded

Fasting blood glucose, A1C, BP,



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report retained knowledge and have demonstrated results within optimal glycemic levels 6 months after program completion

prevention education workshops for individuals at risk for type 2 diabetes

questionnaire

Follow up with participants 3 months post program and 6 months

Dietitians, Registered Nurses, and Certified Diabetes Educators for instructing team for all workshops

funding to deliver program

Height, Weight, Waist Circumference Measurements

Increase healthy behaviors reported in program participants as evidenced by: % of

participants who report eating breakfast

% ofparticipantswho reportdecreasedsweetenedbeverageconsumption

% ofparticipantswho reporteating morefresh fruits andvegetables

% ofparticipantswho reportmore physicalactivity

Provide access to nutrition education workshops for participants that reinforce My Plate and Rethink Your Drink campaigns

Provide access to education for participants on the impact on unhealthy behaviors on diabetes risks.

Create type 2 diabetes prevention education modules on Nutrition 1: Introduction to General Nutrition and Nutrition 2: Advance Concepts

Create education modules on Stress, Coping and Behavior Change Concepts

Assess current knowledge




Pre-program and Post program Wellness Questionnaire

Pre-program and Post Pro-gram Knowledge Questionnaire



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LIVE WELL, BE WELL CHRONIC DISEASE SELF-MANAGEMENT PROGRAM

Program Description The Live Well, Be Well Chronic Disease Self-Management Program is a 6-week, participants education workshop that is evidence based Chronic Disease Self-Management Program developed by Stanford School of Medicine Patient Education Research Center. The program provides information and teaches practical skills on managing chronic health problems. Live Well, Be Well program gives people the confidence and motivation they need to manage the challenges of living with chronic disease including communication with physicians, symptom management, action planning & strategies for disease prevention. Caregivers are encouraged to attend.

Community Need: Chronic Disease Prevention: Live Well Be Well Aim Statement: Increase knowledge and confidence with self-management skills for managing chronic diseases.


Evaluation Plan/

Measures of Success

80% of program participants will report increased knowledge of self- management skills upon program completion

Provide access to Live Well, Be Well workshops for individuals diagnosed with at least one chronic disease.

Provide 4 workshops a year in Aurora and Elgin Area

Recruit participants for program (faith communities, Center for Diabetic Wellness, local physicians, PMMC case managers)

Track the evaluation tool responses for each participant for all 4 workshops

PMMC and PSJH budgets for the instructors to teach this program.

PMMC and PSJH finances the participant materials for this program.

PMMC case managers refer patients with chronic disease that are discharge from the hospital



Program Evaluation Tool

80% of program participants will report increased self-efficacy

Provide access to Live Well, Be Well workshops for individuals

Recruit participants for program (faith communities,

PMMC and PSJH budgets for the instructors to

Referrals from local primary care providers for individuals




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diagnosed with at least one chronic disease.


Center for Diabetic Wellness, local physicians, PMMC case managers)


teach this program.


at risk for type 2 diabetes


80% of program participants will report better communication with their health care providers upon program completion










Increase healthy behaviors reported in program participants as evidenced by: % of participants

who report morephysical activity

%of participantswho report morecopingmanagementtechniques




Track the responses for each participant for all workshops








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COMMUNITY WELLNESS PROGRAM

Program Description The Community Wellness Program provides community education and screening programs on a variety of health and wellness topics both in the community and main hospital location. Components of the program include: blood pressure, blood glucose, blood lipid, body fat and body mass index (BMI) screenings. Health education topics on chronic disease include hypertension, stroke, diabetes, obesity and heart disease.

Community Need: Chronic Disease Prevention: Community Wellness Program Aim Statement: Provide early detection and health education on chronic disease



Success 80% of blood pressure screening participants will report increased awareness of stroke.

Provide screenings in the community on a reoccurring basis.

Engage screening participants in asking questions about hypertension, diabetes, stroke, heart disease and obesity.

Participate in local health fairs

Work with faith community nurses to host screenings at local parishes

Track number of participants at each screening

Track results from Pre and Post knowledge Questionnaire

PMMC budgets for community health nurses to participate in local health fairs

PMMC budgets for screening supplies

Faith Communities

Companeros en Salud Latina Health Festival Steering Committee

Aurora African American Community Health Fair Steering Committee

Local Food Pantry’s

Participant Roster

Pre and Post Knowledge Questionnaire

80% of blood lipid screening participants will report increased awareness of heart disease.


Engage



Track number of


PMMC

Faith Communities


Aurora African

Participant Roster




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screening participants in asking questions about hypertension, diabetes, stroke, heart disease and obesity.

participants at each screening


budgets for screening supplies

American Community Health Fair Steering Committee

Local food pantries

80% of blood glucose screening participants will report increased awareness of diabetes








PMMC budgets for screening supplies

Faith Communities



Local food pantries

Participant Roster


80% of Body Mass Index (BMI) participants will report increase awareness of modifiable risk factors for obesity.








Faith Communities



Participant Roster




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MADRINAS GO RED! HEART DISEASE AWARENESS PROGRAM

Program Description This heart disease awareness and prevention program is a collaboration between PMMC and the American Heart Association. The purpose of the program is to increase visibility of cardiovascular disease and stroke within the bilingual Latino population in the Kane County area, primarily Aurora and Elgin. The program is designed to motivate Hispanic females to take action towards improved cardiovascular health.

Community Need: Chronic Disease Prevention: Madrinas Go RED! Heart Disease Awareness Program Aim Statement: Increase participants’ knowledge on risk factors for heart disease and heart attack in Latino women.



Success 80% of program participants will report increased knowledge of heart disease controllable risk factors and heart attack warning signs

Provide multiple workshops throughout the community for Latino Women.

Attend Madrinas training presented by the American Heart Association in November 2012.

Meet with PMMC Madrinas team to brainstorm possible locations to host workshops.

Engage the community with AHA resources and tools.

Create pre-post knowledge questionnaire for participants

PMMC will provide the healthcare professionals (nurses, nurse practitioners, registered dietitians, faith community nurses) for this program.

PMMC will host the Kick Off Event February 2013.

American Heart Association provides the education material, presentation and attendance incentives for all participants.

Faith Community Parishes will be hosting seminars throughout the year.


Pre Knowledge and Post Knowledge Questionnaire

Workshop Evaluation



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Educate 1,000 Latino women on Heart Disease including heart attack warning signs and diabetes risk.

Recruit additional Madrinas and volunteers to host workshops.

Engage PMMC Marketing team to host Kick Off Event February 2013.

Attend Madrinas training presented by the American Heart Association in November 2012.

Meet with PMMC Madrinas team to brainstorm possible locations to host workshops.

Engage the community with AHA resources and tools.

Create pre-post knowledge questionnaire for participants

PMMC will host Kick Off Event February 2013 and create calendar for workshops to be held.

Association provides the education material, presentation and attendance incentives for all participants.

Faith Community Parishes will be hosting seminars throughout the year.


Community agencies will host workshop locations.

Attendance rosters and track number of participants.

FREEDOM FROM SMOKING PROGRAM

Program Description Although smoking cessation was not one of the six major threats identified in the CHNA it was listed as a priority for Kane County. Smoking cessation is included in the Community Health Implementation Strategy Plan because of the impact that smoking has on the health of an individual when addressing chronic disease management and prevention. Smoking cessation initiatives was identified as a priority to address.

Freedom from Smoking® is a 7-week, small group, program for adults trying to quit smoking and covers topics on what triggers the need to continue smoking, how to cope with changes in quitting and how to find the necessary support. The program teaches participants how to understand their habit, increase their motivation, help them develop an individualized plan for quitting, and teach them skills to maintain a healthy lifestyle.



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Community Need: Chronic Disease Management: Freedom from Smoking Program Aim Statement: Reduce tobacco use and exposure to environmental tobacco smoke.



Success 80% of program participants will report smoking cessation post program and at 6 month follow up.

Offer three (3) cessation groups in a series of seven (7) week coursein offsitecommunity –calendar to becoordinatedwithin theregionalplanning area--locationscommensuratewith thesmokingdemographics

• PromoteIllinois Quit Lineamongparticipants andto thecommunity

• Medical Homereferrals asneeded forattendees

• Providenicotine therapyat the hospitalpharmacy rateat no charge tothe patient

Promote cessation services and quit line in regular publications and among community partners-and submit record of communication messages and venues

Collaboration on 5 A’s refresher orientation developed by KCHD to be conducted at physician committee meetings

Budget for FFS instructors to teach a minimum of 3 workshops and provide location for workshops

Kane County Health Department-

•provide grantfunding tosupportprogramdelivery

•provideeducationmaterials andresources toprogramworkshops

Session Questionnaire for each participant and summary at project conclusion:

• Record ofattendees/number ofsessions/locationand outcomes

• Referral datafrom physiciansand other sources

• Physician andcommunitycommunicationsdocuments

• Six month followup outcome form

AAccttiioonn PPllaann wwiitthh PPrreesseennccee HHeeaalltthh’’ssIInnvvoollvveemmeenntt iinn AAddddrreessssiinngg tthhee NNeeeeddss

FAITH COMMUNITY NURSING PROGRAM

Program Description The Faith Community Nursing (FCN) program at PMMC integrates faith and health in order to serve the health care needs of members of faith congregations and the community. The FCN role is a specialty of nursing focused on the integration of the spiritual dimension into the health system through visits involving advocacy, referral, wellness education and navigation of the health system.

Community Need: Chronic Disease Prevention: Faith Community Nursing Program Aim Statement: Provide faith communities with health information and resources integrating the spiritual dimension with evidence based knowledge to enhance decision making for optimal healthy choices.



Success 85% of congregation members and families who utilized FCN services will report enhanced decision making regarding their health

Provide access to FCN services for members of congregations

Promote FCN services in community calendars and parish newsletters

Promote FCN services among members of the congregation and community

Provide Medical Home referrals as needed for individuals

Budget for FCN FTE

Assist with marketing of services

Support FCN initiatives consistent with HIS plan

Local Parishes that partner with PMMC

Participant Satisfaction Survey

Department scorecard data

Referral data from physicians and other sources

Physician and community communications documents

LANGUAGE ACCESS TO HEALTHCARE (LAH) INTERPRETING SERVICES

Program Description Language Access to Healthcare is a community-based interpreting and translating services program. In an effort to provide equal access to health care, LAH was designed to help break the language barriers for limited English proficient and non-English speaking individuals. Interpreting and translating services are available to individuals and organizations within the hospital’s primary and secondary service area.




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Although language barriers were not a specific need in the CHNA, this program is included in the Community Health Implementation Strategy Plan because of the impact that language barriers has on the health of an individual.

Community Need: Language Assistance Aim Statement: Reduce the language barriers in healthcare settings for limited English proficient and non- English speaking individuals and families as well as for community organizations.



Success 80% of program participants will report that they were better able to explain to their healthcare provider the reasons for seeking care.

Promote interpreting services throughout the community

Provide access to interpreting services as part of community benefit planning

Track the number of patients utilizing our services

Analyze patient satisfaction results

Budget for interpreting services staff

Health Care agencies

Local Physicians

Patient Satisfaction Surveys

Department Scorecard

80% of program participants will report that the quality of medical attention they received was improved







Local Physicians



80% of program participants will report that they were able to make better informed decisions about their health care needs.







Local Physicians





Page 35 of 40

In addition, Presence Mercy Medical Center will continue to meet community needs by providing charity care, Medicaid and SHIP services, and by continuing to provide advocacy and support to local partnerships that help in the development and implementation of select initiatives within the 2012-2016 Kane County Community Health Improvement Plan (CHIP).

MAKING KANE COUNTY FIT FOR KIDS

Partnership Description PMMC continues its partnership with the Kane County Health Department (KCHD) to provide advocacy and support with select initiatives within the structure of the Kane County's Making Kane Fit for Kids initiative. The development of the Fit Kids 2020 Plan was launched in 2008. PMMC provides leadership in specific work groups aimed at obesity interventions. This initiative aims to prevent obesity and its complications, and provide programming to help community members make healthy choices.

Target Population Individuals residing in the Kane County portions of PMMC service area, with focus both on assisting those struggling with obesity as well as helping others make healthier decisions to prevent obesity and its complications.

HEALTHY LIVING COUNCIL OF GREATER AURORA

Partnership Description The Healthy Living Council of Greater Aurora (HLCGA) was formed in 2008 to participate in the Making Kane Fit for Kids Initiative. The current focus of the HLCGA is to explore attitudes, behaviors and cultural differences in the population about obesity and wellness and to obtain empirical evidence on existing community organizations and institutions and barriers to healthy behaviors. This evidence will be used to shape the opinions of key stakeholders in the community so that changes in the environment can be made.

Target Population Individuals residing in the Greater Aurora area of PMMC service area.

KANE COUNTY MENTAL HEALTH COUNCIL

Partnership Description The Kane County Mental Health Council was created in January of 2007. The County’s mental health services providers partnered together to form an alliance dedicated to improving mental health services for children, adults and families in their communities. The alliance formed in response to community demand, and to the findings of the Kane County Health Department’s IPLAN (Illinois Project for Local Assessment of Needs). The independent Council formed to



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coordinate services and to make the system more responsive by bringing together provider organizations, mental health authorities, major funders of mental health services, mental health advocacy groups and public officials. PMMC serves as a representative of the council.

Target Population Individuals residing in Kane County in the PMMC service area.


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NNeexxtt SStteeppss ffoorr PPrriioorriittiieess

For each of the priority areas listed above, Presence Mercy Medical Center will work with Presence McAuley Manor, Presence Fox Knoll, Presence Life Connections and community partners to: Identify any related activities being conducted by others in the community that could be

enhanced by collaborating with one another. Develop measurable goals and objectives so that the effectiveness of their efforts can be

measured. Build support for the initiatives within the community and other health care providers. Develop detailed work plans and continually monitor progress.


Page 38 of 40

PPrriioorriittiieess NNoott BBeeiinngg AAddddrreesssseedd bbyyPPrreesseennccee MMeerrccyy MMeeddiiccaall CCeenntteerr

The Kane County Community Health Improvement Plan (CHIP) is a comprehensive set of policy and program recommendations for our community based on the most up to date information. PMMC, PFK, PMM and PHC have identified the areas where we can have the largest impact on improving the quality of life for all Kane residents-particularly the most vulnerable residents of our community. PMMC, PFK, PMM and PHC will continue to collaborate with Kane Health Department and other community partners to continue to meet the needs of the community.


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IImmpplleemmeennttaattiioonn SSttrraatteeggyy CCoommmmuunniiccaattiioonn

Presence Mercy Medical Center will share the 2013 Implementation Strategy with all internal stakeholders including employees, volunteers and physicians. This document is available at www.presencehealth.org and is also broadly distributed within our community to stakeholders including community leaders, government officials, service organizations and community collaborators.

The following notice is posted in several areas of Presence Mercy Medical Center to assure community awareness of the Community Benefit Act. This report is on file with the Illinois Attorney General’s Office:

Illinois Community Benefits Act This hospital annually files a report

of its Community Benefit Plan with the Illinois Attorney General’s Office.

This report is public information and available to the public by

contacting:

Charitable Trusts Bureau Office of the Attorney General

100 West Randolph Street, 3rd Floor Chicago, Illinois 60601-3175 (312)

814-3942

Required by Section 20(c) of Public Act 093-0480

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