Health + Wellness Magazine Spring / Summer 2020 by Cheshire Medical Center

Health + Wellness

INSIDE:

2018-2019 Community Report

Living healthier together. Spring/Summer 2020

Working Together for Your Heart Health

Cardiologist, Todd Silberstein, DO, discusses the benefits of a pacemaker with one of his patients.

Learn how cardiology services at Cheshire Medical Center quickly and seamlessly expand when you need it. Plus: Helpful information and tips for a healthier heart.

Your Family Medical Home Team Learn how you can harness the power of your Primary Care team’s collaborative approach to patient-centered care.

ALSO INSIDE: Tips, tools, and information about local resources and supports for living healthier together―along with a listing of our upcoming programs on a variety of health-related topics. H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

WALK IN TO TRUSTED CARE

for everyday illnesses and minor injuries.

Health + Wellness Living healthier together.

Health + Wellness magazine is a publication of Cheshire Medical Center. To support the health and wellness of the people of the Monadnock Region, we provide information about our services and medical care, as well as local resources available to support wellness goals. This publication is intended to provide health information to our readers and should not be considered a substitute for consulting with a physician. Cheshire Medical Center has served the communities of the Monadnock Region with high-quality health care since 1892. A member of the Dartmouth-Hitchcock Health system, Cheshire is a nonprofit medical center providing a continuum of care spanning primary care and specialty medicine, to surgical services and acute inpatient care, comprehensive cancer treatment, and inpatient physical rehabilitation. The educational programs listed in Health + Wellness magazine are developed and coordinated through the Center for Population Health. The Center for Population Health (CPH) is a department of Cheshire Medical Center focused on health and wellness education, outreach, and support to individuals, families,

Staffed by Dartmouth-Hitchcock Primary Care Providers, Cheshire Medical Center’s Walk-In Care Clinic can seamlessly connect to our Family Medicine and Specialty Medicine—offering an expanded team of support, should you need a higher level of medical care. Of course, you don’t have to be a Cheshire patient to visit our Walk-In Care Clinic and you never need an appointment. Just walk in! 149 Emerald Street, Keene, NH Open: Mon-Fri: 8am-8pm | Sat-Sun: 10am-4pm | Holidays: 10am-2pm

(603) 354-5484 | cheshiremedwalkin.org Turn to page 17 for tips to help you determine when to go to walk-in care, when to head to the emergency room, and when to call your doctor.

worksites, schools, and the community. CPH provides staff for the Greater Monadnock Public Health Network and support for the Healthy Monadnock community. To sign up to receive Healthier Together, a monthly e-bulletin, and view previous issues of Health + Wellness magazine, visit: cheshiremed.org.

Inside: Pages 4-10 FEATURE: HEART HEALTH

Learn how patient-centered cardiac care can quickly and seamlessly expand when you need it. Plus helpful information and tips for a healthier heart.

Pages 11-16

We are proud to report updates for the fiscal year spanning July 1, 2018 through June 30, 2019, illustrating some of the many ways we impact the lives of people in the Monadnock Region.

OUR

ION

Good to know information to help you decide when to go to the Emergency Department, when to visit Walk-In Care, and when to call your Primary Care provider.

Our Commitment to Quality and Safety

Our Community

2018-2019 COMMUNITY REPORT

Page 17

Our People

Our Patients

VIS

Pages 18-21

Cheshire Medical Center puts patients at the center of Primary Care through a collaborative team model that ensures continuity and efficiency.

OUR MIS SI O

FEATURE: PATIENT-CENTERED MEDICAL HOME MODEL

Our Organization

VA L U E S

Pages 22-29 HEALTH+WELLNESS TIPS + TOOLS

Learn the facts about vaping; find tips for breaking the sleep-stress cycle; try a picnicfriendly potato salad recipe; and hear from the experts on taking care of your feet, as well as the signs of hearing loss. Plus much more.

Pages 30-31 HEALTH+WELLNESS PROGRAMS

Upcoming classes and programs on a variety of health-related topics.

Focus on Patient-Centered CardiAc Care

Working Together for Your Heart Health

“I talk a lot about diet with my patients because losing weight can improve their overall wellbeing. Weight is a major factor for a range of health problems—type 2 diabetes, heart disease and strokes, high cholesterol, sleep apnea, and more.”

—Todd A. Silberstein, DO

heart condition that results in a trip to the emergency room can be terrifying and confusing. If you or a loved one is in the midst of a critical cardiac event, rest assured that Cheshire Medical Center can offer you top-notch care, close to home. “Emergency Department (ED) doctors are excellent at taking care of cardiac conditions because they see so many,” said Alan R. Opsahl, cardiologist at Cheshire. In less severe cases, one of Cheshire’s cardiologists examine a patient in the ED, then follows up with a plan of care. Patients with severe cases are transported by helicopter directly to Dartmouth Hitchcock Medical Center (DHMC). Cheshire’s partnership with the only academic medical center in New Hampshire streamlines our ability to deliver the right care at the right time. Cheshire cardiologists have all worked at DHMC, and collaborate frequently with colleagues there. The heart care provided through the Dartmouth-Hitchcock Health system is among the best, with one of the lowest mortality rates—at 4 percent—in the nation. This means heart patients in the Monadnock Region get the best coordinated care available from experts who see up to 800 heart attack patients a year. “When we have a patient who needs care at Dartmouth, we know who to call,” said Opsahl. “There is a lot of collaboration behind the scenes.” Collaboration goes both ways. Local facilities, like Springfield Medical Center, also send patients to Keene for a higher level of care. For example, many are transported for installation and monitoring of devices that use electrical pulses to help control abnormal heart rhythms, like pacemakers, by Todd Silberstein, DO. Hilary Brown, RN, MSN, the clinical leader of cardiology at Cheshire, said the cardiac team also collaborates with their patients’ doctors and nurses in Primary Care.

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Cardiologist, Cardiovascular Medicine

“While our focus is on the health of a patient’s heart, we are also dedicated to building relationships with each patient and providing compassionate care,” said Brown. “But the most important collaboration is the relationship between the individual patient and his or her entire team of care providers.” One of the most important aspects of the doctor/patient relationship is honesty. Opsahl says doctors need to be honest that some patients may no longer be able to participate in certain activities, but they can still lead active lives. At the same time, patients have to be honest with their caregivers and doctors about their symptoms and if they aren’t sticking to their treatment plans. “We want to keep talking with our patients to keep them from getting sick again,” said Opsahl. “We have patients who come back five or 10 years later and they are still sticking to their plans.” Members of Cheshire’s cardiology team often see their patients out in the community and take pride in the assistance they provide for the continued recovery of their neighbors. It takes skill and compassion to present an accurate diagnosis and get patients on the path to recovery. Cheshire’s cardiology team creates personalized care plans that include nutrition, behavioral health, wellness education, and help to establish a regular medication schedule. That’s the type of support that helps patients live longer and have fulfilling, rewarding lives. “Sometimes, when I run into a former patient at the grocery store, I take a look in their shopping cart,” said Brown. “And when I see fruits and vegetables and lots of good food it makes me so happy.” “Living in a small town, taking care of people, this is what I think a doctor should be doing,” said Opsahl. Continued on page 6.

FROM THE AMERICAN HEART ASSOCIATION

Heart attack or sudden cardiac arrest—how they differ and what to do People often use these terms interchangeably, but they are not the same thing. A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem. What is a heart attack? A heart attack occurs when a blocked artery prevents oxygen-rich blood from reaching a section of the heart. If the blocked artery is not reopened quickly, the part of the heart normally nourished by that artery begins to die. The longer a person goes without treatment, the greater the damage. Symptoms of a heart attack may be immediate and intense. More often, though, symptoms start slowly and persist for hours, days or weeks before a heart attack. Unlike with sudden cardiac arrest, the heart usually does not stop beating during a heart attack. What is cardiac arrest? Sudden cardiac arrest occurs often without warning. It is triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). With its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, a person loses consciousness and has no pulse. Death occurs within minutes if the victim does not receive treatment. What is the link? These two distinct heart conditions are linked. Sudden cardiac arrest can occur after a heart attack, or during recovery. Heart attacks increase the risk for sudden cardiac arrest. Most heart attacks do not lead to sudden cardiac arrest. But when sudden cardiac arrest occurs, heart attack is a common cause.

COMMON HEART ATTACK WARNING SIGNS shortness of breath

jaw, neck, or back pain

pain or discomfort in chest

discomfort or pain in arm or shoulder

naUsea, vomiting, or lightHeadedness

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, back or jaw pain, fainting,indigestion and extreme fatigue.

Other heart conditions may also disrupt the heart’s rhythm and lead to sudden cardiac arrest. These include a thickened heart muscle (cardiomyopathy), heart failure, arrhythmias, ventricular fibrillation, and long Q-T syndrome. WHAT TO DO: HEART ATTACK Even if you’re not sure it’s a heart attack, call 911 or your emergency response number. Every minute matters! It’s best to call EMS to get to the emergency room right away. Emergency medical services staff can begin treatment when they arrive—up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. WHAT TO DO: SUDDEN CARDIAC ARREST Cardiac arrest can strike without warning and is reversible in most victims if it’s treated within a few minutes. Here are the signs: Sudden loss of responsiveness The person doesn’t respond, even if you tap him or her hard on the shoulders, or ask loudly if he or she is OK. The person doesn’t move, speak, blink or otherwise react. No normal breathing The person isn’t breathing or is only gasping for air. If you have tried and failed to get the person to respond, and you think the person may be suffering cardiac arrest, here’s what to do: • Yell for help Tell someone nearby to call 911 or your emergency response number. Ask that person or another bystander to bring you an AED (automated external defibrillator), if there’s one on hand. Tell them to hurry—time is of the essence. If you’re alone with an adult who has signs of cardiac arrest, call 911 and get an AED (if one is available). • Check breathing If the person isn’t breathing or is only gasping, administer CPR. • Give CPR: Push down hard and fast at least two inches at a rate of 100 to 120 pushes a minute in the center of the chest, allowing the chest to come back up to its normal position after each push. • Use an AED Use the automated external defibrillator as soon as it arrives. Turn it on and follow the prompts. • Keep pushing Continue administering CPR until the person starts to breathe or move, or until someone with more advanced training takes over, such as an EMS provider.

Learn more about how to administer CPR and find additional information about heart conditions that can lead to heart attack or cardiac arrest at the American Heart Association’s website: heart.org.

Source: American Heart Association. Learn more at heart.org. H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Focus on Patient-Centered CardiAc Care

Innovative new program streamlines access to cardiac catheterization for Cheshire patients. Some people who visit Cheshire with chest pain or discomfort have non-heart-related conditions like anxiety, gastroesophageal reflux disease (acid reflux), an ulcer, or a hiatal hernia. But if these problems have been ruled out, many patients are candidates for a

“Not only does this program benefit our

cardiac catheterization to determine if a heart condition is causing the symptoms.

patients, it has been a very positive experience

While catheterization is a relatively simple procedure that takes only

for the PCU staff. We enjoy being more

an hour or two, in the past Cheshire’s patients had to wait several days for a bed to open at Dartmouth-Hitchcock Medical Center

involved in our patients’ total experience

(DHMC) for access to the so-called “cath lab.” This could mean spending up to a week in Cheshire’s progressive care unit (PCU).

and it positively impacts their care. We are

To solve this problem, staff at the two medical centers worked

all benefiting from the relationship with our

together to create an innovative new program, transporting patients to DHMC’s outpatient cath lab within a day of arriving at Cheshire.

colleagues within the system.”

“When a patient comes in and they need more tests, we admit them to the PCU, then send them by ambulance to Dartmouth,” says

—Christine M. Driscoll-Carigan, RN

Christine M. Driscoll-Carignan, RN, clinical leader of the progressive

Clinical Leader, Progressive Care Unit

care unit. “They come back here, spend the night, and then they are discharged—reducing their admission to only a few days.” This new process allows patients to remain under the care of their local cardiologist in the community they live in. “We are keeping the care here where people are most comfortable,” says Driscoll-Carignan.

How can catheterization help cardiac patients? At DHMC, a catheter (a long, thin tube) with an X-ray camera is inserted in an artery in the wrist. Experts use that camera to locate any possible blockages in or narrowing of veins, which can cause heart pain. While the procedure is underway, the catheter can help cardiologists diagnose and even fix heart problems in a variety of ways. For example, they can check the pressure and oxygen levels in the heart while also evaluating its pumping function. They can also make sure a patient’s heart valves are operating correctly and take tissue samples to assist with a diagnosis.

Widening a narrowed artery and installing a stent is just one procedure that can be done with cardiac catherterization.

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Catheters are also used in a procedure called an angioplasty, where a narrowed artery is widened with a small balloon. Often, after angioplasty, a stent is installed to help keep the artery open. Catheterization can also be used to repair or replace damaged or defective heart valves and in a procedure called ablation, which corrects an abnormal heart rhythm.

A closer look at one patient’s journey.

Steve Larmon came into the Cheshire Emergency Department experiencing symptoms of a heart attack—resulting in a critical response plan that involved a helicopter ride to life-saving surgery. Steve Larmon, MD, a retired oncologist, spent the majority of his 41-year career as a cancer doctor at Cheshire. An avid runner, last March, at mile 21 during a training run, his leg muscles felt uncharacteristically weak and heavy. He knew something was wrong, stopped running, and called his wife. She found him quickly and drove him to the emergency department (ED) at Cheshire Medical Center. Earlier during his run, he experienced some chest discomfort, but he brushed it off, since he didn’t have any of the risk factors for heart disease and because he was in excellent shape. But on the way to the hospital, he started to feel nauseated and began to sweat—classic signs of a heart attack. That was the moment he finally realized he was having a heart attack. For whatever reason, something was blocking blood flow to his heart so it couldn’t get the oxygen it needed. Upon arrival, Cheshire’s ED team checked his vital signs, performed an electrocardiogram to measure his heart activity, tested samples of his blood, and confirmed Larmon was experiencing a ST-Elevation Myocardial Infarction (STEMI). All heart attacks are serious, but a STEMI is the most dangerous of all. For a patient like Larmon who was suffering from a STEMI heart attack, immediate

acute care at the Heart and Vascular Center at Dartmouth Hitchcock Medical Center (DHMC) in Lebanon is necessary. As Larmon was wheeled through the hallway on a stretcher from Cheshire’s Emergency Department to the helicopter landing pad outside, he saw the same ceiling lights that he’d walked under for decades as a physician; this time from a completely new perspective. He was in a new and vulnerable role as a patient in a dire situation. “Seeing those lights on the ceiling was very emotional.” Larmon was transported by helicopter to DHMC. Within two hours, he was heading into a surgical procedure called cardiac catheterization used to diagnose and treat certain heart conditions. In Larmon’s case, they performed a procedure to open blocked arteries so blood could flow to his heart. During the procedure, his heart stopped beating properly and he went into cardiac arrest. Cardiac arrest is often fatal if appropriate steps aren’t taken immediately. Larmon’s doctors were able to resuscitate him with cardiopulmonary resuscitation (CPR) and defibrillation. They finished the procedure by removing a clot in one of the blood vessels surrounding his heart and by placing four cardiac stents, expandable coils made of metal mesh, which allowed blood to flow again. Continued on page 8.

“The medical team had done everything they could, and intellectually I knew I was ok, but the rehab experience itself really gave me the confidence I needed to be out in the real world again. The rehab staff were supportive, and all the other patients were there for the same reason—to get better. It felt like a team.” —Steve Larmon, MD Cardiac patient

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Focus on Patient-Centered CardiAc Care

Kristi Farren, RN, and Jeannine Lucius, RN, work one-on-one with patients in the Cheshire Cardiac Rehab program.

Comprehensive outpatient cardiac rehabilitation with a personal touch Cheshire Medical Center’s comprehensive outpatient cardiac rehabilitation program is designed for men and women who have experienced a recent heart event. Jeannine Lucius, RN, and Kristi Farren, RN, who work with patients in the cardiac rehab program, were recently recognized by a patient as part of Cheshire Medical Center’s Circle of Gratitude. The nurses said the recognition shows they are on the right track in providing care to their clients. “All of our patients are coming to us after open heart surgery, a heart transplant or a heart attack,” said Lucius. “It’s our job to reassure them it’s OK to try to get back to a normal life. Even though it’s a class of eight, we do a lot of one-on-one work to individualize a treatment plan.” “We meet with them individually and get to know them,” said Farren. “We try to make the program fun so it’s not boring or monotonous.” Farren said because the rehab program is ongoing, new patients mix with old patients and learn from each other. “Everyone is at a different level when they come in,” said Farren. “They can see that everybody is at different points during the rehab,” said Lucius. “The person next to them might be at the end of the program while they’re just getting started, thinking I’m never going to feel well again. Working together they can see that it is possible to get better.”

“While our focus is on your heart, we are about building relationships with our patients.” —Hillary Brown, RN, MSN Clinical Leader of Cardiology

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“They were concerned enough about what had happened that they didn’t complete the full procedure that day,” said Larmon. “Instead, I went back to my recovery room, rested, and went back to the cath lab two days later when they placed another stent for a blockage in a different artery. I came home with a total of five stents.” He was discharged from DHMC with a referral to follow up with Dr. Opsahl in one week, and one week later he would start Cheshire’s Cardiac Rehabilitation program, a medically supervised program designed to improve cardiovascular health after a heart attack, heart failure, angioplasty or heart surgery. “After a cardiac event, some of our patients are nervous about even picking up laundry baskets,” says Dr. Opsahl. “We don’t want them to be scared to live their lives.” Cardiac rehab is a team effort that usually lasts six to eight weeks and is designed to get people to change their behaviors. That could be exercise designed specifically for their condition, eating the right food, eliminating stress in their lives and staying away from tobacco. “Patients love the cardiac rehab program,” says the Clinical Leader of Cardiology, Hillary Brown, RN, MSN. “You would think they would be happy to graduate, but they want to keep coming. This is because of the connections the doctors, therapists, nurses and patients build together.” Even though Larmon had been an avid runner before his heart attack, other lifestyle changes were necessary to avoid another one. Post heart attack, Larmon was unsure about his activity threshold. It was a whole new world that he needed to navigate. “Even when I went out to walk after the first few weeks of the heart attack I was nervous. I just didn’t know what was going to happen.” He went to cardiac rehabilitation for seven weeks at the gym on Cheshire’s fourth floor where he was able to test his new limits and abilities under the watchful eye of members of the cardiac team. He followed a personalized rehab plan created by nurses Jeannine Lucius, RN, and Kristi Farren, RN, along with the cardiologist. They would monitor his workouts at rehab with machines and let him know if he should slow down or if he could push harder. It reassured him to be supported by experts on his path to

“When we have a patient that needs care at Dartmouth, we know who to call. There is a lot of collaboration behind the scenes.”

—Alan R. Opsahl, MD

Cardiologist, Cardiovascular Medicine

recovery. The people working there became a support group for Larmon. “The medical team had done everything they could, and intellectually I knew I was ok, but the rehab experience itself really gave me the confidence I needed to be out in the real world again. The rehab staff were supportive, and all the other patients were there for the same reason—to get better. It felt like a team,” said Larmon. During the 20 exercise sessions he participated in, his resting blood pressure decreased by 20 percent, his metabolic equivalent task (METS) level (a measurement of physical activity level) increased by 51 percent. When Larmon returned for a repeat echocardiogram, the test showed normal function of his heart. “This was significant, considering the major cardiac event-including cardiac arrest,” said Dr. Opsahl. “Everyone worked hard to keep Steve alive and help him fully recover-our team in the ED, the flight medics, the cath lab team at Dartmouth, the rehab nurses, and most importantly, Steve himself.” Larmon’s case illustrates the valuable collaboration between Cheshire cardiologists and their colleagues at other Dartmouth-Hitchcock Health (D-HH) system locations is for patients. Although he never expected to be in this situation, Larmon learned an important lesson that he wants to share with others. Regardless of your fitness level and risk factor for heart disease, a heart attack can surprise anyone. Don’t dismiss any signs. “If you don’t have the risk factors for heart disease, but have discomfort in your chest, please get it checked out,” said Larmon. “I was lucky and am grateful. I was close to home and my wife could get me to the hospital quickly. But if you’re really having heart trouble, call an ambulance for lifesaving care.” Talk with your Primary Care Provider about your concerns and questions around your heart health.

WAYS TO LOWER YOUR RISK OF

A SECOND HEART ATTACK

TAKE YOUR MEDICATIONS

Take medications as your doctor prescribed. They help you avoid another heart attack. Forgetting to take a dose or get a refill can lead to big health problems.

FOLLOW UP WITH YOUR DOCTOR

Getting better means working together with your health care team. See your doctor within 6 weeks of your heart attack to help keep your recovery on track.

PARTICIPATE IN CARDIAC REHAB

Cardiac rehabilitation improves your physical and emotional recovery by increasing your physical fitness, helping you adopt hearthealthy living and addressing sources of stress.

MANAGE RISK FACTORS

4 5

Common risk factors include smoking, high cholesterol, high blood pressure and diabetes. Use medications and lifestyle changes to lower your risk of another heart attack.

GET SUPPORT

Sharing your journey to recovery with family, friends and other survivors can help reduce anxiety and loneliness.

Act now to prevent another heart attack. Visit heart.org/heartattackrecovery to learn more. Source: American Heart Association. Learn more at heart.org.

If you or a loved one experiences symptoms similiar to the ones mentioned in this feature, don’t hesitiate to seek immediate medical attention. H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Focus on Patient-Centered CardiAc Care

What Is high blood pressure (HBP)? Managing Your Medicines If you have heart disease, medicine may be part of your treatment plan to reduce the risk of future health problems. Certain medicines can greatly lower your risk of another cardiac event. That’s why it’s important for you to understand your medicines and take them correctly. These medicines include: Beta-blockers: These drugs treat high blood pressure and some other heart conditions by reducing the heart rate and the workload of the heart. Antithrombotics (Anti-platelet/anti-coagulant medicines): These medicines are used to prevent blood clots from forming in your arteries. Patients who have had cardiac procedures such as angioplasty and stenting to open up their arteries need these drugs to help keep the arteries open. ACE inhibitors: This class of medicines treats high blood pressure and heart failure by interfering with the body’s production of angiotensin, a chemical in the body that causes the arteries to constrict. Patients who can’t take ACE inhibitors may be able to use angiotensin receptor blockers (ARBs). Statins: Medicines that help the body process and remove LDL (bad) cholesterol. This not only lowers cholesterol, but protects the inner lining of the BLOOD PRESSURE arteries. CATEGORY Your doctor may recommend other medicines for you. Be sure to tell all of your health care professionals about all the medicines you’re taking, including over-the-counter medicines, supplements and herbal preparations. Also, talk to your doctor about how lifestyle changes can play an important role in reducing future health problems.

Blood pressure is the force of blood pushing against blood vessel walls. High blood pressure means the pressure in your arteries is higher than it should be. Another name for high blood pressure is hypertension. High blood pressure usually has no signs or symptoms. That’s why it is so dangerous. But it can be managed. Nearly half of the American population over age 20 has HBP, and many don’t even know it. Not treating high blood pressure is dangerous. HBP increases the risk of heart attack and stroke. Make sure you get your blood pressure checked regularly and treat it the way your doctor advises.

How can I tell I have it?

The only way to know if you have high blood pressure is to get it checked regularly by your health care provider. For proper diagnosis of high blood pressure, your health care provider will use an average based on two or more readings obtained on two or more occasions.

Am I at higher risk of developing HBP? There are risk factors that increase your chances of developing HBP. Some you can control, and some you can’t. Those that can be controlled are: • Smoking and exposure to secondhand smoke • Diabetes • Being obese or overweight • High cholesterol • Unhealthy diet (high in sodium, low in potassium, and drinking too much alcohol) • Physical inactivity SYSTOLIC mm Hg (upper number)

NORMAL

LESS THAN 120

and

LESS THAN 80

ELEVATED

120-129

and

LESS THAN 80

HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1

130-139

80 -89

HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2

140 OR HIGHER

90 OR HIGHER

HYPERTENSIVE CRISIS (consult your doctor immediately)

HIGHER THAN 180

and /or

HIGHER THAN 120

Source: American Heart Association. Learn more at heart.org.

DIASTOLIC mm Hg (lower number)

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Know your numbers Your blood pressure is recorded as two numbers: Systolic blood pressure (the first number) indicates how much pressure your blood is exerting against your artery walls when the heart beats. Diastolic blood pressure (the second number) indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats. The chart to the left shows blood pressure categories. Talk to your doctor about your blood pressure numbers.

Taking a collaborative approach to Family Medicine Cheshire Medical Center puts patients at the center of Primary Care through a collaborative team model that ensures continuity and efficiency. Andrew Tremblay, MD (center) is joined by (L-R) Care Coordinator, Niki Forakis, RN, Collaborative Care Nurse, Audrey Trudelle, RN, and Nurse Practicitioner, Currier Neily, APRN. They are just a few of the more than a dozen staff members on Team D in Family Medicine at Cheshire.

Family Medicine teams at Cheshire work to synchronize patient-centered care for the whole person.

r. Andy Tremblay and Nurse Practitioner, Currier Neily, APRN share an office in Family Medicine at Cheshire Medical Center. It’s a small one, 12ʹ x 12ʹ, where their desks are kitty-cornered, with a large whiteboard overhead, keeping an eye on projects. Daily conversations are not only impossible to avoid, but welcome. And, the thing is, it’s all by design. Tremblay and Neily are two of the more than a dozen members of Team D in Family Medicine, and they work together under a style of collaboration called the Patient-Centered Medical Home Team (PCMH) model. It’s a standard devised with the patient at the center of a collaborative approach that ensures continuity of care from a group of professionals, who share information and workload in a way that’s most efficient for those under their care. All four teams at the medical center on Court Street, as well as Cheshire’s family medicine practices in Walpole and Winchester, strive to take this approach. For example, on Team D, Tremblay and Neily are supported by physician assistants, nurse collaborative care coordinators, RN care coordinators, results management nurses, medication renewal managers, team phone nurses, behavioral health consultants, forms managers, patient flow staff, call center receptionists, and registry coordinators, who are proactive in reaching out to patients to make sure they are up-to-date on routine preventative care. This

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Cheshire’s Patient-Centered Medical Home (PCMH) Model

Patient Care Support Whether it’s helping you get the most from your appointments, following up on tests and recommendations, prescribing and monitoring medications, faciliating transitions in care, consulting on behavioral health issues, coordinating support services, or tracking records and paperwork, your medical home team has got you covered. Other members of your team include: 

Results Management Nurses



Patient Flow Staff



Medication Renewal Managers



Call Center Receptionists



Team Phone Nurses



Behavioral Health Consultants



Forms Managers



Care Coordinators offer expert support to help with transitions in care and execution of care plan orders. They work with you to remove barriers to following your care plan when returning home from the hospital or a nursing home.

Registry Coordinators

Patient Care Support

Care Coordinators

Primary Care Providers (PCPs)

Collaborative Care Nurses (CCNs)

Collaborative Care Nurses

Associate Providers

Our Patients

Primary Care Providers

collaborate with Associate Providers and other members of your team to address your specific health concerns. They also work with you to create health and wellness goals and plans to meet those goals.

“This model generates better health outcomes, and we have the data to back that up. We have better outcomes with diabetics, better screening rates, better care because our patients engage with the team.”

—Andrew Tremblay, MD

Department Chair, Primary Care and Family Medicine

work closely with you and your PCP to help manage chronic conditions. With ongoing check-ins, you and your CCN focus on education, mentoring, and health coaching. CCNs also oversee lab tests and health screenings, and monitor the progress of preventative care protocols.

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Associate Providers

partner with your PCP to ensure your current treatment plans are being followed. They diagnose, as well as prescribe treatment and medications.

patient-centered approach takes into account the Every time you talk with a health provider synchronized wellness of the whole person. “The way we want the health care system to go,” says ASK THESE QUESTIONS Tremblay, chair of the Department of Primary Care and Family Medicine, “is we want hand-offs to be thorough and complete and want multiple members of a team to know what’s going on with an individual patient.” Cheshire Medical Center first began transitioning to the (PCMH) model in 2012, when it became one of 30 sites selected—out of 400 reviewed—to take part in the PCT-LEAP Project through the Robert Wood Johnson Foundation. The project was designed to “identify, study, and engage 30 exemplary primary care practices from across the United States that are using their workforce creatively.” Ideally, PCMH provides patients with comprehensive, coordinated care, including prevention, wellness, acute care, chronic care, and support services— both at home and in the medical office, with an eye toward quality and safety. When Tremblay arrived at Cheshire in 2001, he encountered a schedule predominantly filled with patients When to ask questions on his primary care panel who presented with coughs, Ask questions when: colds, infections, and other common health issues. The • You see a doctor, nurse, pharmacist, or other health care provider practice’s approach at the time most often involved • You prepare for a medical test or procedure patients seeing the doctor in 15-minute intervals for • You get your medicine routine, immediate health care concerns, and left little time for in-depth conversations about patient wellness. What if I ask and still don’t understand? There was rarely a moment for Tremblay to inquire Let your provider know if you still don’t understand. You might say, “This is about overall health, such as screening tests, diabetes new to me. Will you please explain that to me one more time?” management, anxiety and depression, and an infinite list of other potential hazards. Who needs to ask these 3 questions? “There was a rising demand to find new methods to Everyone. You are not alone if you find health information confusing at deal with the here and now,” he says, “and how we take that times. Asking questions helps you understand how to stay well or get better. perspective in looking at improving the general health of the community.” Source: Institute for Healthcare Improvement. Learn more at ihi.org. Amid a swell of patients in need of primary care, the LEAP program asked chosen facilities, including Cheshire, to collect data on the number of patients with primary care Access one convenient portal to view needs versus the number of providers. The figures were staggering—between 37 and 40 health information related to your practitioners in family medicine and another visits at Cheshire Medical Center, eight in pediatrics responsible for up to Cheshire’s satellite offices in the 40,000 patients in the region. with Monadnock Region, as well as visits “The idea,” says Tremblay, “was that your doctor as a singular person could not be at Dartmouth-Hitchcock locations. solely responsible for your care without Visit myD-H.org to sign up today! sharing that responsibility.” That realization prompted conversations about innovation and how practitioners Have questions about setting up an account? in Cheshire County might take a different Call Dana Carley, Patient Portal Concierge, at 354-5454 ext. 2446.

1 2 3

What is my main problem?

What do I need to do?

Why is it important for me to do this?

Manage

Your Health Care

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“I can’t imagine my job without the care coordinators. We follow up until the patient feels like they can manage on their own. They know that we are communicating with the doctor, and we let the patient know we are here. The team approach we have keeps things on track and provides the best possible care for the patients.” —Audrey Trudelle, RN Collaborative Care Nurse, Team D Care Coordinator, Niki Forakis, RN and Collaborative Care Nurse, Audrey Trudelle, RN.

approach to patient care. Questions abounded: What are the needs of our patients? What does the community need from its provider base? How can the quality of care be improved? Understanding the need for varying levels of care, depending on the patient and his or her health care requirements, administrators and practitioners at Cheshire began developing a plan for providers to work to the top of their licenses. Those qualified to diagnose would diagnose. Those who could prescribe would prescribe. Those who could educate patients would take on that role. In the meantime, teams of collaborating health care providers were established to ensure patients had many options available in their web of care. When Currier Neily first began working as a nurse practitioner at Cheshire five years ago, she soon found herself thinking that appointments were the easiest part of the job. Trying to ensure patients had scheduled annual mammograms or blood tests, that someone in the office called patients to share test results, that a patient had been in for a colonoscopy, or was managing his or her chronic condition(s) felt overwhelming. But the implementation of the PCMH model began to ease that burden. Now, Neily feels like the touchstone between the patients and their PCPs, with support from so many others on her team to enhance the patient experience. Walking through an ideal care journey, Neily might see a patient for a new concern, a cough, for example. First, she manages the symptoms, but recommendations for additional diagnostic testing might determine a diagnosis of chronic obstructive pulmonary disease (COPD). If that’s the case, Neily then helps the patient set up a consultation with Team D’s Collaborative Care Nurse, Audrey Trudelle, for inhaler training, and the patient is then scheduled to come back for follow-up with Neily or Tremblay. Nurses and PAs, too, help to manage both in-person and virtual visits on the phone, via e-mail, or through the Dartmouth-Hitchcock patient portal.

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“We try to be a family of medical professionals,” says Neily. “People are cared for because we all are communicating. They should know that we talk every day, that we share an office, that [Dr. Tremblay] is told about what’s going on if he hasn’t seen them personally. That is our hope for our patients.” Recently, shares Neily, a longtime patient with diabetes lost his wife, who had been acting as his primary caregiver. At the man’s next appointment, he met with Trudelle, who asked him questions about how his wife’s death might impact his diet or how and when he was taking his medication. “We could not do this without Audrey,” says Neily. “She focuses on patients with COPD and diabetes, does the groundwork for breathing, medicines, taking their blood sugars, and finds out how they are doing after follow-up. Audrey really focuses on the sickest patients. This allows our patients to manage some of these chronic conditions without feeling alone. Our model gives us more opportunities for contact, and the relationships help provide better care.” Trudelle is one of two collaborative care nurses who work on Team D. On a typical day, all seven of her patient slots are full. In addition to creating action plans for patients in need of chronic disease management, she and others work through registries to make sure those who have not been seen recently are contacted and encouraged to come to the office for follow-up. This includes setting up Medicare wellness physicals and providing training on completing advanced care directives, among other tasks. The care coordinators who work on the team spend much of their time on the phone, following up with patients who have been released from hospital stays and doing general triage. Communication then flows to Dr. Tremblay and the other PCPs on Team D: Don Caruso, MD, MPH, Eric Canzanello, DO, Sharon Ferguson, DO, and Lisa Profetto, APRN. “I can’t imagine my job without the care coordinators,” Trudelle says. “We follow up until the patient feels like they can manage

on their own. They know that we are communicating with the doctor, and we let the patient know we are here. The team approach we have keeps things on track.” There is always room for improvement but, in contemplating the PCMH approach today, Tremblay is confident that, at Cheshire, the support structure is in place for continued improvements in comprehensive primary care. “This model generates better health outcomes, and we have data to back that up,” he says. “We have better outcomes with diabetics, better screening rates, better care because our patients engage with the team.” Interested in becoming a Primary Care patient at Cheshire Medical Center? We can help you

Cheshire Medical Center

Offering Cheshire patients and our current and retired employees the convenience of a pharmacy right here within the Medical Center.

Pharmacy

If you’ve visited Cheshire Medical Center recently, you may have noticed our new pharmacy, conveniently located adjacent to the main lobby for easy one-stop shopping. We’re thrilled to offer an on-site pharmacy to improve your patient experience at Cheshire. Accepting most prescription insurance plans.

Services provided include: Located in the main lobby across from registration. Open: Monday-Friday, 7am-7pm and Saturday, 8am-4pm Closed Sundays and Major Holidays

· Automated prescription refill call-in line · Blood pressure checks (See Pharmacy Associate) · Brown bag events · Drug take back box · Immunizations* *As allowed by the NH Board of Pharmacy

find a new provider. Call (800) 653-0776 or email Findmeadoctor@cheshire-med.com. Please let us know your preferred location Family Medicine provider or a Pediatrician for a

Pharmacy Phone: (603) 653-3785 Toll Free: (855) 280-3893

child; and if you have other preferences like the

Email: Cheshire.Pharmacy@cheshire-med.com

(Keene, Walpole, or Winchester); if you need a

provider’s gender.

The Behavioral Health Partner Network Working together to offer coordinated treatment services and recovery support For Primary Care patients of Cheshire and satellite locations who are seeking or currently in recovery from substance use disorder and addiction, along with those who rely on medications for pain management, the Behavioral Health Network (BHPN) offers coordinated support.

Members of the BHPN benefit because they have someone in their corner, bringing them together to talk about the care they provide and implement improvements. It allows them to identify people who may otherwise fall through the cracks when faced with the wide range of circumstances that can hinder recovery. Most importantly, BHPN is a collaborative project between five behavioral health this partnership means people agencies in the Monadnock region, supported by Cheshire’s Behavioral struggling with substance use Center for Population Health. The goal is to improve Health disorder get the services communication between the agencies so they can they need to find their way best serve these patients by reducing redundancies Medical Recovery back from addiction. and coordinating services. This allows providers to spend less time with paperwork and more time Talk to your care provider providing coordinated care to their patients.

BHPN

A person looking for help typically works with a number of different providers or agencies. This can include a doctor, a counselor or psychologist, a treatment center or a recovery agency. BHPN’s system unifies consent of services so the agencies can share information and coordinate care, opening doors to make it easier for people to make their way through a system that can be overwhelming.

Prevention

Treatment

about coordinating your care within the Behavioral Health Partner Network.

Please note: You are eligible to have your care coordinated across a team of services if you have a primary care provider at Cheshire Medical Center and select services from at least one other BHPN partner.

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Cheshire Pediatrics takes a team approach to your child’s primary care. The Pediatrics Department at Cheshire Medical Center takes a team approach to care with a pediatrician or pediatric nurse practitioner serving as your child’s primary care provider and leading a coordinated team from birth, adolescence and through young adulthood to keep your child healthy and strong.

Deborah Hansen, MD, Department Chair of Pediatrics at Cheshire Medical Center, examines one of her young patients.

A pediatrician or pediatric nurse practitioner serves as your child’s primary care provider and leads a coordinated team from birth, adolescence and through young adulthood to keep your child healthy and strong. GOOD-TO-KNOW TIP: Between visits, keep notes about your child’s health and behavior so you can discuss questions at your child’s next appointment.

Starting with frequent well-child visits in their early years, the strong relationships children form with their pediatric providers are at the core of patientcentered care here at Cheshire. “Our patients are likely to see their provider for scheduled appointments more often than adults—most of the staff in our intimate department end up knowing our patients very well,” says Clinical Leader of Pediatrics, Kristen Lippencott-Battey, RN, BSN. Pediatric providers also work in close partnership with parents. “We strive always to provide parents with the information and education they need to understand their options and make informed decisions about their family’s health care,” says Deborah Hansen, MD, chair of pediatrics. “A trusting and open relationship is essential—they are a vital part of each child’s health care team.”

A Child and Adolescent Psychiatrist is on staff to provide consultations at a provider’s request, making diagnoses and working with your child’s health care team to create the best plan of care for them. Pediatric Care Coordinators make sure children with chronic conditions and special health care needs are up to date with their plan of care, assisting parents with next steps, and making connections to available services. For children who need a higher level of care, Cheshire’s connection to the Children’s Hospital at Dartmouth-Hitchcock (CHaD) enables their care to expand seamlessly. Care from specialists at CHaD doesn’t always mean a trip to Lebanon, though. From monthly pediatric cardiologist appointments here in Keene, to real-time telemedicine video conferencing with pediatric neurologists, our teams are forging innovative partnerships to keep your child’s care close to home. Shared electronic medical records help your child’s whole health care team stay on the same page, whether they are cared for by professionals at CHaD, our Walk-In Care Clinic, or specialty services at Cheshire. Through myD-H patient portal and the MyChart app, you can also view your child’s records, prescriptions, test results, and upcoming vaccinations; as well as schedule appointments and connect with any of their providers within the D-H Health system. To reach Cheshire’s Pediatrics department appointment desk, medication refill line, or nurse line by phone, call (603) 354-6666.

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PRIMARY CARE, WALK-IN CARE, OR EMERGENCY CARE? It’s important to understand which care option is best based on your health care need. Hospital Emergency Departments are for very serious or life-threatening medical emergencies. Call 911, or go directly to the nearest hospital emergency room for immediate medical attention for serious or life-threatening conditions such as:

Call your primary care team for non-emergency conditions. Nurses on your team can determine the medical urgency of your condition, offer home care advice, or schedule an appointment—where you’ll spend less time in the waiting room because we’re expecting you.

• Chest pain or heart attack • Major injuries such as broken bones, severe burns, deep cuts or bleeding that won’t stop • Severe abdominal pain • Coughing or vomiting blood • Sudden blurred vision, dizziness, weakness, or loss of coordination or balance • Difficulty breathing or shortness of breath • Numbness in the face, arm, or leg • Sudden, severe headache (not a migraine) • Seizures • High fevers

Remember, while it’s nice to know after-hours medical treatment is available, those options can’t replace your primary care provider. Maintaining regular primary care visits is important for preventive care and managing any health issues you already have.

Cheshire Medical Center Family Medicine (603) 354-5400

 Open Monday - Friday, 8:30 am - 5:00 pm

If your health problem is minor compared to a major injury, heart attack, or stroke, then the Walk-In Care Clinic may be able to treat you sooner than the ER. This is because of a life-saving system called triage. Triage assigns levels of urgency to decide the order in which medical staff need to treat patients.

Cheshire’s Walk-In Care Clinic on Emerald St. in Keene provides care for non-life-threatening medical problems or problems that could become worse if you wait. This includes performing X-rays and lab tests to find out what’s wrong.

‘‘All Emergency Departments treat the most critically-ill patients first. We promise to never delay life-saving treatment to the best of our ability. Many of our priority patients arrive via ambulance because they are very ill, and our staff work hard to do everything possible to provide safe, appropriate care.”

Consider this option for common illnesses such as colds, the flu, earaches, sore throats, migraines, fever, rashes, and minor injuries such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries. For health care needs such as these, you’ll receive care from highly-trained staff, without an appointment. And because the Clinic is part of the DartmouthHitchcock Health system, your health records will be instantly updated for you and your primary care provider through myD-H.

—Jessica Lussier, RN Director of Emergency Services

Cheshire Medical Center Emergency Department (603) 354-6600

‘‘We can treat a wider range of health problems than many people expect. We treat illnesses like sore throats or urinary tract infections and injuries like minor burns or simple bone fractures.”

 Open 24 hours a day, every day of the year. GOOD-TO-KNOW TIPS:

—Marika Henegan, MD Cheshire’s Walk-In Care Clinic

Cheshire Medical Center Walk-In Care Clinic (603) 354-5484 365 days a year, Monday - Friday 8 am - 8 pm,  Open Saturday & Sunday 10 am - 4 pm, Holidays 10 am - 2 pm.

PLEASE NOTE: If you have concerns that your symptoms may be linked to COVID-19, please call (603) 354-5400 and tell our operator, who can direct you to the best resource for your care.

• If possible, bring a list of your current medications when you visit any care provider. • If you visit Cheshire’s ED or Walk-In Care Clinic, your health records will be updated through myD-H. Notify your primary care team to update your health record if you visit a provider outside of the D-H Health system. • Patients enrolled in the myD-H portal also can take advantage of an eVisit, an online medical evaluation done through email for medical issues that aren’t urgent.

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cheshire MEdical center 2018-2019 Community Report

Year in Numbers

Twelve months ending June 30, 2019

Average Daily Inpatient Census

400 Newborns 231,603 Provider Visits

15,455 EKG/EEG Tests Don Caruso, MD, MPH, President and CEO, Cheshire Medical Center and Natalie B. Houder, Chair, Cheshire Medical Center Board of Trustees.

23,358 Emergency Department Visits

Together, we are stronger. to assist the work of the community. We are excited to see the The past year has been rewarding in so many ways for Cheshire dramatic health improvements resulting from our support and Medical Center. The health care environment in which we live the ongoing integration based on community leadership and has continued to evolve, and we believe we are continuing to implementation. provide high quality care in innovative ways for the Monadnock As we impact the population we serve, we are engaging Region. This has been made possible by a committed Board of with other communities so they can also influence their health Trustees, along with an engaged Medical Center workforce. outcomes. Currently we are working We recognize that as the largest through grant funding with New employer in the Monadnock Region, we “We are proud to live our London Hospital to help them engage have a responsibility to our community with their communities in ways that to provide the highest quality care with mission each and every day. will be successful for them. the most qualified staff. We also have Cheshire Medical Center is part a similar responsibility to effectively Health care is changing fast of the Dartmouth-Hitchcock Health support the workforce that provides system and is thus able to play an this care. The vast majority of our and we still have much to important role as a Regional Referral employees live in the local area, raise accomplish. Our priority is to Center in the State of New Hampshire. families here, and care for loved ones There are many days that Mary close by. We must continue to provide a continue to seek innovative Hitchcock Memorial Hospital in fulfilling work environment that values Lebanon is full, but with patients that our employees’ contributions inside the ways we can impact individuals do not require tertiary care. This occurs Medical Center and throughout our because the critical access hospitals in community. and communities in order to the State of New Hampshire do not With numerous community provide the best care possible.” have the breadth and depth of services partnerships, Cheshire Medical to support patients who are very ill, yet Center has continued to build on do not require this advanced level of the Population Health approaches care. Those patients are then sent to a tertiary referral center. that have made us so successful. Vision 2020 has transformed Dartmouth-Hitchcock saw the role that Cheshire could play into Healthy Monadnock. It was clear from its inception that as a Regional Referral Center. With over 200 providers, Telethis hospital-based program needed to be owned, led and ICU and Tele-Emergency Room augmented care, along with operationalized by the community. Cheshire Medical Center the expansion of intensive care services, Cheshire has grown its remains committed to providing experts and substantial funding

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4,485 Admissions

12,086 Volunteer Hours

16,336

Pain Clinic Procedures

131,067 Physical therapy & other outpatient rehabilitation treatments

393,627 Lab Tests

Walk-In Care Clinic Visits

1,648

& 6,935 Endoscopies Colonoscopies

4,735

Surgical Cases

836,967 Pounds of Laundry Processed

90,042 Imaging Exams

21,724 400,049 Meals Served

inpatient services to accommodate those patients who are very sick, but who do not require tertiary care. This partnership has had a positive impact on our profitability and we were able to close the 2018-2019 fiscal year with a positive margin. In addition, this relationship with the Dartmouth-Hitchcock Health system impacts our own community and allows us to continue our visionary work supporting the rural health needs of New Hampshire and Vermont, while also maintaining a sustainable organization. We are proud to live our mission each and every day. Health care is changing fast and we still have much to accomplish. Our priority is to continue to seek innovative ways we can impact individuals and communities in order to provide the best care possible. On behalf of the Cheshire Medical Center Board of Trustees and executive team, we are proud to share these annual report updates in the following pages for the fiscal year spanning July 1, 2018 through June 30, 2019, illustrating some of the many ways we impact the lives of people in the Monadnock Region.

Respiratory Therapy Treatments

Community Benefit Report Summary | July 1, 2018 - June 30, 2019 In total, Cheshire Medical Center provided over $7.5 million in Community Benefits such as unreimbursed charity care, behavioral health services, health professional education, subsidized health services, and community-building activities. These contributions are in addition to the over $26.8 million dollars in unreimbursed Medicaid and Medicare costs absorbed by the medical center. Below is a sample listing of some of the programs Cheshire offers to support health and wellness. Health + Wellness Community Education Programs 764 community members participated in 71 educational programs Tobacco Cessation Assistance 369 program referrals Senior Passport Program 5,290 meals served Cheshire Walkers Program 25 walks were offered, 669 participants Prescribe for Health Initiative 456 participants (171% increase) Family Resource Counseling Assistance provided to 609 newborns, children, and adults “Let No Woman Be Overlooked” Breast & Cervical Cancer Program 32 screenings provided Advance Care Planning (ACP) 495 people visited volunteer-staffed information table, group education sessions attended by 51 participants, 8 outreach sessions engaged 53 people Medications Assistance Program 256 prescriptions supplied to 223 individuals valued at $346,318 Pulmonary Rehabilitation Program Provided services to 244 individuals

Don Caruso, MD, MPH

President and CEO, Cheshire Medical Center

The Behavioral Health Consult Liaison Team Provided consultation to 1,014 patients Sports Medicine Athletic Trainers 743 local students received medical services Cheshire Smiles Program 960 sealants placed, 244 children received preventive services

Nathalie B. Houder

Hearing Aids Assistance Working in partnership with the Lions Clubs in Cheshire County, 7 hearing aids were provided to patients

Chair, Cheshire Medical Center Board of Trustees

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cheshire MEdical center 2018-2019 Community Report

Strength as a system partner.

Many rural hospitals—the majority of which are considered essential to the health and economic well-being of their communities—face a high risk of closure due to financial pressures. Twelve months ending June 30, 2019 Cheshire Medical Center became an affiliate member of Dartmouth-Hitchcock Health (D-HH) in 2015, asserting our commitment to being a sustainable health Billed for services to our patients: system for generations to come. Now five years later, we are thriving, not just Care for inpatients.............................................. 129,118,462 surviving. And being part of D-HH has increased our capacity to improve the lives Services for outpatients......................................551,232,979 of the people and community we serve. Received from other sources................................... 4,712,524 We serve as a Regional Referral Center for D-HH by providing high-volume, (Includes income from incidental services, investments of previous complex medical care for patients. To achieve this designation, Cheshire expanded charitable gifts and unrestricted gifts from hospital donors) medical services, improved access to care in ambulatory services, increased bed capacity, retained higher acuity patients, and maintained a full service seven-day Total from all sources:................................... 685,063,965 per week Intensive Care Unit (ICU). Before this strategic initiative, Cheshire was Amounts billed but not received: diverting more than 100 patients per month. Government programs and After three years, and careful coordination with the larger D-HH system, we commercial contractual agreements...................444,726,626 now divert far fewer patients to other facilities. In October 2015, Cheshire’s average From patients unable to pay and bad debt......... 15,588,339 inpatient census was 30 patients. It has now grown to an average of 58 patients per day. While this helps Cheshire’s financial bottom line and sustainability, it benefits Therefore, we actually received revenue from our community by supporting other smaller, critical access hospitals in our region by patient care and other services of:............... 224,749,000 serving as a referral site for ICU and medical patients in our region, so they can stay closer to home rather than going to Lebanon. Our costs included amounts: Our ability to care for patients requiring acute care also keeps beds available at To pay our employees and physicians............... 132,499,393 Dartmouth-Hitchcock Medical Center (DHMC) for patients requiring tertiary care To pay our suppliers and vendors....................... 63,223,728 at the state’s only Academic Medical Center. To operate the building, depreciation, Through our affiliation with D-HH, we’ve opened Cheshire’s first on-site and pay interest.....................................................14,621,522 pharmacy. Resulting in total costs for patient “The project has been a partnership between Dartmouth-Hitchcock and Cheshire care and other services:................................210,344,643 the entire way,” says Curtis Gibbon, director of retail pharmacy at D-H, which operates three retail pharmacies and oversees the Cheshire pharmacy. “The common Residual earnings..................................................... 14,404,357 goal was to increase and improve the level of service for Cheshire patients. And every Payment of the state person involved saw that through with enthusiasm across the two hospital systems.” Medicaid Enhancement Tax.......................................8,005,357 Telehealth technology is another example of the power of affiliation, expanding our ability to provide high-quality patient care close to home. The excess of amounts received over costs for the year is Through D-H’s Connected Care advanced TeleICU system, a team of critical used to expand services to our community, to improve the care specialists from DHMC works in partnership with Cheshire Medical Center’s facilities and to pay back debt................................6,399,000 Intensive Care Unit (ICU) staff using state-of-the-art video conferencing and monitoring, providing an extra layer of observation for critically ill patients and extra support for staff around-the-clock. • Cheshire’s Emergency Department (ED) houses 21 patient care rooms, two of which are equipped with TeleED. The 24/7 TeleEmergency service is a resource to staff when more help is needed. The video O conference monitors are installed in an upper corner of each of the two ED rooms and enable board-certified N emergency medicine physicians and emergency staff to view and interact with Cheshire emergency Our Our medicine physicians and staff. People Patients • Patients suffering from a stroke at Cheshire benefit from the portable TeleNeurology system. BoardOur Commitment certified neurologists collaborate in real-time with Cheshire’s physicians and providers to evaluate, to Quality and Safety manage and treat patients. Our Our • Cheshire’s Women’s and Children’s Health Unit cares for our smallest and most vulnerable patients. Community Organization Through a portable TeleICN (Intensive Care Nursery), our pediatricians and medical staff consult in real-time with neonatologists at CHaD (Children’s Hospital at Dartmouth-Hitchcock).

Statement of Operations

VIS

OUR MIS SI O

ION

OUR

VA L U E S

A commitment to quality and safety in all that we do for our patients, our community, our staff and our organization is at the core of our ongoing work to fulfill the mission, vision and values of Cheshire Medical Center.

OUR MISSION: To lead our community to optimal health and wellness through our clinical and service excellence, collaboration, and compassion for every patient, every time. OUR VISION: To continually improve the health outcomes of the people we care for through our role in providing high-quality health care; remaining a sustainable resource for our region.

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Together, our community is stronger.

The Center for Population Health at Cheshire Medical Center nurtures partnerships for health and wellness. We believe the health and wellness of every member of our community matters and through our Center for Population Health (CPH) we address those needs. We collaborate with community partners to improve the health and wellness of individuals, families, worksites, schools, and the community through a variety of strategic programs and initiatives that focus on mental health, substance use disorders, tobacco prevention, obesity prevention, access to care, and emergency preparedness. Our work is based on the results of a community needs assessment for our region. According to research, social factors beyond quality medical care—such as education, employment, family stability, safety, and physical activity—impact health. These social determinants of health are non-medical barriers—such as transportation, income, housing and access to healthy food—that need to be addressed for patients to achieve optimal health and well-being.

In the last decade, Cheshire’s efforts have grown from community engagement to include policy change and clinical integration programs that bridge the Healthy Monadnock health improvement initiative with clinical care to improve patient outcomes, and to prevent the onset of disease and illnesses. CPH’s programs and initiatives support an active lifestyle, good nutrition, healthy living conditions, and well-being for all in the community through discounted evening meals for seniors, breast and cervical cancer screenings for low-income or underinsured women, stress management and resiliency classes, high blood pressure prevention and monitoring programs, pulmonary rehabilitation support for individuals with chronic lung disease, health and wellness community education programs, tobacco cessation programs, and more. Read more about how CPH programs are aligning with community need in the Healthier Together Spotlight on page 29.

Cheshire Health Foundation | FISCAL YEAR 2019 REPORT Cheshire Health Foundation cultivates and stewards charitable support to advance Cheshire Medical Center’s health and wellness mission. This includes raising funds for patient care equipment, programs, nursing scholarships and more. We are grateful to our community for supporting all of our fundraising initiatives. In fiscal year 2019, our non-profit Medical Center requested that a “higher reach goal” be set to help make possible the purchase of a state-of-the-art CT scanner. The Foundation asked our community to help us reach our $700,000 goal, and you generously responded with gifts totaling $736,267. In addition to our loyal base of supporters, gifts were made by more than 300 new donors. We are happy to share that the new FISCAL YEAR 2019 CHARITABLE CONTRIBUTIONS BY FUND CT scanner is on schedule to be installed and operational CT Scanner Fund $736,267 in April of this year. Cancer Care Fund $29,268 Cancer Patient Relief Fund

Your support helps to make Cheshire stronger. Thank you for your commitment and all that you do to help us care for our community.

$23,241

Population Health Fund

$96,980

Farnum Rehab & Spine Therapy Funds

$13,044

Tatro & Coughlin Nursing Scholarships Funds

$10,418

Other Patient Care/Patient Assistance

$37,132

TOTAL

$946,350

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Health + Wellness livi n g h ealth i e r to g e th e r

Active living

Out-of-the-Box Outdoor Activities The proven benefits of an active lifestyle include better sleep, weight stability, lower stress levels and better mental health, less chronic pain, and many more than we can list here. Most people sustain physical activity as part of a lifestyle (rather than an on & off gym habit) when we take part in a range of activities we enjoy. So here are a few out-of-thebox ways to get moving during warmer weather: CREATING WITH THE SCENERY Take a walk in the name of art! Most of us have mobile phone cameras to capture landscapes and close-up nature photography. However, you can make fun art projects with found objects too. From collages and mosaics of many textures to mobiles and sculptures, you can turn treasures from your adventures into crafty creations. STUDYING THE WORLD There is so much to explore and learn about outside! Try logging sightings in a bird watching app like Audobon, or Larkwire that turns learning bird sounds into a game. Leafsnap is a tree identification app from the Smithsonian Institution and iNaturalist from National Geographic Society has “missions” where you can add to crowdsourced observations used for science.

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PRODUCE PICKING Instead of hitting the grocery store for your fruit and vegetable needs, try picking your own at a local orchard or farm to get it right from the source. Each summer, Monadnock Table magazine posts a list of farms where you can get some steps in, soak up the scenery, and buy delicious food! PLOGGING ‘Plogging’ is a Swedish term that refers to picking up litter as you explore the outdoors, so you can keep the countryside beautiful for years to come. Hit the streets and bike trails with gloves and a bag for a bit of exercise, and enjoy the knowledge you helped keep our corner of the world clean! PICNICS AND PARTIES Many locals think of picnicking as a romantic or solitary activity while hiking in local woods. But you can also gather your friends in a local park or garden with horseshoes, badminton, volleyball, or any number of games that will get everyone moving.

H E R BY P OTATO S AL AD Healthy eating

8 Food Safety Tips for BBQs & Picnics Fresh air and exercise, friends and family, and coolers of favorite homemade dishes are the ingredients for a happy summer party. But warmer temperatures help bacteria grow, so it’s more important than ever to practice food safety during the hot summer months.

S E RVE S 8 3 pounds small or baby red potatoes 5 tablespoons white wine vinegar, divided ½ cup extra virgin olive oil 2 teaspoons grainy Dijon mustard 1 teaspoon kosher salt ½ teaspoon freshly ground black pepper ½ small red onion sliced 2 tablespoons each minced fresh dill, fresh chives, fresh basil, and Italian flat-leaf parsley

Keep your food from spoiling by following these safety tips from the US Department of Agriculture: 1. Wash hands, utensils, containers, and work surfaces before handling food to prevent harmful bacteria from spreading. 2. Marinate foods in advance, in the refrigerator using a glass or plastic food-safe container. 3. Foods that need to be kept cold include raw meat, poultry, and seafood; deli and luncheon meats or sandwiches; summer salads (tuna, chicken, egg, pasta, or seafood); cutup fruit and vegetables, and perishable dairy products. 4. Separate raw meats, poultry, and seafood from ready-toeat foods including fruits, vegetables, salads, cheeses, and desserts. Use separate coolers, plates, and utensils. 5. Keep cold food in an insulated cooler with plenty of ice or frozen gel packs. Transport the cooler in the passenger area of your car, not in the hot trunk. At the picnic site, cover the cooler with a blanket and place it in the shade. 6. Throw out leftovers that have been sitting out for more than 1 hour. Store the rest in a cooler that still has ice. If all the ice has melted, throw away the food. 7. Bring a food thermometer to be sure grilled foods are cooked enough. 8. Bring hand sanitizer if your picnic site doesn’t have handwashing facilities. Reprinted from: cancer.org/latest-news/keep-foods-safe-at-summerpicnics and based on usda.gov/media/press-releases/2015/05/20/ usda-offers-summer-food-safety-tips-advance-memorial-day-weekend and fda.gov/food/buy-store-serve-safe-food/handling-food-safely-whileeating-outdoors.

I N STRU CTI O N S 1. Put the potatoes in a medium saucepan and cover with cold water by about 2 inches. Bring to a boil over high heat, add 1 tablespoon of kosher salt, and cook the potatoes until fork-tender, about 1520 minutes. Drain well. As soon as the potatoes are cool enough to handle, cut them in half and place them in a large mixing bowl. While the potatoes are still hot, sprinkle them with 3 tablespoons of the vinegar and let cool to absorb the vinegar. 2. In a small bowl, whisk the olive oil, remaining 2 tablespoons of vinegar, Dijon mustard, kosher salt, and pepper. 3. Drizzle the dressing over the potato mixture and gently toss. Add the sliced onion and minced herbs and toss again. Season with more salt and pepper to taste. Serve warm, at room temperature, or chilled. Keeps in the refrigerator for 3-4 days. If serving outdoors, do not leave out for more than 1 hour. Recipe adapted from foodiecrush.com.

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Health + Wellness livi n g h ealth i e r to g e th e r

Thriving with health conditions

Healthy Feet Q & A with Dr. Pinegar Whether you have regular pain, have an injury or deformity, or have neuropathy (loss of feeling) related to diabetes, the Podiatry Department at Cheshire Medical Center is your go-to source to care for your feet.

doing it right, you can end up with an ingrown or deformed toenail, which is more likely to get infected with a fungus or a bacteria.

David Pinegar, DPM, came from Potsdam, N.Y. last September to join three other providers on Cheshire’s podiatry team. See the full Q&A with Dr. Pinegar on our Healthier Together blog at cheshiremed.org.

A. Find shoes that accommodate any

Q. What should we be doing to care for our feet? A. Simple daily practices: changing your

socks and washing your feet with soap and water each day, wearing clean, dry shoes, and being careful to trim your toenails appropriately. If you’re not

Q. What is your first line of advice for people with foot pain?

kind of condition that you have. We can take a look at your feet and determine if your shoes are causing you pain and discomfort. For example, high heels are associated with higher incidents of hammer toe deformities, bunion deformities, arthritic degeneration of the joints, and ankle sprains. Q. What if it’s not your shoe that is causing the pain and discomfort? A. Once we’ve ruled out your shoes, we

can evaluate other things. By looking at all aspects of a person’s life, we can help them figure out what’s causing the pain and discomfort and find solutions.

Q. Are people with certain preexisting conditions susceptible to foot problems? A. Oh, yes, especially people with

diabetes or conditions that cause neuropathy, or the loss of feeling in their feet. You could walk with a sharp rock in your shoe and not know it. By the time somebody notices, they’ve done some damage and could have severe infection that could be limb—or even life-threatening. Q. When and how should people make an appointment to see a podiatrist? A. Usually folks come to us after

getting a referral from their primary care doctor. They’ve been experiencing discomfort and want help. You don’t have to live with pain. We can help you. Feet are so important to enjoying life, and we don’t truly realize how important they are until something goes wrong. This spring, Dr. Pinegar is hosting a free workshop about common foot problems and foot care. See page 31 for details.

David Pinegar, DPM Podiatry/Podiatric Surgery

Dr. Pinegar joined Cheshire Medical Center in 2019. Prior to joining Cheshire Medical Center, he worked at CantonPotsdam Hospital where he served as a surgical podiatrist. He is thoroughly trained in comprehensive forefoot, rearfoot, and ankle surgery, in addition to all surgical/non-surgical aspects of foot and ankle care. Board Certified, Foot and Ankle Surgery and Reconstructive Rearfoot/Ankle Surgery At Cheshire, the Podiatry Department treats patients with postural and/or foot abnormalities, short- and long-term conditions of the skin and musculoskeletal system, and sports-related injuries to the foot and leg, offering both surgical and non-surgical options for patients.

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THE NATIONAL SLEEP FOUNDATION RECOMMENDS THESE TECHNIQUES IF YOU HAVE TROUBLE SLEEPING DUE TO STRESS:

Rest & restorative sleep

Break the Stress-Sleep Cycle for Your Health We all require different amounts of sleep to perform at our best. One person may need a good 9 hours and another might operate just fine on 7. Yet, most of us know what it feels like when we don’t sleep well.

Avoid working out within 3 hours and eating within 1 hour of your bedtime.

of Apps available that offer guided meditations to help you relax.

Try soaking in a hot bath or having a hot cup of non-caffeinated tea before bed.

If you find yourself waking and worrying mid-sleep, break the thought cycle by getting up. Go to the bathroom, make yourself tea, read a book on the couch (not in bed), or meditate before going back to bed.

Spend 5 to 10 minutes doing a calming routine before bed—deep breathing exercises, guided imagery, or progressive muscle relaxation. There are a variety

Nearly one third of all Americans say they don’t get enough good quality sleep. Stress plays a leading role. It’s hard to fall asleep and stay asleep when you’re worrying about work, relationships, or the health of a loved one. What’s worse is that not getting enough sleep can cause even more stress.

Safety & prevention

WORKING OUTDOORS

Stress can stimulate the body and mind so that it inhibits you from entering a relaxed, restorative sleep, contributing to insomnia. People with insomnia find it difficult to fall or stay asleep at night, and suffer from concentration and memory issues, fatigue, and worries about sleep during the day. If you have sleep problems, it’s important to talk to your primary care provider for an evaluation and sleep improvement plan, as it impacts physical and mental health, along with safety.

Whether undertaking yard work, home improvements projects or working professionally outdoors, make safety precautions part of your routine. This is especially important during the warm weather months, when outdoor injuries are the most common. Here a few tips to take action against:

For more tips about getting the best rest and discussing insomnia with your doctor, visit the Rest and Restorative Sleep section of the Healthier Together blog at cheshiremed.org or attend the free Sleep Good – Feel Good! workshop series listed on page 30, hosted by Behavioral Health Specialist, Catherine Sickles.

Sun & heat stroke Avoid this life-threatening condition by wearing loose-fitting, light-colored, lightweight clothing. Apply a shot glass full of 30+ spf every 2 to 4 hours to exposed skin, drink water every hour, and plan physically demanding activities in the early morning or after sunset.

To learn more about how to heal both mind and body, attend the workshop listed on page 30 How You Can Heal by Changing Your Thoughts, Feelings, and Habits by Dr. Mahmoud Rashidi, MD, a neurosurgeon and author of Mind Medicine: Use Your Thoughts to Heal.

Sprains, strains, and tears Prevent the most common summer injuries by taking care walking on slippery or uneven ground, using ergonomic tools, and using proper lifting techniques, including team lifting for heavy items. Wounds Scrapes, punctures and incisions are most often prevented by using proper gloves for the job, ensuring all blades are sharp, and ensuring machine guards are functional—and in use.

Avoid ticks Tuck your pants into your socks and shirt into your pants, carefully treat your regular work clothes with repellant like permethrin, and perform a tick-check after every shift. If you do experience a minor injury, develop heatstroke, or find a tick attached for more than 24 hours, visit the Walk-In Care Clinic at 149 Emerald St. in Keene – open 8-8 on weekdays and 10-4 on weekends. Learn more about which type of health care to seek in an emergency on page 17. Read more about avoiding and treating tick bites by visiting our Healthier Together blog at cheshiremed.org.

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Health + Wellness livi n g h ealth i e r to g e th e r

Healthy aging

Planning for Compassionate Care Many of us avoid advance care planning because we’re fearful of giving up control of our care. But developing an advance care plan is actually about taking control. This is especially true for people who have been diagnosed with a neurological disorder, such as Alzheimer’s or Parkinson’s disease. Losing the ability to make decisions for ourselves is scary to think about. It’s also upsetting to think people might make decisions at odds with how we would like to be cared for—especially well-meaning decisions that may end up causing us to suffer. The best first step is to talk with your family about your wishes and preferences for your end-of-life care. This is not easy, but if you fail to create an advance care plan, you leave all the decisions to your family members or doctors. By creating an advance care directive document and designating the person you would like to carry out your wishes, you make those decisions for yourself while you are able.

Here are some questions to think about and discuss:  How do I want to be treated in my last days?  Do I want to receive life-extending care even if it means causing pain for myself, or anguish for my family?  If I don’t want extraordinary measures taken to extend my life, how do I make that clear to my family and my doctor?

“You may avoid advance care planning because you’re afraid of giving up control of your care. But developing an advance care plan is actually about taking control. Now is the time to empower yourself.” —Barbara Bates, MD, Family Medicine

Barbara Bates, MD Family Medicine | Team C

Dr. Bates has practiced at Cheshire Medical Center since 2013 providing preventive, acute, and chronic care to individuals of all ages. Board Cerification, Family Medicine Cheshire Family Medicine patients receive care from a coordinated team of health care professionals led by a Primary Care Provider that may partner with Associate Providers such as Physician Assistants, to address specific health concerns and to create health and wellness goals and a plan to reach them.

These are sensitive and emotional questions to consider. But now is the time to empower yourself. Clarify and document your end-of-life wishes with an advance care plan. Make copies of that plan and designate someone you love and trust to stand up for you when you no longer can. Talking with a professional and your loved ones at the same time can make it a little easier. Collaborative Care Nurses on each Primary Care team can help you talk it through.

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Trained volunteers are available in Cheshire’s lobby a few times a month to give you more information or make an appointment to help you and your family consider these important decisions. Register for one of two advance care planning workshops led by Collaborative Care Nurse, Lori Guyette, RN, listed on page 31. Or, visit Cheshire Medical Center’s Facebook Events page to find out when Advance Care Planning Volunteers will be available in our lobby.

Thriving with health conditions

Signs of Hearing Loss Close friends and family are on the front lines of hearing loss. We are the first to notice a loved one’s struggle and are in the best position to say “I’ve noticed you’ve been missing some things in our conversations. Let’s get your hearing tested.” Hearing loss signs to look for: 1. You have to repeat yourself while talking to your friend or family member. 2. In noisy environments like cocktail parties, they will struggle to understand what is said or follow the conversation. Afterwards, they may show signs of fatigue because of the energy it takes to try and keep up. 3. Consonants become more difficult for them to discern, so they may mishear words like “sun” and “boy” for “fun” and “toy.” 4. They’ll have a harder time understanding someone speaking via a cell phone than a more powerful land line. 5. Because trying to keep up with conversations takes so much energy, they may start tuning out and decide not to pay attention at all. This is what providers like Noelle Paradis, AuD fear the most—left untreated hearing loss can lead to social isolation and cognitive decline. “Hearing loss doesn’t happen overnight,” says Dr. Paradis. “It comes with aging and noise exposure.”

In that way hearing damage is similar to skin damage from sun exposure—major noise events may have happened a long time ago but you start see the effects in your 60s. “The good news is that today’s hearing aid technology has come a long way. For example, some hearing aid technology can automatically pair with your cell phone so it transmits a signal directly through your hearing aid,” says Dr. Paradis. “A comprehensive hearing test doesn’t take long, and we can suggest a range of new technology designed for someone’s specific hearing needs. So, help your loved one make the call that can improve their life.” To talk with someone about making an audiology appointment, call (603) 354-6673. Cheshire’s Audiology Department is located at 448 West Street, Keene.

Noelle Paradis, AuD, F-AAA Audiology

Dr. Paradis has extensive experience in the field of audiology and is a recognized expert in the region. She has served on the Advisory Board of Early Hearing Detection and Intervention and developed the Newborn Hearing Screening Program at Monadnock Community Hospital in Peterborough, NH. The Cheshire Medical Center Audiology Department offers a variety of services, including diagnostic screenings for children and adults.

For many people, hearing loss is a very personal and difficult topic. But when you see a loved one struggling with hearing loss and missing out on many things because of it, it’s natural to want to help. The first thing to do is have a conversation in a sensitive way. H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Health + Wellness livi n g h ealth i e r to g e th e r

Safety and prevention

No Safe Vape — THE FACTS Just when traditional cigarette use had gone down significantly, e-cigarettes and vaping arrived on the scene. Vaping has taken hold in a big way and so far the results don’t look good. According to the Centers for Disease Control and Prevention (CDC), New Hampshire has the highest percentage of high school students reporting daily use of electronic vapor products. As of November 2019, the CDC reported 1,888 cases of vape-related lung injuries across the U.S. At least 39 people have died and the majority of those who become ill are young males.

offering flavors that target teens, vapes are designed to look like hard drives or pens, allowing young people to conceal them easily.

No Safe Vape — The Dartmouth-Hitchcock Health Initiative With the growing number of vaping-related illnesses and deaths, “No Safe Vape” has mobilized to educate young people and their families in New Hampshire and Vermont about the dangers of vaping and provide resources for those seeking more information or help.

Vaping Q & A What are e-cigarettes? E-cigarettes—also called “vapes,” “vape pens, “Juuls” and “e-cigs”—are handheld, battery-powered vaporizers that simulate smoking. They look like pens, lipsticks, flash drives and even medical inhalers, making it easy to conceal them. The industry claims e-cigarettes offer a safe alternative to traditional cigarettes, but the long-term effects are still unknown.

Is vaping addictive? Not all vape products include nicotine, but most do. The e-cigarette industry is highly unregulated and many vape products that claim to be nicotine-free aren’t. Liquid cartridges and vape pods contain varying amounts of nicotine. The C. Everett Koop Institute at Dartmouth found that kids who vape are three times more likely to go on to smoke regular cigarettes.

What about vapes without nicotine? The American Lung Association says that the youth vaping epidemic is at an all-time high. According to the National Institute on Drug Abuse, more than a third of 12th graders report having vaped in the last 12 months—up 10 percent from the previous year. How did we get here? The e-cigarette industry is relatively new and largely unregulated. The promise of e-cigarettes as a traditional cigarette smoking cessation method may have blinded us all to the truth about vaping. Along with

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E-cigarette liquids usually contain propylene glycol, which is known to release formaldehyde gas when heated. Diecetyl—linked to “popcorn lung” disease—has been found in over 75% of flavored e-cigarettes. Various new chemicals are formed when the liquid juices are heated and converted into a fine mist—many of those chemicals are toxic. For more Q+A about vaping, go to: dartmouth-hitchcock.org/ patient-education/vaping.html#qanda. For a list of resources go to: dartmouth-hitchcock.org/patient-education/vaping.html

H EALTH I E R TO G E TH E R

Spotlight

THE CHESHIRE TOBACCO-FREE COMMUNITIES COALITION IS READY TO HELP YOU QUIT

Cheshire’s Community Needs Assessment aligns population health initiatives with Healthy Monadnock

Are you ready to quit tobacco? Then look no further than the Cheshire Coalition for Tobacco-Free Communities.

The Healthy Monadnock initiative includes leaders from organizations like schools, human services agencies, businesses and health care organizations, including Cheshire’s Center for Population Health (CPH).

The Coalition is your one-stop spot to find the right program for you. All Coalition programs are free. We want you to be healthy and we want to rid our community of the harmful effects of tobacco. The programs available through the Coalition include:

The priorities of Healthy Monadnock’s Leadership Council shift according to the results of Cheshire’s triennial community health needs assessment, along with other data sources and community input. This year, the initiative’s focus will continue on: behavioral health, substance misuse, access to healthy food and active living, emergency preparedness, and health care access.

 Free one-on-one counseling  Assistance with nicotine replacement therapies (patches and gum)

 Tobacco and addiction education  A local support group that meets regularly

 Connection to services through the American Cancer Society and the American Lung Association

 Access to Centers for Disease Control and Prevention video series

 1-800-Quit-Now, a New Hampshire tele-counseling service for people who feel the urge to smoke and just need someone to talk to The Coalition also helps people who have started or are thinking about starting to vape. If you’re ready to quit tobacco, talk to your primary care provider or call the tobacco cessation program at 603-354-6513.

In alignment with these priorities, CPH has worked to ensure residents have the options and support they need to live healthier lives. For example, the Prescribe for Health program includes Activity is Good Medicine, Some of the CPH staff: (L-R) Shawn LaFrance, Olivia Stack, Seth Emont, allowing providers to Laurie Butz-Meyerrose, Maera Cramer, Tracy Clark, Nelson Hayden, “prescribe” exercise Tricia Zahn, Caitlin League at the local YMCA to patients with a reduced cost membership. Beyond eliminating financial barriers to physical activity, this program allows providers to refer patients to Population Health Workers who help patients overcome a range of social determinants of health, like health care access, transportation, healthy eating, and food assistance. Also of note this year are:

Wellpowered Worksites launched Right This Way, a fun, team-based, 10-week online wellness challenge, available to all employees of participating organizations. Cheshire Walkers, offering weekly guided walks for adults of all ability levels, celebrated its 20-year anniversary. The Diabetes Prevention Program, a very effective low-cost, year-long lifestyle change program, offered new sessions in partnership with the Keene Family YMCA. Tobacco 21, a campaign of The Cheshire Coalition for Tobacco-Free Communities’, successfully raised the tobacco purchase age in Keene to 21 last year. Seth Emont, PhD, recently joined CPH as tobacco program manager and will continue supporting tobacco-free community strategies. While those aligned with the Healthy Monadnock initiative make strides to become a healthier community, substance-use disorders have remained areas of concern for our region. The Doorway at Cheshire Medical Center and the Behavioral Health Provider Network, enabling collaboration between Cheshire’s Primary Care Providers and local substance use treatment and recovery organizations for patient care, and have begun to make a positive impact in the community.

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Health + Wellness livi n g h ealth i e r to g e th e r

Upcoming Educational Programs The following is an excerpt listing from our Spring/Summer Program Guide. Designed to provide learning opportunities and supportive connections, these classes and programs are brought to you by the Center for Population Health at Cheshire Medical Center and are part of the many ways we are working to advance the health and well being of the Region. All programs are held at Cheshire Medical Center, 580 Court St., Keene, NH unless otherwise noted. All programs require registration and are free, unless otherwise noted. If special accommodations are required for you to attend any of our programs, please call the Center for Population Health at (603) 354-5460.

Learn How to Navigate myD-H—Cheshire Medical Center’s Patient Portal Dana Carley, Patient Portal Concierge, Cheshire Medical Center

myD-H is Cheshire Medical Center-Dartmouth Hitchcock’s online patient portal that makes managing your health information and communicating with your health care team easy and convenient. If you have questions about creating a myD-H account, or need assistance navigating your account, you can make an appointment with Patient Portal Concierge, Dana Carley at Cheshire Medical Center. Call 603-354-5454 x 2446 to set up a one-on-one session to learn how to get the most out of this useful tool. Tuesdays, March 10–31 All classes: 3:00-4:30 pm Team F/Nurse Clinic Centering Room on Floor 1A

Talkin’ Diabetes Support Group Join us on the 2nd Thursday of every month from 5:30-6:30 pm at Cheshire Medical Center in the Team F/Nurse Clinic Centering Room on Floor 1A. Our free support group will help you get connected to others who have diabetes and stay motivated to take care of yourself. Facilitated by our Outpatient Registered Dietitian, this group is an informal opportunity to ask questions, share information, and walk away with new tools and coping strategies. No registration necessary. For more information, please contact Ruth Goldstein, MS, RD at 603-354-5454, ext. 3815 or rgoldstein@cheshire-med.com. 2nd Thursday of every month All classes: 5:30-6:30 pm Team F/Nurse Clinic Centering Room on Floor 1A

Sleep Good – Feel Good!

Catherine Sickles, Licensed Mental Health Counselor (LCMHC), Behavioral Health Specialist, Cheshire Medical Center Sleep problems are one of the most common concerns that patients bring to Family Medicine, and poor sleep is a contributor to many other health issues—from mood problems to high blood pressure to poor attention span and memory. Join us for this three-week program to explore the benefits of restorative sleep and learn how you can get more of it. 3-week session: Tuesday Evenings, April 14, 21, and 28 All classes: 5:00-6:30 pm North Conference Room 2

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How You Can Heal by Changing Your Thoughts, Feelings, and Habits

Dr. Mahmoud Rashidi, MD, Mind Medicine LLC Dr. Rashidi, neurosurgeon and author of Mind Medicine: Use Your Thoughts to Heal, is dedicated to researching, teaching, and promoting ways to help the mind and body heal. A positive state of mind can have a profound effect on a patient’s healing process, especially when combined with maintaining healthy habits and seeking appropriate medical attention when needed. Dr. Rashidi will provide a brief overview of the brain and how it works and share his insights to help those battling physical/chronic illness, depression, anxiety, stress, and other problems to enjoy a higher quality of life and help with their overall recovery. There will be time for questions and discussion. Thursday, April 16 6:00-8:00 pm Auditorium A & B

Healthy Living with Diabetes Class

Ruth Goldstein MS, RD, LD, Outpatient Registered Dietitian, Cheshire Medical Center Healthy Living with Diabetes is designed to teach you the skills you need to control your diabetes and prevent or delay complications associated with this disease. Each session consists of 4 classes. Topics include diabetes management, healthy eating, activity, medications, & coping with diabetes (stress management). Choose a 4-week session: Tuesdays, May 5–26 Tuesdays, September 1–22 Tuesdays, November 3–24 All classes: 3:00-4:30 pm Team F/Nurse Clinic Centering Room on Floor 1A

Welcome to Medicare

Kim Lauer, Medicare Counselor, Monadnock ServiceLink Turning 65 soon? Need help understanding Medicare? This workshop will focus on the fundamentals of “How Medicare Works” and is designed for anyone who is close to Medicare age, or people who may be retiring and switching from Employer Group Health Insurance to Medicare. Thursday, May 7 6:00-7:30 pm North Conference Rooms 1 & 2

Chair Yoga

Betty Christiansen, Certified Yoga Instructor Chair Yoga is a gentle form of yoga practiced sitting in a chair or standing, using a chair for support. As with other forms of yoga this exercise helps to reduce stress and improve balance, strength, and flexibility. Perfect for anyone new to yoga or for anyone who is uncomfortable getting onto the floor. 3-Week series: Wednesdays, May 13, 20, and 27 All classes: 4:00-5:00 pm Auditorium A & B

Be Good to Your Feet: Common Foot & Ankle Problems David M. Pinegar, DPM, Podiatry, Cheshire Medical Center

Did you know that foot and ankle complaints result in more than 5.3 million visits to doctors each year? Join us to learn about everyday foot and ankle problems such as bunions, hammertoes, heel pain, flat foot, and common ankle pain. You will also learn about the cause, symptoms and treatments for plantar fasciitis (also known as “heel spurs”). Join Dr. Pinegar as he provides tips to help you be good to your feet.

Advance Care Planning: It’s About the Conversation! Lori Guyette, RN, Collaborative Care Nurse, Cheshire Medical Center What if a sudden illness or injury left you unable to speak for yourself? Who would you want to speak for you? What would you want them to know about your values and wishes? Advance care planning is a process that helps any adult at any state of health think about your values and goals; consider health care choices you may have to make in the future; talk about your choices with your doctor and your loved ones; and make or update a written plan for the future (advance directive). Join us in a thought-provoking conversation to help make your wishes known. Make your voice heard and take control of your health care. You will have the opportunity to complete or update your advance directive if you are ready or sign up for a 1:1 meeting with a trained Honoring Care Decisions facilitator for a more in depth conversation. NOTE: Anyone who turns in a COPY of an advance directive for the medical record will be entered into a raffle. Two $50.00 gift cards will be awarded each month.

Choose a date:

Tuesday, May 21 6:00-7:30 pm Auditorium A & B

Wednesday, April 15 3:00-4:30 pm Auditorium B

Know the 10 Signs: Early Detection Matters

Thursday, June 18 11:00 am-12:30 pm Auditorium B

Carrie Amorim Good, Alzheimer’s Association, Massachusetts/New Hampshire Chapter Alzheimer’s and other dementias cause memory, thinking and behavior problems that interfere with daily living. Join us to learn how to recognize common signs of the disease; how to approach someone about memory concerns; the importance of early detection and benefits of a diagnosis; possible tests and assessments for the diagnostic process, and Alzheimer’s Association resources. (60-minute program + 30-minutes Q+A)

Turn to page 26 to read more about the importance of advance care planning.

Tuesday, June 23 1:00-2:30 pm North Conference Rooms 1 & 2

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If a Cheshire employee has made a difference in your visit or stay, share your appreciation by making a donation in their honor. To learn more, call (603) 354-6868 or visit: CheshireHealthFoundation.org.

Cheshire Health Foundation cultivates and stewards charitable support to advance the mission of Cheshire Medical Center. Cheshire Health Foundation | 580 Court Street, Keene, NH 03431 | 603.354-6800 | cheshirehealthfoundation.org