MultiCare Tacoma General Hospital Multicare
2013Community Health Needs Assessmentand Implementation StrategyMultiCare Tacoma General Hospitalmulticare.org
Executive SummaryCommunity Health Needs Assessment (CHNA) and Implementation StrategyMultiCare Health System is a not-for-profit, community-based integrated healthsystem with five hospitals, 10,600 employees and more than 130 Specialty, Primaryand Urgent Care Clinics throughout Pierce, King, Thurston and Kitsap counties.MultiCare is one of the largest health care systems in the South Puget Sound region.Our heritage dates back to the founding of Tacoma’s first hospital in 1882.Priority Health NeedsIn 2012, MultiCare contracted with the Tacoma-Pierce County Health Department to conducta comprehensive Community Health Needs Assessment, using quantitative analysis andqualitative interviews with a representative cross-section of community leaders and arearesidents. The assessment process concluded in the spring of 2013, and in the resultingreport, the Health Department developed the following list of priority health needs: Prevention and Treatment of Chronic Diseases Tobacco Prevention and Cessation Obesity Mental Health Cultural Diversity (health inequities and communication) Special Populations (low-income and aging) Access to CareThree-Year FocusMultiCare convened internal stakeholder meetings to review the assessment and to select thehealth care needs we will focus on system-wide in the next three-year period: Chronic Disease Obesity – Adult and Childhood Tobacco Use Behavioral (Mental and Chemical Dependency) Health Cultural DiversityMultiCare Tacoma General Hospital E1
Executive SummaryCommunity Health Needs Assessment (CHNA) and Implementation StrategyEach of MultiCare’s five hospitals developed its own implementation strategy andcreated internal implementation teams. This Community Health Needs Assessment andImplementation Strategy is focused on MultiCare Tacoma General Hospital in Tacoma anddescribes how the hospital will address the identified health care needs by: Continuing and strengthening existing programs and services Exploring implementation of new strategies Collaborating with community organizations to implement evidence-based strategiesacross the service areaIn addition, this report will outline existing programs and services offered by MultiCare andother community organizations that are addressing the other identified health care needs wechose not to focus on for this time period.The strategies and activities outlined here, in partnership with key community collaborators,will require sustained, coordinated approaches to achieve lasting improvements in the healthof our community. This Implementation Strategy is a roadmap that will likely be revised andenhanced as we continue to address the pressing health issues facing our community.MultiCare Tacoma General Hospital E2
Table of Contents2013 Community Health Needs Assessment (CHNA) and Implementation StrategyExecutive SummaryE-1Introduction1Meeting Community Needs: Tacoma General2CHNA Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Focus 1: Chronic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Focus 2: Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Focus 3: Tobacco Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Focus 4: Behavioral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Focus 5: Cultural Diversity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Anticipated Outcomes and Evaluation26Other Identified Needs27Special Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Access to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Conclusion31AppendicesA-1Appendix 1: Tacoma-Pierce County Health DepartmentCHNA Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1Appendix 2: MultiCare Health System Program Inventory. . . . . . . . . A-22Appendix 3: Community Leaders and Public Health ProfessionalsInvolved in the CHNA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-33MultiCare Tacoma General Hospital
IntroductionProvidingcompassionate carefor our communityMultiCare Health System is a not-for-profit, community-based integratedhealth system of hospitals, clinics, services and providers, with morethan 10,000 employees in numerous locations in Pierce, King, Kitsapand Thurston counties in Washington. As one of the largest health caresystems in the South Puget Sound region, we are dedicated to improvingthe health of the people we serve.MultiCare facilities include: MultiCare Tacoma General Hospital (437 licensed beds) MultiCare Good Samaritan Hospital (286 licensed beds) MultiCare Allenmore Hospital (130 licensed beds) MultiCare Auburn Medical Center (195 licensed beds) MultiCare Mary Bridge Children’s Hospital (82 licensed beds) MultiCare Clinics, Urgent Care Centers, MultiCare Express Clinics,Mary Bridge Subspecialty Clinics MultiCare Good Samaritan Home Health & Hospice MultiCare Good Samaritan Behavioral Health MultiCare Ambulatory Surgery Centers Laboratories NorthwestMultiCare Tacoma General Hospital 1
MultiCare Tacoma General HospitalTacoma General Hospital is a 405-bed hospital located in Tacoma, Washington with its primary servicarea (representing 75% of inpatients served) as shown in the figure below. This report presentsquantitative data specific to the Tacoma General primary service area and qualitative community groudata gathered from focus group-type meetings throughout Pierce County. The quantitative data arepresented first, followed by the community group data and concluding with a description of the methused to collect and analyze data.Meeting Community NeedsMultiCare Tacoma General HospitalMultiCare TacomaGeneral Service AreaFigure 1 Map of Tacoma General Hospital primary service areaMultiCare Tacoma General Hospital is a 437-bed hospitallocated in Tacoma, Washington, with its primary service area(representing 75 percent of inpatients served) shown in the figureabove. Over 600,000 people live in the MultiCare Tacoma GeneralMultiCare Tacoma General Hospital Community Health Needs AssessmentA-6Hospitalprimary service area.MultiCare Tacoma General Hospital 2
Community Health Needs Assessment (CHNA) and Implementation StrategyCHNA MethodologyBackground and ProcessMultiCare Health System and Franciscan Health System contractedwith the Tacoma-Pierce County Health Department to conduct acomprehensive Community Health Needs Assessment (CHNA). Theprocess included quantitative analysis and qualitative interviews withcommunity leaders and residents representing many sectors andpopulation groups, including low-income residents and others affectedby health disparities. The assessment process began in the fall of 2012and concluded in the spring of 2013.(Please see Appendix 1 for the complete Community Health Needs Assessment, as prepared by theTacoma-Pierce County Health Department.)Criteria for Prioritizing Health NeedsIn the CHNA, the Health Department developed the list of priority healthneeds by using these four criteria:1.Is this health concern getting worse over time?2.Is this health concern significantly worse in the service area than inthe comparison area?3.Are relatively large numbers of people affected by this healthconcern?4.Was this health concern repeatedly voiced in community meetingsand focus groups?Health care issues that met at least two of these criteria were deemed apriority by the Health Department. The resulting list of priority needs wasa starting point for discussion, rather than a definitive short list requiringaction.MultiCare Tacoma General Hospital 3
Community Health Needs Assessment (CHNA) and Implementation StrategyPriority Health Needs Identified by the Health DepartmentThe Tacoma-Pierce County Health Department identified the followingpriority health needs for residents within the MultiCare Tacoma GeneralHospital service area: Prevention and Treatment of Chronic Diseases Tobacco Prevention and Cessation Obesity Mental Health Cultural Diversity (health inequities and communication) Special Populations (low-income and aging) Access to CareMultiCare’s Process for Selecting Health Care PrioritiesMultiCare convened internal stakeholder meetings to review theassessment and to select the health care needs we will focus on systemwide. This internal stakeholder group included physician, nurse, andclinic/outpatient leaders from each of our five hospitals. The group chosethe following issues to focus on system-wide in the next three-yearperiod: Chronic Disease Obesity – Adult and Childhood Tobacco Use Behavioral (Mental and Chemical Dependency) Health Cultural Diversity (health inequities and communication)System leaders then worked to create a resource inventory of existingprograms and services offered by MultiCare that address these fouridentified needs. In addition, we met with Franciscan Health System,the Tacoma-Pierce County Health Department and other communityorganizations to explore possible community-wide solutions to someof the identified health care needs. After mapping existing internal andexternal resources, each of MultiCare’s hospitals developed its ownimplementation strategy and created internal implementation teams.MultiCare Tacoma General Hospital 4
Community Health Needs Assessment (CHNA) and Implementation StrategyMultiCare Tacoma General HospitalImplementation StrategyMultiCare Tacoma General’s implementation strategy, outlined on thefollowing pages, describes how the hospital will address the identifiedhealth care needs by: Continuing and strengthening existing programs and services Exploring implementation of new strategies Collaborating with community organizations to implement evidencebased strategies across the service area MultiCare Tacoma General Hospital 5
Community Health Needs Assessment (CHNA) and Implementation StrategyMULTICARE TACOMA GENERAL HOSPITAL PRIORITIESCHRONICCHRONIC DISEASE DISEASEImprove the health andpatients ewellness of patients Reducereadmissionwith cardiovascularratesamong patientsdiseasecardiovascular withReducereadmissiondiseaserates among patients Increasewith the number oftobaccouse quitdiseaseatcardiovasculartemptsamongpatients Promote chronic diswithObstruceaseChronicself-managementtive Pulmonary Disease Promote prevention(COPD)activities in the Promotechronic discommunityease self-management Promote preventionactivities in the communityOBESITYIncrease the percentageof adults and youth whoIncrease the percentageare at a healthy weightof adults and youth whoare at a healthy weightTOBACCO USEIncreaseUSE the percentageof adults who areIncreasethe percentagetobacco-freeof adults who duceReduce depressiondepressionandandanxietyanxiety ratesratesImproveImprove howhowpatients’patients’cultural,cultural, language,language,andandspiritualspiritual thhealthcarecare deliverydelivery1. Improve access tobehavioral (mental andchemical dependency)health services by moving to an open accessmodel of care1. Promote culturaldiversity and healthinequity awarenessamong MultiCare staffHOSPITAL STRATEGIES1. Promote cardiaceducation and servicesin the service area2. Utilize cardiacresources across thecontinuum3. Partner with community organizationsthat are invested orinterested in cardiacdisease prevention1. Promote communityawareness and understanding of the READY,SET, GO! 5210 (RSG5210) program andmessage2. Increase collaboration with communitypartners on programsand policies to improvethe health of ourcommunity3. Surveillance of BMIdata among patients4. Promote weightmanagement programsand services5. Seek grants6. Increase accessto healthy food in theworkplace7. Promote physicalactivity among MultiCareemployees and theirfamilies1. Promote awarenessof and access to tobaccocessation resources andsupport programs2. Promote insurancecovered pharmacotherapy and/or free orlow-costcessation programs forhospital employees3. Continue to support our tobacco-freeworkplace policy for allhospitals and clinics4. Promote a smokefree workplace forhospital employees andlocal businesses2. Increase integrationof behavioral (mentaland chemical dependency) health into chronicdisease prevention andhealth promotion efforts3. Focus on high-riskand high-utilizers ofhealth care services4. Explore ways tointegrate chemical dependency treatment intothe medical care setting2. Increase accessto interpreter/communication services3. Offer blood pressureand type 2 diabetesrisk assessments andhealth education atcommunity events witha focus on underservedpopulations4. Provide sportsphysicals to underserved youth5. Actively participatein Leaders in Women’sHealth, a communitygroup that addressesbreast cancer disparitiesin Pierce CountyMultiCare Tacoma General Hospital 6
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 1: Chronic DiseaseMultiCare Tacoma General Hospital 7
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 1: Chronic DiseaseCardiovascular DiseaseCardiovascular disease (heart disease) is the leading causeof death in the United States. It is mostly preventable throughsmoking cessation, good nutrition, physical activity, and controlof high blood pressure and cholesterol. Many of these activitiescan also prevent obesity and diabetes, which are both importantrisk factors for cardiovascular disease.Our priority is to: Improve the health andwellness of patientswith cardiovasculardisease. Reduce readmissionrates among patientswith cardiovasculardisease. Promote chronicdisease self-management. Promote preventionactivities in theAccording to the CHNA, cardiovascular disease rates are higherin the hospital’s service area compared to the rest of WesternWashington.Our priority is to improve the health and wellness of patients withcardiovascular disease, reduce readmission rates among patients withcardiovascular disease, promote chronic disease self-management andpromote prevention activities in the community through the followingstrategies and activities: Promote cardiac education and services in the service area. Increase awareness of cardiac outpatient services in primary careoffices. Create Smart Phrases in Epic, MultiCare’s electronic healthrecord system, to refer adults to cardiac programs and services. Utilize cardiac resources across the continuum. Focus on reduced readmissions and Heart Failure Bundle toimprove patient outcomes. Partner with community organizations that are invested orinterested in cardiac disease prevention. Link chronic disease with care coordination and contactcommunity organizations about potential partnerships.community.MultiCare Tacoma General Hospital 8
Community Health Needs Assessment (CHNA) and Implementation StrategyInternal Resources for Cardiac ServicesMultiCare Tacoma General Hospital currently offers many cardiacprograms, services and resources for adults, their families and providers.They include, but are not limited to: The Heart Hospital at MultiCare Tacoma General Hospital providesthe highest level of cardiovascular care available in the region. Ourcardiac and vascular services are offered in one location, providingpatients with better connected care. The Heart Hospital includescardiac and vascular operating suites, digital cardiac catheterizationlabs, new cardiovascular intensive care and coronary care units, anda chest pain cardiovascular short stay unit. Cardiac Health & Rehabilitation Program is a physicianreferred, comprehensive approach for improving and maintainingcardiovascular health. Weekly sessions include monitored exercise,relaxation and stress management techniques, nutrition educationand other classes on cardiovascular health. The Preventive Cardiology Department at MultiCare TacomaGeneral Hospital provides services to individuals, focusing on earlydetection, prevention and rehabilitation of cardiovascular disease. Heart Failure Clinic offers testing, education and support for thosesuffering from heart failure, or those who are deemed to be at risk. Chest Pain Centers at MultiCare Good Samaritan Hospital andMultiCare Tacoma General Hospital are two of only six facilities inWashington to be nationally accredited by the Society of Chest PainCenters. The center is designed to provide diagnosis and treatmentwithin the “Golden Hour” after heart attack symptoms appear.Treatment provided within this one-hour window greatly increasespatients’ chances of full recovery. Heart Check Screening offers a comprehensive look at anindividual’s personal risk for heart disease. It includes a personalizedconsultation, risk assessment and basic lab tests. Based on thesetest results, patients are advised on next steps, such as seekingmedical treatment or making lifestyle changes. Chronic Disease Self-Management Program offers resourcesand education for chronic disease patients, including teaching homemonitoring and self-care skills. Integrated Cardiac and Diabetes Services offers earlyintervention for those with pre-diabetes, as well as medical care,support and education for people with diabetes. Weight Loss and Wellness Program is a specialized, therapeuticlifestyle change program that targets the underlying causes ofchronic disease by improving diet, activity and stress management. Diabetes & Cardiac Care Community Outreach providesunderserved communities with free blood pressure and glucosescreenings.MultiCare Tacoma General Hospital 9
Community Health Needs Assessment (CHNA) Implementation ReportCommunity Resources for Cardiac ServicesIn addition to MultiCare programs and services, there are othercommunity organizations and partnerships that are working on this issue.For example: The American Heart Association improves the quality of care forheart and stroke patients by providing CPR and first aid training,improving emergency care for heart attack victims, strengtheningstroke systems of care and helping hospitals treat cardiac andstroke patients according to proven guidelines, using the Get WithThe Guidelines program. MultiCare Health System is an activeparticipant in this organization. Early Heart Attack Care (EHAC) encourages people to call 911if they are having signs and symptoms of a heart attack. Currently50% of people drive themselves to the Emergency Departmentrather than call 911. YMCA of Pierce and Kitsap Counties Cardiac ExerciseProgram A twelve-week exercise program to safely improve fitnessin cardiac patients. MultiCare Tacoma General Hospital 10
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 2: ObesityMultiCare Tacoma General Hospital 11
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 2: ObesityAs the CHNA indicates, obesity rates in adults and youth arealarming. Sixty-four percent of adults and 10 percent of childrenin Pierce County are overweight or obese. Obesity is linked tomany chronic diseases, including diabetes, heart disease, stroke,cancer, osteoarthritis, asthma and sleep apnea. Poor nutritionand lack of physical activity contribute to the obesity rates in ourcommunity.Our priority is to increasethe percentage of adultsand youth who are at ahealthy weight.Obesity is related to a variety of factors, including behavioral,environmental and genetic factors. We know that themost effective long-term strategy will involve communitycollaborations, improved policies and community initiatives tohelp improve the health of individuals in our community.Our priority is to increase the percentage of adults and youth who areat a healthy weight through the following strategies and activities: Promote community awareness and understanding of theReady, Set, Go! 5210 (RSG 5210) program and message. Distribute RSG 5210 materials and other nutrition information/resources within the community. Expand the RSG 5210 Steering Committee to include additionalcommunity partners. Increase the number of professionals, community champions andstudent ambassadors trained in RSG 5210 messaging and tools. Increase the number of provider offices that are RSG 5210“friendly” (e.g., have RSG 5210 messaging present in waitingroom). Partner with physicians to educate patients/family on RSG 5210,promote RSG 5210 messaging and refer patients to weightmanagement services. Collaborate with the YMCA of Pierce and Kitsap Counties, UnitedWay, schools, community organizations and other health systemsto promote the RSG 5210 message.MultiCare Tacoma General Hospital 12
Community Health Needs Assessment (CHNA) and Implementation Strategy Increase collaboration with community partners on programsand policies to improve the health of our community. Partner with community organizations, businesses andgovernment entities to offer RSG 5210 and/or other wellnessactivities. Collaborate with the Tacoma-Pierce County Health Department’sCommunity Transformation Partnership (CTP) to supportcommunity efforts to address obesity. Surveillance of BMI data among patients. Create a BMI database for adult and youth patients to captureinternal BMI data. Promote weight management programs and services. Create Smart Phrases in Epic to promote the RSG 5210 messageand referral to weight management services. Seek grants. Apply for grant funding to support healthy eating and physicalactivity (e.g., Supplemental Nutrition Assistance ProgramEducation (SNAP-Ed) grants for schools and Women, Infants andChildren (WIC). Increase knowledge and best practice education of thebenefits of breastfeeding. Provide education and training to providers and staff on how tosupport patients who wish to breastfeed. Provide breastfeeding education to new mothers beforedischarge home. Increase awareness and messaging to ensure that womenbreastfeed beyond two months. Increase access to healthy food in the workplace. Promote wellness programming to hospital employees. Partner with farmers markets and develop produce deliveryprograms. Promote healthy food choices using RSG 5210 marketing invending machines and cafeterias. Continue to offer healthier options in MultiCare cafeterias. Promote physical activity among MultiCare Tacoma GeneralHospital employees and their families. Promote RSG 5210 to employees and families through theMultiCare Healthy@Work employee wellness program. Promote community fitness and running events with employeesand their families. Promote the Million Minute Mission (MMM) School andCorporate Challenge to employees.MultiCare Tacoma General Hospital 13
Community Health Needs Assessment (CHNA) and Implementation StrategyInternal ResoucesMultiCare offers several services for children, adults and families relatedto nutrition and physical activity programming, weight management,nutrition counseling and healthy lifestyles. These include, but are notlimited to: Ready, Set, Go! 5210 is a community-based initiative in PierceCounty to promote healthy lifestyle choices for children, youth andfamilies. Center for Healthy Living Nutrition Services offers health,wellness and exercise programs. Registered dietitians with expertisein sports nutrition and weight management offer services such ashealth assessments, screenings, menu planning, goal setting andone-on-one and/or group counseling sessions to help individualsand families make healthy changes. Healthy@Work Corporate Wellness Services offers low-costhealth education and prevention programs and screenings directly atthe workplace. Women, Infants and Children (WIC) provides nutritious foods plusother benefits free of charge to eligible families at 11 MultiCare WICsites in Pierce County. Supplemental Nutrition Assistance Program Education(SNAP-Ed) provides nutrition education to schools and to WICclients. Whole, Fresh, Local healthy food choices are featured in theMultiCare Tacoma General cafeteria and café, along with promotionof the RSG 5210 healthy food choices.MultiCare Tacoma General Hospital 14
Community Health Needs Assessment (CHNA) and Implementation StrategyCommunity ResourcesIn addition to MultiCare programs and services, there are other communityorganizations and partnerships that are working on this issue. Some examplesinclude: Tacoma-Pierce County Health Department’s CommunityTransformation Partnership (TPCHD-CTP) supports public healthefforts to reduce chronic diseases, promote healthier lifestyles,reduce health disparities and contain health care spending. Theprevention grant focuses on four priority areas: tobacco-free living,active living, healthy eating and expanding medical services toprevent and treat chronic diseases. Pierce County Gets Fit & Healthy is a partnership betweenMultiCare Health System, the YMCA of Pierce and Kitsap Countiesand the Tacoma-Pierce County Health Department to promotehealth and wellness through online nutrition and physical activityprogramming and an annual community event that focuses onimproving health. MultiCare Tacoma General Hospital 15
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 3: Tobacco UseMultiCare Tacoma General Hospital 16
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 3: Tobacco UseOur priority is to increasethe percentage of adultswho are tobacco-free.According to the CHNA, tobacco use in Pierce County is high,with nearly 17.8 percent of adults reporting they currentlysmoke and 7.2 percent of eighth graders self-reporting the useof tobacco products. Tobacco use can lead to tobacco/nicotinedependence and serious health problems. Secondhand smokeexposure causes disease and death in nonsmoking adults andchildren, including respiratory illness, heart disease and cancer.Children are especially vulnerable. Exposure to cigarette smokecan cause asthma and increase the risk for sudden infant deathsyndrome (SIDS), acute respiratory infections and ear problems.Tobacco cessation can significantly reduce the risk of contractingsmoking-related diseases and has immediate health benefits.Our priority is to increase the percentage of adults who are tobacco-freethrough the following strategies and activities: Promote awareness of and access to tobacco cessationresources and support programs. Increase provider referrals to tobacco cessation programs. Provide “Brief Tobacco Intervention and MotivationalInterviewing” training for providers. Provide tobacco cessation materials and resources to provideroffices and clinics. Continue to use Smart Phrases in Epic to refer to tobaccocessation services. Promote insurance covered pharmacotherapy and/or free orlow-cost cessation programs for hospital employees. Continue to support the MultiCare tobacco-free policy for allhospitals and clinics. Promote a smoke-free workplace for hospital employees andlocal businesses. Offer smoking cessation counseling through our Healthy@WorkEmployee Wellness Program to hospital employees and theirspouses/partners. Offer tobacco cessation programs and services to localbusinesses through the Healthy@Work Corporate WellnessProgram. Partner with organizations in the Community TransformationPartnership to promote tobacco-free policies.MultiCare Tacoma General Hospital 17
Community Health Needs Assessment (CHNA) and Implementation StrategyInternal ResourcesMultiCare offers several services for adults who are ready to quit usingtobacco, both for their health and to limit the impact of tobacco useon children (in terms of exposure to secondhand smoke and modelingbehavior). They include: QuitSmart tobacco cessation web-based program and phonesupport. Tobacco use physician electronic visits (e-visits) for patients viaMyChart, MultiCare’s secure online patient portal. Tobacco-free workplace smoking policy to reduce exposure andaccess to tobacco on all MultiCare Health System properties. Healthy@Work Employee Wellness QuitSmart eight-weekprogram with free pharmacotherapy for employees.Community ResourcesIn addition to MultiCare programs and services, other communityorganizations and partnerships are working on this issue. Someexamples include: Tobacco-Free Alliance of Pierce County (TAP) is dedicated toimproving the health of Pierce County residents by reducing tobaccouse. The Alliance’s mission is to create community collaborationsand networks empowered to promote prevention of youth tobaccouse, tobacco cessation and protection from secondhand smoke. Tobacco Prevention Network (TPN) works to provide a nonsmoking environment throughout the public housing system byassisting housing authorities and landlords who administer Section8 vouchers with implementing no-smoking policies. Washington State Tobacco QuitLine (1-800-QUIT-NOW) is afree service to help Washington State residents quit using tobacco.The QuitLine supports both immediate and long-term needs. Healthcoaches assist tobacco users with overcoming common barriers,such as stress, cravings, irritability and weight gain. The QuitLineis available in both English and Spanish with translation and TTYservices. MultiCare Tacoma General Hospital 18
Community Health Needs Assessment (CHNA) and Implementation StrategyFocus 4: Behavioral HealthMultiC
May 02, 2013 · A -6 . MultiCare Tacoma General Hospital Community Health Needs Assessment . MultiCare Tacoma General Hospital . Tacoma General Hospital is a 405 -bed hospital located in Tacoma, Washington with its primary service area (representing 75% of inpatients s
in our school. Every student voice is heard because every student matters. Tacoma Public School Hillcrest Ave, Tacoma Hillcrest Avenue, Tacoma Ph: 02 4353 1154 E: Tacoma-p.school@det.nsw.edu.au Www.tacoma-p.school@det.nsw.edu.au Term Dates Term 3 2020 21 July—25 Sept Term 4 2020 12 Oct—16 Dec Term 1, 2021 27 January—1 April 21 September 2020
2008 Tacoma: R155 I R155F 2009 Tacoma: R155/ R155F 2010 Tacoma: R155/R155F 2011 Tacoma: R155 I R155F 2012 Tacoma: R155 I R155F 2013 Tacoma: R155 I R155F 3. Does the clutch cover appear damaged, such as broken or excessively scored diaphragm spring fingers? YES - This bulletin does NOT apply. Continue diagnosis using the applicable Repair Manual. NO - Go to step .
Allenmore Hospital January 21, 2022 To: Washington State Nurse Staffing Coalition I, the undersigned, Linda Alderson, with responsibility for Tacoma General Allenmore Hospital nursing staff, attest that the staffing plans and matrices were developed in accordance with RCW 70.41.420 for 2022 and includes all units covered under our hospital
3. Benishiekh General Hospital 4.Biu General Hospital 5. Shani General Hospital 6. Gubio General Hospital 7. Magumeri General Hospital 8. Konduga General Hospital 9. Dikwa General Hospital 10. Mamman Shuwa Memorial Hospital 11. Mafa General Hospital Those rehabilitated but not fully equipped are: 1. Damb
2016 Community Health Needs Assessment and Implementation Strategy MultiCare Tacoma General Hospital multicare.org MTC-7668_CHNA_Ta
documentation format of this plan of care varies depending upon the patient location in the facility, i.e. inpatient, outpatient, or emergency department. Patient and Family Education It is the policy of MultiCare Valley Hospital to plan for, support and coordinate a systematic approach to patient and family education throughout the hospital.
August 24, 2017 Seattle Children’s Hospital Seattle, WA September 25, 2017 Multicare Tacoma General Tacoma, WA November 17, 2017 SeaMar Community Health Center Seattle, WA . Website A unique website hosting the Washington State Telehealth Collaborative was established in 2016 and has all of the meeti
Choir Director: Ms. Cristy Doria Organist: Dr. Devon Howard Choir Accompanists: Madison Tifft & Monte Wilkins After the benediction, please be seated as the graduates leave the sanctuary. The classes of 2018 & 2019 are hosting an invitation-only dinner in the Fellowship Hall in honor of the graduates and their families. Special Thanks to
