1. RAISING HOPE. GIVING HEALTH. TOGETHER, WE MAKE A DIFFERENCE 2012-2013 YORK HOSPITAL COMMUNITY HEALTH CENTER

2. YHCHC MISSION STATEMENT The York Hospital Community Health Center meets the medical needs of the underserved by: The York Hospital Community Health Center meets the medical needs of the underserved by: Providing excellent healthcare Providing excellent healthcare Educating the healthcare providers of the future Educating the healthcare providers of the future Working to improve the health of the community Working to improve the health of the community

3. LORETTA CLAIBORNE BUILDING

4. YHCHC VALUES Innovation – We will try anything within our means to improve the care of our patients Innovation – We will try anything within our means to improve the care of our patients Effectiveness – We make clinical and operational decisions based on the best information available, including capitalizing on opportunities to provide preventative care Effectiveness – We make clinical and operational decisions based on the best information available, including capitalizing on opportunities to provide preventative care

5. YHCHC VALUES Respect – We treat our patients and each other as we would want to be treated Respect – We treat our patients and each other as we would want to be treated Wear name tag at all times while working Wear name tag at all times while working Personal communication is made or received while not in the presence of a patient Personal communication is made or received while not in the presence of a patient Patients are given our undivided attention Patients are given our undivided attention Patients are asked “how they prefer to be addressed?” Patients are asked “how they prefer to be addressed?” Health education is provided but the patient’s right to make an independent choice is respected Health education is provided but the patient’s right to make an independent choice is respected

6. YHCHC VALUES Compassion – We provide care that we are proud to provide and would be proud to receive Compassion – We provide care that we are proud to provide and would be proud to receive Assist patients and their families with directions if they are confused or lost Assist patients and their families with directions if they are confused or lost Make sure our body language and our words communicate kindness and respect. Make sure our body language and our words communicate kindness and respect. Timeliness – We provide care when our patients want and need to receive care Timeliness – We provide care when our patients want and need to receive care

7. RAISING HOPE

8. OUR PATIENT POPULATION Young, primarily single females Young, primarily single females Poor: Income of </=$21,780 annually Poor: Income of </=$21,780 annually 25% Latino/Hispanic;25%Caucasian;24% non-White, non-African-American;14% African-American 25% Latino/Hispanic;25%Caucasian;24% non-White, non-African-American;14% African-American 12% Spanish-only speakers 12% Spanish-only speakers Many access care by walking to our facility Many access care by walking to our facility

11. GIVING HEALTH

13. OB/GYN RESIDENT PHYSICIANS

15. SERVING THE UNDERSERVED FY 2010-2011 21,778 patient visits, lab services, immunizations and other clinical services 21,778 patient visits, lab services, immunizations and other clinical services 2,664 patients served 2,664 patients served 655 obstetrical deliveries 655 obstetrical deliveries 157 outpatient surgeries performed 157 outpatient surgeries performed

16. CERVICAL CANCER PREVENTION Cervical cancer is caused by the human papilloma virus (HPV) Cervical cancer is caused by the human papilloma virus (HPV) HPV is sexually transmitted and often produces no symptoms HPV is sexually transmitted and often produces no symptoms The prevalence of HPV in the reproductive age population is very high: 75% of sexually active adults The prevalence of HPV in the reproductive age population is very high: 75% of sexually active adults The pap smear screens for pre-cancerous cells caused by the HPV virus The pap smear screens for pre-cancerous cells caused by the HPV virus

17. CERVICAL CANCER PREVENTION Virtually all cervical cancers are preventable Virtually all cervical cancers are preventable The key to prevention is screening with a pap smear The key to prevention is screening with a pap smear Women with abnormal pap smears are recommended to undergo colposcopy Women with abnormal pap smears are recommended to undergo colposcopy

18. CERVICAL CANCER PREVENTION INITIATIVE Role of colposcopy Role of colposcopy What is colposcopy? What is colposcopy? Where is it done? Where is it done? Who does the procedure? Who does the procedure? How long does it take? How long does it take? When are results available? When are results available?

19. CERVICAL CANCER PREVENTION INITIATIVE Patients with severely pre-cancerous cells on pap smear screening were referred for evaluation Patients with severely pre-cancerous cells on pap smear screening were referred for evaluation Many patients fail to follow through with these appointments Many patients fail to follow through with these appointments By offering comprehensive services on site, we anticipate better patient compliance and a reduction in cervical cancer By offering comprehensive services on site, we anticipate better patient compliance and a reduction in cervical cancer

20. COLPOSCOPE

21. TREATMENT OF PRE-CANCEROUS CELLS LEEP procedure (Loop electrosurgical excision procedure) LEEP procedure (Loop electrosurgical excision procedure) Removes pre-cancerous cells Removes pre-cancerous cells Currently cannot be performed in our office due to lack of equipment;patients are referred to Gyn Oncology Currently cannot be performed in our office due to lack of equipment;patients are referred to Gyn Oncology Non-compliance rates for evaluation and treatment of pre-cancerous cells are high Non-compliance rates for evaluation and treatment of pre-cancerous cells are high

22. LEEP MACHINE

23. LEEP ELECTRODES

24. CERVICAL CANCER PREVENTION INITIATIVE By providing comprehensive screening services to the greatest number of women in our patient population By providing comprehensive screening services to the greatest number of women in our patient population In evaluating and treating these women with pre-cancerous conditions in a familiar setting with a health care team they are comfortable with, cervical cancers can be prevented…allowing women to better care for their families In evaluating and treating these women with pre-cancerous conditions in a familiar setting with a health care team they are comfortable with, cervical cancers can be prevented…allowing women to better care for their families

26. CASE STUDY- AH 22 year old woman presented to YHCHC with abdominal pain for 24 hours 22 year old woman presented to YHCHC with abdominal pain for 24 hours Her pregnancy test was found to be positive Her pregnancy test was found to be positive The physical exam was inconclusive The physical exam was inconclusive An ultrasound showed a fetus in her fallopian tube and an empty uterus An ultrasound showed a fetus in her fallopian tube and an empty uterus

27. CASE STUDY-AH (CONT’D) She was referred for immediate surgery at York Hospital She was referred for immediate surgery at York Hospital The patient underwent surgical removal of the fallopian tube and was discharged within 24 hours The patient underwent surgical removal of the fallopian tube and was discharged within 24 hours This was a life-saving procedure This was a life-saving procedure Her other tube appeared normal and her chance of a future successful pregnancy is good Her other tube appeared normal and her chance of a future successful pregnancy is good

28. OB AND GYN ULTRASOUND SCREENING Pregnant patients in our population are often uncertain about when they conceived Pregnant patients in our population are often uncertain about when they conceived Knowledge of their ‘gestational age’ is key to determining when to screen for various conditions in pregnancy Knowledge of their ‘gestational age’ is key to determining when to screen for various conditions in pregnancy

29. OB/GYN ULTRASOUND SCREENING Approximately one in five pregnant women have threatened miscarriages or ectopic gestations Approximately one in five pregnant women have threatened miscarriages or ectopic gestations Ectopic pregnancy can be a life threatening condition Ectopic pregnancy can be a life threatening condition A distinction between a ‘viable’ vs. ‘non- viable’ pregnancy can be made by ultrasound A distinction between a ‘viable’ vs. ‘non- viable’ pregnancy can be made by ultrasound

30. ECTOPIC PREGNANCY Can be life threatening and is one of the most frequent causes of maternal mortality Can be life threatening and is one of the most frequent causes of maternal mortality Often underdiagnosed and patient can present with tubal rupture Often underdiagnosed and patient can present with tubal rupture Due to the demographics of our patient population, they often only seek care when the situation is emergent Due to the demographics of our patient population, they often only seek care when the situation is emergent

31. ECTOPIC PREGNANCY Can be diagnosed with an early ultrasound and lab studies Can be diagnosed with an early ultrasound and lab studies Surgery can be avoided in some cases Surgery can be avoided in some cases Early treatment can preserve future fertility and prevent emergency surgical intervention Early treatment can preserve future fertility and prevent emergency surgical intervention

32. PRENATAL COMPLICATIONS Preterm birth and fetal growth restriction are increased in the underserved population It is imperative to have an accurate assessment of the patient’s due date This is determined by a first trimester ultrasound

33. FETAL ULTRASOUND

34. CASE STUDY: RH 29 year old female who presented to the emergency department by ambulance, complaining of abdominal pain and delivering a preterm fetus at 18 weeks’ gestation 29 year old female who presented to the emergency department by ambulance, complaining of abdominal pain and delivering a preterm fetus at 18 weeks’ gestation She required admission to the hospital and underwent surgical evacuation of a retained placenta She required admission to the hospital and underwent surgical evacuation of a retained placenta

35. CASE STUDY: RH (CONT’D) Patient found to have multiple uterine fibroid tumors as the cause for her pregnancy loss Patient found to have multiple uterine fibroid tumors as the cause for her pregnancy loss Within several months of her loss, she was treated with Depo-Lupron, a medication which temporarily shrinks the fibroids Within several months of her loss, she was treated with Depo-Lupron, a medication which temporarily shrinks the fibroids On 2/16/11, she underwent surgical removal of the fibroids On 2/16/11, she underwent surgical removal of the fibroids

36. CASE STUDY: RH (CONT’D) Patient presented to YHCHC on 11/23/11 and was found to be 10 weeks pregnant Patient presented to YHCHC on 11/23/11 and was found to be 10 weeks pregnant She is undergoing serial ultrasounds to check cervical length due to her history of preterm labor She is undergoing serial ultrasounds to check cervical length due to her history of preterm labor She is undergoing careful follow-up for gestational diabetes She is undergoing careful follow-up for gestational diabetes She currently is doing very well at 25 weeks gestation She currently is doing very well at 25 weeks gestation

38. ULTRASOUND AT YHCHC Current machine is unable to discern far fields, requiring referral to another site for accurate assessment in high risk cases Current machine is unable to discern far fields, requiring referral to another site for accurate assessment in high risk cases Patients may not undergo recommended follow-up ultrasound studies due to transportation and other barriers Patients may not undergo recommended follow-up ultrasound studies due to transportation and other barriers This can lead to delays in diagnosis and unncessary emergency dept visits and patient emergencies This can lead to delays in diagnosis and unncessary emergency dept visits and patient emergencies

39. TOGETHER, WITH YOUR SUPPORT, WE CAN MAKE A DIFFERENCE

40. QUESTIONS?