Outpatient Nutrition Services Program
Among the top health concerns identified in our most recent Community Health Needs Assessment are cancer, overweight/obesity, diabetes and heart disease. Treating these and other chronic conditions through diet education is an effective intervention to prevent hospital readmissions and improve health.

Phase 1 of our new program includes expansion of nutrition services along with making use of existing community and health system resources and relationships. Nutrition counseling goes far beyond weight management, offering guidance to improve the health of individuals with cancer, gastro-intestinal diseases, malnutrition and other conditions.

Phase 2 will include development of a multigenerational wellness building, in conjunction with the Integrative Health Program to provide cooking education and hands-on demonstrations for the community, including a kitchen and garden space, a bike-share program to improve access, and multipurpose areas to meet the nutrition and wellness needs of our patients.

Medication Therapy Management
We are expanding the medication therapy management (MTM) program provided by AGHRx RediScripts Pharmacy. RediScripts began providing these services - which include pharmacist intervention, evaluation and development of a medication plan of care within the patient’s overall treatment plan - this past year. Prescription adherence was an impressive 96.5% among MTM participants, compared to a national average of 79%. Moreover, no patients participating in the program were readmitted to the hospital for additional care.

Up to now, the MTM program has been limited to patients of AGHS physicians already enrolled in the Patient Centered Medical Home. Now, any patient of Atlantic General Hospital or Health system who is at-risk for medication mismanagement will be eligible to participate. In addition to one-on-one education, patients receive a pre-packaged medication service that helps simplify complex dosing for people taking multiple medications. With the expansion, this program will be able to accommodate 300 patients.

Integrative Health Services
With this new program we will provide access to a variety of services, allowing patients and their health care provider teams to choose their own treatments and select preferred providers to support the plan of care. The program will include an office to help navigate patients through the process while expanding upon existing community and health system resources and relationships.

Available services will include massage, reflexology, reiki, meditation, tai chi, animal-assisted therapy, acupuncture, nutrition counseling, yoga, essential oils/aroma therapy, osteopathic
manipulation and creative writing.

The second phase of the Integrative Health Services program, to be explored the following year, will include a multigenerational wellness center where community residents can receive these services in one location.

Project Management Office
With the rapid changes happening in healthcare, Atlantic General Hospital and Health System is establishing a project management office. We have hired a project management director who will oversee this office and implement systems to track progress as well as improve workflow and communications in the efficient implementation and funding of complex projects.

In addition to these initiatives, during Fiscal Year 2018 we will continue to research plans for establishing a cardiopulmonary rehabilitation center, a pain rehabilitation program, and geriatric care services.

AGHRx RediScripts Pharmacy Transitions-in-Case Program
We’ve expanded care coordination services offered by RediScripts to include the development of medication plans of care within the overall treatment plan of patients. The goal is to assist patients with medication instructions in simple, easy-to-understand language that is presented in engaging and intuitive formats. While the main focus is on education, patients also benefit by receiving pre-packaged medications, organized in blister packs by dosage amount and time of day - offered as a free service to those participating in the program. This program also allows for patients who have the most complex health or medication requirements to be seen in their homes.

Perioperative Surgical Home Model
Most hospital surgery systems fail to offer a “continuum of care” that covers the full perioperative period, which begins with the decision to operate and often ends well after discharge. Instead, pre-op, surgery and post-discharge are treated as discrete episodes of care. Our initiative improves efficiencies along with standardizing the approach for procedures. It is a big help to our elderly population - many of whom may have chronic health conditions and who comprise a large portion of our surgery patients.

As these patients are typically at higher risk of experiencing complications during or after surgery, this initiative includes the implementation of a standardized pre-admission process in which a nurse case manager identifies high-risk patients, coordinates the necessary testing, and arranges anesthesiologist visits with patients prior to scheduling surgery. Patients are also evaluated via phone following discharge. The result is improved health outcomes, reduced costs because of eliminating cancellations and delays in surgery, lower rates of complications and readmissions, as well as reduced lengths of stay in the hospital.

Women's Health Services in West Ocean City
Building a facility dedicated to providing comprehensive women’s health services - including outpatient minor surgical procedures and diagnostic testing - has been an important focus of our Campaign for the Future. Our newly opened Women’s Health Center provides the latest 3D mammography, ultrasound and bone density testing capabilities, delivered in a warm and comforting environment. Convenient appointments for gynecology consultations are coordinated in conjunction with any needed screenings, working around the schedules of today’s busy women.

During Fiscal Year 2017, AGH also implemented upgrades to the PERKS Electronic Medical Record Keeping System and other IT infrastructure while investigating plans for a cardiopulmonary rehabilitation center, pain rehabilitation program, radiation oncology services, community supportive care services, and additional care coordination support. We extend special thanks to our donors and all others who have supported the AGH Foundation in helping to make these programs possible.

Home Sleep Studies
Traditional sleep studies, also known as a polysomnography (PSG), are conducted in the Hospital's Sleep Lab. The study is used to evaluate heart rhythms, breathing, sleep patterns and bodily movements. It involves spending the night in an unfamiliar sleep lab, with various electrodes and wires connected to the patient's body. While very accurate, the traditional tests are expensive, inconvenient and many patients have difficulty getting a good night's sleep in an unfamiliar place. Home Sleep Studies use a simple device which the patient takes home and wears to bed. The patient is given instructions by a Sleep Tech earlier in the day before the exam and brings it back the next day. The recorded data is evaluated by a physician board-certified in Sleep Disorders. A report is generated and sent to the provider who ordered the test and, if there are positive findings, treatment options can be discussed with the patient.

AGH's Sleep Lab will expand services to provide Home Sleep Tests (HST) to increase patient and provider satisfaction and revenues outside the hospital setting. Implementation of this plan will require the purchase or rental of capital equipment in the form of HST testing units and supplies. The plan is to have Home Sleep Studies operationalized by fall 2015.

Pulmonary Clinic
A Pulmonary Clinic will provide comprehensive disease education, diagnostics and treatment for our patients with chronic pulmonary diseases, by delivering the Right Care in the Right Place for our community. Atlantic General Hospital currently does not offer this service to our patients and community. Readmission rates for chronic pulmonary diseases are one of the highest for Atlantic General Hospital at 8.3%. In 2014 Atlantic General Hospital had 226 patients admitted with a primary diagnosis of COPD. According to the American Lung association Worcester County has 6444 patients with chronic pulmonary disease, and Sussex County Delaware has 29016 patients with chronic pulmonary disease. Evidence has shown that comprehensive education and enhanced literacy reduces hospital readmission rates and as well as patient self­ management of their disease process. A pulmonary clinic could help avoid these admissions by providing an outpatient service to help patients avoid times of exacerbation and how to self­manage their disease process. The plan is to have the Pulmonary Clinic open by August 1, 2015. Pulmonary clinic would benefit patients in multiple ways. Some of these are:

• Reduce recidivism
• Sustained control of symptoms
• Enhanced quality/duration of life
• Teaching proper breathing techniques
• Medication Education
• Relaxation Techniques
• How to do everyday tasks with less shortness of breath
• How to cope with changes that that often accompanies COPD-depression, panic, anxiety and others.
• How to avoid COPD exacerbations

Planning only-Community Supportive Care Services
We will be planning Community Supportive Care Services, beginning with the coordination of care for patients having chronic illness, and ending with collaboration between Cancer Care, PCMH, AGHS, community healthcare providers, and local hospices. Early interventions from Supportive Care and Palliative Medicine Services lead to better patient and caregiver outcomes. These include improvement in symptoms, quality of life, patient/family satisfaction, continuity of care, and reduced caregiver burden. The intent of this plan is to reduce costs, emergency visits, and re-hospitalizations, while providing patient and family-centered support to se1iously ill patients. It is important to start planning in FY 2016 to link diverse health care services for effective and efficient care of patients by providing well-planned care and treatment that anticipates fuh1re care needs, engages the patient, family, and caregivers in patient centered/family oriented care, increases health literacy through the Faith Partnership, and enhances mental health support by partnering with AHC Behavioral Health, Worcester County Health Department, SU, and NAMI/MD. It is anticipated that this plan will require an outpatient setting, build-out expense, and FTE's.

Planning only-Cardiac Rehabilitation
We will begin planning for Cardiology Services to be performed in an out- patient rehab clinic and will be coordinating efforts with a long-term cardiopulmonary rehab and prevention program. The current service/process does not exist at AGH and causes the patients we serve to seek care elsewhere often in a competitor's facility. It is important to start planning in FY 2016 because it will support AGH's Vision and Mission of Care.Coordination and the concept of the Right Care, the Right People, the Right Place and the Right Hospital. It is anticipated that this plan will require additional FTEs, capital equipment acquisition, renovation of new or existing rehab space and IT resources.

Planning only-Nurse PICC Team
We will begin planning for a PICC/Vascular Access team, beginning with nurses placing all inpatient PICC lines at bedside with the use of ultrasound and 3CG Sapiens System and ending with nurses placing PICC lines for all inpatients and outpatients. These goals can be accomplished by staff currently trained with resources already available, and have the required equipment to place PICC's by nurses. The CUITent service/process of placing PICC lines incurs more cost to the patient, delays in discharges and increased resources for imaging and nursing. This plan is intended to improve patient satisfaction, enhance patient safety, decrease IV infiltrates, decrease length of stay, improve safety of medication administration and decrease in our readmissions. It is important to start planning in FY 2016 because it will support AGH's Vision and Mission of Care.Coordination and the concept of Right Care, the Right People, the Right Place and Right Hospital. It is anticipated that this plan will require an additional FTE but will not require additional capital, IS resources or supplies.

Clinical Affiliations and Vertical Integration
Goal: Continue to identify how the organization can align with appropriate healthcare partners to improve the healthcare delivery system in our community.

Clinical Documentation Improvement (CDI) and Computer Assisted Coding (CAC)
Improve documentation and coding accuracy for the healthcare services provided to ensure appropriate reimbursement.

Non-Surgical Weight Loss Program
Goal: to provide a physician-monitored medical weight loss program to complement bariatric surgery options for the region.

Pain Management Program
Goal: to provide increased access to much-needed pain management care to Worcester County and the surrounding area.

West Ocean City Expansion (initiative continued from FY2014)
Goal: to provide additional specialty and primary care services where the community needs them.

Health Literacy Program
Goal: to introduce health literacy concepts into school curriculum
We are working with the Worcester County Public Schools and University of Maryland School of Public Health to draft & implement the first health literacy standards for public schools in the nation.

Provider Relationship Management
Goal: To understand physician preferences and patterns, so we can identify where we need to invest time and resources to meet the needs of our community.

West Ocean City Expansion
Goal: to provide additional specialty and primary care services where the community needs them.

Ancillary Pharmacy
Goal: To improve patient compliance with medication orders by providing convenient prescription fills upon discharge.
This will help to decrease hospital readmissions. Additional benefits will be added convenience, prescription assistance services for indigent, and a reduction in prescription drug costs for associates.

Clinical Affiliations & Vertical Integration
Goal: to identify how the organization can align with appropriate healthcare partners to improve the healthcare delivery system in our community.
We are exploring telemedicine partnerships with rehabilitation centers, home health agencies, and long-term nursing facilities among other efforts.

In Fiscal Year 2013, we focused on three primary strategic initiatives: Expanding our services in the southern Sussex County area; creating a Vascular Access Center of Excellence for patients undergoing hemodialysis; and improving our IT connectivity in the region by investing in connecting to the new Maryland Broadband fiber optic infrastructure.

Southern Sussex County
Sussex County has one of the fastest-growing populations in the region served by Atlantic General Hospital and Health System. To meet the needs of the community and support our mission to improve access to services, we are expanded the medical office in Selbyville, to include specialties such as neurology and women’s health. Additionally, Atlantic General will be improving communication to residents and visitors regarding available healthcare services and offices located in Ocean View, Selbyville, and the Atlantic ImmediCare walk-in clinic in Millsboro Rite Aid.

Vascular Center of Excellence
We also focused on improving our capacity and equipment for accommodating patients who need access for their hemodialysis care. General surgeon, Alae Zarif, M.D., lead this effort with us, including selecting and ordering equipment for our surgical services team. Due to the high incidence of diabetes in our community, and the high proportion of individuals over the age of 65, we care for an increasing number of patients who require hemodialysis in our community.

Maryland Broadband
Due to our expansion of electronic medical records (EMR) throughout the community, our conversion to all-digital imaging in radiology over the past six years, and other uses for the Internet infrastructure in our community, the existing community IT network infrastructure had become over-burdened with all of the traffic (AGH/HS traffic, banking traffic, credit card use traffic in retail settings, etc.) Over the past year, the Maryland Broadband initiative, funded by federal and state grants, laid fiber optic cable along Rt. 113 that connects our region to the rest of Maryland. This project is still being completed, and few “terminal branches” from the main fiber have been connected. This year, we connected the hospital, the James G. Barrett Medical Office Building, and some of our physician offices to this fiber. This has greatly enhanced the speed of our connectivity for our EMR data sharing.

Emergency Room Expansion
With the number of Emergency Room visits continuing to rise, Atlantic General Hospital recently created a pilot program to redesign patient flow, converting two registration areas to triage rooms, where patients are first evaluated, and turning the existing triage room into a protocol room. The protocol room is a space where treatment and diagnostics such as blood draws and EKGs can begin, allowing for a more continuous flow of patients even when the emergency room beds are full. This plan has reduced Emergency Room wait times and increased the community’s access to emergency care. Planning for a more permanent change will begin in the fall of 2011.

AGHS Loyalty Cards and Kiosks
This fiscal year, computer kiosks will be placed in each of the Atlantic General Health System offices. The new system will offer patients the ability to check in for an appointment, update their personal information such as address, marital status and insurance information as necessary, and pay their co-pays for the appointment - all by using their patient loyalty card. The system will help ensure that the most accurate patient information and medical histories are maintained within the electronic health record. The kiosks will feature easy-to-use large button touch screen navigation, PalmSecure identification, patient summary screens, a credit card magnetic swipe, and multi-language support.

Center of Excellence for Joint Surgery
This fiscal year, Atlantic General Hospital is continuing to improve the patient care experience in its Center for Joint Surgery with the goal of evolving the program into a nationally-recognized Center of Excellence that provides patients with the ultimate healing environment - world-class physicians, specially chosen for skill in orthopedic joint replacement, combined with an effective program designed to educate and rehabilitate, through advanced preoperative care, enhanced inpatient experience, and coordinated after-care. Atlantic General Hospital Joint Center specializes in knee, hip and shoulder replacement.

Kronos
Kronos is a staff scheduling software system that furthers Atlantic General Hospital’s e-strategy plan to increase efficiency of hospital operations, thereby allowing the organization to intensify their focus on improving the overall patient care experience.

Project Management Software
This plan will establish a Project Management Office (PMO) for information services, which is a software program that will be used to track Atlantic General’s strategic initiatives and provide standardized status updates for all projects. This initiative is of tremendous importance in a time when large-scale information technology projects are the pathway to a more patient-centered model of care and improved quality measures for healthcare organizations nationwide.