From prenatal care to geriatric services, Crozer-Keystone Health System, whose market includes parts of Pennsylvania, Delaware and New Jersey, has made enormous strides in transforming the well-being of community residents who were most susceptible to poor health outcomes.

For these widespread initiatives, Crozer-Keystone has received the 2013 Foster G. McGaw Prize for Excellence in Community Service. The $100,000 annual prize, presented since 1986, is sponsored by the Baxter International Foundation, and the American Hospital Association and the Health Research & Educational Trust.

John O'Brien, chairman of the prize committee, praised Crozer-Keystone for fostering a healthy environment in which to live and work and to build and maintain families. "The system's exemplary community benefit programs address the entire lifespan — from programs that target the reduction of infant mortality to programs that support, educate and enable seniors to remain in their homes as long as possible," he says.

The system includes five hospitals, several outpatient centers, a wellness sports club, a network of 1,100 primary care physicians and specialists, and 6,500 employees. At the heart of its success are strong alliances with schools, county and local governments, senior centers and diverse faith groups.

"For more than 20 years, Crozer-Keystone Health System has partnered with others to address the needs of the residents of Delaware County," says Joan K. Richards, president and chief executive officer. "Our collaborative efforts have positively touched thousands of individuals. How we measure the impact of programs has changed and matured over time. How we design programs has changed and some of our partners have changed. But what has not changed is our commitment to improving the lives of members of our community."

When a household health survey — which has been conducted every two years since 1992 — repeatedly uncovered disparities in several major underserved areas, the system developed community activities aimed at infant mortality and childhood obesity, along with drug-related interpersonal violence, sexually transmitted diseases and crime.

Zeroing in by ZIP code

Crozer-Keystone serves a county with 550,000 people, an unemployment rate around 13 percent and no local health department. That makes "the system's leadership role in community health improvement of vital importance to vulnerable — and all — area residents," O'Brien says.

Delaware County is densely populated and shares a border with southwest Philadelphia. Well-to-do suburbs flourish near low-income urban neighborhoods, where more than 35 percent of the population lives below the poverty level and more than half of the residents depend on government subsidies.

"We're able to really drill down by ZIP code to begin to look at where the disparities are and address some of the needs of those communities," says Gwen Smith, R.N., president of Springfield Hospital and vice president of Community Health Services at Crozer-Keystone Health System.

Environmental concerns — stemming from oil refineries and other heavy industries along the Delaware River — compound the health problems plaguing economically challenged areas. In Delaware County, the prevalence of breast and lung cancers and other malignancies is much higher than national averages.

Crozer-Keystone instituted a number of programs that have shown positive changes and have grown in terms of people served, funding and impact. Among them are women's and children's health initiatives, which have decreased rates of premature births, low birth weights and infant deaths. "Our work here is at the beginning of the continuum," says Joanne Craig, administrative director of Women's and Children's Health Services. "You cannot have a healthy community if you do not start with healthy babies."

The initiative targets vulnerable women and teens with a history of poor birth outcomes, domestic violence, mental health or substance abuse issues, as well as a lack of familial support. They learn about the importance of maintaining a healthy weight before and during pregnancy and obtaining routine prenatal care for themselves and immunizations for their infants.

"Babies don't come with care tags," Craig says, explaining why the outreach about pregnancy and infant care is crucial. "They don't come with an instruction book."

The health system also undertook measures to lower the recurrence of asthma flare-ups; asthma-related emergency department visits and school absences have fallen. The interventions were implemented after Crozer-Keystone pediatricians performing school physicals found that in one school district, 24 percent of children suffered from asthma — almost 2.5 times higher than the state as a whole.

The initiative consisted of asthma screenings; pulmonology referrals; group education for students, parents and staff; and support of asthma camps and awareness days. A grant from the Environmental Protection Agency funded cleanup efforts to lessen asthma triggers at home.

A positive path for young people

Meanwhile, the adolescent-focused Crozer Wellness Center offers community-based leadership programs for youth from puberty to age 22. Serving more than 100 youths annually in Chester, Pa., the center prepares students for college, and boosts school attendance and on-time graduation rates. It builds workforce, leadership and service skills while reducing the incidence of violence and risky sexual behavior. Recently, the center also started a program for high school students to take introductory courses on a local college campus.

"We're trying to make sure that each young person who comes through our programs receives the support he or she needs to become a healthy, successful adult," says Kate Blackburn, administrative director of the Crozer Wellness Center, which is based at Community Hospital. "A number of our staff are alumni of the programs, which shows that they cared enough to come back."

Nafis Nichols initially joined as a sixth-grader. "As I matriculated through high school, I became a peer leader," he says. After high school, he was hired as a program assistant and later became one of the first participants in an internship created for alumni of the Crozer Wellness Center's programs. During the internship, he worked in departments throughout the health system — from administration to finance and the laboratory. "I've been around the block and gotten a good feel for how a health system works," says Nichols, 28, who earned a college certificate in nonprofit management and is completing his bachelor's degree in marketing. He's now senior program coordinator of Chester Drug Free Communities, which aims to reduce substance abuse in young people.

Along with a supportive family, Nichols credits the Crozer Wellness Center with his interpersonal development and active involvement in community health. "The program played an intricate role in my leadership abilities and skills," he says. It "helps groom and transition you successfully into adulthood."

On the cancer front, Crozer-Keystone's oncology department recruits physicians as speakers for more than 120 early detection and prevention educational programs every year in more than 100 community sites. The topics — determined by the indicators in the biennial health survey — include skin, colorectal, prostate, lung and breast cancers. They target audiences across the lifespan, from youths to older adults.

Breast health programming emphasizes elimination of cancer as a life-threatening disease. Collaborating with 15 local organizations and funded by Susan G. Komen Philadelphia, Crozer-Keystone provides outreach, information and referrals.

"Our goal is to educate the community on the importance of screening and early detection in the hope of diagnosing cancer at the earliest stage, which has a direct effect on patient outcomes," says Marie DeStefano,R.N., senior administrative director of oncology at Crozer-Keystone.

More than 2,000 women are served each year, including diverse immigrant groups with cultural, language and socioeconomic barriers. Separate programs for the uninsured and underinsured cover free mammograms and breast exams for about 600 women annually, as well as continuity of service for those who need follow-up diagnostic procedures and treatment.

Targeting older adults

The Senior Health Services Department bridges the gap between inpatient and outpatient needs for older adults. Through more than 40 yearly community presentations and various telephone support lines, including a triage service to assess needs and make appropriate referrals, the program prolongs independence. A transition program has greatly reduced hospital readmission of Medicaid patients.

Customized assistance is also available. The Crozer-Keystone Village, launched in 2009, relies on a concierge model. Personal navigators help older adults access such services as scheduling medical appointments; obtaining referrals; and arranging transportation, housecleaning, meal preparation and pet care. Membership costs $25 per month. All providers are thoroughly vetted.

"As you know, Americans are living longer," says Barbara Looby, director of senior services at Crozer-Keystone Health System. "We are aging in place, and some of us are aging with grace."

Susan Kreimer is a freelance writer in New York City.

2013 Finalists

In recognition of their significant accomplishments in community service, three Foster G. McGaw Prize finalists each received $10,000:

North Shore-LIJ Health System in Great Neck, N.Y., for its ability to embrace partnerships within the diverse communities it serves and empower people to take ownership of their own health and well-being.

Memorial Hermann Health System in Houston for striving to deliver the best health solutions to people in Southeast Texas through trusted partnerships with physicians, employees and others, while relentlessly pursuing quality and value.

St. Joseph Health, Queen of the Valley Medical Center in Napa, Calif., for committing to extend its role far beyond the traditional medical model and dedicating itself as a catalyst in promoting and safeguarding the community's health.