Community Health Needs Assessment
Community Health Needs Assessment Table of Contents Community Health Needs Assessment Executive Summary ............................................................................................................................................. 1 Community Profiles.............................................................................................................................................. 3 Assessment Process and Community Input....................................................................................................... 6 Watauga County ................................................................................................................................................... 8 Ashe County .......................................................................................................................................................... 13 Avery County......................................................................................................................................................... 17 Community Health Needs Identified in Assessment ....................................................................................... 20 Watauga Medical Center....................................................................................................................................... 22 Cannon Memorial Hospital................................................................................................................................. 23 Blowing Rock Hospital......................................................................................................................................... 24 Community Health Resources............................................................................................................................ 25 Implementation Strategy – Watauga Medical Center Introduction........................................................................................................................................................... 27 Health Needs Addressed...................................................................................................................................... 27 Health Insurance/Affordable Healthcare/Lack of Services............................................................................. 28 Obesity/Diabetes/Proper Nutrition.................................................................................................................... 29
Community Health Needs Assessment Cancer Prevention .............................................................................................................................................
30
Health Needs Not Addressed................................................................................................................................ 31 Implementation Strategy – Cannon Memorial Hospital Introduction .......................................................................................................................................................... 32 Health Needs Addressed ..................................................................................................................................... 32 Access to Primary Healthcare Services............................................................................................................... 33 Obesity/Diabetes/Proper Nutrition/Chronic Disease Management.............................................................. 34 Access to Mental Health Services........................................................................................................................ 35 Health Needs Not Addressed............................................................................................................................... 36 Implementation Strategy – Blowing Rock Hospital Introductions.......................................................................................................................................................... 37 Health Needs Addressed...................................................................................................................................... 37 Affordable Healthcare/Lack of Services.............................................................................................................. 38 Obesity/Diabetes/Proper Nutrition.................................................................................................................... 39 Cancer..................................................................................................................................................................... 40 Health Needs Not Addressed............................................................................................................................... 41
Community Health Needs Assessment I. Executive Summary Appalachian Regional Healthcare System (ARHS) conducted a community health needs assessment (CHNA) and developed an implementation strategy to address the health needs identified in the CHNA. ARHS helmed the assessment process with assistance provided by Watauga, Avery, and Ashe Counties. Data was collected from residents through surveys administered throughout the three counties, and interviews were conducted with key community leaders. This dual set of primary data was strengthened with secondary data from the North Carolina State Center for Health Statistics and County Health Rankings to provide a clear picture of the health issues affecting ARHS’s community. ARHS operates three hospitals in its service area – Watauga Medical Center, Charles A. Cannon. Jr. Memorial Hospital, and Blowing Rock Hospital. ARHS examined each hospital individually and prioritized the identified health needs for each community based upon the ability to make an impact and the significance of the health need to the community. Afterwards, ARHS developed an implementation strategy to take action and establish realizable goals in order to measure ARHS’s progress on addressing these health issues. The following is a list of the priorities. • Watauga Medical Center ◊ Health Insurance/Affordable Healthcare/Lack of Services ◊ Obesity/Proper Nutrition/Diabetes ◊ Cancer • Cannon Memorial Hospital ◊ Access to Primary Healthcare Services ◊ Obesity/Diabetes/Chronic Disease Management ◊ Access to Mental Health Services • Blowing Rock Hospital ◊ Affordable Healthcare/ Lack of Services ◊ Obesity ◊ Memory Care
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Community Health Needs Assessment The CHNA consists of five steps. The steps have been formulated into a picture to further broaden the understanding of the process. While the five steps for a CHNA are generally the same, the method of performing each step may vary between organizations. ARHS utilized methods that best suit the community surrounding each hospital.
ARHS completed the five steps of the CHNA and recorded the methods and results on the following pages. ARHS views this report as more than just a requirement. The CHNA is a representation of the community, and without the community, ARHS would not exist, so we would like to thank you – the community. We prepared this report for the community and desire any input to create a better representation going forward into the future.
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Community Health Needs Assessment II. Community Profile1 The CHNA is used to profile our community and find all of the health issues. However, one of the main characteristics of our community is the demographics. Demographics are vital to a community because it describes the region and culture of the people. Without knowing the demographics of the community it is hard to state the health needs and find a solution to them. A few key demographics that were considered were: location, ethnicity, age, and mean household income.
Appalachian Regional Healthcare System (ARHS) serves a population of approximately 91,000 people in northwestern North Carolina. ARHS’s primary service area is mostly rural and includes Watauga, Ashe, and Avery Counties. The community was determined based on the patients that visit each of the three hospitals. In particular, each hospital determined which counties represent a majority of their patients and the three counties mentioned previously constitute the primary service area. About 56% of the population lives in Watauga County which is home to the cities of Boone and Blowing Rock, as well as Appalachian State University. Data source is U.S. Census Bureau. See the website http://quickfacts.census.gov. The service area statistics were obtained by weighting each county’s statistic by the percentage of the individual county’s population compared to the service area’s total population. 1
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Community Health Needs Assessment
The above two pie charts represent the ethnicity distribution of the community (Watauga, Ashe, and Avery County) and the state of North Carolina. The community’s population is approximately 91% white, 4% African American, 4% Hispanic, and 1% Asian. The ethnicity for the region is not similar to the state or country statistics. The main two differences are the white population, 19% greater than the state average, and the black population, 18% lower than the state average.
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Community Health Needs Assessment
The above two pie charts represent the age distribution of the community (Watauga, Ashe, and Avery County) and the state of North Carolina. The age distribution consists of 16% of the population under the age of 18, 68% between the ages of 18-65, and 16% above the age of 65. Age statistics are similar when compared to North Carolina’s statewide percentages. The most notable age difference is that the age group under the age of 18 is 7.7% lower than the state average.
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Community Health Needs Assessment
The above bar chart represents the median household income distribution of the community (Watauga, Ashe, and Avery County) and state of North Carolina. ARHS’s service area mean household income is $35,590, which is $10,701 lower than the state average. Now that you have an idea of the community served by the hospitals, following is a review of the data assessment process and community input stages. III. Data Assessment Process and Community Input The data assessment process involves collecting statistical data. Prime examples of sources of this statistical data are the U.S. Census Bureau, North Carolina State Center for Health Statistics (NCSCHS), County Health Rankings, and Healthy People 2020. All of these sources were used in this report. Numerous websites nicknamed “warehouses” store this statistical data on the internet and generally allow the public free access. The major hurdle of the data assessment process involves sorting through the swarm of statistics, finding a common representation, and communicating the results in an understandable manner. The U.S. Census Bureau conducts a population and housing census every decade. This information would appear outdated if it were used. Instead, the Census Bureau conducts an American Community Survey annually. The American Community Survey is an ongoing survey that gives communities current information needed to plan investments and services. The survey asks about age, sex, race, income, health insurance, education, and a few other items. It is this survey that provides current, secondary, and statistical data that is useful for the CHNA. 6
Community Health Needs Assessment NCSCHS provides high-quality information on the health of North Carolinians and is mandated to administer statistical activities to the state of North Carolina. NCSCHS continuously explores new ways of obtaining, analyzing, and disseminating health data. The County Health Rankings program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The County Health Rankings show the rank of the health of nearly every county in the nation, and illustrate that much of what affects health occurs outside of the doctor’s office. A variety of measures that affect health are shown on the website. Healthy People 2020 provides science-based, 10 year national objectives for improving the health of all Americans. The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action. For three decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. The community input portion is generally derived from surveys distributed to residents of the community and specific interviews administered to community leaders that represent the community broadly and also represent underserved and chronically diseased populations. Secondary data is generated from the data assessment process and primary data is provided by community input. We have combined both of these inputs into one section to represent data collection as one unified front. ARHS’s assessment process mainly consisted of collaborating with health departments in Watauga, Ashe, and Avery Counties during each county’s community health assessment. Each county differed slightly in their approach to collecting data. However, each county utilized a survey to obtain direct input from their residents. In addition to surveys, the assessment used data from the US Census Bureau, North Carolina State Center for Health Statistics, and benchmarks from Healthy People 2020. The statistical data included amounts for the county, community, state, and national level. A detailed description of each county’s individual assessment process is provided to indicate the different approaches taken to assessing the community’s health.
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Community Health Needs Assessment A. Watauga County2 Watauga County established a task force that consisted of public health officials, hospital staff, Appalachian State University, mental health, and youth advocates for Watauga Counties. Prior to and during the survey collection, county residents were informed of the assessment through radio public service announcements, advertisements on agency websites, and word of mouth. The survey was available on-line through Survey Monkey, and at designated community agencies including county health departments, childcare centers, community health clinics, and other human service agencies. In total, 538 surveys were completed. Survey respondents represented various agencies and organizations in the community. Participants were asked a litany of questions designed to gauge current beliefs regarding community health, challenges, and service needs. The limitations of this study were primarily the subjective nature of open-ended questions. Participant responses were categorized based on the interpretations made by the creator of the survey.
2
See “Watauga County’s 2011 Community Health Assessment.”
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Community Health Needs Assessment Primary Health Concerns Household Income Total (N)
Male (%)
Female (%)
Caucasian (%)
Other (%)
75K (%)
Obesity
123
36
20.2
24.1
7.11
16.7
20.4
23.7
28.8
Cancer
26
3.6
5.4
4.9
7.1
8.3
3.4
5.1
4.9
Diabetes
12
1.8
2.4
2
14.3
4.2
4.1
0.8
1.1
Proper Nutrition
24
6.3
4.1
4.7
0
2.8
6.8
3.4
4.3
Mental Health
10
1.8
2
2
0
0
2
1.7
2.7
Substance Abuse Health Concerns
27
2.7
5.9
4.9
14.3
4.2
7.5
3.4
4.9
Tobacco Related Health Concerns
19
8.1
2.4
3.7
0
4.2
2.7
4.2
3.8
Health Issues Due to Environmental Concerns
6
1.8
1
1.2
0
2.8
1.4
0
1.1
Lack of Services
37
6.3
7.3
6.7
21.4
2.8
4.1
10.2
9.2
Affordable Services / Insurance
179
23.4
37.3
34.9
14.3
37.5
36.7
33.9
31.5
Other
58
8.1
12
10.8
21.4
16.7
10.9
13.6
7.6
The above chart is an excerpt from the Watauga County Community Health Assessment. The chart displays the total number of surveys and the breakdown percentages for multiple categories. The total number of surveys on the chart does not equal the total number of surveys completed. The difference is because some people decided not to answer the question or had both/all of the answers checked. In those situations the question with the invalid response was not used in the statistics. However, this charts demonstrates what the community believes are
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Community Health Needs Assessment the biggest health concerns. Also note that the chart displays input taken from minority populations and individuals with low-income. Information from the surveys was compared to secondary health data from the North Carolina State Center for Health Statistics and Healthy People 2020. The data from the surveys were utilized by the health department representatives and community human service agency representatives to select the community needs and prioritize the health issues for the county. The health department representing Watauga County selected three health priorities to address (obesity, health insurance/affordable healthcare, and substance abuse prevention). Primary data from interviews, statistics, and survey results were presented to the Appalachian District Community Health Assessment Team to discuss the priorities for Watauga County. This group worked together to select the top three priorities for Watauga County. The priorities are presented with a graph to display how the county and state compare with the Healthy People 2020 target goal. Green indicates that the target is being met, while red indicates that the target is not being met.
Watauga
North Carolina (29%)
Obesity
(25%)
30.6% -5.6%
Healthy People 2020 Target
-1.6%
Above is the graph for obesity in the county, state, and the Healthy People 2020 target. Watauga County and North Carolina statistical numbers were obtained from County Health Rankings. The middle line represents the Healthy People 2020 target. While the targets are being met, obesity still remains an important health priority for the county. 10
Community Health Needs Assessment Watauga
Health Insurance/Affordable Care
(19%)
+1%
North Carolina (21.1%)
+3.1% 18%
Healthy People 2020 Target
Above is the graph for health insurance/affordable care in the county, state, and the Healthy People 2020 target. Watauga County and North Carolina statistical numbers were obtained from County Health Rankings. The middle line represents the Healthy People 2020 target. Neither the county nor the state is meeting the target.
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Community Health Needs Assessment Watauga
(12%)
Substance Abuse
(18%)
North Carolina
25.5% -7.5%
Healthy People 2020 Target
-13.5%
Above is the graph for substance abuse in the county, state, and the Healthy People 2020 target. Watauga County and North Carolina statistical numbers were obtained from County Health Rankings. The middle line represents the Healthy People 2020 target. Both the county and the state are meeting the target. Watauga County Community Health Assessment Team considered numerous factors into their consideration of the three most important health priorities. So coming to a conclusion based upon quantitative (statistical) data only would skew the health priorities. They also had survey results and interviews to add to the data. The CHA team chose the three health needs based upon all of the quantitative data, surveys, interviews, as well as the ability to make an impact and significance of the health issue to the community. The Community Health Assessment Team consisted of the following individuals and entities: Bryan Belcher, Watauga County Healthy Carolinians, Appalachian Regional Healthcare System; Janet Braithwaite, Ashe Memorial Hospital; Ralph Castillo, Alleghany Memorial Hospital; Stephanie Craven, Appalachian District Health Department; Cindy Douglas, Appalachian District Health Department; Beth Fornadley, Appalachian District Health Department; Jennifer Greene, Appalachian District Health Department; Angela Hagaman, Western Youth Network; Kaitlyn Jongkind, Appalachian District Health Department; Teri Vandyke, Appalachian District Health Department; and R.D. Williams, Ashe Memorial Hospital.
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Community Health Needs Assessment In a recent Robert Wood Johnson Foundation report, Watauga County ranked the 3rd overall healthiest county in North Carolina. The criteria for the healthiest county look at a model of population health emphasizing policies and programs; health factors and health outcomes.3 B. Ashe County 4 The Ashe County assessment process closely resembled the Watauga County assessment process. Ashe County used information for the assessment that was collected from county residents using written survey instruments. Prior to and during the survey collection, county residents were informed of the assessment through radio public service announcements, advertisements on agency websites, and word-of-mouth. The survey was available online through Survey Monkey, and at designated community agencies including county health departments, childcare centers, community health clinics, and other human service agencies. In total, 479 surveys were completed. Survey respondents represent various agencies and organizations in the community. Participants were asked a litany of questions designed to gauge current beliefs regarding community health, challenges, and service needs. The limitations of this study were primarily the subjective nature of open-ended questions. Participant responses were categorized based on the interpretations made the creator of the survey. Primary Health Concerns Household Income Total (N)
Male (%)
Female (%)
Caucasian (%)
Obesity
70
11.1
16.2
Cancer
91
18.5
20.2
75K (%)
15.5
7.1
13.1
17.4
16.2
13.5
20
14.3
19.7
24
17.1
18
Diabetes
5
0
1.3
1.1
0
1.6
0.8
0.9
1.1
Proper Nutrition
15
4.9
2.9
2.9
14.3
2.5
2.5
4.3
4.5
Mental Health
27
4.9
6.1
6.1
0
4.9
5.8
6
7.9
Substance Abuse Health Concerns
30
9.9
5.9
7
0
4.1
4.1
12.8
6.7
Tobacco Related Health Concerns
8
1.2
1.9
1.6
7.1
1.6
0.8
3.4
1.1
Health Issues Due to Environmental Concerns
10
0
2.7
2
7.1
2.5
2.5
2.6
1.1
Lack of Services
17
7.4
2.9
3.8
7.1
1.6
3.3
5.1
6.7
Affordable Services / Insurance
119
32.1
24.7
26.3
14.3
30.3
28.1
19.7
25.8
Other
65
9.9
15.2
13.7
28.6
18
10.7
12
13.5
3
See High Country Press at www.hcpress.com.
4
Other (%)
See “Ashe County’s 2011 Community Health Assessment.” 13
Community Health Needs Assessment The chart on the previous page is an excerpt from the Ashe County Community Health Assessment. The chart displays the total number of surveys and the breakdown percentages for multiple categories. The total number of surveys on the chart does not equal the total number of surveys completed. The difference is because some people decided not to answer the question or had both/all of the answers checked. In those situations the question with the invalid response was not used in the statistics. However, this charts demonstrations what the community believes are the biggest health concerns. The health department representing Ashe County selected three health priorities to address (obesity, health insurance/affordable healthcare, and mental health). Primary data from interviews, statistics, and survey results were presented to the Appalachian District Community Health Assessment Team to discuss the priorities for Ashe County. This group worked together to select the top three priorities for Ashe County. The priorities are presented with a graph to display how the county and state compare with the Healthy People 2020 target goal. Green indicates that the target is being met, while red indicates that the target is not being met.
Ashe County
North Carolina (29%)
Obesity
(23%)
30.6% -7.6%
Healthy People 2020 Target
-1.6%
Above is the graph for obesity in the county, state, and the Healthy People 2020 target. Ashe County and North Carolina statistical numbers were obtained from County Health Rankings. The middle line represents the Healthy People 2020 target. Both the county and state are meeting the target.
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Community Health Needs Assessment Ashe County
Health Insurance/Affordable Care
(21%)
+3%
North Carolina (21.1%)
+3.1% 18%
Healthy People 2020 Target
Above is the graph for health insurance/affordable care in the county, state, and the Healthy People 2020 target. Ashe County and North Carolina statistical numbers were obtained from County Health Rankings. The middle line represents the Healthy People 2020 target. Neither the county nor the state is meeting the target.
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Community Health Needs Assessment Ashe County
North Carolina
+13.7%
+1.9%
(12.1%)
Mental Health
(23.9%)
10.2%
Healthy People 2020 Target
Above is the graph for mental health in the county, state, and the Healthy People 2020 target. Ashe County and North Carolina statistical numbers were obtained from North Carolina State Center for Health Statistics. The middle line represents the Healthy People 2020 target. Neither the county nor the state is meeting the target. Ashe County Community Health Assessment Team considered numerous factors into their consideration of the three most important health priorities. So coming to a conclusion based upon quantitative (statistical) data only would skew the health priorities. They also had survey results and interviews to add to the data. The CHA team chose the three health needs based upon all of the quantitative data, surveys, interviews, and the ability to make an impact and significance of the health issue to the community. The Community Health Assessment Team consisted of the following individuals and entities: Bryan Belcher, Watauga County Healthy Carolinians, Appalachian Regional Healthcare System; Janet Braithwaite, Ashe Memorial Hospital; Ralph Castillo, Alleghany Memorial Hospital; Stephanie Craven, Appalachian District Health Department; Cindy Douglas, Appalachian District Health Department; Beth Fornadley, Appalachian District Health Department; Jennifer Greene, Appalachian District Health Department; Angela Hagaman, Western Youth Network; Kaitlyn Jongkind, Appalachian District Health Department; Teri Vandyke, Appalachian District Health Department; and R.D. Williams, Ashe Memorial Hospital.
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Community Health Needs Assessment Ashe County was ranked the 42nd healthiest overall county in North Carolina by the Robert Wood Johnson Foundation. The criteria for the healthiest county look at a model of population health emphasizing policies and programs; health factors and health outcomes.5 C. Avery County6 The Avery County assessment process was conducted by Professional Research Consultants, Inc. (PRC) which is a nationally-recognized healthcare consulting firm. The assessment process incorporated primary data from community health surveys and compared the results to benchmark data at the regional, state, and national levels. This benchmark data consisted of data reported in the most recent Behavioral Risk Factor Surveillance System (BRFSS) Prevalence and Trend Data report published by the Centers for Disease Control and Prevention (CDC) and the US Department of Health & Human Services; and Healthy People 2020. Many of the questions in the community health survey administered in Avery County are derived from the CDC, BRFSS, as well as other public health surveys; other questions were developed specifically to address particular issues of interest to local communities. To ensure the best representation of the population surveyed, a telephone interview methodology, one that incorporates both landline and cell phone interviews, was employed. The primary advantages of telephone interviewing are timeliness, efficiency and random-selection capabilities. The survey was divided into six general areas designed to gather a comprehensive picture of community health in Avery County. The areas included quality of life, general health status, chronic conditions & injury, modifiable health risks, access to health services, and health education & outreach. The survey results were compared to Healthy People 2020 data to compare primary and secondary data and formulate a solid basis to determine which health needs are most important to the community. The sample design used for this effort consisted of a random sample of 200 individuals age 18 and older in Avery County, North Carolina. The health department representing Avery County selected three health priorities to address (substance abuse prevention and increasing availability/access of mental health services; access to primary healthcare services; and access to dental care services). Primary data from surveys and secondary data from statistics were presented at a public forum to discuss the priorities for Avery County. This group worked together to select the top three priorities for Avery County. The priorities are presented with a graph to display how the county and state 5
See High Country Press at www.hcpress.com.
6
See “Avery County’s 2012 Community Health Assessment.” 17
Community Health Needs Assessment compare with the Healthy People 2020 target goal. Green indicates that the target is being met, while red indicates that the target is not being met.
Avery County
North Carolina
+13.2%
+1.9%
Mental Health
(23.4%)
(12.1%)
10.2%
Healthy People 2020 Target
Above is the graph for mental health in the county, state, and the Healthy People 2020 target. Avery County and North Carolina statistical numbers were obtained from North Carolina State Center for Health Statistics. The middle line represents the Healthy People 2020 target. Neither the county nor the state is meeting the target.
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Community Health Needs Assessment Avery County
North Carolina
+8%
+3.1%
Health Insurance / Affordable Care
(26%)
(21.1%)
18%
Healthy People 2020 Target
Above is the graph for health insurance/affordable care in the county, state, and the Healthy People 2020 target. Avery County and North Carolina statistical numbers were obtained from County Health Rankings. The middle line represents the Healthy People 2020 target. Neither the county nor the state is meeting the target.
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Community Health Needs Assessment Avery County
Visited Dentist in Past Year
(60.4%)
+11.4%
North Carolina (68.4%)
+19.4%
49%
Healthy People 2020 Target
Above is the graph for the percentage of the community that visited the dentist in the past year in the county, state, and the Healthy People 2020 target. Avery County and North Carolina statistical numbers were obtained from 2012 Avery County CHA conducted by PRC. The middle line represents the Healthy People 2020 target. Both the county and the state are meeting the target. Avery County was ranked the 22nd healthiest overall county in North Carolina by the Robert Wood Johnson Foundation. The criteria for the healthiest county look at a model of population health emphasizing policies and programs; health factors and health outcomes.7 IV. Community Health Needs Identified in Assessment ARHS is unique in the fact that it operates three hospital facilities: Watauga Medical Center in Boone (Watauga County), Charles A. Cannon, Jr. Memorial Hospital in Linville (Avery County), and Blowing Rock Hospital in Blowing Rock (Watauga County). ARHS considers Ashe, Avery and Watauga counties as its Primary Service Area. ARHS is in a position to combine and utilize the resources of the three hospitals to meet the community’s needs. Fortunately, the IRS recently issued Proposed Regulations for CHNAs that enable ARHS to take advantage of their position. The Proposed Regulations §1.501(r)-3(b)(7)(E)(v) lists the requirements for a group of hospital facilities that collaborate on the assessment process to issue the same CHNA report.
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See High Country Press at www.hcpress.com. 20
Community Health Needs Assessment The four requirements are (1) that the community for all hospital facilities be defined the same, (2) the hospital facilities conduct a joint CHNA process, (3) the joint CHNA report is clearly identified as applying to the hospital facility, and (4) an authorized body of the hospital facility adopts the joint CHNA report. The community has been defined as the same three counties (Watauga, Ashe, and Avery) for all three hospital facilities. The hospital facilities worked together to conduct the CHNA process, and each hospital facility is specifically identified. Finally, the authorized body of each hospital facility adopted the joint CHNA report. The survey results gathered by each county were counted and compiled to make a list of the health needs the community believed were the most important. Based on the number of responses, twelve health needs were identified. • Access to healthcare • Affordable healthcare/health insurance • Aging problems • Cancer • Diabetes • Environmental health concerns • Heart disease • Mental health • Obesity • Proper nutrition • Substance abuse • Tobacco use ARHS commenced the CHNA process by looking at the communities actually served by the hospital. The committee is now concluding the CHNA process by prioritizing the health needs identified by the community. Each individual hospital is prioritizing their own needs to address and implementing strategies to meet those health needs chosen as priorities. The health needs not chosen as priorities will be addressed in the implementation strategy. The three hospitals identified their health priorities and decided to choose the following health needs to address:
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Community Health Needs Assessment Watauga Medical Center 1. Health Insurance/Affordable Healthcare/Lack of Services 2. Obesity/Proper Nutrition/Chronic Disease 3. Cancer Watauga Medical Center chose the three health priorities above for the hospital. The health needs were based on two factors: the ability of the hospital to impact the health need, and the significance of the health need to the community. Primary data from interviews and survey results along with secondary statistical data from the North Carolina State Center for Health Statistics were presented to Chuck Mantooth, President, Watauga Medical Center, Claire Cline, ARHS Sr. VP Patient Care and Chief Clinical Officer, Kim Bianca, ARHS Sr. VP Outpatient & Clinical Services, and Gillian Baker, ARHS VP Corporate Communications & Community Outreach to discuss the priorities for Watauga Medical Center.
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Community Health Needs Assessment Cannon Memorial Hospital 1. Access to Primary Healthcare Services 2. Obesity/Proper Nutrition/Chronic Disease Management 3. Access to Mental Health Services Cannon Memorial Hospital chose the three health priorities above for the hospital. The health needs were based on two factors: the ability of the hospital to impact the health need, and the significance of the health need to the community. Primary data from interviews and survey results along with secondary statistical data from the North Carolina State Center for Health Statistics were presented to Carmen Lacey, President, Charles A. Cannon Jr. Memorial Hospital and Gillian Baker, ARHS VP Corporate Communications & Community Outreach to discuss the priorities for Cannon Memorial Hospital. This group worked together to select the top three priorities for the hospital.
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Community Health Needs Assessment Blowing Rock Hospital 1. Affordable Healthcare/Lack of Services 2. Obesity/Proper Nutrition/Chronic disease 3. Cancer Blowing Rock Hospital chose the three health priorities above for the hospital. The health needs were based on two factors: the ability of the hospital to impact the health need, and the significance of the health need to the community. Primary data from interviews and survey results along with secondary statistical data from the North Carolina State Center for Health Statistics were presented to Tim Ford, President & CEO Blowing Rock Hospital, Claire Cline, ARHS SVP Patient Care and Chief Clinical Officer, and Gillian Baker, ARHS VP Corporate Communications & Community Outreach to discuss the priorities for Blowing Rock Hospital. This group worked together to select the top three priorities for the hospital.
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Community Health Needs Assessment V. Community Health Resources ARHS’s service area has many resources available to meet the twelve identified health needs. ARHS plays a large role in the community by offering volunteer services, facilitating health fairs and screenings, and sponsoring support groups.
Legend Health Needs Access to Healthcare Affordable Healthcare / Health Insurance Aging Problems Cancer Diabetes Heart Disease Mental Health Obesity Substance Abuse Proper Nutrition Environmental Health Concerns Tobacco Use
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Abbreviation ATH AHHI AP CN DB HD MH OB SA PN EHC TU
Community Health Needs Assessment Healthcare Facilities & Other Resources
Description of Facility Resource
Health Needs
AccessCare
Provides improved access to medical services
Alcoholics Anonymous of Boone
Provides support for recovering alcoholics and those affected by alcoholism
ATH SA
Alzheimer’s Association of Western NC
Provides peer or professionally led groups for caregivers and others dealing with Alzheimer’s disease
AP
American Cancer Society
Provides resources, information and support that will help you stay motivated to eat right and get active, quit smoking or help a loved one kick the habit, and understand what cancer screenings you need.
American Heart Association
Provides public education and awareness to the community
American Red Cross - Watauga / Avery
Provides assistance to people in need
Appalachian District Health Department Ashe, Alleghany & Watauga County Health Departments
Provides education and provision of essential public health services
Appalachian Healthcare Project
Provides access to healthcare for low income, uninsured residents in Watauga and Avery County
ATH/CN/DB/HD/OB
Appalachian Regional Healthcare System
Provides high quality and compassionate healthcare for the region with three hospitals, Blowing Rock Hospital & Extended Care, Chalres A. Cannon, Jr. Memorial Hospital, Watauga Medical Center; a physician practice management group and an array of outpatient centers
ATH/AHHI/AP/CN/DB/ HU/MH/OB/PN/TU
Ashe Medication Assistance Program
Provide assistance to people getting their medication by reducing or getting the medicine for free
Avery Cares
Individual, group and family counseling for Substance Abuse
Avery County Department of Social Services
Provides citizens who meet basic financial and social needs to become self sufficient
Camp Sunshine
Provides bereavement summer camp for children
Community Care Clinic - A Free Clinic
Provides healthcare to low-income persons in our community who do not have health insurance
DayMark Recovery Services
Provides crisis services and therapy
MH/SA
Girls on the Run
Girls on the Run is a life-changing after school program for 3rd - 5th grade girls. Its highly interactive curriculum combines self-esteem enhancing lessons with uplifting workouts aimed to develop the whole girl; her physical, mental, emotional and social wellbeing
OB/PN
High Country Community Health Watauga and Avery County
Provides dental and medical care for everyone
High Country Diabetes Support Group
Provides information on diabetes and on care and treatment options for those with diabetes
High Country United Way
A community-based organization that develops human and financial resources to improve the quality of life and deploys resources via Health, Income and Education Vision councils.
AP/CN/TU
AP/HD PN ATH/AHHI/DB/OB/PN/ EHC/TU
ATH/ AHHI SA ATH/AHHI MH ATH/AHHI
ATH/AHHI/DB/SA/TU DB ATH/OB/PN/HD/DB
Hospice of Watauga County
Provides hospice care and bereavement for the ill
Latino Health Programs
Provides education, increased access to care, and other services to Latinos in Watauga and Avery County
AP
McLeod Addictive Disease Center
Provides addictive disease treatment services
SA
ATH/DB/OB/PN
Seby B. Jones Regional Cancer Center
Provides cancer treatment and a Cancer Resource Alliance
CN
Services for Aging -Ashe, Avery and Watauga
Provides services and opportunities to the elderly
AP
Toe River Health District - Avery County Health Department
Provides education and provision of essential public health services
Watauga County Department of Social Services
Provides citizens who meet basic financial and social needs to become self sufficient
Watauga County Planning and Inspections
Provides strategic plans for the county in case of a natural disaster
Watauga County Project on Aging
Provides supportive services to the elderly
AP/PN
Wellness Center of Appalachian Regional Healthcare System - Watauga County
Personal training; High school strength and conditioning; Cancer wellness program; Prenatal/ Postnatal classes; CPR classes; Nutrition classes; First Aid classes; Facilities offer and indoor track, weight lifting equipment, Racquetball, Volleyball and Basketball courts, Childcare services and a pool.
OB/PN
Williams YMCA of Avery County
YMCA programs, activities and relationships teach and model Christian values - compassion, honesty, respect, responsibility and faith are evident in all that they do
ATH/AHHI/EHC ATH/AHHI EHC
OB/PN/DB
26
Implementation Strategy
Implementation Strategy -Watauga Medical Center I. Introduction Watauga Medical Center (Medical Center) will engage key community partners in implementing evidencebased strategies across the service area. Acknowledging the many organizations and resources in place to address the health needs of our communities, the Medical Center has strategically reviewed both internal and external resources. This portion of the CHNA, the Implementation Strategy, will explain how the Medical Center will address health needs identified in the CHNA by continuing existing programs and services, and by implementing new strategies. It will also explain why the hospital cannot address all the needs identified in the CHNA, and if applicable, how the Medical Center will support other organizations in doing so. II. Health Needs Addressed As aforementioned in the CHNA report, the following are the needs the Medical Center has chosen to address. We discuss why we chose to address each need, how we will address the need, who the responsible party will be, and any goals that will be set forth from the beginning, as well as time frame for achieving those goals. The three health needs being addressed by Watauga Medical Center are: 1. Health Insurance/Affordable Healthcare/Lack of Services 2. Obesity/Diabetes/Proper Nutrition 3. Cancer Prevention
27
Implementation Strategy -Watauga Medical Center Community Health Need:
Health Insurance / Affordable Healthcare / Lack of Services / Access to Healthcare
Specific Needs Identified in the CHNA:
High percentage of individuals lacking health insurance, affordable health insurance, and lack of health services
Healthy People 2020 Target is 18%
Watauga County 19%; Ashe County 21%; Avery County 26%
Goals:
Increase the access to medical services in the community
Strategy: Increase insurance accessibility / affordability Action Step
Accountability
Timeline
Desired Outcome
1. Educate the public on available insurance and / or Health Insurance Exchange products
Hospital
Fall 2013
Increase Awareness
2. Educate the public on how one would access the Health Insurance Exchange products
Hospital
Fall 2013 and into 2014
Increase Awareness
Strategy: Increase access to care for low income, uninsured residents Action Step
Accountability
Timeline
Desired Outcome
1. Provide access to primary & specialty care, hospital inpatient and outpatient care; to include diagnostic test and surgeries; and access to pharmaceuticals for the low income, uninsured residents of Watauga & Avery County through Appalachian Healthcare Project
Hospital
Ongoing
Increased Services
2. Opening of a Federally Qualified Health Center to provided expanded care to area residents
Outside Agency
Winter 2013
Increase services
Strategy: Increase the types of service provided by the system Action Step
Accountability
Timeline
Desired Outcome
1. Cardiology Service line is offering increased diagnostic testing and interventional procedures such as angioplasty and stents
Hospital
Summer 2013 ongoing
Increase access to services
2. Recruited three new cardiologists and one nurse practitioner since January 2012
Hospital
achieved
Expand capabilities
3. Implement Orthopaedic and Sports Medicine Service Line Hospital
Summer / Fall 2013 ongoing
Increase access to services
4. Open a specialty clinic in Ashe and Avery County to provide cardiology, oncology and orthopaedic care
Hospital
Spring 2013
Increase access to services
5. Opening of a Rheumatology practice
Hospital
Summer 2013 ongoing
Increase access to services
Accountability
Timeline
Desired Outcome
1. Physician Recruitment Strategy determines the health Hospital needs of the community and identifies where there is a need to recruit to fill in gaps expected due to physician retirement, closing of practices, etc.
2013
Increase access to services
2. Expanding and perfecting the recruitment model
Hospital
2013; will re-evaluate annually
Increase access to services
3. Actively recruiting for hospitalists, family medicine physicians, orthopaedic surgeons, rheumatologists, psychiatrists, internal medicine, and emergency department physicians
Hospital
ongoing; Expand capabilities continue until successful; continually reevaluate need
Strategy: Physician Recruitment Action Step
28
Implementation Strategy -Watauga Medical Center Community Health Need:
Obesity / Diabetes / Proper Nutrition
Specific Needs Identified in the CHNA: Healthy People 2020 Target is 30.6% Goals:
High percentage of obesity Watauga County 25%; Ashe County 23%; Avery County 30% Reduce number of individuals that are obese.
Strategy: Begin Population Health Management Strategies Action Step 1. The Population Health Management Task Force will investigate implementation of tools within area physician practices to encourage patients to better manage their health 2. ARHS is embarking on a population health management model with its employees, ARHS is one of the largest employers in the county. Management of the health of the employee population provides education, not only to the employees but to their families as well, to increase the reach for this activity. Strategy: Increase Community Awareness of Diabetes and Obesity Action Step 1. Host diabetes support group
2. Hold Community wide health screenings including results, counsel, follow-up, referral to local healthcare professionals if necessary, and educational materials. Screening conducted by a RN, held at health fairs and other community events when asked 3. Have articles published in the local newspaper, and on the website, on topics relating to diabetes, healthy eating, and exercise Strategy: Employee Wellness Programs Action Step 1. Love Your Life (LYL) is an annual worksite health incentive progarm which promotes healthy living through behavioral, educational, and risk-reduction activities such as preventative exams, exercise, stress management, tobacco free status, and monthly nutrition challenges. 2. Assist ARHS employees and hospital visitors with access to healthier food choices, the Red Apple Campaign highlights the healthiest choices in the cafeterias and vending machines. 3. For ARHS employees and families a local CSA, Fresh from the Farm, provides fresh local produce during summer months 4. The Wellness Center offers discounted memberships to ARHS employees and families and corporate memberships to area businesses 5. Require that each employee on the corporate health insurance complete a Health Risk Appraisal annually at open enrollment. Use data from HRA to drive behavior changes. 6. Offer Weight Watchers at Work and Show me the Weigh programs as a way to get employees engaged in managing their weight to prevent obesity 7. Develop Corporate Health Services Program to offer ARHS’s Love Your Life Program to area businesses
Strategy: Increase Physical Activity in the Community Action Step 1. Place flyers in the hospital and local medical practices, as well as postings to the website, to promote fitness classes and programs offered at the Wellness Center 2. Sponsorship of area walks and runs; exploring new avenues of involvement and promotion Strategy: Childhood Obesity Action Step 1. Sponsorship of sports programs for youth including Little League baseball; exploring new avenues of involvement and promotion 2. Latino Health Program to implement KidShape program to reach overweight and obese Latino Children with a three-prong approach of nutrition, physical activity and behavioral modification 3. Work with the Wellness Center to build activities and programs for youth such as youth strength and conditioning programs 4. BLAST is an 8 week program offered by Watauga Medical Center’s Wellness Center for children between the ages of 7-12 that will promote healthy lifestyles, fitness and good nutrition habits. There are no requirements for participation other than wanting to have fun and wanting to learn about fitness, nutrition and overall wellness.
29
Accountability Hospital
Timeline Fall 2013 ongoing
Hospital
Fall 2013 ongoing
Accountability Hospital
Timeline Ongoing, 6 per year
Hospital
Ongoing, 4-6 per year
Desired Outcome Increased awareness, education / support for diabetics and family members Increase awareness and education; promote healthy living
Hospital
Ongoing, Minimum 6 per year
Increase awareness and education; promote health living
Accountability Hospital
Timeline Ongoing
Desired Outcome Promote healthy living
Hospital
Ongoing
Promote healthier food choices
Hospital
Each summer Ongoing; Reevaluate annually Annually
Promote healthier food choices
Hospital Hospital Hospital Hospital
Accountability Hospital Hospital
Accountability Hospital Hospital / Latino Health Program Hospital / Wellness Center Hospital
Desired Outcome Increase Awareness and education, promote healthy living Increase education, promote healthy living
Promote healthy living Promote healthy living
Throughout the year Development 2013, implementation 2014 and ongoing
Promote healthy living and education Promote healthy living and education
Timeline Ongoing; Website September 2013 Ongoing; Reevaluate annually
Desired Outcome Promote healthy living and education Promote healthy living, support community health efforts
Timeline Ongoing; reevaluate annually 2013; Minimum 2 times per year
Desired Outcome Promote healthy living, support community health efforts Promote healthy living and provide education
Summer 2013 and ongoing Ongoing, Re-evaluate the need annually
Promote healthy living, support community health efforts Promote healthy living for youth programs
Implementation Strategy -Watauga Medical Center Community Health Need:
Cancer
Specific Needs Identified in the CHNA:
High percentage of cancer related deaths (per 100,000 people)
Healthy People 2020 Target is 160.6 deaths
Watauga County 158.8; Ashe County 166.4; Avery County 167.7
Goals:
Reduce the number of cancer related deaths
Strategy: Expand the delivery of Oncology Services Action Step
Accountability
Timeline
Desired Outcome
1. Implemented an Oncology Patient Navigator who will work with patient to address all the needs they face once diagnosed with cancer.
Hospital
Spring 2013 Ongoing
Measurably improves coordination of care
2. Implement a new track of the Thrive Transition to Wellness program. This track is specifically for cancer patients who benefit from a medically supervised exercise program
Hospital
Spring 2013 Ongoing
Improved patient fatigue scale scores and improved patients’ prognosis for a healthy recovery following cancer treatment
3. To develop a Breast Health program to assist with screenings, early diagnosis and follow-thru once a patient is diagnosed with breast cancer
Hospital
Summer/Fall 2013 Ongoing
Improve time from abnormal diagnosis to treatment
Action Step
Accountability
Timeline
Desired Outcome
1. Send medical professionals to groups such as Kiwanis, Rotary, etc. to speak on cancer related topics
Hospital
Minimum 2 per year
Increase awareness of cancer related issues
2. Conduct outreach to area churches and/or senior centers through a Wellness Wednesday program
Hospital
Minimum 4 per year
Increase awareness of cancer signs, symptoms and early diagnosis options
Strategy: Increase awareness of cancer in the community
Strategy: Sponsorship efforts to increase awareness of cancer in the community Action Step
Accountability
Timeline
Desired Outcome
1. Corporate Sponsor for American Cancer Society “Relay for Life”
Hospital
Annual, June 2013
Increase cancer awareness and raise money for research
2. Participate in the American Cancer Society Prevention Study-3 (CPS-3) as an enrollment site in the High Country to get area residents enrolled in the longitudinal cancer prevention study
Hospital
Enrollment begins Fall 2013
Provide ongoing research into cancer prevention
Strategy: Provide opportunities for early detection of Cancer Action Step
Accountability
Timeline
Desired Outcome
1. Offer free breast and cervical cancer screenings
Hospital / Health department
Ongoing
Increased number of uninsured patients screened
2. Provide an annual melanoma screening
Hospital / physician practice
Annually
Early detection of skin cancer
3. Provide an annual Prostate Cancer screenings via PSA with an area community
Hospital
Annually
Early detection of prostate cancer
4. Assess tobacco usage status upon admission and provide patients with tobacco cessation literature and referral to NCQuit line
Hospital
Ongoing
Patients initiate tobacco cessation and reduce prevalence of cancer
30
Implementation Strategy -Watauga Medical Center II. Health Needs Not Addressed Several needs outlined in the CHNA process have not been addressed in this plan. In initial discussion and subsequent prioritization, the Medical Center considered the levels to which some needs were already being addressed in the service area. Additionally, some community needs fall out of the scope of expertise and resources of the hospital. The following chart outlines why some of the needs identified in the needs assessment aren’t addressed: Community Need Aging problems
Heart disease
Mental health
Substance abuse
Environment health concerns Tobacco-related health concerns
31
Reasons Needs Not Addressed This need is addressed by Appalachian Regional Healthcare System’s Blowing Rock Hospital as it embarks on the development of a state-of-the-art 112-bed Post-Acute Care Facility slated to open in 2015. While Heart Disease was not chosen as one of the focus areas for this Community Health Needs Assessment, it is being addressed in the access to care/ lack of services action plan. ARHS implemented a cardiology service line in 2012 and has continued to expand on services to address the needs of this population, such as access to interventional cardiology services locally. This need is addressed by Appalachian Regional Healthcare System’s Charles A. Cannon, Jr. Memorial Hospital as it manages the behavioral health services offered by ARHS This need is best addressed by agencies in the community who work specifically with substance abuse prevention and patients, such as Daymark Recovery Services (patients), Western Youth Network (prevention), Project Lazarus (education and prevention), Alcoholics Anonymous (patients) and private counselors (patients) This need is best managed by Appalachian District Health Department’s Environmental Health Division, Appalachian State University’s Sustainability Department and The Evergreen Committee of the Boone Area Chamber of Commerce This need is addressed slightly in the Cancer Action Plan as ARHS staff assess smoking status upon admission to the hospital and addresses smoking cessation opportunities with patients. However, since not every resident of the county will present at an ARHS facility for admission the need is being addressed by the Appalachian District Health Department’s Northwest Tobacco Prevention coalition, which has the following goals: Four Program Goals • Prevent Initiation of Tobacco Use Among Young People • Eliminate Exposure to Secondhand Smoke • Promote Cessation for Adults and Youth • Identify and Eliminate Tobacco-Related Disparities in Specific Populations
Community Health Needs Assessment I. Introduction Charles A. Cannon Jr. Memorial Hospital (Hospital) will engage key community partners in implementing evidence-based strategies across the service area. Acknowledging the many organizations and resources in place to address the health needs of our communities, the Hospital has strategically reviewed both internal and external resources. This portion of the CHNA, the Implementation Strategy, will explain how the Hospital will address health needs identified in the CHNA by continuing existing programs and services, and by implementing new strategies. It will also explain why the hospital cannot address all the needs identified in the CHNA, and if applicable, how the Hospital will support other organizations in doing so. II. Health Needs Addressed As aforementioned in the CHNA report, the following are the needs the Hospital has chosen to address. We discuss why we chose to address each need, how we will address the need, who the responsible party will be, and any goals that will be set forth from the beginning, as well as time frame for achieving those goals. The three health needs being addressed by Charles A. Cannon, Jr. Memorial Hospital are: 1. Access to Primary Healthcare Services 2. Obesity/Diabetes/Proper Nutrition/Chronic Disease Management 3. Access to Mental Health Services
32
Implementation Strategy -Cannon Memorial Hospital Community Health Need:
Access to Primary Healthcare Services
Specific Needs Identified in the CHNA:
High percentage of individuals lacking health insurance, affordable health insurance, and lack of health services
Healthy People 2020 Target is 18%
Watauga County 19%; Ashe County 21%; Avery County 26%
Goals:
Reduce the number of individuals without access to healthcare
Strategy: Increase insurance accessibility / affordability Action Step
Accountability
Timeline
Desired Outcome
1. Educate the public on available insurance and / or Health Insurance Exchange products
Hospital
Fall 2013
Increase Awareness
2. Educate the public on how one would access the Health Insurance Exchange products
Hospital
Fall 2013 and into 2014
Increase Awareness
Strategy: Increase the types of services provided by the system Action Step
Accountability
Timeline
Desired Outcome
1. Expand Dr. Charles Baker’s practice to be the Baker Center for Primary Care. Expansion to include recruitment of additional providers for ongoing coverage for Avery and surrounding county residents
Hospital
Fall 2013, ongoing
Expand capabilities
2. Cardiology Service Line is offering increased diagnostic testing and interventional procedures such as angioplasty and stents.
Hospital
Summer 2013, ongoing
Increase services
3. Recruited three new cardiologists and one nurse pracitioner since January 2012.
Hospital
Achieved
Expand capabilities
4. Implement an Orthopaedic and Sports Medicine Service Line
Hospital
Summer 2013, ongoing
Increased services
5. Open a specialty clinic in Ashe and Avery County to provide cardiology and oncology
Hospital
Spring 2013
Increase services
6. Recruit additional provider to Elk River Medical Associates in Banner Elk
Hospital
Summer 2013
Increased services
7. Opening of a Federally Qualified Health Center to provided expanded care to area residents
Outside Agency
Winter 2013
Increased services
Action Step
Accountability
Timeline
Desired Outcome
1. Physician Recruitment Strategy plan determines the health needs of the community and identifies where there is a need to recruit to fill in gaps expected due to physician retirement, closing of practices, etc.
Hospital
2013
Increase access to services
2. Expanding and perfecting the recruitment model
Hospital
2013; will re-evaluate annually
Increase access to services
3.Actively recruiting for hospitalists, family medicine physicians, orthopaedic surgeons, rheumatologists, and emergency department physicians
Hospital
Ongoing; Expand capabilities continue until successful; Reevaluate need annually
Strategy: Physician Recruitment
33
Implementation Strategy -Cannon Memorial Hospital Community Health Need:
Obesity / Diabetes / Proper Nutrition
Specific Needs Identified in the CHNA: Healthy People 2020 Target is 30.6% Goals:
High percentage of obesity Watauga County 25%; Ashe County 23%; Avery County 30% Reduce number of individuals that are obese.
Strategy: Begin Population Health Management Strategies Action Step 1. The Population Health Management Task Force will investigate implementation of tools within area physician practices to encourage patients to better manage their health 2. ARHS is embarking on a population health management model with its employees, ARHS is one of the largest employers in the county. Management of the health of the employee population provides education, not only to the employees but to their families as well, to increase the reach for this activity. 3. The ARHS owned primary care medical practices in Avery County are Patient-Centered Medical Homes which work to ensure the patients have access to chronic disease management services and the patient and provider work as a team to manage the health of the patient. Strategy: Increase Community Awareness of Diabetes and Obesity Action Step 1. Hold Community wide health screenings including results, counsel, follow-up, referral to local healthcare professionals if necessary, and educational materials. Screening conducted by a RN, held at health fairs and other community events when asked 2. Have articles published in the local newspaper, and on the website, on topics relating to diabetes, healthy eating, and exercise Strategy: Employee Wellness Programs Action Step 1. Love Your Life (LYL) is an annual worksite health incentive progarm which promotes healthy living through behavioral, educational, and risk-reduction activities such as preventative exams, exercise, stress management, tobacco free status, and monthly nutrition challenges. 2. Assist ARHS employees and hospital visitors with access to healthier food choices, the Red Apple Campaign highlights the healthiest choices in the cafeterias and vending machines. 3. For ARHS employees and families a local CSA, Fresh from the Farm, provides fresh local produce during summer months 4. The Avery Y offers discounted memberships to ARHS employees and families and corporate memberships to area businesses 5. Require that each employee on the corporate health insurance complete a Health Risk Appraisal annually at open enrollment. Use data from HRA to drive behavior changes. 6. Offer Weight Watchers at Work and Show me the Weigh programs as a way to get employees engaged in managing their weight to prevent obesity 7. Develop Corporate Health Services Program to offer ARHS’s Love Your Life Program to area businesses Strategy: Increase Physical Activity in the Community Action Step 1. Place flyers in the hospital and local medical practices, as well as postings to the website, to promote fitness classes and programs offered at the local YMCA 2. Sponsorship of area walks and runs; exploring new avenues of involvement and promotion Strategy: Childhood Obesity Action Step 1. Sponsorship of sports programs for youth including Little League baseball; exploring new avenues of involvement and promotion 2. Latino Health Program to implement KidShape program to reach overweight and obese Latino Children with a three-prong approach of nutrition, physical activity and behavioral modification 3. Work with the YMCA to build activities and programs for youth 4. Provide an Athletic Trainer for Avery County Schools to encourage children to be safe when active in sports and to assess problems with athletic participation
Accountability Hospital
Timeline Fall 2013 ongoing
Hospital
Fall 2013 ongoing
Hospital
Spring 2013 and ongoing
Increased services
Accountability Hospital
Timeline Ongoing, 4-6 per year
Desired Outcome Increase awareness and education; promote healthy living
Hospital
Ongoing, Minimum 6 per year
Increase awareness and education; promote health living
Accountability Hospital
Timeline Ongoing
Desired Outcome Promote healthy living
Hospital
Ongoing
Promote healthier food choices
Hospital
Each summer Ongoing; Reevaluate annually Annually
Promote healthier food choices
Throughout the year Development 2013, implementation 2014 and ongoing
Promote healthy living and education Promote healthy living and education
Accountability Hospital / YMCA Hospital
Timeline Ongoing; Website September 2013 Ongoing; Reevaluate annually
Desired Outcome Promote healthy living, support community health efforts Promote healthy living, support community health efforts
Accountability Hospital
Timeline Ongoing; reevaluate annually 2013; Minimum 2 times per year 2014 and ongoing
Desired Outcome Promote healthy living, support community health efforts Promote healthy living and provide education Promote healthy living, support community health efforts Supporting community health and youth sports programs
Hospital Hospital Hospital Hospital
Hospital / Latino Health Program Hospital / YMCA Hospital
2012 Ongoing
Desired Outcome Increase Awareness and education, promote healthy living Increase education, promote healthy living
Promote healthy living Promote healthy living
34
Implementation Strategy -Cannon Memorial Hospital Community Health Need:
Access to Mental Health
Specific Needs Identified in the CHNA:
Access to Mental Health Services
Healthy People 2020 Target is 64.6%
Local data N/A
Goals:
Increase the proportion of adults ages 18 and older with serious mental illness who receive treatment
Strategy: Improve Access to Mental Health Services Action Step
Accountability
Timeline
Desired Outcome
1. Develop Co-location services so that consumers will have access to Behavioral Health Services within their primary care setting
Hospital System
Ongoing-three Easier access to care, increased compliance locations by 2015
2. Expand ARHS Crisis Services to include coverage of ARMA practices and settings so that patients can be appropriately assessed and dispositioned withouth having to report to the Emergency Department or avoid care altogether.
ARHS Behavioral Health Team
Full Implementation by 2015
Increased access to services
Action Step
Accountability
Timeline
Desired Outcome
1. Recruit and retain one psychiatrist and two Psychiatric Nurse Practitioners within the next 12 months, maintain adequate provider staffing levels
Hospital
Ongoing
Appointments with prescribers available within 1 week of request
Strategy: Physician Recruitment
35
Implementation Strategy -Cannon Memorial Hospital II. Health Needs Not Addressed Several needs outlined in the CHNA process have not been addressed in this plan. In initial discussion and subsequent prioritization, the Hospital considered the levels to which some needs were already being addressed in the service area. Additionally, some community needs fall out of the scope of expertise and resources of the hospital. The following chart outlines why some of the needs identified in the needs assessment aren’t addressed:
Community Need Substance abuse / Suicide
Poverty
Lack of Youth Activities (year-round) Dental Care
Child Abuse
Reasons Needs Not Addressed This need is best addressed by agencies in the community who deal specifically with substance abuse prevention and patients, such as Daymark Recovery Services (patients), Western Youth Network (prevention), Project Lazarus (education and prevention), Alcoholics Anonymous (patients) and private counselors (patients), Avery Cares (patients). Suicide is not a health concern chosen to be addressed by Charles A. Cannon, Jr. Memorial Hospital, but by increasing access to Mental Health Services the hospital may impact suicide rates in the county. Cannon Memorial Hospital has not chosen poverty as a focus area, however the healthcare system offers Appalachian Healthcare Project, an access to care program for low income, uninsured Avery and Watauga County residents. In addition, the healthcare system has a charity care program for residents who don’t qualify for Appalachian Healthcare Project, but meet charity care guidelines. The William YMCA of Avery County along with Avery County Schools and Avery County Parks and Recreation address the needs of year-round activities for youth in the county. This need is being addressed by High Country Community Health (HCCH), a local Federally Qualified Health Center. HCCH has plans to open a dental clinic which will provide services on a sliding fee scale to area residents This need is best served by the Avery County Department of Social Services
36
Implementation Strategy -Blowing Rock Hospital I. Introduction Blowing Rock Hospital (Hospital) will engage key community partners in implementing evidence-based strategies across the service area. Acknowledging the many organizations and resources in place to address the health needs of our communities, the Hospital has strategically reviewed both internal and external resources. This portion of the CHNA, the Implementation Strategy, will explain how the Hospital will address health needs identified in the CHNA by continuing existing programs and services, and by implementing new strategies. It will also explain why the hospital cannot address all the needs identified in the CHNA, and if applicable, how the Hospital will support other organizations in doing so. II. Health Needs Addressed As aforementioned in the CHNA report, the following are the needs the Hospital has chosen to address. We discuss why we chose to address each need, how we will address the need, who the responsible party will be, and any goals that will be set forth from the beginning, as well as time frame for achieving those goals. The three health needs that are being addressed by Blowing Rock Hospital are: 1. Affordable Healthcare/Lack of Services 2. Obesity/Diabetes/Proper Nutrition 3. Cancer
37
Implementation Strategy -Blowing Rock Hospital Community Health Need:
Affordable Healthcare / Lack of Services
Specific Needs Identified in the CHNA:
Affordable Healthcare / Lack of Services
Healthy People 2020 Target is 18%
Watauga County 19%
Goals:
Increase the amount of long-term care services for the elderly
Strategy: Expand services for the elderly Action Step
Accountability
Timeline
Desired Outcome
1.Implement a new 112-bed state of the art post-acute care facility to replace the current Blowing Rock Hospital. The new facility will provide short and long term rehabilitation services, a secure memory care unit, a long term care unit, and a palliative care unit.
Hospital
2013-2015, Ongoing
Increased access to services
2. Investigate implementation of a new retirement community, adjacent to the new Blowing Rock Facility. It will serve area residents along the continuum of idependent living, assisted living and skilled nursing care.
Outside organization
to be determined
Increased access to services
3. Provide a Primary Care Medical Clinic and pharmacy adjacent to the new facility
Hospital
Fall 2015 / Winter 2016
Increased access to services
Strategy: Increase the types of service provided by the system Action Step
Accountability
Timeline
Desired Outcome
1. Cardiology Service line is offering increased diagnostic testing and interventional procedures such as angioplasty and stents.
Hospital
Summer 2013 ongoing
Increased access to services
2. Recruited three new cardiologists and one nurse practitio- Hospital ner since January 2012
Achieved
Expand capabilities
3. Implement an Orthopaedic and Sports Medicine Service line
Hospital
Summer/Fall 2013, ongoing
Increased access to services
4. Open a specialty clinic in Ashe and Avery County to provide cardiology, oncology and orthopaedic care
Hospital
Spring 2013
Increased access to services
5. Opening of a Rheumatology practice
Hospital
Summer 2013, Increased access to services Ongoing
Action Step
Accountability
Timeline
Desired Outcome
1. Physician Recruitment Strategy plan determines the health needs of the community and identifies where there is a need to recruit to fill in gaps expected due to physician retirement, closing of practices, etc.
Hospital
2013
Increase access to services
2. Expanding and perfecting the recruitment model
Hospital
2013; will re-evaluate annually
Increase access to services
3. Actively recruiting for hospitalists, family medicine physicians, orthopaedic surgeons, rheumatologists, psychiatrists, internal medicine, and emergency department physicians
Hospital
ongoing; Expand capabilities continue until successful; continually reevaluate need
Strategy: Physician Recruitment
38
Implementation Strategy -Blowing Rock Hospital Community Health Need:
Obesity / Diabetes / Proper Nutrition
Specific Needs Identified in the CHNA: Healthy People 2020 Target is 30.6% Goals:
High percentage of obesity Watauga County 25%; Ashe County 23%; Avery County 30% Reduce number of individuals that are obese.
Strategy: Begin Population Health Management Strategies Action Step 1. The Population Health Management Task Force will investigate implementation of tools within area physician practices to encourage patients to better manage their health 2. ARHS is embarking on a population health management model with its employees, ARHS is one of the largest employers in the county. Management of the health of the employee population provides education, not only to the employees but to their families as well, to increase the reach for this activity. Strategy: Increase Community Awareness of Diabetes and Obesity Action Step 1. Host diabetes support group
2. Hold Community wide health screenings including results, counsel, follow-up card, referral to local healthcare professionals if necessary, and educational materials. Screening conducted by a RN, held at health fairs and other community events when asked 3. Have articles published in the local newspaper, and on the website, on topics relating to diabetes, healthy eating, and exercise Strategy: Employee Wellness Programs Action Step 1. Love Your Life (LYL) is an annual worksite health incentive progarm which promotes healthy living through behavioral, educational, and risk-reduction activities such as preventative exams, exercise, stress management, tobacco free status, and monthly nutrition challenges. 2. Assist ARHS employees and hospital visitors with access to healthier food choices, the Red Apple Campaign highlights the healthiest choices in the cafeterias and vending machines. 3. For ARHS employees and families a local CSA, Fresh from the Farm, provides fresh local produce during summer months 4. The Wellness Center offers discounted memberships to ARHS employees and families and corporate memberships to area businesses 5. Require that each employee on the corporate health insurance complete a Health Risk Appraisal annually at open enrollment. Use data from HRA to drive behavior changes. 6. Offer Weight Watchers at Work and Show me the Weigh programs as a way to get employees engaged in managing their weight to prevent obesity 7. Develop Corporate Health Services Program to offer ARHS’s Love Your Life Program to area businesses
Strategy: Increase Physical Activity in the Community Action Step 1. Place flyers in the hospital and local medical practices, as well as postings to the website, to promote fitness classes and programs offered at the Wellness Center 2. Sponsorship of area walks and runs; exploring new avenues of involvement and promotion
39
Accountability Hospital
Timeline Fall 2013 ongoing
Hospital
Fall 2013 ongoing
Accountability Hospital
Timeline Ongoing, 6 per year
Hospital
Ongoing, 4-6 per year
Desired Outcome Increased awareness, education / support for diabetics and family members Increase awareness and education; promote healthy living
Hospital
Ongoing, Minimum 6 per year
Increase awareness and education; promote health living
Accountability Hospital
Timeline Ongoing
Desired Outcome Promote healthy living
Hospital
Ongoing
Promote healthier food choices
Hospital
Each summer Ongoing; Reevaluate annually Annually
Promote healthier food choices
Throughout the year Development 2013, implementation 2014 and ongoing
Promote healthy living and education Promote healthy living and education
Timeline Ongoing; Website September 2013 Ongoing; Reevaluate annually
Desired Outcome Promote healthy living and education Promote healthy living, support community health efforts
Hospital Hospital Hospital Hospital
Accountability Hospital Hospital
Desired Outcome Increase Awareness and education, promote healthy living Increase education, promote healthy living
Promote healthy living Promote healthy living
Implementation Strategy -Blowing Rock Hospital Community Health Need:
Cancer
Specific Needs Identified in the CHNA:
High percentage of cancer related deaths (per 100,000 people)
Healthy People 2020 Target is 160.6 deaths
Watauga County 158.8; Ashe County 166.4; Avery County 167.7
Goals:
Reduce the number of cancer related deaths
Strategy: Expand the delivery of Oncology Services Action Step
Accountability
Timeline
Desired Outcome
1. Implemented an Oncology Patient Navigator who will work with patient to address all the needs they face once diagnosed with cancer.
Hospital
Spring 2013 Ongoing
Measurably improves coordination of care
2. Implement a new track of the Thrive Transition to Wellness program. This track is specifically for cancer patients who benefit from a medically supervised exercise program
Hospital
Spring 2013 Ongoing
Improved patient fatigue scale scores and improved patients’ prognosis for a healthy recovery following cancer treatment
3. To develop a new Breast Health program to assist with screenings, early diagnosis and follow-thru once a patient is diagnosed with breast cancer
Hospital
Summer/Fall 2013 Ongoing
Improve time from abnormal diagnosis to treatment
Action Step
Accountability
Timeline
Desired Outcome
1. Send medical professionals to groups such as Kiwanis, Rotary, etc. to speak on cancer related topics
Hospital
Minimum 2 per year
Increase awareness of cancer related issues
2. Conduct outreach to area churches and/or senior centers through a Wellness Wednesday program
Hospital
Minimum 4 per year
Increase awareness of cancer signs, symptoms and early diagnosis options
Timeline
Desired Outcome
1. Coporate Sponsor for American Cancer Society “Relay for Hospital Life”
Annual, June 2013
Increase cancer awareness and raise money for research
2. Participate in the American Cancer Society Prevention Study-3 (CPS-3) as an enrollment site in the High Country to get area residents enrolled in the longitudinal cancer prevention study
Enrollment begins Fall 2013
Provide ongoing research into cancer prevention
Strategy: Increase awareness of cancer in the community
Strategy: Sponsorship efforts to increase awareness of cancer in the community Action Step
Accountability
Hospital
Strategy: Provide opportunities for early detection of Cancer Action Step
Accountability
Timeline
Desired Outcome
1. Offer free breast and cervical cancer screenings
Hospital / Health department
Ongoing
Increased number of uninsured patients screened
2. Provide an annual melanoma screening
Hospital / physician practice
Annually
Early detection of skin cancer
3. Provide an annual Prostate Cancer screenings via PSA with an area community
Hospital
Annually
Early detection of prostate cancer
4. Assess tobacco usage status upon admission and provide patients with tobacco cessation literature and referral to NCQuit line
Hospital
Ongoing
Patients initiate tobacco cessation and reduce prevalence of cancer
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Implementation Strategy -Blowing Rock Hospital
II. Health Needs Not Addressed Several needs outlined in the CHNA process have not been addressed in this plan. In initial discussion and subsequent prioritization, the Hospital considered the levels to which some needs were already being addressed in the service area. Additionally, some community needs fall out of the scope of expertise and resources of the hospital. The following chart outlines why some of the needs identified in the needs assessment aren’t addressed:
Community Need Mental health
Substance abuse
Environment health concerns Tobacco-related health concerns
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Reasons Needs Not Addressed This need is addressed by Appalachian Regional Healthcare System’s Charles A. Cannon, Jr. Memorial Hospital as it manages the behavioral health services offered by ARHS This need is best addressed by agencies in the community who work specifically with substance abuse prevention and patients, such as Daymark Recovery Services (patients), Western Youth Network (prevention), Project Lazarus (education and prevention), Alcoholics Anonymous (patients) and private counselors (patients) This need is best managed by Appalachian District Health Department’s Environmental Health Division, Appalachian State University’s Sustainability Department and The Evergreen Committee of the Boone Area Chamber of Commerce This need is addressed slightly in the Cancer Action Plan as ARHS staff assess smoking status upon admission to the hospital and addresses smoking cessation opportunities with patients. However, since not every resident of the county will present at an ARHS facility for admission the need is being addressed by the Appalachian District Health Department’s Northwest Tobacco Prevention coalition, which has the following goals: Four Program Goals • Prevent Initiation of Tobacco Use Among Young People • Eliminate Exposure to Secondhand Smoke • Promote Cessation for Adults and Youth • Identify and Eliminate Tobacco-Related Disparities in Specific Populations
Community Health Needs Assessment Conclusion The needs of the community are a top priority of Appalachian Regional Healthcare System as we stay true to our vision: “To build a regional healthcare system that results in healthier individuals and an enhanced quality of life.” We look forward to partnering with the community to fulfill the needs outlined in this assessment. Continued dialogue is important to ARHS, please contact the healthcare system at
[email protected] with ideas about enhancing the health of the community. For more information about services offered by Appalachian Regional Healthcare System, please visit www.apprhs.org. Thank you for your interest in the health of our community.
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