2013
Community Health Needs Assessment Columbia, South Carolina
A collaborative study between Palmetto Health and Providence Hospitals
PO Box 2266 Columbia, SC 29202
2435 Forest Drive, Columbia, SC 29204
Table of Contents
Executive Summary
2
Purpose
5
Methodology
5
Department of Health and Environmental Control
8
National Research Corporation
8
Hospital Specific Emergency Room Data
10
Providence Hospitals Survey Data
11
Mission 2011 and 2012
12
Interviews and Town Hall Meetings
14
Limitations
15
Consistent Themes
15
Providence Hospitals Palmetto Health 2013 Community Health Needs Survey
16
2013 Survey Responses - Graphs
19
Appendix Broad Interest Interviewees Collaborators and Community Assistance Data Sources Tabulation Matrix
Palmetto Health & Providence Hospitals 2013 Community Health Needs Assessment (CHNA)
EXECUTIVE SUMMARY The collective data supports the following top critical areas as the most significant unmet health needs in Richland and Lexington counties, particularly in households making less than $25,000 per year. These top critical areas were determined by considering the information in all the data sources, looking at the top percentile rankings in community surveys conducted, the frequency of issues mentioned in town hall meetings, service provider surveys, personal interviews and other components of data collected as identified in the main body of this assessment. Access to Care 33 percent: In the 2013 Providence Hospitals survey, 33 percent of the respondents who indicated they had difficulty receiving health care in the last 12 months were uninsured. The Providence Hospitals and National Research Corporation (NRC) 2012 survey, along with Mission 2011 and 2012*, data provide us with the underlying reasons responders in the various data points are uninsured, underinsured or have had difficulty accessing health care. Identified barriers to health care, which is understood as medical, dental and vision care, are: Cost of coverage: 53-64 percent Insurance does not cover or is not accepted: 39 percent Unemployed: 33 percent Employer does not offer coverage: 15 percent Don’t understand plans: 10 percent Previous medical condition: 6 percent Transportation: 4-7 percent
High Blood Pressure (29-39 percent) and High Cholesterol (23-28 percent) remain in the top four identified issues as significantly high health risks when compared to NRC 2010 data. However, 41 percent and 21 percent of the respondents, respectively, also indicated in 2012 that they have engaged in preventive behaviors but at a lower rate when compared to the NRC 2010 data. 2
Smoking: Thirty six percent of respondents in the NRC data report this risk, and 27 percent of the Providence survey respondents also identify themselves as smokers. DHEC data indicates that 21.8 percent of Lexington County and 17.4 percent of Richland County residents are smokers. Engagement in preventative behavior for this condition, however, remains in the bottom four categories.
Depression/Anxiety: Thirty percent identified these as a health risk in the NRC data, and in 17 percent of the Providence survey respondents, as well. In addition, 27 percent of the survey respondents report feeling sad or worried. Service provider interviews support that mental health issues exist as unmet needs in the community.
Obesity rate 14-31 percent: Obesity is identified in the NRC assessment as a high health risk for households with an income of less than $25,000 but is slightly higher (16 percent) in higher income levels. Twenty-two percent of the Providence survey participants stated that a physician diagnosed them as obese. DHEC data for Lexington and Richland counties lists obesity at 31 percent for both counties. Provider surveys support the conclusion that obesity is a high health risk and the Lexington County Healthy Partners survey indicates it as the second highest need.
Diabetes 8-23%: NRC data indicates that diabetes incidence is 23 percent among households with less than $25,000 annual income. DHEC data for Lexington and Richland counties indicate 8 to10 percent of the population has diabetes, and the Providence survey indicates 13 percent of survey participants have diabetes.
Dental Care 58 percent: Although dental care was not specifically considered in the surveys or DHEC statistics, our local emergency room data and data from Mission 2011 and 2012 efforts reveal a gap in dental care in the community. Fifty-eight percent of the population served at Mission 2012 presented with dental needs. Providence Hospitals’ survey indicated that 32 percent of individuals having difficulty receiving care identified dental care as the top issue. Emergency department data indicates that: 1. The number of dental cases has grown by an average of 21 percent each year since 2009*. 2. The number of non-emergent cases (which can be seen in a dental office) to total cases has grown from 62 percent in 2009 to 73 percent in 2012. 3
3. Eighty one percent of cases are unfunded or covered by Medicaid at Palmetto Health hospitals. 4. Providence Hospitals had 1,245 cases presented in FY 2012 with 75 percent as Medicaid and Self-Pay.
Other Information Participants were asked in the Palmetto-Providence survey about which health topics they wanted more information. Heart related illnesses such as blood pressure, cholesterol, heart disease, heart attack etc. had the highest percent of responses at 15 percent. Diabetes had the second highest percentage of responses at 14.55 percent. The topic of cancer in its various forms was third on the list at 13.18 percent. The collective responses related to eating healthy, weight loss and obesity was fourth on the list at 11.8 percent.
When participants were asked the question about health topics they thought their children needed more information about, the top three answers were: nutrition 27.14 percent, dental hygiene 18.6 percent and drug abuse 11.63 percent.
*Mission 2011 & 2012 is an event when service providers across the community gather for two days and provide free care to the underinsured or uninsured in our communities.
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Purpose A provision of the Patient Protection and Affordable Care Act of 2010 requires all tax exempt hospitals to conduct a community health needs assessment every three years. Palmetto Health and Providence Hospitals complied with this new provision and conducted an initial assessment in 2011 and updated the data in 2013. The results will be reported on the IRS form 990, Schedule H for tax year 2013. Per the Federal Register Volume 78, No. 66, April 5, 2013, one survey meets the requirement for both Baptist and Richland campuses and both Providence Downtown and Northeast campuses.
The
information
will
be
made
available
on
our
respective
websites:
www.palmettoheath.org. and www.providencehospitals.com. The assessment has two main objectives: 1. Assess/Identify top health related needs/issues in the community. 2. Address these issues with possible solutions in an implementation strategy.
Methodology Palmetto Health (PH) is a healthcare system consisting of Palmetto Health Baptist, Palmetto Health Children’s Hospital, Palmetto Health Heart Hospital, Palmetto Health Richland and Richland Springs Providence Hospitals, a Catholic hospital ministry, is a faith-based organization of the Sisters of Charity Health System. Providence is located in downtown Columbia with a second hospital in the northeast area of Columbia. Mr. Charles D. Beaman, Jr., CEO of Palmetto Health, discussed with Mr. George Zara, CEO of Providence Hospitals, the possibility of conducting the Community Health Needs Assessment jointly. Both systems serve the same population and working collaboratively would conserve resources. Mr. Beaman and Mr. Zara agreed and identified personnel in their respective organizations to work collaboratively to fulfill the requirements of the Community Health Needs Assessment (CHNA). The population was identified as Richland and Lexington counties. These two counties are typically considered Palmetto Health’s and Providence Hospitals’ primary market1. The 2012 population2 of these counties, based on the 2010 census is 665,362. This number is expected
1
80 percent of Palmetto Health’s inpatient admissions reside in these two counties and 64% of Providence Hospitals. 2 Claritas Demographic
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to grow approximately 7.7 percent by 2017. The following map identifies these two counties in red.
• • •
Blue Cross – Palmetto Health Baptist and Parkridge Red Cross ‐ Palmetto Health Richland Orange Cross – Providence Downtown and Providence NE
The process of gathering data/information incorporated both qualitative and quantitative methods. Secondary research was used from community agencies (See Appendix for a list of participants and organizations). Primary research (both qualitative and quantitative) was gathered through National Research Corporation’s (NRC) 3 Community Needs Assessment, Palmetto Health’s and Providence’s Emergency Room data, Mission 2011 and 2012 data, 3
NRC was founded in 1981 and is the largest most comprehensive consumer‐reported assessment of hospitals and health systems available. Palmetto Health has a membership agreement with NRC to conduct its Consumer Research.
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Providence Hospital and Palmetto Health’s survey via email, town hall meetings and interviews with community stakeholders. The qualitative portion of the CHNA consisted of interviews and town hall meetings of community leaders, elected officials and stakeholders. These were done simultaneously to help form our questions and to confirm what we were hearing from our interviews.
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Department of Health and Environmental Control South Carolina produces county reports through the Public Health Statistics and Information Services (PHSIS) that provide health indicators. Starting with the DHEC research helped the hospitals focus in specific areas. Table 1 is a summary of Richland and Lexington counties for those notable health indicators. Table 1
Health Indicator Not able to see doctor last 12 months due to cost Have you been told you have diabetes Have you been told you have hypertension Obese (20+ years of age) Current Smokers
Rate4 Lexington Richland 17.6 14.4
Rank5 Lexington Richland 24 9
Rate SC 16.4
8.1
10.2
4
13
10.4
30.7
31.3
12
13
33.4
31.2 21.8
31.3 17.4
12 27
13 8
32.4 20.5
Statistical Findings 1. It appears access to care is more of an issue in Lexington County. 2. Lexington County has more smokers. 3. Both counties are consistent with or better than the overall SC rate.
National Research Corporation The purpose of the study was to determine health status, chronic conditions and preventive health behaviors in the community. It addresses high risk behaviors and much of what is measured in the Healthy People 2010 profiles. The following charts compare the percentage of Richland and Lexington county households in lower income categories that report one or more household members have been diagnosed with the chronic condition.
4 5
Rate per 1000 Ranked in ascending order where 1 equals the lowest rate in the state
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Top health risks: (
