Verde Valley Medical Center 2012 Community Health Needs Assessment In the spring of 2012, Verde Valley Medical Center (VVMC) embarked on a comprehensive Community Health Needs Assessment (CHNA) process to identify and address the key health issues for our community. From a small outpatient clinic in 1939, Verde Valley Medical Center in Cottonwood has grown into a full‐service, 99‐bed, nonprofit hospital serving North Central Arizona. Four locations serve the Verde Valley and surrounding communities: Cottonwood campus, Sedona campus, Camp Verde Health Center, and Village of Oak Creek Health Center. More than 800 professional and support staff are employed at VVMC. The Medical Staff is comprised of nearly 100 physicians representing 25 medical specialties. VVMC is accredited by DNV Healthcare, the newest hospital accreditation organization deemed by Center for Medicare and Medicaid Services (CMS) to accredit hospitals, and VVMC is licensed by the State of Arizona. We are a member of Northern Arizona Healthcare, which also serves patients through Flagstaff Medical Center and Northern Arizona Homecare and Hospice. VVMC is governed by a voluntary board of directors comprised of local citizens representing their local communities. All revenue in excess of expenses is returned to the community in the form of improved facilities, new equipment and services, recruitment and retention, and health education programs. Our vision of VVMC is to be the best regional medical center in the country. This vision is shared by the team of the Board of Directors, Administration, the Medical Staff and our colleagues. Accreditation Verde Valley Medical Center is nationally accredited by DNV Healthcare.
Definition of the Community Served
[IRS Form 990, Schedule H, Part V, Section B, 1a, 2]
Verde Valley Medical Center completed its last Community Health Needs Assessment in 2012.
CHNA Community Definition The study area for the survey effort (referred to as the “VVMC Service Area” in this report) includes the following residential ZIP Codes in the Camp Verde, Cottonwood and Sedona region of Arizona: 86322, 86324, 86325, 86326, 86331, 86335, 86342, 86336, 86339, 86340, 86351 and 86341. A geographic description is illustrated in the following map.
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Comparisons to previous research in 1997 and/or 2010 are made throughout this report wherever possible; however, note that 1997 study area excluded the 86024 ZIP Code.
Demographics of the Community
[IRS Form 990, Schedule H, Part V, Section B, 1b]
The population of the Verde Valley is around 65,000. There is a very high percentage of elderly in our area. These tend to have chronic diseases and conditions that affect the way they navigate through the healthcare process. Age/Gender: In the city the population was spread out with 23.4% under the age of 18, 8.2% from 18 to 24, 23.3% from 25 to 44, 21.4% from 45 to 64, and 23.8% who were 65 years of age or older. The median age was 41 years. For every 100 females there were 86.9 males. For every 100 females age 18 and over, there were 81.4 males. The racial makeup of the city was 85.24% White, 0.49% Black or African American, 1.57% Native American, 0.41% Asian, 0.03% Pacific Islander, 9.66% from other races, and 2.59% from two or more races. 20.53% of the population was Hispanic or Latino of any race. Income: The median income for a household in the city was $27,444, and the median income for a family was $37,794. Males had a median income of $24,308 versus $19,977 for females. The per capita income for the city was $17,518. Marital, Familial Status: There were 3,983 households out of which 25.3% had children under the age of 18 living with them, 44.5% were Married Couples living together, 10.8% had a female as Head of Household with no Husband present, and 40.5% were non‐families. 34.4% of all households were made up of individuals and 19.1% had someone living alone who was 65 years of age or older. The average household size was 2.27 and the average family size was 2.90. Other Relevant Segmentation: Cottonwood is a city in Yavapai County, Arizona, United States. According to 2006 Census Bureau estimates, the population of the city is 11,171. The Verde Valley has experienced significant population growth in recent years, 51% between 1990 and 2000.
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Community makeup: Community
1990 Population
2000 Population
2010 Population
Incorporated Communities Cottonwood
5,918
9,179
11,265
Clarkdale
2,144
3,422
4,097
Camp Verde
6,243
9,451
10,873
Jerome
403
329
444
Sedona
7,720
10,192
10,031
22,428
35,573
36,710
Sub-Total
Unincorporated Communities Verde Village
7,037
10,610
13,483
Big Park
3,024
5,245
6,147
Cornville
2,089
3,335
3,433
Lk Montezuma
1,841
3,344
4,706
Sub-Total
13,991
22,534
27,769
Verde Valley Total
36,419
55,107
64,479
Yavapai County
107,714
167,517
211,033
Existing Healthcare Facilities & Resources
[IRS Form 990, Schedule H, Part V, Section B, 1c]
Verde Valley Medical Center recognizes that there are many existing healthcare facilities and resources within the community that are available to respond to the health needs of residents. These organizations include the following: Acute-Care Hospitals/Emergency Rooms
Verde Valley Medical Center
Verde Valley Medical Center – Sedona Campus Federally Qualified Health Centers & Other Safety Net Providers
Community Health Center of Yavapai (FQHC)
Yavapai County Department of Health Services Nursing Homes/Adult Care
Harmony Home Care
Tender Hearts Senior Care Mental Health Services/Facilities
Verde Valley Guidance Clinic
Verde Valley Medical Center
Catholic Social Services Emergency Medical Services (EMS)
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Clarkdale Fire Department
Cottonwood Fire Department
Guardian Air Transport
Montezuma Rimrock Fire Department
Sedona Fire Department
Verde Valley Ambulance Company
Verde Valley Fire District Home Healthcare
Helping Hands In Home Care
Northern Arizona Homecare
Nurses Network
ResCare HomeCare
Sedona Nursing Service
Verde Valley Care Givers Hospice Care
Northern Arizona Hospice
Hospice Compassus School Health Services
Camp Verde Unified School District
Cottonwood – Oak Creek School District No.6
Mingus High School District
Sedona – Oak Creek Unified School District Other Community-Based Resources
MATFORCE (Substance Abuse)
Sedona Senior Center
Verde Valley Family Resource Center
Verde Valley Senior Citizen’s Association
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How CHNA Data Were Obtained
[IRS Form 990, Schedule H, Part V, Section B, 1d]
CHNA Goals & Objectives This Community Health Needs Assessment, a follow‐up to similar studies conducted in 1997 and 2010, is a systematic, data‐driven approach to determining the health status, behaviors and needs of residents in the Verde Valley Medical Center (VVMC) Service Area. Subsequently, this information may be used to inform decisions and guide efforts to improve community health and wellness. A Community Health Needs Assessment provides information so that communities may identify issues of greatest concern and decide to commit resources to those areas, thereby making the greatest possible impact on community health status. This Community Health Needs Assessment will serve as a tool toward reaching three basic goals: To improve residents’ health status, increase their life spans, and elevate their overall quality of life. A healthy community is not only one where its residents suffer little from physical and mental illness, but also one where its residents enjoy a high quality of life. To reduce the health disparities among residents. By gathering demographic information along with health status and behavior data, it will be possible to identify population segments that are most at‐risk for various diseases and injuries. Intervention plans aimed at targeting these individuals may then be developed to combat some of the socio‐economic factors which have historically had a negative impact on residents’ health. To increase accessibility to preventive services for all community residents. More accessible preventive services will prove beneficial in accomplishing the first goal (improving health status, increasing life spans, and elevating the quality of life), as well as lowering the costs associated with caring for late‐stage diseases resulting from a lack of preventive care. This assessment was conducted on behalf of Verde Valley Medical Center by Professional Research Consultants, Inc. (PRC). PRC is a nationally‐recognized healthcare consulting firm with extensive experience conducting Community Health Needs Assessments such as this in hundreds of communities across the United States since 1994. CHNA Methodology This assessment incorporates data from both quantitative and qualitative sources. Quantitative data input includes primary research (the PRC Community Health Survey) and secondary research (vital statistics and other existing health‐related data); these quantitative components allow for trending and comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through a Key Informant Focus Group.
Community Health Survey The survey instrument used for this study is based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to health promotion and disease prevention objectives and other recognized health issues. The final survey instrument was developed by the Verde Valley Medical Center and PRC, and is similar to the previous surveys used in the region, allowing for data trending. A precise and carefully executed methodology is critical in asserting the validity of the results gathered in the PRC Community Health Survey. Thus, 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.
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The sample design used for this effort consisted of a random sample of 400 individuals age 18 and older in the VVMC Service Area. Once the interviews were completed, these were weighted in proportion to the actual population distribution so as to appropriately represent the VVMC Service Area as a whole. All administration of the surveys, data collection and data analysis was conducted by Professional Research Consultants, Inc. (PRC). The sample design and the quality control procedures used in the data collection ensure that the sample is representative. Thus, the findings may be generalized to the total population of community members in the defined area with a high degree of confidence. Public Health, Vital Statistics & Other Data A variety of existing (secondary) data sources was consulted to complement the research quality of this Community Health Needs Assessment. Data for the VVMC Service Area were obtained from the following sources (specific citations are included with the graphs throughout this report): Centers for Disease Control & Prevention National Center for Health Statistics Arizona Department of Public Safety Arizona Department Health Services US Census Bureau US Department of Health and Human Services US Department of Justice, Federal Bureau of Investigation Note that secondary data reflect county‐level data for Yavapai County, Arizona. Community Stakeholder Input [IRS Form 990, Schedule H, Part V, Section B, 1h & 3] As part of the Community Health Needs Assessment, a focus group was held on May 22, 2012, among 17 key informants in the community, including: representatives from public health; physicians; other health professionals; social service providers; and other community leaders. A list of recommended participants for the focus group was provided by Valley Verde Medical Center. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Participants included a representative of public health, as well as several individuals who work with low‐income, minority or other medically underserved populations, and those who work with persons with chronic disease conditions. Focus group candidates were first contacted by letter to request their participation. Follow‐up phone calls were then made to ascertain whether they would be able to attend. Confirmation calls were placed the day before the groups were scheduled to insure a reasonable turnout. Audio from the focus group session was recorded, from which verbatim comments in this report are taken. There are no names connected with the comments, as participants were asked to speak candidly and assured of confidentiality. NOTE: These findings represent qualitative rather than quantitative data. The groups were designed to gather input from participants regarding their opinions and perceptions of the health of the residents in the area. Thus, these findings are based on perceptions, not facts.
Information Gaps
[IRS Form 990, Schedule H, Part V, Section B, 1i]
While this assessment is quite comprehensive, it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. It must be recognized that these information gaps might in some ways limit the ability to assess all of the community’s health needs.
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For example, certain population groups — such as the homeless, institutionalized persons, or those who only speak a language other than English or Spanish — are not represented in the survey data. Other population groups — for example, pregnant women, lesbian/gay/bisexual/transgender residents, undocumented residents, and members of certain racial/ethnic or immigrant groups — might not be identifiable or might not be represented in numbers sufficient for independent analyses. In terms of content, this assessment was designed to provide a comprehensive and broad picture of the health of the overall community. However, there are certainly a great number of medical conditions that are not specifically addressed.
Vulnerable Populations
[IRS Form 990, Schedule H, Part V, Section B, 1f]
The CHNA analysis and report yielded a wealth of information about the health status, behaviors and needs for our population. A distinct advantage of the primary quantitative (survey) research is the ability to segment findings by geographic, demographic and health characteristics to identify the primary and chronic disease needs and other health issues of vulnerable populations, such as uninsured persons, low‐income persons, and racial/ethnic minority groups. For additional statistics about uninsured, low‐income, and minority health needs please refer to the complete PRC Community Health Needs Assessment report, which can be viewed online at http://verdevalley.healthforecast.net. Public Dissemination
[IRS Form 990, Schedule H, Part V, Section B, 5‐5c]
This Community Health Needs Assessment is available to the public using the following URL: http://verdevalley.healthforecast.net. HealthForecast.net™ is an interactive, dynamic tool designed to share CHNA data with community partners and the public at large. This site:
Informs readers that the CHNA Report is available and provides instructions for downloading it;
Offers the CHNA Report document in a format that, when accessed, downloaded, viewed, and printed in hard copy, exactly reproduces the image of the report;
Grants access to download, view, and print the document without special computer hardware or software required for that format (other than software that is readily available to members of the public without payment of any fee) and without payment of a fee to the hospital organization or facility or to another entity maintaining the website. Links to this dedicated HealthForecast.net™ site are also made available at RHMC’s hospital website at: http://www.verdevalleymedicalcenter.com . VVMC will provide any individual requesting a copy of the written report with the direct website address, or URL, where the document can be accessed. VVMC will also maintain at its facilities a hardcopy of the CHNA report that may be viewed by any who request it.
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Health Needs of the Community
[IRS Form 990, Schedule H, Part V, Section B, 1e]
Areas of Opportunity for Community Health Improvement The following “health priorities” represent recommended areas of intervention, based on the information gathered through this Community Health Needs Assessment and the guidelines set forth in Healthy People 2020. From these data, opportunities for health improvement exist in the region with regard to the following health areas (see also the summary tables presented in the following section). These areas of concern are subject to the discretion of area providers, the steering committee, or other local organizations and community leaders as to actionability and priority.
Areas of Opportunity Identified Through This Assessment Lack of Coverage & Insurance Instability Difficulties Accessing Healthcare (Including Barriers of Cost, Physician Availability, Lack of Transportation) Difficulty Accessing Children’s Healthcare Routine Checkups (Adults) Preventive Cancer Screenings Rating of Local Healthcare Services
Access to Health Services
Arthritis, Osteoporosis & Chronic Back Conditions Family Planning
Births to Unwed Mothers Teen Births Blood Pressure Screening Prevalence of High Blood Pressure & Cholesterol
Heart Disease Immunization & Infectious Diseases
Senior Flu Vaccination
Injury & Violence Prevention
Unintentional Injury Deaths (including Motor Vehicle Crashes) Firearm Safety (Firearm-Related Deaths, Prevalence of Firearms) Domestic Violence
Mental Health & Mental Disorders
Chronic Depression Suicides
Oral Health
Regular Dental Care Dental Insurance Coverage
Respiratory Diseases
Substance Abuse
Prioritization Process
Prevalence of Osteoporosis (50+) Prevalence of Chronic Neck Pain Activity Limitations
Pneumonia/Influenza Deaths Prevalence of Nasal/Hay Fever Allergies Cirrhosis/Liver Disease Deaths Drug-Induced Deaths
[IRS Form 990, Schedule H, Part V, Section B, 1g, 6g]
After reviewing the Community Health Needs Assessment findings, the Verde Valley Medical Center’s Senior Management Team met on Wednesday, October 24, 2012, to determine the health needs to be prioritized for action in FY2012‐FY2014.
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During the detailed presentation of the CHNA findings, senior management members, through a process of understanding key local data findings (Areas of Opportunity) ranked identified health issues against the following established, uniform criteria:
Magnitude. The number of persons affected, also taking into account variance from benchmark data and Healthy People targets.
Impact/Seriousness. The degree to which the issue affects or exacerbates other quality of life and health‐related issues.
Feasibility. The ability to reasonably impact the issue, given available resources.
Consequences of Inaction. The risk of not addressing the problem at the earliest opportunity. Prioritization Results From this exercise, the Areas of Opportunity were prioritized as follows:
Access to Healthcare Services
Heart Disease & Stroke
Respiratory Disease
Mental Health & Mental Disorders
Arthritis, Osteoporosis & Chronic Pain
Injury & Violence Prevention
Substance Abuse
Family Planning
Oral Health
Community‐Wide Community Benefit Planning
[IRS Form 990, Schedule H, Part V, Section B, 6c‐6d]
As individual organizations begin to parse out the information from the 2012 Community Health Needs Assessment, it is Verde Valley Medical Center’s hope and intention that this will foster greater desire to embark on a community‐wide community health improvement planning process. Verde Valley Medical Center has expressed this intention to partnering organizations and is committed to being a productive member in this process as it evolves.
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Verde Valley Medical Center FY2012‐FY2014 Implementation Strategy For more than 75 years, Verde Valley Medical Center has demonstrated its commitment to meeting the health needs of the Verde Valley region. This summary outlines Verde Valley Medical Center’s plan (Implementation Strategy) to address our community’s health needs by 1) sustaining efforts operating within a targeted health priority area; 2) developing programs and initiatives to address identified health needs; and 3) promoting an understanding of these health needs among other community organizations and within the public itself.
Hospital‐Level Community Benefit Planning Priority Health Issues To Be Addressed
In consideration of the top health priorities identified through the CHNA process — and taking into account hospital resources and overall alignment with the hospital’s mission, goals and strategic priorities — it was determined that Verde Valley Medical Center would focus on developing and/or supporting strategies and initiatives to improve:
Access to Health Services
Heart Disease
Respiratory Disease
Immunizations
Integration with Strategic / Operational Planning
[IRS Form 990, Schedule H, Part V, Section B, 6e]
Beginning in 2013, VVMC includes objectives within its operational plan.
Priority Health Issues That Will Not Be Addressed & Why
[IRS Form 990, Schedule H, Part V, Section B, 7]
In acknowledging the wide range of priority health issues that emerged from the CHNA process, Verde Valley Medical Center determined that it could only effectively focus on those which it deemed most pressing, most under‐addressed, and most within its ability to influence.
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Health Priorities Not Chosen for Action
Reason
Substance Abuse
VVMC has limited resources, services and expertise available to address alcohol, tobacco and other drug issues. Other community organizations have infrastructure and programs in place to better meet this need. Limited resources excluded this as an area chosen for action. Family Planning VVMC believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action. Arthritis, Osteoporosis & VVMC offers physical therapy and joint replacement Chronic Back Conditions classes. However the prevention of these conditions are addressed by the State and County health departments, so we have excluded this area as chosen for action Oral Health VVMC believes that this priority area falls more within the purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action. Injury & Violence VVMC believes that this priority area falls more within the Prevention purview of the county health department and other community organizations. Limited resources and lower priority excluded this as an area chosen for action.
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Implementation Strategies & Action Plans
[IRS Form 990, Schedule H, Part V, Section B, 6f-6h]
The following displays outline VVMC’s plans to address those priority health issues chosen for action in the FY2013FY2015 period.
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ACCESS TO HEALTH SERVICES
Community Partners
Verde Valley Care Givers Association Yavapai County City of Cottonwood Verde Valley Senior Center Local Healthcare Providers
Goal
To improve healthcare access services for the residents of Verde Valley
Outcome Measures
Residents will report less barriers to accessing health care in the Verde Valley
Timeframe
FY2013-FY2015
Scope
This strategy will focus on residents in the Verde Valley region of AZ.
Strategies
Strategy #1: Build the capacity of local primary care clinics to provide primary and preventive healthcare services. Increase the number of primary care appointments Increase the number of unique patient visits Strategy #2: Reduce all cause readmissions by 10% Evaluate and understand the reasons for readmissions to the hospital Collaborate with external partners to decrease the number of readmissions Strategy #3: At least 40% of employees will be screened for cholesterol, blood pressure and diabetes Employees will be offered free screenings and education throughout the year Strategy #4: Enhance access to the right care at the right place at the right time Patient portal See unassigned patients in primary clinic within 5 days of discharge from VVMC
Financial Commitment Anticipated Outcomes
Results
Verde Valley residents will have more access to health care, routine checkups and pediatric care.
Pending
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Heart Disease
Community Partners
Goal
Outcome Measures
Yavapai County City of Cottonwood Verde Valley Senior Center Local healthcare providers
Provide blood pressure, cholesterol and glucose screenings
Residents reporting they have had a Blood Pressure and Cholesterol Screening
Timeframe
FY2013-FY2015
Scope
Residents of Verde Valley region of AZ.
Strategy #1: Screen appropriate out patients for high cholesterol and diabetes Identify and contact patients at risk Monitor patient results and follow up
Strategies & Objectives
Strategy #2: Offer free community blood pressure, cholesterol and diabetes screenings Market free weekly screenings/education to community members Offer screenings on site and in the community Strategy #3: Provide free cholesterol, blood pressure and diabetes screenings to employees and dependents Offer screenings on site Offer employees insurance discounts for attending screenings and other prevention activities
Financial Commitment
$
Anticipated Outcomes
Results
Residents of the Verde Valley will have access to blood pressure, cholesterol and diabetes screenings as well as education.
Pending
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Respiratory Disease
Community Partners
Yavapai County Verde Valley Senior Center Local healthcare providers Local pharmacies and retail providers
Goal
Reduce the incidence of influenza and pneumonia in Verde Valley, AZ
Outcome Measures
Mortality from Influenza and Pneumonia in Verde Valley, AZ
Timeframe
FY2013-FY2015
Scope
Residents of Verde Valley region of AZ.
Strategy #1: Primary care providers recommending annual vaccinations to appropriate patients. Reminder calls to appropriate patients to receive vaccination Strategy #2: Hospital offers free vaccines to all employees, medical staff and volunteers Employees and medical staff will be required to be vaccinated
Strategies & Objectives
Strategy #3: Local pharmacies and grocery stores offer inexpensive vaccines to community members Advertised to community and offered in convenient locations Strategy #4: Hospital provides vaccine, influenza and pneumonia education to the community. Newspaper articles and presentations
Financial Commitment
$
Anticipated Outcomes
Results
There will be no increase in the influenza and pneumonia mortality rates for the Verde Valley region of AZ.
Pending
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Immunization
Community Partners
Yavapai County Verde Valley Senior Center Local healthcare providers Local pharmacies and retail providers
Goal
Increase the number of seniors receiving Flu vaccine
Outcome Measures
Mortality from Influenza and Pneumonia in Verde Valley, AZ
Timeframe
FY2013-FY2015
Scope
Residents of Verde Valley region of AZ.
Strategy #1: Primary care providers recommending annual vaccinations to appropriate patients. Reminder calls to appropriate patients to receive vaccination Strategy #2: Hospital offers free vaccines to all employees, medical staff and volunteers Employees and medical staff will be required to be vaccinated
Strategies & Objectives
Strategy #3: Local pharmacies and grocery stores offer inexpensive vaccines to community members Advertised to community and offered in convenient locations Strategy #4: Hospital provides vaccine, influenza and pneumonia education to the community. Newspaper articles and presentations
Financial Commitment
$
Anticipated Outcomes
Results
There number of seniors receiving flu vaccine will increase for the Verde Valley region of AZ.
Pending
Adoption of Implementation Strategy
[IRS Form 990, Schedule H, Part V, Section B, 6a-6b]
On June 6, 2013, the Board of Verde Valley Medical Center, which includes representatives from throughout the Verde Valley region, met to discuss this plan for addressing the community health priorities identified through our Community Health Needs Assessment. Upon review, the
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Board approved this Implementation Strategy and the related budget items to undertake these measures to meet the health needs of the community. VVMC Board Approval & Adoption:
By Name & Title
Date
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