NORTHERN HOSPITAL OF SURRY COUNTY MOUNT AIRY, NC 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN

Transcription

1 NORTHERN HOSPITAL OF SURRY COUNTY MOUNT AIRY, NC 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN ADOPTED BY BOARD RESOLUTION SEPTEMBER 23, 2013

2 Dear Cmmunity Resident: (NHSC) welcmes yu t review this dcument as we strive t meet the health and medical needs in ur cmmunity. All nt-fr-prfit hspitals and sme gvernmental are required t develp this reprt in cmpliance with the Affrdable Care Act. The 2013 identifies lcal health and medical needs and prvides a plan t indicate hw NHSC will respnd t such needs. This dcument suggests areas where ther lcal rganizatins and agencies might wrk with us t achieve desired imprvements and illustrates ne way we, NHSC, are meeting ur bligatins t efficiently deliver medical services. NHSC will cnduct this effrt at least nce every three years. As yu review this plan, please see if, in yur pinin, we have identified the primary needs and if ur intended respnse shuld make apprpriate needed imprvements. We d nt have adequate resurces t slve all the prblems identified. Sme issues are beynd the missin f the hspital and actin is best suited fr a respnse by thers. Sme imprvements will require persnal actins by individuals rather than the respnse f an rganizatin. We view this as a plan fr hw we, alng with ther rganizatins and agencies, can cllabrate t bring the best each has t ffer t address the mre pressing, identified needs. The reprt is a respnse t a federal requirement f nt-fr-prfit and sme gvernmental hspitals t identify the cmmunity benefit it prvides in respnding t dcumented cmmunity need. Ftntes are prvided t answer specific tax frm questins. Fr mst purpses, they may be ignred. Of greater imprtance, hwever, is the ptential fr this reprt t guide ur actins and the effrts f thers t make needed health and medical imprvements. Please think abut hw t help us imprve the health and medical services ur area needs. I invite yur respnse t this reprt. We all live and wrk in this cmmunity tgether and ur cllective effrts can make living here mre enjyable and healthier. Thank Yu, 830 Rckfrd Street P.O. Bx 1101 Mt. Airy, NC

3 Munt Airy, NC Cmmunity Health Need Assessment Page i Table f Cntents Executive Summary... 1 Prject Objectives... 2 Brief Overview f... 2 Apprach... 4 Findings... 9 Definitin f Area Served by the Hspital Facility Demgraphic f the Cmmunity Leading Causes f Death Primary and Chrnic Disease Needs and Health Issues f Uninsured Persns, Lw-Incme Persns, and Minrity Grups Findings Cnclusins frm Public Input t Summary f Observatins frm Surry Cunty Cmpared t All Other State Cunties, in Terms f Cmmunity Health Needs Summary f Observatins frm Surry Cunty Peer Cmparisns Cnclusins frm the Demgraphic Analysis Cmparing Surry Cunty t Natinal Averages Key Cnclusins frm Cnsideratin f the Other Statistical Data Examinatins Existing Health Care Facilities, Resurces, and Implementatin Plan Significant Needs Other Needs Identified During the CHNA Prcess Overall Cmmunity Need Statement and Pririty Ranking Scre: Appendices Appendix A Lcal Expert Advisr Opinin abut Significant Needs Appendix B Prcess t Identify and Priritize Cmmunity Need... 48

4 Munt Airy, NC Page 1 EXECUTIVE SUMMARY

5 Munt Airy, NC Page 2 Executive Summary ("NHSC" r the "Hspital") is rganized as a gvernmental ntfr-prfit hspital. A (CHNA) is part f the required hspital dcumentatin f Cmmunity Benefit under the Affrdable Care Act (ACA), required f all ntfr-prfit hspitals as a cnditin f retaining 501(c)(3) status. A CHNA assures NHSC identifies and respnds t the primary health needs f its residents. This study is designed t cmply with standards required f a nt-fr-prfit hspital 1. Tax reprting citatins in this reprt wuld nrmally be superseded by the mst recent Frm Schedule H ( Frm 990 ) filings made by the hspital. Hwever, as a gvernmental entity, NHSC des nt file such, and des nt frsee ding s in the future. Prject Objectives NHSC partnered with Qurum Health Resurces (QHR) fr the fllwing 2 : Cmplete a CHNA reprt, cmpliant with Treasury IRS; Prvide the Hspital with infrmatin required t cmplete the IRS Frm 990 Schedule H; and Prduce the infrmatin necessary fr the Hspital t issue an assessment f cmmunity health needs and dcument its intended respnse. Brief Overview f Typically, nn-prfit hspitals qualify fr tax-exempt status as a Charitable Organizatin, described in Sectin 501(c) 3 f the Internal Revenue Cde; hwever, the term 'Charitable Organizatin' is undefined. Prir t the passage f Medicare, charity was generally recgnized as care prvided t the less frtunate withut means t pay. With the intrductin f Medicare and Medicaid, the gvernment met the burden f prviding sme cmpensatin fr such care. In respnse, IRS Revenue ruling eliminated the Charitable Organizatin standard and established the Cmmunity Benefit Standard as the basis fr tax-exemptin. Cmmunity Benefit determines if hspitals prmte the health f a brad class f individuals in the cmmunity, based n factrs including: Emergency rm pen t all, regardless f ability t pay; Surplus funds used t imprve patient care, expand facilities, train, etc.; 1 Part 3 Treasury/IRS Ntice Requirements and 2 Part 3 Treasury/IRS Sectin 3.03 (2) third party disclsure ntice

6 Munt Airy, NC Page 3 Cntrlled by independent civic leaders; and All available and qualified physicians are privileged. Specifically, the IRS requires: Effective n tax years beginning after March 23, 2012, each 501(c)(3) hspital facility is required t cnduct a CHNA at least nce every three taxable years and adpt an implementatin strategy t meet the cmmunity needs identified thrugh such assessment; The assessment may be based n current infrmatin cllected by a public health agency r nn-prfit rganizatin and may be cnducted tgether with ne r mre ther rganizatins, including related rganizatins; The assessment prcess must take int accunt input frm persns wh represent the brad interests f the cmmunity served by the hspital facility, including thse with special knwledge r expertise f public health issues; The hspital must disclse in its annual infrmatin reprt t the IRS (Frm 990 and related schedules) hw it is addressing the needs identified in the assessment, and, if all identified needs are nt addressed, the reasns why (e.g., lack f financial r human resurces); Each hspital facility is required t make the assessment widely available and ideally dwnladable frm the hspital web site; Failure t cmplete a CHNA in any applicable three-year perid results in a penalty t the rganizatin f $50,000. Fr example, if a facility des nt cmplete a CHNA in taxable years ne, tw, r three, it is subject t the penalty in year three. If it then fails t cmplete a CHNA in year fur, it is subject t anther penalty in year fur (fr failing t satisfy the requirement during the three-year perid beginning with taxable year tw and ending with taxable year fur); and An rganizatin that fails t disclse hw it is meeting needs identified in the assessment is subject t existing incmplete return penalties 3. This reprt was develped under the guidance f IRS/Treasury as mdified by the Draft Federal Regulatins published in the April 5, 2013 Federal Register. 3 Sectin 6652

7 Munt Airy, NC Page 4 APPROACH

8 Munt Airy, NC Page 5 T cmplete a CHNA, the hspital must: Apprach Describe the prcesses and methds used t cnduct the assessment; Surces f data and dates retrieved; Analytical methds applied; Infrmatin gaps impacting ability t assess the needs; and Identificatin f with whm the Hspital cllabrated. The prpsed regulatins prvide that a hspital facility s CHNA reprt will be cnsidered t describe hw the hspital facility tk int accunt input if the CHNA reprt: 1) Summarizes, in general terms, the input prvided and hw and ver what time perid such input was prvided; 2) Prvides the names f rganizatins prviding input and summarizes the nature and extent f the rganizatin s input; and 3) Describes the medically underserved, lw incme, r minrity ppulatins being represented by rganizatins r individuals prviding input. Describe the prcess and criteria used in priritizing health needs; Describe existing resurces available t meet the cmmunity health needs; and Identify the prgrams and resurces the hspital facility plans t cmmit t meeting each identified need, and the anticipated impact f thse prgrams and resurces n the health need. QHR takes a cmprehensive apprach t assess cmmunity health needs. We perfrm several independent data analyses based n secndary surce data, augment this with lcal survey data, and reslve any data incnsistency r discrepancies frm the cmbined pinins frmed frm lcal experts. We rely n secndary surce data, and mst secndary surces use the cunty as the smallest unit f analysis. We asked ur lcal expert area residents t nte if they perceived the prblems r needs identified by secndary surces t exist in their prtin f the cunty 4. Mst data used in the analysis is available frm public internet surces. Critical data needed t address specific regulatins r develped by the individuals cperating with us in this study is displayed in the reprt f the appendix. Data surces include 5 : 4 Respnse t Schedule H (Frm 990) Part V B 1 i 5 Respnse t Schedule H (Frm 990) Part V B 1 d

9 Munt Airy, NC Page 6 Web Site r Data Surce Data Element Date Accessed Data Date Truven (frmerly knwn as Thmsn) Market Planner and and iweb.nhpc.rg Assessment f health needs f Surry Cunty cmpared t all NC cunties Assessment f health needs f Surry Cunty cmpared t its natinal set f peer cunties Assess characteristics f the hspital s primary service area, at a zip cde level, based n classifying the ppulatin int varius sci-ecnmic grups, determining the health and medical tendencies f each grup and creating an aggregate cmpsitin f the service area accrding t the cntributin each grup makes t the entire area; and, t access ppulatin size, trends, and sci-ecnmic characteristics T identify the availability f Palliative Care prgrams and services in the area T identify the availability f hspice prgrams in the cunty May 31, t 2010 May 31, t 2009 May 31, May 31, May 31, T examine the prevalence f diabetic cnditins and change in life expectancy May 31, thrugh T determine availability f specific health resurces May 31, T examine area trends fr heart disease and strke T identify ptential needs amng a variety f resurce and health need metrics T identify applicable manpwer shrtage designatins May 31, t 2010 May 31, t 2010 May 31,

10 Munt Airy, NC Page 7 Web Site r Data Surce Data Element Date Accessed Data Date T determine relative imprtance amng 15 tp causes f death May 31, published 11/29/12 spx Health Prfessinal Shrtage Area August 22, /22/13 In additin, we deplyed a CHNA Rund 1 survey t ur lcal expert advisrs t gain lcal input as t lcal health needs and the needs f pririty ppulatins. Lcal expert advisrs were lcal individuals selected t cnfrm t the input required by the Federal guidelines and regulatins 6. We received cmmunity input frm 15 lcal expert advisrs. Survey respnses started Mnday, June 3, 2013 at 7:23 a.m. and ended with the last respnse n Friday, June 28, 2013 at 11:21 a.m.; Infrmatin analysis augmented by lcal pinins shwed hw Surry Cunty relates t its peers in terms f primary and chrnic needs and ther issues f uninsured persns, lwincme persns, and minrity grups. Respndents cmmented n if they believe certain ppulatin grups (r peple with certain situatins) need help t imprve their cnditin, and if s, wh needs t d what 7. When the analysis was cmplete, we put the infrmatin and summary cnclusins befre ur lcal grup f experts 8, wh were asked t agree r disagree with the summary cnclusins. They were free t augment ptential cnclusins with additinal statements f need 9. Cnsultatin with 15 lcal experts ccurred again via an internet-based survey (explained belw) during the perid beginning Wednesday, July 3, :43 a.m. and ending Mnday, August 5, :45 a.m. With the prir steps identifying ptential cmmunity needs, the lcal experts participated in a structured cmmunicatin technique called a Delphi methd, riginally develped as a systematic, interactive frecasting methd that relies n a panel f experts. Experts answer questinnaires in a series f runds. We cntemplated and implemented ne rund as referenced during the abve dates. After each rund, we prvided an annymus summary f the experts frecasts frm the previus rund, as well as reasns prvided fr their judgments. The prcess encuraged experts t revise their earlier answers in light f the replies f ther members f their panel. Typically, this prcess decreases the range f answers and mves the expert pinins tward a cnsensus "crrect" answer. The prcess stps when we identify the mst pressing, highest pririty, cmmunity needs. 6 Respnse t Schedule H (Frm 990) Part V B 1 h; cmplies with 501(r)(3)(B)(i) 7 Respnse t Schedule H (Frm 990) Part V B 1 f 8 Part respnse t Schedule H (Frm 990) Part V B 3 9 Respnse t Schedule H (Frm 990) Part V B 1 e

11 Munt Airy, NC Page 8 In the NHSC prcess, each lcal expert allcated 100 pints amng all identified needs, having the pprtunity t intrduce needs previusly unidentified and challenge cnclusins develped frm the data analysis. A rank rder f pririties emerged, with sme needs receiving nne r virtually n supprt, and ther needs receiving identical pint allcatins. The prpsed regulatins clarify a CHNA need nly identify significant health needs, and need nly priritize, and therwise assess, thse significant identified health needs. A hspital facility may determine whether a health need is significant based n all f the facts and circumstances present in the cmmunity it serves. The determinatin f the break pint, Significant Need as ppsed t Other Need, was a qualitative interpretatin by QHR and the NHSC executive team where a reasnable break pint in the descending rank rder f vtes ccurred, indicated by the weight amunt f pints each ptential need received and the number f lcal experts allcating any pints t the need. Our criteria included the Significant Needs had t represent a majrity f all cast vtes. The Significant Needs als needed a plurality f Lcal Expert participatin. When presented t the NHSC executive team, the dichtmized need rank rder (Significant vs. Other) identified which needs the hspital needed t fcus upn in determining where and hw it was t develp an implementatin respnse Respnse t Schedule H (Frm 990) Part V Sectin B 6 g, h and Part V B 1 g

12 Munt Airy, NC Page 9 FINDINGS

13 Munt Airy, NC Page 10 Findings Definitin f Area Served by the Hspital Facility 11 NHSC, in cnjunctin with QHR, defines its service area as Surry Cunty in NC, which includes the fllwing ZIP cdes: Ararat Dbsn Lwgap Munt Airy Pilt Muntain Silam Elkin State Rad In 2011, the Hspital received 76% f its Medicare inpatients frm this area Respnds t IRS Frm 990 (h) Part V B 1 a 12 Truven MEDPAR patient rigin data fr the hspital; Respnds t IRS Frm 990 (h) Part V B 1 a

14 Munt Airy, NC Page 11 Demgraphic f the Cmmunity 13 The 2013 ppulatin fr Surry Cunty is estimated t be 75, and expected t increase at a rate f 1%. This is lwer than the 4.6% prjected NC grwth and the 3.3% natinal grwth. Surry Cunty anticipates a ppulatin f 76,671 by Accrding t the ppulatin estimates utilized by Truven, prvided by The Nielsen Cmpany, the 2013 median age fr the cunty is 41.8 years, which is lder than the State median age (37.8 years), and the natinal median age (37.5 years). The 2013 Median Husehld Incme fr the area is $35,396 which is lwer than the State median incme f $41,990, and the natinal median incme f $49,233. Median Husehld Wealth value is abve bth the Natinal and the State values. The Median Hme Values fr the area is $111,098 which is lwer than the Natinal and State values. Surry Cunty s unemplyment rate as f April, 2013 was 9.3% 15, which is wrse than the 8.5% statewide and 7.5% natinal civilian unemplyment rates. The prtin f the ppulatin in the cunty ver 65 is 17.9%, abve the State average. The prtin f the ppulatin f wmen f childbearing age is 17.6%, belw the State average f 20% and natinal average f 19.8%. 3.3% f the ppulatin is Black nn-hispanic and 84.7% is White nn- Hispanic. The Hispanic ppulatin cmprises 10.3% f the ttal. 13 Respnds t IRS Frm 990 (h) Part V B 1 b 14 All ppulatin infrmatin, unless therwise cited, surced frm Truven (frmally Thmsn) Market Planner 15

15 Munt Airy, NC Page 12 The ppulatin als was examined accrding t characteristics presented in the Claritas Prizm custmer segmentatin data. This system segments the ppulatin int 66 demgraphically and behavirally distinct grups. Each grup, based n annual survey data, is dcumented as exhibiting specific health behavirs. The makeup f the service area, accrding t the mix f Prizm segments and its characteristics, is cntrasted t the natinal ppulatin averages t discern the fllwing table f prbable lifestyle and medical cnditins present in the ppulatin. Items with red text are viewed as statistically imprtant, ptentially adverse findings. Items with blue text are viewed as statistically imprtant, ptential beneficial findings. Items with black text are viewed as either nt statistically different frm the natinal nrmal situatin, r nt cnsidered either favrable r unfavrable in ur use f the infrmatin.

16 Munt Airy, NC Page 13

17 Munt Airy, NC Page 14 Leading Causes f Death

18 Munt Airy, NC Page 15 Primary and Chrnic Disease Needs and Health Issues f Uninsured Persns, Lw- Incme Persns, and Minrity Grups Sme infrmatin is available t describe the size and cmpsitin f varius uninsured persns, lw incme persns, minrity grups, and ther vulnerable ppulatin segments. Specific studies identifying needs f such grups, distinct frm the general ppulatin at a cunty unit f analysis, are nt readily available frm secndary surces. The Natinal Healthcare Disparities Reprt results frm a Cngressinal directive t the Agency fr Healthcare Research and Quality (AHRQ). This prductin is an annual reprt t track disparities related t "racial factrs and sciecnmic factrs in pririty ppulatins." The emphasis is n disparities related t race, ethnicity, and sciecnmic status. The directive includes a charge t examine disparities in "pririty ppulatins," which are grups with unique healthcare needs r issues that require special attentin 16. Natinally, this reprt bserves the fllwing trends: Measures fr which Blacks were wrse than Whites and are getting better: Diabetes Hspital admissins fr shrt-term cmplicatins f diabetes per 100,000 ppulatin; HIV and AIDS New AIDS cases per 100,000 ppulatin age 13 and ver; and Functinal Status Preservatin and Rehabilitatin. Female Medicare beneficiaries age 65 and ver, wh reprted ever being screened fr steprsis with a bne mass r bne density measurement. Measures fr which Blacks were wrse than Whites and staying the same: Cancer Breast cancer diagnsed at advanced stage per 100,000 wmen age 40 and ver; breast cancer deaths per 100,000 female ppulatin per year; adults age 50 and ver wh ever received clrectal cancer screening; clrectal cancer diagnsed at advanced stage per 100,000 ppulatin age 50 and ver; clrectal cancer deaths per 100,000 ppulatin per year; Diabetes Hspital admissins fr lwer extremity amputatins per 1,000 ppulatin age 18 and ver with diabetes; Maternal and Child Health Children ages 2-17 wh had a dental visit in the calendar year; Children ages mnths wh received all recmmended vaccines; Mental Health and Substance Abuse Adults with a majr depressive episde in the last 12 mnths wh received treatment fr depressin in the last 12 mnths; peple age 12 and ver treated fr substance abuse wh cmpleted treatment curse;

19 Munt Airy, NC Page 16 Respiratry Diseases Adults age 65 and ver wh ever received pneumcccal vaccinatin; hspital patients with pneumnia wh received recmmended hspital care; Supprtive and Palliative Care High-risk lng-stay nursing hme residents with pressure sres; shrt-stay nursing hme residents with pressure sres; adult hme health care patients wh were admitted t the hspital; hspice patients wh received the right amunt f medicine fr pain; Timeliness Adults wh needed immediate care fr an illness, injury, r cnditin in the last 12 mnths, wh received care as sn as they wanted; emergency department visits where patients left withut being seen; and Access Peple with a usual primary care prvider; peple with a specific surce f nging care. Measures fr which Asians were wrse than Whites and getting better: Cancer Adults age 50 and ver wh ever received clrectal cancer screening; and Patient Safety Adult surgery patients wh received apprpriate timing f antibitics. Measures fr which Asians were wrse than Whites and staying the same: Respiratry Diseases Adults age 65 and ver wh ever received pneumcccal vaccinatin; hspital patients with pneumnia wh received recmmended hspital care; and Access Peple with a usual primary care prvider. Measures fr which American Indians and Alaska Natives were wrse than Whites fr the mst recent year and staying the same: Heart Disease Hspital patients with heart failure wh received recmmended hspital care; HIV and AIDS New AIDS cases per 100,000 ppulatin age 13 and ver; Respiratry Diseases Hspital patients with pneumnia wh received recmmended hspital care; Functinal Status Preservatin and Rehabilitatin Female Medicare beneficiaries age 65 and ver wh reprted ever being screened fr steprsis with a bne mass r bne density measurement; Supprtive and Palliative Care Hspice patients wh received the right amunt f medicine fr pain; high-risk, lng-stay nursing hme residents with pressure sres; adult hme healthcare patients wh were admitted t the hspital; and Access Peple under age 65 with health insurance.

20 Munt Airy, NC Page 17 Measures fr which American Indians and Alaska Natives were wrse than Whites fr the mst recent year and getting wrse: Cancer Adults age 50 and ver wh ever received clrectal cancer screening; and Patient safety Adult surgery patients wh received apprpriate timing f antibitics. Measures fr which Hispanics were wrse than nn-hispanic Whites fr the mst recent year and getting better: Maternal and Child Health Children ages 2-17 wh had a dental visit in the calendar year; Lifestyle Mdificatin Adult current smkers with a checkup in the last 12 mnths wh received advice t quit smking; adults with besity wh ever received advice frm a health prvider abut healthy eating; and Functinal Status Preservatin and Rehabilitatin Female Medicare beneficiaries age 65 and ver wh reprted ever being screened fr steprsis with a bne mass r bne density measurement. Measures fr which Hispanics were wrse than nn-hispanic Whites fr mst recent year and staying the same: Cancer Wmen age 40 and ver wh received a mammgram in the last 2 years; adults age 50 and ver wh ever received clrectal cancer screening; Diabetes Adults age 40 and ver with diagnsed diabetes wh received all three recmmended services fr diabetes in the calendar year; Heart Disease Hspital patients with heart attack and left ventricular systlic dysfunctin wh were prescribed angitensin-cnverting enzyme inhibitr r angitensin receptr blcker at discharge; hspital patients with heart failure wh received recmmended hspital care; HIV and AIDS New AIDS cases per 100,000 ppulatin age 13 and ver; Mental Health and Substance Abuse Adults with a majr depressive episde in the last 12 mnths wh received treatment fr depressin in the last 12 mnths; Respiratry Disease Adults age 65 and ver wh ever received pneumcccal vaccinatin; hspital patients with pneumnia wh received recmmended hspital care; Lifestyle Mdificatin Adults with besity wh ever received advice frm a health prvider t exercise mre; Supprtive and Palliative Care Lng-stay nursing hme residents with physical restraints; high-risk, lng-stay nursing hme residents with pressure sres; shrt-stay

21 Munt Airy, NC Page 18 nursing hme residents with pressure sres; adult hme health care patients wh were admitted t the hspital; hspice patients wh received the right amunt f medicine fr pain; Patient Safety Adult surgery patients wh received apprpriate timing f antibitics; Timeliness Adults wh needed care right away fr an illness, injury, r cnditin in the last 12 mnths and gt care as sn as wanted; Patient Centeredness Adults with ambulatry visits wh reprted pr cmmunicatin with health prviders; children with ambulatry visits wh reprted pr cmmunicatin with health prviders; and Access Peple under age 65 with health insurance; peple under age 65 wh were uninsured all year; peple with a specific surce f nging care; peple with a usual primary care prvider; peple unable t get r delayed in getting needed care due t financial r insurance reasns Measures fr which Hispanics were wrse than nn-hispanic Whites fr the mst recent year and getting wrse: Maternal and Child Health Children ages 3-6 wh ever had their visin checked by a health prvider. We asked a specific questin t ur lcal expert advisrs abut unique needs f pririty ppulatins. We reviewed their respnses t identify if any f the abve trends were bvius in the service area. Accrdingly, we place great reliance n the cmmentary received t identify unique ppulatin needs t which we shuld respnd. Specific pinins frm the lcal expert advisrs are summarized as fllws 17 : Access t care/affrdability; Obesity; Cancer; Alchl/Substance Abuse; Mental Health; and Diabetes. Statistical infrmatin abut special ppulatins fllws: 17 All cmments and the analytical framewrk behind develping this summary appear in Appendix A.

22 Munt Airy, NC Page 19 Findings Upn cmpletin f the CHNA, QHR identified several issues within the Mt. Airy cmmunity:

23 Munt Airy, NC Page 20 Cnclusins frm Public Input t 15 area residents participated in a survey asking pinins abut their perceptin f lcal healthcare needs. In descending rder f pinin, six tpics were identified as being f "Majr Cncern" r "Mst Imprtant Issue t Reslve": 1. Access t care/affrdability 91% listed as a majr cncern; 2. Mental health/suicide 73% listed as a majr cncern; 3. Peple Making Unhealthy Fd Chices/Obesity 73% listed as a majr cncern; 4. Alchl/Substance Abuse 55% listed as a majr cncern; 5. Cmpliance Behavir 45% listed as a majr cncern; and 6. Cancer 26% listed as a majr cncern. Summary f Observatins frm Surry Cunty Cmpared t All Other State Cunties, in Terms f Cmmunity Health Needs In general, Surry Cunty residents are abut average health fr State; In a health status classificatin termed "Health Outcmes," Cunty ranks 61 st amng 100 cunties (best being #1). On measures f mrbidity and mrtality, Surry Cunty perfrms wrse than bth State averages and Natinal benchmarks fr premature death (death befre the age f 75), pr r fair health, pr physical health days, and pr mental health days. Surry Cunty perfrms better than State average, but wrse than the Natinal benchmark fr lw birth weight; and In anther health status classificatin "Health Factrs," Surry Cunty fares slightly better, ranking 51 st amng the 100 cunties. Clinical care measures n the supply f primary care physicians and diabetic screenings are better than State averages, but d nt meet Natinal benchmarks. On measures f uninsured, supply f dentists, preventable hspital stays, and mammgraphy screening, Surry Cunty perfrms wrse than State averages and des nt meet Natinal benchmarks. Cnditins where imprvement remains t achieving state average rates and then natinal gals include: Adult smking; and Adult besity.

24 Munt Airy, NC Page 21 Summary f Observatins frm Surry Cunty Peer Cmparisns The federal gvernment administers a prcess t allcate all cunties int "peer" grups. Cunty "peer" grups have similar scial, ecnmic, and demgraphic characteristics. Health and wellness bservatins when Surry Cunty is cmpared t its natinal set f peer cunties and cmpared t natinal rates make the fllwing bservatins: UNFAVORABLE bservatins ccurring at rates wrse than natinal AND wrse than amng peers: Lw Birth Weight (<2500 g); Premature Births (<37 weeks); Births t Wmen under 18; N Care in First Trimester; Black nn Hispanic Infant Mrtality; Breast Cancer (Female); Crnary Heart Disease; Hmicide; Lung Cancer; Mtr Vehicle Injuries; Strke; and Suicide. SOMEWHAT A CONCERN bservatins because ccurrence is EITHER abve natinal average r abve peer grup average: White nn Hispanic Infant Mrtality; Hispanic Infant Mrtality; Nenatal Infant Mrtality; and Unintentinal Injury. BETTER PERFORMANCE better than peers and natinal rates: Very Lw Birth Weight (<1500 g); Births t Wmen age 40-54; Births t Unmarried Wmen; Infant Mrtality; Pst-nenatal Infant Mrtality; and Cln Cancer.

25 Munt Airy, NC Page 22 Cnclusins frm the Demgraphic Analysis Cmparing Surry Cunty t Natinal Averages Surry Cunty in 2013 cmprises 75,900 residents. During the next five years, it is expected t see a ppulatin increase f 1% t achieve 76,671 residents. This is lwer than the anticipated state grwth (4.6%) and the natinal grwth (3.3%). The ppulatin is lder and has a lwer median incme than the state and natinal cmparisns. 17.9% f the ppulatin is age 65 r lder, higher than NC. 0.4% are nn-hispanic White, Asian, and Pacific Island rigin; Hispanics cnstitute 10.3% f the ppulatin; Blacks cmprise 3.3% f the ppulatin; Whites 84.7%. Females ages 15 t 44 cmprise 17.6% f the ppulatin, less than the percentage in NC (20%) r the natin (19.8%). The fllwing areas were identified cmparing the cunty t natinal averages. Metrics impacting mre than 30% f the ppulatin and that are statistically significantly different frm the natinal average: Persnal Respnsibility fr Health was 7.7% belw average, impacting 60.6% an adverse finding; Pap/Cervix Screening was 14% belw average, impacting 51.8% an adverse finding; Rutine Chlesterl Screening was 8.7% belw average, impacting 46.4% an adverse finding; OB/GYN 1+ Visit was 14% belw average, impacting 39.7% an adverse finding; Emergency Rm Use was 6.5% abve average, impacting 36.2% an adverse finding; Cmpliance with Treatment Recmmendatins was 16.2% belw average, impacting 33.8% an adverse finding; Chrnic High Bld Pressure was 26.3% abve average, impacting 33.2% an adverse finding; and Tbacc Use: Cigarettes was 22.6% abve average, impacting 31.8% an adverse finding. Situatins and cnditins statistically significantly different frm the natinal average, but impacting less than 30% f the ppulatin include: Rutine Screen: Prstate 2 yr was 7.3% belw average, impacting 29.5% an adverse finding; BMI: Mrbid/Obese was 9.3% abve average, impacting 27.9% an adverse finding; Chrnic Lwer Back Pain was 22.6% abve average, impacting 27.6% an adverse finding; Healthy Eating Habits was 10.3% belw average, impacting 26.5% an adverse finding; Chrnic High Chlesterl was 10.2% abve average, impacting 24.6% an adverse finding;

26 Munt Airy, NC Page 23 Cancer Screen: Clrectal 2 yr was 6.1% belw average, impacting 23.2% an adverse finding; Chrnic Allergies was 17.4% abve average, impacting 22% an adverse finding; Chrnic Diabetes was 30.8% abve average, impacting 13.6% an adverse finding; Chrnic Osteprsis was 30.1% abve average, impacting 12.6% an adverse finding; Chrnic Heart Disease was 38.6% abve average, impacting 11.6% an adverse finding; Chrnic COPD was 30.9% abve average, impacting 8.8% an adverse finding; and Very Unhealthy Eating Habits was 22.4% abve average, impacting 3.3% an adverse finding. Key Cnclusins frm Cnsideratin f the Other Statistical Data Examinatins Additinal bservatins f Surry Cunty fund: Palliative Care prgrams (prgrams fcused nt n curative actins but designed t relieve disease symptms pain and stress arising frm serius illness) d nt exist in the cunty; Hspice: fur prgrams exist in the cunty; and Per 2013 data, Surry Cunty is a Health Prfessinal Shrtage Area (HPSA) fr Primary Medical Care, Dental, and Mental Health fr Medically Indigent and Lw Incme Ppulatins 18. Ranking the causes f death in Cunty finds the leading causes t be the fllwing (in descending rder f ccurrence): Heart Disease #1 cause f death statewide and in Cunty 222.3/100,000 ranking #44 amng 100 NC Cunties; Cancer #2 cause f death statewide and in Cunty 199.3/100,000 ranking #47 NC Cunty; Accidents #3 cause f death in Cunty, statewide # /100,000 ranking #20 NC Cunty significantly higher than expected; Strke #4 cause f death statewide and in Cunty 56.5/100,000 ranking #51 NC Cunty significantly higher than expected; Lung Disease #5 cause f death statewide and in Cunty 53.7/100,000 ranking #22 NC Cunty significantly higher than expected; 18

27 Munt Airy, NC Page 24 Alzheimer's #6 cause f death statewide and in Cunty 32.6/100,000 ranking #22 NC Cunty significantly higher than expected; Flu-Pneumnia #7 cause f death in Cunty, statewide # /100,000 ranking #39 NC Cunty; Diabetes #8 cause f death in Cunty, statewide #7 22.3/100,000 ranking #66 NC Cunty; Suicide #9 cause f death in Cunty, statewide # /100,000 ranking #13 NC Cunty significantly higher than expected; Kidney Disease #10 cause f death in Cunty, statewide #8 15/100,000 ranking #74 NC Cunty; and Amng ther leading causes f death, Hypertensin is significantly higher than expected. The incident f Heart Disease death is abve state and natinal averages. The incident f Strke deaths is well abve bth state and natinal averages. Diabetes is abve state average. Life expectancy fr Surry Cunty males in 1989 was 70.1 years, 3.2 years behind the tp cunties, imprving in 2009 t 72.8 years, 6 years behind the tp cunties. Life expectancy fr Surry Cunty females in 1989 was 79.1 years, 1.3 years behind the tp cunties, decreasing in 2009 t 78.7 years, 3.8 years behind the tp cunties.

28 Munt Airy, NC Page 25 EXISTING HEALTH CARE FACILITIES, RESOURCES, AND IMPLEMENTATION PLAN

29 Munt Airy, NC Page 26 Significant Health Needs We used the pririty ranking f area health needs by the lcal expert advisrs t rganize the search fr lcally available resurces as well as the respnse t the needs by Nrthern Hspital f Surry Cunty 19. The fllwing list includes: Identifies the rank rder f each identified Significant Need; Presents the factrs cnsidered in develping the ranking; Establishes a Prblem Statement t specify the prblem indicated by use f the Significant Need term; Identifies current effrts respnding t the need; Establishes the Implementatin Plan prgrams and resurces Nrthern Hspital f Surry Cunty will devte t attempt t achieve imprvements; Dcuments the Leading Indicatrs will use t measure prgress; Presents the Lagging Indicatrs believes the Leading Indicatrs will influence in a psitive fashin; and Presents the lcally available resurces nted during the develpment f this reprt as believed t be currently available t respnd t this need. In general, is the majr hspital in the service area. Nrthern Hspital f Surry Cunty is a 133-bed, acute care medical facility lcated in Munt Airy, NC. The next clsest facilities are utside the service area and include: Hugh Chatham Memrial Hspital 81 bed acute care medical facility in Elkin, NC; 27.2 miles away frm Munt Airy (30 minutes) Pineer Cmmunity Hspital f Stkes 25-bed critical access hspital in Danbury, NC; 26.9 miles away frm Munt Airy (39 minutes) Twin Cunty Reginal Hspital 139-bed acute care medical facility in Galax, VA; 30.9 miles away frm Munt Airy (42 minutes) All data items analyzed t determine significant needs are Lagging Indicatrs, measures presenting results after a perid f time, characterizing histrical perfrmance. Lagging Indicatrs tell yu nthing abut hw the utcmes were achieved. In cntrast the Implementatin Plan utilizes Leading Indicatrs. Leading Indicatrs anticipate change in the Lagging Indicatr. Leading Indicatrs fcus n shrt-term perfrmance, and if accurately selected, anticipate the brader achievement f desired change in the Lagging Indicatr. In the QHR 19 Respnse t IRS Frm 990 h Part V B 1 c

30 Munt Airy, NC Page 27 applicatin Leading Indicatrs als must be within the ability f the hspital t influence and measure. Significant Needs 1. ACCESS/AFFORDABILITY OF HEALTH CARE Lack f access t affrdable care is the leading Lcal Expert cncern; uninsured rate abve NC average and twice the US gal. Prblem Statement: Lcal residents shuld nt be withut access t care because f limited payment ability. NHSC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: NHSC has an nsite resurce available fr Medicaid eligibility t assist patients, as well as cmmunity members; NHSC s ED is available t all patients, regardless f ability t pay; NHSC prvides financial supprt and resurces t lcal free clinic; NHSC prvides resurces t supprt grant applicatins fr ther rganizatins t fund indigent care in the cmmunity; and NHSC prvides care and services t indigent ppulatin at reduced r n expense. NHSC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: 20 Supprt medical hmes, an apprach t prviding cmprehensive primary care fr children, yuth, and adults in a setting that facilitates partnerships between individual patients, their persnal physicians, and (when apprpriate) patients' families; Increase use f telemedicine as a way fr patients t access qualified health and mental health prfessinals; and Assist in enrlling uninsured individuals and families in Medicare, Medicaid, Children s Health Insurance Prgram, and Insurance Marketplaces (i.e., Exchanges). ANTICIPATED RESULTS FROM NHSC IMPLEMENTATION PLAN NHSC s effrts can help address the symptms f and results frm prblems f affrdability and access, but it can d little t impact the underlying causes f this prblem which stem frm unemplyment, limited educatin, adverse lifestyle chices and ther factrs. LEADING INDICATOR NHSC WILL USE TO MEASURE PROGRESS Vlume f patient financial assistance effrts shuld increase frm 2012 vlumes. 20 This sectin in each need fr which the hspital plans an implementatin strategy respnds t Schedule H (frm 990) Part V Sectin B 6. a. and 6. b.

31 Munt Airy, NC Page 28 FY 2012 Medicaid applicatins = 506 received; 444 apprved) LAGGING INDICATOR NHSC WILL USE TO IDENTIFY IMPROVEMENT Cunty residents uninsured 2010 = 22% ( Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Advanced Patient Advcacy 118 Hamby Rd Dbsn, NC Rckfrd St. Mt. Airy, NC MENTAL HEALTH/SUICIDE Secnd highest Lcal Expert cncern. Suicide #9 cause f death, ranked #13 cunty in NC; Higher than expected. Pr mental health days exceed state and natinal gals. Surry Cunty is a Health Prfessinal Shrtage Area fr Mental Health, with a 2 FTE shrtage accrding t HRSA. Prblem Statement: Availability and access t mental health resurces needs t increase. NHSC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: NHSC prvides 24-hur ED staff trained in identificatin and awareness f psychiatric and substance abuse cnditins, with intent t stabilize fr transfer, r discharge with apprpriate utpatient referral; NHSC prvides access t telepsychiatric services via bard-certified psychiatrist fr psychiatric patients in crisis; and NHSC prvides utpatient pediatric mental health supprt services. NHSC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: Crdinating effrts with the rganizatins listed in the Additinal Resurces belw which ffer resurces respnding t this need by identifying hw NHSC services can benefit their initiatives. NHSC will initiate effrts by cntacting each rganizatin t establish a frum fr effrt cllabratin; Emergency service staff will receive nging training in suicide tendency identificatin and awareness f interventin strategies; and NHSC will develp plicies in the fur cre principles Desire, Capability, Intent and Buffers in accrd with the recmmendatins f the Natinal Suicide Preventin Lifeline

32 Munt Airy, NC Page 29 ANTICIPATED RESULTS FROM NHSC IMPLEMENTATION PLAN: NHSC s effrts can help address the symptms f, and results frm, adverse lifestyle chices and ther factrs; and Increased awareness f suicide desire and preventin. LEADING INDICATOR NHSC WILL USE TO MEASURE PROGRESS: Vlume f patients and vlunteers invlved in suicide preventin 2012 suicide attempt patient encunters = vlunteers/participants in suicide preventin educatin prgrams = ED/psych-related visits = 835 Management f psychiatric and mental health patients number f staff receiving mental health/psychiatric training = length f stay in ED fr psych/mental health issues (gal f reducing) = 1.8 LAGGING INDICATOR NHSC WILL USE TO IDENTIFY IMPROVEMENT: Suicide death rate (per 100K in cunty) = 17.9 Pr mental health days = 3.7/mnth Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Partners Behaviral Health Management Surry Cunty Sheriff s Office 118 Hamby Rd Dbsn, NC Elkin Business Park Dr. Elkin, NC N. Main St. Dbsn, NC OBESITY/OVERWEIGHT #3 highest cncern f Lcal Experts; Healthy Eating habits rates belw natinal average; Obesity rate abve Nrth Carlina and natinal averages; Fast Fd as % f restaurants belw Nrth Carlina average, but significantly abve natinal benchmark; Engage in Vigrus Exercise impacts 48.3% f pp., 5% belw average; Healthy Eating Habits impacts 26.5% f pp., 10.3% belw average; Adult Obesity impacts 31% f pp, 6% abve natinal benchmark. Prblem Statement: Awareness f maintaining a healthy weight and lifestyle needs t increase. NHSC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: NHSC supprts exercise events, including 5K runs;

33 Munt Airy, NC Page 30 NHSC prvides educatinal materials t prmte healthy eating and habits; NHSC prvides emplyees with incentives t utilize fitness clubs and prgrams fr healthy eating; and NHSC hsts a weekly diabetes educatin prgram in cllabratin with Surry Cunty Health and Nutritin Center. NHSC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: NHSC will wrk with Surry Cunty Health and Nutritin Center t increase educatin and utilizatin f wellness prgrams; NHSC will wrk with Surry Cunty schls t spnsr a Cuch t 5K prgram; NHSC will supprt American Heart Assciatin initiatives, including Jump t Healthy Heart ; and NHSC will wrk t increase emplyee wellness prgram, including reimbursement f fitness club membership. ANTICIPATED RESULTS FROM NHSC IMPLEMENTATION PLAN: NHSC anticipates increased physical activity and imprved diet will lead t a decline in besity rate. LEADING INDICATOR NHSC WILL USE TO MEASURE PROGRESS: Annual enrllment in NHSC fitness incentive prgram. FY 2012 enrllment = 52 LAGGING INDICATOR NHSC WILL USE TO IDENTIFY IMPROVEMENT Cunty Obesity rate 2012 = 31% Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center 118 Hamby Rd Dbsn, NC American Heart Assciatin 101 Centreprt Dr., Ste 103 Greensbr, NC American Diabetes Assciatin 1300 Baxter Street, Suite 150 Charltte, Nrth Carlina ALCOHOL/SUBSTANCE ABUSE #4 highest cncern f Lcal Experts; Excessive Drinking belw Nrth Carlina average and natinal gal. Surry Cunty is a Health Prfessinal Shrtage Area fr Mental Health.

34 Munt Airy, NC Page 31 Prblem Statement: Substance abuse rate needs t decrease NHSC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: NHSC prvides 24-hur ED staff trained in identificatin and awareness f psychiatric and substance abuse cnditins. NHSC DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION PLAN FOR THIS NEED FOR THE FOLLOWING REASONS 22 : Lack f expertise r cmpetency within NHSC; and Need is addressed by ther facilities and rganizatins. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Partners Behaviral Health Management Alchlics Annymus Surry Cunty Sheriff s Office 200 Elkin Business Park Dr. Elkin, NC Cunty Hme Rd. Dbsn, NC N. Main St. Dbsn, NC Cmpliance Behavir Respnsible fr my health 8% belw average impacts 60% f ppulatin; fllw treatment 16% belw average impacts 33% f ppulatin; mst rutine screenings fr cancer and heart disease belw natinal average. Prblem Statement: Increase the number f residents engaged in treatment and cmpliant with treatment effrts. NHSC SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: NHSC has Case Management resurces in place t crdinate pst-discharge, fllw-up referrals, and utpatient clinical services fr patients; NHSC s Scial Wrkers crdinate pst-discharge and fllw-up cmmunity-based services fr patients; NHSC supprts mnitring fr bld thinner services at physician ffices; and NHSC prvides a multitude f cancer screening educatin and services. NHSC IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: NHSC Case Management and Scial Wrkers will cntinue t educate patients n treatment ptins and available resurces. 22 Nte in Answer t NO fr respnding t Schedule H (Frm 990) Part V B 7

35 Munt Airy, NC Page 32 NHSC Case Management and Scial Wrkers will cntinue t prvide fllw-up and pstdischarge phne calls t patients regarding utpatient care (i.e., prescriptins and fllw-up appintments); NHSC will cntinue t prvide educatin n cancer screening and treatment; and NHSC will crdinate with Hme Health prviders regarding patient treatment and cmpliance. ANTICIPATED RESULTS FROM NHSC IMPLEMENTATION PLAN: Increased treatment cmpliance. LEADING INDICATOR NHSC WILL USE TO MEASURE PROGRESS: NHSC percent f patients wh reprted that YES, they were given infrmatin abut what t d during their recvery at hme. FY 2012 results = 85% CMS Cre Measure f Preventative Care, percent f patients assessed and given. Pneumnia vaccine (2012) = 445 Influenza vaccine (2012) = 626 LAGGING INDICATOR NHSC WILL USE TO IDENTIFY IMPROVEMENT Percent 65+ receiving Pneumnia vaccinatin (2006) = 70.7% Percent 65+ receiving Flu vaccinatin (2006) = 68.3% Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Surry Medical Ministries Clinic 118 Hamby Rd Dbsn, NC Rckfrd St. Mt. Airy, NC CANCER #2 cause f death, rate as expected, 6th highest cncern f Lcal Experts; 47 th cunty (ut f 100 NC cunties); mammgraphy screening 62%, belw NC and natinal benchmark; breast cancer rates are unfavrable t peer and natinal rates; cln cancer favrable t peer and natinal rates. Prblem Statement: Cancer detectin and screening services need greater participatin. NHSC HOSPITAL SERVICES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: NHSC prvides supprt t the American Cancer Sciety and ther cmmunity grups;

36 Munt Airy, NC Page 33 NHSC prvides cancer screening, diagnsis, and treatment educatinal materials t patients and the cmmunity; NHSC prmtes cancer awareness in minrity ppulatins; and NHSC prmtes cancer screening during OB/GYN examinatins. NHSC HOSPITAL IMPLEMENTATION PLAN PROGRAMMATIC INITIATIVES: Crdinating effrts with the rganizatins listed in the Additinal Lcal Resurces belw which ffer resurces respnding t this need by identifying hw NHSC services can benefit their initiatives. NHSC will cntinue crdinating with these rganizatins t further cllabratin effrts; Cntinue prviding educatinal material t distribute t patients receiving a cancer diagnsis r interested in the disease; Distribute educatinal materials at lcal events, such as health fairs and ther cmmunity events; and Prvide supprt fr annual Relay fr Life event, hsted by the American Cancer Sciety. ANTICIPATED RESULTS FROM NHSC IMPLEMENTATION PLAN An increase in the use f screening and cancer detectin services leading t earlier interventin and increased survival. LEADING INDICATOR NHSC WILL USE TO MEASURE PROGRESS: Vlume f clnscpy and mammgraphy exams shuld increase frm 2012 vlumes. FY 2012 mammgraphy screenings = 5179 FY 2012 clnscpy screenings = 304 LAGGING INDICATOR NHSC WILL USE TO IDENTIFY IMPROVEMENT Cancer death rate per 100,000 (2010 rate) = 178 Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: American Cancer Sciety Surry Cunty Health and Nutritin Center Surry Cunty Cancer Supprt Grup 4-A Oak Branch Dr Greensbr, Nrth Carlina Hamby Rd Dbsn, NC Grace Mravian Church 1401 Nrth Main St. Mt. Airy, NC

37 Munt Airy, NC Page 34 Other Needs Identified During the CHNA Prcess 7. Dental There is a dental Health Prfessinal Shrtage Area based n lw incme access; dentist per pp. 3,243:1, ver twice the natinal benchmark, and exceeds state average. Prblem Statement: Increase access t dental care. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Surry Medical Ministries Clinic 118 Hamby Rd Dbsn, NC Rckfrd St. Mt. Airy, NC Crnary Heart Disease #1 cause f death, Surry C ranks #44 f 100 Nrth Carlina cunties and abve NC average; stress test 5% belw average impacts 15% f pp.; rates wrse than US but better than peers. Prblem Statement: Need t increase educatin and awareness f the causes f Crnary Heart Disease. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: American Heart Assciatin 101 Centreprt Dr., Ste 103 Greensbr, NC Surry Cunty Health and Nutritin Center 118 Hamby Rd Dbsn, NC Diabetes Chrnic diabetes 30.8% higher than natinal average impacts nearly 14% f ppulatin; #8 cause f death, rate as expected. Surry ranks #66 (f 100 with #1 being the wrst) in NC, abve state average, diabetic screening lwer than natinal gal, but slightly exceeding state gal. Prblem Statement: The rate f diabetes in the cmmunity needs t be reduced. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: American Diabetes Assciatin 1300 Baxter Street, Suite 150 Charltte, Nrth Carlina Surry Cunty Health and Nutritin Center 118 Hamby Rd Dbsn, NC

38 Munt Airy, NC Page Smking/Tbacc Use Adult smking higher than Nrth Carlina average and mre than duble natinal gal; tbacc use 22.6% abve natinal average impacts 31.8% f pp. Prblem Statement: Incident f adult smking shuld nt exceed the state average Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center American Cancer Sciety 118 Hamby Rd Dbsn, NC A Oak Branch Dr Greensbr, Nrth Carlina American Lung Assciatin 514 Daniels St. #109 Raleigh, NC Sexually Transmitted Disease (STD) STD rate f 181 infectins per 100,000 ppulatin significantly belw NC average but abve natinal gal; respnsibility fr health nearly 8% belw average impacts 60.6% f ppulatin. Prblem Statement: The incidence f Sexually Transmitted Disease needs t decline Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Surry Cunty Department f Scial Services Surry Cunty Schl System 118 Hamby Rd Dbsn, NC Hamby Rd Dbsn, NC N. Crutchfield St. Dbsn, NC Maternal/Child Health Better than peer cunty averages. fr Lw Birth Weight, Very Lw Birth Weight, Births t Unmarried Wmen, Infant Mrtality, White nn-hispanic Infant Mrtality, Nenatal Infant Mrtality, and Pst-nenatal Infant Mrtality; teen birth rate slightly better than NC but higher than natinal gal; children in pverty abve NC and significantly abve natinal gal; children in single-parent husehlds favrable t NC but slightly abve natinal gal; OB/Gyn visits 14% belw average impacts 39.7% f ppulatin. Prblem Statement: Increase the percent f pregnant wmen seeking care during the first trimester Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center 118 Hamby Rd Dbsn, NC

39 Munt Airy, NC Page 36 Lifeline Pregnancy Health Center 154 N. Renfr St. Mt. Airy, NC Flu/Pneumnia #7 cause f death; 39 th f 100 cunties in NC. Prblem Statement: The incidence f death frm flu/pneumnia needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center 118 Hamby Rd Dbsn, NC Lcal Physicians Kidney #10 cause f death, rank #74 wrst cunties in NC. Prblem Statement: The incidence f death frm Kidney disease needs t decline Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Munt Airy Dialysis Center f Wake Frest University 118 Hamby Rd Dbsn, NC Newsme St. Mt. Airy, NC High Bld Pressure 26% abve natinal average impacts 33% f ppulatin; ranks #15 cause f death in Surry Cunty, lwer than expected. Prblem Statement: Hypertensin as a cause f death needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center 118 Hamby Rd Dbsn, NC American Heart Assciatin 101 Centreprt Dr., Ste 103 Greensbr, NC High Chlesterl Chrnic high chlesterl 10% abve average impacts 24.6% f ppulatin; screening 9% belw average impacting 46% f ppulatin. Prblem Statement: The incidence f chlesterl screening needs t increase.

40 Munt Airy, NC Page 37 Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Lcal Physicians 118 Hamby Rd Dbsn, NC Emergency Service Emergency rm use was 6.5% abve average, impacting 36.2% an adverse finding. Prblem Statement: Need t maintain emergency rm services, while having mre urgent care needs managed in urgent care center r setting. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Hugh Chatham Memrial Hspital 830 Rckfrd St. Mt. Airy, NC Parkwd Dr. Elkin, NC Palliative Care/Hspice Palliative Care (fcus n relief f disease symptms, pain and stress) prgrams d nt exist in Surry Cunty. There are fur hspice prviders in the area. Prblem Statement: The utilizatin f palliative and hspice care needs t increase. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Jan and Hward Wltz Hspice Hme Muntain Valley Hspice and Palliative Care 945 Zephyr Rd. Dbsn, NC Technlgy Lane, Ste 200 Mt. Airy, NC COPD/Pulmnary Lung #5 cause f death; rank #22 wrst cunty in NC; Chrnic COPD 31% abve average impacts 8.8% f ppulatin; chrnic allergies 17.4% abve average impacts 22% f ppulatin. Prblem Statement: The incidence f death frm COPD needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: American Lung Assciatin 514 Daniels St. #109 Raleigh, NC

41 Munt Airy, NC Page 38 Lcal Physicians Life Expectancy/Premature Death Male and Female Life Expectancy less than NC and belw U.S. average; pr health perceptin 22% in Surry C as cmpared t 18% in NC and 10% in U.S.; life expectancy has slightly increased fr men in the Surry C area, but has slightly decreased fr wmen in the same timeframe. Prblem Statement: Life expectancy needs t increase. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Lcal Physicians 118 Hamby Rd Dbsn, NC Lw Back Pain Chrnic Pain 22.6% abve average impacts 27.6% f ppulatin. Prblem Statement: The incidence f chrnic lw back pain needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Lcal Physicians 118 Hamby Rd Dbsn, NC Pririty/Vulnerable Ppulatins Access and Affrdability #1 significant need identified by Lcal Experts; emergency rm use was 6.5% abve average, impacting 36.2% an adverse finding; High schl graduatin rates f 85% exceed state average, but Sme Cllege rates are belw state and natinal benchmarks, unemplyment is higher than state average, and nearly duble natinal benchmarks, children in pverty (30%) exceeds NC average, and is mre than duble the natinal benchmark f 14%. Inadequate scial supprt is slightly lwer than state average. Prblem Statement: Child health and preventin resurces need t increase. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Surry Cunty Department f Scial Services 118 Hamby Rd Dbsn, NC Hamby Rd Dbsn, NC

42 Munt Airy, NC Page Predispsing Factrs Pr physical and mental health days higher than state and natinal; scial and ecnmic factrs including unemplyment and children in pverty exceed NC averages. Prblem Statement: Pr physical and mental health days need t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Surry Cunty Department f Scial Services 118 Hamby Rd Dbsn, NC Hamby Rd Dbsn, NC Lcal Envirnment Better air quality than NC average, but wrse than natinal gal. Less than half the recreatinal facilities as targeted by the natinal benchmark. In the area f fd availability, while n 3% f the ppulatin des nt have healthy fd readily available cmpared t 7% fr NC, it still des nt meet natinal gal f 1%. Prblem Statement: The availability f healthy fd needs t increase. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Department f Parks and Recreatin Salvatin Army 118 Hamby Rad, Suite 336 Dbsn, NC S Suth St. Mt Airy, NC Accidents #3 cause f death, rank #20 wrst cunty in NC and higher than expected; mtr vehicle crash death rate 19 deaths/100,000 slightly abve KY average, and significantly abve natinal gal. Prblem Statement: The incidence f death frm accidents needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Sheriff s Office Surry Cunty Fire Department Nrth Carlina Department f Transprtatin 218 N. Main St. Dbsn, NC State St. Mt. Airy, NC Silas Creek Pkwy Winstn-Salem, NC

43 Munt Airy, NC Page Hmicide Hmicide #14 cause f death; #77 cunty in NC; vilent crime rate favrable t NC gal; hmicide rate favrable t peer cunty average. Prblem Statement: The incidence f death frm hmicide needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Sheriff s Office Munt Airy Plice Department 218 N. Main St. Dbsn, NC Rckfrd St. Mt. Airy, NC Strke #4 cause f death, rank #51 cunty in NC; Rate higher than expected. Prblem Statement: The incidence f death frm Strkes needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Surry Cunty EMS 118 Hamby Rd Dbsn, NC State St. Mt. Airy, NC Chrnic Osteprsis Chrnic Osteprsis 30% abve average impacts 12.6% f ppulatin. Prblem Statement: The incidence f chrnic steprsis needs t decline. Other Lcal Resurces identified during the CHNA prcess which are believed available t respnd t this need include the fllwing: Surry Cunty Health and Nutritin Center Lcal Physicians 118 Hamby Rd Dbsn, NC Overall Cmmunity Need Statement and Pririty Ranking Scre: Significant Needs Where Hspital Has Implementatin Respnsibility 1. Access/Affrdability 2. Mental Health/Suicide 3. Obesity/Overweight 5. Cmpliance Behavir

44 Munt Airy, NC Page Cancer Significant Needs Where Hspital Did Nt Develp Implementatin Plan 4. Alchl/Substance Abuse Other Needs Where Hspital Develped Implementatin Plan N/A Other Identified Needs Where Hspital Did Nt Develp Implementatin Plan 7. Dental 8. Crnary Heart Disease 9. Diabetes 10. Smking/Tbacc Use 11. Sexually Transmitted Disease 12. Maternal/Child Health 13. Flu/Pneumnia 14. Kidney 15. High Bld Pressure 16. High Chlesterl 17. Emergency Services 18. Palliative Care/Hspice 19. COPD/Pulmnary 20. Life Expectancy/Premature Death 21. Lw Back Pain 22. Pririty/Vulnerable Ppulatins 23. Predispsing Factrs 24. Lcal Envirnment 25. Accidents 26. Hmicide 27. Strke 28. Chrnic Osteprsis

45 Munt Airy, NC Page 42 APPENDICES

46 Munt Airy, NC Page 43 Appendix A Lcal Expert Advisr Opinin abut Significant Needs A ttal f 15 lcal expert advisrs participated in an nline survey ffering pinins regarding their perceptins f cmmunity health needs. The fllwing is an analysis f their respnses: The first questin was pen-ended. What d yu believe t be the mst imprtant health r medical issue cnfrnting the residents f yur Cunty? Answers were placed in a Wrd Clud frmat fr analysis and generated the fllwing image: Wrd Cluds are analytical tls, which give greater visual prminence t wrds appearing mre frequently in the surce text. This infrmatin visualizatin establishes a prtrait f the aggregate respnses, presenting the mre frequently used terms with greater text size and distinctin in the visual depictin. Cmmn article wrd (i.e., a, the, etc.), nn-cntextual verbs (i.e., is, are, etc.) and similar wrds used when writing sentences are suppressed by this applicatin. Specific verbatim cmments received were as fllws Educatin t prmte cmpliance with health care needs at hme. It wuld be great t have a Nurse questin/answer line t accmmdate the cmmunity with health care questins. Many peple cme t the hspital fr things that culd be taken care f at hme. They read the discharge infrmatin, the medicatin side effects, what they Ggle, they watch

47 Munt Airy, NC Page 44 medicatin cmmercials with all the hrrible things that can happen and the pinin f friends and family. That is what sme f them rely n t make their health care decisins. Free clinic pen mre than ne day a week fr fur hurs. I believe that besity is ne f the mre imprtant health r medical issues cnfrnting the residents f ur cunty. Since besity has such far-ranging negative effects n health, I believe this wuld be a gd fcus and mney well spent. Cardiac Disease Diabetes Psychiatric Disrders Drug Addictin - pids, meth, crack, alchl Obesity related diseases Many peple are ut f wrk r d nt have a stable place f emplyment and mst likely d nt have insurance r d nt qualify t receive assistance frm Medicaid r Medicare. With this being said, it seems t me that the mst imprtant health r medical issue is nt being able t affrd ging t the dctr r dentist fr regular physicals r cleanings. This pses an issue shrt-term and lng-term. Mst f the uninsured will wait until their cnditins wrsen befre seeking help and by then it culd be t severe fr a physician t treat r cure them. Yes, there are "free clinics" that the uninsured can attend, but mst f these clinics are pen certain days f the week fr s many hurs and are unable t assist every patient that walks in, which pstpnes the patient again t wait anther day r mre befre getting medical attentin. Als, there is a lack f dental services fr uninsured adults and I believe this t is an imprtant medical issue cnfrnting the residents f ur cunty. Prescriptin Drug Misuse and Abuse tp ur list f health cncerns in the cunty, as we see this issue affecting mre and mre f ur departments, and citizens f all ages and sciecnmic status. Lack f Insurance cverage, pverty and preventative care Dependency n medicatin t treat symptms. We need t prmte active lifestyles and preventative measures s ur cunty is nt dependent n prescribed medicatin fr survival. Medicare patients ut number ur patient rati and need is t cver their needs with quality Health Care fr the right price and service!! Every cmpnent f service is based n payment fr that service prvided. We need t get Gvernment and Nn-Prfit tgether. when we agree n that price then the quality f that service prvided will increase. Due t lss f jbs there are many peple withut insurance r the financial means t visit the MD r buy medicatins. Als there is a lack f educatin regarding health cnditins. 1. There is an increasingly grwing prblem with abuse f bth street drugs and prescriptin medicatins. There is a need fr bth inpatient/utpatient services in this area, as well as educatin fr the general public as t hw t handle and manage mental health issues and cncerns. There is a lack f knwledge in regards t hw t access mental health services if

48 Munt Airy, NC Page 45 needed in the general ppulatin. This ranges frm hw t g abut getting treatment fr a family member r friend, r even a patient that is experiencing mental health issues. Where d they g? Wh d they call? What if the individual is unwilling t g? 2. Lack f access t healthcare fr thse wh are uninsured. What is available fr these individuals? The Surry Cunty cmmunity needs mre ministries such as Surry Medical Ministries. Many peple avid ging t the hspital simply because they are uninsured and are fearful f the charges that will be accrued as a result f a hspital visit. What are the ptins available t cver the expense? Mre educatin is needed in this area. As with all cmmunities, residents need Quick and Efficient medical services available 24/7. Nn-gv't funded transprtatin t and frm areas f medical and health needs. The geriatric ppulatin and mental health. Substance abuse Trauma Autism Spectrum Disrders Md Disrders Our secnd questin t the lcal experts was, D yu perceive there are any primary and/r chrnic disease needs, as well as ptential health issues, f uninsured persns, lw-incme persns, minrity grups and/r ther ppulatin grups (i.e. peple with certain situatins), which need help r assistance in rder t imprve? If yu believe any situatin as described exists, please als indicate wh yu think needs t d what. The respnses generated the fllwing image: Specific verbatim cmments received were as fllws:

49 Munt Airy, NC Page 46 I am aware f a large amunt f peple smking in this area. Easy access t smking cessatin prgrams may be f benefit. A pack f cigarettes is $5 and nictine gum is $45. If we culd find a way t make the cessatin prducts available at a reasnable cst we culd ffer thse as an ptin t smking. We may be able t utilize the manufacturer f these prducts r the tbacc cmpanies as a resurce. Obesity is anther issue within the cmmunity. Exercise needs t be mre enjyable and free. Lw incme peple cannt affrd gyms. While I was in Campeche, Mexic they had Zumba instructrs in cmmunity areas utside where they where ding Zumba with at least a hundred peple participating. It was s enjyable. We culd utilize a lcal park, have an instructr, have it pen t anyne and everyne, have water available, set a cnvenient evening time and prmte Nrthern Hspital t the cmmunity. Mental health issues and the availability f care fr thse wh are uninsured. We als see a lt f hepatitis cases that cannt receive treatment because f lack f ability t pay. Mst are peple just cming ut f jail. Since besity has such far-ranging negative effects n health, such as high bld pressure, diabetes, and heart disease t name a few, there is a need fr assistance. I believe all peple culd benefit because besity is fund thrughut all ppulatin grups. I believe that besity leads t the high incidence f heart attack, strke, diabetes, etc. in ur cmmunity. It is my pinin that many peple simply d nt have the educatin r the financial resurces t eat healthier and btain necessary medicatin. The elderly and the lwincme individuals struggle with this mre. Frm persnal experience, wrking in hme health fr 10 years, it was evident that clients wuld have t chse between purchasing fd and purchasing medicatin. I believe that case managers wh have experience with discharge planning, physicians, pharmacists, ur lcal health and nutritin center, and the hspital shuld wrk tgether t find a slutin. I wuld als suggest getting Pilt Muntain Pride invlved in the nutritin side f this cause. Pilt Muntain Pride has lcally grwn prduce that many f ur residents in the cunty cannt affrd but wuld be a much healthier ptin. Based n what I have seen, the number f diabetes and chlesterl are increasing in the Hispanic ppulatin. They shuld be educated n these tpics and the risks invlved with these medical issues. We have n regulated husing standards in place in Surry Cunty, and many f ur lwincme residents live in sub-standard husing, with n pprtunity t imprve their living cnditins. Yes Hispanic ppulatin-need bilingual caregivers/staff fr cmmunicatin related t their healthcare Jbless/Hmeless-need access t care management fr chrnic diseases Elderly

50 Munt Airy, NC Page 47 ppulatin-lack f caregivers, access t care, financial resurces fr fd, shelter and medicatin Juvenile diabetes-we need t d mre t educate ur cmmunity n preventative measures t prevent juvenile diabetes thrugh diet and exercise. The senir class f patients needs can nt be meet if regulatins stand in the way f better healthcare. Lw incme peple and senir adults are suffering the mst frm the regulatins. As with Diabetes r Heart Disease there needs t be teaching regarding thse cnditins. There has t be a way t reach ut t the lw-incme, minrity grups and uninsured t get valuable infrmatin t these peple. Maybe infrmal classes within the neighbrhds r cmmunity churches. This culd be a cmbined effrt f all the healthcare agencies in ur area. YES, withut a dubt!!! Knwledge is pwer. When peple are aware and infrmed f their health status, whether it be hypertensin r their HIV status, they are mre likely t be practive in better managing their lifestyle and being practive in lifestyle changes. This is fr mst, nt all. Heart Disease, Diabetes, Obesity, HIV/AIDS are grwing epidemics amngst ur peple? We must ask urselves why? It is a knwn fact that uninsured, lwincme, minrity persns are mre likely t be affected by these primary/chrnic diseases. We need mre health educatrs, educatinal classes free and pen t the cmmunity, supprt grups, HIV/AIDS cmmunity testing, free clinics, etc in rder t imprve these cnditins. The U.S. Gv't has set up every imaginable grup pssible t cause peple t depend n the Gv't t meet each need. This is what, I feel, this type f survey is all abut. The right answers, and service will be prvided--free. The wrng answers, and services nt prvided, then Fees will be charged t a health care cmpany by the U.S. Gv't. These types f surveys are setting up a wall fr businesses such as the t be CONTROLLED by the U. S. Gv't. Mental health. We need t ffer lcal mental health supprt at ur hspital instead f using telehealth. Mental Health, Develpmentally Disabled, and Substance Abuse issues can begin being assessed and treated in the persn's PCP ffice, and then referred t Cmmunity Mental Health MCO if necessary.

51 Munt Airy, NC Page 48 Appendix B Prcess t Identify and Priritize Cmmunity Need 23 Individuals Participating as Lcal Expert Advisrs 23 Respnds t IRS Schedule H (990) Part V B 1. g. and V B 1. h.

52 Munt Airy, NC Page 49 Advice Received frm Lcal Experts Q. D yu agree with the bservatins frmed abut the cmparisn f Surry Cunty t all ther State cunties? I disagree with sme r all f the abve bservatins 7% D yu agree with the bservatins? I agree with the abve bservatins 93% The primary is still regulating the best fees and pricing equally. In additin t the abve mentined, I believe Surry Cunty has significant mental health service needs. In view f the patient ppulatin and bservatin f cmmunity it is apparent that we have a large degree f besity and smking. I have als nticed that peple n gvernment assistance purchase very unhealthy chices f fd with their EBT card. It wuld be much healthier if it perated mre like the WIC prgram.

53 Munt Airy, NC Page 50 Q. D yu agree with the bservatins frmed abut the cmparisn f Surry Cunty t its peer cunties?