2014 Implementation Plan (based on Community Needs Assessment)

Transcription

1 P a g e Implementation Plan (based on Community Needs Assessment)

2 River Valley Health Partners/East Liverpool City Hospital: 2014 Implementation Plan P a g e 2 TABLE OF CONTENTS I. Executive Summary Page 3 II. Prioritization Process Page 3 III. Description of Prioritized Needs Page 4 IV. Community Resources to Address Needs... Page 5 V. Needs Identified in the CCHNA Being Addressed by ELCH..Page 6-12 VI. Needs Not Addressed in CCHNA.. Page 14

3 P a g e 3 I. EXECUTIVE SUMMARY River Valley Health Partners/East Liverpool City Hospital (ELCH) collaborated with area health care providers to conduct a Columbiana County Health Needs Assessment (CCHNA). The goal was to identify the needs of residents living in Columbiana County, and subsequently to develop strategies to address the identified needs. This process was led by the Columbiana County Health Needs Assessment Steering Committee, in partnership with East Liverpool City Hospital; the Community Action Agency of Columbiana County; Salem Community Hospital; the Columbiana County, East Liverpool City and Salem City Health Departments; and other community providers. The Steering Committee used both qualitative and quantitative data including community survey data, key informant interviews, demographic data and other statistical secondary data, which was gathered to identify and prioritize health problems and risk factors for residents in the Columbiana County service area. The Steering Committee made significant efforts to ensure that all geographic regions of the county and socio-demographic groups, including underserved and/or vulnerable populations, were represented in the study, along with obtaining public health input. (Note that the full report of the CCHNA is posted on East Liverpool City Hospital s website at and was approved by the Hospital s Board of Directors on October II. PRIORITIZATION PROCESS From July 2011 through November 2012, the Steering Committee met to gather and analyze the primary and secondary data gathered through the CCHNA, using the 6-step Community Health Improvement model as outlined by the Association for Community Health Improvement. Using these sources, the Steering Committee identified community health needs based on the following criteria: size, severity, and long-term impact. Needs were then evaluated based on these criteria, as well as whether data was available to quantify the need and measure progress. The Steering Committee also considered the ability of county health and social service providers to impact the need based on capacity and resources currently available. In November 2012, the Committee met to prioritize the needs and issues using a Criteria Matrix as follows:

4 P a g e 4 Criteria Definition Low Score Medium Score High Score Accountable Entity Magnitude of the Problem Capacity (Systems and Resources) Extent to which the issue is an important priority to address in action plan Degree to which problem leads to death, disability or impaired quality of life; and/or has a variance from the benchmark/goal Extent to which internal capacity is currently in place and organization equipped to act on issue Important priority for the community to address Low numbers of people are affected; already meets or exceeds the benchmark/goal Little capacity or resources Important but not for this action planning effort Moderate numbers of people affected; close to benchmark/goal Some capacity and resources Important priority for the Steering Committee High numbers of people affected; far from benchmark/goal Solid capacity and resources III. DESCRIPTION OF PRIORITIZED NEEDS Using the OptionFinder audience response polling system, the Steering Committee obtained input regarding the potential to impact the issues identified, the Steering Committee s and/or collaborating organizations ability to be an accountable entity, the severity and magnitude of the problem and the capacity of systems and resources to address the problem. Based on this input and the prioritization criteria determined in the Criteria matrix, each identified need was given a score in each category. The Steering Committee members scores were then compiled and the needs were ranked according to the total scores, with the following CCHNA needs prioritized for in order: 1. Chronic Disease: Cancer Screenings, Heart Disease and Stroke, Obesity, Diabetes 2. Physical Activity and Nutrition: Lack of Exercise, Nutrition 3. Healthy Mothers, Babies, Children: Pediatric Care, Prenatal Care (Infant Mortality) 4. Infectious Disease: Adult Immunizations 5. Access to Medical Care: Cost/Affordability/Access, Lack of Providers, Mental Health and Substance Abuse Based on these results, the Steering Committee members agreed that they would focus on addressing obesity prevention as the one, joint county-wide priority for targeting county-wide resources; and that each hospital would develop its own individual action plan to address the community health issues that are of top priority for their organization. The Board of Directors of East Liverpool City Hospital (the Hospital ) has determined that the health needs identified in the CCHNA should be addressed through the following implementation strategies, which were approved on October 30, 2013.

5 P a g e 5 IV. COMMUNITY RESOURCES TO ADDRESS NEEDS A strategic approach to community health improvement involves the collection and analysis of data regarding health status and factors contributing to poor health, combined with capacity building and collaborative efforts between diverse stakeholders to address both the symptoms and underlying causes of health issues. As such, hospitals are in a position to leverage their charitable resources and build greater capacity to address complex health concerns in a cost effective manner. Acknowledging the many organizations and resources in place to address the health needs of our communities, East Liverpool City Hospital will engage key community partners in implementing evidence-based strategies across the Hospital s geographic service area, which includes the southern portion of Columbiana County. East Liverpool City Hospital intends to implement these evidenced-based, community preventive health activities to help reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger base of effective prevention programming. The Hospital s list of activities includes the development of prioritizing strategies to assist in reducing racial and ethnic disparities and addressing the needs of vulnerable populations. As a not-for-profit hospital, ELCH will partner with local public health agencies to develop and implement a multi-pronged approach to impact these issues and establish metrics and systems to monitor community health improvement initiatives. Many of our community health improvement initiatives leverage substantial external resources and foster good working relationships with community stakeholders and other collaborative partners to achieve the strategic allocation of charitable resources, develop appropriate interventions, and establish metrics and systems to monitor community health improvement initiatives. After reviewing this data and mapping existing resources, East Liverpool City Hospital has developed an Implementation Plan and assumed a leadership role in collaborating with its partners to analyze area healthcare utilization and costs, explore barriers to care, identify partner needs and resources, plan/redesign services, track outcomes and share accountability in order to facilitate effective programming to improve the health of the residents within the Hospital s service area. All of the activities described in the following implementation plan are aligned with these five health priorities, with many of the activities addressing multiple combinations of these priorities. The Guide to Community Preventive Services (The Community Guide) provides evidence-based findings and recommendations about public health interventions and policies to improve health and promote safety. The Community Preventive Services Task Force (Task Force) an independent, nonfederal, unpaid body of public health and prevention experts bases its findings and recommendations on systematic reviews of the scientific literature. With oversight from the Task Force, scientists and subject matter experts from the Centers for Disease Control and Prevention have conducted these reviews in collaboration with a wide range of government, academic, policy and practice-based partners.

6 P a g e 6 V. NEEDS IDENTIFIED IN THE CCHNA BEING ADDRESSED BY EAST LIVERPOOL CITY HOSPITAL This portion of the CCHNA, the Implementation Strategy, will explain how ELCH will address health needs identified in the CCHNA by continuing existing programs and services, and by implementing new strategies. It will also explain why the Hospital cannot address all the needs identified in the CCHNA, and if applicable, how ELCH will support other organizations in doing so. It should also be noted that many of the strategies and activities outlined address risk factors associated with multiple health problems. For example, strategies to promote healthy eating and physical activity will affect obesity and chronic disease, as well as potentially having a positive impact on mental health and/or reducing substance abuse. A. CHRONIC DISEASE: Cancer Screenings, Heart Disease and Stroke, Obesity, Diabetes Description of Need: Cancer (all sites) and heart disease are the top leading causes of death in Columbiana County. The county s highest cancer death rates are for lung, followed by prostate and breast cancer. The county also has a higher proportion of adults with diabetes compared to other U.S. counties and a higher death rate due to diabetes compared to other Ohio counties. CCHNA Findings and Recommendations: CCHNA Community Survey respondents identified a number of chronic disease-related conditions as the top three 3 Community Health Needs. These included cancer care/treatment (66 respondents), obesity/sedentary lifestyles (65 respondents) and heart disease/high blood pressure/cholesterol (61 respondents). Focus group participants noted that the high incidence of cancer in the community is one of the reasons that they rated the community s health status as fair or poor. Obesity was also mentioned as an environmental factor that is impacting the overall health of the community, because it is a contributing factor for multiple, other health conditions. In addition, diabetes was also mentioned as a significant and related problem that is impacting the health of the community. Focus group participants suggested increasing disease awareness and conducting more screenings as ways to address chronic disease in the community.

7 P a g e 7 CCHNA Need Identified: Action Steps for Addressing Need Indicator/Progress CHRONIC DISEASE Measurement & Timeframe Goal: To positively impact Using evidence-based approaches Targeted funds for FY the rates of chronic disease described in The Community Guide to 2014 and FY 2015 in the ELCH service area Community Preventive Services, dedicated to chronic by: specific activities will include: disease prevention a. Providing increased community education regarding chronic disease prevention b. Conducting diseasespecific, community-based screenings c. Expanding disease management opportunities a. Education Increase nutrition education for and support of local food banks Increase physician education to the community to create awareness regarding chronic disease and prevention Increase public education via print and social media to create awareness regarding chronic disease and prevention b. Screenings Increase number of community based cancer screenings related to skin, prostate and colorectal cancers Develop mechanism for financially disadvantaged to receive free/low cost breast cancer screening Increase community-based opportunities for blood pressure and blood sugar screenings c. Disease management Increase presence of diabetes and nurse educators as community resources action steps Evaluate community benefit program metrics to determine the number of programs and participants reached Monitor health and quality of life data through the HCI-CHNA web- based community health data platform of appropriate community indicators B. PHYSICAL ACTIVITY AND NUTRTION: Lack of Exercise, Nutrition Description of Need: Low physical activity and unhealthy eating are associated with a higher risk of: Chronic diseases, such as Type 2 diabetes, hypertension, heart disease and certain cancers Overweight and obesity CCHNA Findings and Recommendations: Columbiana County has a high percentage of obesity and sedentary behavior compared to other Ohio counties. Over one-third of adults that live in the county are obese (35.8%) and 29.4% describe themselves as sedentary, meaning that they do not participate in any leisure-time physical activities. Childhood obesity is also widespread in Columbiana County, with the percentage of children who are obese as monitored in the third grade equaling 35.8%, at the same rate as adults.

8 P a g e 8 The need for better nutrition, more exercise, access to gyms and enough food were identified as top community needs related to physical activity and nutrition by survey respondents. Malnutrition and obesity were also offered as reasons why focus group participants rated the health status of the community fair or poor. Correspondingly, only a small percentage of Community Survey respondents engage in health habits related to physical activity and nutrition. For example, only a little over a quarter of respondents indicated that they eat fresh fruits and vegetables daily; however, access to fresh fruits and vegetables was mentioned by 17 Community Survey respondents as one of the attributes of living in Columbiana County that contributes to their well-being in a positive way. In addition, only 8.2% of Community Survey respondents indicated that they always exercise 5 or more times a week for 30 minutes or more. However, recreational opportunities, the closeknit/family oriented community and the slower pace/less stress were the three most frequently mentioned attributes about the environment that contributes to health and well-being in Columbiana County. When asked to identify what the community should be doing to improve health, focus group participants suggested promoting healthy diets, and noted that inactivity is prevalent. Other community observations were that physical inactivity leads to obesity; many of the foods consumed are convenient and processed, but not nutritious; and children spend too much time watching TV or playing games. Key stakeholder interviews indicated that access to affordable, healthy foods is a major barrier to health for the low-income and underserved populations, and some also reported a lack of understanding of good nutrition, combined with a lack of motivation to make healthy eating a priority. Community survey respondents also identified many environmental needs related to nutrition, including healthy menu items at restaurants, improved offerings and marketing at grocery stores, increased awareness about community gardens and farmers markets, and education about how to eat healthy with a busy lifestyle.

9 P a g e 9 CCHNA Need Identified: Action Steps for Addressing Need Indicator/Progress PHYSICAL ACTIVITY & Measurement & Timeframe NUTRITION Goal: To work with existing/expanded Using evidence-based approaches described in The Community Guide to Targeted funds for FY 2014 and FY 2015 community partners to Community Preventive Services, specific dedicated to physical activities will include: broaden community access activity, nutrition and a. Physical Activity obesity prevention action to recreational activities, Provide increased opportunities and steps promote existing resources community education about the Evaluate community benefit for improved physical importance of physical activity as a program metrics to determine activity and nutrition, and significant disease prevention tool the number of programs and alert people to the real To conduct community-wide participants reached impact of obesity; thus campaigns to promote physical activity positively impacting the in collaboration with community Monitor health and quality of rates of physical activity and partners, such as by hosting the Walk life data through the HCI- With a Doc programs in regional CHNA web- based community consumption of healthy communities and participating in health data platform of foods in the ELCH Service collaborative sponsorship of other appropriate community Area local walking/running programs indicators Assist in the creation of or enhanced access to places for physical activity combined with informational outreach activities b. Nutrition Provide increased opportunities for and community education about the importance of healthy nutrition as a significant disease prevention tool Increase nutrition education for and support of local food banks and/or access to healthy meal preparation classes for vulnerable populations Increase presence of nutrition educators as community resources Encourage access to fruits and vegetables in partnership with area farm markets c. Obesity Prevention Increase physician education to the community to create awareness regarding obesity prevention strategies Increase public education via print and social media to create awareness regarding the importance of obesity prevention Enhance school-based programs promoting nutrition and physical activity in collaboration with the Coordinated Action for School Health (CASH) Coalition

10 C. HEALTHY MOTHERS, BABIES, CHILDREN: Prenatal Care (Infant Mortality), Pediatric Care P a g e 10 Description of Need: Maternal, infant and child mortality and morbidity are key indicators of the health of a community, and are important predictors of the health of the next generation. CCHNA Findings and Recommendations: Focus group participants identified the need for teen pregnancy prevention and birth control, along with neglect and child abuse as environmental issues that are impacting the health of the community. In addition, Columbiana County has an especially high percentage of mothers who smoke during pregnancy (26.2%), as compared to other Ohio counties. Interventions that were suggested by focus group participants related to maternal/child health include parenting classes for all teenage parents and watching for signs of child abuse. Due to the loss of jobs, poverty levels, and transient populations in Columbiana County, the stakeholders have also noted that families do not seem to have adequate parenting skills. CCHNA Need Identified: Action Steps for Addressing Need Indicator/Progress PRENATAL and Measurement & Timeframe PEDIATRIC CARE Goal: To improve prenatal a. Partnering with physicians and area Targeted funds for FY care by impacting the rates health care providers to provide 2014 and FY 2015 of women who use tobacco tobacco cessation education: dedicated to prenatal products during pregnancy During prenatal visits, along with tobacco cessation action and helping to keep them related education during the steps Hospital s childbirth classes off tobacco after giving During postnatal visits to identify Evaluate community benefit birth; and to improve and to treat tobacco use and program metrics to pediatric care by reducing dependence and develop determine the number of tobacco use initiation by interventions to reduce exposure programs and participants children and adolescents secondary smoke reached b. Collaborate with Work with CASH Coalition to community partners to provide school-based education education regarding use initiation by children and parenting skills adolescents conduct community-based and resources to reduce tobacco b. Collaborating with area physicians, social service and mental health organizations to develop parenting education and interventions, which have the potential to affect a variety of adolescent risk behaviors and associated health outcomes *Note that the Hospital currently devotes significant financial and human resources toward providing improved prenatal and pediatric medical care and access through the River Valley Partners Physicians, which employs 3 Family Practice Physicians and 2 OB/GYNs and 1 GYN. Monitor health and quality of life data through the HCI- CHNA web- based community health data platform of appropriate community indicators

11 P a g e 11 D. INFECTIOUS DISEASE: Adult Immunizations Description of Need: Columbiana County has very high influenza and pneumonia death rates compared to other Ohio counties. CCHNA Findings and Recommendations: Colds/Flu was also identified as one of the Top 3 Community Health Needs by a small number (11), individuals on the Community Survey. This monitor of community health was selected due to its measurability and high potential to reduce mortality through increased utilization of adult immunization. It should be noted that focus group participants did not have much discussion or make many comments related to the category of Infectious Diseases, and stakeholder interview participants did not comment on needs or issues related to this category. CCHNA Need Identified: Action Steps for Addressing Need Indicator/Progress ADULT Goal: To positively IMMUNIZATIONS impact the rates of morbidity and mortality related to pneumonia and influenza in the ELCH Service Area by: a. Increasing community demand for vaccinations b. Enhancing access to vaccinations c. Offering provider-based interventions and reducing the b. Enhancing Access exposure to vaccine preventable disease Using evidence-based approaches described in The Community Guide to Community Preventive Services, specific activities will include: a. Increased Demand Use evidence-based, multi- component interventions that include community education and site-specific interventions to the targeted populations aged >65 and vulnerable populations Expand access in health care settings and vaccination interventions in nonmedical settings to improve vaccination coverage, including vaccination programs in churches and in partnerships with area home health care providers Measurement & Timeframe Targeted funds for FY 2014 and FY 2015 dedicated to chronic disease prevention action steps Evaluate community benefit program metrics to determine the number of programs and participants reached Monitor health and quality of life data through the HCI-CHNA web- based community health data platform of appropriate community indicators c. Provider Interventions Reduce missed opportunities for vaccination through provider assessment and identification, standing orders, and provider education community indicators

12 E. ACCESS TO MEDICAL CARE: Cost/Affordability/Access, Lack of Providers, Mental Health and Substance Abuse P a g e 12 Description of Need: Limited access to health care as a result of a lack of adequate health insurance coverage, adequate/affordable/accessible health services and/or prescription medications is impacting the overall health of the county. In addition, Columbiana County has a large percentage of adults who are unable to afford to see a doctor compared to other U.S. counties. CCHNA Findings and Recommendations: Community survey participants most frequently identified the top 3 Community Health Needs as adequate health insurance coverage, adequate/affordable/accessible health services, and prescription assistance/affordable medications. While mentioned less frequently, affordable/accessible dental services, access to good doctors and transportation were also mentioned as top needs. Access to Healthcare: Many of the focus group participants mentioned a combination of access and attitudinal barriers that impact care including: lack of insurance, people not caring about their health, people unable to afford health care, and people choosing not to go to the doctor. Access-related issues were also expressed by all of the stakeholders interviewed and a majority of the interviewees listed multiple issues related to the inability of underprivileged individuals to access necessary health care. Stakeholders also expressed that the lack of access to necessary funding for medications, specialists, nutritious groceries, and doctors (non-specific) are some of the environmental factors driving the perceived poor health status in Columbiana County. They also identified access issues related to poverty, the unstable workforce and lack of insurance coverage, education, transportation and locations of and access to clinics and services as needs in the Columbiana County region. There are also a number of data conclusions that support the issue of access to healthcare as a significant problem in Columbiana County. While the majority (84.3%) of respondents to the Community Survey indicated that they are always or usually able to see a health care provider when needed, this also leaves a sizable portion of the population underserved. Of those who are not able to access services when needed, the most frequent barriers mentioned were no insurance (30.9%) and care being too expensive (29.8%). Of these respondents, almost a third (32.4%) indicated that they have difficulty finding free or reduced cost services, and almost a quarter of the respondents (21.6%), indicated that they have difficulty finding a provider that accepts their insurance. The majority of respondents (78.3%) indicated that they always take prescription medicine as directed, and 72% indicated that they always take over the counter medicines as directed. Access to Mental Health and Substance Abuse Services: There are a number of conclusions and observations that can be made regarding Mental Health and Substance Abuse from the data. The most frequently identified needs included mental health/stress management services (86), substance abuse services (37) and tobacco cessation services (29). In addition, Columbiana County has a high suicide death rate compared to other Ohio counties, and there is a high number of reported poor mental health days (average 3.8 days in last month), compared to other U.S. counties. Substance abuse issues were identified by the focus group participants under the category of other problems that are impacting the health of the community. The use of illegal drugs and the community degradation that it causes were listed as problems that are impacting the social determinants of community health. Participants indicated that more resources should be devoted to drug prevention activities and stronger law enforcement and

13 P a g e 13 judicial actions against offenders would help or are needed. More drug testing was also identified by several focus group participants as a future action that should be pursued, and they noted that medicine abuse/misuse is an emerging trend that needs to be closely monitored. According to stakeholders, the predominant and underlying factors of poverty and lack of education are major determinants of the mental health issues currently seen in Columbiana County, and several stakeholders stated that there is a need for additional mental health services in Columbiana County. They feel that action needs to be taken to bring more awareness and prevention to this topic. In addition, Neurological diagnoses for Autism, ADHD, ODD are needed along with more psychiatrists to provide mental health care. CCHNA Need Identified: Action Steps for Addressing Need Indicator/Progress ACCESS Measurement & Timeframe Goal: To increase community access to health care by: a. Reducing structural barriers for vulnerable populations to reduce racial and ethnic disparities b. Reducing costs related to preventative and primary care health services through programs and advocacy for the uninsured/underinsure d c. Improving provider delivery and/or referral networks to increase the number of practicing primary care providers and/or community resources to remove barriers to access Using evidence-based approaches described in The Community Guide to Community Preventive Services, specific activities will include: a. Structural Barriers Provide Case Management at entry points to inpatient and ED services to identify the needs of patients at risk for excessive resource usage, suboptimal outcomes, or suboptimal coordination of services Train providers about the culture and language of the people they serve b. Mental Health and Substance Abuse Offer inpatient programs to meet the needs of some populations including geriatric behavioral health substance abuse patients. Collaborate with outpatient based programs for substance abuse Work with local agencies including CASH to provide education Targeted funds for FY 2014 and FY 2015 dedicated to chronic disease prevention action steps Evaluate community benefit program metrics to determine the number of programs and participants reached Monitor health and quality of life data through the HCI-CHNA web- based community health data platform of appropriate community indicators

14 P a g e 14 VI. NEEDS NOT ADDRESSED IN CCHNA Columbiana County has a high percentage of poverty among children, families, and the general population, as compared to other U.S. counties; along with a high unemployment rate and low proportion of adults with a college degree compared to other U.S. counties. The top environmental needs identified in the Community Survey portion of the CCHNA included enough money, access to employment/better jobs and safe water/clean air. In addition, focus group participants identified the weather, chemical waste and unemployment as environmental determinants that impact community health. Stakeholders interviewed cited multi-faceted and intertwined demographic and socio-economic issues related to income, the poor economy, drug abuse, lack of education, and unemployment as key environmental drivers of the health status of the community. These are all factors that are blamed for the unhealthy environment found in much of Columbiana County. Those participating in the CCHNA report that these factors have a trickledown effect resulting in a loss of jobs leading to foreclosures, which leads to more transient populations that leads to students lack of education and reduced opportunities for better incomes and access to a proper diet and healthier lifestyle. Each of these needs listed above is important and should be addressed by various county-wide organizations and/or community partners of the Hospital. However, due to their societal magnitude and the Hospital s limited resources and capacity to meaningfully impact the economic foundation of the county, the Hospital has chosen to allocate significant internal resources to the priority health needs which yield the greatest opportunities to affect a positive change, as outlined in this Implementation Plan. ~River Valley Health Partners/East Liverpool City Hospital Implementation Plan was approved by East Liverpool City Hospital s Board of Directors on October 30,2013