Redington-Fairview General Hospital 2017 Community Health Needs Assessment Annual Report Original Community Needs Assessment: November 2007 Updated: January 2010; April 2012, September ; August 2015; July 2016 Annual Report August 2017 Approved by Board of Directors September 27, 2017
EXECUTIVE SUMMARY RFGH Community Engagement Strategies Community health outreach strives to promote healthy behaviors through the services provided. RFGH Community Health offers community education, disease prevention and wellness initiatives based on community need. RFGH is the fiscal agent for Somerset Public Health who serves the greater Somerset in the prevention of chronic disease by working collaboratively with regional health and wellness providers. The intent of the 2017 community health assessment annual report is to: assess the progress on the specific health priorities established in the community health improvement plan: diabetes, tobacco and the older adult assess progress on additional strategic initiatives in meeting the needs of citizens whose health needs are at risk in our community BRIEF HISTORY Community Health Needs Assessments and / or annual reports have been completed since 2007. In 2015 RFGH Healthy Community Goals were strategized and remain in place. a. to promote healthy behaviors (promote nutrition and weight status, promote physical activity and fitness, reduce tobacco use and reduce use of alcohol and other drugs) b. to promote healthy and safe communities (improve environmental health, increase vaccinations, prevent injuries, and promote educational and community based programs) c. to improve systems (access to primary care, specialty care and emergency care) improve maternal, infant and child care, improve health communication and technology, improve public health infrastructure) d. to prevent; reduce; and manage diseases and disorders (cancer, cardiovascular/ heart disease and stroke, chronic diseases, infectious diseases, pulmonary and respiratory health) In 2016, RFGH collaborated with the Maine Shared Health Needs Assessment & Planning Process Project - a collaboration of multiple healthcare systems across Maine and the Maine CDC. A qualitative survey was completed in Kennebec and Somerset by community leadership and health experts, local government, other governmental agencies, youth serving organizations, faith based organization, and other interested individuals. Key health issues identified from the qualitative survey: obesity (childhood and adult), elder health, depression, cardiovascular and respiratory diseases, diabetes, drug and alcohol abuse, nutrition and physical activity, tobacco use, oral health and mental health. Key health factors identified were poverty, employment, food insecurity, housing, adverse childhood experiences, social support and interactions, access to behavioral care / mental health care, health care insurance, health literacy, access to oral care, transportation, access to healthy foods. As a means of gathering additional input from the direct community that RFGH serves, a simple qualitative survey was developed by RFGH and taken to a total of 18 community events / presentations of 850 individuals. The survey focused on which health issues impact their overall health. The surveys focused on family health, infectious diseases, chronic diseases, healthy behaviors and other health issues. Cardiovascular health, obesity, musculoskeletal, diabetes, cancer and depression were all identified as major or moderate chronic disease problems. Healthy behavior concerns were physical activity and nutrition, drug and alcohol abuse, and tobacco use. Other issues include mental health and oral health. 2
UPDATE TO 2016 ASSESSMENT DATA HEALTH RANKINGS published by the University of Wisconsin Population Health Institute, looks at health outcomes to see how healthy a county is and at health factors which influence the health of a county. Measures used are mortality, morbidity, health behaviors, access to care, quality of care, income, education, community safety, and environment. The indicators for health factors are similar to indicators throughout the Maine Shared Community Health Needs Assessment. An individual s health status is impacted by disparities such as income, education levels, and access to medical care. According to the 2017 national Health Rankings Somerset currently ranks 12 out of 16 for health outcomes and 15 out of 16 for health factors, an improvement over 2015 and 2016. The following flow chart helps one understand the Health Rankings. Somerset DEMOGRAPHICS & SOCIOECONOMIC STATISTICS Based on statistics from data in 2014 and 2015 reported in the 2017 Health Rankings, 14% of Somerset s adults are uninsured, 26% of children live in poverty. RFGH services most of Somerset, which is 80% rural. ACCESS TO CARE / HEALTH CARE QUALITY Somerset has 1:1760 ratio of patients to Primary Care Physicians to Maine s 1:800; a 1:5,110 Dentists compared to Maine s 1:1690 and a 1:1620 for Mental Health Providers while Maine is 1:240. Access barriers may include transportation, cost, education, lack of usual source of care, lack of insurance, child care, and others. 2016 RFGH / SPH ACCESS TO CARE /HEALTH SERVICES STRATEGIES AND OUTCOMES Indicators for Health Factors Adult Smoking Obesity Physical Inactivity Access to exercise opportunities Excessive drinking Alcohol impaired driving deaths STI Chlamydia rate Teen Births % Uninsured Population to provider ratios Preventable hospital stays Diabetic monitoring Mammography screening High school graduation (in 4 yrs) Some college Unemployment Children in poverty Income inequality Children in single-parent households Social associations Violent crime Injury deaths Air pollution particulate matter Drinking water violations Severe housing problems Driving alone to work Long commute driving alone 2016 - Prescription Assistance Program 37 individuals received assistance; 95 applications processed Strategies access to rapidly responding EMS; BLS 900+ community members trained in BLS through RFGH instructors Move More Kids Transportation Outcomes Somerset Explorer 7,692 riders / opportunities to be physically active, commute to provider office, obtain food, supplies or to go to work. 3
CHRONIC DISEASE (S) Chronic diseases include cardiovascular diseases (heart and stroke), cancer, chronic respiratory diseases, diabetes, and bone and joint disorders (i.e. arthritis and osteoporosis). Their causes may have underlying socioeconomic, cultural, political and environmental contributing factors and individuals may have additional risk factors that place them at an increased likelihood for a particular chronic disease or injury. Lack of physical inactivity, poor nutrition and tobacco use are the risk factors most individuals can adjust in their daily life and our community health programming can have an impact upon. These risk factors have an impact on all of the chronic diseases. Key indicators from the 2016 RFGH Community Health Risk Assessment are below with RFGH / SPH strategies to make a positive impact on our community. Adult obesity rates continue to rise Health Data Year Somerset Maine Rankings Obesity 35% 28% PHYSICAL ACTIVITY INDICATORS Maine Shared Community Health Needs Somerset Maine US Sedentary lifestyle no leisure time physical activity in past month (Adults ) 2011 ) 29.3% 22.4 25.3 TOBACCO INDICATORS Health Data Somerset Maine Rankings Year Current adult 2014 21% 19% smoking Current adult smoking 2015 18% 19% 2016 KEY RFGH / SPH TOBACCO STRATEGIES & OUTCOMES Rates of adult smoking in Somerset have decreased from 31% in to just reported 18% (error 2016 KEY TOBACCO STRATEGIES & OUTCOMES 1:1 tobacco consults with RFGH Certified Tobacco Specialist- 22 To date: 78 of 211 consults in 11 years have quit for > 37% abstinence rate > 6 NUTRITION INDICATORS 2016 KEY RFGH / SPH NUTRITION STRATEGIES & OUTCOMES Road to Wellness 35 attended (those who need to lose >100#) weight not measured Nutrition and Exercise Presentation 74 Students MSAD 59 Average 4# weight loss/ individual in 2016 Weigh to Go (WTG) - 144 completed class To date: 71 participants in database who have attended WTG for > 6 months; average wt. loss 28.51# Youth Tobacco Prevention 4th & 5th grades- 4 school districts + Community school 475 students Support Group average 4 members / session offered twice / month Youth Tobacco Prevention High School students: Class room Tobacco prevention SAD 54 345 students High School after school program 15 students SEE RFGH COMMUNITY HEALTH IMPROVEMENT PLAN ~ HEALTH PRIORITY TOBACCO USE (ATTACHED) FOR IMPACT AND UPDATE OF ACTIONS TAKEN. SPH Cooking Matters Classes with 60 teens; 905 children in grades K-3 enrolled in Pick a Better Snack Curriculum; 1933 adults and Children participated in Snap-Ed classes July 2015 June 2016. 2016 KEY PHYSICAL ACTIVITY STRATEGIES & OUTCOMES Total miles: 32,072 in the 100 Mile Club Program Movement Matters Panel presentation 45 attended 93.84% of teachers surveyed provide opportunities for physical activity during class time 8 schools participated in the 100 Mile Club Program activity before, during and after school for students to run and walk 100 miles during the school year 4
CHRONIC DISEASE INDICATORS CHRONIC DISEASE STRATEGIES AND OUTCOMES Cardiovascular Health Hypertension prevalence 39.6% 32.8% 31.4% High cholesterol 43.3% 40.3% 38.4% Respiratory / Pulmonary Health COPD diagnosed 2011-9.1% 7.6% 6.5% Asthma emergency department 2011 101.2 67.3 N/A visits per 10,000 Current asthma (adults) 2011-14.4 11.07 9.0 Current asthma (youth 0-17) 2011-12.01 9.1 N/A Pneumonia emergency department rate per 100,000 2011 1379.2* 719.9 N/A Diabetes Diabetes prevalence (ever been told) 2011-11.8 9.6 9.7 Pre-diabetes prevalence 2011-8.1% 6.9 N/A Diabetes long term complication hospitalizations 2011 47.2 59.1 N/A 2016 KEY CARDIOVASCULAR HEALTH STRATEGIES & OUTCOMES Heart Health Support Group - 442 attended Cardiac Rehab Education Classes 90 attended 2016 KEY RESPIRATORY HEALTH STRATEGIES & OUTCOMES Informational Heart Health Table at 3 locations 290 Heart Health Support Group 442 attended COPD presentation by RT and Pharm D 30 attended Support Group - 280 attended COPD presentation to worksite 16 attend 2016 KEY DIABETES STRATEGIES & OUTCOMES Support Group offered monthly X 10 70 attend DSMT Program ongoing A1C Champion Presentation 25 attended NDPP -23 participants who lost over 267 # collectively in 16 weeks to lower their prediabetes risk; 10/23 exceeded the 7% weight loss goal Cancer Incidence all cancers per 100,000 2007-2011 472.0 500.1 453.4 Mortality all cancers per 100,000 2007-2011 204.9* 185.5 168.7 Colorectal screening 2012 70.1% 72.2% N/A Mammograms female age 50+ in past 2 yrs 2012 82.8% 82.1% 77% 2016 KEY CANCER STRATEGIES & OUTCOMES Support Group offered monthly with average 20/month attending (approx. 200 attendees) Skin Cancer prevention awareness @ farmers market 50 received information Fatty Liver Disease 65 attended presentation by Dr. Henry Colorectal cancer screening / risks 7 attend SEE RFGH COMMUNITY HEALTH IMPROVEMENT PLAN ~ HEALTH PRIORITY DIABETES (ATTACHED) FOR IMPACT OF ACTIONS TAKEN TO DATE Relay for life education for early detection of skin, lung, colorectal, breast cancer 329 received information Breast Cancer awareness with Dr. Stannard; Radiology and a Survivor 28 attended Pancreatic cancer prevention awareness EMS outreach 100 received information 5
ADDITIONAL HEALTH TOPIC INICATORS 2016 ADDITIONAL HEALTH TOPIC STRATEGIES & OUTCOMES Maine Shared Community Health Data Year Live births for which the mother 2010- received early and adequate prenatal 2012 care Live births to 15-19 year olds per 1.000 2010-2012 Low birth weight (<2500grams) 2010-2012 Somerset Maine US 75.5% 86.4% 84.8% 27.8 20.5 26.5 6.1% 6.6% 8.0% 2016 KEY PREGNANCY AND BIRTH STRATEGIES & OUTCOMES Labor and Delivery class to 47 expectant mothers Newborn class to 27 expectant mothers 2016 KEY IMMUNIZATION STRATEGIES & OUTCOMES 411 children vaccinated through 4 school districts and 3 community school 442 adults through community clinics Maine Shared Community Health Needs Data Somerset Maine US Year Lyme disease incidence per 1000,000 2014 33.2 105.3 10.5 TB incidence per 100,000 2014 0 1.1 3.0 Hep C (acute incidence per 100,000 2014 2.0 2.3 N/A 2016 KEY INFECTIOUS DISEASE STRATEGIES & OUTCOMES Infection control practitioner presented about ticks and mosquitos / prevention to three worksites 137 attendees 2016 KEY SUBSTANCE AND ALCOHOL ABUSE STRATEGIES & OUTCOMES Maine Shared Community Health Needs Drug affected baby referrals received as a percentage of all live births Emergency medical service overdose response per 100,000 Opiate poisoning (ED visits) per 100,000 Maine Shared Community Health Needs Children with confirmed elevated blood lead levels (% among those screened) Children with unconfirmed elevated blood level (% among those screened) Homes with private wells tested for arsenic Lead screening among children age 12-23 months Lead screening among children age 24-35 months SEE RFGH COMMUNITY HEALTH IMPROVEMENT PLAN ~ HEALTH PRIORITY OLDER ADULT (ATTACHED) FOR IMPACT OF ACTIONS Data Somerset Maine US Year 2014 12.3% 7.8% N/A 2014 281.5 391.5 NA Maine Shared Community Health Needs Data Somerset Maine US Year Adults immunized annually for influenza 2011-37.6% 41.5% N/A Adults immunized for pneumococcal 2011-73.1% 72.4% 69.5% pneumonia ages 65 + Immunization exemptions among kindergarteners for philosophical reasons 2015 3.9 3.7 N/A 2011 Data Year 22.7 25.1 NA Somerset Maine US 2.4% 2.5% N/A 9.1% 4.2% N/A 45.4% 43.3% N/A 41.1% 49.2% N/A 40.7% 27.6% N/A 3 school systems have school resource officers 4 schools implement an Impaired Driving Awareness Day 100% School Districts (5) meet policy standards of Tobacco Free Maine 4 schools have youth groups that focus on preventing peer alcohol and drug use 4 schools implemented Parents Who Host Lose the Most at Prom and Graduation time 2016 KEY ENVIRONMENTAL HEALTH STRATEGIES & OUTCOMES Radon harmful effects 75 attended presentation Preschool lead screenings collaboration with KVCAP 9 preschools with 57 preschoolers tested. Two students with elevated levels (follow up per State of me protocol) 6
SUMMARY RFGH and SPH are working dilligently to achieve the strategies and obtain outcomes that align with the healthy community goals, objectives and strategies of RFGH, the national healthy People 2020 national health plan, and the Healthy Maine 2020 plan. Key topic areas that were addressed in this annual report included access to health services; nutrition and weight status, physical activity, older adults, environmental health, infectious diseases chronic diseases (cancer, diabetes, cardiovascular health, respiratory diseases); youth, substance abuse; and tobacco. It is a snapshot of strategies to meet those key indicators that we know can be improved upon in time. It is also a highlight of positive outcomes from the strategies and initiatives taken to date. Much has been done in Somerset around tobacco use and it shows positive results. In approximately the past ten years, the county has decreased to a rate of 18% from 31%. It is exciting to see that our youth are engaging in more physical activity which the anticipation is that it will have an impact on their weight as adults. The current rate of adult obesity is too high, rising year after year, leading to many complications such as chronic diseases. There is also much to be done in Somerset to improve the health status of our citizens. Somerset is an aging county in which many will be impacted by chronic diseases. Redington Fairview General Hospital Community Health and Somerset Public Health look forward to continuing the pursuit of the health of our community by working directly, or in collaboration with others to identify and provide health prevention and education services throughout the community. The Commuity Health Workplan may be accessed at www.rfgh.net for further information about the RFGH strategies to meet topic areas. The RFGH Community Health Assessment 2016 may be accessed at www.rfgh.net. The public is welcome to download or view several county and state reports and datasets that are available on the Maine CDC website at www.maine.gov/shnapp/. 7