Community Health Needs Assessment. December 2016

Transcription

1 Cmmunity Health Needs Assessment December 2016

2 Cntents Intrductin... 1 Abut Cmmunity Health Needs Assessments... 1 Acknwledgments... 2 Summary f Cmmunity Health Needs Assessment Prcess... 2 Cmmunity Served by the Medical Center... 2 Defined Cmmunity... 3 Cmmunity Characteristics... 3 Cmmunity Ppulatin and Demgraphics... 3 Sciecnmic Characteristics f the Cmmunity... 4 Health Status f the Cmmunity... 6 Health Outcmes and Factrs... 7 Health Care Resurces Hspitals and Health Centers Medical Center Market Share Other Health Care Facilities and Prviders Estimated Demand fr Hspital Services Key Interviewees Methdlgy Results f Key Interviews Evaluatin f Respnse t 2013 CHNA Identificatin and Priritizatin f Health Needs Appendices Key Interviewee Prtcl Surces... 20

3 Intrductin Baxter Reginal Medical Center (the Medical Center) is an Arkansas nnprfit rganizatin, lcated in Muntain Hme, Arkansas. A 10-member bard f directrs gverns the Medical Center and ensures that medical services are available t the residents f Muntain Hme and surrunding areas. The Medical Center is an integrated health care prvider serving residents f nrth Arkansas fr mre than 50 years. The Medical Center prudly ffers a wide range f services and specialties t meet the needs f Arkansans clse t hme. With mre than 100 primary care, mid-level and specialist physicians n the medical staff, and apprximately 1,500 emplyees, the Medical Center is made up f an experienced and dedicated team. The Medical Center prvides health care slutins with cmpassin and respect fr the uniqueness f every individual. Guided by a values-based culture t cnsistently deliver clinical and service excellence t ur patients, the Medical Center strives fr excellent care fr every patient, every time. Abut Cmmunity Health Needs Assessments As a result f the Patient Prtectin and Affrdable Care Act, tax-exempt hspitals are required t assess the health needs f their cmmunities and adpt implementatin strategies t address significant identified needs. Cmpliance with sectin 501(r) f the Internal Revenue Cde (IRC) requires that a taxexempt hspital facility: Cnduct a cmmunity health needs assessment every three years. Adpt an implementatin strategy t meet the significant cmmunity health needs identified thrugh the assessment. In each subsequent assessment, evaluate the impact f previus implementatin strategies n identified needs. The cmmunity health needs assessment must take int accunt input frm persns wh represent the brad interest f the cmmunity served by the hspital facility, including thse with special knwledge f r expertise in public health and thse representing lw-incme, medically underserved, r minrity ppulatins in the cmmunity. The hspital facility must make the cmmunity health needs assessment widely available t the public. This cmmunity health needs assessment is intended t dcument the Medical Center s cmpliance with IRC Sectin 501(r). Health needs f the cmmunity have been identified and priritized s that the Medical Center may adpt an implementatin strategy t address specific needs f the cmmunity. The prcess invlved: A cmprehensive evaluatin f the implementatin strategy that was develped as a result f the initial cmmunity health needs assessment cmpleted in March Cllectin and analysis f a large range f data, including demgraphic, sciecnmic and health statistics, health care resurces and patient use rates. Interviews with individuals wh represent a) brad interests f the cmmunity, b) ppulatins f need and c) persns with specialized knwledge in public health. 1

4 This dcument is a summary f all the available evidence cllected during the cmmunity health needs assessments required by the IRS during tax year It will serve as a cmpliance dcument, an assessment f the impact f the previus implementatin strategy and a resurce until the next assessment cycle. Acknwledgments The cmmunity health needs assessment research team wuld like t thank all thse wh cntributed t the cmmunity health assessment described herein. We are grateful fr the many key infrmants wh gave their time and expertise t infrm bth the directin and utcmes f the study. We greatly appreciate the cntributin f their stries. Summary f Cmmunity Health Needs Assessment Prcess The purpse f the cmmunity health needs assessment is t understand the unique health needs f the cmmunity served by the Medical Center and t dcument cmpliance with new federal laws utlined abve. The Medical Center engaged BKD, LLP t cnduct a frmal cmmunity health needs assessment. BKD is ne f the largest CPA and advisry firms in the United States, with apprximately 2,500 partners and emplyees in 34 ffices. BKD serves mre than 1,050 hspitals and health care systems acrss the cuntry. The cmmunity health needs assessment was cnducted frm July thrugh December The fllwing steps were cnducted as part f the Medical Center s cmmunity health needs assessment:. An evaluatin f the impact f actins taken t address the significant health needs identified in the 2013 cmmunity health needs assessment was cmpleted t understand the effectiveness f the Medical Center s current strategies and prgrams. This evaluatin is included at Page 14. Ppulatin demgraphics and sciecnmic characteristics f the cmmunity were gathered and reprted utilizing varius third parties (see references in Appendices). The health status f the cmmunity was then reviewed. Infrmatin n the leading causes f death and mrbidity infrmatin was analyzed in cnjunctin with health utcmes and factrs reprted fr the cmmunity by CuntyHealthrankings.rg. Health factrs with significant pprtunity fr imprvement were nted. An inventry f health care facilities and resurces was prepared. Cmmunity input was prvided thrugh five key interviews, and any cmments received prviding feedback n the previus assessment and implementatin strategy. Results and findings are described in the Key Interviewee prtin f this reprt. Infrmatin gathered in the abve steps was analyzed and reviewed t identify health issues f uninsured persns, lw-incme persns and minrity grups and the cmmunity as a whle. Health needs were then priritized taking int accunt the perceived degree f influence the Medical Center has t impact the need and the health needs impact n verall health fr the cmmunity. Infrmatin gaps identified during the priritizatin prcess have been reprted. Cmmunity Served by the Medical Center The Medical Center is lcated in Muntain Hme, Arkansas, in Baxter Cunty. Muntain Hme is apprximately tw and a half hurs east f Fayetteville, Arkansas, and tw hurs suth f Springfield, Missuri, the clsest metrplitan areas. The twn is nt served by any divided highways. 2

5 Defined Cmmunity A cmmunity is defined as the gegraphic area frm which a significant number f the patients utilizing hspital services reside. While the cmmunity health needs assessment cnsiders ther types f health care prviders, the Medical Center is the single largest prvider f acute care services. Fr this reasn, the utilizatin f hspital services prvides the clearest definitin f the cmmunity. During the initial cmmunity health needs assessment prcess, an analysis f inpatient discharges and utpatient visits was perfrmed t determine where the Medical Center s patients resided. This analysis shwed that the large majrity f the Medical Center s patients were frm Baxter and Marin Cunties, bth lcated in nrthern Arkansas. In the three years since the last cmmunity health needs assessment was cnducted, there have nt been significant changes in the ppulatin f the area, nr have any new hspitals been pened. Therefre, Medical Center management believes that their cmmunity has remained unchanged frm the previus cmmunity health needs assessment. This reprt will include data frm the tw cmmunity cunties listed abve. Cmmunity Characteristics Cmmunity Ppulatin and Demgraphics The cmmunity served by the Medical Center is a rural area in nrth central Arkansas. Accrding t 2015 prjectins based n the mst recent U.S. Census Bureau estimates, abut 61,000 peple live in the tw cunties included in the cmmunity. The Medical Center is lcated in Muntain Hme, Arkansas, which is the largest twn in the cmmunity with a ppulatin f arund 13,000 peple. 3

6 A majr distinguishing feature f the Medical Center s cmmunity is the age breakdwn f this ppulatin. The chart abve shws the breakdwn f the cmmunity s ppulatin by age grup. Accrding t the U.S. Census Bureau, abut 28% f the cmmunity s ppulatin is ver age 65, which is much higher than in Arkansas (15%) r the United States (13%) as a whle. Additinally, the percentage f the cmmunity ppulatin ver age 65 is expected t cntinue increasing ver the next five years, as shwn n the chart belw. This age grup uses mre health services than any ther, s the Medical Center shuld prepare fr increased patient vlume in the near future. Additinally, the percentage f the cmmunity aged 44 and belw is expected t shrink ver the next five years, which culd cntribute t difficulties in recruiting enugh care prviders t manage the aging ppulatin. Surce: Ttal Ppulatin by Cunty and Develpment District Prjectins Sciecnmic Characteristics f the Cmmunity The sciecnmic characteristics f a gegraphic area influence the way residents access health care services and perceive the need fr health care services within sciety. Factrs such as educatinal attainment, pverty levels, unemplyment rates and insurance cverage levels cntribute significantly t the health status f a cmmunity. Sciecnmically, the cmmunity served by the Medical Center is similar t many ther parts f rural Arkansas. Abut 23% f the ppulatin has btained an assciate s degree r higher, cmpared t abut 37% f the U.S., while abut 14% f the ppulatin des nt have a high schl diplma, which is cmparable t the cuntry as a whle. Lwer levels f educatin have been linked t negative health utcmes, s the educatinal attainment f the cmmunity is relevant t the cnsideratin f the health needs f the cmmunity. Surce: U.S. Census Bureau, American Cmmunity Survey 4

7 The incme levels f individuals within the cmmunity als have a significant effect n their ability t access health services. The average per-capita incme in the Medical Center s cmmunity is $20,470, cmpared t $22,595 fr the state f Arkansas and $28,554 fr the United States. Lwer than average per capita incme suggests that many members f the cmmunity may have difficulty btaining health care, especially preventative care. The chart belw shws the percentage f the cmmunities ppulatin living belw the federal pverty line accrding t the mst recent U.S. Census Bureau American Cmmunity Survey, with the percentage f children under age 18 shwn separately. The specific health needs f lw-incme members f the cmmunity shuld be cnsidered carefully thrughut the preparatin f this assessment. Baxter Marin Arkansas United States Ppulatin in Pverty 0% 5% 10% 15% 20% 25% 30% % Children in Pverty % Ppulatin in Pverty Sme sciecnmic measures in the cmmunity have imprved significantly since the publicatin f the 2013 cmmunity health needs assessment. One such measure is the percentage f the cmmunity that is withut health insurance cverage. Effective January 1, 2014, the Patient Prtectin and Affrdable Care Act expanded health cverage fr many Americans. Arkansas expanded Medicaid eligibility and created a prgram, initially knwn as the Arkansas Private Optin and mre recently termed Arkansas Wrks, that allws federal expansin funds t instead be used t subsidize premiums fr private cmmercial insurance plicies fr lw-incme Arkansans. This prgram has had a significant effect n the patient mix f the Medical Center. In 2013, befre this prgram went in t effect, 11% f the Medical Center s patient encunters were uninsured, while in 2014, that number drpped t nly 8%, representing a 29% decrease in uninsured patient encunters at the Medical Center. The lng-term impact f this grwth in insurance cverage n health needs cannt yet be determined. In additin, cntinued supprt fr this expansin at the state and federal level is nt assured. 5

8 Anther sciecnmic measure that has been imprving steadily ver the past several years is the unemplyment rate. The chart abve shws that the unemplyment rate f the cmmunity has been drpping sharply ver the past five years, alng with thse f the state f Arkansas and the United States. As the ecnmy imprves and mre peple find emplyment, the sciecnmic status f the cmmunity shuld be strengthened as access t healthcare is imprved. Health Status f the Cmmunity This sectin f the assessment reviews the health status f Marin and Baxter Cunty residents. As in the previus sectin, cmparisns are prvided with the state f Arkansas. This in-depth assessment f the mrtality and mrbidity data, health utcmes, health factrs and mental health indicatrs f the cunty residents that make up the cmmunity will enable the Medical Center t identify pririty health issues related t the health status f its residents. Gd health can be defined as a state f physical, mental and scial well-being, rather than the absence f disease r infirmity. Accrding t Healthy Peple 2010, the natinal health bjectives released by the U.S. Department f Health and Human Services, individual health is clsely linked t cmmunity health. Cmmunity health, which includes bth the physical and scial envirnment in which individuals live, wrk and play, is prfundly affected by the cllective behavirs, attitudes and beliefs f everyne wh lives in the cmmunity. Healthy peple are amng a cmmunity s mst essential resurces. Numerus factrs have a significant impact n an individual s health status: lifestyle and behavir, human bilgy, envirnmental and sciecnmic cnditins, as well as access t adequate and apprpriate health care and medical services. Studies by the American Sciety f Internal Medicine cnclude that up t 70% f an individual s health status is directly attributable t persnal lifestyle decisins and attitudes. Persns wh d nt smke, wh drink in mderatin (if at all), use autmbile seat belts (car seats fr infants and small children), maintain a nutritius lw-fat, high-fiber diet, reduce excess stress in daily living and exercise regularly have a significantly greater ptential f aviding debilitating diseases, infirmities and premature death. 6

9 The interrelatinship amng lifestyle/behavir, persnal health attitudes, and pr health status is gaining recgnitin and acceptance by bth the general public and health care prviders. Sme examples f lifestyle/behavir and related health care prblems include the fllwing: Smking Alchl/drug abuse Pr nutritin Lack f exercise Lifestyle Primary Disease Factr Lung cancer Cardivascular disease Emphysema Chrnic brnchitis Cirrhsis f liver Mtr vehicle crashes Unintentinal injuries Malnutritin Suicide Hmicide Mental illness Obesity Digestive disease Depressin Cardivascular disease Depressin Overstressed Mental illness Alchl/drug abuse Cardivascular disease Health Outcmes and Factrs An analysis f varius health utcmes and factrs fr a particular cmmunity can, if imprved, help make that cmmunity a healthier place t live, learn, wrk and play. A better understanding f the factrs that affect the health f the cmmunity will assist with hw t imprve the cmmunity s habits, culture and envirnment. This prtin f the cmmunity health needs assessment utilizes infrmatin frm Cunty Health Rankings, a key cmpnent f the Mbilizing Actin Tward Cmmunity Health (MATCH) prject, a cllabratin between the Rbert Wd Jhnsn Fundatin and the University f Wiscnsin Ppulatin Health Institute. The Cunty Health Rankings mdel is grunded in the belief that prgrams and plicies implemented at the lcal, state and federal levels have an impact n the variety f factrs that, in turn, determine the health utcmes fr cmmunities acrss the natin. The mdel prvides a ranking methd that ranks all 50 states and the cunties within each state, based n the measurement f tw types f health utcmes fr each cunty: hw lng peple live (mrtality) and hw healthy peple feel (mrbidity). These utcmes are the result f a cllectin f health factrs and are influenced by prgrams and plicies at the lcal, state and federal levels. 7

10 Cunties in each f the 50 states are ranked accrding t summaries f a variety f health measures. Thse having high ranks, e.g., 1 r 2, are cnsidered t be the healthiest. Cunties are ranked relative t the health f ther cunties in the same state n the fllwing summary measures: Health Outcmes rankings are based n an equal weighting f ne length f life measure and fur quality f life measures. Health Factrs rankings are based n weighted scres f fur types f factrs: Health behavirs (nine measures) Clinical care (seven measures) Scial and ecnmic (seven measures) Physical envirnment (tw measures) A mre detailed discussin abut the ranking system, data surces and measures, data quality and calculating scres and ranks can be fund at the website fr Cunty Health Rankings ( As part f the analysis f the needs assessment fr the cmmunity, the cmmunity cunties will be used t cmpare the relative health status f the cmmunity t the state f Arkansas as well as t a natinal benchmark, if available. A better understanding f the factrs that affect the health f the cmmunity will assist with hw t imprve the cmmunity s habits, culture and envirnment. The fllwing table, frm Cunty Health Rankings, summarizes the 2016 health utcmes and factrs fr each f the tw cunties in cmmunity, including its rank within Arkansas 75 cunties. Measures underperfrming the state average are highlighted in red. The data upn which the uninsured patients measure was based is frm 2012 and therefre des nt reflect the imprvement discussed earlier resulting frm the 2014 Medicaid expansin. 8

11 Health Outcme/Factr Baxter Cunty Marin Cunty Natinal Metric Rank Metric Rank Arkansas Benchmark Health Outcmes Length f Life Premature death Years f ptential life lst befre age 75 per 100,000 ppulatin (age-adjusted) 10,500 10,500 9,100 5,200 Quality f Life Pr r fair health Percent f adults reprting fair r pr health (ageadjusted) 18% 21% 23% 12% Pr physical health days Average number f physically unhealthy days reprted in past 30 days (age-adjusted) Pr mental health days Average number f mentally unhealthy days reprted in past 30 days (age adjusted) Lw birth weight Percent f live births with lw birth weight (<2500 grams) 7% 7% 9% 6% Health Factrs 3 22 Health Behavirs 2 6 Adult smking Percent f adults that reprt smking at least 100 cigarettes and that they currently smke 20% 23% 25% 14% Adult besity Percent f adults that reprt a BMI >= 30 29% 31% 33% 25% Fd envirnment index Ranking frm 1-10 that cnsiders accessibility f healthy fds Physical inactivity Percent f adults reprting n leisure-time physical activity 32% 33% 32% 20% Access t exercise pprtunities Percent f individuals wh live within three miles f a recreatinal facility 72% 55% 61% 91% Excessive drinking Percent f adults that reprt excessive drinking in the past 30 days 13% 13% 14% 12% Alchl-impaired driving deaths Percent f mtr vehicle crash deaths with alchl invlvement 15% 9% 30% 14% Sexually transmitted infectins Chlamydia rate per 100K ppulatin Teen birth rate Per 1,000 female ppulatin, ages Clinical Care 2 48 Uninsured adults Percent f ppulatin under age 65 withut health insurance 19% 20% 19% 11% Primary care physicians Rati f ppulatin t primary care physicians 1,170:1 5,480:1 1,540:1 1040:1 Dentists Rati f ppulatin t dentists 2,150:1 8,180:1 2,300:1 1340:1 Mental health prviders Rati f ppulatin t mental health prviders 370:1 4,090:1 520:1 370:1 Preventable hspital stays Hspitalizatin rate fr ambulatry-care sensitive cnditins per 1,000 Medicare enrllees Diabetic screening Percent f diabetic Medicare enrllees that receive HbA1c screening 86% 85% 83% 90% Mammgraphy screening Percent f female Medicare enrllees that receive mammgraphy screening 71% 59% 58% 71% Scial and Ecnmic Factrs High schl graduatin Percent f ninth grade chrt that graduates in 4 years 87% 95% 85% 93% Sme cllege Percent f adults aged years with sme pstsecndary educatin 61% 45% 55% 72% Children in pverty Percent f children under age 18 in pverty 26% 33% 26% 13% Incme inequality Rati f husehld incme at the 80th percentile t that at the 20th percentile Children in single-parent husehlds Percent f children that live in husehld headed by single parent 33% 34% 37% 21% Vilent crime rate Vilent crimes per 100,000 ppulatin Injury deaths Deaths frm intentinal and unintentinal injuries per 100,000 ppulatin Physical Envirnment Air pllutin-particulate matter days Average daily density f fine particulate matter Severe husing prblems Percentage f husehlds with severe husing prblems in facilities, crwding, r cst 14% 15% 15% 9% 9

12 Health Care Resurces The availability f health resurces is a critical cmpnent t the health f a cmmunity and a measure f the sundness f the area s health care delivery system. An adequate number f health care facilities and health care prviders is vital fr sustaining a cmmunity s health status. Fewer health care facilities and health care prviders can impact the timely delivery f services. A limited supply f health resurces, especially prviders, results in the limited capacity f the health care delivery system t absrb charity and indigent care, as there are fewer prviders upn which t distribute the burden f such care. This sectin will address the availability f health care resurces t the residents f the Medical Center s cmmunity. Hspitals and Health Centers The Medical Center has 268 acute beds and is the nly hspital lcated in the cmmunity. Hwever, because the cmmunity spans a large gegraphic area, there are several ther hspitals that receive a significant share f the cmmunity s patients. The chart belw summarizes hspital services available t the residents f Baxter and Marin Cunties: Summary f Nearby Hspitals Facility Miles frm Bed Annual Type BRMC Size Discharges Baxter Reginal Medical Center Muntain Hme, AR Shrt-term Acute Care ,646 Nrth Arkansas Reginal Medical Center Harrisn, AR Shrt-term Acute Care ,609 Stne Cunty Medical Center Muntain View, AR Critical Access CxHealth Springfield, MO Shrt-term Acute Care ,083 Mercy Hspital Springfield Springfield, MO Shrt-term Acute Care ,462 Surce: Cstreprtdata.cm The fllwing is a brief descriptin f the health care services available at each f these facilities: Nrth Arkansas Reginal Medical Center (NARMC) Lcated in Harrisn, Arkansas, NARMC is apprximately ne hur west f the Medical Center. It ffers services such as cancer treatment, cardiac rehabilitatin services, wmen s services and cmmunity educatin. Stne Cunty Medical Center (SCMC) Lcated in Muntain View, Arkansas, Stne Cunty Medical Center is apprximately a ne hur drive suth f the Medical Center. It ffers emergency medicine, family medicine and rthpedic surgery services. CxHealth With tw lcatins in Springfield, Missuri (CxNrth and CxSuth), CxHealth is a large, full-service hspital that prvides a wide variety f health care services, including a Level I Trauma Center. It is apprximately tw hurs and 15 minutes nrthwest f the Medical Center. Mercy Hspital-Springfield (Mercy) Frmerly knwn as St. Jhn s Hspital, Mercy is a large, fullservice hspital that ffers a wide range f services, including a cancer center, children s care and integrative medicine. It is apprximately tw hurs and 15 minutes nrthwest f the Medical Center. 10

13 Medical Center Market Share The market share f a hspital relative t that f its cmpetitrs may be based largely n the services required by patients and the availability f thse services at each facility. Fr this study, the market share f the Medical Center was cnsidered based n the type f services required by thse patients in the cmmunity. The ability t attain a certain relative market share (percentage) f the cmmunity varies based n a number f factrs, including the services prvided, gegraphical lcatin and accessibility f each cmpeting facility. The chart belw presents the relative market share f each hspital that had discharges f residents frm the cmmunity. This table presents an analysis f data fr the mst currently available year, shwing the percentage f ttal discharges frm each hspital. This infrmatin prvides an idea f summary market share, as well as the utmigratin f patients frm the cmmunity. Fr 2014, the Medical Center maintained apprximately 78% f all discharges frm the cmmunity with CxHealth and Nrth Arkansas Reginal Medical Center individually capturing arund 3%. The remaining 18% f discharges is made up f numerus hspitals, each with less than 3% f the ttal cmmunity discharges. Because Arkansas law prhibits the Arkansas Department f Health frm prviding hspital-specific discharge infrmatin, the data in the chart abve was estimated based n Medicare discharges by zip cde and hspital, which is available frm the Centers fr Medicare & Medicaid Services. Other Health Care Facilities and Prviders Muntain Hme Christian Clinic Lcated in Muntain Hme, Arkansas, this faith-based clinic prvides free medical care fr adults wh are belw the federal pverty level and have n insurance. Kindness, Inc. Lcated in Muntain Hme, Arkansas, Kindness, Inc., is a nt-fr-prfit rganizatin that prvides nnmedical services such as transprtatin t medical and ther appintments, grcery shpping assistance, respite fr primary care givers, minr hme repairs, installatin f safety bars and wheelchair ramps, reassurance calls and friendly visitatin t senirs and ther individuals in the Cmmunity. 11

14 Hme Health Agencies The cmmunity is hme t seven hme health agencies that prvide services such as medicine supervisin, cmpaninship, husekeeping, persnal care and in-hme nursing t senirs and ther hmebund residents f the cmmunity. Area Agencies n Aging With lcatins in Baxter and Marin Cunties, the Area Agencies n Aging prvide varius services t senir citizens in the cmmunity, including adult day care, emergency respnse systems, husing, Meals n Wheels, caregiver supprt prgrams, medical supply delivery and in-hme care. Hmetwn Health Initiative A branch f the Arkansas Department f Health, the Hmetwn Health Initiative wrks with lcal cmmunities and rganizatins t identify health issues and implement slutins that imprve the health f lcal citizens. Cunty Health Departments The Health Departments f Baxter and Marin Cunties exist t prevent, prmte and prtect the public s health. The departments prvide WIC (Wmen, Infants and Children) Supprt Prgrams fr families wh meet certain nutritinal and financial guidelines. Other services include family planning; health educatin; immunizatins; and screenings fr bld pressure, hepatitis, sexually transmitted diseases, HIV and tuberculsis. Area Nursing Hmes There are twelve nursing hmes in the area with a ttal f 948 beds. They prvide residential, medical and rehabilitative services t the elderly and disabled in the cmmunity. Estimated Demand fr Hspital Services As the cmmunity ages and verall ppulatin rises, the estimated demand fr hspital services is expected t increase. During 2016, the Medical Center cnducted an analysis cmparing their current available physician supply t the ttal demand within the cmmunity fr physician services. The chart belw shws the current supply f physician FTEs versus the demand. There is a deficit f apprximately 31 primary care physicians, 33 medical specialty physicians and 14 surgical sub-specialty physicians. The Medical Center will cntinue t fcus n physician recruitment t ensure cmmunity residents have access t the care they need. 12

15 Key Interviewees Speaking with key interviewees (cmmunity stakehlders that represent the brad interest f the cmmunity with knwledge f r expertise in public health r thse representing lw-incme, medically underserved r minrity ppulatins within the cmmunity) is a technique emplyed t assess public perceptins f the cunty s health status and unmet needs. These interviews are intended t ascertain pinins amng individuals likely t be knwledgeable abut the cmmunity and influential ver the pinins f thers abut health cncerns in the cmmunity. Key interviewees included the cunty health department directrs frm each cunty in the Medical Center s cmmunity, as well as individuals wh are knwledgeable abut ppulatins within the cmmunity whse health and quality f life may nt be as gd as thers, such as representatives f rganizatins serving the medically indigent, children in pverty, r the elderly. Methdlgy Dialgues with five key interviewees were cnducted in August Interviewees were determined based n their specialized knwledge r expertise in public health r their invlvement with underserved and minrity ppulatins. All interviews were cnducted by Medical Center persnnel using a standard questinnaire. A cpy f the interview instrument is included in the appendix. A summary f their pinins is reprted withut judging the truthfulness r accuracy f their remarks. Cmmunity leaders prvided cmments n the fllwing issues: Health and quality f life fr residents f the primary cmmunity Barriers t imprving health and quality f life fr residents f the primary cmmunity Opinins regarding the imprtant health issues that affect cmmunity residents and the types f services that are imprtant fr addressing these issues Delineatin f the mst imprtant health care issues r services discussed and actins necessary fr addressing thse issues Interview data was initially recrded in narrative frm. Interviewees were assured that persnal identifiers such as name r rganizatinal affiliatins wuld nt be cnnected in any way t the infrmatin presented in this reprt. This technique des nt prvide a quantitative analysis f the leaders pinins, but reveals cmmunity input fr sme f the factrs affecting the views and sentiments abut verall health and quality f life within the cmmunity. 13

16 Key Interviewee Interview Results As stated earlier, the interview questins fr each key infrmant were identical. The questins n the interview instrument are gruped int fur majr categries fr discussin: 1. General pinins regarding health and quality f life in the cmmunity 2. Underserved ppulatins and cmmunities f need 3. Barriers t imprving health and quality f life 4. Mst imprtant health and quality f life issues While many issues were raised during the interviews, a few items std ut as being mentined cnsistently by nearly all f the interviewees. These issues are summarized belw: The interviewees were ptimistic abut the health status f the cmmunity. All five interviewees felt that quality f life in the cmmunity had imprved ver the last three years. The majr health prblems nted by the key interviewees were diabetes, besity and tbacc use. The majr cntributing factrs t pr health in the cmmunity nted by the key interviewees were lw incme, pr eating habits and tbacc use. Several interviewees in mre rural parts f the cmmunity stated that there is a need fr mre dental and mental health services. Evaluatin f Respnse t 2013 CHNA The Medical Center prepared an implementatin strategy in respnse t the needs identified in its 2013 needs assessment. A listing f thse needs, alng with the steps taken by the Medical Center t address them, is belw. Aging Prblems Hspital experts speak at the fur Cmmunity Huses. Cmmunity Huses are n-campus sites that prvide educatinal prgrams and resurces free f charge t cmmunity members. BRMC-Mruk Family Educatin Center n Aging expanded free educatinal wrkshps fr the aging ppulatin, including Rck Steady Bxing, a prgram fr patients with Parkinsn s disease. The Medical Center prvided free screenings fr high bld pressure, chlesterl, hearing and visin impairment at the annual health fair. The Medical Center perfrmed extensive testing/screening at Fairlamb Senir Health Clinic fr pssible dementia and Alzheimer s patients. Preventative Health & Wellness Created Wellness Cmmittee fr hspital wrkers, which implemented a healthier hspital menu, a campaign t use the stairs and a campaign t utilize the hspital gym. The Medical Center ffered healthy cking thrugh the Cmmunity Huses. The Medical Center cntinued t expand health services with cmmunity partners at the Annual Health Fair. The Medical Center ffered free smking cessatin prgrams with expanded lcatins. 14

17 Mammgraphy screenings were prvided t rural area wmen thrugh the Mbile Mammgraphy Unit utreach prgram. The Medical Center s Reppell Diabetes Learning Center prvides educatin and ther tls t help members f the cmmunity manage their diabetes t achieve maximum persnal health and wellness and avid further cmplicatins. Access t Primary Care The Medical Center advertised thrugh scial media, internet and radi fr cmmunity members t help find a physician. The Medical Center assisted with Cmmunity sign up pprtunities t the Arkansas Private Optin, nw knwn as Arkansas Wrks, by prviding lcatins, advertising awareness and IPA trainers. Walk-in clinics were established at Yellville-Summit High schl, Wal-Mart, Family Practice Clinics in Salem, AR and Flippin, AR. The Medical Center develped and participated in the Clinically Integrated Netwrk, Accuntable Care Organizatin, and patient centered medical hmes. The Medical Center established a Cmmunity Paramedic Prgram: One-n-ne cunseling centered n medicatin, nutritin, cmmunity resurces. Because ppulatin health data takes time t becme publically available, it is difficult t quantitatively assess the impact f actins taken by the Medical Center in respnse t the previus needs assessment. Hwever, there are indicatins that the Medical Center s effrts are having a psitive effect n the health f the cmmunity. Fr example, the number f uninsured patient encunters at the Medical Center drpped 29% frm 2013 t 2014, as discussed n Page 5 f this needs assessment. Additinally, the Medical Center received psitive feedback frm the Arkansas Department f Health regarding the wrk being dne at their Reppell Diabetes Learning Center. The Medical Center believes that as it cntinues t wrk t meet the health needs f the cmmunity, further gains will be made in these and ther areas where a need has been identified. Identificatin and Priritizatin f Health Needs Based n a review f the data gathered during this assessment, including leading causes f death, rankings f health utcmes and factrs as well as surveys and interviews, numerus health needs were identified. These needs were priritized and evaluated t determine which were significant t the cmmunity. The criteria included the numbers f persns affected, the seriusness f the issue, whether the health need particularly affected persns living in pverty r members f an underserved ppulatin, and availability f cmmunity resurces t address the need. As a result, the fllwing list f significant needs was identified: 1. Physician Recruitment 2. Obesity 3. Diabetes 4. Tbacc Use 5. Health Educatin 15

18 The Medical Center will develp an updated implementatin strategy t address the needs identified during the cmmunity health needs assessment. This assessment will be made publicly available n the Medical Center s website. Public cmments n this assessment may be directed t the Medical Center s administratin at 624 Hspital Drive, Muntain Hme, Arkansas

19 APPENDICES Cmmunity Health Needs Assessment 2016

20 KEY INFORMANT INTERVIEW PROTOCOL

21 KEY INFORMANT INTERVIEW Cmmunity Health Needs Assessment fr: Interviewer s Initials: Date: Start Time: End Time: Name: Title: Agency/Organizatin: # f years living in Cunty: # f years in current psitin: address: Intrductin: Gd mrning/afternn. My name is [interviewer s name]. Thank yu fr taking time ut f yur busy day t speak with me. I ll try t keep ur time t apprximately 40 minutes, but we may find that we run ver up t 50 minutes ttal nce we get int the interview. (Check t see if this is kay). [Name f Organizatin] is gathering lcal data as part f develping a plan t imprve health and quality f life in Cunty. Cmmunity input is essential t this prcess. A cmbinatin f surveys and key infrmant interviews are being used t engage cmmunity members. Yu have been selected fr a key infrmant interview because f yur knwledge, insight, and familiarity with the cmmunity. The themes that emerge frm these interviews will be summarized and made available t the public; hwever, individual interviews will be kept strictly cnfidential. T get us started, can yu tell me briefly abut the wrk that yu and yur rganizatin d in the cmmunity? Thank yu. Next I ll be asking yu a series f questins abut health and quality f life in Cunty. As yu cnsider these questins, keep in mind the brad definitin f health adpted by the Wrld Health Organizatin: Health is a state f cmplete physical, mental and scial well-being and nt merely the absence f disease r infirmity, while sharing the lcal perspectives yu have frm yur current psitin and frm experiences in this cmmunity. 17

22 Questins: 1. In general, hw wuld yu rate health and quality f life in Cunty? 2. In yur pinin, has health and quality f life in Cunty imprved, stayed the same, r declined ver the past few years? 3. Why d yu think it has (based n answer frm previus questin: imprved, declined, r stayed the same)? 4. What ther factrs have cntributed t the (based n answer t questin 2: imprvement, decline r t health and quality f life staying the same)? 5. What barriers, if any, exist t imprving health and quality f life in Cunty? 6. In yur pinin, what are the mst critical health and quality f life issues in Cunty? 7. What needs t be dne t address these issues? 8. The prir CHNA indicated the fllwing as the mst significant health needs. Is there anything that is nt n the list that shuld be? This Assessment Access t medical services Tbacc use Obesity Aging Prblems What d yu think is mst critical health need included n the list abve r ther f the cmmunity? 9. D yu think any f the abve have imprved ver the last 3 years? Why r why nt? What needs t be dne t cntinue t imprve in these areas? 10. In yur pinin, are any the fllwing areas in which the hspital shuld be addressing? Why r why nt? Ecnmic Develpment Affrdable Husing Pverty Educatin Healthy Nutritin Physical Activity Drug and Alchl Abuse 18

23 12. Are there peple r grups f peple in Cunty whse health r quality f life may nt be as gd as thers? Wh are these persns r grups? 13. Are there peple r grups f peple wh have a mre difficult time btaining necessary/preventive medical services? If s, wh are these persns r grups? Why d yu think they have a mre difficult time? What can be dne t imprve the situatin? 14. Hw wuld yu rate the hspital s effrts n cmmunicating hw they are addressing the identified health needs? Hw have yu received cmmunicatin regarding the hspital s effrts? 15. What d yu think is the hspital s rle in addressing the identified health needs f the cmmunity? Clse: Thanks s much fr sharing yur cncerns and perspectives n these issues. The infrmatin yu have prvided will cntribute t develp a better understanding abut factrs impacting health and quality f life in Cunty. Befre we cnclude the interview, Is there anything yu wuld like t add? 19

24 SOURCES Cmmunity Health Needs Assessment 2016

25 Surces Ttal Ppulatin by Cunty and Develpment District Prjectins. < U.S. Census Bureau. American Cmmunity Survey Surce gegraphy: Tract U.S. Department f Labr: Bureau f Labr Statistics September. Surce gegraphy: Cunty Cunty Health Rankings: Mbilizing Actin Tward Cmmunity Health Rbert Wd Jhnsn Fundatin and the University f Wiscnsin Ppulatin Health Institute. 26 July 2016 < Cst Reprt Data. Online Medicare Cst Reprt Wrksheets and Data Sets. < HealthyPeple.gv U.S. Department f Health and Human Services. 30 Nv < 20