2003 Capital Region Community Health Needs Assessment Report. Introduction

Transcription

1 Attachment Capital Region Community Health Needs Assessment Report Introduction Concord Hospital has a longstanding history of working collaboratively with other organizations to assess and address community needs. In 1994, Capital Region Health Care, Concord Hospital s parent organization, initiated the Concord Region Community Health Assessment Project. This project brought together representatives of many health and human service provider agencies to undertake a collaborative health assessment project to understand the crucial health issues in the community, to prioritize those problems for which there was a reasonable opportunity to have a positive effect, and to develop and implement action plans to improve health. They examined both primary and secondary data, and Concord Hospital provided the resources for project activities. That informal collaboration became a foundation for the 1998 and 2000 community needs assessments and community benefit plans. In 2003, Concord Hospital and its affiliated partners undertook another systematic assessment of the health needs of the Concord region community. While earlier versions of this effort drew heavily upon the work of external researchers, the 2003 effort was designed, implemented, and reviewed by a work group of internal stakeholders selected from among those who would be most closely involved with the design and implementation of plans to address the community health needs revealed by the assessment. History In the 1994 assessment, access to primary care was identified as an important issue, particularly for the uninsured and the underinsured. A second issue identified was that, even when adequate health and human services resources were available in the Concord area, both providers and consumers had difficulty accessing information about them. The 1995 Community Health Assessment resulted in three initiatives. The first initiative was an Information Technology Project, designed to develop a community health resource directory using advanced technologies to link providers and consumers with current, comprehensive, and accurate information about available health and human service resources in the community. This initiative attracted a grant for $200,000 from the Department of Health and Human Services Community Grant Fund for to create a website for the New Hampshire Helpline information and referral database, providing Internet accessibility to both providers and consumers ( A grant program was also established to assist community organizations acquire the technology to use the new Internet resource. The second initiative was an Adolescent Health Project, designed to improve school-based health education experiences for adolescents. The result was the establishment of a schoolbased adolescent health clinic at Merrimack Valley High School. In addition to the two collaborative initiatives of the Community Health Assessment Project, Concord Hospital created and expanded the Capital Region Family Health Center in response to the expressed need in the community for improved access to primary care for the medically underserved population.

2 In 1998, the Community Provider Network of Central New Hampshire (CPNCNH) assumed the responsibility for the Concord Region Community Health Assessment Project. This multiagency coalition works to identify community needs and collaborate to meet those needs in a coordinated fashion. Concord Hospital served as a lead agency in the formation of this coalition, itself a response to the community s expressed need for improved coordination of health and human services. The 1998, the CPNCNH group identified two additional community needs: the need for better coordination of parenting skills education programs and the need to improve school persistence and reduce drop-out rates. Resulting efforts led to an ongoing calendar of parent education programs offered in the Concord region through the use of the Concord Monitor website, designed to improve communication about and coordination of community-based parenting skills education programs. A discussion of a possible extension to the primary grade levels of a successful Familystrength program in place at Rundlett Middle School was also begun. However, in the case of both of these projects, competing community priorities prevented a full realization of the goals of the project. Instead, many of these same community organizations collaborated on a grant-funded adolescent health program. The overall theme that emerged from both the 1995 and 1998 Community Health Assessments was the community s need for improved communication and coordination among service providers. In response to this need, Concord Hospital initiated several formal affiliations and informal collaborative ventures. With the enactment of New Hampshire Community Benefit legislation, Concord Hospital and the other health and human services organizations of the Community Provider Network of Central New Hampshire began a community needs assessment process for the Merrimack County, New Hampshire region, with the United Way of Merrimack County serving as the lead agency. In 2000, these organizations collaborated and shared resources to develop a single report of qualitative and quantitative information to describe the needs of the community, to assess the most serious needs for future service provision, and to develop plans to address those needs. This coalition assessed both health and social service needs in the community. The 2000 assessment employed consultants to capture secondary data about the health and human service needs and utilization patterns of the residents of the community. Concord Hospital and Riverbend Community Mental Health Centers provided utilization and diagnostic code information from their databases. The pattern of calls to the New Hampshire Helpline provided further indication of demand for services in the community. A thorough review was also made of statewide and national data. In addition, several outreach efforts were designed to gather community members opinions about the needs of their families, the towns, and the community in which they live. These primary data were gathered in a variety of ways: provider and key informant focus groups, informal discussions of community needs with a variety of consumer groups, a telephone survey, and a written needs survey of consumers of Concord Hospital services. The following issues emerged from the 2000 Community Needs Assessment, with the following responses from Concord Hospital and its affiliates: High cost of health care, particularly prescription drugs. o Response: Concord Hospital provided charitable care for inpatient, emergency and diagnostic needs; the Capital Region Family Health Center and the Hillsboro Family Health Center continued to provide primary and 2

3 preventive care to the uninsured, underinsured, and other at-risk populations; Concord Hospital launched a prescription support service to assist patients to secure free medications from participating pharmaceutical companies; the CH Philanthropy Program raised funds for programs and services for the low income and underserved members of the community. Smoking and substance abuse. o Dental care. o Response: CRFHC offered successful smoking cessation programs during pregnancy care; the Center for Health Promotion participated in the Capital Area Tobacco Free Coalition and the Concord Substance Abuse Coalition; the Teen Clinic at the CRFHC and off-site school based health services in Pittsfield, Pembroke, Hillsboro-Deering, and Merrimack Valley high schools offered services to teens related to smoking and substance abuse prevention and cessation, in addition to meeting their other health care and health risk behavior reduction needs. Response: the CRFHC Dental Clinic offered a wide range of dental services and preventive dental health care and education to members of the community regardless of the ability to pay. Behavioral Health. o Response: Concord Hospital and Riverbend Community Mental Health Center strengthened their partnership to provide augmented emergency room crisis intervention services; the CRFHC and the NH Dartmouth Family Practice Residency Program identified behavioral health needs and intervention strategies for all patients during primary care visits. Motor vehicle injury prevention. o Response: Concord Hospital supported the Greater Concord Safe Community Coalition s focus on increasing seat belt usage; Emergency Nurses Care also initiated child passenger safety and restraint usage programs. Process The 2003 Health Needs Assessment In January, 2003, after several months of planning, the first meeting of the 2003 Capital Region Health Needs Assessment Work Group was held. Pamela Puleo, Vice President for Philanthropy and Public Affairs invited work group members to participate. Workgroup members included representatives from: Concord-based Capital Region Health Care affiliates, the City of Concord, Dartmouth-Hitchcock Concord, The Community Provider Network of Central New Hampshire and various Hospital departments and services. The intent in seeking workgroup members was to engage these people who were responsible for the provision of key health services in the health needs assessment study itself, thereby building the credibility of the study results with professionals who are in the position of addressing needs through program activity. Deborah Taylor, Ph.D., research consultant affiliated with Concord Hospital and associated with the capital region health needs assessment process since 1994, was asked to facilitate group meetings and offer technical assistance. Nancy Vinje, Philanthropy Associate, served as the project manager. 3

4 The work group members were: Name Organization/Dept Title Deborah Taylor, PhD Consultant Pamela Puleo, FAHP CH Philanthropy Vice President Nancy Vinje CH Philanthropy Philanthropy Assoc. Eileen Male Concord Regional Visiting Grant Writer Nurse Association Elizabeth (Beth) Smith, Dartmouth-Hitchcock, Medical Director MD Concord Sheila Johnson Dartmouth-Hitchcock Operations Concord Eugene Blake City of Concord Health Officer Nancy Carr Robertson Allen Dartmouth-Hitchcock, Lebanon Director, Community Health Improvement Patti Nichols CH Spiritual Care Director Leslie Mahoney CH Emergency Dept Director Lynn Duffy CH The Family Place Educator Marie Wawryziniak Capital Region Family Health Center Community Health Services Director Johane Telgener CH Center for Health Manager Promotion Jayne Peck CH Quality Assurance Quality Management Analyst Mary Macklin, RN CH Heart Failure Coordinator Program Pat Ristaino Dutton CH Behavioral Health and Director Substance Abuse Gary Sobelson, MD Concord Family Medicine and Concord Hospital Board of Trustees Family Practice Physician and Hospital Trustee Laura Merron Community Provider Network of Central NH Executive Director At the first work group meeting, Michael B. Green, President and CEO of Concord Hospital, charged the group to work together to benefit the community by assembling information about health needs that are already being met and about unmet community health needs. The ultimate goal of this process was to maximize the use of resources to benefit the health of the community and its most vulnerable members. As a part of this initial meeting, the work group discussed the meaning of the term health needs and the term community. We agreed that our focus should be on the identification of needs for which health care organizations are the most appropriate providers of service; although social service needs also have an important impact on access to health services, they were not the point of focus for this assessment. We also agreed that our assessment would rely on empirical data about health needs above impressions and anecdotal evidence. This focus would allow us to identify the community s most pressing health needs and would allow us to track the status of those needs over time. In addition, we defined the community as the 22 towns that comprise the primary service area of Concord Hospital. 4

5 Methodology The work group decided to undertake several separate types of data collection processes to build a comprehensive picture of community health needs. These were: Stakeholder Interviews with key community leaders and representatives. Both a stakeholder interview template and a supplemental written survey tool based on the interview template were developed. (See Appendix B.) Sixteen stakeholder candidates were identified. Of those 16, 14 interviews were actually conducted. (Attached is a list of the interviewees and their titles). The stakeholder interview template was used to ensure consistency in what questions were asked and how they were asked, and to make it easier to record data. A substantial amount of time (45 minutes) was requested for each interview, and questions elicited both general information and more specific thoughts and ideas. Through the interview, stakeholders were asked to identify our region s most vulnerable populations and the organizations and/or individuals that were serving those populations. Referencing the health needs identified in the 2000 health needs assessment, stakeholders were asked about the current, most important health needs in the community, and encouraged to think broadly. For all of the needs identified, stakeholders were asked whether the need was currently being fully met, partially met, or was unmet. Stakeholders were then asked to prioritize the top three needs of the region, and, further, to provide some specific ideas about what ought to be done to address the needs. Focus Group Meetings with key community groups in our service area. A focus group template and supplemental written survey based on the focus group template were developed. (See Appendix C.) Focus group meetings were held with the following groups: Senior Citizens Members of the Community Provider Network of Central New Hampshire Riverbend Community Mental Health providers and clients Teens Young Mothers School nurses and counselors Clergy from various faith communities These focus group meetings were conducted at various times and locations in the area, and were led by a professionally trained facilitator who donated her time to this project, with the aid of a note- taker. The sessions lasted approximately 1-1/2 hours, and refreshments were provided. Group participants were invited to attend in a variety of ways, including mailed invitations on Capital Region Health Needs Assessment letterhead, telephone calls, and in-person requests. The focus groups ranged in size from 4 to 17 participants. In addition to listing and prioritizing needs on a flip chart, participants were invited to write specific concerns in their own words on 3 x 5 index cards. Participants rated whether needs were being met, partially being met, or unmet. Data Set Analysis, including state, regional, and organizational data sets concerning health needs, service utilization, and behavior risk patterns. The 5

6 following data sets were reviewed for pertinent trends related to the community's health in the Concord Hospital Service Area: Community Health Profile, Concord Service Area, Dartmouth-Hitchcock Alliance, January Behavioral Risk Factor Surveillance System, Bureau of Health Statistics and Data Management, NH DHHS, Health Insurance Coverage in New Hampshire, Office of Health Planning and Medicaid, NH DHHS, Primary Care Access Data Set, NH DHHS, Community Health Status Report, Merrimack County NH, HRSA, US DHHS, July Youth Risk Behavior Survey, New Hampshire Department of Education, Inpatient Ambulatory Care Sensitive Hospitalization Rates for Concord Hospital Service Area Residents, Teen Birth Rates for towns of Hillsboro, Pittsfield, Allenstown, Chichester. Merrimack County, and State of NH, Bureau of Health Statistics, NH DHHS, Only the Community Health Profile compiled by the Dartmouth-Hitchcock Alliance in 2003, and the updated health insurance survey conducted by the New Hampshire Department of Health and Human Services in 2002 were new or updated since the last community health assessment. The group also reviewed Concord Hospital Emergency Department data for FY 2002 to identify trends in health problems that prompt an emergency visit. A telephone survey and a written consumer survey to assess the needs and service utilization of community members. (See Appendices D and E.) RKM Research and Communications of Portsmouth, NH, was commissioned to meet with the work group members to develop these surveys, to conduct the telephone survey, and to summarize and report the results of the telephone and written surveys back to the workgroup. These surveys were designed around the health needs identified in the previous iterations of the community health needs assessment and the health needs identified through the 2003 data sets analysis, stakeholder interviews, and focus groups results. The telephone survey reached 400 residential health care decision makers living in the Merrimack County region. All respondents were selected from a stratified random sample of households in the towns and cities in the hospital primary service area. The survey was administered by RKM Research June 14-18, For the purposes of analysis, comparisons were drawn between Concord residents and the residents of other communities. Each interview lasted approximately minutes. A profile of the respondents was developed from responses to survey questions about household structure, health insurance status, and so on. Respondents were asked about their own health needs and the health needs of members of their household, and they were asked their perceptions of the health needs of the community. They were also asked about their best source for health services information. 6

7 Findings Concord Hospital distributed the self-administered written survey through 11 provider locations during the month of July. Those locations were: Concord Hospital Emergency Department Capital Region Family Health Center Hillsboro Family Health Center Concord Family Medicine Penacook Family Physicians Family Physicians of Pembroke Pittsfield Medical Center Concord Regional Visiting Nurse Association Downtown Health Clinic McKenna House Homeless Shelter Pittsfield Food Pantry St. Vincent depaul Food Pantry at St. John s Church 621 surveys were returned and summarized, and comparisons were drawn between Concord residents and the residents of other communities. A profile of the respondents was developed from responses to the written survey as well. These respondents were also asked about their own health needs and the health needs of members of their household, their perceptions of the health needs of the community, and about their best source for health services information. Each of these four tasks was undertaken by a sub-group of the work group members. Each subgroup was responsible for designing, conducting, summarizing and presenting its portion of the assessment information. (See Appendix F for the final summary reports of each of the subgroups.) The sub-group that worked on the telephone survey and the written consumer survey collected their data last. This decision was made so that these surveys could specifically focus on any continuing or new health needs identified in the data set analysis, the stakeholder interviews, and the focus group meetings. Each subgroup began their work with a process outline (all of these outlines are presented in Appendix A) and with the collected findings of the earlier capital region health needs assessments. The entire work group met monthly so that its members could update each other on the progress of the sub-groups and discuss preliminary findings. The sub-groups worked through the summer of 2003, at which point their summarized findings were presented to the entire work-group for review. The group developed a list of health needs themes that had been repeated across the various data gathering techniques. Careful attention was paid to gathering information about health needs that were currently being met as well as unmet health needs. The themes identified by the group represent the core findings of the 2003 capital region health needs assessment, and they will shape the planning by the hospital and the other participating organizations for FY 05 and beyond. The primary health needs of the community that emerged from the 2003 assessment were those that were identified by all of methodologies employed or identified as very significant in one or more of the methodologies. They were: 7

8 Health Service Needs Affordability of health care was an overarching health issue, especially for the uninsured and underinsured members of the community. The issue of access to health care emerged in surveys, focus groups, and interviews; however, a deeper analysis revealed that access really meant affordability. Affordability and access to the following health services were the most important unmet or incompletely met health service needs: Mental health Substance abuse prevention and treatment Dental care, for routine and emergency care, and for prevention Prescription assistance Health Education/Prevention and Health Information Needs The community health needs assessment also revealed unmet or only partially met needs for: Ready access to information about health services that are available in the community Health education for prevention overall, smoking, obesity, and parenting education Injury prevention Also, there was some direct evidence that health needs are currently being met more successfully for most residents of the community than in the earlier assessments. Specifically, whereas access to primary care was the most important health need identified in the 1995 assessment, 90% of respondents to the 2003 written survey reported that they have access to primary care. This figure should be viewed in the context that 5% percent of all 2003 telephone survey respondents reported they do not have health insurance, and other data sources suggest that approximately 9-10% of community members overall do not have health insurance. While most community residents have access to primary care and health insurance, the health needs of the members of the community who do not are acute and persistent. The results of provider focus groups and interviews provide a detailed picture of those health needs. Conclusions The 2003 Capital Region Health Needs Assessment Work Group led Concord Hospital and its affiliated partners in a thorough assessment of the met and unmet health needs of the Concord region. Engaging those who are responsible for designing the programs to respond to community health needs and focusing on reliable measures of health needs resulted in an assessment process that was efficient, thorough, and realistic. Several major points emerged from the analysis: Unlike the results from the original 1995 assessment, in % of community residents indicated that they have access to primary care. This may in part reflect the work of the hospital and its affiliated partners in addressing that need. For those members of the community who are uninsured and underinsured, obtaining affordable health care continues to be the most significant unmet health need. Their most important needs are affordability and access to services for mental health, substance abuse, dental care, and prescription assistance. 8

9 There is a continuing emphasis on the need for health education and prevention programs, and for the development of an effective mechanism for disseminating information on the health services that are available in the community. Community residents report that their health care providers are their best sources for health services information. Planning Process The results of the community health needs assessment will be disseminated to the broader community and will be the focus of future planning for both continuing and new programs for the 2005 fiscal year and beyond. Dissemination of Results: The work group has planned the following activities to share the results of this assessment: The report will be shared with the Concord Hospital Board of Trustees, key stakeholders, and legislators at an event planned for October 10, **We should add some details about this once it has taken place** The report results will be shared with the participants of the interviews, focus groups and surveys. They will disseminate the primary findings of the health needs assessment using a variety of outlets and media, including: Post on the Concord Hospital website for community review and feedback, Publish in the Hospital s Health News Page feature in the Concord Monitor Develop presentation, poster and handout materials to be distributes to health care agencies and offices New or Continued Programs and Services The following details the ongoing programs and services and future plans for addressing the identified health needs from the 2003 Assessment. In addition, the report results will be communicated to a larger group of the front-line planners and managers of the hospital and its affiliated partners. These key professionals will be asked to use these identified health needs when planning programs and services for fiscal year 2005 and beyond. Select new and continuing programs will be approved, implemented and evaluated based upon their fit with these identified community health needs. Health Service Needs: Affordability and Access to Health Care: Primary Care regardless of ability to pay (CRFHC) Primary Care regardless of ability to pay (DHC) Charitable Care for Emergency and Inpatient Care (CH) Senior Health, Flu and Immunization Clinics (CRVNA) Downtown Health Clinic at St. Paul s Church (CRVNA) Charitable Primary Care from Family Practice Physicians (CH/CRPG/CRPC) Mental Health: Baby s First Homecoming home visits for post partum depression (CRVNA) Bereavement Support Groups (CRVNA) 9

10 Clinical Consultations (CH/RCMH) Emergency Services (CH/RCMH) Substance abuse prevention and treatment: Concord Substance Abuse Coalition (CPNCNH) Fresh Start Program (CH/RCMH) Fresh Start Friends and Family Program (CH/RCMH) Addiction Free Pain Management (CH/RCMH) After Care Program (CH/RCMH) Clinical Consultations in Primary Care Setting (CRFHC/RCMH) Dually Diagnosed Addicts Program (CH/RCMH) Dental care, for routine and emergency care, and for prevention: Capital Region Family Health Center Dental Services Oral health promotion and caries prevention services during well child visits (CRFHC) Dental Clinics for Children (CRVNA) Restorative dental care for children (CRVNA) Prescription assistance: Added.5 FTE to Prescription Assistance Program in FY2003 (CH/CRFHC) Medication Bridge Program (DHC) Expand Prescription Assistance Marketing in FY2004 (CH) Emergency Medication Vouchers (CRFHC) Health Education/Prevention and Health Information Needs Ready access to information about the health services that are available in the community Health education for prevention overall, smoking, obesity, and parenting education Parent Friend Program (CRVNA) Baby s First Homecoming home visits (CRVNA) Community Education Programs (CRVNA) Health Education Programs (DHC) Parenting, Weight Management and Obesity Programs (CHP) Meet with physician office practices to explain educational programs. (CHP) Provide more information and health tips to physician practices. (CHP) Injury prevention Prenatal Car Seats for those who cannot afford (CH-The Family Place) Car Seat Inspection Stations (CHP) Home Safety Evaluations and Fall Risk Assessments (CRVNA) Sponsor Play to Address Issue of Senior Falls, Safety (CH in collaboration with the NH Falls Risk Reduction Task Force) Fall Risk Screening for Seniors (CHP) 10