Community Health Needs Assessment Mercy St. Francis Hospital 2012

Transcription

1 Community Health Needs Assessment Mercy St. Francis Hospital 2012

2 Our Mission: As the Sisters of Mercy before us, we bring to life the healing ministry of Jesus through our compassionate care and exceptional service. Introduction Mercy St. Francis Hospital is located in Howell County, Missouri. It is a 25-bed, acutecare, general medical/surgical fully hospital. It is fully accredited by the Joint Commission and designated by the State of Missouri as a critical access hospital. Mercy St. Francis is part of Mercy Health and operates as a regional hospital within the 13 county region served by Mercy Springfield. Mercy Hospital in Springfield was founded by Sisters of Mercy answering the call in 1891 to meet the health needs of this community. Mercy St. Francis and the rest of Mercy continue to meet this call and to strengthen our community health assessment processes, partnerships and program development. Community health is part of our tradition and core to our Mission. Mercy St. Francis joined Mercy in 1998 through a co-sponsorship agreement between the Sisters of Mercy and the Daughters of St. Francis of Assisi. In 2006, interior, exterior, and hospital ground renovations were completed. Recent features include the implementation of an advanced electronic health record system. The assessment of community health and associated needs is an ongoing process. We are committed to working together with our community to identify current and future resources and collaborations that will: Improve access to care. Improve health outcomes. Reduce the cost of care. Provide opportunities for disease prevention and health promotion. Partnerships and collaborations with the community and across Mercy boundaries will be directed at providing accessible and sustainable quality health care to all members of our community with special attention to individuals who are medically underserved and economically fragile. The needs assessment process involved review of both quantitative and qualitative information to attain the full scope of our community s needs. This summary is reflective of our dedication to serving the community and documentation that Mercy St. Francis Hospital is in compliance with IRS requirements for conducting community health needs assessments. Description and Basic Community Demographics Mercy St. Francis Hospital is a rural community hospital located in Laclede County, Missouri. The city population of Mountain View is 5164 (2010). The primary service area is Howell, Shannon and Texas Counties with a combined regional service population of approximately 51,600 (2012). Summer 2012 Page 1

3 The projected growth rate for the Mercy St. Francis service area is 1% over the next five years, compared to Missouri s average of 4%. Within the Mountain View region, 21% of the population is uninsured while Missouri s average is 15% (2012). Summer 2012 Page 2

4 MARKET OVERVIEW Howell County, MO Child Health Indicators Children in poverty (Percent) % 26.3% 26.1% Children under 6 in poverty (Percent) % 27.1% 25.8% Children enrolled in MO HealthNet for Kids (Percent) 58.2% 56.0% 47.8% 48.7% 48.7% Children receiving public SED mental health services (Number) Percentage of Children receiving cash assistance (Percent) 7.1% 7.0% 7.2% 6.9% 6.2% Children receiving food stamps (Percent) 46.7% 48.1% 45.9% 45.7% 49.2% Children receiving subsidized child care (Number) Students enrolled in free/reduced price lunch (Percent) 59.3% 59.3% 58.7% 55.4% 58.1% Low birth weight infants (Percent) % 6.6% 6.7% 7.2% 7.3% Infant mortality (per 1,000 live births) (Rate) Births to teens, ages (per 1,000) (Rate) Children in single parent families (Percent) % 21.8% 28.9% Child deaths, ages 1-14 (per 100,000) (Rate) Public clinic immunization (Percent) % 75.2% 76.4% 85.2% 76.4% Child abuse and neglect (per 1,000) (Rate) Source: The Annie E. Casey Foundation Kids Count Data Center; Missouri Partnership for Children 7 Summer 2012 Page 3

5 Who was Involved in Assessment? Community Members: The voice of our local community members is at the heart of our assessment. Mercy St. Francis held community roundtable events in both 2010 and 2011 to dialogue directly with a variety of local community members regarding their health care needs, ideas and concerns. These discussions brought attention to local needs and also brought to light common themes throughout Mercy, including the need for a greater emphasis on wellness and prevention, education, technology and access. We also heard that a focus on children in the community is essential, promoting healthy habits at an early age. Concerns for the challenges of the local economy, the increase in our aging population, and the need for health care workforce development were also expressed. Mercy will continue to listen to and engage the communities we serve with the 2013 community roundtable discussions. Mercy Mission Community Health/Community Benefit Team: Mercy Mission Community Health and Community Benefit Team co-workers lead our work with the community needs assessment as part of their responsibility for overseeing the community benefit/community health for Mountain View. Input also came from Mercy Springfield and Mercy St. Francis Hospital leadership, Finance, Advocacy, Philanthropy, Clinic leaders, regional leaders, and Marketing and Communications. Mercy Planning & Research provided analysis of both internal and external demographics, utilization, chronic conditions and heath status data. External organizations are also engaged by Mercy to analyze current utilization and future demand for health care services, as well as to assist Mercy on an ongoing basis in measuring and providing benchmark data on patient satisfaction of inpatients, ambulatory surgery and Emergency Department patients. Community Assessment Process 1. Review of existing community health needs assessments. Examine existing community health needs assessments. The needs assessment examination process included the collection and analysis of quantitative data available in State, Federal, and local community/public health resources. Mercy staff reviewed the following data within the past two years: Local community groups in Mountain View. Missouri Hospital Association Southwest/Southeast Regions Assessing the Health of Our Communities Report The County Health Rankings for 2011/2012. University of Wisconsin-Population Health Institute/Robert Wood Johnson Foundation. Community Data Profiles & Missouri Information for Community Assessment (MICA) 2010/2011. Missouri Department of Health & Senior Services-Bureau of Health Informatics. Issues in Missouri Health Care 2011 Assuring an Adequate Health Care Workforce in Missouri s Medically Underserved Areas. Department of Health and Human Services Healthy People 2020 (Dec. 2010). Data from Mercy s Health Information Systems Department 2010/2011/2012. Summer 2012 Page 4

6 2. Listen to the voice of the community. Mercy-wide sponsored community roundtable events in both 2010 and These initial assessments were followed up by meetings with community partners like our schools and other nonprofit organizations. Continuation of the community roundtable process across Mercy begins in Analyze and summarize the data. 4. Conduct an in-depth review of current community benefit activities. 5. Conduct resource assessment: internal and community. 6. Align assessment needs and priorities with resources and community benefit criteria. 7. Create an implementation plan with community collaborations. Community Resource Development, Connection, and Coordination Primary Health Needs Identified After careful analysis of the data collected, multiple health needs were identified with the following priorities chosen: 1. Obesity Prevention 2. Access to health care for uninsured and/or underserved individuals. 3. Access and health/wellness education and services for women and children. 4. Development of community collaborations/partnerships. Missouri s overall health ranking is 42 out of 50 states and Howell County ranks 98 th in health outcomes and 75 th in health factors out of 115 counties. Prevalence of health factors exceeding national benchmarks (2012) in Howell County include: Adult Smoking 27% (national 14% and 24% Missouri) Adult Obesity 30% (national 25% and Missouri 31%). Teen birthrate was 68 per 1,000 in ages while the national benchmark is 22 per 1,000 and Missouri is 44. Primary chronic diseases among adults (18+) within Mountains View s primary service area are hypertension 32%, arthritis 27%, asthma 13%, depression/anxiety 12%, diabetes 9%, and coronary heart disease 5%. In addition, 3% have had a stroke, 4% have had a heart attack, and 6% are living with some type of cancer. Source: Truven Health Analytics Continuum of Care, Although chronic disease management and development of prevention strategies is a significant ongoing need, it was targeted only in specific areas from a community benefit perspective at this time. We have a highly developed Care Management team with Nurse On Call services addressing many of these needs and strategizing to better meet future needs. We work closely with Care Management in this regard with a focus on those with limited resources. Our increased aging population, their needs, and increased workforce development is an ongoing need and priority that we are already addressing on many levels. We provide multiple senior services to the community. We also collaborate with local and regional schools and Summer 2012 Page 5

7 universities to support the educational needs of nurses, advanced practice providers, physicians, occupational and physical therapy providers and other health care professionals. Implementation Plans for the Identified Primary Health Needs To set priorities, criteria focused on identifying disproportionate unmet need, primary prevention strategies, advancement toward a continuum of care and programs that are collaborative. Consideration was also given to existing internal and community initiatives. 1. Improve obesity prevention. 2. Improve access to health care for uninsured and/or underserved individuals. 3. Improve access and health/wellness education and services for women and children. 4. Development of community collaborations/partnerships Mercy St. Francis Mountain View Initial Implementation Plan November 15, 2013 Community Health Needs Assessment Priority: Obesity Prevention Improve Obesity Prevention Goal 1: Mercy St. Francis Mountain View will continue to work with the community and schools to develop obesity prevention strategies. The initial metric will be the development of a community-wide strategy for obesity prevention. Improve Community Health Needs Assessment Priority: Improve Access to Health Care for Uninsured and/or Underserved Individuals. Improve Access to Health Care for Uninsured/Underserved Individuals Goals: Continue to work with Mountain View s Free Medical Clinic, the Good Samaritan Care Clinic. Provide assistance with volunteer and in-kind support. Status of the Clinic and the number of patients seen reviewed in this ongoing partnership. Community Health and Wellness Education through diabetes and other chronic disease management classes. The initial metric is the number of attendees. Telehealth Services Expansion - Implementation of virtual care programs. Improve Community Health Needs Assessment Priority: Improve Access to Care and Health/Wellness Education for Women and Children Improve Health/Wellness Education and Services for Women and Children through: Mercy Mountain View is working with area schools to implement and utilize the HealthTeacher Program. HealthTeacher is an online health education resource tool for school-aged children K thru 12 that includes lessons, interactive presentations, and additional resources to integrate health into any classroom. St. Jude s Children s Hospital affiliation with Mercy Springfield for any children in the community needing these specialized services. Promotion of children/family safety education. Summer 2012 Page 6

8 Improve Community Health Needs Assessment Priority: Development of Community Collaborations/Partnerships Development of Community Collaborations/Partnerships Goal 1: Collaborate with local health department and other community groups. Review existing partnerships/collaborations and also consider possible new partnerships, especially those that relate to the CHNA priorities. Next Steps Continue to evaluate current Mercy and community resources Continue to develop more detailed implementation plans including metrics Communication and coordination within Mercy teams and the greater community Summer 2012 Page 7

9 Mountain View, MO Community Needs Assessment March 2013

10 PRIMARY SERVICE AREA & PATIENT ORIGIN The majority (83%) of Mercy St. Francis Hospital s acute care patients reside in Howell and Shannon Counties in southeast Missouri. Three in ten patients share the same zip code (65548) as the hospital. % Mercy Hospital Mercy Clinic Mercy Patient Origin by Zip Code based on inpatient volume (volumes 1% or less not shown) Other hospital (non-mercy) MO 9% 9% 2% 2% 34% 2% 9% 34% 17% 2% 9% 6% 17% 10% 6% 10% Community Snapshot MOUNTAIN VIEW POPULATION Total Area Population: 51,637 5-Yr Growth: +4% Race: 95% White; 1% Multiracial Ethnicity: 2% Hispanic (of any race) Age Cohorts: 25% Children (0-17) 18% Females (15-44) 17% Seniors (65+) Median Age: Yr Growth Age Group Count % Count % Count % , % 10, % 418 4% , % 2, % -38-2% , % 4, % % , % 6, % 320 6% , % 12, % % , % 6, % 393 6% , % 7, % % 80+ 2, % 2, % 196 8% Total Area 51, % 53, % 1,847 4% 2% 2% HOUSEHOLD ECONOMICS Total Households: 20,987 Average Income: $39,629 Annual Income <$15K: 23% INSURANCE COVERAGE 37% Private 22% Medicare 20% Medicaid 21% Uninsured INPATIENT MARKET SHARE 6,671 % Market Share total inpatient discharges in the Mountain View PSA FFY11 Discharges 59% OZARKS MEDICAL CENTER 3,918 12% MERCY HOSPITAL SPRINGFIELD 806 8% COX SOUTH 524 7% MERCY ST. FRANCIS HOSPITAL 437 3% MO RESIDENTS/AR HOSPITALS 180 2% BARNES-JEWISH HOSPITAL 116 2% POPLAR BLUFF REG. MEDICAL CTR % OTHER (incl. 0.3% Mercy) 582 OUTPATIENT MARKET SHARE (hospital-based only) 670,677 % Market Share total outpatient volume in the Mountain View PSA 2010 OP Volume 40% PHYSICIAN OFFICES 271,079 19% OZARKS MEDICAL CENTER 130,038 13% INDEPENDENT LABS 86,478 8% MERCY ST. FRANCIS HOSPITAL 53,671 2% COX SOUTH 16,264 2% MERCY HOSPITAL SPRINGFIELD 14,856 1% TEXAS COUNTY MEMORIAL 4,361 14% OTHER (incl. 0.01% Mercy) 93,930 EDUCATION (based on population ages 25+) 13% Some High School 25% Some College 42% High School Diploma 13% Bachelor s Degree/greater SERVICES & PHYSICIANS In FFY11, Mercy St. Francis Hospital s top inpatient service lines were pulmonary (43%) and gastroenterology (14%). The 35% of patients leaving the Mountain View area for inpatient services primarily go to Mercy Hospital Springfield for cardiovascular and general surgery services. There are approximately 82 physicians (41% primary care) located in the PSA area, of which 7% are integrated with Mercy. Sources: Map Mercy Locations Directory, AHD (other locations); Inpatient Patient Origin & Market Share HIDI, FFY11 (does not include Normal Newborns); Outpatient Market Share Data represents 187 procedure groups (categories of CPT and HCPCS codes). Hospitals include hospital-based outpatient services only. Physician Offices and Independent Laboratories represent procedures performed in a physician s office and/or lab regardless of affiliation with a hospital or health system. Truven Health Outpatient Market Profiles, 2010; Demographics Truven Health, 2012; Payer Mix Truven Health Insurance Estimates, 2012; County Health Rankings, 2012; Inpatient Services HIDI, FFY11; Physicians Buxton, April 2012

11 MARKET OVERVIEW Mountain View 13-Zip Code PSA Emergency Department Visit Estimates by Age/Gender Groups and Acuity Status (Emergent vs. Urgent) In the Mountain View 13-Zip Code Primary Service Area, 48% of all ED visits are considered urgent. On a national scale, 62% of ED visits are considered urgent and can likely be treated in different care settings. Female Male Age Group 2012 Emergent Visits 2012 Urgent Visits 2012 Total ED Visits ,875 2, ,093 3,246 5, ,663 1,837 4, , , ,038 2, ,247 1,862 3, ,800 1,433 3, , ,748 Total 14,746 13,577 28,323 The age cohort account for 30% of all ED visits in the Mountain View PSA Within that age group, the majority of visits (60%) are urgent (non-emergent) Source: Truven Health Analytics Emergency Department Estimates,

12 MARKET OVERVIEW Mountain View 13-Zip Code PSA Top ED Diagnosis Codes Diagnosis 3-digit ICD9 Volume % SYMPTOMS INVOLVING RESPIRATORY SYSTEM/CHEST 786 1, % OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS 789 1, % GENERAL SYMPTOMS % SYMPTOMS INVOLVING HEAD & NECK % DISORDERS OF URETHRA & URINARY TRACT NEC % SYMPTOMS INVOLVING DIGESTIVE SYSTEM % ASTHMA % OTHER & UNSPECIFIED BACK DISORDER % INJURY NEC & NOS % OTHER DIAGNOSES XXX % Diagnosis 3-digit ICD9 Volume % OTHER DIAGNOSES XXX % OTHER & UNSPECIFIED BACK DISORDER % ACUTE UPPER RESPIRATORY INFECTION MULT SITES NOS % GENERAL SYMPTOMS % OTHER SYMPTOMS INVOLVING ABDOMEN & PELVIS % OTHER CELLULITIS & ABSCESS % BACK SPRAINS & STRAINS NEC & NOS % SYMPTOMS INVOLVING RESPIRATORY SYSTEM/CHEST % SUPPURATIVE/NOS OTITIS MEDIA % SYMPTOMS INVOLVING HEAD & NECK % Source: Truven Health Analytics Outpatient Health Profiles,

13 MARKET OVERVIEW Mountain View 13-Zip Code PSA Chronic Conditions Identified Among 18+ Population in the PSA Disease Prevalent Cases % of 18+ Pop Source: Truven Health Analytics Continuum of Care, 2012 Prevalence in Ages < 65 Prevalence in Ages 65+ Count % of Total Cases Count % of Total Cases Pain/Aching of Joints 14,004 36% 9,615 69% 4,390 31% Hypertension 12,502 32% 7,036 56% 5,465 44% Low Back Pain 11,527 30% 8,638 75% 2,888 25% Arthritis 10,457 27% 5,789 55% 4,668 45% Migraine Headaches 5,623 14% 5,160 92% 464 8% Sinusitis 5,592 14% 4,278 77% 1,315 24% Asthma 4,958 13% 3,973 80% % Depression/Anxiety 4,554 12% 3,685 81% % Diabetes 3,406 9% 1,801 53% 1,605 47% Hay Fever 3,392 9% 2,719 80% % Hearing Impairment 2,884 7% 1,265 44% 1,618 56% Coronary Heart Disease 2,123 5% % 1,401 66% Chronic Bronchitis 1,933 5% 1,368 71% % Heart Attack 1,649 4% % 1,056 64% Stroke 1,235 3% % % Angina 1,078 3% % % Emphysema 921 2% % % Congestive Heart Failure 852 2% % % Ulcers 742 2% % % Breast Cancer 692 2% % % Weak/Failing Kidneys 671 2% % % Liver Condition 553 1% % % Prostate Cancer 510 1% % % Skin Cancer 387 1% % % Cervical Cancer 322 1% % 54 17% Colon/Rectal Cancer 261 1% 73 28% % Uterine Cancer 168 0% 85 51% 82 49% Lung Cancer 98 0% 26 26% 72 74% 5

14 MARKET OVERVIEW Howell County, MO County Health Ranking *National Benchmark = 90th percentile (i.e., only 10% are better) Note: Blank values reflect unreliable or missing data Source: 2012 County Health Rankings provided by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute Howell County Error Margin National Benchmark* Missouri Rank out of 115 counties HEALTH OUTCOMES 98 Mortality 99 Premature death 10,898 9,687-12,109 5,466 7,981 Morbidity 88 Poor or fair health 21% 17-26% 10% 16% Poor physical health days Poor mental health days Low birthweight 7.1% % 6.0% 8.1% HEALTH FACTORS 75 Health Behaviors 74 Adult smoking 27% 21-33% 14% 24% Adult obesity 30% 25-37% 25% 31% Physical inactivity 31% 25-37% 21% 28% Excessive drinking 12% 7-20% 8% 17% Motor vehicle crash death rate Sexually transmitted infections Teen birth rate Clinical Care 38 Uninsured 20% 18-22% 11% 15% Primary care physicians 1,559:1 631:1 1,274:1 Preventable hospital stays Diabetic screening 85% 78-92% 89% 84% Mammography screening 57% 50-64% 74% 65% Social & Economic Factors 89 High school graduation 84% 86% Some college 46% 41-51% 68% 61% Unemployment 9.2% 5.4% 9.6% Children in poverty 33% 24-42% 13% 21% Inadequate social support 21% 15-28% 14% 19% Children in single-parent households 29% 23-36% 20% 32% Violent crime rate Physical Environment 50 Air pollution-particulate matter days Air pollution-ozone days Access to recreational facilities Limited access to healthy foods 5% 0% 8% Fast food restaurants 49% 25% 47% 6

15 MARKET OVERVIEW Howell County, MO Child Health Indicators Children in poverty (Percent) % 26.3% 26.1% Children under 6 in poverty (Percent) % 27.1% 25.8% Children enrolled in MO HealthNet for Kids (Percent) 58.2% 56.0% 47.8% 48.7% 48.7% Children receiving public SED mental health services (Number) Percentage of Children receiving cash assistance (Percent) 7.1% 7.0% 7.2% 6.9% 6.2% Children receiving food stamps (Percent) 46.7% 48.1% 45.9% 45.7% 49.2% Children receiving subsidized child care (Number) Students enrolled in free/reduced price lunch (Percent) 59.3% 59.3% 58.7% 55.4% 58.1% Low birth weight infants (Percent) % 6.6% 6.7% 7.2% 7.3% Infant mortality (per 1,000 live births) (Rate) Births to teens, ages (per 1,000) (Rate) Children in single parent families (Percent) % 21.8% 28.9% Child deaths, ages 1-14 (per 100,000) (Rate) Public clinic immunization (Percent) % 75.2% 76.4% 85.2% 76.4% Child abuse and neglect (per 1,000) (Rate) Source: The Annie E. Casey Foundation Kids Count Data Center; Missouri Partnership for Children 7

16 UTILIZATION Mercy St. Francis Hospital Mountain View Top Acute Inpatient Discharges March 1, 2012 February 28, 2013 Note: Accounts for 53% of their total 481 Acute IP Discharges % of Total Age Breakouts MSDRG Inpatient Inpatient Code MSDRG Description Discharges Discharges < 18 % % % % 80+ % 194 SIMPLE PNEUMONIA & PLEURISY W CC 69 14% 4 6% 2 3% 12 17% 27 39% 24 35% 195 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 43 9% 0 0% 0 0% 8 19% 15 35% 20 47% 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 43 9% 0 0% 5 12% 9 21% 5 12% 24 56% 641 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC 22 5% 1 5% 2 9% 4 18% 7 32% 8 36% 603 CELLULITIS W/O MCC 20 4% 0 0% 3 15% 8 40% 3 15% 6 30% 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 17 4% 0 0% 0 0% 5 29% 7 41% 5 29% 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC 13 3% 0 0% 0 0% 3 23% 7 54% 3 23% 193 SIMPLE PNEUMONIA & PLEURISY W MCC 11 2% 0 0% 0 0% 1 9% 5 45% 5 45% 292 HEART FAILURE & SHOCK W CC 10 2% 0 0% 0 0% 0 0% 2 20% 8 80% 178 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 9 2% 0 0% 0 0% 0 0% 1 11% 8 89% TOTAL % 5 2% 12 4% 50 19% 79 31% % Source: Epic Hospital Billing Report 8

17 UTILIZATION Mercy St. Francis Hospital Mountain View Top Inpatient Admissions from the ED March 1, 2012 February 28, 2013 Note: Accounts for 35% of their total 358 ED Admissions MSDRG Description ED Inpatient Admissions % of Total ED Age Breakouts Inpatient Admissions < 18 % % % % 80+ % Pneumonia 38 11% 3 8% 1 3% 4 11% 9 24% 21 55% CHF (congestive heart failure) 18 5% 0 0% 0 0% 4 22% 3 17% 11 61% COPD (chronic obstructive pulmonary disease) 13 4% 0 0% 0 0% 4 31% 7 54% 2 15% Altered mental status 10 3% 0 0% 0 0% 1 10% 3 30% 6 60% Syncope 10 3% 0 0% 0 0% 2 20% 3 30% 5 50% UTI (urinary tract infection) 9 3% 0 0% 1 11% 1 11% 1 11% 6 67% Vomiting 8 2% 0 0% 1 13% 1 13% 4 50% 2 25% Hypoxia 7 2% 0 0% 0 0% 1 14% 5 71% 1 14% Dehydration 7 2% 0 0% 2 29% 1 14% - 0% 4 57% Community acquired pneumonia 6 2% 0 0% 0 0% 1 17% 4 67% 1 17% TOTAL % 3 2% 5 4% 20 16% 39 31% 59 47% Source: Epic - Report ED0004: Inpatient admits from the ED (patient class includes emergency, inpatient, surgery, surgical OP/extended care, and observation) 9

18 UTILIZATION Mercy St. Francis Hospital Mountain View Top ED Visit Volume By ICD9 Codes March 1, 2012 February 28, 2013 Note: Accounts for 21% of their total 8,109 ED Visit Volume ED % of ED Age Breakouts ICD9 Code Diagnosis Volume Volume <18 % % % % 80+ % Pneumonia, organism unspecified 207 3% 29 14% 25 12% 38 18% 60 29% 55 27% Acute upper respiratory infections of unspecified site 206 3% % 27 13% 11 5% 5 2% 4 2% Unspecified disorder of the teeth and supporting structures 183 2% 9 5% % 19 10% 3 2% 3 2% Abdominal pain, unspecified site 175 2% 33 19% 93 53% 29 17% 13 7% 7 4% Urinary tract infection, site not specified 172 2% 37 22% 48 28% 25 15% 27 16% 35 20% Chest pain, unspecified 160 2% 5 3% 41 26% 61 38% 37 23% 16 10% 490 Bronchitis, not specified as acute or chronic 154 2% 33 21% 53 34% 39 25% 17 11% 12 8% Headache 146 2% 13 9% 81 55% 40 27% 7 5% 5 3% Lumbago 135 2% 1 1% 76 56% 39 29% 15 11% 4 3% Fever, unspecified 130 2% 75 58% 23 18% 16 12% 10 8% 6 5% TOTAL 1,668 21% % % % % 147 9% Note: 109 (1%) of ED discharges did not list diagnosis Source: Epic - Report ED0018: ED Visit Reason 10