Mercy Medical Center Dyersville COMMUNITY HEALTH NEEDS ASSESSMENT. CONDUCTED IN FISCAL YEAR 2018 FOR Fiscal Years 2019, 2020, and 2021

Transcription

1 Mercy Medical Center Dyersville COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN FISCAL YEAR 2018 FOR Fiscal Years 2019, 2020, and 2021

2 Mercy Medical Center Dyersville Community Health Needs Assessment Contents Mercy Medical Center Dyersville...2 Community Health Needs Assessment...2 Introduction...4 Our Vision, Mission and Values Ground Us...4 Mission Statement...4 Our Vision Calls Us...4 Our Values Guide Us...4 Executive Summary...4 CHNA Approval...5 Review of Previous CHNA...5 Comments from previous CHNA...8 Community Description...9 Geographic Area Served...9 How Population Served Was Identified...9 Demographics of Population...9 Health Facilities...10 Services Provided...10 Process and Methods...12 Steering Committee Members...12 Steering Committee Meetings...13 Taskforce Membership...13 County Health Rankings...13 Health Outcomes...13 Health Factors...14 Community Input...15 Methods used to solicit input...15 Health Department Input...15 Representation of medically underserved, low-income, and minority populations...15 Community Input Survey Results...15 Mercy Dyersville CHNA Page 2 of 28

3 Select Key Findings from Data Review...21 Dubuque County and Iowa Health Data from County Health Rankings...21 Dubuque County Health Portrait 2017, from Community Commons...21 Iowa Department of Public Health core measures:...22 Dubuque County cancer incidence rates: (Iowa Cancer Registry) Cancer In Iowa, University of Iowa College of Public Health...25 Significant Community Health Needs...26 Ranking of significant community health needs and brief description:...26 Conclusion...27 Implementation Strategy...27 How to obtain copies...27 Contact Information...27 Next CHNA Due Date...28 Mercy Dyersville CHNA Page 3 of 28

4 Introduction For the third time, Mercy Medical Center Dyersville joined the Dubuque County Community Health Needs Assessment Health Improvement Plan (CHNA-HIP) coalition. This assured broad involvement from many key organizations across our service area. For that reason, some of the processes, data and findings reported here are identical to those detailed in the Dubuque County Community Health Needs Assessment. Mercy participated in all aspects of steering, coordinating and completing the process. Mercy Medical Center Dyersville is a 20-bed critical access hospital serving 17 rural communities in western Dubuque County. Oak Crest Manor a 40-bed nursing home and a physician practice are also on the campus. Mercy Dyersville is a partner of Mercy Dubuque, which is accredited by The Joint Commission, and is a member of Mercy Health Network (MHN) of Des Moines, Iowa and Trinity Health (TH) of Livonia, Michigan. Our Vision, Mission and Values Ground Us Mission Statement Mercy Medical Center - Dyersville and Mercy Health Network serves with fidelity to the Gospel as a compassionate, healing ministry of Jesus Christ to transform the health of our communities. Our Vision Calls Us Mercy Health Network will set the standard for a personalized and radically convenient system of health services. Our Values Guide Us Reverence: We honor the sacredness and dignity of every person. Integrity: We are faithful to who we say we are. Commitment to the Poor: We stand with and serve those who are poor, especially the most vulnerable. Compassion: Solidarity with one another, capacity to enter into another s joy or sorrow Excellence: Preeminent performance, becoming the benchmark, putting forth our personal and professional best. Justice: We foster right relationships to promote the common good, including sustainability of the Earth. Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care. Executive Summary This Community Health Needs Assessment was developed collaboratively between Mercy Medical Center Dyersville, Mercy Medical Center Dubuque, Unity Point Health Finley Hospital, Dubuque County Health Department, City of Dubuque Health Services, and Crescent Community Health Center. Mercy Medical Center Dyersville is a critical access hospital, with Dubuque County as its primary service area. Also located in Dubuque County are Mercy Medical Center Dubuque, a community medical-surgical hospital, and Unity Point Health Finley Hospital, another community medical-surgical hospital. The service area is relatively homogenous, with a white non-hispanic population of 93%, and a very low overall population growth. Mercy Dyersville CHNA Page 4 of 28

5 The process began by convening the steering committee, comprised of representatives from organizations representing a broad variety of community organizations with an interest in health and wellness. The Steering Committee collected primary and secondary data and organized taskforces of content experts from the community to analyze and identify priority health needs in the community. The task forces reviewed secondary research consisting of statistical information about disease occurrence, mortality, and behavioral patterns of Dubuque County residents compared to Iowans in general or to previous periods of time. Some of the data sources used for this research were Community Commons, County Health Rankings, and Iowa Vital Statistics, and a community input survey updated and designed for this process.. Based on the secondary research as well as the survey findings, the steering committee reviewed the taskforce recommendations and identified and prioritized, through discussion and consensus, fourteen significant health needs: 1. Opioid Use and Abuse 2. Obesity & Overweight 3. Alcohol Use and Abuse 4. Mental Health Access 5. Influenza Immunizations 6. Healthy Homes 7. Primary Care Access 8. Emergency/Disaster Planning 9. Drinking Water Protection 10. Dental Care Access 11. Specialty Care Access 12. Elder Care Access 13. HIV/AIDS Screening and Prevalence 14. STD/STI Screening and Prevalence These are further addressed in the hospital's forthcoming Implementation Strategy. CHNA Approval Preliminary information regarding the CHNA was presented and discussed at the Mercy Medical Center - Dyersville Board Meeting on April 23, As the CHNA was not complete, the Board appointed Board Member, Colleen Walters, as the authorized person to adopt the final report. Ms. Walters reviewed and adopted the completed CHNA on behalf of the board on May 29, Review of Previous CHNA In 2016, Mercy's CHNA identified several high priority health needs, including: 1. Reducing obesity 2. Reduction in alcohol abuse in particular and substance abuse in general 3. Diabetes screening and management 4. Not taking prescribed medication for high blood pressure 5. Increased screening for prostate cancer Mercy Dyersville CHNA Page 5 of 28

6 6. Community concerns about insufficient access to mental health providers 7. Insufficient bilingual health care providers in the community From these high priority health needs, Mercy collaborated with Mercy Medical Center Dubuque, Dubuque County Health Department, and the Dubuque County Wellness Coalition to focus on addressing the goal of reducing obesity in our communities. Mercy, in partnership with many community partners, supported and implemented numerous interventions to address obesity in our community, and we continue to look for and implement new and innovative opportunities to respond to our community needs. Our goal from the previous CHNA-HIP was to reduce obesity among Dubuque County adults from 29% to 27% by June 30, The data source used, countyhealthrankings.org does not have this data point up to date. Thus, it is difficult to say with certitude that this goal has been achieved. However, the data available from that measure does indicate we have stabilized the percentage, and we believe the initiatives listed below will result in the desired impact as updated data becomes available. The list below highlights actions taken since implementation of the 2015 CHNA-HIP we believe have made an impact on the health of our community, towards the goal of reduced obesity. - Broaden the scope of the Dubuque County Wellness Coalition to include organizational representation capable of carrying strategic policies back to their organizations, and organizations that better represent the cultural and economic diversity of the community and all geographic areas of the county. o The Dubuque Wellness Coalition consists of community members and organizations working to impact policy and infrastructure identify gaps and duplication of efforts and utilize data to influence individual and community health. Members consist of City Health, Leisure Service Department, Dubuque County Health Department, IDPH, Dubuque Community & Holy Family Schools, Live Health Dubuque, Hy-Vee, Multi-Cultural FC, Mercy, Finley, Hillcrest, Iowa State University Extension, VNA, Crescent CHC, Tri-State Trail Vision, St. Stephen's Food Bank, Dubuque Community Y, Helping Services, and other local business. o Although membership has expanded and represents more sectors and organizations, cultural diversity has not changed. - Involve the Local Food Systems Working Group and other community-based organizations that have a specific interest in nutrition, weight loss, and physical activity in the process. o Dubuque Eats Well is a network of community members and organizations working together to transform the local food system. o Local food systems group representative is a member of the Coalition and reported out/received coalition input on local foods assessment, local food activities etc. o Established Double Up Food Bucks (DUFB) program which distributed $4,100 DUFB dollars to SNAP recipients attending the Dubuque Farmers Market (DFM). Over 50 vendors were engaged redeeming DUFB in 2016, and recorded over 200 NEW SNAP market goers. o Weekly offerings of Snap-Ed friendly recipes are through #MealMonday social media series, as well as a recipe on the back of the DFM Market Map. o The Agricultural Urbanism Toolkit is a three year ( ), three phase process through which stakeholders in the greater Dubuque area are coming together to evaluate the local food system, identify assets and gaps, and create a shared vision Mercy Dyersville CHNA Page 6 of 28

7 and goals, leading towards the implementation of tactics to move the local food system forward. Current projects addressing the social determents include The, Double Up Food Bucks and Sinsinawa Collaborative Farms. o In addition, there is progressive work around numerous community gardens including Dubuque Rescue Mission, Washington Neighborhood, Four Mounds, Dr. Viner, Jaycees, St. Luke's, West Minster Presbyterian. Other projects include Farm to Institution, Convivium Urban Farmstead, Kids at Market, Chefs at Market, 3rd Annual Tristate Local Food Summit, Bee Branch Project, 2016 Driftless Farm and Food Fest, Community Supported Agriculture connecting with businesses. - Secure commitments from participating partner organizations and coalition members to assist in implementing and supporting environmental change. o Mercy collaborated with the Iowa SNAP Incentive Project proposed by the Iowa's Healthiest State Initiative to increase fresh fruits and vegetable access to low income residents. o Mercy expanded our Community Benefit Ministry Grant program to invite community organizations to request grant funding for programs addressing priority health needs. During Fiscal Years (July 2015 June 2018) Mercy awarded $86,000 to the community organizations and programs targeting healthy behaviors, exercise, nutritious foods and obesity reduction listed below. Mercy also plans to distribute nearly $40,000 during Fiscal Year 2019 to similar community programs. Organization Program Grants Distributed FY Crescent Community Community Gardening $28,800 Health Center for a Healthier Life Clarke University Geriatric Wellness Falls $10,000 Prevention Program Northeast Iowa Scouting for Food $7,000 Council, Boy Scouts of America Sinsinawa Sinsinawa Mound $10,000 Dominicans Collaborative Farm Dubuque Rescue Mission School of $15,000 Mission Preservation St. Stephen Food Bank Growing and Giving $10,200 Dubuque Main Street Double Up Food Bucks $5,000 Total $86, The current year's CHNA Community Input Survey responses highlight community perspectives on the progress made over the past CHNA cycle. The survey asked, "Over the past 3-5 years, what would you say are the most significant improvements in our community that have improved health and well-being? Over 569 responses to this question were submitted. The following sample comments highlight progress made regarding this focus area. - "Organic food selection has really improved!" - "Access to outdoor activities" Mercy Dyersville CHNA Page 7 of 28

8 - "Working to clean up river area, walking, hiking areas." - "Increased community efforts to grow food and make it available to those living with food insecurity." - "Improved access to physical activity opportunities parks, trails, fitness facilities, a variety of exercise classes. Robust farmers market and focus on local healthy foods." - "Better dietary information at stores. Weight loss programs" - "YMCA is starting new health programs to fight diabetes, high blood pressures, and arthritis. Insurances started paying gym memberships." - "Nutrition information through classes and publications" - "Increased social gathering places that incorporate additional activities to foster wellbeing and health." - "Maintaining bike trails and parks, and encouraging people to get out and use them more." Comments from previous CHNA Mercy did not receive any comments from the public on this CHNA. Mercy Dyersville CHNA Page 8 of 28

9 Community Description Geographic Area Served This assessment focuses on the primary service area for Mercy Medical Center - Dyersville, principally Dubuque County, Iowa. How Population Served Was Identified This definition of the community is based on the primary residence of MMC-DY's patients: over calendar years , 90.22% of inpatient discharges were patients from Dubuque County, Iowa. County 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 CY Total Dubuque Delaware Clayton Jackson Buchanan Grand Total 83.00% 10.00% 4.00% 2.00% 1.00% % 89.90% 5.05% 5.05% 0.00% 0.00% % 85.90% 12.82% 1.28% 0.00% 0.00% % 93.75% 4.17% 2.08% 0.00% 0.00% % 92.06% 6.35% 1.59% 0.00% 0.00% % 96.43% 2.38% 1.19% 0.00% 0.00% % 90.22% 6.69% 2.57% 0.34% 0.17% % Demographics of Population US Census Bureau Quick Facts Population estimates, July 1, 2017, (V2017) Population, Census, April 1, 2010 Population, percent change - April 1, 2010 (estimates base) to July 1, 2017, (V2017) Persons under 5 years Persons under 18 years Persons 65 years and over Dubuque County 97,041 93, % 6.3% 23.0% 17.0% Iowa 3,145,711 3,046, % 6.4% 23.3% 16.4% United States 325,719, ,745, % 6.2% 22.8% 15.2% Mercy Dyersville CHNA Page 9 of 28

10 Female persons White alone Black or African American alone American Indian and Alaska Native alone Asian alone Native Hawaiian and Other Pacific Islander alone Two or More Races Hispanic or Latino White alone, not Hispanic or Latino Veterans, Foreign born persons, Households, Persons per household, Language other than English spoken at home, percent of persons age 5 years+, High school graduate or higher, percent of persons age 25 years+, Bachelor's degree or higher, percent of persons age 25 years+, With a disability, under age 65 years, Persons without health insurance, under age 65 years In civilian labor force, total, percent of population age 16 years+, In civilian labor force, female, percent of population age 16 years+, Mean travel time to work (minutes), workers age 16 years+, Median household income (in 2016 dollars), Per capita income in past 12 months (in 2016 dollars), Persons in poverty 50.6% 93.3% 3.2% 0.3% 1.3% 0.4% 1.5% 2.3% 91.3% 6, % 38, % 92.3% 29.2% 7.2% 4.1% 69.0% 64.6% 16.5 $56,154 $28, % 50.8% 91.4% 76.9% 3.7% 13.3% 0.5% 1.3% 2.5% 5.7% 0.1% 0.2% 1.8% 2.6% 5.8% 17.8% 86.2% 61.3% 203,277 19,535, % 13.2% 1,242, ,716, % 21.1% 91.7% 87.0% 27.2% 30.3% 7.9% 8.6% 5.0% 10.1% 67.6% 63.1% 63.3% 58.3% $54,570 $55,322 $28,872 $29, % 11.8% 12.7% Source: US Census Bureau QuickFacts, Health Facilities Three hospitals are located in Dubuque County: Mercy Medical Center Dyersville Mercy Medical Center Dubuque UnityPoint Health Finley Hospital Services Provided Mercy is a 20-bed critical access hospital serving 17 rural communities in western Dubuque County. Oak Crest Manor a 40-bed nursing home and a physician practice are also on the campus. Mercy Dyersville is a partner of Mercy Dubuque, which is accredited by The Joint Commission, and is a member of Mercy Health Network and Trinity Health of Livonia, Michigan. Mercy Dyersville CHNA Page 10 of 28

11 Primary patient-centered health care services provided at MMC-DY include: Emergency/Trauma, Acute and Skilled Care, Rehabilitation Services (PT/OT/Speech), Ambulatory Surgery, Home Care, Specialty Clinics. Mercy Dyersville CHNA Page 11 of 28

12 Process and Methods This CHNA was conducted in partnership with Dubuque County, City of Dubuque, Crescent Community Health Center and Mercy Medical Center Dubuque and Unity Point Finley Hospital, herein "steering committee". The steering committee collected information from primary and secondary data sources. Data was also collected through a community input survey in Dubuque County. Surveys were gathered between January 11 and January 22, The survey was offered on-line via "Survey Monkey" and was available in English and Spanish languages. The steering committee developed a communications plan to spread the word around the community and ultimately 1052 completed responses were collected. Summary results are available upon request. When the steering committee first met in November 2017, they reviewed the previous CHNA/HIP documents for Mercy and for the County of Dubuque. In the previous CHNA-HIP Mercy focused on results from the "Healthy Behaviors and Lifestyles" section of the Dubuque County CHNA-HIP process. However, we determined that including the full scope of the Dubuque County CHNA-HIP into Mercy's CHNA better represents the spectrum of health needs across our county and communities. Previous years' county CHNA-HIP have used general categories of Healthy Behaviors, Disease Infection Control, Healthcare Access, and Environmental Health. The steering committee determined to continue utilizing this framework as it best positioned us to assess the community health needs more comprehensively than focusing on just one as we had in the past. The data collection process moved forward simultaneously collecting existing data and developing and executing the community-wide survey related to these four broad categories. The steering committee reviewed, revised and improved upon the survey from in the previous CHNA-HIP cycle. In the review process, we also collected and reviewed community input surveys from other hospitals and communities as a comparison for improving the comprehensiveness of our tool. The steering committee then reviewed and compared to the survey results to the collected data. The results and data were consistent with each other, validating both findings. The steering committee then began forming taskforces of community experts to evaluate the data, including survey results, and identify the priority needs for each of the four categories. The steering committee identified and invited community members, experts and leaders from across the community to participate on the taskforces. Each taskforce reviewed the data, conducted a SWOT analysis and made recommendations to the steering committee regarding priority needs and focus areas for our health implementation plans. The steering committee then convened to review and adopt the recommendations from the steering committees. Steering Committee Members Joseph Norris, Mercy Medical Center Dubuque & Dyersville Patrice Lambert, Dubuque County Health Department (CHAIR) Stacey Killian, Unity Point Finley Hospital, Visiting Nurse Association Jonathan Wilke, Unity Point Finley Hospital Mary Rose Corrigan, City of Dubuque Travis Schrobilgen, City of Dubuque Angela Petsche, Crescent Community Health Center Mercy Dyersville CHNA Page 12 of 28

13 Steering Committee Meetings November 2, 2017 January 24, 2018 April 13, 2018 November 14, 2017 February 6, 2018 April 19, 2018 November 28, 2017 February 21, 2018 April 25, 2018 December 13, 2017 February 28, 2018 May 2, 2018 January 3, 2018 March 8, 2018 May 17, 2018 January 17, 2018 April 6, 2018 Taskforce Membership The steering committee invited the following community organizations to participate and share their expertise on each taskforce: Healthy Behaviors: City of Dubuque, Dubuque County Health Department, Dubuque School District, Dubuque YMCA, Grand River Medical Group, Helping Services, Hy- Vee, Iowa State Extension, Mercy Dubuque and Dyersville, Unity Point Health System, Western Dubuque School District Healthcare Access: Crescent Community Health Center, Dubuque County, Dubuque County Board of Health, Dubuque County Early Childhood, Dubuque County Emergency Management, Grand River Medical Group, Hillcrest Family Services, Medical Associates, Mercy Dubuque & Dyersville, Unity Point Health System Disease Infection Control: City of Dubuque, Dubuque County Health Department, Dubuque School District, Iowa Department of Public Health, Medical Associates, Mercy Dubuque & Dyersville, Unity Point Health System Environmental Health: City of Dubuque, Clarke University, Dubuque County Health Department, Dubuque Soil & Water Conservation, Loras College, Unity Point Health System County Health Rankings County Health Rankings ( provides comparative rankings and data for a variety of different health factors and health outcomes. These rankings are an effort to highlight the importance of many different factors in determining the health of a population. County Health Rankings is a project supported by Robert Wood Johnson foundation and University of Wisconsin Population Health Institute. Health Outcomes Health outcomes represent how healthy counties are within the state. The healthiest county in the state is ranked #1. The ranks are based on two types of measures: how long people live and how healthy people feel while alive. According to County Health Rankings 2018, Dubuque County ranks 41 out of 99 counties in Iowa in health outcomes. Mercy Dyersville CHNA Page 13 of 28

14 Health Factors Health factors represent what influences the health of a county. They are an estimate of the future health of counties as compared to other counties within a state. The ranks are based on four types of measures: health behaviors, clinical care, social and economic, and physical environment factors. According to County Health Rankings 2018, Dubuque County Ranks 27 out of 99 counties in Iowa in health factors. Mercy Dyersville CHNA Page 14 of 28

15 Community Input Methods used to solicit input The primary methods for community wide input included: steering committee, taskforces, and the community-wide survey. Results of this input follow. In addition to soliciting community wide input, the steering committee also invited broad representation for the taskforces and welcomed involvement throughout the process. The Steering Committee reviewed the survey responses and overall felt the community input supported and validated the collected data. The Steering committee presented these results and the collected data to the taskforces. The taskforces used the compiled data to further assess and prioritize our community needs. Health Department Input We obtained input from multiple departments of health throughout this process. First, Patrice Lambert of the Dubuque County Health Department and Mary Rose Corrigan from City of Dubuque Public Health were members of the Steering Committee. Second, we reviewed the Community Health Needs Assessment and Community Health Improvement Plans for Grant County, Wisconsin and Jo Daviess County, Illinois to assure we were taking into consideration other priority needs in our region though they are beyond our primary service area for the purposes of our needs assessment process. We find the priority needs identified in this CHNA overlap and align well with the priority needs of the secondary service area. Representation of medically underserved, low-income, and minority populations The Steering Committee sought and considered the needs, input, and concerns of underrepresented persons and populations throughout this process. Serving on the Steering Committee, Angela Petsche from Crescent Community Health Center and Stacey Killian from Unity Point Finley Hospital Dubuque Visiting Nurse Association represented the populations their organizations serve. The primary makeup of these populations are those who are underrepresented in the community: those who are medically underserved, in poverty; and/or from minority populations. In addition, representatives from Dubuque School District, Western Dubuque School District, and Dubuque Early Childhood participated on the taskforces and represented the needs and best interests of the youth population that comprises 23% of our community. The Steering Committee reviewed reported demographic information of those who completed the survey and found that distribution by ethnicity, age, income and zip code were consistent with the community's demographic profile. Community Input Survey Results Community wide survey results were taken into consideration when prioritizing which needs to focus on for the term of this CHNA-HIP. Summary responses are included below; please contact us if you would like to review the full results. Mercy Dyersville CHNA Page 15 of 28

16 The survey tool was originally designed for the previous CHNA-HIP process. The Steering Committee consulted various community input surveys when revising the survey tool for this cycle. Most questions were revised, though to varying degrees. The Steering Committee had two primary goals for the community input survey. First, to identify which community health needs, identified through the data collection process, were of highest priorities to the community to address. Second, we aimed to solicit community input regarding any needs that we had missed that community members believed needed to be addressed in the coming 3-5 years. The Steering Committee also had the survey translated into Spanish language to make the survey more accessible. Only two responses were received using the Spanish translation. In the next cycle, the Steering Committee will look to expand language availability to meet the needs of the community. Mercy Dyersville CHNA Page 16 of 28

17 Question: From the list below, please check THREE items that you think are the most important health concerns for our community to address in the next 3-5 years. (Check exactly 3 below) Answer Choices Mental health/mental illness/suicide Obesity/overweight Illegal drug use Cancer Prescription drug abuse Heart disease and stroke Alcohol abuse Diabetes Chronic pain Pregnancy/infant health Dental health Respiratory and lung problems Sexually transmitted diseases High blood pressure Unintentional injuries Responses 73.21% % 41.30% 28.65% 25.95% 17.67% 16.28% 14.14% 9.21% 8.19% 5.12% 4.28% 4.00% 3.07% 1.02% Answered Question: From the list below, please check THREE behaviors that you think have the greatest impact on overall community health. (Check exactly 3 below) Answer Choices Responses Drug abuse 63.63% 684 Being overweight 50.05% 538 Poor diet 42.14% 453 Lack of exercise 41.12% 442 Alcohol Abuse 40.09% 431 Tobacco use 20.19% 217 Dropping out of school 16.09% 173 Unprotected sex 11.72% 126 Not getting flu shots or 11.26% 121 other vaccinations Not wearing a helmet 2.33% 25 Not using seat belts 1.40% 15 Answered 1075 Mercy Dyersville CHNA Page 17 of 28

18 Question: From the list below, please check THREE environmental hazards that you feel are needs that should be addressed in our community in the next 3-5 years. (Check exactly 3 below) Answer Choices Responses Healthy homes 44.19% 475 Drinking water protection 40.00% 430 Disaster preparedness 32.37% 348 Water pollution 30.79% 331 Food safety 27.53% 296 Food waste 21.30% 229 Air Pollution 19.44% 209 Hazardous waste 17.12% 184 Hazardous materials 15.63% 168 Radon 15.35% 165 Lead poisoning 11.26% 121 Vector (disease-carrying animals and insects) control 11.07% 119 Soil Erosion 9.49% 102 Radiological health 4.47% 48 Answered 1075 Question: Using a scale from Strongly Disagree to Strongly Agree, please rate these statements about Health Care Access in our community: Strongly Disagree Neither Agree Strongly Disagree Agree nor Agree Disagree Most residents in my community are able to access a primary care provider (family doctor, pediatrician, general 2.60% 17.30% 12.84% 57.86% 9.40% practitioner) when needed. Most residents in my community are able to access a medical specialist (cardiologist, dermatologist, 7.63% 27.35% 20.28% 39.53% 5.21% neurologist, etc.) when needed. Most residents in my community are able to access a dentist when needed. 5.86% 19.81% 17.21% 46.14% 10.98% Most residents in my community are able to obtain prescription medications 2.88% 16.93% 20.37% 51.07% 8.74% when needed. People new to my community know how 3.63% 19.81% 38.60% 33.58% 4.37% to get health care. There are enough health care providers who accept Medicaid or other forms of 19.72% 27.72% 31.44% 16.74% 4.37% medical assistance in my community. There are enough bilingual health care providers in my community % 30.79% 44.56% 6.98% 2.51% Mercy Dyersville CHNA Page 18 of 28

19 Question: Please select up to THREE of the most important barriers that you believe keep people in our community from accessing health care. (You may check 1-3 options below) Answer Choices Responses Not able to pay out-of-pocket expenses (co-pays, 80.09% 861 prescriptions, etc.) Lack of health insurance 64.47% 693 Not able to navigate the health care system 39.16% 421 Not enough providers; hard to get an appointment 35.35% 380 Lack of transportation 18.88% 203 Language or cultural barriers 16.74% 180 Time limitations 10.88% 117 Lack of trust 6.88% 74 Lack of child care 6.79% 73 Other (please describe) 5.95% 64 In addition to the questions with fixed responses, three questions offered free-text response for comments. One question was retrospective and so is not included here, the other two are summarized below. All responses were categorized as follows: Question: Please describe any other health needs that were not mentioned in the previous questions that you feel should be addressed in the next 3-5 years in our community. 698 responses were received and categorized: Category Count of Category Count of Response Response Mental Health 99 Dental 8 N/A 74 Sexual Health 7 Specialty Care 68 Crescent 7 Access 58 Transportation 6 Substance Abuse 53 Childcare 5 Provider Shortage 36 Obesity 3 Affordability 30 Dyersville 3 Environment 28 Mercy 3 Insurance 26 Pharmacy 2 Cancer 18 Cultural 2 Aging 17 Marijuana 2 Mercy Dyersville CHNA Page 19 of 28

20 Public Safety 17 Individual 2 Responsibility Nutrition 16 Language 2 Political 15 Provider Shortage 1 General 14 Veterans 1 Health Education 13 Pain 1 Children 13 Men's Health 1 Education 13 Pediatrics 1 Exercise 11 Finley 1 Public Health 10 Communication 1 Women's Health 9 Marshall Islands 1 Total: 698 Question: What do you see as barriers that prevent our community from becoming healthier? 830 responses were received and categorized: Category Count of Response Category Count of Response Money 153 Access - General 17 Individual Responsibility 92 Obesity 15 Access - Insurance 76 Access - Transportation 13 Political 57 Pharmacy 11 Access - Nutrition 52 Dental 8 Substance Abuse 44 Environment - Chemicals 8 Education 42 Children 6 Education - Health Literacy 32 Access - Housing 4 Access - Exercise 30 Aging 4 N/A 28 Access - Affordability 3 Culture 28 Jobs 3 Access - Providers 26 Marshall Islands 2 Access - Mental 26 Quality Care 2 Access - Care 25 Cancer 2 Education - Nutrition/Cooking 20 Total: 830 Crime 1 Mercy Dyersville CHNA Page 20 of 28

21 Select Key Findings from Data Review Dubuque County and Iowa Health Data from County Health Rankings (countyhealthrankings.org), for each year 2013 through % of adults in Dubuque County report physical inactivity, compared to 24% throughout Iowa. The sexually transmitted infection rate (412.8) is higher than the statewide rate (382). 6% of adults in Dubuque County are uninsured compared to a statewide average of 7%. The per capita ratio of primary care physicians to population is higher than the statewide average (1,380:1 for Dubuque compared to 1350:1 for Iowa). Dubuque County is ranked eighth best of Iowa's 99 counties in Clinical Care. Dubuque County (10.2) reported a higher rate of air pollution air particulate matter than the state (9.6). Dubuque County (12%) had a lower percentage of the population driving longer commutes alone than the statewide percentage (20%). Dubuque County reported drinking water violations. Dubuque County Health Portrait 2017, from Community Commons (communitycommons.org/chna). 9.55% of Dubuque County households receive SNAP benefits compared to 11.73% for Iowa. 42% of Dubuque County Adults are reported overweight compared to 35% for Iowa. 28.7% of Dubuque County adults are not taking blood pressure medication when needed compared to 19.1% in Iowa. Dubuque County (51.21%) has a higher percentage of Medicare Beneficiaries with high blood pressure than the Iowa average (50.98%). 77.4% Dubuque County female Medicare enrollees with mammogram in past 2 years compared to 68.5% for the statewide average. 82.6% Dubuque County adult females, age 18+, with regular pap test (age-adjusted) compared to 79.5% for the statewide average. 69.4% Dubuque County adults, age adjusted screened for colon cancer compared to the statewide average of 60%. 10.1% of adults in Dubuque County smoke cigarettes, compared to 18.1% for Iowa. Dubuque County has 31.5% age-adjusted estimated adult excessive drinking compared to the Iowa average of 21.4%. Percent of adults never screened for HIV/AIDS is higher (78.7%) than the Iowa average (73.82%). Dubuque County age-adjusted percent of population age 65+ with pneumonia vaccination (68.5%) is slightly below the Iowa average (69.9%). Chlamydia infection rate per 100,000 pop. in Dubuque County (412.76) is higher than the statewide average (382). Gonorrhea infection rate per 100,000 pop. in Dubuque County (86.73) is higher than the statewide average (53.1). Mercy Dyersville CHNA Page 21 of 28

22 Dubuque County has a lower percentage of the insured population receiving Medicaid (15.24%) than the Iowa average (17.96%) Dubuque County (140) has more mental health providers per 100,000 than the Iowa rate (125.1) but well below the national average rate of % of Dubuque County adults are without a regular doctor compared to 17.93% in Iowa. Dubuque County has a lower percentage of uninsured population (5.46%) than the Iowa average (6.82%) Dubuque County has a lower percentage of uninsured population under 19 years old (2.79%) than the Iowa average (3.63%). Dubuque County has dentists per 100,000 population compared to the state rate of Dubuque County (74.74) has a higher percentage of fast food establishments per 100,000 population than the state average (63.19). Dubuque County (25.23) has a higher percentage of population with low food access than the statewide average (21.41%). Dubuque County (16.02) has a lower rate of grocery stores per 100,000 population than Iowa (20.06). Dubuque County (24.7%) has a comparable percentage of substandard housing units to the Iowa average (24.44%). Iowa Department of Public Health core measures: ( Age adjusted heart attacks per 10,000 population. Mercy Dyersville CHNA Page 22 of 28

23 Mercy Dyersville CHNA Page 23 of 28

24 Emergency visits due to heat related illness per 10,000 population. Mercy Dyersville CHNA Page 24 of 28

25 Dubuque County cancer incidence rates: (Iowa Cancer Registry) Malignant cancer frequency and incidence age-adjusted rates by year in Dubuque County, Rate Count Pop IA: Dubuque County (19061) ,924 IA: Dubuque County (19061) ,612 IA: Dubuque County (19061) ,227 IA: Dubuque County (19061) ,981 IA: Dubuque County (19061) ,587 IA: Dubuque County (19061) ,125 Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P ) standard. Malignant cancer frequency and incidence age-adjusted rates by year in state of Iowa, Rate Count Pop ,179 3,050, ,217 3,065, ,910 3,076, ,952 3,092, ,604 3,109, ,603 3,123,899 Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P ) standard Cancer In Iowa, University of Iowa College of Public Health. Mercy Dyersville CHNA Page 25 of 28

26 Significant Community Health Needs This CHNA identified the top needs within Dubuque County using the expertise of the steering committee, community taskforces, and community wide survey. Those needs fall into four categories of need within Dubuque County. The committee examined the specific needs from each category and prioritized each of the 14 identified needs based on magnitude of persons affected, impact on quality of life, feasibility and community resources, and the consequences of inaction. Work is underway to identify community partners and potential resources available for addressing the significant health needs below. This information will be utilized in the development of the implementation strategy. Ranking of significant community health needs and brief description: 1. Opioid Use and Abuse Our county has been particularly impacted by the opioid crisis and lack of treatment and resources available across the community. 2. Obesity & Overweight Over 40% adults in the community report being overweight. 3. Alcohol Use & Abuse The age-adjusted percentage of adults who drink excessively in Dubuque County is 31.5% 4. Mental Health Access We have many mental health resources in the community, but there are significant access challenges related back to awareness of services, provider availability, and insurance coverages. 5. Influenza Immunizations Our community continues to see high incidence of influenza-associated hospitalizations year over year. 6. Healthy Homes Data indicates particular concerns with childhood lead poisoning rates, household moisture and gas challenges, and general safety issues impact the overall health and safety of the community. 7. Primary Care Access Though uninsured rates are low, many surveyed, indicated challenges with accessing primary care related to insurance, transportation, and availability. 8. Emergency/Disaster Planning Community preparedness is the ability of communities to prepare for, withstand, and recover in both the short and long terms from public health incidents. 9. Drinking Water Protection Data indicates private water supplies for those not served by public water systems are negatively impacted by inadequate wastewater treatment in un-sewered communities. 10. Dental Care Access 11. Specialty Care Access 12. Elder Care Access 13. HIV/AIDS Screening and Prevalence Dubuque County has a high incidence of known positive HIV/AIDS diagnoses and data indicates 14% of Iowans living with HIV are undiagnosed. 14. STD/STI Screening and Prevalence Gonorrhea and Chlamydia infection rates are higher than the state averages. Mercy Dyersville CHNA Page 26 of 28

27 Conclusion This assessment is an effort to analyze the current state of health and socioeconomic factors in the Mercy Medical Center-Dyersville service area. Limitations and inconsistencies in available data can make it challenging to accurately compare indicator performance between the local communities, the state and the nation as a whole. As areas of concern are selected for further conversation about community collaboration and community benefit planning, additional data may be sought if needed. There are some indicators where local-level data was not available and this assessment may point out areas for future data collection. Implementation Strategy The identified priority needs will be incorporated into a Mercy Medical Center Dyersville Community Benefit Implementation Strategy that will inventory current programs in place and recommend additional services and collaborative efforts to target priority needs. Once drafted, the Community Benefit Implementation Plan will be presented to the Mercy Medical Center Dyersville Board of Trustees for input and approval, after which objectives and targets will be established to integrate into the hospital's operating plan and budget. How to obtain copies This Community Health Needs Assessment will be posted to the Mercy Medical Center- Dyersville website: Paper copies of this document are available upon request by visiting the Information Desk at either Mercy Dyersville or Mercy Dubuque. You can also write or call the Office of the President to request a copy of the document. Office of the President Mercy Medical Center Dubuque & Dyersville 250 Mercy Drive Dubuque, Iowa Phone: Contact Information Mercy invites your feedback regarding this Community Health Needs Assessment. If you would like to share your feedback with us, please contact the Office of the President for Mercy Dubuque and Dyersville by phone or by mail (below). Office of the President Mercy Medical Center Dubuque & Dyersville 250 Mercy Drive Dubuque, Iowa Phone: Mercy Dyersville CHNA Page 27 of 28

28 Next CHNA Due Date The next Community Health Needs Assessment will be scheduled for completion by June 30, Mercy Dyersville CHNA Page 28 of 28