Avista Adventist Hospital 2013 Community Health Needs Assessment

Transcription

1 Avista Adventist Hospital 2013 Community Health Needs Assessment Avista Adventist Hospital- Community Health Needs Assessment

2 TABLE OF CONTENTS 1 INTRODUCTION a Brief description of hospital, history and services provided b Mission statement, vision and values c Organizational commitment to community benefit d Commitment statement to the uninsured and underinsured COMMUNITY HEALTH NEEDS ASSESSMENT a Community a i Definition of community served by the hospital a ii Demographics of the community a iii Uninsured persons, low-income persons, and minority groups b Data collection b i Process used to gather data b ii Information gaps c Health needs of the community c i Process to identify and prioritize needs c ii Prioritized list and description of community health needs c iii Healthcare resources available in the community to meet the needs CONTACT INFORMATION Avista Adventist Hospital- Community Health Needs Assessment

3 1 INTRODUCTION 1A BRIEF DESCRIPTION OF HOSPITAL, HISTORY AND SERVICES PROVIDED More than 100 years ago the Seventh-day Adventist church established a sanitarium in Boulder Colorado, dedicated to providing healthcare for the surrounding community. However, as time passed the hospital realized the original facility and location had limitations that would inhibit its ability to grow. In 1990, a new hospital was opened in Louisville, where the beautiful facility now called Avista Adventist Hospital sits upon a hill with magnificent views of the Rockies. The community response has been overwhelming, and because of the remarkable growth Avista has experienced, the hospital has expanded to nearly double its original size. This expansion has increased capacity, reduced waiting times for several critical services, and allowed for the addition of important, new capabilities and technologies. Today, Avista Adventist Hospital is a full service, 114-bed acute-care hospital with a medical staff of more than 600 physicians. In addition to providing first-rate critical care services (emergency, trauma and intensive care), Avista is the home to the area's leading birthing services and largest Neonatal Intensive Care Unit. Known for devotion to whole person care and tireless attention to creating a safe, compassionate and healing environment, Avista and its 642 associates have been recognized for excellence by an impressive list of independent organizations that assess quality and patient satisfaction. Avista is connected to Centura Health, Colorado's health care leader, and its integrated statewide network of 13 hospitals, seven senior living communities, medical clinics, affiliated partner hospitals, Flight for Life Colorado, and home care and hospice services. Avista's and Centura Health's strength lies in their ability to deliver world-class care to people where and when they need it most. Together, they provide care that transcends the walls of a hospital and connections to top expertise and technology that only Avista Adventist Hospital and Centura Health can make. Avista s Distinctive Services Avista recognized for excellence recipient of award for continuous performance improvement from Colorado Performance Excellence (CPEx) consistent high scores in consumer satisfaction, as measured by national survey of patient experiences (HCAHPS) Avista named "Top Performer" recognized for high performance on key quality measures by The Joint Commission, the leading accreditor of U. S. health care organizations Award-winning Intensive Care Unit recipient of Beacon Award for Critical Care Excellence recognized as leader in excellent patient outcomes, healthy work environment and high professional goals Award-winning New Life Center recognized by HealthStream Research for being in the top tier of hospitals for patient satisfaction features 28 labor, delivery and postpartum suites, a Level IIIB nursery and a private spa room for new mothers Award-winning Total Joint and Spine Care Center recipient of award by HealthStream research in recognition of outstanding patient satisfaction led by surgeons trained at some of the nation's top teaching institutions Avista Adventist Hospital- Community Health Needs Assessment

4 Pain management program offers the latest treatments for painful conditions often with fewer side effects, less risk of complications and less reliance on medication Emergency Department features private rooms, a special area for children, and dedicated diagnostic equipment for fast test results Surgical services with state-of-the-art operating suites Critical care services Patient & Community Resources Ask-A-Nurse free health information and help finding a doctor at A network of physicians who access the same electronic medical records so they have the latest information on each patient, regardless of whether he/she enters the hospital, Emergency Department, or a physician's office Community education classes for childbirth prep, exercise, joint pain, spine care and more Free online symptom checker at avistahospital.org For more information about Avista Adventist Hospital, visit 1B MISSION STATEMENT, VISION AND VALUES Our Mission: We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. Our Vision: To fulfill a covenant of caring for our communities to become their partner for life. Our Core Values: Compassion- In serving our customers, their families and each other, we will: o Honor the individuality of each person; o Treat each person with dignity, taking the time to be present, to listen, to explain and to understand; o Create a caring environment that exudes humanity, humility, grace and love. Respect- In working with each other, we will: o Encourage and value the contributions of each person, and make each feel supported, reassured and empowered; o Listen well, communicate openly and honestly, and encourage others to do the same; o Treat others as we would like to be treated ourselves, relating so well with them that they actively seek to associate with us. Integrity- In all of our interactions, we will: o Foster trust by being truthful, empathetic and consistent; o Be authentic and courageous, aligning what we are thinking, saying, feeling, and doing; o Be responsible for and follow through on the commitments we make. Spirituality- In honoring the missions, ministries, and heritages of our Catholic and our Adventist sponsors, we will: o Add meaning and purpose to the lives of our associates, physicians, and partners; o Celebrate the role of spirituality in healing for each individual; Avista Adventist Hospital- Community Health Needs Assessment

5 o Serve each other and our communities in harmony with the inclusiveness, wholeness and touch that characterized Christ's healing ministry. Stewardship- In managing the natural, human, and financial resources to which we have been entrusted, we will: o Seek ways to appropriately utilize resources, allowing us to become more effective and productive; o Act responsibly, taking only those actions that align with our mission; o Be accountable to the organization and to each other for our actions and the outcomes they produce. Imagination- In seeking to grow our ministry, we will: o Look beyond the challenges of the present and envision what is possible; o Cultivate and reward innovation and risk taking; o Embrace continuous learning and positive technological advancement. Excellence- In all we do, we will: o Put forth our personal and professional best, providing the highest quality of care of which we are capable; o Commit ourselves to continuous improvement, seeking to set the recognized performance standards within our industry; o Deliver a superior experience for all of our customers, sensing their needs and exceeding their expectations. 1C ORGANIZATIONAL COMMITMENT TO COMMUNITY BENEFIT Colorado s needs are growing. To live our mission in an economy that challenges more people than ever before, Centura Health continues to lead the way in helping Coloradans access quality health care. The connected network of facilities, entities and foundations that form the Centura Health family are serving community needs through education, preventive care, safety initiatives, health advocacy, counseling and support groups. Our work in our communities is born out of the second part of our mission, which compels us to serve others by nurturing the health of our communities. From access for the uninsured, to serving as a voice for health care in the state legislature, to community classes and education to build strong, healthy communities, Centura Health is a partner for life. We are more committed than ever before to making our world a better place, and we seek to make the most impact in every community we touch. Avista Adventist Hospital is fulfilling its commitment to community benefit by expending significant amounts of money in the following specific ways: Charity Care Unreimbursed Medicaid Unreimbursed Medicare Community Benefit Avista Adventist Hospital provided $11.7 million in total community benefit in fiscal year Avista Adventist Hospital- Community Health Needs Assessment

6 Avista Adventist Hospital has been a leader for several years in bringing community stakeholders together to identify community health improvement opportunities and work collaboratively to find solutions. Avista, through its CEO, was a founding member of the Boulder County Civic Forum which is the research arm of The Community Foundation. The Boulder County Civic Forum was founded in 1995 and is an organization that is supported by businesses, government, foundations, and individuals. The mission is to Promote healthy decision making that will sustain the environmental quality, economic vitality and livability of the Boulder County region through information, research, education and dialogue. More than 400 community members came together to identify four visions for a healthy community including; a vision for the people, for the environment, for the economy, and for culture and society. The 50 indicators selected to measure these visions are still used today more than 15 years later. Avista s annual sponsorship, in partnership with other Boulder County hospitals, has allowed for the biennial publication of Boulder County TRENDS ( The publication reports on the tracking of community indicators and offers a longitudinal gauge of what the community is doing well, where improvement is possible, and how to get involved. Avista has also been a key contributor to the Boulder County Health Improvement Collaborative (BCHIC) since the organization s inception in The mission of BCHIC is to improve the quality, safety, efficiency and accessibility of health care and public health services for all patients in our community through collaboration and the timely, secure exchange of clinical data. Projects include: health information exchange implementation in Boulder County, development of a community data sharing contract, and care collaboration across providers for Boulder County s neediest patients. Avista staff members have contributed significant time and expertise, and the hospital has been a financial contributor. 1D COMMITMENT STATEMENT TO THE UNINSURED AND UNDERINSURED According to Centura.org, more than 700,000 Coloradans are without health insurance and, as a result, growing numbers are facing difficulties paying for medical care. Centura Health believes that hospitals should have the ability to offer discounts to those who are unable to obtain insurance and do not meet charity care criteria. It is the policy of Centura Health to provide uninsured patients with discounted rates for all hospital bills. The discount is applied to all hospital inpatient, outpatient and Emergency Room bills that have been screened and do not have third-party insurance, Medicare, Medicaid, Champus, or other governmental payer programs and do not meet the Centura charity guidelines. Centura Health strives to compassionately serve uninsured patients with an understanding of the financial burdens they may face. Centura supports and advocates for meaningful and appropriate changes in legislation that improve access to affordable, quality medical care for the uninsured. Centura Health will treat uninsured patients in the following manner: Uninsured patients will be treated fairly and with respect during and after treatment, regardless of their ability to pay. Uninsured patients will be provided with financial counseling, including assistance applying for local, state and federal health care programs such as Medicare, Medicaid and the Colorado Indigent Care Program. Uninsured patients will be informed of and assisted in applying for charity care available through Centura Health as appropriate. Avista Adventist Hospital- Community Health Needs Assessment

7 Centura Health utilizes a charity discount schedule that takes into account state or federal poverty guidelines to aid in the qualification of patients seeking assistance in meeting their financial obligations. Financial counselors will attempt to meet with all uninsured patients prior to discharge from the hospital. Financial counselors will use best efforts to personally contact uninsured patients before any collection activities are initiated. Uninsured patients that do not qualify for assistance will receive a 30 percent discount off billed charges. This will automatically be adjusted during the billing process, so that all statements and collection efforts will be based on the discounted amount. Centura will also offer an additional 15 percent Prompt Pay Discount for accounts paid in full within 60 days of receiving the first statement of patient liability. If at any point an alternative payment source is identified, all discounts stated in this policy will be reversed. A call center is available so that patients may speak to an individual who can help them with questions on their bills; the call center phone number is prominently displayed on all billing correspondence. Hospital-based physicians and related entities will be encouraged to follow the Centura Health Principles Regarding Uninsured Patients but this is done at their discretion. Centura Health will not engage in the following activities: Centura Health will not pursue legal action for nonpayment of hospital bills against any patient who has worked with Centura to demonstrate his or her inability to pay and who is unemployed or otherwise financially unable to pay. Centura Health will not pursue legal action for nonpayment if the only way to collect payment would be to place a lien on the patient's home. Centura Health always has distinguished itself from other hospitals and systems in its treatment of the uninsured: Centura Health hospitals will continue to treat patients in their emergency rooms without regard to the patient's ability to pay. All patients will continue to be triaged and treated as appropriate. Centura Health has provided numerous outreach programs to the community in its pursuit of healthy communities and constantly seeks opportunities to advance its health care ministry. It is not the practice of Centura Health to place a lien on a patient's home when it is the patient's only asset. Centura Health will continue to work for increased access and coverage for the uninsured through legislative and community activity. Avista Adventist Hospital- Community Health Needs Assessment

8 It is the practice of Centura Health not to pursue legal action for nonpayment unless it has first examined the patient's eligibility for other assistance or charity care. 2 COMMUNITY HEALTH NEEDS ASSESSMENT 2A COMMUNITY 2A I DEFINITION OF COMMUNITY SERVED BY THE HOSPITAL To ensure alignment with publicly available Colorado Department of Public Health and Environment (CDPHE) data, Centura Health leaders decided that Colorado counties would comprise the geographic area for the 2012 Community Health Needs Assessment (CHNA). Individual Centura hospital facilities then examined their primary market areas and identified Colorado counties where at least 10% of their patient population resided. The counties identified by each facility comprise the Primary Service Area used in the data reports. The Primary Service Area for Avista Adventist Hospital includes Boulder, Broomfield, and Adams Counties. Avista Adventist Hospital Service Area Map The map above shows Avista s primary service area, which includes zip codes that the hospital reaches out to in order to communicate the services and programs available to the community. The hospital serves the counties of Boulder, Broomfield, and Adams and the zip codes include the following: 80020, 80021, 80023, 80026, 80027, 80030, 80031, 80221, 80229, 80233, 80234, 80241, 80260, 80301, 80302, 80303, 80304, 80305, 80306, 80307, 80308, 80309, 80516, While this data is representative of the entire Avista service area, Avista will target a more narrowly focused demographic area for this Community Health Needs Assessment; concentrating on the areas of Boulder and Broomfield Counties which demonstrate the greatest healthcare needs. Avista Adventist Hospital- Community Health Needs Assessment

9 2A II DEMOGRAPHICS OF THE COMMUNITY The population of Boulder County is 294,567 and consists of 117,222 households. The median age is 35 and the county is home to the University of Colorado. The racial/ethnic makeup is as follows: 87% White (including Latino), 4% Asian, 1% African American,.4% Native American, 3% two or more races, 5% some other race. 17% of the population speaks a language other than English at home. 94% of the population are high school graduates, 58% have earned a bachelor s degree or higher, and 26% have a graduate degree. The median family income as of 2008 was $85,602 while 14% of individuals, 8% of families, and 13% of children were living below the poverty level. The population of Broomfield County is 55,880 and consists of 22,646 households. The county is experiencing vast growth in family population and much of the demographics represent these growing families. The racial/ethnic is as follows: 89% White (including Latino), 6.1% Asian, 1.5% African American,.9% Native American, and 2.4% two or more races. 12.2% of the population speaks a language other than English at home. 95.4% of the population are high school graduates and 41.9% have earned a bachelor s degree or higher. The median family income as of 2010 was $75,590, while 5.5% of Broomfield County lives below the poverty level. Population by age, HSR 16 and Colorado, 2010 and Percent change Average annual growth rate HSR 16 Age 0-18 years 85, , % 1.8% Age years 244, , % 0.3% Age 65 years and older 31,341 63, % 7.3% All ages 361, , % 1.4% Colorado Age 0-18 years 1,334,223 1,587, % 1.8% Age years 3,284,580 3,656, % 1.1% Age 65 years and older 541, , % 5.5% All ages 5,160,189 6,171, % 1.8% HSR 16 includes: Boulder and Broomfield Counties SOURCE: Colorado Health Institute using data from the Colorado Demography Office Unemployment rates, HSR 16 and Colorado, Oct-Dec 2009 Jan-Mar 2010 April-June 2010 July-Sept 2010 HSR % 7.7% 7.1% 7.1% 7.0% Colorado 7.1% 9.5% 8.8% 8.6% 8.8% Oct - Dec 2010 Median household income and percent of population at or below 100% and 200% of the federal poverty level (FPL), HSR 16 and Colorado, Avista Adventist Hospital- Community Health Needs Assessment

10 Median household income % of population at or below 100% of FPL, all ages % of population at or below 200% of FPL, ages 0-18 % of population at or below 200% of FPL, ages HSR 16 $47, % 39.4% 37.7% Colorado $38, % 45.8% 37.0% Health insurance status, HSR 16 and Colorado, SOURCE: Colorado Household Survey, HCPF, analyzed by the Colorado Health Institute. 2A III UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS 92.7% of White, non-hispanic/latino adults in the service area indicated that they had some sort of health care coverage compared to 61.8% of White, Hispanic/Latino adults, and 94.8% of Asian American/Pacific Islander adults. 5.8% of White, non-hispanic/latino adults reported that their general health was fair or poor compared to 20.8% of White, Hispanic/Latino adults and 4.4% of Asian American/Pacific Islander. The ageadjusted incidence rate of all cancers per 100,000 population was for White, non-hispanic/latinos; for White Hispanic/Latinos; for Black/African Americans; and for Asian American/Pacific Islanders. The age-adjusted incidence rate of mortality due to heart disease per 100,000 population was for White, non-hispanic/latino; for White, Hispanic/Latino; for Black/African American; 70.0 for Asian American/Pacific Islander; and for American Indian/Native Alaskan. The age-adjusted incidence rate of mortality due to cancer per 100,000 population was for White, non-hispanic/latino; for White, Hispanic/Latino; 48.7 for Black/African American; 85.6 for Asian American/Pacific Islander; and for American Indian/Native Alaskan. In the late summer of 2012 Avista hopes to have additional information from the Boulder County Public Health dashboard, which will include disparities data on Boulder County level indicators. Health Disparities Profile for Region 16 Region 16 includes: Boulder and Broomfield Counties Population Characteristics Region16 Colorado measure Avista Adventist Hospital- Community Health Needs Assessment

11 Total Population: 343,953 4,861,515 White, non-hispanic/latino 278,830 3,508,736 White, Hispanic/Latino 42, ,833 Black/African American 4, ,718 Asian American/Pacific Islander 15, ,112 American Indian/Native Alaskan 2,875 64,116 Source: CDC/NCHS 2007-based, bridged-race population estimates, Adult Health Region16 Colorado measure Health Care Coverage % of adults who reported they had any kind of health care coverage White, non-hispanic/latino White, Hispanic/Latino Black/African American * * 68.1 Asian American/Pacific Islander American Indian/Native Alaskan General Health Status % of adults who reported that their general health was 'fair' or 'poor' White, non-hispanic/latino White, Hispanic/Latino Black/African American * 15.0 Asian American/Pacific Islander American Indian/Native Alaskan * 24.6 Source: Behavioral Risk Factor Surveillance System (BRFSS) Survey, Health Statistics Section, CDPHE, * Indicates fewer than 50 respondents in subgroup. Mortality Region16 Colorado measure Heart Disease Age-adjusted incidence rate of mortality due to heart disease per 100,000 in population White, non-hispanic/latino White, Hispanic/Latino Black/African American Asian American/Pacific Islander American Indian/Native Alaskan Malignant Neoplasms Age-adjusted incidence rate of mortality due to cancer per 100,000 in population White, non-hispanic/latino White, Hispanic/Latino Black/African American Asian American/Pacific Islander American Indian/Native Alaskan Source: Vital Statistics Unit, Health Statistics Section, CDPHE, Avista Adventist Hospital- Community Health Needs Assessment

12 *Indicates fewer than three events in category. 2B DATA COLLECTION 2B I PROCESS USED TO GATHER DATA The Center for Health Administration at the University of Colorado Denver was retained to conduct the data collection for the Centura Health system and its respective hospital facilities. Additionally, Avista gathered data from Boulder County Public Health Department s (BCPH) 2011 Public Health Improvement Process (PHIP). PUBLIC HEALTH DATA Data for the Community Health Needs Assessment (CHNA) was predominantly collected from the Colorado Department of Public Health and Environment (CDPHE). The CDPHE s Colorado Behavioral Risk Factor Surveillance System Survey ( ) was used to determine information about adult behaviors that impact health, such as substance abuse, eating and exercise habits, and smoking. The national Youth Risk Behavior Survey ( ) was queried to determine behaviors that impact the health of students from 9th through 12th grades. The CDPHE s database was also probed for information on mortality rates for a variety of health indicators. The BCPH s PHIP included conducting an assessment of community health status and the capacity of the broader public health system to address health needs. They prepared a county public health plan on the basis of their assessments, including setting priorities for providing services. BCPH contracted with Primetime Research and Evaluation to lead a formal prioritization and capacity assessment based on the National Public Health Performance Standards Program (NPHPSP) process. From March through June 2011, Primetime Research and Evaluation developed methods to prioritize BCPH activities and measure its capacity to provide public health services according to Ten Essential Services developed by the NPHPSP. The outcomes of the process identified Obesity, Mental Health, and Substance Abuse as the three prioritized health needs. Response strategies for obesity include measuring BMI, increasing access to healthy foods, monitoring prevalence rates of vigorous activity, and track commuting patterns. Mental health issues will be addressed by monitoring suicide rates and attempted suicide rates, evaluating early childhood social and emotional development, and prevention efforts around post-partum depression. The efforts to prevent substance abuse include metrics such as binge drinking, age when alcohol is introduced, parental monitoring initiatives, marijuana use, and prescription drug use. Avista is committed to its relationship with BCPH and other community partners and will explore new methods to support and advance their efforts. COMMUNITY LEADER INTERVIEWS Rather than repeat a duplicative community engagement with the same stakeholders, Avista chose to utilize the community feedback obtained through BCPH s PHIP. Primetime Research and Evaluation conducted interviews with the BCPH PHIP Core Team, as well as selected BCPH employees and a variety of community stakeholders. The interviews consisted of a review of a list of 30+ health outcomes and were followed by a Avista Adventist Hospital- Community Health Needs Assessment

13 discussion of what the interviewee felt were the most important health outcomes to prioritize over the next five years. Primetime Research and Evaluation also completed the formal health system capacity assessment in Boulder County, which was conducted through a series of ten 3 hour meetings held during the month of May Each meeting focused on one of the Ten Essential Public Health Services. These meetings were conducted through facilitated focus groups consisting of 6 10 invited participants. These participants tasks were 1) to review the evaluation measures developed by the NPHPSP for that session s essential service, 2) participate in the group discussion about the health system s capacity and performance of that public health function, 3) come to a consensus on a rating score of the current capacity, and 4) to express concerns and provide recommendations for improvement. Participants selected for each meeting were chosen based on area of expertise or interest and relationship to the essential service to be discussed. Invitations were sent to a broad range of key partners from the local public health agency, state service agencies, community based organizations, academic institutions, hospitals, school systems, foundations, law enforcement agencies, and non profit organizations. Additionally, invitations were sent to people in local governmental or quasi governmental entities including first responders, elected officials, social service providers, administrators, diversity advocates, and others. Invitations were also extended to individuals in the business community, media, and judicial institutions. Approximately 70 key participants (6 10 per meeting) responded to the request to participate in the assessment sessions. Organizations that were represented included: Avista Adventist Hospital 20 th Judicial District Board of County Commissioners Boulder Community Hospital Boulder County Aging Services Boulder County Attorney Boulder County Community Services Boulder County Emergency Operations Center Boulder County Healthy Kids Boulder County Housing and Human Services Boulder County Judicial System Boulder County Kid Connects Boulder County Land Use Boulder County Medical Society Boulder County Public Health Boulder County Sheriff Boulder Valley School District Boulder Valley Women s Health Center Carriage House City of Boulder City of Longmont Civic Forum Clinica Family Health Services Avista Adventist Hospital- Community Health Needs Assessment

14 Colorado Department of Public Health and Environment Colorado School of Public Health Colorado Statewide Parent Coalition Community Action Program Community Foundation Early Childhood Council of Boulder County Emergency Family Assistance Association Environmental Defense Environmental Protection Agency Exempla Foothills United Way Head Start Healthy Youth Alliance Imagine! Kaiser Permanente LiveWell Longmont Longmont Police Longmont United Hospital Mental Health Partners OUR Center Parenting Place Regis University Saint Benedict Salud Community Health Center St. Vrain Valley School District United Church of Christ University of Colorado University of Northern Colorado Whole Foods Those involved in Avista Adventist Hospital s community health needs assessment also include: Boulder County Public Health (BCPH)- Represented by Heath Harmon, Director of Health Programs** Works to protect, promote, and enhance the health and well-being of all people and the environment in Boulder County. Under the direction of the Boulder County Board of Health, the department s 200+ staff and numerous volunteers/interns provide services in several BCPH divisions housed within six sites to address the diverse public health needs of our community The Boulder County Civic Forum- Represented by Morgan Rogers, Program Director* and Max Taffet, Program Research Associate* Promotes healthy decision making that will sustain the environmental quality, economic vitality and livability of the Boulder County region through information, research, education and dialogue. Its goals are to articulate a vision for healthy Boulder County communities, Avista Adventist Hospital- Community Health Needs Assessment

15 measure progress toward that vision through a biennial community indicators report and an updated website, inform and educate the public and decision makers about issues of interest and concern, identify community assets and opportunities for strategic action, convene dialogues and partnerships to address key issues through collaboration, advocate for systemic community change to create lasting solutions, and assess the impact of these actions. Clinica Family Health Services- Represented by Susan Wortman, Development Director** Clinca has five locations in the local area. They provide a full spectrum of family health care services including wellness services, health information, immunizations, and comprehensive pregnancy services. They serve 41,000 patients annually through 200,000 visits to a patient population that consists of 97% of patients below 200% of the poverty level. Avista Adventist Hospital has a strong historical relationship with Clinica which includes financial support, inpatient care, and nationally recognized diabetes care management. * Person with special knowledge of or expertise in public health **Representative of medically underserved, low-income, and minority populations RANKING QUESTIONNAIRE In April and May 2012 Avista Adventist Hospital distributed their own health issues ranking questionnaire where participants were asked to rank several health issues using a scale of 1 to 5, with 1 meaning not a critical issue and 5 meaning a very critical issue. The questionnaire was distributed to various community stakeholders, including members of the hospital community benefit steering committee, patients upon their discharge from the hospital, and individuals visiting Clinica Family Services. Avista collected and analyzed numerous completed questionnaires for consideration in the prioritization process. 2B II INFORMATION GAPS BCPH went through an exhaustive and valid process for identifying community health needs and Avista is confident that the combination of that process, the hospital s long-lasting partnership with the Community Foundation and the Civic Forum, and the recent health needs assessment tool gives Avista accurate insights into the genuine health needs of the local community. However, as with any research, there are potential information gaps for minority segments of the population struggling for representation, but the strong partnership Avista shares with Clinica Family Health Services minimizes that potential representation gap. As the implementation strategies evolve it will be important to continually evaluate any additional information obtained specifically around the priority areas of access and diabetes to maximize effectiveness of interventions. Obtaining more specific data narrowly focused on zip codes and census tracts will also be valuable. 2C HEALTH NEEDS OF THE COMMUNITY 2C I PROCESS TO IDENTIFY AND PRIORITIZE NEEDS Avista Adventist Hospital- Community Health Needs Assessment

16 Avista formed a Community Benefit Advisory Committee which included the hospital CEO, hospital senior leadership, a hospital community board member, and strategic community stakeholders representing both the Boulder County Civic Forum and the Boulder County Health Improvement Collaborative (BCHIC). This group studied the data and their objectives were to leverage historical successes, renew community partnerships and validate the current understanding of the community health needs and the strategies that impact them. Through analysis that took into account quantifiable data from the Colorado Department of Public Health and Environment (CDPHE) and Boulder County Public Health (BCPH), qualitative information from the ranking questionnaire, and the historical experience from community stakeholders, the Advisory Committee identified six needs. The process of prioritization involved ranking the issues based on quantitative and qualitative needs and the issues with the greatest needs were prioritized highest to lowest. 2C II PRIORITIZED LIST AND DESCRIPTION OF COMMUNITY HEALTH NEEDS 1. Access to Health Services- Access is a critical component of achieving and maintaining good health. The ability to access health care is influenced significantly by the presence of health insurance. Lack of health insurance is correlated with a decline in health screening rates, delayed medical consultation for adverse health conditions, advanced disease progression and higher mortality rates. 2. Diabetes- With the recent increases and future projected increases in the incidence of type 2 diabetes mellitus and with the incidence increasing in teenagers and young adults, the already substantial public health effect of diabetes will become greater in years to come. 3. Mental Health- Avista doesn t just recognize the importance of physical health. Treating mental health is just as important to an individual s overall wellbeing. Monitoring suicide rates, attempted suicide rates, evaluating early childhood social and emotional development, and prevention efforts around post-partum depression are all necessary steps that need to be taken to improve the overall mental health of the community. According to NIMH, Suicide rates are up from Substance Abuse- Education around substance abuse is necessary for a healthier community. The statistics around the effects of substance abuse are staggering. The National Institute on Drug Abuse reports that $96 billion in healthcare costs annually are associated to tobacco use, $30 billion to alcohol and $11 billion to illicit drugs. 5. Obesity- Obesity has become an epidemic in the United States. According to the CDC, over 1 in every 3 Americans are obese. In fact, medical costs due to obesity were about $147 billion dollars in Increasing access to healthy foods, monitoring prevalence rates of vigorous activity, and tracking commuting patterns ensures a healthier community. 6. Immunizations- As a healthcare organization it isn t enough to just treat disease and illness. Immunizations can prevent an individual from getting sick in the first place, saving resources for less preventative ailments. 2C III HEALTHCARE RESOURCES AVAILABLE IN THE COMMUNITY TO MEET THE NEEDS Healthcare Workforce: Dentists 275 Nurse Practitioners 184 Physicians 1,186 Physician Assistants 168 Psychologists 294 Registered Nurses 3,020 Avista Adventist Hospital- Community Health Needs Assessment

17 Health care utilization profile, HSR 16 and Colorado, HSR 16 Colorado Health care utilization1 Visited an emergency room in the past year 20.4% 24.3% Visited a primary care physician in the past year 94.5% 90.9% Deferred medical care due to cost Insured 18.6% 16.9% Uninsured 58.3% 43.7% Usual source of care2 A doctor's office or private clinic 79.3% 76.1% A community health center or other public clinic 11.0% 11.8% A retail clinic like Wal-Mart 0.6% 0.2% A hospital emergency room 2.8% 4.7% An urgent care center 2.3% 3.2% Certified Nurse Aides 1,156 Certified Nurse Midwives 30 Clinical Social Workers 477 Dental Hygienists 177 Licensed Practical Nurses 410 Nursing Home Administrators 10 Occupational Therapists 172 Optometrists 72 Pharmacists 307 Physical Therapists 428 Podiatrists 13 Psychiatric Technicians for the Mentally Ill 1 Psychiatric Technicians for the Developmentally Disabled 0 Respiratory Therapists 106 Social Workers 38 Avista Adventist Hospital- Community Health Needs Assessment

18 Some other place 3.9% 3.5% Does not go to one place most often 0.1% 0.4% area for Avista Adventist Hospital are two other acute care hospital facilities: Within the main service Good Samaritan Medical Center: Good Samaritan Medical Center, part of Exempla Healthcare, is a full service acute care hospital in Boulder County. The medical specialties include emergency and level III trauma care, cardiology, oncology, orthopedics, surgical services, women s and children s services and neurology. 200 Exempla Circle, Lafayette, Colorado Boulder Community Hospital: Boulder Community Hospital is a 159 bed hospital. It offers emergency services, cardiology, orthopedic, and neurological services. It also operates Foothills Hospital Campus a 60 bed hospital which offers women s and children s services Balsam Street, Boulder, CO Another significant stakeholder and community partner is Clinica Family Health Services with five locations in the local area. They provide a full spectrum of family health care services including wellness services, health information, immunizations, and comprehensive pregnancy services. They serve 41,000 patients annually through 200,000 visits to a patient population that consists of 97% of patients below 200% of the poverty level. Avista Adventist Hospital has a strong historical relationship with Clinica which includes financial support, inpatient care, and nationally recognized diabetes care management. 3 CONTACT INFORMATION Avista Adventist Hospital 100 Health Park Drive Louisville, CO Avista Adventist Hospital- Community Health Needs Assessment