Mercy Medical Center Redding 2014 Community Health Needs Assessment Report

Mercy Medical Center Redding 2014 Community Health Needs Assessment Report

Table of Contents Mission Statement... 3 Dignity Health Mission Statement Definition of Community... 3 Community Needs Index... 4 Community Health Needs Assessment (CHNA) Process... 5 Health Areas of Opportunity... 6 Prioritizing Needs... 6 Attachments A Assessment Data for Priority Areas... 8 B Community Need Index Map... 21 2 P a g e

Mercy Medical Center Redding Mercy Medical Center Redding (MMCR) serves a primary service area comprised of zip codes in Redding and surrounding communities in Shasta, Tehama and Trinity County. Portions of Shasta County and all of Trinity County are federally designated as Medically Underserved Areas and Populations. Due to the recession there has been a growing need for services provided to the un-/underinsured. Insurance coverage estimates for 2014 showed a total of 39% of individuals in Mercy Redding s PSA are either uninsured (17.3%) or have Medi-Cal (21.7%) coverage. People are often turning to the Emergency Department for basic non-acute medical services. To respond effectively to these needs requires collaborative problem solving. Nonprofit organizations need to work together to leverage resources and maximize health assets in innovative ways to enhance existing programs and ensure sustainable health programs and services are available over the long-term. Community-based collaboration will be a priority for Mercy Medical Center Redding and will help drive community benefit efforts in the future. Mission Statement Dignity Health is committed to furthering the healing ministry of Jesus. We dedicate our resources to: delivering compassionate, high-quality, affordable health services; serving and advocating for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life. Description of the Community Served by the Hospital: Mercy Medical Center Redding (MMCR) serves a primary service area comprised of zip codes in Redding and surrounding communities in Shasta, Tehama and Trinity County. Portions of Shasta County and all of Trinity County are federally designated as Medically Underserved Areas and Populations (full California map is included in Attachment C). Due to the recession there has been a growing need for services provided to the un-/underinsured. Insurance coverage estimates for 2014 showed a total of 39% of individuals in Mercy Redding s PSA are either uninsured (17.3%) or have Medi-Cal (21.7%) coverage. People are often turning to the Emergency Department for basic non-acute medical services. To respond effectively to these needs requires collaborative problem solving. Nonprofit organizations need to work together to leverage resources and maximize health assets in innovative ways to enhance existing programs and ensure sustainable health programs and services are available over the longterm. Community-based collaboration will be a priority for Mercy Medical Center Redding and will help drive community benefit efforts in the future. 3 P a g e

MMCR defined the community by using the primary service area definition that was provided by the Hospital s Business Development and Strategic Planning department. MMCR s primary service area demographics are listed below: Population: 209,900 Diversity: o Caucasian 79.6% o Hispanic 11.0% o Asian & Pacific Islander 2.7% o African American 1.0% o American Indian/Alaska Native 2.1% o 2+ Races 3.5% o Other 0.1% Median Income: $42,518 Uninsured: 17.3% Unemployment: 10.9% No HS Diploma: 12.0% Renters: 33.6% CNI Median Score: 3.8 Medi-Cal Patients: 21.7% Other Area Hospitals: Shasta Regional Medical Center Community Need Index The Community Need Index (CNI) is a tool used by Dignity Health facilities to measure community need in a specific geography by analyzing the degree to which a community has the following health care access barriers: Income Barriers, Educational Barriers, Cultural Barriers, Insurance Barriers, and Housing Barriers. By using statistical modeling, the combination of above barriers results in a score between 1 (less needy) and 5 (most needy). Analysis has indicated significant correlation (96%) between the CNI and preventable hospital admissions. Communities ranked as scoring a 5 are more than twice as likely to need inpatient care for preventable conditions (ear infection, etc.) than communities with a score of 1. The CNI map is listed in Appendix B and identifies areas in Redding and surrounding areas with associated CNI scores. It is apparent that most of the zip codes within Shasta County are in need the most and represent areas of opportunity for Mercy Medical Center Redding to consider for specific community benefit s intervention strategies. 4 P a g e

How the Assessment was Conducted: MMCR is committed to involving and informing the residents of Shasta County in a Community Needs Assessment Survey process. A community health needs assessment (CHNA) is a systematic process involving the community, to identify and analyze community health needs in order to prioritize, plan and act upon unmet community health needs. An assessment is conducted every three years, most recently in 2014, and identifies the health needs of residents by acknowledging ongoing health concerns within the community. Through surveys and the evaluation of existing health related data, community benefit staff compiled a report inventorying community health priorities and provided recommendations for areas of intervention. MMCR conducted the 2014 CHNA at the facility level using community benefit staff to oversee the process. By conducting the CHNA at the facility level, the Hospital was able to gain a better insight into the needs of the community. MMCR took into consideration available internal and external resources and partnered with outside individuals and organizations as appropriate throughout the CHNA process. Based on this assessment, issues of greatest concern were identified and the Hospital determined the areas to commit resources to, thereby focusing outreach efforts to continually improve the health status of the community we serve. The CHNA process incorporated data from primary sources (survey) and secondary data research (vital statistics and other existing health-related data) relating to a wide array of community health indicators. Primary data was collected by using paper surveys and an identical web-based survey via Survey Monkey.com. We looked to our community partners to represent their respective communities in the survey process. The final survey instrument was developed by Mercy Medical Center Redding and Public Health and is similar to the previous surveys used in the region. The surveys were used to collect information from community members, stakeholders and providers for the purpose of understanding community perception of needs. The surveys were emailed to approximately 1,000 emails through a distribution list that the Hospital compiled and uses to disseminate health education materials. The Hospital distributed surveys to zip codes within the primary service area, including zip codes with disproportionate unmet health needs. There were 168 surveys completed for a return rate of approximately 16.8%. The following partners assisted the hospital in conducting the needs assessment: Mercy Medical Center Redding Advisory Council - This group of active community members represent all of the communities in our primary service area. They completed the survey in addition to participating in the priority setting process once the data was compiled. 5 P a g e

Shasta County Public Health In addition to providing assistance with the survey design, Public Health representatives distributed the surveys to their employees and clients. Secondary data was used to validate the information obtained from the surveys and was provided through the free web-based platform CHNA.org. This web-based tool was designed to assist hospitals in completing the CHNA at the local level in order to help reduce the costs incurred by Hospitals. The data provided through CHNA.org has aggregated data available from 7,000 public data sources, including the Centers for Disease Control and Prevention and the National Center for Chronic Disease Prevention and Health promotion. Once the primary and secondary data were collected and compiled, MMCR community benefit staff analyzed the data and compared it to prior assessments to determine the potential health areas of opportunity with the intent of building upon previous efforts. Health Areas of Opportunity After analyzing all of the information available, a list of eight focus areas became the Hospital s health areas of opportunity, many of which overlap. Listed below are the focus areas (any primary and secondary data available for these areas is listed in Attachment A): Access to Care Cancer Diabetes Heart Disease and/or Stroke Mental Health Obesity (lack of exercise and poor eating habits) Substance Abuse (alcohol and drug) Tobacco Use Prioritizing Needs: An essential component of the CHNA is to prioritize the health opportunities that are identified through the assessment process. MMCR carefully considered how to prioritize various community benefit initiatives. After the health opportunities were identified, they were ranked by a small committee comprised of a representative from a local community health collaborative and a representative of Shasta County Public Health. The ranking tool contained seven criteria with which to rank each health opportunity. Each criterion was assigned a specific weighted value. Definitions of the criteria used are listed below: 6 P a g e

High Incidence or Prevalence - Is the local rate/percent higher than the state or national rate/percent? Consider absolute numbers directly affected by the problem, as well as disproportionate rates among special populations (subgroups of age, sex, race/ethnicity, geographic region). Trending - What are the trends? Is the rate/percent increasing or decreasing over time? Severity of Problem/Consequences - Consider the degree to which the problem leads to death, disability or impairs one s quality of life. Also consider the risk of exacerbating the problem by not addressing at the earliest opportunity. Amenable to Intervention - Consider how likely it is that interventions will be successful in preventing or reducing the consequences of a problem. Keep in mind all types of intentions (e.g., community education, policy and/or organizational changes, etc.), the potential to reach populations at greatest risk, and the ability of the community at large to mobilize to support the intervention. In other words can we make a difference? Resources Available - Consider what programs are currently in place to address the problem, and consider the ability of organizations to reasonably impact the issue, given available resources. Costliness of Treatment of Problem/Consequences - Consider the financial costs of treating the problem; what costs might be saved by preventing or reducing the severity of the problem? Acceptability - Considering what the community feels is important, as it can mean greater community support later on. After the participants ranked each of the areas of opportunity, the results were compiled and further discussion ensued to select the areas that should be the focus for the next community benefit planning cycle (FY2015 FY2018). 7 P a g e

Attachment A - Assessment Data for Priority Areas of Opportunity: Top Health Concerns Respondents to the survey were asked to choose one health concern from a list of 21 options that they perceive as the number-one health concern in the community. The following bar chart represents the top eight reported health concerns (concerns that were less than 1% of answers are not included): 30% 25% 20% 15% 10% 5% 0% 27% 17% 11% 11% 10% 8% 5% 5% Top Health Risk Behaviors Still focused on the community as a whole, respondents were then asked to choose one behavioral health risk from a list of 13 that they perceive as the number-one behavioral health risk in the area. The following bar chart represents the top six reported health concerns (health risk behaviors that were less than 1% of answers are not included): 20% 15% 16% 15% 10% 8% 8% 5% 4% 3% 0% Poor Eating Habits Being Overweight Alcohol Abuse Lack of Exercise Tobacco Use Not Using Birth Control 8 P a g e

Access to Care Access to health services means the timely use of personal health services to achieve the best health outcomes. It requires 3 distinct steps: Gaining entry into the health care system. Accessing a health care location where needed services are provided. Finding a health care provider with whom the patient can communicate and trust. Access to health care impacts: Overall physical, social, and mental health status Prevention of disease and disability Detection and treatment of health conditions Quality of life Preventable death Life expectancy -Healthy People 2020 (www.healthypeople.gov) Shasta County Respondent Data The community health needs assessment shifted from a community focus back to individual health issues, asking respondents questions regarding their ability to access health services or providers. The graphs below list the data collected from the responses. 10 In the Past 12 months, was there a time that you needed to see a doctor but were unable to? 8 6 4 2 12.73% Yes 87.27% No 10 5 If you answered "yes" to the previous question, please specify why 57.14% Did not have health insurance 42.86% Health Lack of insurance was transportation not accepted 9 P a g e

In order to identify how healthcare resources are utilized in the area, respondents were asked where they seek healthcare services in the community. The majority reported seeking care in a doctor s office, followed by urgent care, hospital emergency department, and clinics. The graph below shows the data collected for the various locations respondents seek medical care in the community: 10 8 6 When you are sick or need advice regarding your health, which of these places do you seek care? 9 4 35.00% 2 11.88% Hospital or ER Urgent Care/Walk-In Clinic Doctors Office 6.25% Clinic 0.63% 1.25% Hospital Outpatient Clinic Military or Other VA Healthcare CHNA.org Data 10 P a g e

Cancer Continued advances in cancer research, detection, and treatment have resulted in a decline in both incidence and death rates for all cancers. Among people who develop cancer, more than half will be alive in 5 years. Yet, cancer remains a leading cause of death in the United States, second only to heart disease. In the coming decade, as the number of cancer survivors approaches 12 million, understanding survivors health status and behaviors will become increasingly important. Many cancers are preventable by reducing risk factors such as: Use of tobacco products Physical inactivity and poor nutrition Obesity Ultraviolet light exposure -Healthy People 2020 (www.healthypeople.gov) Shasta County Respondent Data 18.00% of respondents reported being diagnosed with cancer. The following graphs represent the percentage of individuals that have been screened for specific types of cancer within the last 12 months. 5 % of individuals screened for specific cancers 49.50% 4 35.56% 3 2 1 6.72% 5.97% Prostate Exam Colonoscopy Mammogram Pap Smear 11 P a g e

CHNA.org Data Diabetes Diabetes affects an estimated 23.6 million people in the United States and is the 7th leading cause of death. Diabetes: Lowers life expectancy by up to 15 years. Increases the risk of heart disease by 2 to 4 times. Is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. In addition to these human costs, the estimated total financial cost of DM in the United States in 2007 was $174 billion, which includes the costs of medical care, disability, and premature death. -Healthy People 2020 (www.healthypeople.gov) Shasta County Respondent Data 2 Diabetes 2 15.00% 1 5.00% Diabetes - Type 1 (Insulin Dependent) Diabetes - Type 2 (Non-Insulin Dependent) 1.89% Diabetes limits activities 12 P a g e

CHNA.org Data Heart Disease and/or Stroke Heart disease is the leading cause of death in the United States. Stroke is the third leading cause of death in the United States. Together, heart disease and stroke are among the most widespread and costly health problems facing the Nation today, accounting for more than $500 billion in health care expenditures and related expenses in 2010 alone. Fortunately, they are also among the most preventable. The leading modifiable (controllable) risk factors for heart disease and stroke are: High blood pressure High cholesterol Cigarette smoking Shasta County Respondent Data Diabetes Poor diet and physical inactivity Overweight and obesity -Healthy People 2020 (www.healthypeople.gov) 28.92% of respondents reported being diagnosed high blood pressure and 26.22% reported being diagnosed with high cholesterol. The following graphs represent the percentage of individuals that reported been diagnosed with angina or coronary artery disease, congestive heart failure, and heart attack. No respondents reported having a stroke; however the sample size for this assessment was small. 8.00% 7.00% 6.00% 4.00% 4.00% 3.00% 2.00% Angina or Coronary Congestive Heart Failure Heart Attack Stroke 13 P a g e

CHNA.org Data Mental Health Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges. Mental health is essential to personal well-being, family and interpersonal relationships, and the ability to contribute to community or society. 14 P a g e

Mental health and physical health are closely connected. Mental health plays a major role in people s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person s ability to participate in treatment and recovery. -Healthy People 2020 (www.healthypeople.gov) Shasta County Respondent Data 28.83% of respondents reported feeling depressed or sad for most days for 2 years or more prior to this assessment and 53.05% reported seeking help from a professional for a mental or emotional problem. CHNA.org Data 15 P a g e

Obesity (lack of exercise and poor eating habits) Diet and body weight are related to health status. Good nutrition is important to the growth and development of children. A healthful diet also helps Americans reduce their risks for many health conditions including: Overweight and obesity Type 2 diabetes Malnutrition Osteoporosis Iron-deficiency anemia Oral disease Heart disease Constipation High blood pressure Diverticular disease Dyslipidemia (poor lipid profiles) Shasta County Respondent Data Some cancers -Healthy People 2020 (www.healthypeople.gov) Respondents self-reported their weight status using the terms: very underweight, slightly underweight, about the right weight, slightly overweight, and very overweight (graph below) and 5.71% indicated that their weight limits their activities. In regards to physical activity, 65.29% of the respondents did not meet the CDC guideline 150 minutes of moderate-intensity aerobic activity in the week prior to the survey. A healthy diet was measured by the number of fruits and vegetables consumed and 88.8% of respondents did not meet the recommended minimum of 5+ servings of fruits and vegetables in the week prior to the survey. 6 Self-Reported Weight Status 54.88% 5 4 3 2 1 6.10% 2.44% 26.83% Very Slighty About the underweight underweight right weight Slighty overweight 15.24% Very overweight 16 P a g e

CHNA.org Data Substance Abuse (alcohol and drug) Substance abuse has a major impact on individuals, families, and communities. The effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public health problems. These problems include: 17 P a g e

Teenage pregnancy Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) Other sexually transmitted diseases (STDs) Domestic violence Shasta County Respondent Data Child abuse Motor vehicle crashes Physical fights Crime Homicide Suicide -Healthy People 2020 (www.healthypeople.gov) Due to the fact that data collected is self-reported, there was only information provided by respondents was for alcohol use. Respondents reported how many days they drank alcoholic beverages in the month prior to the survey and on days they drank, how many drinks did they consume. 4 3 How Many Days in the Past Month? 34.34% 31.33% 2 1 15.06% 9.04% 10.24% None 1 to 5 6 to 14 15 to 24 25 to 30 7 6 5 4 3 2 1 How Many Drinks per Day? 65.75% 23.97% 9.59% 0.68% None 1 to 2 3 to 5 6 to 8 9 to 10

CHNA.org Data Tobacco Use Scientific knowledge about the health effects of tobacco use has increased greatly since the first Surgeon General s report on tobacco was released in 1964. Tobacco use causes: Cancer Heart disease Lung diseases (including emphysema, bronchitis, and chronic airway obstruction) Premature birth, low birth weight, stillbirth, and infant death There is no risk-free level of exposure to secondhand smoke. Secondhand smoke causes heart disease and lung cancer in adults and a number of health problems in infants and children, including: Severe asthma attacks Respiratory infections Ear infections Sudden infant death syndrome (SIDS) Smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth and gums, periodontitis, and tooth loss. Cigar use causes cancer of the larynx, mouth, esophagus, and lung. -Healthy People 2020 (www.healthypeople.gov) Shasta County Respondent Data Respondents self-reported that 94.55% did not smoke cigarettes. 5.45% of respondents smoked every day or some days. There were follow-up questions which included asking about chewing tobacco and electronic cigarettes and there were no responses for either of those questions. 19 P a g e

CHNA.org Data Next steps Mercy Medical Center Redding will establish implementation strategies for priority areas and community benefit staff is committed to: Researching what other local organizations are doing to address the priorities Developing a work plan to address priorities as appropriate Establishing metrics with measurable outcomes or outputs Coordinating work with other departments as appropriate Communicating with the community at large 20 P a g e

Attachment B - Mercy Medical Center Redding Community Needs Index (CNI) Map 1-1.7 Lowest Need 1.8-2.5 2 nd Lowest 2.6-3.3 Mid 3.4-4.1 2 nd Highest 4.2-5 Highest Need Zip Code CNI Score Population City County State 96001 4 34,342 Redding Shasta California 96002 4.2 32,992 Redding Shasta California 96003 3.6 45,650 Redding Shasta California 96007 4.4 23,666 Anderson Shasta California 96013 4.4 4,851 Burney Shasta California 96019 4.6 10,135 Shasta Lake Shasta California 96022 3.4 16,279 Cottonwood Tehama California 96073 2.4 3,932 Palo Cedro Shasta California 96080 4.4 27,912 Red Bluff Tehama California 96088 3.4 4,989 Shingletown Shasta California 96093 3.6 3,654 Weaverville Trinity California CNI MEDIAN SCORE: 3.8 21 P a g e