Community Health Needs Assessment FY 2013
Contents Introduction...1 Executive Summary... 1 Organization Description... 3 How the Assessment was Conducted...4 Community Served by the Hospital...5 Identification and Description of Geographical Community... 5 Defined Community or Service Area... 5 Community Population and Demographics... 5 Socioeconomic Characteristics of the Community... 5 Income, Poverty and Unemployment... 6 Uninsured Status... 6 Education... 6 Community Health Care Resources... 6 Hospitals... 6 Ambulatory Care Clinics... 6 Other Licensed Facilities...7 Physicians... 7 Health Departments... 7 Health Status of the Community...7 Leading Causes of Death... 8 Primary Health Conditions Responsible for Inpatient Hospitalization... 8 Health Outcomes and Factors...8 Health Statistics and Rankings... 8 Primary Data...10 Community Input-Surveys... 10 Health Issues of Uninsured Persons, Low-Income Persons and Minority Groups... 10 Violence in the Community... 10
Contents (continued) Priority Community Health Needs Identified...11 Appendix...14
Introduction During 2012, a community health needs assessment was conducted by Jewish Hospital Shelbyville to support its mission to enhance the health of people in the communities it serves, to comply with the Patient Protection and Affordable Care Act of 2010 and federal tax-exemption requirements, and to identify health needs of the community to help prioritize the allocation of hospital resources to meet those needs. Based on current literature and other guidance from the Treasury and IRS, the following steps were completed as part of the community health needs assessment: The community served was defined utilizing inpatient data on patient origin. This process is further described in Community Served by the Hospital. Population demographics and socioeconomic characteristics of the community were gathered and reported using various sources (see references in Appendices). The health status of the community was then reviewed. Information on the leading causes of death and morbidity was analyzed in conjunction with health outcomes and factors reported for the community by CountyHealthrankings.org. Health factors with significant opportunity for improvement were noted. An inventory of health care facilities and resources was prepared. Through a collaborative process conducted by the North Central District Health Department, Jewish Hospital Shelbyville, Baptist Hospital Northeast, and other community organizations, community input was obtained through a series of meetings and survey. Information gathered in the steps above was analyzed and reviewed to identify health issues of uninsured persons, low-income persons and minority groups and the community as a whole. Health needs were prioritized utilizing a method that weighs: 1) the size of the problem; 2) the seriousness of the problem; 3) the impact of the problem on vulnerable populations; 4) how important the problem is to the community; 5) prevalence of common themes; 6) how closely the need aligns with the strategies and strengths of the hospital and KentuckyOne Health; and 7) an evaluation of existing hospital programs responding to the identified need. Information gaps were identified during the prioritization process and reported. The hospital engaged BKD, LLP to assist with compiling secondary data and prioritizing identified health needs. Executive Summary In collaboration with other community health partners, Jewish Hospital Shelbyville has identified community health needs by undergoing an assessment process. More than 1,800 residents provided input through a survey (paper and online, English and Spanish). Another 25 community leaders and health professionals shared their expertise at a special community forum. In addition, secondary data was compiled from demographic and socioeconomic sources as well as national, state and local sources of information on disease prevalence, health indicators, health equity and mortality. From a compilation of information, Jewish Hospital Shelbyville leaders entered into a dialogue with other key community partners, to discuss the results of the evaluation/health priorities and consensus was reached. The process identified the following issues with scores of 14 or more (on a scale of 28): Page 1
Cancer Heart disease Stroke Adult smoking Adult obesity Chronic lower respiratory disease Physical inactivity Doctors Office Hours Limited Access to Healthy Foods Diabetes Uninsured Children in Poverty Substance abuse With an understanding that collaborative efforts have the greatest opportunity for measurable, collective impact, Jewish Hospital Shelbyville has worked in partnership with the local North Central District Health Department. Through the implementation of the community s MAPP (Mobilizing for Action through Planning and Partnerships) assessment and plan, we envision a community-wide culture where healthy eating and active living are the norm. In addition, the hospital is partnering with the Kentuckiana Regional Planning & Development Agency (KIPDA) and the University of Louisville Kent School of Social Work through their CDC funded Rural Diabetes Coalition and grant to help with the prevention and management of this and other chronic diseases. Together, we believe our combined efforts will help achieve a community focus on increased physical activity, better nutrition, healthy public policy and access to needed resources. NCDHD Shelby MAPP/Diabetes Coalition Priorities Correlated Community Health Need Substance Abuse Adult Smoking Substance Abuse Healthy Eating and Active Living Access to Services Adult Obesity Heart Disease Physical Inactivity Limited Access to Healthy Foods Doctors Office Hours Children in Poverty Uninsured Prevention and Management of Chronic Illness Diabetes Cancer Heart Disease Stroke Jewish Hospital Shelbyville will continue to work with the community to execute an implementation plan to realize goals to address these identified health needs. Page 2
Organization Description Jewish Hospital Shelbyville has provided comprehensive, high-quality services to the people of Shelby, Henry and Spencer counties for more than 100 years. Located just 30 minutes east of downtown Louisville, the 42-private bed community hospital provides a full range of comprehensive services including 24/7 emergency care, critical care, state of the art diagnostic imaging, cardiac & pulmonary rehabilitation, general and specialized surgery, physical therapy, occupational therapy and speech language pathology, pain management, sleep medicine, and wound care. Founded in 1906 by the King s Daughters & Sons Organization, the hospital was originally located on Henry Clay Street in downtown Shelbyville. In 1954, the community opened a new facility in what was then the far western part of Shelby County, offering growth in space and new services. In the late 1980 s, Jewish Hospital HealthCare Services began management of the hospital and in 1992 purchased the facility. Since that time, the Jewish Hospital organization has invested over $45 million in facility updates and new services. In 2009, the hospital completed a $2 million dollar expansion of its Emergency Department, doubling the size of the space to accommodate growing community need. Thanks to the generosity of the Canadian Harland D. Sanders Foundation & Charitable Trust and local community donors, the hospital now boasts a modern Emergency Department, including 13 private treatment rooms, a state-of-the art trauma room, bedside registration and other new equipment. Members of the Sanders Foundation commissioned the making of a bronze statue of Colonel Harland Sanders which now greets guests as they arrive at the hospital facility. Colonel Sanders and his wife, Claudia, were residents of Shelbyville and supporters of the local hospital. In 2012, Jewish Hospital Shelbyville, along with the Jewish Hospital & St. Mary s HealthCare merged with Saint Joseph Health System forming KentuckyOne Health, the Commonwealth s largest health system with more than 200 locations including hospitals, outpatient facilities and physician offices, and more than 3,100 licensed beds. An 18-member volunteer board of directors governs KentuckyOne Health, its facilities and operations, including Jewish Hospital Shelbyville, with this mission: Our Purpose To bring wellness, healing and hope to all, including the underserved. Our Future To transform the health of communities, care delivery and health care professions so that individuals and families can enjoy the best of health and wellbeing. Our Values Reverence: Respecting those we serve and those who serve. Integrity: Doing the right things in the right way for the right reason. Compassion: Sharing in others joys and sorrows. Excellence: Living up to the highest standards. Page 3
The new organization is investing in an integrated electronic health record system and other IT improvements, as well as facility, equipment and telehealth investments in communities across the state. While guided by the KentuckyOne Health Board, Jewish Hospital Shelbyville remains strongly connected to its community through a local Advisory Council of business and community leaders. The hospital also recently launched a new Patient and Family Advisory Council. How the Assessment was Conducted Jewish Hospital Shelbyville collaborated with the North Central District Health Department, Baptist Hospital Northeast and other community leaders to conduct the Community Health Needs Assessment. Members of the general public were asked to complete a survey on their perceptions of the community s health care needs. The survey was available in English and Spanish and covered a broad range of topics from access to health care to perception about the most pressing health care needs. Over 2,000 surveys were completed. The survey were distributed online and through paper surveys, made available in both English and Spanish. A forum was conducted by NCDHD on August 23, 2012, tailored to gather input from community leaders and health professionals. It was attended by 30 individuals representing a wide array of expertise. The appendix includes a list detailing the organizations represented at this forum as well as the survey tool used to solicit community input. In addition, secondary data was compiled from demographic and socioeconomic sources as well as national, state and local sources of information on disease prevalence, health indicators, health equity and mortality. Page 4
Community Served by the Hospital Identification and Description of Geographical Community In the heartland of the bluegrass, Shelby County is located on Interstate 64 between Louisville and Lexington. Shelbyville is the largest city and county seat of Shelby County with population of just over 42,000. Because the community is 30 minutes from downtown Louisville, the county is considered part of Metro Louisville MSA. Besides Jefferson County, Shelby County is surrounded by Henry, Franklin, Anderson, Spencer and Oldham counties. Defined Community or Service Area A community is defined as the geographic area from which a significant number of the patients utilizing hospital services reside. While the community health needs assessment considers other types of health care providers, hospitals are the single largest provider of acute care services. For this reason, the utilization of hospital services provides the clearest definition of the community. Jewish Hospital Shelbyville defines its service area for this community health needs assessment based on where the majority of its inpatients reside. Based on the patient origin of inpatient discharges from January to December 30, 2011, management has identified the community as listed on Exhibit 1 representing patient origin of the top zip codes in its community. A demographic snapshot for Shelby County is provided in Exhibit 2. This community health needs assessment relies on county-level data. Because almost 80 percent of Jewish Hospital Shelbyville s discharges originate in Shelby County, the hospital collaborated with the North Central District Health Department in conducting its community health needs assessment. The North Central District Health Department also serves populations in Henry and Spencer counties and plans are in place to expand the survey and needs assessment to those counties as soon as the Shelby County plan is complete. Jewish Hospital Shelbyville receives approximately 10% of admissions from both Spencer and Henry counties. They are considered to be a part of the hospital s primary service area and select data from those counties have been included in this report. Community Population and Demographics Jewish Hospital s primary service area is comprised of three counties: Shelby, Henry and Spencer. Almost 80 percent of the hospital s discharges come from Shelby County. Exhibit 2 shows the demographics and socioeconomic characteristics of Jewish Hospital Shelbyville s primary service area for the most recent period available. Of particular note, Shelby County s growing Hispanic population has reached 9.1% of population, the highest population of Hispanics by percentage in the state of Kentucky. Socioeconomic Characteristics of the Community The socioeconomic characteristics of a geographic area influence the way residents access health care services and perceive the need for them. The economic status of an area may be assessed by examining multiple variables within the community. The following exhibits are a compilation of data that includes household income, poverty, unemployment rates and educational attainment for the community served by Jewish Hospital Shelbyville. These standard measures will be used to compare the socioeconomic status of the counties served internally as well as to the state. Page 5
Income, Poverty and Unemployment Exhibit 5 presents the median household income, population in poverty and the unemployment rate for Shelby, as well as Henry and Spencer counties. Median household incomes range from $42,506 to $61,921. Henry County has the highest level of population in poverty at 18.5%, which is just below the state percentage of 18.98. Exhibit 6 presents the average annual resident unemployment rates for counties in Jewish Hospital Shelbyville s defined community illustrating that unemployment rates for all counties have risen in recent years. Uninsured Status Exhibit 7 presents health insurance coverage status by age (under 65 years) and income (at or below 400 percent of poverty) for Shelby, Henry and Spencer counties as compared to the state of Kentucky. Education The educational attainment of community residents may impact the local economy. Higher levels of education generally lead to higher wages, less unemployment and job stability. These factors may indirectly influence community health. Exhibit 8 indicates Shelby County residents obtain a bachelor s degree or higher at rates higher than state averages, but below national averages; in Henry County, only 13.8% of residents obtain advanced education, which is considerably lower than the state average and about half the national average. Spencer County ranks below both state and national averages as well. Community Health Care Resources The availability of health care resources is critical to the health of a county s residents. A limited supply of health resources, especially providers, results in poorer health status of the community. In addition, the limited capacity of the health care delivery system to absorb charity and indigent care as there are fewer providers upon which to distribute the burden of indigent care. Shelby and Spencer counties have transitioned over the years from rural communities to cities considered suburban to Metro Louisville. While Louisville offers a variety of health care facilities and providers, transportation to receive those services is often unavailable. Henry County remains a rural community. The next section addresses the availability of health care resources to the residents of Jewish Hospital Shelbyville s service area. Hospitals Jewish Hospital Shelbyville is the only licensed acute care facility in Shelby County. Baptist Hospital Northeast, a 120 bed acute care hospital in Oldham County, Kentucky, also considers Henry County to be a part of their primary service area. Spencer County is considered part of the primary service area of several Louisville hospitals, as well as Jewish Hospital Shelbyville. Exhibit 9 summarizes hospital services available in the Shelby, Henry and Spencer counties. In 2011, nearly 80% of Jewish Hospital Shelbyville patients were from Shelby County, representing roughly 26% of all hospitalizations from Shelby County (excluding OB). Approximately 48% of Henry County hospitalizations and 33% of Spencer County hospitalizations were to the Baptist Hospital system. Ambulatory Care Clinics Kentucky reports 20 ambulatory care clinics in the state. There are no ambulatory care clinics in Shelby, Henry or Spencer counties. Page 6
Other Licensed Facilities There are licensed facilities other than hospitals in Shelby, Henry and Spencer counties. These facilities include home health, day care, rehabilitation agencies and private duty nursing providers. A complete inventory may be obtained through the Kentucky Cabinet for Health and Family Services at http://chfs.ky.gov/ohp/con/inventory.htm. Physicians According to the Kentucky Board of Medical Licensure and the Kentucky Board of Dentistry, Shelby County ranks lower per 1,000 population than state average of primary care physicians (.5 to 1), specialist physicians (.5 to 1.4) and dentists (.5 to.6). Health Departments The North Central District Health Department is the only such agency that serves Shelby, Henry and Spencer counties. As stated earlier, Jewish Hospital Shelbyville collaborated with the NCDHD to conduct its community health needs assessment as the majority of patients originate in Shelby County. The North Central District Health Department has been a driving force to improve the health and well-being of the citizens of Shelby, Henry, Spencer and Trimble counties. In addition to health services, NCDHD has an environmental services branch that provides inspection of and support on septic systems, food services, rabies control, radon information, water sample analysis and more. Health services include: WIC, immunizations, family planning, pregnancy tests, head lice checks, cancer screens, sexually transmitted infection testing, tuberculosis testing, diagnosis and treatment and well-child exams. Health Status of the Community This section of the assessment reviews the health status of Shelby County residents. As in the previous section, comparisons are provided with the state of Kentucky and the United States. This in-depth assessment of the mortality and morbidity data, health outcomes, health factors and mental health indicators of Shelby County residents that make up the community will enable Jewish Hospital Shelbyville to identify priority health issues related to the health status of its residents. Good health can be defined as a state of physical, mental, and social well-being, rather than the absence of disease or infirmity. According to Healthy People 2010, the national health objectives released by the U.S. Department of Health and Human Services, individual health is closely linked to community health. Community health, which includes both the physical and social environment in which individuals live, work and play, is profoundly affected by the collective behaviors, attitudes and beliefs of everyone who lives in the community. Healthy people are among a community s most essential resources. Numerous factors have a significant impact on an individual s health status: lifestyle and behavior, human biology, environmental and socioeconomic conditions, as well as access to adequate and appropriate health care and medical services. Studies by the American Society of Internal Medicine conclude that up to 70 percent of an individual s health status is directly attributable to personal lifestyle decisions and attitudes. People who do not smoke, who drink in moderation (if at all), use automobile seat belts (car seats for infants and small children), maintain a nutritious low-fat, high-fiber diet, reduce excess stress in daily living and exercise regularly have a significantly greater potential of avoiding debilitating diseases, infirmities and premature death. The interrelationship among lifestyle/behavior, personal health attitude and poor health status is gaining recognition and acceptance by both the general public and health care providers. Page 7
Health problems should be examined in terms of morbidity as well as mortality. Morbidity is defined as the incidence of illness or injury and mortality is defined as the incidence of death. However, the law does not require reporting the incidence of a particular disease, except when the public health is potentially endangered. Due to limited morbidity data, this health assessment relies heavily on death and death rate statistics for leading causes in death. Such information provides useful indicators of health status trends and permits an assessment of the impact of changes in health services on a resident population during an established period of time. Community attention and health care resources may then be directed to those areas of greatest impact and concern. Leading Causes of Death Records from Kentucky Vital Statistics and reported by the State Data Center indicate that heart disease is the number one cause of death in Shelby County, accounting for 27 percent of all deaths. In addition to cancer, the other top causes of death are malignant neoplasms (cancer) and stroke/cerebrovascular disease. Exhibit 11 reflects leading causes of death for Shelby, Henry and Spencer counties, and compares the rates, per thousand, to the state and U.S. rates, per thousand. Shelby and Spencer counties death rates are slightly lower than both state and national averages. Henry County Primary Health Conditions Responsible for Inpatient Hospitalization The top conditions responsible for inpatient hospitalizations within Shelby County are heart disease, chronic obstructive pulmonary disease (COPD), and mental or emotional diagnosis. Health Outcomes and Factors Health Statistics and Rankings An analysis of various health outcomes and factors for a particular community can, if improved, help make that community a healthier place to live, learn, work, and play. And a better understanding of the factors that affect the health of the community will assist with how to improve the community s habits, culture and environment. This portion of the community health needs assessment utilizes information from County Health Rankings, a key component of the Mobilizing Action Toward Community Health (MATCH) project, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The County Health Rankings model is grounded in the belief that programs and policies implemented at the local, state and federal levels have an impact on the variety of factors that, in turn, determine the health outcomes for communities across the nation. The model ranks all 50 states and the counties within each state based on two types of health outcomes how long people live (mortality) and how healthy people feel (morbidity) and four health factors. These are defined below: Health Outcomes rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Health Factors rankings are based on weighted scores of four factors: Health behaviors (6 measures) Page 8
Clinical care (5 measures) Social and economic (7 measures) Physical environment (4 measures) Those having high ranks, e.g. 1 or 2, are considered to be the healthiest. A more detailed discussion about the ranking system, data sources and measures, data quality and calculating scores and ranks can be found at the website for County Health Rankings (www.countyhealthrankings.org). As part of this community health needs assessment, the relative health status of Shelby County is compared to the state of Kentucky and a national benchmark. A better understanding of the factors that affect the health of the community will assist with how to improve the community s habits, culture and environment. The following table from County Health Rankings summarizes the 2012 health outcomes for Shelby County, the primary community for Jewish Hospital Shelbyville. Each measure is described and includes a confidence interval or error margin surrounding it if a measure is above the state average and the state average is beyond the error margin for the county, then further investigation is recommended. Health Outcomes rankings are based on an equal weighting of one length of life (mortality) measure and four quality of life (morbidity) measures. Shelby County compares favorably to the state of Kentucky on most measures, but ranks poorly on national benchmarks. Exhibit 13 summarizes the health rankings for Shelby, Henry and Spencer counties. Page 9
Primary Data Community Input-Surveys As previously stated, to obtain feedback from the general public, surveys were conducted in Shelby County by the North Central District Health Department, in collaboration with Jewish Hospital Shelbyville and a consortium of community organizations. This included an assessment of primary factors of a healthy community, primary health problems facing Shelby County, greatest risk factors, and barriers to receiving care. The majority of respondents agreed that cost/expense was the biggest barrier to health care. Other barriers include inability to take off from work to receive care and limited office hours. The survey solicited input from participants regarding health problems of the community. Addiction (alcohol, illegal drugs and tobacco) and obesity were identified as the biggest health problems in the Shelby County. While community input has been received, the NCDHD is in the early stages of completing their first assessment. Data has not been analyzed, nor have they developed action plans. Health Issues of Uninsured Persons, Low-Income Persons and Minority Groups While there is no data on specific issues related to uninsured, low-income or minority groups in Shelby County, other larger communities have assessed this impact and report: Citizens in the poorest neighborhoods have lower life expectancies. Opportunities for physical activity in some neighborhoods could be impeded by safety issues including hazards for pedestrians and bicyclists, or high rates of violent crime. Violence in the Community According to the Kentucky State Police data, Shelby County s violent crime offenses are higher, at 300 offenses per 100,000, than the state offense rate of 267. Shelby County ranks lower than the national offense rate of 469 offenses per 100,000. Drug arrests are slightly lower than the state rate. Page 10
Priority Community Health Needs Identified Using findings obtained through the community survey and collection of primary and secondary data, Jewish Hospital Shelbyville completed an analysis of these inputs (see Appendix E) to identify community health needs. The following data was analyzed to identify health needs for the community: Leading Causes of Death: Leading causes of death for the community were reviewed and the death rates for the leading causes of death for each county within the Jewish Hospital Shelbyville CHNA community were compared to U.S. adjusted death rates. Causes of death in which the county rate compared unfavorably to the U.S. Adjusted death rate resulted in a health need for the Jewish Hospital Shelbyville CHNA Community. Primary Causes for Inpatient Hospitalization: The primary causes for inpatient hospitalization resulted in an identified health need for the community. Health Outcomes and Factors: An analysis of the County Health Rankings health outcomes and factors data was prepared for each county within the Jewish Hospital Shelbyville CHNA Community. County rates and measurements for health behaviors, clinical care, social and economic factors and the physical environment were compared to national benchmarks. County rankings in which the county rate compared unfavorably (by greater than 30 percent of the national benchmark) resulted in an identified health need. Primary Data: Health needs identified through community surveys, focus groups and key informant interviews (if applicable) were included as health needs. Needs for vulnerable populations were separately reported on the analysis in order to facilitate the prioritization process. Stroke/Cerebrovascular Disease Heart Disease Mental or Emotional Diagnosis Chronic Lower Respiratory Disease (COPD) Addiction/Smoking Obesity Physical Inactivity Access to Care Communication/Health Education 1) How many people are affected by the issue or size of the issue? For this factor ratings were based on the percentage of the community who are impacted by the identified need. The following scale was utilized. >20% of the community=4; >10% and <20%=3; >5% and <10%=2 and <5%=1. For specialty hospitals the impact to the patient population was also considered. 2) What are the consequences of not addressing this problem? Identified health needs which have a high death rate or have a high impact on chronic diseases received a higher rating for this factor. 3) The impact of the problem on vulnerable populations. Needs which pertain particularly to vulnerable populations were received a rating of 4 for this factor. 4) How important the problem is to the community. Needs identified through community surveys and/or focus groups. Page 11
5) Prevalence of common themes. Determined by how many sources of data (Leading Causes of Death, Primary Causes for Inpatient Hospitalization, Health Outcomes and Factors and Primary Data) identified the need. 6) How closely does the need align with KentuckyOne Health strategies? 7) Does the hospital have existing programs which respond to the identified need? Page 12
Each need was then ranked based on these seven prioritization metrics. These were the top priority issues that emerged: Page 13
Community Health Needs Assessment 2012 Appendix Health Department Survey Page 14