Implementation Plan 2016 CHI Health Plainview Plainview, E
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Table of Contents Introduction... 3 Organization Mission... 3 Community Served by the Hospital... 4 Implementation Strategy Process... 5 Prioritized Health eeds... 6 Prioritization Process... 6 Prioritized Health eeds Identified in CHA... 7 Significant Health eeds to be Addressed... 9 Priority Area #1: utrition, Physical Activity & Weight Status...9 Priority Area #2: Behavioral Health 12 Significant Health eeds ot Addressed... 16 Authorization... 16 Appendix... 16 2
Introduction This document outlines CHI Health Plainview s Implementation Strategy Plan (ISP) to address our community s health needs, as determined by the 2015 Community Health eeds Assessment (CHA), adopted by the Board on June 24, 2016. Details of CHI Health Plainview, including its history and services, can be found at www.chihealth.com/chna. Purpose and Goals of ISP CHI Health and our local Hospitals make significant investments each year in our local community to ensure we meet our Mission of creating healthier communities. The ISP is a critical piece of this work to ensure we are appropriately and effectively working and partnering in our communities. The goals of this ISP are to: 1. Identify strategies that will meaningfully impact the areas of high need identified in the CHA that affect the health and quality of life of residents in the communities served by CHI Health. 2. Ensure that appropriate partnerships exist or are developed and that resources are leveraged to improve the health of the most vulnerable members of our community and to reduce existing health disparities. 3. Identify core measures to monitor the work and assure positive impact for residents of our communities. 4. Ensure compliance with section 501(r) of the Internal Revenue Code for not for profit hospitals under the requirements of the Affordable Care Act. Organization Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities. CHI Health carries on the faith traditions of our founders: The Sisters of St. Francis of Perpetual Adoration, The Sisters of Mercy, the Immanuel Lutheran communities, the Jesuits of Creighton University, and the men and women who formed the ebraska Heart Hospital. Each brought a distinct way of incorporating faith and spirituality with clinical care and all shared a calling and passion for serving those most in need in our community through compassionate care and excellence in medicine. In 2012, Catholic Health Initiatives accepted full sponsorship of CHI Health bringing together 15 acute care hospitals, 4 behavioral health facilities, 2 specialty hospitals, over 120 clinics, and multiple health services across the ebraska and Iowa region to carry on this healing ministry. We live out our mission through our core values: 3
Reverence Profound respect and awe for all of creation, the foundation that shapes spirituality, our relationships with others and our journey to God. Integrity Moral wholeness, soundness, fidelity, trust, truthfulness in all we do. Compassion Solidarity with one another, capacity to enter into another's joy and sorrow. Excellence Preeminent performance, becoming the benchmark, putting forth our personal and professional best. This mission calls us to create healthier communities and we know that the health of a community is impacted beyond the services provided within our wall. This is why we are compelled, beyond providing excellent health care, to work with neighbors, leaders and partner organizations to improve community health. The following implementation plan outlines our commitment to this mission and to our communities. Community Served by the Hospital CHI Health Plainview is located in Plainview, E and largely serves the Pierce County area. Pierce County was identified as the community for the 2015 CHA, as it is the primary service area for CHI Health Plainview. Some data charts will show other counties in the orth Central District, as data was compiled for all counties served by CDHD, but for this implementation plan, Pierce is the community being served by CHI Health Plainview. 4
Plainview, E is located 141 miles from Omaha, E and 100.6 miles from Sioux City, IA. According to the most recent census estimates, Pierce County is 100% rural, encompasses 573 square miles and has 7,208 residents. 1 The orth Central District, which includes Pierce County as well as eight additional counties, is 87.8% rural, whereas the state of ebraska is 26.9% rural, thus explaining orth Central District s low population density of about 3.18 persons per squaree mile. 2 The majority of the residents in Pierce County (98.4%) are non Hispanic, white residents. The remaining minority proportion is 1.6% Hispanic or Latino, 0.4% Black, and 0. 2% Asian. 3 Implementationn Strategy Process In order to select priority areas and design meaningful, measureable strategies, leadership from CHI Health Plainview reviewed the dataa and top health needs from the 2015 CHA. For each top healthh need, the hospital took into consideration existing partnerships, available resources, the hospital s level of expertise, existing initiatives (or lack 1 U.S. Census Bureau Quick Facts (v2015 estimate) accessed May 2016 http:// /www.census.gov/quickfacts 2 US Ce ensus Bureau, American Community Survey. 2010 2014. Accessed March 2016 3 U.S. Census Bureau Quick Facts (v2014 estimate) accessed May 2016 http:// /www.census.gov/quickfacts 5
thereof), potential for impact, and the community s interest in the hospital engaging in that health area. In addition, the hospital considered potential other areas of need as defined by the IRS. As described in the IRS instructions for the Form 990, Schedule H for Hospitals, community need may be demonstrated through the following: A community needs assessment developed or accessed by the organization Documentation that demonstrated community need or a request from a public agency or community group was the basis for initiating or continuing the activity or program The involvement of unrelated, collaborative tax exempt or government organizations as partners in the activity or programs Throughout development of the plan, numerous internal and community partners were consulted to ensure the appropriate strategies were selected, the right partners were engaged, and resources were leveraged through a partnership with the orth Central District Health Department and by aligning with the community health improvement plan and its current work. otably, there is a strategic priority in the CHI Health Strategic Plan that states Develop and implement initiatives that will meaningfully impact the top identified community health needs. To further assure alignment and integration with the organization, CHI Health Strategy and Planning team members participated in the development of the following plans. With the CHI Health Plainview President leading the implementation planning and program implementation, the plan is integrated and aligned with the culture of the hospital. Prioritized Health eeds Prioritization Process Led by Dr. Joseph itzke, PhD. of Ionia Research, stakeholders were convened to review the data collection results from the CHA including highlights of notable statistics and correlations between various data. Community eeds were identified through data analysis according to the following criteria: indicators were failing to meet the national HP2020 targets indicators were trending in the wrong direction presence of apparent disparities presence of significant discrepancies between district and state indicators issue affects a large number of district residents issue was identified as a significant problem based on community input If these criteria were present, the indicator was identified as a need. Indicators were grouped and examined by topic area, which were further identified as community needs. During the data presentation, stakeholders were given strategic issue identification worksheets and asked to record potential strategic issues they noticed during the presentation and specific significant health need data that caused them to identify it as a potential strategic issue. 6
Definitions and criteria were provided. Following the data presentation, stakeholders engaged in workgroups to complete the following steps: Review the strategic issues recorded on the identification worksheet, Ensure the issues are strategic using the definitions and criteria provided Eliminate duplicates and group the remaining issues by topic or theme Give headings to describe the general health category to grouped areas Present information to larger group while strategic issue categories were documented Through a process of voting and discussion community health priorities for the district were identified. After evaluating resources, staff, and capacity, CHI Health Plainview, along with community partners, identified behavioral health (encompassing both mental health and substance abuse) and physical wellness (physical activity, nutrition, and obesity) as the two priority areas of focus. More details regarding the prioritization process can be found in the CHA. Prioritized Health eeds Identified in CHA Health eed Statement Reason(s) for high priority Hospital Priority* Access to Healthcare Services Cancer Aging Problems (e.g. arthritis, hearing/vision loss, etc.) Diabetes Heart Disease & Stroke Injury & Violence Mental Health utrition, Physical Activity & Weight Lack of access to facilities, physicians, rate of uninsured, financial hardship, transportation, cultural competency, coverage limitations Cancer deaths: Lung, Prostate, Colorectal Cancer Incidence: Prostate, Lung, Skin, Breast Cancer Screening: Cervical, Colon, Breast Cancers ranked as a top concern Increasing older population Disability prevalence Aging problems ranked as a top concern Diabetes Deaths Diabetes Incidence Risky behaviors (see utrition, Physical Activity & Weight) Mortality Awareness Incidence decreasing Heart Disease & Stroke ranked as top concern Safety seat/safety belt usage (children) Texting while driving Using cell phones while driving Access to care Stigma Overweight prevalence (adults) Amount of physical activity Access to recreation/fitness centers Y Y 7
utrition, weight and physical activity ranked as top concern Respiratory Diseases Oral Health Chronic Obstructive Pulmonary Disease (COPD) Asthma Incidence of tooth extraction Incidence of tooth decay Regular dentist visits Environmental Health Adequate housing Immunizations Vaccinations Pneumonia Influenza Substance Abuse Binge drinking Seeking help for alcohol/drug issues Substance abuse among children (youth survey) Tobacco use * see below for explanation and details Y 8
Significant Health eeds to be Addressed Priority Area #1: utrition, Physical Activity, and Weight Goal Improve community physical health and wellness. Community Indicators CHA 2013 33.7% of orth Central District adults are either overweight or obese (2012) 26% of the orth Central District youth are either overweight or at risk of being overweight 35% of adults were obese in Pierce County in 2012 (County Health Rankings) 30% of adults aged 20 and over reported no leisure time for physical activity in 2012 25% of Pierce County residents report limited access to healthy foods in 2010 CHA 2016 72% of orth Central District adults are either overweight or obese (2014) 32% of Pierce County population report being physically inactive 82% of adults report inadequate fruit/vegetable consumption 34% of population with adequate access to locations for physical activity in 2014 11% of population lack adequate access to food in 2013 CHA 2019 Timeframe FY 17 19 Background Rationale for priority: Adult obesity levels remain above U.S.; appears to be progress in childhood overweight however disparities exist across income levels and race; need to build on momentum and sustain efforts; Hospital has expertise, resources, and partnerships to leverage this work. utrition, physical activity, and weight status were identified as health priorities in the 2015 CHA. Contributing Factors: fruit and vegetable consumption, physical activity, access to healthy foods, socio economic status ational Alignment: utrition and weight status was identified by Healthy People 2020 as a priority health topic. 1.1 Strategy & Scope: Develop and promote healthy lifestyles through 5 4 3 2 1 Go! campaign in children ages 5 12 years old attending schools across the orth Central District in ebraska. 9
Anticipated Impact Hospital Role/ Required Resources Partners Increased knowledge of health promotion message Increased consumption of fruits and vegetables Improved healthy living habits in kids Improved healthy weight of children and a reduction of chronic disease CHI Health System Role(s): Funder Provides technical assistance CHI Health Plainview s Role(s): Strategic Partner orth Central District Health Department Local School Districts Community health leaders Required Resources: Community Partner time Educational Materials Key Activities Measures Data Sources/Evaluation Plan Continue partnership with local health department to develop infrastructure to support campaign Explore partnership with UL Extension to further promote the message into Antelope and Knox counties Provide orth Central District Health Department with technical assistance and campaign support including school campaigns, assemblies, promotion at health fairs, Increase practice of 5 recommended healthy habits in children 5 12 years old Increase in children s awareness and knowledge of message # of children reached by message Fruit and vegetable intake among participating students Water intake among participating students Low fat dairy intake among participating students Daily screen time reported by students Daily hours of physical activity reported by students Data will be reviewed and reported by internal team using the following data sources: Community surveys (every three years) Pre & post Child/Student surveys (yearly) School Interviews (yearly) 10
Results (pending) 1.2 Strategy & Scope: Continue and expand to two lab fairs a year, at a subsidized price, for those in Pierce County with limited access to healthcare services. Anticipated Impact Hospital Role/ Required Resources Partners Improved awareness and behavior around healthy nutrition and physical activity habits. Improved management of chronic diseases within the population served. Increased awareness of self disease management. CHI Health Plainview s Role(s): Lead Implementer orth Central Health Department Required Resources: Staff and Space Equipment Key Activities Measures Data Sources/Evaluation Plan Host lab fair annually in Pierce County. Explore feasibility of offering additional lab fair in county Create survey to evaluate change in participants self reported knowledge, skills and behaviors based on their participation in the lab fair. Create survey for providers/professionals on their perceived impact in participants (especially as it relates to their knowledge of returning patients). Ensure CHI Health patients, with elevated labs, are contacted by physician and follow up is scheduled Explore education opportunity/intervention around lab work and outcomes umber of uninsured/underinsured served umber of patients put in contact with medical home or resource umber of referrals to care umbers of appointments for follow up Change in patient s knowledge Data will be reviewed and reported by an internal team yearly using the following data sources: Lab Fair survey Clinic data 11
Results (pending) Priority Area # 2: Behavioral Health Goal To increase the preventive outreach, educational efforts and resources that support the resiliency of community members who experience mental health and substance use issues. Community Indicators CHA 2013 51% of CD residents reported heavy drinking 15% of Pierce County residents reported having been depressed 3.0 mentally unhealthy days reported in past 30 days for CD CHA 2016 22.9% of Pierce County respondents reported heavy drinking 12% of Pierce County residents reported having been depressed 1.9 mentally unhealthy days reported in past 30 days for CD 8% of adults report more than 14 days or poor mental health per month in 2014 (County Health Rankings) CHA 2019 Timeframe FY 17 19 Background Rationale for priority: Mental disorders have been shown to be the most common cause of disability and suicide is the 11 th leading cause of death in the United States making it an important issue across the country. Mental health has been closely tied to physical health and often inhibits one from maintaining good physical health, possibly leading to chronic disease, which can have a serious effect on the mental health of the person. In the 2015 CHA, mental health and substance abuse were both identified as top health needs within the community. Contributing Factors: lack of availability of services, high cost, lack of insurance coverage, family and community dynamics, social support, and stigma ational Alignment: Behavioral health was identified as a top health issue by Healthy People 2020. Additional Information: CHI Health received grant funding from CHI national to implement behavioral health programs planned by community coalitions developed through a previous planning grant 12
2.1 Strategy & Scope: Increase the overall awareness of existing and potential resources among community stakeholders through an established behavioral health community coalition. Anticipated Impact Hospital Role/ Required Resources Partners Improve overall community awareness of existing and potential resources Increase usage of services due to increased awareness CHI Health System Role(s): Provides financial support System level leadership by Behavioral Health Service Line Behavioral Health Coalition CHI Health Plainview s Role(s): Sponsor Fiscal Agent Community Partner Required Resources: Staff time CHI Mission & Ministry Grant Funding Key Activities Measures Data Sources/Evaluation Plan Establish a coalition with support staff and an identified backbone organization Develop a community behavioral health resource guide with links to providers and programs. Community coalition continues to meet to address behavioral health issues in the community. Begin developing a sustainability plan for post grant. Finalize sustainability plan and prepare to implement. Community Coalition shares resources formally and informally with members and rate the coalition as effective. Increased awareness of community resources through increased usage of those resources Sustainability plan complete Data will be reviewed and monitored as part of the coalition work using the following data sources: Community Service Provider Survey (Annually) Coalition Member survey (Annually) Results (pending) 13
2.2 Strategy & Scope: Provide community wide training on mental health and substance use to stakeholders such as healthcare workers, law enforcement, EMTs, pastors, school personnel, and elder care workers. Anticipated Impact Hospital Role/ Required Resources Partners Improve behavioral health care to those in need through CHI Health System Role(s): Behavioral Health increased stakeholder knowledge around mental health and Provides financial support Coalition substance use learned in evidence based trainings System level leadership by Behavioral Health Service Line Region 4 Increase community knowledge and action in addressing Local law enforcement behavioral needs among community members CHI Health Plainview s Role(s): Local clergy Improve health care for those effected by trauma Fiscal Agent Local school district Increase ability for community to identify someone in crisis Sponsor and ability to refer to the appropriate resource Community Partner Increase in safer restraint methods ensuring safer care of patient Required Resources: Reduction in number of people being restrained Staff Trainers Training/Curriculum materials Key Activities Measures Data Sources/Evaluation Plan Offer MADT (i.e., restraint) Training to law enforcement and other community stakeholders. Increased knowledge of behavioral healthcare providers and other community members Data will be reviewed and monitored as part of the Offer Mental Health First Aid Training throughout the umber and type of community professionals trained coalition work using the community in both years 1 and 2. If implemented, number of trained on Crisis Response Team and following data sources: Coalition explores Crisis Response Team concept. number of Crisis Response Team response incidents Post training training Trauma Informed Care Training offered to other community evaluations (bi annually) members and medical staff. Crisis Response data (biannually) Results (pending) 14
2.3 Strategy & Scope: Increase access to mental health providers in the community that may include support of medication management services, increased use of tele psych, and education of community healthcare providers on behavioral health. Anticipated Impact Hospital Role/ Required Resources Partners Increase usage of services due to increased access Improve mental health Increase knowledge on behavioral health and treatment Decrease law violations CHI Health System Role(s): Provides financial support System level leadership by Behavioral Health Service Line CHI Health Plainview s Role(s): Fiscal Agent Sponsor Community Partner Behavioral Health Coalition Region 4 Community healthcare providers Local law enforcement Local school district Required Resources: Staff Mental Health providers Telehealth technology/equipment Key Activities Measures Data Sources/Evaluation Plan Develop a community plan to increase access to mental health umber of youth accessing tele psych and other medication Data will be reviewed on a biannual providers and for training community healthcare providers on management services basis by the coalition behavioral health. Decrease in law violations, EPC s and transportations by law using the follow data Implement plan to increase access to mental health providers enforcement and school violations sources: in the schools and the community, i.e., tele psych in the Law enforcement data schools. Hospital Records Grant evaluation tool Results (pending) 15
Significant Health eeds ot Addressed In acknowledging the range of priority health issues that emerged from the CHA process, CHI Health Plainview prioritized the health issues above in order to most effectively focus resources and meaningfully impact the selected health issues. As described in the process above, the hospital took into consideration health disparities, in order to select the priorities. The following identified needs will not be prioritized in this implementation plan for the following reasons. Access to Healthcare Services. By providing care as a critical access hospital, CHI Health Plainview allows for increased access to services along with providing charity care to for patients who are low income. Increased access to behavioral health services is also being addressed in the priority area chosen. Aging Population & Related Illnesses. Due to resources and hospital capacity, this priority will not be a focus for the hospital. The hospital will participate in any Health Department efforts around this priority through partnering and attending work group meetings. Housing and Environmental Health. This priority is currently being addressed by other organizations within the community. Chronic Disease. CHI Health will continue to perform existing work around chronic disease and will address some of this priority through the work around obesity, nutrition, and physical activity. Safety. This was not determined as a priority area based on the considerations above and in order to focus and meaningfully impact other areas of need. Authorization The CHI Health Board of Directors approved and adopted this Implementation Plan on October 20, 2016. In addition, the plan was presented and reviewed by the CHI Health Plainview Community Board on October 5, 2016. Appendix CHI Health Plainview s Community Health eeds Assessment Report can be found at www.chihealth.com/chna and a free copy may be obtained by contacting kelly.nielsen@alegent.org or 402 343 4548. 16