Community Health Needs Assessment Implementation Plan Overview Our community health taskforce concluded that a 56-bed hospital located in rural Coshocton County Ohio is in a unique position to help improve the health of our communities. While the hospital is a small community hospital with limited service lines, our community has many ongoing programs and the need to develop new programs that encourage collaboration from organizations like ours. In June 2016, Coshocton County Memorial Hospital, our previous entity, filed for bankruptcy under Chapter 11 of the bankruptcy code. On November 1, 2016, Prime Healthcare Foundation acquired all assets of the hospital and the name was changed to Coshocton Regional Medical Center. For many years, the hospital has been the source of primary health care for our residents through our hospital, employed physicians and surgeons and our 24-hour emergency services. We coordinate transports and referrals when specialty care is needed to treat heart events, cancer, and other illnesses or injuries beyond our scope, and we take care of the health needs of patients for primary care, general surgery, and some specialties. The location and scope of the service area of our small community hospital limits us from offering a full complement of care in the areas of highest mortality heart disease and cancer. Therefore, we recognize we must take a strong leadership role in educating our overall population on preventive care and disease management. This initiative will be best accomplished by developing collaborations with other community resources and regional providers to support meaningful screening, education and disease management programs. In addition, our focus must include ways to counter the corresponding risk behaviors that are prevalent in our community and that can contribute to higher-than-average mortality rates. Our community s culture reflects the Appalachian Ohio s high poverty levels, low median income levels, high unemployment, high drop-out rate, and risky health behaviors such as smoking and obesity. It is our challenge to not only strive to elevate our screening and education programs, but also to gain a better understanding of how we can reach those population segments at the greatest risk. We also believe it is important to help our low income and/or uninsured population with access to health care, screenings and health management by making sure they are aware of services, discounts or coverage available to them. Finally, we strive to address specific needs identified in our community health needs assessment by instituting new programs and service lines that meet identified needs. 1
Priority 1: Cardiovascular Disease Goal: Reduce the overall heart disease death rate by increased educational programming, awareness and access to care Baseline Data Source: The Ohio Department of Health, Center for Vital and Health Statistics. An ageadjusted mortality rate of 157.7 puts Coshocton County below the 2010 rate 191.7 for the state of Ohio and well below our rate of 204.9 in 2009. It should be noted that the heart disease mortality rate dropped significantly (157.7) in 2010, but had remained above 200 for the previous 5 years. This drop appears to be an anomaly connected to the unusually low death rate in 2010. Lead: Chief Clinical Support Officer Laboratory Cardiologist Emergency Services Cardiac Rehabilitation Staff Radiology Department Potential Collaboration Resources Genesis HealthCare System Heart Services (Cardiologist employer) Coshocton County Health Department Coshocton City Health Department Kno-Ho-Co Ashland Kids America Create awareness of the warning signs and risks of heart disease through a minimum of four free public events each year. Two of these events may be collaborations with the Health Services of Coshocton and the Senior Center community blood draws. Nurse or physician counseling at the event will extend the benefits the screenings currently provide. Offer free heart screenings such as Peripheral Artery Disease (PAD) screenings at no less than one event during the year. Begin annual awareness event for February, incorporating the expertise of a cardiologist as the speaker. We specifically want to target women and heart disease with a Wear Red event with heart-healthy meal and education. Develop a Walk with a Doc program at Kids America, with one of our internal medicine physicians, family physicians and/or our cardiologist joining the walking group once a month. Continue to grow and support the post-heart attack program/support group. The Mended Hearts program began in mid-2016 and we want to grow the program through the support and planning of the cardiac rehabilitation staff. Participate in the Annual Health, Safety and Wellness Expo in conjunction with the Chamber of Commerce and the Community Safety Council. The hospital provides free screenings including 2
blood pressure checks and free peripheral arterial disease screenings. We have physicians and nurse practitioners on hand throughout the event to answer questions and provide health information as needed. Obesity is the risk factor identified as number one in the CHNA survey and is a critical factor in heart disease and diabetes, the priorities identified as the top two. To address the obesity issue in our community, we are planning the following intervention strategies: o Develop and provide free public programs for nutritional guidance conducted by dietitians. Programs could include healthy holiday meal planning; healthy food substitutions; label reading; healthy cooking on a budget. o Work with community leaders to put a focus on exercise. Coordinate a task force to include fitness centers (Kids America, etc.), school administrators, city officials, and others to coordinate a get out and exercise or create a healthy Coshocton campaign for the community. o Create a health coach walk that incorporates a variety of health professionals to walk with a group on a regular basis. Similar to a walk with a doc program, this concept includes dietitians, physical therapists, nurses, etc. We will solicit collaboration from other groups such as county commissioners, sheriff s department, educators, etc. to serve as speakers/walk leaders for this program. o Transform the hospital cafeteria s menu into a healthy eating resource for our community. The cafeteria is visited by many of our community members and carries the suggestion that if food is made to serve to patients, it must be healthy (low sodium, low fat, fresh, etc.). In keeping with a healthy community focus, we will develop a plan to identify calories, fat, sodium and other content for the cafeteria items. Also, we will encourage staff to manage servings according to the Weight Watchers Points model. o Participate in the activities of the Coshocton County Family & Children First Council events that encourage safe, healthy activities for families in Coshocton County. The council is comprised of nor-for-profit organizations in our community, but the hospital has not been involved in the past. The activities will begin with participation in the Youth Health Day in May. The event is for all 7 th graders in the county (approximately 400) and emphasizes health and safety issues through a series of discussions and interactive sessions. The hospital will provide an emergency room physician to discuss helmet use and other safe practices and a physical therapist who will talk about exercise safety. Other speakers provide information such as ATV safety, nutrition, safe texting, yoga, self defense, and appreciating the great outdoors. The hospital will also work with a national helmet manufacturer to secure pricing to be able to purchase one helmet for each 7 th grader. 3
Priority 2 Diabetes Baseline Data Source: Centers for Disease Control While diabetes ranks as the sixth leading cause of death, the prevalence of diagnosed diabetes in Coshocton has grown from 9.9 percent in 2009 to 12.3 percent in 2013, while the state prevalence has gone from 9.5 percent to 9.2 percent in the same timeperiod. Community members identified prevalent health risk factors in Coshocton County that included obesity, unhealthy eating habits, and physical inactivity all risk factors for diabetes. Goal: Provide opportunities to increase awareness of proper disease and lifestyle management to help lower the mortality rate and increase quality of life. Lead: Chief Medical Officer Dietary Nursing Physical Therapy Laboratory Potential Collaborators American Diabetes Association Community Physicians Muskingum Valley Health Center (Federally Qualified Health Coshocton Senior Center (Kno-Ho-Co) Coshocton County Health Department Develop an ongoing diabetes support group program that will be held at least twice a year over a multi-week schedule or as a monthly support group. The program would provide: o Disease education presented by a healthcare provider o Nutritional information from a dietitian o Occasional cooking demonstrations o Exercising with diabetes presented by physical therapists o Insulin and pump management presentation by pharmacist o Diabetes management open discussion with support group and program leader The diabetes program will be presented at no cost to participants and their support person. Develop a task force to include representatives from family practice physicians, dietitians, case management, Kno-Ho-Co, MVHC, nursing and the population affected with diabetes. The task force will be charged with suggesting meaningful methods of reaching the low-income diabetes population and enhancing their understanding and involvement with diabetes self-management. The conclusion of this task force will be used to encourage collaboration on a county-wide program to encourage and facilitate better self-management. Develop a wound management service line to help diabetes patients who struggle with wounds that will not heal due to the disease. With the age of our population and the prevalence of diabetes, 4
adding this service line will help patients who either travel for wound care or receive sub-standard care. Provide free fingerstick glucose checks at health fairs. The hospital co-sponsors a community-wide health fair each January with free fingersticks and with healthcare providers available to discuss results and answer questions. The hospital also participates in a community-wide senior expo in November with free fingersticks and diabetic counseling. 5
Priority 3 Cancer Baseline Date Source: Coshocton County Cancer Profile, Ohio Cancer Incidence Surveillance System, Ohio Department of Health. Coshocton County has ranked higher than the state of Ohio in deaths from cancer with the highest cancer incidence groups ranking as lung, breast and colon and rectum cancer. High smoking rates may account for the disparate numbers in incidence of lung cancer. Of additional concern is the fact that while incidence of cancer is higher nationally, the mortality rate for cancer is lower in the U.S. overall versus Coshocton County (age-adjusted rates). This may indicate the need for improved access to care for those diagnosed with the disease, as well as an educational push to encourage cancer screenings. Goal: Increase awareness of the need for cancer prevention and screenings while developing methods to help patients navigate the process from diagnosis through treatment. Lead: Chief Medical Officer Outpatient Oncology Nursing Radiology Potential Collaborators Health Services of Coshocton; Hospice Services American Cancer Society Trinity Breast & Cervical Program (Trinity Health Care, Steubenville, Ohio) Regional physicians and healthcare providers Muskingum Valley Health Center Coshocton Health Departments When cancer is detected, the cost of treatment can be an overwhelming next step for low income families. Coshocton Hospital is able to work through the Trinity Breast and Cervical Program offered by Trinity Health Care to provide grants to pay for screening services and provide some limited resources for treatment for low income women. The program has been in place, but we will work with our surgeons and women s care physicians to ensure there is adequate knowledge about this program in our communities. Our oncology department head nurse coordinates the cancer support group for the hospital. The group assists with emotional support as well as ongoing education for survivors and those new to the cancer journey. With this implementation plan, we intend to place greater focus on this support group to encourage more men and newly diagnosed patients to join the group. Also, we will help the oncology nurse schedule speakers and assistance with the educational section of the monthly meetings. 6
Priority 4 Chronic Lower Respiratory Disease Baseline Data Source: Ohio Department of Health, Vital Statistics. Chronic lower respiratory disease is the third leading cause of death in Coshocton County and Ohio. With the exception of 2006 and 2008, Coshocton County has experienced more deaths (age-adjusted rate per 100,000) from this disease than the state of Ohio overall from 2005 through 2010. Goal: Increase awareness of ways to avoid the risk of developing chronic lower respiratory disease and develop programs to help patients manage the complications associated with the disease. Lead Respiratory therapy Pulmonary rehab Director of nursing Family practice provider Potential Collaborators Coshocton Health Departments Kno-Ho-Co (Senior Center) Coshocton Behavioral Health Choices Investigate the potential for a pulmonary support group to be run by the pulmonary rehab specialists. If deemed feasible, we intend to establish a support group with monthly speakers talking about the challenges faced by those with respiratory disease and determining how to help them manage those challenges. Work with Coshocton Behavioral Health Choices to understand ways we can work with them to discourage the use of tobacco products. A possible concept is the hosting of tobacco cessation groups at the hospital with help from Coshocton Behavioral Health Choices. The programs will be available to both the public and to our inpatients who want to attend. Explore strategies to supply nicotine replacement therapy to tobacco cessation groups hosted at the hospital. 7
Priority 5 Substance Abuse Baseline Data Source: The Ohio Department of Health. Accidental deaths from overdose have increased steadily in Ohio from 2006 to 2015, with an 18 percent increase in 2015 over 2014, and led the nation in opioid-overdose deaths in 2014, according to state-by-state statistics compiled by the Henry J. Kaiser Family Foundation. While statistics on drug use not resulting in death are not available, discussions with the Sheriff s Department s Drug Task Force Officers and the County Prosecutor suggest substantial increases in heroin and methylamphetamine use in Coshocton County. Goal: Work in collaboration with local agencies to begin an organized grass roots effort to fight substance abuse. Lead: Administrator/CNO Nursing Emergency providers Social worker Family practice providers Potential Collaboration Resources Coshocton Health Departments Coshocton Behavioral Health Choices Coshocton Sheriff s Department Coshocton County Prosecutor Regional ministerial associations Work with the collaborators listed above to help launch the Coshocton County Drug Coalition. The drug coalition is a community-based effort to maintain focus on substance abuse, work toward getting answers to help defend against the problem, and educate the community about the signs and risks of substance abuse. Investigate the feasibility of creating a medical detox program for the hospital to treat patients for the three days required prior to acceptance into a residential recovery program. 8
Priority 6 - Depression Baseline Data Source: The Ohio Department of Health, Behavioral Risk Factor Surveillance System has identified that 24.7 percent of individuals in Region 8 (Coshocton, Guernsey, Morgan, Muskingum, Noble and Tuscarawas Counties) have been told by a health professional that they have a depressive disorder. This exceeds Ohio s rate of 20.2 percent. Goal: Collaborate with local mental health agencies to coordinate programs to help those suffering from depression in our communities. Lead Emergency Department Nursing Manager Education Nursing Social worker Physician (ED and/or family practice) Potential Collaborators Community Religious Leaders AllWell Behavioral Health Coshocton County Health Department Develop a collaborative group including health care professionals, mental health professionals and our social worker to discuss programs to help with education and support for depression. These opportunities may include programs already underway with the mental health agencies that can be further supported by the hospital or programs that the group determines may be beneficial to launch. One potential is a series of classes that educate individuals on countering depressing with hobbies and interests. Monthly classes may include art, literature, yoga, photography, or music. When a plan is developed by the group, the hospital will actively collaborate to develop programs. Work with the local support chapter of the National Alliance on Mental Illness (NAMI) to determine potential collaborations. The group will continue to meet monthly at the hospital at no cost, a practice that began in winter 2016. 9
Additional Community Health Needs Coshocton Regional Medical Center is a sole community hospital located in Coshocton County, Ohio. The members of our community, located in the Appalachian region of Ohio, are faced with a variety of health challenges due in part to low income levels and higher than average poverty levels. The high prevalence of uninsured residents (20.1% of adults and 17.1% of children versus state estimates of 15.3% and 5.3% per U.S. Census America Community Survey, 2010-2014 estimates) has contributed to a reluctance of many to see preventive care. While we would prefer to focus community outreach on every health need identified in our community health needs assessment, we are limited by resources and our limited supply of specialty providers. The health needs assessment identified some health concerns that we did not address as a priority item in our implementation plan. We recognize the importance of these health issues and offer assistance through our emergency services or physician clinics to help guide patient to community or regional resources that can assist. For example, we do not have obstetrics services, so we would refer expectant mothers to an OB-GYN in the region for care. In addition, we do not provide acute pediatric services due to our proximity to Nationwide Children s Hospital in Columbus and Akron Children s Hospital in Akron, Ohio; we refer patients to these hospitals as appropriate. The list of health needs we cannot specifically address as a priority in our implementation plan is as follows: As a community hospital, we do not have access to medical specialists in specific fields such as geriatrics, dentistry, psychiatry, pulmonology or infections disease. At this time and with the size and scope of our organization, limited resources prevent us from being able to do significant outreach to appropriately address these health concerns in our community: o Alzheimer s disease o Babies born addicted to drugs o Babies at a low birth weight o Kidney disease o Mental health issues o HIV/AIDS o STDs o Oral health o Car/other crashes 10