Fiscal Year 2018 Community Health Needs Assessment Avera Sacred Heart Hospital 501 Summit Street, Yankton, SD 57078 Fiscal Year 2018
Fiscal Year 2018 Avera Sacred Heart Hospital Community Health Needs Assessment Summary: This is an assessment of the health needs within the primary service area of Avera Sacred Heart Hospital, Yankton, S.D., utilizing aspects of the South Dakota Department of Health s Good & Healthy South Dakota Community Health Needs Assessment and Improvement Planning toolkit, independently facilitated focus groups, and an online survey. During the fiscal year a community health needs assessment was conducted by Avera Sacred Heart Hospital for the seven county primary service area: Yankton, Bon Homme, Charles Mix, Hutchinson and Clay counties in South Dakota and Knox and Cedar counties in Nebraska. South Dakota Hutchinson Nebraska Charles Mix Bon Homme Yankton Clay Iowa Knox Cedar State Population Yankton South Dakota 22,702 Bon Homme South Dakota 6,985 Charles Mix South Dakota 9,396 Clay South Dakota 13,964 Hutchinson South Dakota 7,301 Cedar Nebraska 8,564 Knox Nebraska 8,701 2
Yankton is the seat of Yankton and takes pride in being the first capital city of Dakota Territory. Avera Sacred Heart Hospital is located on the banks of the Missouri River in Southeast South Dakota. Description of Community Served by the Hospital The Benedictine Sisters of Sacred Heart Monastery founded Avera Sacred Heart Hospital in 1897. At the bequest of Bishop Thomas O Gorman, the Sisters created a 30-bed hospital to provide health care for the sick and injured in the frontier region. In the past 100+ years, Avera Sacred Heart Hospital s rural health mission has grown into a regional health service network organized to provide comprehensive services to residents of southeastern South Dakota and northeastern Nebraska. Avera Sacred Heart Hospital adheres to Avera s mission: Avera is a health ministry rooted in the gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. The core values of compassion, hospitality, and stewardship guide Avera employees in their daily work. Compassion: The compassion of Jesus, especially for the poor and the sick of body and spirit, shapes the manner in which health care is delivered by Avera s employees, physicians, administrators, volunteers and sponsors. Compassionate caring is expressed through sensitive listening and responding, understanding, support, patience, and healing touch. Hospitality: The encounters of Jesus with each person were typified by openness and mutuality. Welcoming presence, attentiveness to needs, a gracious manner seasoned with a sense of humor, are expressions of hospitality in and by the Avera Health community. Stewardship: Threaded through the mission of Jesus was the restoration of all the world to right relationship with its Creator. In that same spirit and mission, the members of Avera Health treat persons, organizational power and earth s resources with justice and responsibility. Respect, truth and integrity are foundational to right relationships among those who serve, and those who are served. Yankton is the most populated county in Avera Sacred Heart Hospital s service area and ranks as the #1 county for discharges for the hospital. In 2013, 1700 of the 3,434 patients discharged from the hospital originated from Yankton according to market data from the South Dakota Association of Health Care Organizations. Avera Sacred Heart Hospital service area spans counties in Southeast South Dakota and Northeast Nebraska. Approximately 3
73 percent of all discharges from the hospital originate from five counties in South Dakota: Yankton (50 percent), Bon Homme (9 percent), Charles Mix (8 percent), Clay (3 percent), and Hutchinson (3 percent). It is required that the assessment include individuals from the community who represent broad interests of the community served including medically underserved, low-income or minority populations residing in Yankton. In defining community, Avera Sacred Heart Hospital has taken in to consideration all members of Yankton and our larger service area regardless of socio-economic status. Avera Sacred Heart Hospital is committed to meeting the needs of all who need care regardless of their ability to pay. In a spirit of charity and justice, Avera exists in response to God s calling for a healing ministry to the sick, the elderly and the oppressed, and to provide healthcare services to all persons in need, without regard to the consideration of age, race, sex, creed, national origin or ability to pay...avera is committed to providing charity care to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care based on their individual financial situation. Consistent with its mission to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values, Avera strives to ensure that the financial capacity of people who need health services does not prevent them from seeking or receiving care. (Avera Fiscal Policy #605 Financial Assistance and Billing Practices) The economic state of our primary county, Yankton, remains stable. The unemployment rate has decreased from 4.6 percent in 2011 to 3.5 percent in 2013 and further decreased to 2.6 percent in 2017 according to Bureau of Labor Statistics, Local Area Unemployment data. Median household income for the county is $48,991, approximately 8.7 percent lower than the median household income for the State of South Dakota, $53,263. The percentage of people 100 percent below the federal poverty level for Yankton is 13.6 percent compared to 14 percent for the State of South Dakota. Please refer to the following table for all other primary service area county economic data. 4
Indicators Children under 18 years age in poverty Median Household Income % of persons below 100% of the Federal Poverty Level Indicators Children under 18 years age in poverty Median Household Income % of persons below 100% of the Federal Poverty Level Indicators Children under 18 years age in poverty Median Household Income % of persons below 100% of the Federal Poverty Level Data Source Year (Group of Years) Economic Security and Financial Resources SAIPE = Small Area Income and Poverty Estimate Yankton Bon Homme Clay # % # % # % Charles Mix # % SAIPE 2015 684 14.5% 208 17.1% 430 17.7% 922 34.6% SAIPE 2015 $48,991 $48,900 $43,902 $41,005 SAIPE 2015 2,808 13.6% 808 14.6% 2,242 19% 2,088 23.3% Data Source Year (Group of Years) State of South Hutchinson Dakota # % # % SAIPE 2015 265 18.2 36,584 17.7% SAIPE 2015 $49,558 $53,263 SAIPE 2015 840 12.3% 114,291 14.00% Data Source Year (Group of Years) Cedar Knox State of Nebraska # % # % # % SAIPE 2015 263 12.4% 414 20.1% 73,349 15.9% SAIPE 2015 $56,092 $45,466 $55,073 SAIPE 2015 787 9.4% 1,141 13.7% 224,696 12.2% 5
Age Group Under 5 years Data Source ACS 5 to 9 years ACS 10 to 14 years ACS 15 to 19 years ACS 20 to 24 years ACS 25 to 34 years ACS 35 to 44 years ACS 45 to 54 years ACS 55 to 59 years ACS 60 to 64 years ACS 65 to 74 years ACS 75 to 84 years ACS 85 years and over ACS Age Group Under 5 years Data Source ACS 5 to 9 years ACS 10 to 14 years ACS 15 to 19 years ACS 20 to 24 years ACS 25 to 34 years ACS 35 to 44 years ACS 45 to 54 years ACS 55 to 59 years ACS 60 to 64 years ACS 65 to 74 years ACS 75 to 84 years ACS 85 years and over ACS Year (Group of Years) 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 Year (Group of Years) 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 2011-2015 Age Distribution ACS = American Community Survey Yankton Bon Homme Clay Charles Mix Hutchinson State of South Dakota % % % % % % 6.0% 4.6% 5.0% 8.5% 6.4% 15.0% 5.8% 5.0% 4.7% 8.4% 6.4% 7.0% 5.9% 5.6% 4.6% 7.6% 6.0% 6.5% 6.3% 5.7% 14.4% 7.5% 6.6% 6.8% 6.1% 6.7% 21.2% 5.8% 4.5% 7.2% 12.9% 12.6% 12.9% 10.0% 9.2% 13.1% 12.1% 11.6% 8.9% 9.7% 10.3% 11.4% 14.3% 14.1% 8.7% 12.3% 12.7% 13.0% 7.3% 8.4% 4.7% 7.0% 7.6% 6.9% 6.5% 5.2% 4.5% 5.4% 6.5% 6.1% 8.4% 9.2% 5.6% 8.5% 9.4% 7.8% 6.4% 7.8% 3.1% 6.1% 8.5% 4.7% 2.0% 3.4% 1.9% 3.2% 6.0% 2.4% Cedar, NE Knox, NE % % 5.9% 6.2% 7.2% 5.6% 7.1% 8.0% 7.1% 6.3% 4.6% 4.1% 8.9% 8.0% 9.4% 9.2% 14.2% 14.0% 7.9% 7.6% 6.5% 7.5% 9.4% 10.9% 7.6% 8.0% 4.1% 4.7% 6
Avera Sacred Heart Hospital s primary service area of Yankton is predominately Caucasian (92.3 percent). Latino/Hispanic comprises 3.3 percent of the population and 2.2 percent is American Indian. Race & Ethnicity ACS = American Community Survey Race/Ethnic Group Bon Charles State of Year Data Yankton Homme Mix Clay Hutchinson South (Group of Source Dakota Years) % % % % % % White ACS 2010-2014 92.3% 92.8% 66.6% 92.5% 97.1% 85.0% Black or African American ACS 2010-2014 2.1% 1.3% 0.7% 2.0% 0.3% 1.6% American Indian or Alaska Native ACS 2010-2014 2.2% 6.2% 35.1% 4.2% 2.9% 8.6% Asian ACS 2010-2014 0.6% 1.1% 0.3% 2.6% 0.2% 1.2% Native Hawaiian or other Pacific ACS 2010-2014 0.2% 0.0% 0.1% 0.0% 0.0% 0.0% Islander Some other race ACS 2010-2014 0.9% 0.9% 0.6% 1.1% 0.4% 0.9% Two or more races ACS 2010-2014 1.7% 2.4% 3.1% 2.4% 0.9% 2.6% Hispanic or Latino Origin ACS 2010-2014 3.3% 4.0% 2.5% 2.5% 1.9% 3.3% Race & Ethnicity ACS = American Community Survey Race/Ethic Group Data Source Year (Group of Years) Cedar, NE % Knox, NE % White ACS 2010-2014 99.4% 88.9% Black or African American ACS 2010-2014 0.4% 0.3% American Indian or Alaska Native ACS 2010-2014 0.7% 10.8% Asian ACS 2010-2014 0.1% 0.6% Native Hawaiian or other Pacific ACS 2010-2014 0.1% 0.6% Islander Some other race ACS 2010-2014 0.2% 0.8% Two or more races ACS 2010-2014 0.8% 1.5% Hispanic or Latino Origin ACS 2010-2014 1.6% 2.5% 7
Who Was Involved in the Assessment Avera Sacred Heart Hospital utilized aspects of the Community Health Needs Assessment and Improvement Planning toolkit developed by the South Dakota Department of Health, focus groups conducted by Maximizing Excellence, LLC, and an online survey. The Community Health Needs Assessment and Improvement Planning toolkit was developed to offer communities a reliable resource that can be used to identify, prioritize, and address their community health needs. Avera Sacred Heart Hospital extensively utilized the toolkit during the Fiscal Year 2015 Community Health Needs Assessment and elected to build upon those results for this Community Health Needs Assessment. The Good & Healthy South Dakota Community Health Needs Assessment and Implementation Planning toolkit provided a strong framework to guide and assist Avera Sacred Heart Hospital in conducting the assessment. The process included gathering data focused on the nutrition, physical activity, tobacco usage, and chronic disease management. Avera Sacred Heart Hospital contracted with Maximizing Excellence, LLC to conduct three focus groups hosted in Yankton, S.D. Careful consideration was taken to ensure that input gathered was representative of the community at large including the medically underserved, low-income or minority populations. Invitations were sent to members of the Yankton Chamber of Commerce, service groups (Lions Club, Rotary Club, Sertoma Club, etc.), agency leaders (e.g. Boys and Girls Club, Yankton Health Services, Food Bank, the Senior Citizen Center, the Banquet, South Dakota Department of Social Service Yankton Region, etc.) and recruitment flyers soliciting input at the focus groups were placed throughout the community. Personal invitations were extended to individuals identified as key informants working with or representing low-income, minority and medically underserved populations of the community. The Community Health Needs Assessment Steering Committee felt the focus group participants were a sampling of the crosssection of socio-economic demographics and represented the interests of the medically underserved, minorities and low-income members primarily of Yankton. The focus groups were open to participants throughout the Avera Sacred Heart Hospital service area. Participants included individuals representing local businesses, nonprofits, the retiree community, the City of Yankton, higher education, the Yankton School District, South Dakota Department of Social Services, and general community members. The focus groups were conducted in 90 minute sessions. In exchange for their time, participants were offered a $40 gift card to the local grocery store. The Community Health Needs Assessment Steering Committee met monthly beginning in September 2016 through May 2017 to gather and review data. Avera Sacred Heart Hospital solicited members of the community to serve on the steering committee with specific requests made to members of the medically underserved, minority, and low-income populations in the 8
community and those who work with marginalized populations. Steering committee membership is comprised of individuals with expertise in health care, public health, geriatric nursing, chronic disease management, diabetes management, wellness, and public relations who demonstrated a willingness to be involved in the assessment and work or volunteer with the underserved or marginalized members of the Yankton community. Committee members are involved with the Banquet (provides free community meals), The Center (Senior Citizens Center), Junior Achievement, Yankton, Yankton Chamber of Commerce, United Way, etc. (Appendix 1) How the Assessment Was Conducted Members of the steering committee met and determined that Avera Sacred Heart would build on the work of the Fiscal Year 2015 Community Health Needs Assessment by once again utilizing aspects of the South Dakota Department of Health, Good & Healthy South Dakota Community Health Needs Assessment toolkit. We determined we would also contract with Maximizing Excellence, LLC to conduct three focus groups. The committee felt an online survey would also be beneficial for gathering data. Maximizing Excellence, LLC drafted the online survey questions. The committee worked with the Avera Health marketing department to facilitate the online survey. Click Rain, Inc., a marketing technology agency based in Sioux Falls developed the online marketing for the online survey. Advertisements were placed on the social media site Facebook. The steering committee reviewed the previous community health needs assessments conducted in 2012 and 2015. Since the prior CNHA was completed, Avera Sacred Heart Hospital has received requests for printed copies of the assessment. However, no written comments were received regarding that community health needs assessment or implementation plan. Based on the Avera Sacred Heart Hospital Board of Directors recommendation, the 2012 community health needs assessment and implementation plan focused on diabetes prevention, education, and screening. Avera Sacred Heart Hospital utilized the Centers for Disease Control and Prevention (CDC) approved program Lifestyle Coaching which is part of the CDC National Diabetes Prevention Program to address the need. Registered nurses and registered dieticians from the hospital were trained to offer this year-long program. There are cohorts of the Lifestyle Coaching program meeting; one has transitioned to monthly meetings per the program guidelines, and the other is meeting weekly. Avera Sacred Heart Hospital held programs on diabetes risks, prevention, and education throughout the year. Screenings were conducted and distributed for use in the community. Over 75 community members participated in the Diabetes Recognition event hosted by the hospital. Avera Sacred Heart 9
Hospital will continue to create awareness around diabetes focusing on prevention, education, and screenings. Based on the Avera Sacred Heart Hospital Board of Directors recommendation, the 2015 community health needs assessment and implementation plan focused on nutrition education, healthy choices, and awareness and to continue to increase care coordination between the hospital and clinical providers in service of our mutual patients and colleagues. Avera Sacred Heart Hospital Community Health Needs Implementation Plan Results Goal Objectives Results Increase nutrition education, healthy choices, and awareness in the community By the end of FY16, Avera Sacred Heart Hospital will implement quarterly nutrition education opportunities at various community events such as Ribfest, Riverboat Days, YankTON challenge, etc. Avera Sacred Heart provided healthy nutrition education at the Yankton Seed Library kickoff event, Riverboat Days, YankTON challenge, and the Kid s fair. Increase care coordination between the hospital and clinical providers By the end of FY17, Avera Sacred Heart Hospital will provide assistance to local service agencies regarding how to prepare healthy meals with regular staple items. We will provide recipes, cooking tips, etc. By the end of FY16, Avera Sacred Heart Hospital will post healthy recipes and cooking tips on its Facebook page at least quarterly. By the end of FY17, Avera Sacred Heart Hospital will explore the possibility of hosting a Farmers Market at the hospital. By the end of FY16, Avera Sacred Heart Hospital will satisfy the requirements of the Good & Healthy SD Vending and Snack Bar grant it was awarded by the State of South Dakota. In FY16, Avera Sacred Heart will establish a Chief Medical Officer position that will have the primary responsibility of developing and strengthening physician and clinic relationships. By the end of FY16, Avera Sacred Heart Hospital will increase the number of patients with advance directives from 19% to 25%. By the end of FY16, Avera Sacred Heart Hospital will request from and grant access to electronic medical records within the hospital and various local clinics to facilitate a better flow of information for patient care where applicable and when appropriate. Avera Sacred Heart Hospital was instrumental in establishing the Yankton Food Council which provides monthly education and recipes. While quarterly posts to the Facebook page were not successful, Avera Health has established a Balance Blog that highlights healthy nutrition and other various health topics that is pushed out through social media. The Market on the Market at the Meridian is a new farmers market that was established in 2016. The market is open Thursday evenings and Saturday mornings. Avera Sacred Heart Hospital elected not to pursue its own market in support of this one. The requirements of the grant were satisfied. Avera Sacred Heart Hospital presented in experiences with bringing healthy vending at the Spring 2016 Good and Healthy South Dakota conference. A KSFY television Medical Minute segment highlighted Avera Sacred Heart s work with healthy vending and snacking. Dr. Kevin Bray, MD with Yankton Medical Clinic was selected as the chief medical officer. Avera Sacred Heart Hospital successfully increased the number of patients with advance directives from 19% to 27.5% Access was requested and granted. 10
Throughout FY 16 and FY17, Avera Sacred Heart Hospital and the OR Taskforce comprised of hospital personnel and local physicians will assess and implement recommended changes to the surgical department from Huron Consulting. By the end FY 17, Avera Sacred Heart Hospital will research the Joint Commission s certification for integrated care. The OR Taskforce worked extensively with Huron Consulting and implemented changes to the surgical department at Avera Sacred Heart Hospital. Avera Sacred Heart Hospital researched the certification but elected not to pursue it. The Good & Healthy South Dakota Community Health Needs Assessment and Implementation Planning toolkit focuses on four primary areas: physical activity, nutrition, tobacco use, and chronic disease management. Additional information was solicited from key community informants and the community in general through the three focus groups conducted by Maximizing Excellence, LLC. Questions used in the focus groups centered on the four primary areas identified by Good & Healthy South Dakota. Information was also solicited about how Avera Sacred Heart Hospital is currently meeting the needs of the community, advance directives, and other pertinent information participants wished to share. Avera Sacred Heart Hospital utilized the questions prepared for the Fiscal Year 2015 Community Health Needs Assessment in the focus groups. Those questions were developed through collaboration with the South Dakota Department of Health Good & Healthy South Dakota coordinators and the masters-prepared social workers from Maximizing Excellence, LLC. A copy of the focus group report is included in Appendix 2. The online survey questions were created by the masters-prepared social workers from Maximizing Excellence, LLC. Those questions had been previously utilized by other hospitals in the Avera Health system when conducting their Community Health Needs Assessments. The committee felt the questions were well vetted and applicable for use by Avera Sacred Heart. The online survey was available for 4 weeks. A total of 112 individuals completed the survey. Ninety-three participants indicated their zip code: 57 individuals from Yankton, 2 from Bon Homme, 7 from Charles Mix, 5 from Clay, 3 from Hutchinson all in South Dakota; 2 individuals from Cedar, NE, 9 from Knox, NE and 8 individuals from outside of the primary service. Nineteen individuals elected not to complete the zip code question. A copy of the survey results is included in Appendix 3. South Dakota Good & Healthy Community Health Indicators were gathered from a variety of resources and data sets. Sources for this secondary data include: Community Commons, Small Area Income and Poverty Estimates from the United States Census Bureau, American Community Survey from the United States Census Bureau, Health Indicator Warehouse, Health Rankings, and the Behavior Risk Factor Surveillance System. These indicators 11
support the information gathered through the focus groups and the online survey. Steering committee members reviewed and evaluated the focus groups report, the online survey results, and the community health indicators to rank the health needs identified through the community health needs assessment process. Common themes were identified and considered from across all information sets: nutrition, physical activity, tobacco use, chronic disease management, coordinated care, community perceptions, advance directives, access to care, and affordable care. A multi-voting technique was used to select the top three priorities from the ten themes. Criteria was based on size, seriousness, economic feasibility, potential for impact, availability of community assets, need due to limited community assets, probability of success, and value of the presented themes. In round one, each participant could vote for as many themes as desired. The top five results were nutrition, physical activity, coordinated care, access to care, and affordable care. In round two, the participants were allotted up to four votes. At the end of the second round, three main priorities were established: nutrition, coordinated care, and access to care. 12
Health Needs Identified/Programs & Resources Nutrition: Nutrition was identified as a significant concern throughout the community and specifically a lack of programming centered on nutrition, making good choices and basic cooking skills. Focus group participants indicated more needs to be done to increase the availability, affordability, and convenient access to healthy options, especially amongst those most in need, within the community. (Maximizing Excellence, LLC report) Participants stressed the importance of employing preventive measures related to nutrition. The need also aligns with the Healthy People 2020 goal, which is to: Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. On March 4, 2015, approximately 20 people gathered in Yankton to begin discussions on nutritional educational needs in the surrounding areas including Yankton and Vermillion, S.D. The main focus of the meeting was to advocate that South Dakota State University (SDSU) Extension Service reconsider offering nutrition education programs in Yankton. Due to budget constraints, this program was eliminated approximately six years ago. Avera Sacred Heart Hospital was part of the discussion and supportive of increasing nutritional awareness, education, and skills in the community. As a result of this meeting, the SDSU Extension program was reinstated in the community. A food council spearheaded by the Extension program and individuals from Avera Sacred Heart Hospital began. The food council meets monthly to promote healthy choices throughout the community. A different fruit or vegetable is highlighted each month and recipes are available to help people utilize the main ingredient. The Yankton Food Council hosted a Conversation on Hunger at the Avera Sacred Heart Hospital Pavilion on July 12, 2017. Twenty-seven individuals representing twenty-three different agencies, non-profits, South Dakota Social Services, health care, and local business leaders gathered to discuss food insecurities specifically in Yankton and in the surrounding communities as well. The United Way & Volunteer Services of Greater Yankton collaborated with the Yankton Food Council to contract with Maximizing Excellence, LLC to facilitate the meeting and ongoing steps to possibly create a Food Insecure Collaborative. Much of the discussion focused on lack of access to healthy choices. The need for nutritional programming is evidenced by data gathered concerning the prevalence of adults and children with a body mass index 13
(BMI) score of 30 or greater, signifying obesity. The reported lack of fruits and vegetable being consumed by adults in Yankton and in South Dakota in general is concerning. Avera Sacred Heart Hospital is committed to continue to provide quality nutrition education in its service area. Nutrition CC = Community Commons, SDYR = South Dakota Youth Risk Behavior Survey, KFF = Kaiser Family Foundation Indicator % of Adults who are Obese based on BMI of >30 Indicator Average servings per day of fruit Average servings per day of vegetables % of High School Seniors who consume 5 or more fruits and vegetables daily % of Children overweight ages 10-17 Data Source Year (Group of Years) Yankton % Bon Homme Charles Mix Clay Hutchinson Cedar, NE Knox, NE % % % % % % CC 2014 29.2% 32.1% 33.1% 29.8% 29.4% 28.1% 27.9% Data Source Year (Group of Years) State of South Dakota State of Nebraska CC 2015 1.18 1.30 CC 2015 1.65 1.79 SDYR 2013 18.3% KFF 2015 26.5% 28.9% 14
Physical Activity: Physical activity or perceived lack of physical activity in the community was a concern identified through the community health needs assessment. A desire for more family focused recreation at affordable rates was highlighted. Avera Sacred Heart Hospital s Wellness Center offers over 120 group exercise classes monthly. Two swimming pools and a variety of exercise equipment, machines, and personal trainers are available to members. Memberships are offered at a discounted rate to the over 1,200 hospital employees and their family members. Avera Sacred Heart Hospital colleagues are actively involved in planning a variety of physical activities in the community including 5K fun runs, the YankTON weight loss challenge, etc. Yankton s Summit Activities Center also houses an indoor pool, fitness equipment, gymnasiums, fitness classes, and personal training sessions as well as outdoor facilities for tennis, track, softball, and walking paths. The Summit Activities Center is a collaborative effort between the City of Yankton and the Yankton School District. Single and family memberships are available. There are a number of private businesses and gyms offering fitness and exercise options in the community along with an active Yankton Parks and Recreation Department. Avera Sacred Heart Hospital will continue to provide quality opportunities for physical activity in the community. Physical Environment Indicators CC = Community Commons, NEPH = National Environmental Public Health Tracking Network Indicators Rate of recreational facilities per 100,000 population Data Source Year Yankton Bon Homme Charles Mix Clay Hutchinson Cedar NE CC 2015 17.82 No data 10.95 7.21 No Data 11.29 Knox NE No Data Population living within ½ mile of a park NEPH 2010 10,906 3,122 3,026 9,448 2,805 2,912 2,455 Tobacco Use: Tobacco use was not seen as a significant concern by participants in the focus groups. According the Health Rankings data sets adult smoking percentages in the Avera Sacred Heart Hospital primary service 15
areas in South Dakota is below the South Dakota average of 20%: Yankton 16%, Bon Homme 16%, Charles Mix 16%, Clay 19%, and Hutchinson 14%. The Tobacco Coalition of Yankton is actively involved in many community activities, educational offerings, and policy development focused on reducing the use of tobacco. All data gathered through the community health needs assessment concerning tobacco use will be shared with the coalition. Chronic Disease Management: Chronic diseases account for seven of every 10 deaths in the United States. They are among the most prevalent, costly, and preventable health problems. Examples of chronic diseases include cancer, heart disease, stroke, obesity, arthritis, and diabetes. Healthy lifestyles can reduce the risk for developing chronic disease. Chronic Health Indicators, Morbidity & Preventive Services CC = Community Commons, KFF = Kaiser Family Foundation, CHR = Health Rankings Indicators % of adults that report having been diagnosed as having Diabetes, per 1000 % of adults age 18+ ever diagnosed with Coronary Heart Disease or Angina % of adults that report having been diagnosed with high blood pressure % of adults that report fair or poor health Average number of reported physically unhealthy days per month among adults 18 years of age and over Average number of reported mentally unhealthy days per month among adults 18 years and over % of adult women respondents who report having mammogram Data Source Year Yankton Bon Homme Charles Mix Clay Hutchinson Cedar NE Knox NE % % % % % % % CC 2013 0.05 0.068 0.088 0.076 0.066 0.051 0.064 CC CC 2011 2012 2006 2012 4.62% No Data No Data 6.7% No Data No Data No Data 27.3% 29.1% 26.0% 26.4% 38.3% 23.8% 21.2% KFF 2015 South Dakota 13.7% Nebraska 13.9% CHR 2016 2.8 2.9 3.8 3.4 2.7 2.9 CHR 2016 2.6 2.5 3.2 3.0 2.5 2.7 CHR 2016 67% 70% 59% 60% 60% 62% 16
Number of Cancer Deaths per 100,000 KFF 2013 South Dakota 154.1 Nebraska 160.7 Coordinated Care: The need for more collaborative, coordinated health care in Yankton surfaced during focus group discussions. Increased communication and collaboration between ASHH [Avera Sacred Heart Hospital] and Yankton Medical Clinic and other community resources could further enhance the patient experience and quality of care received. (Maximizing Excellence, LLC report) On April 1, 2017, Avera Sacred Heart Hospital purchased the Lewis and Clark Specialty Hospital and Medical Office Building in Yankton, SD. This 10 bed facility and office building is now part of Avera Sacred Heart Hospital. This further enhances Avera Sacred Heart Hospital s commitment to providing quality, coordinated care throughout the region. As part of the purchase, Avera Sacred Heart Hospital now has a primary clinic Yankton. The Avera Medical Group Family Practice clinic is staffed by one physician and two advanced care providers. Avera Sacred Heart Hospital and Yankton Medical Clinic collaborated to provide additional access to their respective electronic medical records to promote the seamless delivery of care between the two facilities. Specifically, the Emergency Department physicians at Avera Sacred Heart Hospital can now access the records at the Yankton Medical Clinic when necessary to provide safe and effective care to those patients. A chief medical officer position was created and hired in 2015. Dr. Kevin Bray, obstetrician and gynecologist at the Yankton Medical Clinic, serves in this role. Dr. Bray helps to communicate information between the two facilities and guide the clinical care at the hospital. In 2016, Lewis and Clark Behavioral Health Services opened its chemical dependency unit on third floor of the Avera Sacred Heart Hospital Benedictine Center. This sixteen bed unit provides residential substance treatment through a state of the art 28 day intensive inpatient treatment program. Avera Sacred Heart Hospital is committed to continue efforts to collaborate with health care providers throughout its service area. Advance Directives: The need for advance directives is a concern for health care facilities and health professionals. Advance directives are legal documents that allow 17
a person to articulate decisions about end-of-life care ahead of time. AARP (2008) indicated that only about one-third of adults have an advance directive. Avera Sacred Heart increased the number of patients who indicate they have an advance directive from 19% in 2015 to 27.4% in 2017. The goal established through the 2015 Community Health Needs Assessment Implementation Plan was 25%. Community education events in Yankton, Cedar, and Knox resulted in over 300 individual participants learning about the importance of advance directives. All patients admitted to Avera Sacred Heart Hospital are given information about advance directives and referrals are made to the Pastoral Care Chaplains who facilitate the advance directive paperwork for the hospital. Avera Sacred Heart Hospital is committed to continue increasing advance directives in its service area. Community Perceptions: Focus groups expressed their appreciation for Avera Sacred Heart Hospital. appreciated ASHH s encouragement of employee community involvement and pay attention when ASHH employees give back to the community, either through donations or volunteering. They spoke to ASHH s commitment to community well-being through their sponsorship of events, organizations, and initiatives like healthy vending machines and free C-pap checks. (Maximizing Excellence, LLC report) The focus groups recommend providing incentives for employee community engagement. The employees and leadership of Avera Sacred Heart Hospital are strongly encouraged to be contributing members of the Yankton community and their home communities in the surrounding service area. At this time, Avera Sacred Heart Hospital does not feel it is necessary to incentivize employees to continue to be active participants in the community. Access to Care and Affordable Care: Availability, accessibility, and affordability of basic care and specialty services housed in Yankton influence overall community health Services deemed most important or associated with significant need vary on a person-to-person basis but share a common thread: available services are only as helpful as they are 1) accessible, in terms of hours and transportation; and 2) affordable, in terms of insurance coverage and out-of-pocket costs. (Maximizing Excellence, LLC report) In 2012, approximately 16.3 percent of adults in Yankton under age 65 did not have health insurance. In 2015, that number decreased to 10.2% according to the Small Area Health Insurance Estimates. With 18
the implementation of the Affordable Care Act and the opening of the health insurance exchanges, the uninsured rate among U.S. adults averaged 12.9 percent for fourth quarter 2014. (Gallup-Healthways Well- Being Index) The State of South Dakota has elected to not expand Medicaid to 138 percent of federal poverty guidelines. As a result, there are approximately 48,000 South Dakotans who do not qualify for Medicaid and are not eligible for subsides to offset the cost of health insurance on the health exchanges. (South Dakota Department of Social Services: Medicaid Expansion Estimates, Demographics and Cost, April 2013) Access to Care SAHIE = Small Area Health Insurance Estimates, CHR = Health Rankings Indicators % of adults under 65 years (18-64) of age without health insurance Data Source Year Yankton Bon Homme Charles Mix Clay Hutchinson Cedar NE Knox NE SAHIE 2015 10.2% 12.8% 19.5% 11.9% 11.4% 9.1% 13.3% Primary Care Physician Ratio CHR 2016 990:1 1,400:1 1,160:1 1,550:1 2,430:1 Nebraska 1,350:1 Mental Health Providers Ratio CHR 2016 201:1 6,990:1 No Data 2,330:1 7,300:1 Nebraska 1,420:1 Ninety-two percent of the focus group participants indicated they had a doctor s appointment or went to the hospital in the past year. (Maximizing Excellence, LLC report) Of the online survey participants, 66.67% indicated they were able to see a doctor when they needed to; 12.5% indicated they could not afford it. When asked how would you rate the accessibility of healthcare services in your community, 3.19% indicated a 1, 7.45% indicated a 2, 24.47% indicated a 3, 36.17% indicated a 4, and 28.72% indicated a 5 on a scale of 1 to 10. Significant barriers to accessing the resources in the community include transportation, affordability, and availability of timely care. In terms of accessible, affordable transportation, Liberty Mobility Now, Inc. is establishing service in Yankton. It is a ride-share platform similar to Uber but focused on rural and small urban communities. Yankton Area Progress Growth (YAPG) partnered with Liberty to bring its services to the Yankton Area. Avera Sacred Heart Hospital is a contributing member of YAPG. 19
Avera Sacred Heart Hospital was an active advocate for the presence of a federally-qualified health center in Yankton. allpoints Clinic opened in 2013; in 2016 the clinic transitioned to Horizon s Healthcare. The clinic is located on the Avera Sacred Heart Hospital campus. Horizon s Healthcare offers a sliding fee scale for medical, dental, and behavioral health services. Availability of services according to the focus groups, revolves around limited hours, limited interpreter services, significant wait times for certain specialties e.g. dermatology, few options for working poor, and lack of available child care. Avera Sacred Heart Hospital contracts with an interpreter service that specializes in healthcare to provide aroundthe-clock access to over one hundred different languages. Avera Sacred Heart Hospital now has a primary clinic in Yankton, Avera Medical Group Family Medicine staffed with one physician and two advance practice providers. Avera Medical Group also staffs an Ear, Nose and Throat clinic, Pain clinic, Behavioral Health clinic, and Podiatry clinic in Yankton. Avera Medical Group has a number of family practice clinics throughout Knox and Cedar counties in Nebraska. Avera Sacred Heart Hospital will continue its commitment to provide high quality services to meet the needs of its service area. Community Assets Identified The community health needs assessment identified a number of community assets (Appendix 4), including Avera Sacred Heart Hospital and its community benefit programs, the clinical providers in the community, solid educational institutions, and numerous service groups. Summaries: Assessment and Priorities Avera Sacred Heart Hospital utilized aspects of the South Dakota Department of Health to utilize the Good & Healthy South Dakota Community Health Needs Assessment and Implementation Planning toolkit, contracted with Maximizing Excellence, LLC to conduct three focus groups in Yankton and conducted and online survey to solicit input for this Community Health Needs Assessment. Secondary data was gathered from a number of resources recommended by Good & Healthy South Dakota coordinators and Avera Health. Three significant needs were identified and prioritized in the community health needs assessment process: nutrition, a collaborative, coordinated health care delivery system for Yankton, and access to care. Nutrition policy, regulation, environmental considerations, education, and awareness are a need in the Yankton community. Because good nutrition is foundational to a healthy life, the committee is recommending Avera Sacred Heart Hospital concentrate community efforts on nutrition education, healthy choices, and awareness for the next three years. The committee is also recommending Avera Sacred Heart Hospital continue to increase care coordination between the hospital and 20
clinical providers in service of our mutual patients and colleagues. The committee recommends efforts to put forth to continue to provide access to quality health care for the Avera Sacred Heart Hospital service area. The results of the Community Health Needs Assessment focus group report was presented to the Avera Sacred Heart Hospital Board of Directors on March 6, 2017. The Avera Sacred Heart Hospital Fiscal Year 2018 Community Health Needs Assessment Report and Implementation Strategy was presented to the Avera Sacred Heart Hospital Board of Directors on August 8, 2017 for discussion and consideration. The Board of Directors accepted the Avera Sacred Heart Hospital Fiscal Year 2018 Community Health Needs Assessment Report and Implementation Strategy at the August 8, 2017 meeting. 21
Avera Sacred Heart CHNA 2017 Process Overview... 2 Executive Summary of Findings... 3-7 Appendices... 8-25 Focus Group Questions with Participant Responses... 9-24 Recruitment Flyer... 25
Process Overview Maximizing Excellence, LLC (MELLC) was contracted to develop, facilitate, compile, and analyze three focus groups for Avera Sacred Heart Hospital (ASHH) in support of their 2017 Community Health Needs Assessment (CHNA). With the passage of the Patient Protection and Affordable Care Act in 2010, all nonprofit hospitals are required to conduct a CHNA every three years. A CHNA is a systematic method of identifying unmet health and health care needs of a given population through data collection and analysis and developing strategies to address them. The focus groups were just one part of ASHH s effort to satisfy CHNA requirements. To initiate the assessment, MELLC spoke with Kara Payer, Vice President of Mission, to revisit ASHH s 2015 CHNA and to understand expectations for this iteration. The 2017 CHNA and the next will be spaced just two years apart to sync up with the Avera system s CHNA schedule in 2019. Because of the proximity of assessments, it was decided to use 2015 CHNA focus group questions to allow for direct comparison and to evaluate progress on implemented strategies. MELLC led the focus group recruitment effort by utilizing existing community contacts and approaching local businesses and community organizations with the opportunity for their employees. MELLC also developed a flyer to generate additional community interest. The sample was not limited by any demographic or social marker. Participants included individuals representing local businesses, nonprofits, the retiree community, the city of Yankton, higher education, and the Yankton school district among community members with general interest in the health of Yankton. In total, 25 individuals participated. Three focus groups were offered onsite at Avera Sacred Heart s Pavilion, December 14-15, 2016, in Yankton, South Dakota. Participation was framed as an opportunity to contribute to improving the quality and delivery of health care in Yankton and throughout the region. Individuals were invited to attend one 90-minute focus group session and complete a survey; in exchange, they were offered a $40 gift card to a local grocery store. Focus group questions focused on identifying significant health care needs facing families and the community. Participants were prompted to assess needs related to the four focus areas adapted from the South Dakota Good and Healthy Toolkit: nutrition, physical activity, tobacco use, and chronic disease management. To close, participants were asked to brainstorm actions, programs, and/or strategies they think would make the biggest impact in addressing the community health needs in Yankton. The data collected is subjective as individuals were asked to share their perception of community need, which may or may not accurately reflect reality for all Yankton residents. Upon completion of the focus groups, MELLC compiled and analyzed focus group data in development of a summary report to be published by ASHH. This report includes a process overview, executive summary of findings, prioritized needs, and all raw data from the focus groups. This report was presented to ASHH leadership on January 20, 2017. 2017 Maximizing Excellence, LLC 2
Executive Summary of Findings Praise for Avera Sacred Heart Participants value ASHH s presence in the Yankton community. They appreciate ASHH s encouragement of employee community involvement and pay attention when ASHH employees give back to the community, either through donations or volunteering. They also spoke to ASHH s commitment to community well-being through their sponsorship of events, organizations, and initiatives like healthy vending machines and free C-pap checks. When asked what ASHH is doing well, participants in all focus groups lifted ASHH s commitment to student education and training through job shadowing and financial assistance with training programs. They also spoke to the high quality of health care services provided to them as patients, including a well-managed ER, same-day surgery center, and specialty services like Ob/Gyn and memory care. Investment in new technology, such as 3-D mammography and MRI, is valued by participants. One participant said the mission permeates throughout the building. Other participants shared that ASHH facilities hospital, wellness center, Pavilion are inviting, healthy assets to the community. Within the facilities, staff were described as compassionate, friendly, caring, and respectful. Participants acknowledged that the nurse to patient ratio is very good compared to larger cities and value the holistic care provided to them by ASHH staff. 2017 Maximizing Excellence, LLC 3
Executive Summary of Findings The State of Health in Yankton, South Dakota Options for recreation and community support for nutrition services help make Yankton a healthy community to live in. The trails are well kept, the Summit Activities Center is an asset, and there are many resources to meet nutrition needs, including the Farmers Market, community garden, and organizations such as the Yankton Area Banquet, Food for Thought, and the Contact Center. ASHH s presence within the community as a health care system and as a proponent of community wellness is also seen as beneficial to overall health. Despite these existing strengths, health does not come easily to a significant subset of Yankton residents. Participants identified several barriers to living a healthy lifestyle, of which affordability and culture were the primary determinants. For low-income individuals and families, there is an excessive cost and preparation time associated with healthy groceries, while fast food is less expensive and readily available. To the participants knowledge, there is no free access or sliding scale fee structure associated with any of the recreation facilities. Therefore, participants see choosing a healthy lifestyle as cost-prohibitive. Speaking to culture, participants see an active drug/alcohol scene, general lack of motivation among individuals to make healthy choices, and an unwillingness on the part of community leaders to be progressive in helping the community thrive as factors that perpetuate what is unhealthy about Yankton. Service Scope and Delivery Availability, accessibility, and affordability of basic care and specialty services housed in Yankton influence overall community health. Participants recognize that the size of Yankton may limit capacity to host services but urge the hospital systems to consider bringing additional services and more quality doctors to the community. They feel this would cut down on long waiting lists and trips to Sioux Falls. Services deemed most important or associated with significant need vary on a person-to-person basis but share a common thread: available services are only as helpful as they are 1) accessible, in terms of hours and transportation; and 2) affordable, in terms of insurance coverage and out-of-pocket costs. Participants identified improved service delivery as a significant health care need facing the community and an area of improvement for ASHH. They would like to see communitywide education leading to general awareness of available services and how to access them. Once services are accessed, participants called for improved communication on treatment options, navigation, and cost between health care systems and the patient. Participants value availability, relational care, and time from physicians and care staff. Increased communication and collaboration between ASHH and Yankton Medical Clinic and other community resources could further enhance the patient experience and quality of care received. Participants prioritized service delivery for low-income individuals and families, asserting the importance of equal access to quality health care in Yankton. 2017 Maximizing Excellence, LLC 4
Executive Summary of Findings: Focus Areas Nutrition Participants spoke to the existence of programs that promote nutrition and increase the availability of affordable or free healthy food options in Yankton, including the Boys and Girls Club, Sack Packs, Food for Thought, and the community garden. Although considerable efforts already exist, more needs to be done to increase the availability, affordability, and convenient access to healthy options, especially amongst those most in need, within the community. For the community to embrace a nutritious lifestyle, participants believe education on what to eat and why, where to get it, and how to prepare it is key. They recommend nutrition be treated as a preventive health measure by ASHH with the incorporation of dieticians and wellness coaches into general patient care. Motivation is necessary to complement education and may be brought about by incentivized educational seminars or wellness programs involving local physicians. Physical Activity When discussing physical activity, participants focused on tangible strategies to increase the community s physical activity, while recognizing individual action can only be influenced to a limited extent. Options for recreation could be increased for all age groups: children and adolescents, families, adults, and seniors. Children and adolescents would benefit from more organized activities such as youth sport leagues while more activities that involve adults and children or that are offered at the same time could boost family recreation. Adults may be attracted to adult intramurals or incentivized by a program similar to Silver Sneakers. Above all, these options and general access to recreational space must be affordable. Tobacco Participants spoke to a decrease in the visibility of public smoking and do not believe tobacco use is prevalent among high school students. Ongoing education and resources for tobacco users to quit should continue. Overall, participants think that illicit drug and alcohol use are more of a concern to community health than tobacco use. Chronic Disease Management Participants believe that chronic disease patients will be healthier and experience better treatment outcomes with substantial education upon diagnosis and continual education paired with tools beyond. This increased support and accountability from within the health care system is needed. Participants would like to see this care be direct and personalized through establishing a single point of contact for patients and expanding the Planet Heart program to other chronic diseases for early detection and healthy lifestyle guidance. It is recommended that ASHH match the growing demand for chronic disease care with adequate specialty services as many currently wait for care due to the lack of local specialists. Lack of affordable care also impedes upon people accessing the care needed to manage a chronic disease. 2017 Maximizing Excellence, LLC 5
Executive Summary of Findings Barriers to Accessing Resources Transportation was the most often noted barrier to accessing resources in Yankton. Patients currently have two options: Yankton Transit and the cab companies. Yankton Transit is only in operation Monday thru Friday, stops service at 4:30 p.m., and requires a 24-hour notice. This limited operation proves cumbersome to navigate for patients reliant on public transportation for access to health care. Yankton cab companies recently raised their rates and in doing so have made it less affordable for low-income patients. Participants would like ASHH to be a major player in establishing an affordable and easily accessible transportation option for elderly and low-income patients. Affordability and availability of health care are also significant barriers. The few plan options available are usually accompanied by high deductibles and out-of-pocket costs. Participants do not believe that income-based care options are well known within the community. For those that have secured insurance, they are met with limited hours available for making appointments, long waiting lists for specialty services, and limited provider availability due to patient demand. Access is further compromised for non-english speaking clients as interpretation services do not meet the growth in diversity. Access is also compromised for parents who do not have child care coverage to attend appointments. Participants spoke to a socio-economic divide in Yankton that has led to significant disparity in the overall health and well-being of and health care received by community members. One focus group said there are two Yanktons, the wealthy and the low-income/poor. Existing programs targeted at bridging the divide were reported as not being as successful as they need to be. Other Findings: Advanced Directives Forty percent of participants said they have an advanced directive; most cited family consideration as cause for having one. Of those who do not have an advanced directive, many have been asked multiple times in different settings to develop one. A few participants suggested that the issue be handled in a more informative and sensitive manner by physicians and nurses. It is not a document that should come by haste or misinformation. Doctor Visit Frequency Ninety-two percent of participants have had a doctor s appointment or went to the hospital in the past year. Other Focus Areas In addition to expanding the focus area Tobacco Use to include all drugs and alcohol, participants would like to see priority given to mental health and comprehensive health care accessibility for low-income individuals and families. 2017 Maximizing Excellence, LLC 6
Executive Summary of Findings Responding to Barriers: Avera Sacred Heart as a Patient Advocate Due to Avera s mission and connection with the Catholic Church, participants believe the hospital has a responsibility to advocate on behalf of the working poor, low-income, diverse, and all others who are not able to speak up for themselves. Regardless of action taken or strategy implemented, participants envision Avera taking the lead on resolving Yankton s most significant health care needs, along and/or in partnership with other efforts. Avera has an opportunity to be a major player in the following initiatives: Expansion of programs for people who need sliding scale or free services Expansion of interpreter services to meet growing diversity More affordable Avera premiums and plans in the marketplace Increased access to mental health care Incentives for employee community engagement Extension of ASHH fitness campaign beyond wellness center members Collaboration with SDSU Extension Emphasis on preventive care, especially with nutrition and physical activity Affordable and accessible transportation for the low-income and elderly Online educational resources to promote healthy lifestyles and awareness of resources Collaborate with Yankton Medical Clinic on behalf of patient convenience and well-being Have the Avera Board of Directors be representative of the Yankton community in terms of race, income, education, age, etc. Participants also generated actions, programs, and strategies for other community organizations to adapt to close gaps in service and eliminate barriers. A full list of those can be found in the appendices (pg. 23). 2017 Maximizing Excellence, LLC 7
Avera Sacred Heart CHNA 2017- Appendices Table of Contents Focus Group Questions with Participant Responses... 8-24 Recruitment Flyer... 25 2017 Maximizing Excellence, LLC 8
Q: What is healthy about the community? Recreation Options* Bike/Walking trails; well-kept Summit Center Golf course Social aspect; social media used to promote fitness Nutrition* Heathy food options Farmers Market Community garden Cooking classes for both kids and adults Resources to meet nutrition needs: The Banquet, Food for Thought, Contact Center o Many food resources offered at no cost Healthcare Options and System Presence* Lots of health care options available to everyone Strong health care system Various communitywide health challenges provided by Avera Wellness Other Opportunities for the arts Collaboration among service agencies *All focus groups discussed trails, available food resources, and health care options. 2017 Maximizing Excellence, LLC 9
Q: What keeps people from being healthy in Yankton? Nutrition* Cultural/ meat and potatoes diet Excessive amount of fast food restaurants High cost of healthy groceries Affordability* Mental health care (especially for working poor those not Medicaid eligible but unable to pay co-pays or out-of-pocket costs) Unaffordable recreation facilities; i.e., Summit Center Lack of free indoor recreation space, especially in winter months Lack of education, specifically about Medicaid options Drugs/Alcohol Access to illicit drugs; Yankton is a hub Drug use by both youth and adults Active/popular bar scene Availability Lack of basic, routine dental care for low- to middle-income families Flu shots were not offered in the schools during 16-17 school year Long waiting lists for specialty services; many times trips to Sioux Falls are necessary Lack of adequate psychiatric care to meet mental health needs Community Culture Lack of motivation among individuals to make healthy choices Unwillingness to be progressive or spend money to help community grow Very conservative, narrow-minded culture Stigma to mental health care needs/treatment *All focus groups discussed poor diet/unhealthy food options and affordability of recreation, nutrition, health care. 2017 Maximizing Excellence, LLC 10
Q: What services are most important to you? Specialty Services* Participants answers were not limited by services currently available in Yankton. Emergency room Cancer Center Dermatology Home-health Nursing homes Hospice Diabetes educator Dental care Eye care Behavioral health/addiction treatment Adolescent and teen services Mental health care Availability and Accessibility* Wide range of available hours (evening and weekend) Access to weekend and evening appointments that insurance will cover Transportation Same-day appointments for sickness Health and Wellness Services Wellness programs Physical activity/recreation options Access to gyms, including affordability (Summit Center is expensive) Wellness Center is only affordable option, yet it is very small Massage therapy Other Services Child care to cover doctor s appointments and gym visits Qualified doctors Spiritual care/community churches *All focus groups discussed local specialty services and access to care. 2017 Maximizing Excellence, LLC 11
Q: Most significant health care related need facing your family? Affordability of Services and Medications* Deductibles are too high and keep people from coming in for appointments Health care premiums are double my house payment Seems like money is put into facilities, yet medical bills are sky high Specialty Services Quality doctors to fill needs Many specialties are limited Oncology Endocrinology Neurology Dermatology Orthopedics Health Insurance Options Avera and Sanford are only options; don t accept each other s providers *All focus groups discussed the affordability of services and medications. 2017 Maximizing Excellence, LLC 12
Q: Most significant health care related need facing your community? Awareness and Knowledge* Community awareness of available services and how to access them Costs need to be presented before health care services are provided Need increased awareness of Shine Center Treatment options aren t always communicated to patients Nutrition/Hunger Many children are at the Banquet Community education for nutrition Accessible/affordable healthy foods for low-income families Simple recipes and cooking instruction for low-income families Specialty services More psychiatrists/child psychiatrists Dermatology Orthodontics Well-managed pain management clinic Respite care Health Care Delivery and Cost Reform Policy changes for affordability Gap in insurance coverage between retirement and Medicare age Avera and Yankton Medical Center need to collaborate/work together *All groups discussed the need for increased knowledge and awareness. 2017 Maximizing Excellence, LLC 13
Q: Most significant health care need related to physical activity? Affordability* Affordable or free-of-charge recreation center Affordable space for community activities Affordable youth and adult activities Options for Children and Adolescents Organized activities: youth sports, sports leagues, dance teams, etc. Families Family-friendly recreation center Family activities that involve adults and children Time-efficient options for families with children Child care options for adults while working out Adults and Seniors Adult intramurals Wellness programs like the Silver Sneakers program for seniors Community Embrace of Physical Activity More awareness and use of trails Sidewalks need to be cleared after snow Negative connotations surround exercise *All groups discussed the cost of services. 2017 Maximizing Excellence, LLC 14
Q: Most significant health care need related to nutrition? Education* Education on healthy choices, especially for low-income families on food stamps What to eat, portion sizes, sugar consumption Education at the Banquet with families combine healthy meal prep with dinner Dieticians are typically only utilized when disease is involved Availability, Affordability, and Convenient Access* More healthy, affordable options in Yankton Fresh fruits and vegetables for low-income families Quick, healthy meal prep options Transportation Community Embrace of Nutrition Our culture embraces excess of unhealthy choices We are known for buffets Education exists but without motivation *All groups discussed education on general nutrition and the need for more nutritious options. 2017 Maximizing Excellence, LLC 15
Q: Most significant health care need related to tobacco use? Participants spoke to a decrease in the visibility of public smoking and do not believe tobacco use is prevalent among high school students. Education Connecting people to resources to help them quit o No one seems to know SD Quits exists or they don t want to use it DARE programs may need to be reintroduced at an older age Target low-income individuals for whom smoking may be part of their lifestyle Alcohol and Illicit Drugs Alcohol is a bigger problem than tobacco; a person in SD consumes 38 gallons of alcohol/year Active bar scene Marijuana is more of an issue o College students think marijuana is fine and recreational (local poll by professor) More illicit drugs (meth and heroin are now in Yankton) 2017 Maximizing Excellence, LLC 16
Q: Most significant health care need related to chronic disease management? Education and Skill Development* Health literacy Continual education with resources and tools to apply the knowledge Concrete plans for food and exercise Support and Accountability* Single point of contact for patients with a new diagnosis Educator available when diagnosis is given Support groups for various chronic diseases More time needed to talk one-on-one with doctors Continual follow-up, support, and accountability (i.e., case worker/patient support) o Within the health care system o More than just the initial conversation or pamphlet Systems of Care Communication between health care systems to ensure streamlined health care services More collaboration/communication among service providers Recognize and address co-occurring mental health needs Availability and Affordability There are long waiting lists for appointments with specialists Few local specialists Specific specialty services o Diabetes may be most prevalent an Endocrinologist would be helpful o We have an aging population, so the demand is growing for cancer services A lot of people put off getting a diagnosis because of the cost involved/large deductibles Specific Programs Produce prescriptions for both youth and adults who have already been diagnosed with a chronic disease or are borderline Heart Clinic Planet Heart could be advertised more and expanded to other chronic diseases Weight management *All focus groups discussed community education, skill development, and increased support. 2017 Maximizing Excellence, LLC 17
Q: Other areas that should be prioritized? Substance Use/Abuse Both prescribed and nonprescribed drugs Illicit drugs more so than tobacco synthetics, meth, heroin Mental Health Limited provider options Providers have full schedules Service Accessibility for All Servant s Heart is only open twice per month Transportation options limit access (public transit route schedule and expensive cab fare) Interpreter services need to be better developed to handle growth in diversity Food pantry hours require parents to leave work to get food Other Elder care is limited and expensive ($9,000/month for a room at one center) Local representatives should be available to speak with when calling social services More children are living in homeless shelters/women s shelters than ever before 2017 Maximizing Excellence, LLC 18
Q: Doctor or hospital visit in the past year? Ninety-two percent of participants have had a doctor s appointment or went to the hospital in the past year. Of the two that reported they had not, one has not needed to go and the other stated, I do not do well with doctors. Q: Most significant barriers to accessing resources in your community? Transportation* most notably the lack of options and cost Affordability* Lack of payment plan options Lack of affordable insurance Availability of Adequate, Timely Care* Hours; limited available hours for appointments Limited interpreter services Access to providers Long waiting lists for specialty services; i.e., dermatology Few options for working poor Limited access to dental care for working poor and elderly After hours appointments only available at Convenient Care Child care is not open in evenings or for drop-off cases when parents are sick/need to go to an appointment Lack of Awareness/Education People do not know of available services or how to access them All Points should promote more people may not know about income-based care Other Preventive foot care not covered by insurance Personal comfort. People feel intimidated and low-income individuals may not seek help because they feel inferior *All groups discussed transportation, affordability, and availability of care. 2017 Maximizing Excellence, LLC 19
Q: What is one thing Avera Sacred Heart is doing well? Student Education and Training* Provide job shadowing opportunities Preparing students for future employment via training programs Recruiting high school students for CNA positions by paying for half of program/training Community Engagement and Support* Employees are active in the community; donate time and money Hospital encouraged employees to give back to the community and to volunteer Sponsor community events and organizations Healthy community initiatives (vending machines, education, C-pap checks, etc.) Services* Well-managed ER Memory Care Unit Convenience lab arrangements Diabetes care Dialysis OB, prenatal program, lactation services Spiritual care Planet Heart Same-day surgery center New hospitalist Quality of Staff Compassionate Staff call to follow up post-appointment Friendly and caring nurses/cnas Nurse to patient ratio very good compared to larger cities Respect the whole family of those patients receiving care Facilities the mission permeates throughout the building Investment in 3-D mammography and MRI Inviting, healthy facility Pavilion is an asset to the community by allowing rooms to be used A lot of options including hospital, clinic, wellness center amenities, and classes *All groups discussed ASHH s willingness to provide learning opportunities for students, community engagement, and various services available in Yankton. 2017 Maximizing Excellence, LLC 20
Q: How could Avera Sacred Heart improve how it serves the community? Patient Experience* Improve discharge planning More transparent, efficient, and accurate billing system Greater staff availability and patient support More relational care from physicians and care staff; talk with not at Physicians to spend more time with patients Ensure proper staff training on amount and delivery of information Service Flow* Introduce case workers who follow and help patients navigate all health care services More streamlined processes for home health, hospice, and other services Greater collaboration/communication between hospitals and clinics Collaboration with community resources; i.e., mental health and nutrition Access to records from Yankton Medical Clinic and vice versa Programs and Services* Expand Planet Heart program and apply to other chronic diseases; i.e., cancer, diabetes Risk management evaluation process for nursing homes Educational seminars with incentives Physicians may add some credibility to programs and services Too costly for a lot of people Community Engagement Sponsorships now determined corporately rather than locally; prefer local Have physicians engaged in community outreach and education Facilities Invest in building a larger wellness center *All focus groups discussed the patient experience, how services are offered and consumed, and added or enhanced programs and services. 2017 Maximizing Excellence, LLC 21
Q: One aspect of health care you would change in Yankton? Avera to be more active* Activities noted: Expand interpreter services to meet growing diversity Targeted advocacy on behalf of elderly More affordable Avera premiums and plans in the marketplace More choices for physicians to avoid limiting patient access Increase access to mental health, particularly for low-income families Go to members of the community and get their feedback; i.e., the Banquet Other changes: Establish an Avera Clinic Establish a coordinated health care system Collaboration between Avera and Yankton Medical Clinic Emphasize preventive care Improved communication between patient and doctor More mental health resources; i.e., psychiatrists *All focus groups discussed participant desire to see Avera active in ensuring health care is affordable and accessible for individuals and families in Yankton. 2017 Maximizing Excellence, LLC 22
Q: Actions, programs, strategies to make biggest impact on health care needs? Avera should be a major player in the following initiatives: Expansion of programs for people who need sliding scale or free services Employees could mentor with Big Friend Little Friend; provide incentives Extend Avera s fitness campaign beyond members Collaborate with SDSU Extension Affordable and accessible transportation for the low-income and elderly Online educational resources to promote healthy lifestyles and awareness of resources Host a community interest forum with those you serve Have the Avera Board of Directors be representative of the Yankton community in terms of race, income, education, age, etc. current board composition is not Nutrition and Physical Activity General wellness programs, not just for weight loss Endorse Blue Zone practices Coordinated exercise classes for adults and youth, separate but at the same time Free community center Affordable/free activities and sports for children Other ideas: Conduct a Collective Impact Study to study efficacy of social services in addressing community needs Create a centralized forum of resources transportation, child care, mental health, etc. Pain management program for substance abuse in town ESL classes, especially to address communication barrier with Hispanics Support groups for those with chronic/terminal illnesses New Link program by United Way to connect professionals Incorporate animal therapy Options for low-income elderly to receive quality care Involve the elderly in the community garden program; they can teach the kids and food can be donated back to the families 2017 Maximizing Excellence, LLC 23
Q: Do you have an advanced directive? Forty percent of participants said they have an advanced directive; some said it was due to consideration for family members and one person said it was the smart thing to do. Of those who do not have an advanced directive, most have been asked multiple times in different settings to develop one. A few participants suggested that if possible, the issue be handled in a more informative and sensitive manner by physicians and nurses. They feel that it is a document that should not come by haste or misinformation. 2017 Maximizing Excellence, LLC 24
Recruitment Flyer 2017 Maximizing Excellence, LLC 25