September 2015
Illinois Valley Community Hospital Illinois Valley Community Hospital (IVCH) is a notfor-profit hospital located in north central Illinois. From the organization s mission statement: Illinois Valley Community Hospital is dedicated to providing exceptional care through a commitment to clinical excellence and compassion for every patient, every day. IVCH has undertaken a community health needs assessment (CHNA) as stipulated by the Patient Protection and Affordable Care Act which requires tax exempt hospitals to conduct a needs assessment and develop an implementation strategy every three years. This report highlights findings from the data collected, and identifies community health needs and actions to address these needs. A stakeholders working group, comprised of the following members and representing the broad interests of the communities served, was responsible for the CHNA process. They developed a survey instrument, evaluated survey responses, collected and evaluated secondary data, synthesized the primary and secondary data, and identified and prioritized community health needs. Member Name Jennie Barrie Kelly DeBoer, MD Lisa Carlson Amanda DeGrush Ray Fischer Mary Jauch, RN Julie Kerestes Angela O'Bryant, RN Dawn Moutray Gene Vogelgesang Amy Stone, RN Julie Sloan Peggy Cain Makalia Peters Christine Kohut Position, Organization La Salle County Health Department Family Physician, IVCH Oglesby Med. Group Chief Financial Officer, (Interim) IVCH Alternatives for the Older Adult Deacon, Pastoral Care, IVCH Emergency Room, IVCH Director, La Salle County Health Department Coordinating Chair, IVCH Social Services Director, IVCH Public Relations Director, IVCH School Nurse, LaSalle Public Schools United Way March of Dimes-Heartland Division Director Alternatives for Older Adult North Central Director of Access Services 1
Communities Served by IVCH The IVCH service area includes portions of La Salle, Bureau and Putnam counties, and is illustrated on the adjacent map. Also shown on the map are: the locations of IVCH, the Hygienic Institute, the five other hospitals in the area, and the eleven zip codes which account for almost all of the patients seen at IVCH. 2
Population As shown in Table 1, the threecounty area has about 150,895 residents. No population growth is projected for the area. The majority are White, with almost three-quarters of the population residing in LaSalle County. Children/youth under the age of 18 make up 23.9% of the population, ages 20-39 comprise 22.8%, while 35.5% are between the ages of 40-64 and 17.8% are 65 years and older. TABLE 1. Estimated Population by County, Race and Ethnicity, 2012 2013 LaSalle County Bureau County Putnam County Total Population 111,241 33,840 5,814 White 95.2% 96.6% 97.6% African-American 2.3% 0.9% 0.9% Hispanic 8.9% 8.6% 4.7% Asian 0.9% 0.9% Z Native American Z 0% Z: Value greater than zero but less then half unit of measure shown. Source: United States Census Bureau; State & County Quick Facts 2015; https//quickfacts.census.gov County Health Rankings TABLE 2. Health Rankings by County, 2015 Health Outcomes Factors LaSalle 47 75 Bureau 26 48 Data on health outcomes and other health factors are evaluated and published annually by the Robert Wood Johnson Foundation (www. countyhealthrankings.org). The data are used to rank counties within a state, and provide an indication of the overall health status of a given county. Rankings for LaSalle, Bureau, and Putnam (out of 102 counties in Illinois) are shown in Table 2. Putnam 16 69 Source: County Health Rankings & Roadmaps; 2015 Causes of Death There were 1,792 deaths among residents of the IVCH service area in 2014. As is the case nationally and statewide, heart disease and cancer were the leading causes of death. Table 3 presents data on deaths and death rates, in total and for heart disease and cancer. *Per 100,000 population; not age adjusted Source: Illinois Department of Public Health,IQuery Source: United States Census Bureau; State & County Quick Facts 2015; https//quickfacts.census.gov TABLE 3. Deaths and Death Rate, Heart Disease & Cancer, 2012 Heart Disease Cancer Population Deaths Rate* Deaths Rate* Illinois 12,859,995 26,670 180.6 24,570 178 LaSalle 111,241 323 218 294 198 Bureau 33,840 95 191 74 152 Putnam 5,816 18 207 20 230 3
Health, Health Status and Related Issues The 2015 County Health Rankings & Roadmaps report that: 16% of the adults in the service area do not have health insurance. 11% say they could not see a physician due to the cost. 16% of persons age 18 or greater report fair or poor health, averaging 4 days of poor physical health and 3 days of poor mental health per month. The adult obesity rates in area counties (30-31%) are above the Illinois rate (27%) and below the National Benchmark (35%). In LaSalle County, 22% of adults report smoking; almost twice the National benchmark and 1/3 higher than the State of Illinois. Excessive drinking was reported by 24% of the adults in LaSalle County; above the Illinois and National rates. Education; Health & Related Behaviors in School-Aged Children The 2015 County Health Rankings indicates that: In LaSalle County, 84% have a high school diploma while in Bureau the rate is 87% and Putnam County is at 83%. The State of Illinois's high school diploma rate is 82% In 2015 in LaSalle County, 21% of children were eligible for free lunches. 4
Education; Health & Related Behaviors in School-Aged Children The Illinois Youth Survey collects information from 6th, 8th, 10th, and 12th grade students about nutritional and activity habits, alcohol, tobacco and drug use, school safety, and other selected behavioral issues. Table 4 profiles selected health related factors for students in LaSalle County in 2014 while Table 5 profiles selected behavioral/ social factors. Source: Illinois Youth Survey, 2014 TABLE 4. Selected Health Factors, LaSalle County, 2014 Grade Overweight, Body mass index Abused any obese; (BMI) above substance, last self-reported healthy weight 12 months 6 24% 24% 12% 8 33% 27% 36% 10 40% 32% 61% 12 34% 25% 74% TABLE 5. Selected Behavioral Factors, LaSalle County, 2014 Grade Truant 10+ Ever bullied Fighting at times past least once, last school year 12 months 6 18% 57% 33% 8 24% 60% 33% 10 13% 42% 34% 12 10% 37% 21% Note: Data from school-based surveys (Tables 4 & 5) and for some of the indicators reported in the County Health Rankings & Roadmaps were not available for Bureau and Putnam counties because of their smaller population. 5
Income and Unemployment Per the County Health Rankings, 2015, median household income in LaSalle ($49,487), Bureau ($49,062), were both below the State of Illinois figure of $56,212. Putnam County's median household income is $58,438. The December 2014 figures from the Illinois Department of Employment Security show that unemployment rates in LaSalle (8.3%), Bureau (7.4%), and Putnam (7.8%) were higher than the State of Illinois (7.1%) and United States (6.2%), However every county mentioned above has seen improvement in their unemployement rate since 2012. Poverty As shown in Table 6, poverty rates in all three counties increased from 2010 to 2014 in both the all ages and under 18 categories, with the exception of LaSalle county in the "all ages" category where there was a slight decrease. TABLE 6. Poverty Rate for Service Area Counties, 2010 & 2014 All Ages Under 18 2010 2014 2010 2014 La Salle County 13.2% 12.9% 17.6% 18.7% Bureau County 11.2% 12% 17.6% 19.8% Putnam County 7.8% 10.5% 13.7% 20.6% Illinois 13.8% 14.4% 19.4% 20.4% United States 15.8% 15.6% 21.6% 21.9% Health Needs of the Community Surveys of Community Residents Primary data for this assessment came from two sources, a community study performed for IVCH by Leede Research in 2008 and a survey developed, distributed, and analyzed by the stakeholders working group specifically for the CHNA. The 2008 study was administered by telephone and 302 interviews were completed. Table 7 shows the responses by more than 7.5% of interviewees to the questions: What are the three greatest health needs facing you and your family in the next two years? TABLE 8. Extent to Which Needs Are Being Met, 2015 Issue/ Need Score Table 8 shows the scores, ranging from 1 ( not at all met ) to 7 ( totally met ), on how well eight specific health needs were being met. Availability of specialists 4.33 Access to specialized treatment 4.55 Convenient hours at area clinics 4.70 Availability of transportation 4.91 Availability of quality health care services 5.05 Availability of urgent care 5.30 Availability of family physicians 5.38 Availability of home health care 5.57 Source: IVCH Community Study; 2015 6
Health Needs of the Community The stakeholders working group developed a survey comprised of 40 health and related issues/factors. Respondents catorgorized each factor as being a major concern, a minor concern, or not a concern. Potential needs were explored in seven categories; housing (4 issues), social (11), healthcare (11), education/ school (7), employment/economic (5), transportation (1), and spiritual (2). TABLE 10. Respondent Household Composition, 2015 Households w/adults w/children 0 n.a. 35% 1 25.7% 11.8% 2 52% 16.5% 3 9.5% 7% 4 or more 6.4% 4.6% Surveys were distributed through the IVCH magazine Health Scenes, electronically/internet, and in person at a variety of distribution sites. A total of 153 completed surveys were received; Survey Monkey (85), Focus Group (68). Females (61.5%) and Whites (86%) represented large majorities of respondents in their respective cohorts. Tables 9 and 10 profile other characteristics respondents. Source: IVCH Community Needs Survey; 2015 7
COMMUNITY HEALTH NEEDS ASSESSMENT-SEPTEMBER 2015 EXECUTIVE SUMMARY Introduction and Objectives Illinois Valley Community Hospital (lvch) has undertaken a community health needs assessment as stipulated by the Patient Protection and Affordable Care Act which requires tax exempt hospitals to conduct needs assessments and develop community benefit plans every three years. The needs assessment is a primary tool used by the Hospital to determine its community benefit plan, which outlines how the Hospital will give back to the community in the form of health care and other community services to address unmet community health needs. The 2015 Community Health Needs Assessment has four objectives: Develop a comprehensive profile of health status, quality of care and care management indicators for residents of the IVCH service area. Identify a set of priority health needs (public health and health care) for follow-up. Provide access to the Community Health Needs Assessment data and assistance to stakeholders who are interested in using it. Provide recommendations on strategies that can be undertaken by healthcare providers, public health staff, communities, policy makers, and others to follow-up on the information provided with actions that may improve the health status of the community. The primary IVCH service area is located in North Central Illinois and includes portions of La Salle, Bureau and Putnam counties. Methodology Primary Data Collection Stakeholders who represent the broad interests of the community served were identified by IVCH, contacted and asked to participate in the needs assessment process. The key stakeholders developed a survey tool for use across the defined service area of IVCH. The survey tool asked participants their level of concern for multiple health care areas as well as social and environmental topics which could impact an individual's health. Methods of distributing the survey included focus groups and electronically via an online survey website.
Secondary Data Collection Secondary data was collected from a variety of local, county, state and national sources to present a community profile. When pertinent, these data sets are presented in the context of the three counties and the State, framing the scope of an issue as it relates to the broader community. Analyses were conducted at the most local level possible for the IVCH primary service area, given the availability of the data. Community Profile Community health needs assessments are designed, in part, to identify issues where changes in the healthcare delivery system can improve both patient care and preventive services for those at risk for health problems. This section describes the characteristics of the IVCH service area population. The population for the IVCH primary service area is 150,895. Children and youth under the age of 18 make up 22.7% of the population; Adults age20-39 years of age comprise 25.2%; 34.9% are between the ages of 40-64; and 17.2% ofthe population are seniors aged 65 years and older. The population of the service area consists primarily of White/Caucasians (87.5%) and Hispanics (8.7%). The area has a notably larger percentage of Whites, and a smaller percentage of all other races/ethnicities when compared to the State of Illinois. Household Income: The reported median household income for La Salle, Bureau, and Putnam counties ($49,487, $49,062, and $58,438 respectively) were below the State of Illinois average of $56,212. Unemployment rates for the three county service area are La Salle County - 8.3%, Bureau County - 7.4%, and Putnam County 7.8% which are all higher than the State of Illinois rate of 7.1% and National rate of 6.2%. Poverty levels in two of the three counties (Bureau: 12%, Putnam: 10.5%) have increased over the past 3 years while remaining below the State of Illinois (14.4%) and National (15.6%) rates. The poverty level for LaSalle County (12.9%) showed a slight decrease from three years ago. For 2012, the federal poverty threshold for one person was $11,670 and for a family of four $23,850. The poverty rates paint an important picture of the population within the IVCH primary service area. The percentage of the population in the service area with a high school diploma is slightly above the State of Illinois rate of 82%.
Recommendations The following areas were identified as Priority Needs based on analysis of the Primary and Secondary data: Priority need identified Percent of respondents who felt this was one of three greatest health needs facing them and their families in~he next two years 1. Cost of healthcare 47% 2. Affordable insurance 36% 3. Quality of healthcare 29% 4. Affordable prescriptions 28% 5. Dental 27% 6. Aging/elderly issues 24% 7. Mental health 16% Implementation Strategies to Meet Identified Community Needs Initiatives in Response to Needs Previously Identified IVCH has responded to needs identified in the 2012 Community Survey through the following initiatives. The IVCH Wound and Hyperbaric Center opened in 2013. It is the only center in the Illinois Valley to offer hyperbaric oxygen treatment in addition to advanced wound care. Three medical physicians staff and oversee the treatments in this state of the art facility. The Wound Care Center serves a 20 mile radius, with the following counties included: Bureau, DeKalb, Grundy, Kendall, LaSalle, Lee, Livingston, Marshall, and Putnam. In a joint venture with St. Margaret's Hospital and IVCH, Valley Regional Cancer Center serves patients in the surrounding communities. Medical services are offered by Illinois Cancer Care, Valley Regional Health Services, and Valley Radiation Oncology. Another joint venture between local health care systems St. Margaret's Hospital, Perry Memorial Hospital, and IVCH includes the Associated Gastroenterology Consultants. Two local gastroenterologists work with all three hospitals to provide comprehensive gastroenterology care to our communities. Perry Memorial Hospital medical office building houses a satellite office for the IVCH Women's Health Care Center. Two OB/GYNs and a certified nurse midwife have office hours at the Perry Memorial site two days a week in addition to expanded office hours in the Peru office. IVCH employs three OB/GYNs and four certified nurse midwives with expanded provider hours; 10 hours per day, Monday - Friday. IVCH offers medical directorship services to area nursing homes. The Hygienic Institute is a Rural Health Clinic operated and subsidized by IVCH. It is an important resource in addressing community health needs. The Hygienic Institute offers a medical physician as well as two family nurse practitioners. Expanded provider hours accommodate more patients to meet the greatest needs.
IVCH recently added a board certified infectious disease physician who also adds to the medical staff of the IVCH Wound and Hyperbaric Center. This physician is the only infectious disease physician in the Illinois Valley and serves the aging and diabetic patient population. IVCH offers a Sleep Medicine Clinic staffed by an internal medicine physician and a team of sleep specialists. IVCH provides numerous other healthcare related services for example, patient transportation (North Central Area Transit van), community outreach and education programs, Mea Is on Wheels - as part of the organization's commitment to serving the community. Addressing Needs Identified in the 2015 CHNA IVCH has begun the transition to Rural Health Status. In the past year, several mid-level providers have joined the medical staff to provide expanded service hours at the hospital's clinics. The mid-level providers will provide care at least 50% of the time that all clinics are open. Expanding office hours and clinicians will allow easier access to quality care for patients. It will allow less complex issues to be dealt with immediately so that more complex issues can be referred for further evaluation. Quality mid-level providers will decrease the patient's cost for healthcare services. Ultimately, this will result in less emergency room visits for non-emergent care issues which will lessen the cost of healthcare expenses to the hospital. The Affordable Care Act has insured more of the community but some still struggle with high deductibles and out of pocket expenses. IVCH offers a financial assistance program that addresses these needs. Patients can apply for financial assistance with the IVCH healthcare system to accommodate their financial needs. IVCH also offers a charity care program and extended payment plans. IVCH has qualified individuals on-site that can assist the community to sign up for insurance through the Healthcare Marketplace. IVCH utilizes Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey to distribute patient surveys. These tools are critical in identifying areas of patient satisfaction in need of improvement. The surveys are looked at weekly and a monthly committee meets to determine what areas of care require intervention for improvement in quality. Addressing quality and patient satisfaction are a high priority at IVCH. These survey scores are reported by the federal government through the Hospital Compare program. The healthcare providers at the IVCH clinics utilize prescription programs available through many retail pharmacies located here in the Illinois Valley. In addition, many pharmaceutical companies offer discount prescription programs for certain medications. IVCH office staff are skilled in assisting patients to fill out the required documentation to qualify for these programs. IVCH does not employ dental professionals. The emergency department cares for a number of patients with dental concerns and dental health related problems. The IVCH emergency department refers all dental patients to a list of dental providers in the surrounding community and several counties. North Central Behavioral Health Systems serves clients through eight locations in central and north central Illinois with a broad range of mental health and addiction services for individuals and families. Funding for a significant patient population in our community has been scheduled to be terminated this spring. IVCH sees the need for intervention in this area and is looking at options with other local hospitals to address these very specialized needs.
Future Initiatives to Meet Needs in the Community IVCH is working with Perry Memorial Hospital to jointly recruit a board certified Pediatrician. The two hospitals recognize a need in the community for a specialist to take care of the needs of the littlest members of the community. IVCH will offer a follow-up survey to the community to address the more specific needs for the "aging/elderly issues" question as well as the "quality of healthcare" question on our 2015 CHNA. IVCH recognizes that this was a high priority need for many in the Focus Groups taking the survey and we would like to better understand what areas the community feels are lacking. The survey will be distributed by mail in the summer of 2016 with results reviewed and a plan of action in place before the end of the year. IVCH has recently added two internal medicine physicians and an orthopedic surgeon that serve the community of Streator after the closure of the community hospital. Illinois Valley Community Hospital is dedicated to providing excellent healthcare and exceptional service to the community it serves. This CHNA will help guide future efforts and initiatives in fulfilling this commitment. Conclusion IVCH is adding additional specialized equipment to aid in the care of patients with obesity, also reducing the risk of injury to staff. IVCH is implementing a new electronic patient record and patient billing system for all professional services provided. This system will provide state of the art ability for IVCH physicians to coordinate patient care and patient friendly access to scheduling personal health information and understandable patient bills. IVCH is recruiting a family physician to expand the staff at the Hygienic Institute which serves the neediest of the Illinois Valley patients. On an ongoing basis, IVCH evaluates the physician needs within the service areas. In addition to the rural health expansion outline above, IVCH continues to recruit internal medicine physicians to serve the aging population and chronic disease prevalence. Expansion of ENT, Sleep Medicine, orthopedics, and pain management is being planned. IVCH has joined the Illinois Rural Community Care Organization which will initially provide data to participants to be used to develop strategies to lower the cost, with improved quality of care. Part ofthis is having a nursing care coordinator for patients needing chronic disease management.