St. Anthony North Hospital 2013 Community Health Needs Assessment St. Anthony North Hospital - Community Health Needs Assessment 2012 1
CONTENTS 1 INTRODUCTION... 3 1a Brief description of hospital, history and services provided... 3 1b Mission statement, vision and values... 4 1c Organizational commitment to community benefit... 5 1d Commitment statement to the uninsured and underinsured... 5 2 COMMUNITY HEALTH NEEDS ASSESSMENT... 6 2a Community... 6 2a i Definition of community served by the hospital... 6 2a ii Demographics of the community... 7 2a iii Uninsured persons, low-income persons, and minority groups... 10 2b Data collection... 15 2b i Process used to gather data... 15 2b ii Information gaps... 17 2c Health needs of the community... 17 2c i Process to identify and prioritize needs... 17 2c ii Prioritized list and description of community health needs... 18 2c iii Healthcare resources available in the community to meet the needs... 19 3 CONTACT INFORMATION... 22 St. Anthony North Hospital - Community Health Needs Assessment 2013 2
1 INTRODUCTION 1A BRIEF DESCRIPTION OF HOSPITAL, HISTORY AND SERVICES PROVIDED St. Anthony North Hospital is a full service, 196-bed hospital, serving the north metro community since 1971. St. Anthony North specializes in emergency and trauma, cardiac care, advanced wound care, spine and joint surgery, women s services and senior services. St. Anthony North is sponsored by Catholic Health Initiatives and is part of Centura Health, Colorado s largest hospital and health care network delivering advanced care to more than half a million people each year, across 14 hospitals, seven senior living communities, medical clinics, affiliated partner hospitals, Flight For Life Colorado, and home care and hospice services. Distinctive services A full-service, acute care hospital; St. Anthony North features a number of distinctive medical disciplines: 24-hour emergency care with Level III trauma designation Cardiac Care, Cath Lab, Cardiac Rehabilitation and Telemetry St. Anthony North Family Medicine Residency and Medical Center Wound Care Center with Hyperbaric Oxygen Therapy ICU Medical and surgical services. The Birthplace Orthopedic and Spine Institute Women's Health Specialists Outpatient services and day surgery Senior Health Center Sleep Disorders Center Advanced Imaging Services St. Anthony North Medical Pavilion Patient & Community resources The St. Anthony Family Medicine Residency Program is located at St. Anthony North Hospital making it a primary inpatient teaching site for family practice physicians. Through this program, medical residents advance their skills in family medicine, including obstetrics and inpatient medicine. Ask-A-Nurse offers free health information and physician referrals. Pastoral Nurse Program serves 10,000 indigent and uninsured people each year. Sexual Assault Nurse Examiner program (SANE) assists 100 women each year. Injury prevention services, often in collaboration with local police and fire departments. St. Anthony North Hospital serves homeless families through participation in a program called Growing Home. Health Passport, a free membership program providing health and wellness educational opportunities to the community. Through this program health insurance counseling and benefits assistance is offered. For more information about St. Anthony North Hospital, visit www.stanthonynorth.org. St. Anthony North Hospital - Community Health Needs Assessment 2013 3
1B MISSION STATEMENT, VISION AND VALUES Our Mission: We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. Our Vision: To fulfill a covenant of caring for our communities to become their partner for life. Our Core Values: Compassion- In serving our customers, their families and each other, we will: o Honor the individuality of each person; o Treat each person with dignity, taking the time to be present, to listen, to explain and to understand; o Create a caring environment that exudes humanity, humility, grace and love. Respect- In working with each other, we will: o Encourage and value the contributions of each person, and make each feel supported, reassured and empowered; o Listen well, communicate openly and honestly, and encourage others to do the same; o Treat others as we would like to be treated ourselves, relating so well with them that they actively seek to associate with us. Integrity- In all of our interactions, we will: o Foster trust by being truthful, empathetic and consistent; o Be authentic and courageous, aligning what we are thinking, saying, feeling, and doing; o Be responsible for and follow through on the commitments we make. Spirituality- In honoring the missions, ministries, and heritages of our Catholic and our Adventist sponsors, we will: o Add meaning and purpose to the lives of our associates, physicians, and partners; o Celebrate the role of spirituality in healing for each individual; o Serve each other and our communities in harmony with the inclusiveness, wholeness and touch that characterized Christ's healing ministry. Stewardship- In managing the natural, human, and financial resources to which we have been entrusted, we will: o Seek ways to appropriately utilize resources, allowing us to become more effective and productive; o Act responsibly, taking only those actions that align with our mission; o Be accountable to the organization and to each other for our actions and the outcomes they produce. Imagination- In seeking to grow our ministry, we will: o Look beyond the challenges of the present and envision what is possible; o Cultivate and reward innovation and risk taking; o Embrace continuous learning and positive technological advancement. Excellence- In all we do, we will: o Put forth our personal and professional best, providing the highest quality of care of which we are capable; o Commit ourselves to continuous improvement, seeking to set the recognized performance standards within our industry; o Deliver a superior experience for all of our customers, sensing their needs and exceeding their expectations. St. Anthony North Hospital - Community Health Needs Assessment 2013 4
1C ORGANIZATIONAL COMMITMENT TO COMMUNITY BENEFIT Colorado s needs are growing. To live our mission in an economy that challenges more people than ever before, Centura Health continues to lead the way in helping Coloradans access quality health care. The connected network of facilities, entities and foundations that form the Centura Health family are serving community needs through education, preventive care, safety initiatives, health advocacy, counseling and support groups. Our work in our communities is born out of the second part of our mission, which compels us to serve others by nurturing the health of our communities. From access for the uninsured, to serving as a voice for health care in the state legislature, to community classes and education to build strong, healthy communities, Centura Health is a partner for life. We are more committed than ever before to making our world a better place, and we seek to make the most impact in every community we touch. As a testament to our commitment to serving the most fragile members of our community, the hospital provided $24.3 million in uncompensated care, charity care and community benefit in fiscal year 2012. 1D COMMITMENT STATEMENT TO THE UNINSURED AND UNDERINSURED According to Centura.org, more than 700,000 Coloradans are without health insurance and, as a result, growing numbers are facing difficulties paying for medical care. Centura Health believes that hospitals should have the ability to offer discounts to those who are unable to obtain insurance and do not meet charity care criteria. It is the policy of Centura Health to provide uninsured patients with discounted rates for all hospital bills. The discount is applied to all hospital inpatient, outpatient and Emergency Room bills that have been screened and do not have third-party insurance, Medicare, Medicaid, Champus, or other governmental payer programs and do not meet the Centura charity guidelines. Centura Health strives to compassionately serve uninsured patients with an understanding of the financial burdens they may face. Centura supports and advocates for meaningful and appropriate changes in legislation that improve access to affordable, quality medical care for the uninsured. Centura Health will treat uninsured patients in the following manner: Uninsured patients will be treated fairly and with respect during and after treatment, regardless of their ability to pay. Uninsured patients will be provided with financial counseling, including assistance applying for local, state and federal health care programs such as Medicare, Medicaid and the Colorado Indigent Care Program. Uninsured patients will be informed of and assisted in applying for charity care available through Centura Health as appropriate. Centura Health utilizes a charity discount schedule that takes into account state or federal poverty guidelines to aid in the qualification of patients seeking assistance in meeting their financial obligations. Financial counselors will attempt to meet with all uninsured patients prior to discharge from the hospital. Financial counselors will use best efforts to personally contact uninsured patients before any collection activities are initiated. St. Anthony North Hospital - Community Health Needs Assessment 2013 5
Uninsured patients that do not qualify for assistance will receive a 30 percent discount off billed charges. This will automatically be adjusted during the billing process, so that all statements and collection efforts will be based on the discounted amount. Centura will also offer an additional 15 percent Prompt Pay Discount for accounts paid in full within 60 days of receiving the first statement of patient liability. If at any point an alternative payment source is identified, all discounts stated in this policy will be reversed. A call center is available so that patients may speak to an individual who can help them with questions on their bills; the call center phone number is prominently displayed on all billing correspondence. Hospital-based physicians and related entities will be encouraged to follow the Centura Health Principles Regarding Uninsured Patients but this is done at their discretion. Centura Health will not engage in the following activities: Centura Health will not pursue legal action for nonpayment of hospital bills against any patient who has worked with Centura to demonstrate his or her inability to pay and who is unemployed or otherwise financially unable to pay. Centura Health will not pursue legal action for nonpayment if the only way to collect payment would be to place a lien on the patient's home. Centura Health always has distinguished itself from other hospitals and systems in its treatment of the uninsured: Centura Health hospitals will continue to treat patients in their emergency rooms without regard to the patient's ability to pay. All patients will continue to be triaged and treated as appropriate. Centura Health has provided numerous outreach programs to the community in its pursuit of healthy communities and constantly seeks opportunities to advance its health care ministry. It is not the practice of Centura Health to place a lien on a patient's home when it is the patient's only asset. Centura Health will continue to work for increased access and coverage for the uninsured through legislative and community activity. It is the practice of Centura Health not to pursue legal action for nonpayment unless it has first examined the patient's eligibility for other assistance or charity care. 2 COMMUNITY HEALTH NEEDS ASSESSMENT 2A COMMUNITY 2A I DEFINITION OF COMMUNITY SERVED BY THE HOSPITAL St. Anthony North Hospital - Community Health Needs Assessment 2013 6
To ensure alignment with publicly available Colorado Department of Public Health and Environment (CDPHE) data, Centura Health leaders decided that Colorado counties would comprise the geographic area for the 2013 Community Health Needs Assessment (CHNA). Individual Centura hospital facilities then examined their primary market areas and identified Colorado counties where at least 10% of their patient population resided. The counties identified by each facility comprise the Primary Service Area used in the data reports. The Primary Service Area for St. Anthony North Hospital includes Adams County and parts of Broomfield County to include the cities of Westminster, Federal Heights, Thornton, Northglenn, Commerce City and portions of Arvada, Broomfield and unincorporated Adams County. The total population of Adams County according to the 2010 census was 441,603 residents with another 55,889 residents in Broomfield County. Note: Census for Unincorporated Adams County not available. St. Anthony North Hospital Service Area Map 2A II DEMOGRAPHICS OF THE COMMUNITY Population: Both Adams and Broomfield Counties, have percentages of young populations that exceed state averages. Adams County has one of the state s lowest percentages of seniors 1. 1 Graphs refer to a MNDOG primary service area. The acronym MNDOG refers to the Mountains-North Denver Operating Group which is a Centura Health operating group comprised of the following hospitals: St. Anthony North Hospital (Westminster, CO), St. Anthony Hospital (Lakewood, CO), Avista Adventist Hospital (Broomfield, CO), St. Anthony Summit Medical Center (Frisco, CO) and OrthoColorado Hospital (Lakewood, CO). St. Anthony North Hospital - Community Health Needs Assessment 2013 7
Race: Adams and Broomfield Counties are predominately of White race, which includes Hispanics. Adams County person s of Hispanic or Latino origin is 38%. Broomfield and Adams Counties both have Asian populations greater than the state average. St. Anthony North Hospital - Community Health Needs Assessment 2013 8
Education: Adams County has one of the lowest education levels in the state with only 81% having a high school education and 20% with a Bachelor degree or higher. Income: Adams County has a median household income of $53,779 while Broomfield County median income is $77,606. Adams County has one of the highest poverty rates in the state 13.3% and Broomfield is one of the lowest levels in the state at 4.9%. Single Parent Homes: One of the key contributors to poverty is single parent homes headed by females. Adams County has a 7.5% rate one of Colorado s highest. Employment: The unemployment rate in Adams County is 10.2% higher that the states average of 8.9%. Broomfield is 7.9%, lower than Colorado s average. St. Anthony North Hospital - Community Health Needs Assessment 2013 9
Healthcare Coverage Demographics: Adams County 81.6% Broomfield County 86.8% Insurance coverage increases with age secondary to Medicare. Females are more likely to have insurance than males, married are more likely to have insurance over single, Caucasian more likely to have insurance over Hispanic. Coverage increases based on educational levels and income that directly relates to employment. 30.4% of eligible adults are not enrolled in Medicaid in Adams County and 42.2% of eligible children are not in CHP+. 2A III UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS There are many determinants of the health status of a population. While there is a significant focus on the biologic and behavioral aspects of health, there are other underlying factors that have a great deal of influence on the health of our communities such as population size, racial and ethnic characteristics, educational attainment and income level. The Social Determinants of Health model, as defined by the World Health Organization (WHO), explains how the societal and physical conditions in which people live, learn, work and play affect health. Examples of WHO s social determinants include: safe and affordable housing, quality education, food accessibility, language/literacy, and access to economic and job opportunities. Often, those population groups that suffer the worst health status are also those that have the highest poverty rates and the least education. The primary and chronic disease needs of the uninsured, low-income persons and minority groups in St. Anthony North s service area are: St. Anthony North Hospital - Community Health Needs Assessment 2013 10
Access to Care - Coverage, Eligible Adults Not Enrolled in Medicaid St. Anthony North Hospital - Community Health Needs Assessment 2013 11
ETOH and Substance Abuse St. Anthony North Hospital - Community Health Needs Assessment 2013 12
Congestive Heart Failure (CHF) St. Anthony North Hospital - Community Health Needs Assessment 2013 13
Chronic Obstructive Pulmonary Disease (COPD) St. Anthony North Hospital - Community Health Needs Assessment 2013 14
Diabetes 2B DATA COLLECTION 2B I PROCESS USED TO GATHER DATA The Center for Health Administration at the University of Colorado Denver was retained to conduct the data collection for the Centura Health system and its respective hospital facilities. St. Anthony North Hospital - Community Health Needs Assessment 2013 15
PUBLIC HEALTH DATA Data for the Community Health Needs Assessment (CHNA) was predominantly collected from the Colorado Department of Public Health and Environment (CDPHE). The CDPHE s Colorado Behavioral Risk Factor Surveillance System Survey (2003-2010) was used to determine information about adult behaviors that impact health, such as substance abuse, eating and exercise habits, and smoking. The national Youth Risk Behavior Survey (2003-2010) was queried to determine behaviors that impact the health of students from 9th through 12th grades. CDPHE publishes data on selected health indicators that includes county, regional and state level data on a variety of health, environmental and social topics. This data are used in Colorado s Health Assessment and Planning System (CHAPS) which is a standard process created to help local public health agencies meet assessment and planning requirements. According to CDPHE, these indicators are useful for anyone who needs Colorado health data for a community health assessment or for other research purposes. CHAPS focuses on the indicators selected specifically to facilitate standardized health assessment across all jurisdictions in Colorado. The indicators are organized according to a Health Equity Model which takes into account a wide range of factors that influence health. This model groups the social determinants of health into: Life course perspective: how populations are impacted differently during the various stages of life Social determinants of health: societal influence, such as economic opportunity, physical environment and social factors that play critical roles in the length and quality of life Health factors: components of health behaviors and conditions, mental health and access, utilization and quality of health care Population health outcomes: measures of quality of life, morbidity, mortality and life expectancy Another source of data was the Tri-County Health Department s Community Health Profile, issued in December 2011. It is a comprehensive report displaying information about the overall health of residents in St. Anthony North s region. Our final source of information was CASOA, Community Assessment Survey for Older Adults, December 2011 administered in Adams County. COMMUNITY LEADER INTERVIEWS One community phone interview and multiple surveys were done in a variety of settings and with various individuals in our service area. Tri-County Health Department- Allison Hawkes, MD, MS, Program Manager* was interviewed by phone in March 2012 providing her perspective on health issues in Adams County via an individual interview and was available on a limited consulting basis. The patient population that is frequently seen by the Health Department is also served by St. Anthony North Hospital. RANKING QUESTIONNAIRE A written ranking questionnaire was used to help prioritize the health care needs in our community. Each participant was asked to rank health issues using a scale of 1 to 5, with 1 meaning not a critical issue and 5 meaning a very critical issue. Over 350 surveys were completed in settings that made taking the survey St. Anthony North Hospital - Community Health Needs Assessment 2013 16
comfortable for the participants; they were St. Anthony North s 9 Health Fair, April 22, 2012; St. Anthony North s Family Medicine Clinic, March 2012; Community Reach, March 2012; Arapahoe House, March 2012; and Villas of Sunny Acres, February 2012. The results of the surveys were averaged to provide a quantitative measure that was used in the prioritization process. 2B II INFORMATION GAPS Gaps in St. Anthony North s Health Needs Assessment data come from the transient population that is a part of Adams County. This population is comprised of homeless individuals, homeless families, undocumented persons and the Hmong which have no written language. These particular gaps link with the identified needs in St. Anthony North s community health needs assessment of 1) Access to care coverage, eligible adults not enrolled in Medicaid. 2) Mental Health specifically as it relates to ETOH abuse. It is believed that using the CDPHE s data base for health needs provided very good information on Adams and part of Broomfield counties in St. Anthony North s service area. However, using county data versus zip code information within the hospital s market may have limited the ability to learn the precise location of populations at risk for certain health issues. Nevertheless, it is our understanding that the Affordable Care Act encourages the use of data that currently exists and discourages spending addition amounts or resources on new, more expensive research based on zip codes. 2C HEALTH NEEDS OF THE COMMUNITY 2C I PROCESS TO IDENTIFY AND PRIORITIZE NEEDS When all this data was A Community Health Needs Assessment (CHNA) Steering Committee at St. Anthony North Hospital was formed including different disciplines, representatives from Community Reach, Arapahoe House, Tri-County Health, St. Anthony North Community Board, local Clergy and Villas of Sunny Acres prioritized the Health Needs of our community. Participants selected for the CHNA Team were chosen based on area of expertise and the needs of our community surveyed. The following members included: Carrie Baker, SAN Family Medicine Candy Cordova, HBA/Financial Counselor Kathleen Drozda, SAN Pastoral Nurse Coordinator ** Kathy Duval, SAN Director of Therapies Darcy Gentry, SAN Trauma Services Kathleen Harrington, SAN Community Ed Coordinator Sr. Patricia Hayden, VP Mission Integration Allison Hawkes, Program. Mgr., Tri-County Health Dept.* Deborah Horne, VP Business Ops & Strategies Betsy Isherwood-Katz, SAN Director of Case Management Fr. Ken Koehler, Community Board Member & Local Pastor Sharon Meyers, Chief Dev Officer St. Anthony North Foundation Kate Olsen, Communication Officer, Arapahoe House ** Lindy Schultz, Marketing Exc., Community Reach ** St. Anthony North Hospital - Community Health Needs Assessment 2013 17
Mary Grace Smigiel, Executive Director, Villas of Sunny Acres Julia Spigarelli, Director of Senior Living, Villas of Sunny Acres Dana Talarico, Community Board Member * Person with special knowledge of or expertise in public health **Representative of medically underserved, low-income, and minority populations The CHNA Steering Committee all did a half day community plunge where the purpose was to take a firsthand look at our community to begin to understand health needs. The goal was to identify barriers that obstruct our community from living healthy lives, gain a community perspective of health management, and prioritize highest needs based on community assessment. After the plunges the CHNA Steering Committee went to work studying all the sources of data. The Committee prioritized the results and a plan was drafted. 2C II PRIORITIZED LIST AND DESCRIPTION OF COMMUNITY HEALTH NEEDS The following health needs were identified as significant. Each of the following indicators had either 1) a total average of 3.6 or above in the Ranking tools, 2) a top ranking by the County and/or Older Adults, 3) a top ranking of 2 or more stars by community interviews, or 4) a worse than the state average in the data. Adams County 1. Access to care coverage, eligible adults not enrolled in Medicaid 2. Cancer 3. Mental Health a. ETOH Abuse 4. Obesity a. Diabetes b. Heart disease 5. Smoking 6. General Health a. Tooth decay 7. HIV/AIDS, gonorrhea, chlamydia 8. Hep B Broomfield County 1. Cancer a. Breast b. Colon c. Melanoma 2. Pneumonia vaccination 3. Pertussis 4. Suicide rates 5. Sexually active adults not using birth control St. Anthony North Hospital - Community Health Needs Assessment 2013 18
2C III HEALTHCARE RESOURCES AVAILABLE IN THE COMMUNITY Resources for Adams and Broomfield Counties: Acute Care Hospitals (Inpatient Hospitals): St. Anthony North Hospital North Suburban Medical Center Colorado Critical Access Hospital Platte Valley Medical Center Good Samaritan Hospital The Children s Hospital, Denver Clinical Care (Clinical Resources & Direct Care): Tri County Health Department Salud Family Health Centers TCHD: Immunization Clinic Denver Health Public Health Immunization Center Visiting Nurse Association: Flu shot clinic Nurse-Family Partnership Clinica Family Health Colorado Influenza and Pneumoccal Alert Coalition Colorado Immunization Program Colorado Department of Public health Immunizations Mental Health/Substance Abuse Services (Behavioral Health Resources): AA and Al-Anon Arapahoe House Community Reach Center Yellow Ribbon Suicide Prevention Program Colorado Division of Behavioral Health Federation of Families for Children s Mental Health Mental Health Association of Colorado National Alliance on Mental Illness Foothills Behavioral Health Oral Health (Dental & Preventative Care): Colorado Bright Beginnings Kids in Need of Dentistry (KIND) Oral Health Awareness Colorado Child Health Plan Plus Division-Oral, Health, Delta Dental Mountain Dental Senior Services (Older Adults & Geriatric Care): St. Anthony North Hospital - Community Health Needs Assessment 2013 19
Health Passport Metro Community Provider Network Women s Services (Female Related Health Services): Northeast Women s Center The Young Women s Breast Cancer Translational Program Human Services (Basic Needs & Resources): Growing Home Alternative to Family Violence Caring for Colorado Colorado Anti-Violence Program Colorado Moves Counseling Center Colorado Coalition for the Homeless The Domestic Violence Program Colorado Indigent Care Program Volunteers of America Children s & Teens Services (Services for Persons Under 18 Years of Age): Actions for Healthy Kids Colorado Rocky Mountain Youth Clinics New Horizons Teen Clinic CDHS: Prevention/Reduction of Under 18 Alcohol, Tobacco and Other Drug Use Colorado Children s Immunization Coalition Colorado Connections for Healthy Kids Adams 14 Community Health Services Sexual Health & HIV/AIDS (Social Wellness related to Sexuality & Reproduction): Colorado AIDS Project Colorado Coalition for STD Prevention Colorado Organization for Latino Opportunity and Reproductive Rights CDPHE: Family Planning Planned Parenthood of the Rocky Mountains The Colorado HIV/AIDS Care and Prevention Coalition Cancer Services (Multi-System Invasive Diseases): Susan G. Komen Foundation Denver Affiliate Medicaid Breast and Cervical Cancer Program Lung Cancer and Other Thoracic and Related Cancers University of Colorado Cancer Center Breast Cancer program University of Colorado Hospital Tomo Therapy Treatment Facility Colorado Cancer Research Program The Colorado Blood Cancer Institute St. Anthony North Hospital - Community Health Needs Assessment 2013 20
Discussion Group for Men Affected by Cancer The Colorado Cancer Coalition American Cancer Society Diabetes (Insulin Irregularity): American Diabetes Association of Colorado Colorado Diabetes Prevention and Control Juvenile Diabetes Research Foundation Defeat Diabetes Tobacco Usage & Lung Disease (Tobacco Related Illnesses): American Lung Organization Colorado Breath/GASP Colorado Colorado Quit line State Tobacco Education and Prevention Partnership Injury (Traumatic & Unintentional Accidents): American Medical Response Team Brain Injury Alliance Colorado Colorado DOT Safety Education and Enforcement Program CSU: Colorado Injury Control Resource Center State Highway Safety Showcase Fall Prevention Network Car Seats Colorado General Health (Overall Wellness): Colorado Dept of Health and Human Services Denver Chapter of American Heart Association Community Health Services Center for Obesity Research and Prevention Clinic Nutrition Center Colorado Community Health Network Colorado Foundation for Medical Care 9 Health Fair CDPHE Colorado Department of Public Health Health Care for All Colorado Regional Prevention Center Services Empower Colorado Colorado Department of Health and Environment Elevate Your Health Colorado Colorado Foundation for Physical Fitness Live Well Colorado St. Anthony North Hospital - Community Health Needs Assessment 2013 21
Colorado Physical Activity and Nutrition Program Center for Obesity Research and Prevention Eat Right Colorado City and County of Broomfield Public Health and Environment Division Broomfield Health and Human Services Live Well Broomfield 3 CONTACT INFORMATION St. Anthony North Hospital 2551 W. 84 th Avenue Westminster, CO 80031 303-426-2151 www.stanthonynorth.org St. Anthony North Hospital - Community Health Needs Assessment 2013 22