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Summit Healthcare Regional Medical Center Community Health Needs Assessment

Summit Healthcare Regional Medical Center Community Health Needs Assessment. May 10, 2013. May 10, 2013 Dear Residents of our White Mountain communities,

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Summit Healthcare Regional Medical Center Community Health Needs Assessment

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  1. Summit Healthcare Regional Medical CenterCommunity Health Needs Assessment May 10, 2013

  2. May 10, 2013 • Dear Residents of our White Mountain communities, • I am pleased to share with you the results from the hospital’s first Community Health Needs Assessment, which was completed in May of this year. Undertaken in part to make sure we meet new IRS requirements for maintaining our tax exempt status, this project has also helped us to better understand the people that we serve – how healthy is our population, and how well are your health needs being met? • Based on our data findings, plus results from a community survey and input from community leaders, we have identified mental health and substance abuse services as the leading area of unmet health needs in our region. • Summit Healthcare leaders are committed to helping to address the issues that have been identified. During this process we learned that other groups and organizations in our area are also concerned about gaps in mental health and substance abuse services and want to work with us to find effective and sustainable solutions. By pooling our ideas and resources, we believe that we can make real progress that has a positive impact in our local communities. • We are in the early stages of working with our community partners to develop action plans going forward. If you would like more information about the status of these projects or would like to be involved as a community partner, please feel free to contact me. • Best regards, • Ron McArthur, FACHE • Chief Executive Officer

  3. Table of Contents Introduction & Project Overview 4 Needs Assessment Methodology 10 Needs Assessment Key Findings 16 Process to Establish Health Improvement Priorities 30 Appendices 35 Appendix A: Community Definition and Profile 36 Appendix B: County Health Rankings 41 Appendix C: Mortality and Morbidity 47 Appendix D: Personal Health Behaviors 56 Appendix E: Clinical Care 59 Appendix F: Physical Environment and Public Safety 62 Appendix G: Community Survey Results 65 Appendix H: Community Leader Meeting Attendees 74 Appendix I: Additional Information 77

  4. 4 Introduction and Project Overview

  5. 5 Introduction & Project Overview Project Goals The Community Health Needs Assessment project completed by Summit Healthcare Regional Medical Center (“Summit”) in early 2013 was designed to meet five major goals: • Better understand the community we serve – how healthy is our population, and how well are their health needs being met? • Gain focus for the hospital’s community health outreach efforts – how can we best use our resources to address the most pressing needs? • Strengthen the community health component of the hospital’s strategic plan – how can we better align our community health activities with the overall goals and priorities of the organization? • Create synergies with other organizations working to address health issues – what are the opportunities to work with other groups in the community to achieve shared goals? • Comply with requirements outlined in the Affordable Care Act (ACA) for non-profit 501(c)(3) hospitals to conduct a community health needs assessment and implement strategies to address identified needs. Additional information about ACA requirements can be found in Appendix I. Consulting Assistance Summit engaged Strategy Connections, a health care consulting company based in Fort Collins, Colorado, to provide consulting assistance for completing the CHNA project. Carol Davis, Owner and Principal Consultant, served as project leader and primary consultant throughout the project. A summary of Ms. Davis’ qualifications and experience is included in Appendix I.

  6. 6 Introduction & Project Overview Community Health Improvement Model Summit’s model for community health improvement as shown below considers health status data, community survey results and community leader perspectives in determining priority health needs that the hospital will help to address over the next three years. On an annual basis as part of the budget development process, Summit Healthcare will identify specific initiatives to be undertaken during the year that will help to address highest priority community health needs. Health Status Data Action Plan & Implementation Priority Needs for Summit Healthcare to Address Community Survey Leader Perspectives

  7. 7 Introduction & Project Overview Project Timeline The CHNA project kicked off in May 2012 and concluded in May 2013, with timing of the various components as follows: Project Kick Off Meetings Community Survey Planning Meeting with Community Leaders May 2012 Jun-Aug 2012 Sep-Oct 2012 Dec 2012-Jan 2013 Feb 2013 May 2013 Health Status Data Collection & Analysis Survey Analysis; Prliminary Health Needs Development Board Approval of Community Health Priorities

  8. 8 Introduction & Project Overview Definition of Community • Area A: • 85901 Show Low • 85902 Show Low • 85912 White Mountain Lake • 85923 Clay Springs • 85928 Heber • 85929 Lakeside • 85933 Overgaard • 85934 Pinedale • 85935 Pinetop • 85937 Snowflake • 85939 Taylor • 85924 Concho • 85940 Vernon • Area B: • 85911 Cibecue • 85930 McNary • 85926 Fort Apache • 85941 Whiteriver

  9. 9 Introduction & Project OverviewDemographic Overview Source: The Nielsen Company (data retrieved 10/31/2012)

  10. Needs Assessment Methodology

  11. 11 Needs Assessment Methodology Secondary Data Summit analyzed both secondary and primary data in the CHNA process . Secondary data analysis uses data that was collected by others and is already in existence. A reference list of secondary data sources used in the needs assessment can be found on page 12. In addition, all statistics used in the report are fully referenced. The availability of credible and objective measures of health status is essential to understanding overall health of the population. Without such data, the ability to prioritize health needs would be severely limited and based solely on small scale observations, anecdotal information, and personal opinions and agendas. This data, although critical to the integrity of the process, has important limitations that need to be acknowledged: • Most health status data is collected and reported only at the county level. Summit’s primary service area encompasses only the southern half of Navajo County. The characteristics of the population served by Summit could be quite different from the overall county profile. • Data is not current. Most of the data used in this report is based on 2010 statistics. Although changes in specific indicators tend to be small from year to year, the lag time makes it especially difficult to identify potential trends in a timely manner or to determine whether targeted interventions are having the intended impact and should be continued, modified or discontinued.

  12. 12 Needs Assessment Methodology Secondary Data Sources • County Health Rankings 2012 • Arizona Health Status & Vital Statistics 2010 • Behavioral Risk Factor Surveys 2009, 2010 • Dartmouth Atlas • Arizona Cancer Registry • Centers for Disease Control • Crime in Arizona Report 2010 • The Nielsen Company Data from above-listed sources allowed for easy comparison of Navajo County with other counties in Arizona. Additional sources of data

  13. 13 Needs Assessment Methodology Primary Data Primary data is new data that was collected by Summit via a community survey to gain additional insight into health status and perception of health needs. The survey, designed and tabulated by Strategy Connections, utilized a convenience sampling methodology, which means that respondents self-selected to participate. It was available both on-line and in hard copy. The survey was advertised via e-mail distribution lists and newsletters of a wide variety of local organizations, including school districts, businesses, public health, health care organizations and county/city/town governments. The survey was completed by 164 individuals. A profile of survey respondents is depicted on page 14, and detailed survey results can be reviewed in Appendix G. Community input received from the survey was invaluable to the needs assessment process, and Summit appreciates those who took the time to share their opinions. It is, however, important to be cautious in reviewing and interpreting the results due to these limitations: • Convenience sampling, while economicaland helpful, does not produce statistically valid results that can be generalized to the overall target population. In other words, we can’t say that results from this survey are representative of the entire population of the community, only that the findings are representative of those individuals who chose to participate. • The profile of those who responded to the survey does not reflect overall demographics of the community. Most respondents were Caucasian females from the Show Low–Pinetop–Lakeside area. Elderly individuals, males and minority populations, especially American Indians, were underrepresented in survey participation. • Community survey: convenience sampling design, how advertised, when conducted, profile of respondents • Information limitations and gaps

  14. 14 Needs Assessment Methodology Community Survey:164 Respondents No Answer: 21% No Answer: 22% >4: 12% No Answer: 21% 65+: 7% 3-4: 26% 45-64: 44% Male: 20% 2: 34% Female: 59% 18-44: 27% 1: 7% No Answer: 22% Other Apache: 5% No Answer: 22% Other Navajo: 9% No Answer: 22% Vernon: 4% Asian: <1% Snowflake/Taylor: 10% American Indian: 3% Don’t Live Here: 4% Hispanic: 6% Part Time/Seasonal: 0% Lakeside/Pinetop: 23% White: 69% Full Time: 74% Show Low: 27%

  15. 15 Needs Assessment Methodology Health Needs Assessment Process for Area B – Fort Apache Reservation For purposes of the health needs assessment, Summit Healthcare defined its community as the southern 1/3 of Navajo County, which corresponds to the geographic area where 80% of the hospital’s inpatients reside. Due to significant differences in demographics and governance, this large area was subdivided into two regions – Area A and Area B as shown on the map on page 8. The process of identifying health needs described in this report pertains primarily to Area A, although county-wide health status data includes Area B as well. With significantly different demographic characteristics (summarized on page 9 – younger, less household income, 94% American Indian, higher unemployment), the Area B population likely has unique community health needs as well. Area B lies within the Fort Apache Indian Reservation, which is governed by the White Mountain Apache Tribe. The Indian Health Service (IHA) is responsible for providing health care services to this population. Summit leaders work closely with IHS leaders to identify health needs on an ongoing basis and provide certain specialty services not available through local IHS providers, including high risk obstetrics, surgery, oncology, urology and wound care. In addition, Summit has a mutual aid agreement with Whiteriver Indian Hospital for supplies and disaster-planning. Summit is currently working with IHS leaders on ways to address the need for transportation when residents require health care services at Summit. Summit leaders also meet periodically with tribal leaders to discuss specific programs (e.g. First Things First) and other topics of mutual interest. Summit Healthcare is committed to working collaboratively with tribal and IHS leaders to address community health needs for residents of the Fort Apache Reservation. We support their ongoing processes to identify and prioritize the issues and will continue to assist with providing solutions whenever possible.

  16. Needs Assessment Key Findings

  17. 17 Needs Assessment Key Findings 10 Highest Survey Scores for Needs Being Met

  18. 18 Needs Assessment Key Findings 6 Lowest Survey Scores for Needs Being Met (“Poor” or “Fair”)

  19. 19 Needs Assessment Key Findings 10 Highest Survey Scores for Importance in Improving Overall Community Health

  20. 20 Needs Assessment Key Findings 8 Areas of Potential Community Need (Data + Survey Results

  21. Needs Assessment Key Findings Mental Health & Substance Abuse Services 21 How important for improving health of community? How well are needs being met? X Decreasing substance abuse Excellent X Decreasing suicides X Improving stress management skills 10 10 Very Important 9 9 Very Good 8 8 7 7 Moderately Important Good X 6 6 Substance abuse services X Mental health services 5 5 4 4 Somewhat Important Fair 3 3 2 2 Poor 1 1 Not At All Important 0 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  22. Needs Assessment Key Findings Specialty Physicians 22 How well are needs being met? Excellent 10 9 Very Good 8 7 X Specialty physicians Good 6 5 4 Fair 3 2 Poor 1 0

  23. Needs Assessment Key Findings Obesity Treatment 23 How well are needs being met? How important for improving health of community? Excellent X Achieving a healthy weight 10 10 Very Important 9 9 Very Good 8 8 7 7 Moderately Important Good 6 6 X Obesity treatment services 5 5 4 4 Somewhat Important Fair 3 3 2 2 Poor 1 1 Not At All Important 0 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  24. 24 Needs Assessment Key Findings No Health Insurance How well are needs being met? Excellent 10 9 Very Good 8 7 Good 6 X No health insurance 5 4 Fair 3 2 Poor 1 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  25. Needs Assessment Key Findings Cancer Screening Exams 25 How important for improving health of community? Getting recommended screening exams X 10 Very Important 9 8 7 148 total deaths - #2 cause of death Moderately Important 6 5 4 Somewhat Important 3 394 total new cancer cases 2 1 Not At All Important 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  26. Needs Assessment Key Findings Management of Chronic Diseases 26 How well are needs being met? Excellent 10 Asthma/COPD/respiratory X Dialysis 9 X X X Very Good Heart disease 8 Diabetes X X Chronic pain 7 Stroke/neurological Good 6 5 4 Fair 3 2 Poor 1 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  27. 27 Needs Assessment Key Findings Prenatal Care How important for improving health of community? How well are needs being met? Excellent X Getting prenatal care 10 10 Very Important 9 9 Very Good 8 8 7 7 Moderately Important Good 6 6 X Pregnancy-related care 5 5 4 4 Somewhat Important Fair 3 3 2 2 Poor 1 1 Not At All Important 0 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  28. 28 Needs Assessment Key Findings Exercise & Physical Fitness How important for improving health of community? X Increase exercise & physical fitness 10 Very Important 9 8 7 Moderately Important 6 5 4 Somewhat Important 3 2 1 Not At All Important 0 Note: Arizona counties ranked from #1 (best) to #15 (worst)

  29. 29 Needs Assessment Key Findings Survey Results: One Thing to Most Improve Health?

  30. Process to Establish Health Improvement Priorities

  31. 31 Process to Establish Health Improvement Priorities Community Leader Meeting • Summit Healthcare leaders hosted a meeting of invited community representatives to share key findings from the health needs assessment and to seek input on which health needs are the most important to address. The priority-setting meeting was held on Wednesday, February 6, 2013 from 6:00-7:30 p.m. at a local restaurant. • Thirty-five individuals representing 18 organizations participated in the meeting. A complete list of attendees, including job title and organization, is located in Appendix H. • The agenda consisted of the following segments: • Welcome and introductory remarks by Ron McArthur, CEO of Summit Healthcare • Presentation of key findings from health needs assessment • Audience discussion and voting on perceived priority of eight community health needs • Additional discussion • Next steps and concluding remarks

  32. 32 Process to Establish Health Improvement PrioritiesHealth Needs Presented for Community Leader Input • Availability of Services • Mental health and substance abuse services • Specialty physicians • Obesity treatment • Services for individuals without health insurance • Compliance with Prevention and Treatment Guidelines • Cancer screening exams • Management of chronic diseases • Prenatal care • Healthy Lifestyle • Exercise and physical fitness

  33. 33 Process to Establish Health Improvement PrioritiesResults of Community Leader Voting After the list of 8 community health needs was presented, attendees had an opportunity for questions and large group discussion. Then 26 voting participants (Summit representatives did not vote) were asked to rate the importance of each issue on a scale from 1 (“less important”) to 5 (“very important) using Turning Point audience response technology and based on the following criteria: • Does this issue affect a large number of individuals and families? • Does the community have (or can we acquire) the necessary skills and resources to make a difference? Results from the voting exercise were as follows:

  34. 34 Process to Establish Health Improvement PrioritiesSummit Healthcare Board Decision and Next Steps At its monthly meeting on May 10, 2013, the Summit Healthcare Board of Directors reviewed key findings from the health needs assessment process, including results from the community leader meeting that was held on February 6. The Board then considered and passed the following motion: a) To adopt mental health and substance abuse services as the leading community health need that Summit will help to address by working with other community groups to find collaborative and sustainable solutions, and b) to adopt the seven other improvement areas as priorities to consider for Summit’s various community outreach programs and services. Initial implementation activities include the following projects to be completed by December 31, 2013: • Mental health and substance abuse • Continue efforts to recruit a psychiatrist and/or develop a telemedicine option for psychiatry. • Convene community partners to more clearly identify and prioritize gaps in services. • Seven other improvement areas • Review current services provided by Summit that focus on these areas (listed on page 33), and identify opportunities to improve effectiveness or potentially expand services to address unmet needs. Implementation plans with specific projects and resource requirements for subsequent years will be developed annually during Summit’s budget planning process for the next fiscal year. An action plan for FY2014 will be adopted by the board no later than December 31, 2013.

  35. Appendices

  36. Appendix A:Community Definition and Profile

  37. 37 Community Definition and ProfileMap of Defined Community • For purposes of the community health needs assessment, Summit Healthcare defined its community as the southern 1/3 of Navajo County, which corresponds to the geographic area where 80% of the hospital’s inpatients reside. Due to significant differences in demographics and governance, this large area was subdivided into two regions as follows: • Residents of Area A accounted for 69.7% of Summit’s inpatient discharges between July 1, 2011 and June 30, 2012. Area A encompasses 11 zip codes: • 85901 Show Low • 85902 Show Low • 85912 White Mountain Lake • 85923 Clay Springs • 85924 Concho • 85928 Heber • 85929 Lakeside • 85933 Overgaard • 85934 Pinedale • 85935 Pinetop • 85937 Snowflake • 85939 Taylor • 85940 Vernon • Area B lies within the Fort Apache Indian Reservation. Residents of Area B accounted for 10.3% of Summit’s inpatient discharges during the same 12-month period. Area B includes 4 zip codes: • 85911 Cibecue • 85930 McNary • 85926 Fort Apache • 85941 Whiteriver Sources: Intellimed for patient origin, Microsoft MapPoint 2011 for map boundaries

  38. 38 Community Definition and ProfileSummit Healthcare Inpatient Origin (7/1/2011-6/30/2012) Source: Intellimed; excludes newborns

  39. 39 Community Definition and ProfileDemographic Overview: Area A Source: The Nielsen Company (data retrieved 10/31/2012)

  40. 40 Community Definition and ProfileDemographic Overview: Area B Source: The Nielsen Company (data retrieved 10/31/2012)

  41. Appendix B:County Health Rankings

  42. County Health Rankings Introduction to County Health Rankings • County Health Rankings is a collaboration between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The project publishes an annual report that assesses the overall health of nearly every county in all 50 states, using a standard way to measure how healthy people are and how long they live. • Results are aggregated into two overall categories: 1) health outcomes, and 2) health factors. • Ranking for health outcomes is based on mortality and morbidity data. • Ranking for health factors considers data on health behaviors, clinical care, social and economic factors, and physical environment.

  43. 43 County Health Rankings Arizona Maps for Health Outcomes and Health Factors Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 4/10/2012.

  44. 44 County Health Rankings Navajo County Data Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data. Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.

  45. 45 County Health Rankings Navajo County Data Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data. Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.

  46. 46 County Health Rankings Navajo County Data Notes: National benchmark reflects 90th percentile; i.e., only 10% are better. Blank values reflect unreliable or missing data. Source: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.

  47. Appendix C:Mortality and Morbidity

  48. 48 Mortality and MorbidityAge-Adjusted Mortality Rates for 10 Leading Causes of Death County number is FAVORABLE (>10% positive variation from state number) but not necessarily statistically significant County number is UNFAVORABLE (>10% negative variation from state number) but not necessarily statistically significant Note: All rates per 100,000 population and age-adjusted. Source: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012.

  49. 49 Mortality and MorbidityAdditional Mortality Measures County number is FAVORABLE (>10% positive variation from state number) but not necessarily statistically significant County number is UNFAVORABLE (>10% negative variation from state number) but not necessarily statistically significant Source for #1, 2, 3, 4, 5: Arizona Health Status and Vital Statistics 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012. Source for #6: County Health Rankings; data retrieved from www.countyhealthrankings.org on 6/11/2012.

  50. 50 Mortality and MorbidityOverall Health Status and Limitations County number is FAVORABLE (>10% positive variation from state number) but not necessarily statistically significant County number is UNFAVORABLE (>10% negative variation from state number) but not necessarily statistically significant Source for #1, 5, 6: Behavioral Risk Factor Surveys 2009 and 2010; Arizona Department of Health Services; data retrieved from www.azdhs.gov on 6/11/2012. Source for #2, 3, 4, 7: County Health Rankings; data retrieved from www.countyhealthrankings.orgon 6/11/2012..

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