Community Health Needs Assessment

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1 Community Health Needs Assessment MAY 2013

2 Welcome to Noland Health Services Noland Health Services, Inc. (Noland Health, NHS), based in Birmingham, is a not-forprofit healthcare organization specializing in long term acute care hospitals and full-service senior living communities. A pioneer in establishing programs to meet 's changing health care needs, NHS serves its communities through innovative, high quality health services. Our Mission Noland Health Services is dedicated to identifying and meeting the health care needs of the people and communities we serve by providing innovative, high quality health services in a compassionate, efficient and effective manner. About Us Through its Hospital Division, Noland Health Services specializes in establishing innovative long term acute care regional referral hospitals by partnering with premier general acute care hospitals The Senior Living Division develops strategically located, comprehensive multi-level senior living communities offering seniors the security of knowing that additional assistance is available, should their needs change. Noland Health Services' hospitals and senior living communities offer comprehensive Case Management Services to assist patients and residents with care management needs. This service is supported through a unique corporate focus on case management which views health and/or clinical resource management as a value added service. Our strategic position as a health and wellness continuing care provider of independent living, assisted living, specialty care for Alzheimer s/dementia, skilled nursing and rehabilitation, as well as long-term acute hospital care, facilitates an expertise in continuum management of an individual s ongoing needs. The case management program supports knowledge in all areas of both acute and post-acute healthcare and community resources and seeks to provide educational resources to the healthcare community on issues related to patient management. Source: nolandhealth.com 1

3 Noland Health Services Inventory There are many services and programs that are already offered by Noland to residents of the service areas of Noland LTACH hospitals. These services include providing treatment for a complete variety of complex medical conditions including, but not limited to: Respiratory Failure Ventilator Management/Weaning Tracheostomies Multi-System Failure Wounds Multiple Trauma Dysphasia Management Complicated Diabetes Amputations Complex Orthopedics Neuromuscular/Neurovascular Diseases Nutritional Support Post-Surgical Recovery Noland also offers a wide range of Patient Support and Patient Care Services: 24 Hour Nursing Coverage 24 Hour Respiratory Therapy, including Ventilator Weaning Physical Therapy Occupational Therapy Speech and Language Pathology Wound Care Case Management ADL Training Dietary and Nutritional Services Pharmacy (Drugs and Biologicals) Laboratory Diagnostic Radiology Medical Specialty Consults 2

4 Process and Methodology Noland Health Services identified community health needs by undergoing an assessment process. This process incorporated a comprehensive review by the hospital s Community Needs Assessment Team along with secondary and primary data input using the expertise of Dixon Hughes Goodman, LLP. The team used several sources of quantitative health, social and demographic data specific to the home county of each facility provided by local public health agencies, health care associations and other data sources. Noland Health Services took advantage of this opportunity to collaborate with its administrators, physicians, public health agencies, and local organizations. Noland sought outside assistance from the Dixon Hughes Goodman CHNA team in this process. DHG provided data, organized community input, facilitated priority sessions, and supported the report drafting process. The assessment process consists of five steps pictured below: 3

5 The data assessment piece was completed during February and March of In this step, service areas were defined, external data research was completed and key findings were summarized. As the data assessment was completed, the community input phase was started. Phone interviews were conducted with persons with knowledge of public health. In addition, physicians were asked to complete written surveys and administrators were interviewed in person. A summary of this dialog was created and is included in this report. A prioritization session was then held to summarize and overlay data elements with key community input findings. From this session, priorities were decided on based upon the significance of the need to the service area, and Noland Health s ability to impact the need. Based on these priorities, each of the six Noland Hospitals decided on which priorities would be included in their implementation strategy and which priorities would not be addressed. These can be found in the Implementation Strategy document. This report and strategy were then approved by the board and made widely available on the Noland Health website. Below is a list of steps that were taken in each phase of the process: Data Assessment Send Data Request Community Definition Send/Receive Data Request Information Conduct External Data Research Provide Data Assessment Key Findings Develop Data Summary Report Community Input Identify Community Interviewees (Public Health, Employees, etc) Schedule Interviews Finalize written Physician Survey Tool for MEC meetings Conduct Interviews Conduct written Physician surveys in MEC meetings Summarize Interview responses Develop Interview Summary Report Prioritization/Implementation Strategy Create Summary of Data Assessment & Community Input Prepare Prioritization Grid Attend Prioritization Session at Administrators Meeting Provide Summary of Prioritized Implementation Strategies Reporting Confirm Board Date to Present CHNA Findings Develop Outline of the CHNA Report Create CHNA Report Develop Implementation Strategy Develop Board Presentation for CHNA Present CHNA Process, Findings & Implmentation Strategy to Board Review and Edit Changes from Board Meeting Publish CHNA Report on the website Complete Form 990 Schedule H Attach Implementation Strategy to Form 990 File Form 990 Schedule H 4

6 Community Served Noland Health Services specializes in long term acute care hospitals (LTACH) for patients who require care due to chronic diseases or complex medical conditions. Noland's hospitals are located in Anniston, Birmingham, Dothan, Montgomery, Alabaster and Tuscaloosa. Noland is the largest provider of long term acute care in. LTACHs are innovative regional referral hospitals dedicated to meeting the complex treatment and clinical education needs of patients and families who require extended (generally exceeding 25 days) or specialty focused stays in a hospital setting. For the purpose of this assessment, we have used each facility s home county as its service area. Using a county definition as the service area is crucial for our analysis as many of our secondary data sources are county specific and serve as a comparison tool to other counties, the state of, and the United States. 5

7 In order to present the data in a way that would tell a story of the community and also identify needs, we used a framework based on demographics and many key health factors. Additionally, after taking a closer look at the patient mix of Noland Health, it was found that approximately 65% of Noland patients were over the age of 65. This aging population became the focus of the CHNA. Noland Health Patient Mix 34% 35% 18% 13% < >75 The needs of the elderly acute patient and their families are the target focus of our Community Health Needs Assessment and allow us to focus on health needs that are most likely to be needs our hospitals can impact in our communities. 6

8 Data Assessment - Secondary Data Many different sources were looked at in order to create a snapshot of each Noland Facility s home county and more specifically, their target patients. The following sources were used in this process: Demographics: Nielsen Claritas demographics were used to create maps of total population and breakdowns of the elderly population. This information was pulled for each county and the state of. Additionally, multiple income/poverty maps were created and 2018 demographics were included Health ings: This source is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. It gives a general snapshot of how healthy each county is in relation to others in the same state. It measures and ranks both health outcomes and health factors that lead to those outcomes. Each indicator is weighed, standardized, and ranked in order to come up with an overall ranking of health for each county in. ing areas included: Health Outcomes Mortality Morbidity Health Factors Tobacco Use Diet and Exercise Alcohol Use Sexual Activity Access to Care Quality of Care Education Income Family and Social Support Community Safety Built Environment Other Health Indicators: Health Indicators Warehouse contains thousands of health indicators, often with county level data. We used certain indicators that relate directly to the aging population. These indicators were at a county and state level. Some of these indicators included: 65+ receiving flu vaccination ( ) Adults with high blood pressure ( ) Females over 50 receiving mammograms ( ) Adults over 50 receiving colonoscopies ( ) 7

9 Inpatient Medicare Data: With a focus on the 65+ population, we collected Medicare data for each county to examine discharges by provider and product line. An analysis of this data helped to identify what product lines may be out-migrating from the county to receive care elsewhere. This was done using the 2011 Medicare Standard Analytic File. LTACH Potential Patients: Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. In this section, Medicare data was used to pull specific DRGs that historically have longer lengths of stay and make up a majority of current LTACH patients. This was done using the 2011 Medicare Standard Analytic File. This data assessment with the above elements was shared with the Noland administration team of each Noland facility in a group meeting. Six data assessments were presented, each specific to the home county of a Noland facility. The results would be overlaid with the input that would follow to prioritize needs of each county. On the next pages, a summary of data for each county has been provided. 8

10 Noland Anniston- Calhoun Data According to 2012 Health ings, Calhoun ranked 38 of 67 counties in Health Factors. Below are the subcategory rankings that were used to arrive at this overall ranking. Source: countyhealthrankings.org Social and Economic Environment (40%) Focus Area Measure Weight Calhoun Education (10%) High school graduation 5% 72% 70% Some college (Percent of adults aged % 24 49% 56% 68% years with some post-secondary education) Employment (10%) Unemployment rate (percent of population 10% age 16+ unemployed) 9.5% 9.5% 5.4% 28 Income (10%) Family and social support (5%) Community safety (5%) Children in poverty (percent of children 10% under age 18 in poverty) Inadequate social support (percent of adults 2.5% without social/emotional support) Percent of children that live in single-parent 2.5% household Violent crime rate per 100,000 population 5% 32% 27% 13% 35 22% 23% 14% 35 39% 37% 20% Physical Environment (10%) Focus Area Measure Weight Calhoun Environmental quality (4%) Built environment (6%) than 1 or 10 miles from a grocery store) Fast food restaurants (percent of all restaurants that are fast food) 2% Health Behaviors (30%) Focus Area Measure Weight Calhoun Tobacco use (10%) Adult smoking (percent of adults that smoke) Diet and exercise Adult obesity (percent of adults that report (10%) a BMI >= 30) Air pollution-particulate matter days 2% Air pollution-ozone days (average number of 2% Access to recreational facilities 2% Limited access to health foods (percent of population who lives in poverty and more 10% 27% 23% 14% % 34% 33% 25% Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% 34% 31% 21% 2% 19% 14% 0% 59% 55% 25% Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or bringe drinking) Motor vehicle crash deaths per 100,000 population Sexually transmitted infections (chlamydia rate per 100,000 population) Teen birth rate (per 1,000 females ages 15-19) 2.5% 13% 12% 8% 2.5% % % Clinical Care (20%) Focus Area Measure Weight Calhoun Access to care (10%) Uninsured (percent of population < age 65 5% without health insurance) 16% 16% 11% Ratio of population to primary care physicians 5% 1304:1 952:1 631:1 8 Quality of care (10%) Preventable hospital stays (rate per 1,000 5% Medicare enrollees) Diabetic screening (percent of diabetics 5% that receive HbA1c screening) Mammography screening 5% % 82% 89% 61% 66% 74% 43 9

11 The majority of LTACH patients are hospitalized for specific conditions represented by 7 DRG s. Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. 10

12 Noland Birmingham- Jefferson Data According to 2012 Health ings, Jefferson ranked 16 of 67 counties in Health Factors. Below are the subcategory rankings that were used to arrive at this overall ranking. Source: countyhealthrankings.org Health Behaviors (30%) Focus Area Measure Weight Jefferson Tobacco use (10%) Adult smoking (percent of adults that smoke) Diet and exercise Adult obesity (percent of adults that report (10%) a BMI >= 30) 10% 22% 23% 14% % 32% 33% 25% Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% 29% 31% 21% 9 Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or bringe drinking) Motor vehicle crash deaths per 100,000 population Sexually transmitted infections (chlamydia rate per 100,000 population) Teen birth rate (per 1,000 females ages 15-19) 2.5% 15% 12% 8% 2.5% % % Clinical Care (20%) Focus Area Measure Weight Jefferson Access to care (10%) Uninsured (percent of population < age 65 5% without health insurance) 14% 16% 11% Ratio of population to primary care physicians 5% 555:1 952:1 631:1 2 Quality of care (10%) Preventable hospital stays (rate per 1,000 5% Medicare enrollees) Diabetic screening (percent of diabetics 5% that receive HbA1c screening) Mammography screening 5% % 82% 89% 71% 66% 74% 3 Social and Economic Environment (40%) Focus Area Measure Weight Jefferson Education (10%) High school graduation 5% 69% 70% Some college (Percent of adults aged % 10 64% 56% 68% years with some post-secondary education) Employment (10%) Unemployment rate (percent of population 10% age 16+ unemployed) 9.4% 9.5% 5.4% 24 Income (10%) Family and social support (5%) Community safety (5%) Children in poverty (percent of children 10% under age 18 in poverty) Inadequate social support (percent of adults 2.5% without social/emotional support) Percent of children that live in single-parent 2.5% household Violent crime rate per 100,000 population 5% 28% 27% 13% 17 23% 23% 14% 39 42% 37% 20% Physical Environment (10%) Focus Area Measure Weight Jefferson Environmental quality (4%) Built environment (6%) Air pollution-particulate matter days 2% Air pollution-ozone days (average number of 2% Access to recreational facilities 2% Limited access to health foods (percent of 2% population who lives in poverty and more than 1 or 10 miles from a grocery store) Fast food restaurants (percent of all restaurants that are fast food) 2% 15% 14% 0% 61% 55% 25%

13 The majority of LTACH patients are hospitalized for specific conditions represented by 7 DRG s. Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. 12

14 Noland Dothan- Houston Data According to 2012 Health ings, Houston ranked 12 of 67 counties in Health Factors. Below are the subcategory rankings that were used to arrive at this overall ranking. Source: countyhealthrankings.org Health Behaviors (30%) Focus Area Measure Weight Houston Tobacco use (10%) Adult smoking (percent of adults that smoke) Diet and exercise Adult obesity (percent of adults that report (10%) a BMI >= 30) 10% 20% 23% 14% % 33% 33% 25% Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% 33% 31% 21% 24 Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or bringe drinking) Motor vehicle crash deaths per 100,000 population Sexually transmitted infections (chlamydia rate per 100,000 population) Teen birth rate (per 1,000 females ages 15-19) 2.5% 11% 12% 8% 2.5% % % Clinical Care (20%) Focus Area Measure Weight Houston Access to care (10%) Uninsured (percent of population < age 65 5% without health insurance) 17% 16% 11% Ratio of population to primary care physicians 5% 1063:1 952:1 631:1 12 Quality of care (10%) Preventable hospital stays (rate per 1,000 5% Medicare enrollees) Diabetic screening (percent of diabetics 5% that receive HbA1c screening) Mammography screening 5% % 82% 89% 67% 66% 74% 12 Social and Economic Environment (40%) Focus Area Measure Weight Houston Education (10%) High school graduation 5% 69% 70% Some college (Percent of adults aged % 23 53% 56% 68% years with some post-secondary education) Employment (10%) Unemployment rate (percent of population 10% age 16+ unemployed) 8.4% 9.5% 5.4% 9 Income (10%) Family and social support (5%) Community safety (5%) Children in poverty (percent of children 10% under age 18 in poverty) Inadequate social support (percent of adults 2.5% without social/emotional support) Percent of children that live in single-parent 2.5% household Violent crime rate per 100,000 population 5% 28% 27% 13% 18 20% 23% 14% 28 40% 37% 20% Physical Environment (10%) Focus Area Measure Weight Houston Environmental quality (4%) Built environment (6%) Air pollution-particulate matter days 2% Air pollution-ozone days (average number of 2% Access to recreational facilities 2% Limited access to health foods (percent of 2% population who lives in poverty and more than 1 or 10 miles from a grocery store) Fast food restaurants (percent of all restaurants that are fast food) 2% 17% 14% 0% 53% 55% 25%

15 The majority of LTACH patients are hospitalized for specific conditions represented by 7 DRG s. Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. 14

16 Noland Montgomery- Montgomery Data According to 2012 Health ings, Montgomery ranked 15 of 67 counties in Health Factors. Below are the subcategory rankings that were used to arrive at this overall ranking. Source: countyhealthrankings.org Health Behaviors (30%) Focus Area Measure Weight Montgomery Tobacco use (10%) Adult smoking (percent of adults that smoke) Diet and exercise Adult obesity (percent of adults that report (10%) a BMI >= 30) 10% 20% 23% 14% % 34% 33% 25% Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% 30% 31% 21% 19 Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or bringe drinking) Motor vehicle crash deaths per 100,000 population Sexually transmitted infections (chlamydia rate per 100,000 population) Teen birth rate (per 1,000 females ages 15-19) 2.5% 13% 12% 8% 2.5% % % Clinical Care (20%) Focus Area Measure Weight Montgomery Access to care (10%) Uninsured (percent of population < age 65 5% without health insurance) 14% 16% 11% Ratio of population to primary care physicians 5% 947:1 952:1 631:1 5 Quality of care (10%) Preventable hospital stays (rate per 1,000 5% Medicare enrollees) Diabetic screening (percent of diabetics 5% that receive HbA1c screening) Mammography screening 5% % 82% 89% 67% 66% 74% 17 Social and Economic Environment (40%) Focus Area Measure Weight Montgomery Education (10%) High school graduation 5% 52% 70% Some college (Percent of adults aged % 52 59% 56% 68% years with some post-secondary education) Employment (10%) Unemployment rate (percent of population 10% age 16+ unemployed) 9.3% 9.5% 5.4% 22 Income (10%) Family and social support (5%) Community safety (5%) Children in poverty (percent of children 10% under age 18 in poverty) Inadequate social support (percent of adults 2.5% without social/emotional support) Percent of children that live in single-parent 2.5% household Violent crime rate per 100,000 population 5% 32% 27% 13% 41 22% 23% 14% 50 49% 37% 20% Physical Environment (10%) Focus Area Measure Weight Montgomery Environmental quality (4%) Built environment (6%) Air pollution-particulate matter days 2% Air pollution-ozone days (average number of 2% Access to recreational facilities 2% Limited access to health foods (percent of 2% population who lives in poverty and more than 1 or 10 miles from a grocery store) Fast food restaurants (percent of all restaurants that are fast food) 2% 14% 14% 0% 55% 55% 25%

17 The majority of LTACH patients are hospitalized for specific conditions represented by 7 DRG s. Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. 16

18 Noland Shelby- Shelby Data According to 2012 Health ings, Shelby ranked 1 of 67 counties in Health Factors. Below are the subcategory rankings that were used to arrive at this overall ranking. Source: countyhealthrankings.org Health Behaviors (30%) Focus Area Measure Weight Shelby Tobacco use (10%) Adult smoking (percent of adults that smoke) Diet and exercise Adult obesity (percent of adults that report (10%) a BMI >= 30) 10% 20% 23% 14% % 28% 33% 25% Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% 24% 31% 21% 2 Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or bringe drinking) Motor vehicle crash deaths per 100,000 population Sexually transmitted infections (chlamydia rate per 100,000 population) Teen birth rate (per 1,000 females ages 15-19) 2.5% 13% 12% 8% 2.5% % % Clinical Care (20%) Focus Area Measure Weight Shelby Access to care (10%) Uninsured (percent of population < age 65 5% without health insurance) 10% 16% 11% Ratio of population to primary care physicians 5% 838:1 952:1 631:1 1 Quality of care (10%) Preventable hospital stays (rate per 1,000 5% Medicare enrollees) Diabetic screening (percent of diabetics 5% that receive HbA1c screening) Mammography screening 5% % 82% 89% 73% 66% 74% 2 Social and Economic Environment (40%) Focus Area Measure Weight Shelby Education (10%) High school graduation 5% 76% 70% Some college (Percent of adults aged % 1 75% 56% 68% years with some post-secondary education) Employment (10%) Unemployment rate (percent of population 10% age 16+ unemployed) 7.0% 9.5% 5.4% 1 Income (10%) Family and social support (5%) Community safety (5%) Children in poverty (percent of children 10% under age 18 in poverty) Inadequate social support (percent of adults 2.5% without social/emotional support) Percent of children that live in single-parent 2.5% household Violent crime rate per 100,000 population 5% 13% 27% 13% 1 20% 23% 14% 4 19% 37% 20% Physical Environment (10%) Focus Area Measure Weight Shelby Environmental quality (4%) Built environment (6%) Air pollution-particulate matter days 2% Air pollution-ozone days (average number of 2% Access to recreational facilities 2% Limited access to health foods (percent of 2% population who lives in poverty and more than 1 or 10 miles from a grocery store) Fast food restaurants (percent of all restaurants that are fast food) 2% 11% 14% 0% 49% 55% 25%

19 The majority of LTACH patients are hospitalized for specific conditions represented by 7 DRG s. Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. 18

20 Noland Tuscaloosa- Tuscaloosa Data According to 2012 Health ings, Tuscaloosa ranked 8 of 67 counties in Health Factors. Below are the subcategory rankings that were used to arrive at this overall ranking. Source: countyhealthrankings.org Health Behaviors (30%) Focus Area Measure Weight Tuscaloosa Tobacco use (10%) Adult smoking (percent of adults that smoke) Diet and exercise Adult obesity (percent of adults that report (10%) a BMI >= 30) 10% 23% 23% 14% % 35% 33% 25% Physical inactivity (percent of adults that report no leisure time physical activity) 2.5% 29% 31% 21% 22 Alcohol use (5%) Sexual activity (5%) Excessive drinking (percent of adults who report heavy or bringe drinking) Motor vehicle crash deaths per 100,000 population Sexually transmitted infections (chlamydia rate per 100,000 population) Teen birth rate (per 1,000 females ages 15-19) 2.5% 13% 12% 8% 2.5% % % Clinical Care (20%) Focus Area Measure Weight Tuscaloosa Access to care (10%) Uninsured (percent of population < age 65 5% without health insurance) 14% 16% 11% Ratio of population to primary care physicians 5% 1027:1 952:1 631:1 Quality of care (10%) Preventable hospital stays (rate per 1,000 5% Medicare enrollees) Diabetic screening (percent of diabetics 5% that receive HbA1c screening) 84% 82% 89% 16 Mammography screening 5% 72% 66% 74% Social and Economic Environment (40%) Focus Area Measure Weight Tuscaloosa Education (10%) High school graduation 5% 69% 70% Some college (Percent of adults aged % 11 62% 56% 68% years with some post-secondary education) Employment (10%) Unemployment rate (percent of population 10% age 16+ unemployed) 8.3% 9.5% 5.4% 7 4 Income (10%) Family and social support (5%) Community safety (5%) Children in poverty (percent of children 10% under age 18 in poverty) Inadequate social support (percent of adults 2.5% without social/emotional support) Percent of children that live in single-parent 2.5% household Violent crime rate per 100,000 population 5% 23% 27% 13% 10 18% 23% 14% 14 36% 37% 20% Physical Environment (10%) Focus Area Measure Weight Tuscaloosa Environmental quality (4%) Built environment (6%) Air pollution-particulate matter days 2% Air pollution-ozone days (average number of 2% Access to recreational facilities 2% Limited access to health foods (percent of 2% population who lives in poverty and more than 1 or 10 miles from a grocery store) Fast food restaurants (percent of all restaurants that are fast food) 2% 14% 14% 0% 60% 55% 25%

21 The majority of LTACH patients are hospitalized for specific conditions represented by 7 DRG s. Because of the specialized focus of an LTACH on acute patients with long lengths of stay, one focus of our community needs assessment is understanding these potential patients who might have issues of access to the services needed for their conditions and health status. 20

22 Community Input Findings Subsequent to the secondary data assessment, the Community Needs Assessment Team entered into dialogue with key hospital administrators, physicians, and those with knowledge/expertise in public health. During this phase, the team conducted face to face interviews, phone interviews, and also conducted written surveys in which respondents were able to comment and discuss general community health issues of their specific service area. Comments were also encouraged on those needs specific to long term care and the aging population. Through these numerous interviews and surveys, a summary of community input was created. This summary would eventually be used to help focus in on priorities and ultimately, implementation strategies. The list below includes respondents who participated in this phase. They included experts in the field of public health, long term care, hospital administration, medicine, and case management. All input was collected and summarized during March Respondents included: Alva Lambert- Executive Director, State Health Planning & Development Agency Barbara Estep Statewide Health Coordinating Council Committee Robert Crowder- Executive Director, Southern Regional Council on Aging (SARCOA) Natalie Palmer- Director of Case Management, Noland Health Services Andy Tatnall- Administrator, Noland Hospital Shelby Kaye Burk- Administrator, Noland Hospital Dothan Susan Legg- Administrator, Noland Hospital Montgomery Bill Mitchell- Administrator, Noland Hospital Anniston Dale Jones- Administrator, Noland Hospital Tuscaloosa Laura Wills- Administrator, Noland Hospital Birmingham In addition, a written survey of physicians was conducted. Respondents were asked to identify and discuss major health issues facing those residents 65 and older in their service area. Respondents included physicians from the following areas: Cardiology Family Medicine Infectious Diseases Physical Medicine and Rehabilitation Pulmonary Internal Medicine Nephrology 21

23 The following summary was created based on the responses from the groups above. Those in bold were mentioned multiple times. Issues Administrators Physicians Other Education and Awareness Education on insurance coverage Education of discharge planners on patient options Wound care education Knowledge of resources Collaboration and outreach Family support education Access to Appropriate Resources Transportation Supply of adequately trained physicians Access to mental health services (more outpatient psych, public health advocacy) Uninsured/underinsured in the community Requirement of a referral to see physicians (access) Lack of practices accept Medicare/Medicaid Medication access due to cost Difficulty establishing PCP / Fair Cost of PCP Prevention and Screening Cancer screening issues Renal Disease dialysis Influenza (vaccinations) Very few preventative programs Health Issues Impacting the Elderly Diabetes Type 2 Diabetes Cardiovascular Pulmonary Self-Responsibility for health Smoking Obesity / Lack of exercise or nutrition Need for wellness programs Health Issues of LTACH Patients and Families Vent dependency and inability to place Recurrent or slow healing wounds, thus repeated admissions Family support/education Education of discharge planners on patient options Understanding of how LTACHs fit in the continuum of care Nonpaying patients due to AL no recognizing LTACHS ( no Medicaid) 22

24 Prioritization of Needs Identified by Data and Input A priority session was held at the Noland Corporate office with all Noland Hospital Administrators and other hospital division leadership. The purpose of this session was to discuss data and input and prioritize the needs of each hospital s defined community. Criteria used included importance to the service area (elderly residents with acute needs), relevance of the health issue to the population served, and the ability of Noland to effectively impact and improve the health issue. The following five issues were identified as priorities. Issues in these categories were brought up numerous times and serve as a framework for each facility s implementation strategies. Education: Lack of education was targeted as a major issue by our community input and data assessment information. Lack of education covers all areas from patient and family education to education of resources and understanding the role of LTACHs in the continuum of care. On the patient side, there was a significant need for education of insurance coverage and wound care. With respect to the acute care setting, there was a need identified for a better understanding of post- acute care discharge options. The need for outreach and collaboration is great in most of these areas and many facilities used this as a cornerstone of their individual implementation strategies. Access to Appropriate Resources: This was also an issue mentioned very often in the community input phase. Barriers of access can arise from financial status, lack of transportation, lack of physicians accepting certain insurance coverage (Medicaid, Medicare), and a general lack of knowledge on services available in close proximity. The uninsured and underinsured not only have access problems in seeing physicians, but also issues in receiving their proper medications. Access to primary care physicians at a reasonable cost was also noted in community input discussions. Prevention and Screening: Prevention and screening for disease becomes increasingly important as the population ages. Cancer screenings, flu vaccinations, and prevention from kidney disease were all mentioned in this category during community input and were confirmed in the data assessment. Also, the need for more preventative programs was consistently identified as a need. Health Issues Impacting the Elderly: Many diseases and conditions were mentioned as major issues facing community members over 65 years of age. Noland s patient base is predominantly the elderly with needs for long term acute care, thus the assessment focuses on the health issues and needs of the elderly acute patient and their families. Specific conditions and health issues most often identified included cardiovascular disease, pulmonary disease, diabetes, and multiple cancer sites. In addition to these conditions, behaviors that may cause these conditions were also mentioned. Obesity, lack of nutrition, lack of exercise, and smoking were behaviors that were identified in community input as issues leading to chronic disease. Health Issues of LTACH Patients and Families: Through administrator and physician expertise in the LTACH setting, a number of issues were identified in the community input phase that dealt specifically with LTACH patients and their families. Many of these patient related health issues could be linked to other categories listed in priority areas described above. Family support and 23

25 education was found to be a critical need because of the family s integral role in the decision making process. Many of the issues mentioned in all sections directly affect the family maybe more so than the patient. Knowledge of the LTACH environment is crucial for a family. The understanding of how LTACHs fit in the continuum of care is also important, not only for the families, but for discharge planners and other acute care staff. Specifically related to patients of LTACHs, there is an issue of finding the appropriate setting for discharge of patients who may be vent dependent after their stay at the LTACH is complete. Another health issue that was mentioned was the chance of readmission due to recurrent or slow healing wounds. Each category mentioned above can be linked to the others. For instance, lack of knowledge of resources could lead to an access issue which in turn leads to a lack of prevention or screening and ultimately one of the major issues impacting the elderly. These issues would be prioritized and used in implementation strategies for each specific facility. Below is a list of strategies that were developed in these specific areas. Action steps for these strategies will be explained in the implementation document. Often the strategies fall into more than one area and therefore are listed in both areas. Area Education Access to Appropriate Resources Strategy Educate community and providers on LTACHs roll in continuum of care Educate the community on the importance of proper wound care Clinical education with families Offer family education opportunities Educate businesses on services available in LTACH Educate healthcare and physician personnel on LTACH Educate seniors on Medicare coverage Address readmission rates with Acute Care facilities and Nursing Homes Obtain or create patient guide on medication management Educate LTACH patient/family on community-based healthcare resources Educate community and providers on LTACHs roll in continuum of care Address financial barriers of healthcare for the uninsured/underinsured Educate healthcare and physician personnel on LTACH Educate seniors on Medicare coverage Increase community knowledge of insurance coverage Obtain or create patient guide on medication management Increase LTACH patients' access to Primary Care Physicians Educate LTACH patient/family on community-based healthcare resources Prevention and Screening Health Issues Impacting Elderly Health Issues of LTACH Patients and Families Increase awareness of community programs addressing obesity/nutrition Reduce smoking in the community Become a voice in the community of the importance of proper nutrition Offer family education opportunities Clinical education with families Enhance communication with family members Develop methodology to enhance family involvement Educate LTACH patient & their family on post-acute care options Obtain or create patient guide on medication management Increase LTACH patients' access to Primary Care Physicians Educate LTACH patient/family on community-based healthcare resources 24

26 Noland Health will initiate the development of implementation strategies for health priorities identified above. This Implementation Plan will be rolled out over the next three years. The team will work with community partners and health issue experts on the following for each of the approaches to addressing health needs listed: Identify what other local organizations are doing to address the health priority Develop support and participation for these approaches to address health needs Develop specific and measurable goals so that the effectiveness of these approaches can be measured Develop detailed work plans Communicate with the assessment team and ensure appropriate coordination with other efforts to address the issue The team will then develop a monitoring method at the conclusion of the Implementation Plan to provide status and results of these efforts to improve community health. Noland Health is committed to conducting another health needs assessment in three years. In addition, Noland Health will continue to play a leading role in addressing the health needs of those within the community, with a special focus on the aging population of. As such, community benefit planning is integrated into our Hospital s annual planning and budgeting processes to ensure we continue to effectively support community benefits. Board Approval This Community Health Needs Assessment Report for fiscal YE June 30, 2013 was adopted by the Noland Health Board of Directors at its meeting held on May 8, Also in this meeting, the Board of Directors approved implementation strategies to address the above mentioned prioritized needs. 25

27 Appendix A - Community Input Questions Community Health Needs Assessment Interview Guide - Administrators Written Survey - Physicians What do you see as the 2 major health issues facing community residents 65 and older? 1 2 For issue #1 identified above please answer the following: A. What resources are available in your community to address this health issue? B. Do members of the community have reasonable access to these resources? C. Identify programs and/or resources that could help address the need. D. How can the healthcare community (providers, physicians, others) make an impact on this issue? For issue #2 identified above please answer the following: A. What resources are available in your community to address this health issue? B. Do members of the community have reasonable access to these resources? C. Identify programs and/or resources that could help address the need. D. How can the healthcare community (providers, physicians, others) make an impact on this issue? Are there any barriers to accessing your services? Are there any barriers for your patients in accessing other medical resources? Are there any barriers for your patients in accessing community resources? Are there any barriers to care coordination? Are there specific barriers for the uninsured and underinsured? Are there activities that Noland Health could participate in that would help accelerate improvement in some of these health priorities? (Non-financial) Are there prevention efforts that would significantly impact the health of your patients? What other information that you would like to share about your community's health? 26

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