University of Minnesota Medical Center Community Health Needs Assessment (CHNA) Implementation Plan

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1 University of Minnesota Medical Center Community Health Needs Assessment (CHNA) Implementation Plan University of Minnesota Medical Center, Fairview and University of Minnesota Amplatz Children s Hospital provide world class, state-of-the-art patient care. The medical center was ranked as the top hospital in the Twin Cities metro area by U.S. News & World Report in Together, the medical center and children s hospital have 1,600 licensed beds, employ nearly 7,000 people and serve hundreds of thousands of patients each year. Areas of specialization include organ and blood and marrow transplantation, heart disease care and prevention, cancer care, the neurosciences and behavioral health. The medical center and hospital were created in 1997 as a result of a merger between University of Minnesota Hospital and Clinic and Fairview Health Services. As a division of Fairview, they re part of a statewide network of hospitals, primary care and specialty care clinics, home care and hospice services, pharmacies, senior housing and long-term care facilities. This implementation plan summarizes the process to date and priorities established for University of Minnesota Medical Center, Fairview to sustain and develop community benefit programs that 1) address prioritized needs from the 2012 Community Health Needs Assessment (CHNA) conducted by the medical center s CHNA Steering Committee with assistance from Fairview Health Services Community Health Department and 2) respond to additional identified community health needs. Target Areas and Populations Fairview Health Services identified the community and assessment area as the population within the zip codes that comprise the Primary Service Area for University of Minnesota Medical Center, Fairview. The entire population within this area is included in the assessment; we did not limit our assessment to only Fairview patients. See appendix A for a map of the assessment area. How the Implementation Strategy was Developed The medical center s implementation strategy was developed based on the findings and priorities established by its CHNA Steering Committee. University of Minnesota Medical Center, Fairview, along with Fairview Community Health, provided leadership for the 2012 CHNA. The medical center reached out to members of the community in the fourth quarter of 2011, asking a diverse group of community leaders to represent the community by becoming a member of the CHNA Steering Committee. The following are members of that Steering Committee: Tom Clancy, University of Minnesota School of Nursing Diane Cross, Board Member, University of Minnesota Medical Center, Fairview Connie Delaney, University of Minnesota School of Nursing, and Board Member, University of Minnesota Medical Center, Fairview Sandra Eliason, M.D., Fairview Clinics Ann Ellison, Director, Fairview Community Health Mohammed Hassan, M.D., University of Minnesota Physicians Carrie Link, MD University of Minnesota Department of Family Medicine and Community Health Donna McAlpine, University of Minnesota School of Public Health Gretchen Musicant, Commissioner, Minneapolis Department of Health and Family Support Sahra Noor, Director, Department of Community Health, University of Minnesota Medical Center, Fairview 1

2 Marge Page, Vice President, University of Minnesota Medical Center, Fairview Hiba Sharif, Department of Community Health, University of Minnesota Medical Center, Fairview Carolyn Wilson, President, University of Minnesota Medical Center, Fairview Major Needs and How Priorities Were Established Both qualitative and quantitative data was gathered in the assessment process. The qualitative data included: Focus groups of three populations (mothers, seniors, vulnerable) Web surveys Key stakeholder interviews with elected officials, community leaders, physicians and members of community-based agencies. Quantitative data included: Mortality data Hospital utilization data Emergency room data Community Need Index (CNI) scores which are based on underlying socio-economic indicators of health. Causation has been shown between high CNI scores and inappropriate emergency room admission for ambulatory sensitive conditions. See appendix B for a map of CNI scores for the assessment area. The assessment resulted in a number of themes. The themes identify specifically what University of Minnesota Medical Center, Fairview community members need to maintain or improve their health and/or specific medical conditions that require attention. The six top themes that emerged are: Health information and education Mental health Diabetes Low birth weight/infant mortality Heart disease Cultural competency These six themes were discussed by the Steering Committee members and then prioritized using a Need Prioritization Worksheet and Criteria, see appendix C. As a result of the discussion, the group reclassified both healthcare information and education and cultural competency to be used as strategies throughout all action planning rather than as individual action items. The prioritization, by the Steering Committee, resulted in the following top health needs for the community: 1. Mental health 2. Heart disease A review of current community benefit programs found that the medical center is meeting existing community needs through provision of charity care, Medicaid services, health professional education programs, as well as participation in the Health Commons, the Healthy Kids & Communities initiative and numerous community education and health events. These activities were determined to be valuable priorities for the medical center s implementation strategy. 2

3 Description of What University of Minnesota Medical Center, Fairview Will Do to Address Community Needs The University of Minnesota Medical Center, Fairview CHNA Steering Team has identified specific initiatives to address these top community health needs. Significant consideration was given to those opportunities that align priority needs with research opportunities of the University of Minnesota Academic Health Center. Mental Health Action Plan The medical center will collaborate with University of Minnesota researchers and the University of Minnesota Department of Psychiatry to create a community-based educational campaign to raise awareness regarding mental health, particularly early identification of symptoms and links to community and clinical resources to improve the mental health of the communities we serve. We will use data and research findings from studies conducted by researchers from the University of Minnesota s Academic Health Center to develop a culturally inclusive curriculum in partnership with the community. Training will be provided to neighborhoods with high community needs index scores. It will be delivered in school settings, through faith based organizations and at Health Commons a drop-in health and wellness center that serves low-income, immigrant populations in the Cedar Riverside neighborhood. Hennepin County has identified mental health as a top priority for county residents through its 2012 community health assessment. The medical center will collaborate with Hennepin County and participate in its Community Health Improvement workgroups to address mental health needs through education and community-connected initiatives being developed by the City of Minneapolis and Hennepin County. Heart Disease Action Plan The medical center will continue community-based initiatives around access to healthy foods and physical activity programming currently under way at Health Commons in collaboration with the medical center s Dietetic Internship program and University of Minnesota s Extension Services with funding from the UCare Fund. These initiatives are focused around the development of community gardens, nutrition education and cooking classes and the establishment of farmers markets that can be accessed by employees and community members. The medical center will identify additional opportunities to align with research initiatives at the Academic Health Center that focus on prevention and treatment of heart disease and will work with University of Minnesota Physicians Cardiovascular Service Line to identify clinical initiatives that align and address the identified community needs. University of Minnesota Medical Center, Fairview also will explore opportunities to partner with the City of Minneapolis Public Health Department in its Healthy Corner Store Initiative which promotes access to fruits and vegetables by redesigning convenience stores in high CNI score neighborhoods. Other Community Needs While not identified as one of the community s top two health needs, health information and education is something that the medical center sees as a priority. The CHNA data related to health information and education will be communicated across the organization. Efforts will be made to increase and improve all aspects of health information and education that is provided broadly to the community. 3

4 Next Steps for Priorities For each of the priority areas listed above, the medical center will work with the CHNA Steering Committee and community partners to: Identify any related activities being conducted by others in the community that could be built upon. Develop measurable goals and objectives to evaluate the effectiveness of the any interventions. Build support within the community for the identified initiatives. Develop detailed work plans. Priority Needs Not Being Addressed and the Reasons The needs of our community are many and diverse. To provide focus, the priority areas were selected where the medical center, with its partners at University of Minnesota Physicians and University of Minnesota, can have the greatest impact due to our particular strengths and expertise. Resources The work of the action plans will be supported by a 1.8 dedicated community health staff and $73,000 for programming. Approval Each year, University of Minnesota Medical Center, Fairview s Board will review the prior fiscal year s Community Benefit Report and approve the Community Benefit Implementation Strategy for addressing priorities identified in the most recent Community Assessment and other plans for community benefit. This report was prepared for the Nov. 9, 2012 meeting of the Patient Care Committee of the Board and was approved at that meeting. 4

5 Appendices A. Primary Service Area Map B. Community Need Index (CNI) Score Map C. Need Prioritization Worksheet and Criteria D. Definition of Community Zip Codes by Hospital PSA E. Qualitative Data Tools and Questions F. Top Ten Health Conditions by Population and Hospital

6 Appendix A: Primary Service Area Map University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children s Hospital Primary Service Area

7 Appendix B: Community Need Index (CNI) Score Map University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children s Hospital CNI Scores

8 Need Prioritization Worksheet Criterion and Considerations Guide Criteria #1: Is the need health related? Considerations: To what degree is the need health related? Criteria #2: Is the need tied to Community Need Index (CNI) scores or similar measure of vulnerability? Considerations: To what degree is the need tied to CNI scores or other measure such as the percentage of school Free and Reduced Lunch (FRL) participants (e.g. A community may have a low CNI score, but a school within that community may have a high percentage of students who qualify for FRL). The Community Need Index (CNI) Scores were developed by Catholic Healthcare West and Thompson Reuters. Their underlying data is used to create an objective measure of socio-economic barriers to health care access among populations and their effect on hospital admissions. CNI Scores range from a 5 (highest health disparity/highest community need) to a 1 (lowest health disparity/lowest community need). CNI Scores provide a high-level measure of community need and allow for comprehensive comparative analysis to be made on many levels ranging from individual zip code comparison to regional or multi-state comparisons. Criteria #3: Is the need tied to assessment or otherwise documented? Considerations: To what degree is the need tied to assessment (i.e. where did the need fall on your list of priorities)? Are there contributing factors that may indicate the need for more immediate intervention (i.e. the need may fall lower on the assessment, but there are additional considerations that make it a higher priority)? Criteria #4: What is the magnitude of the need? Considerations: How many persons does the need affect, either actually or potentially? Criteria #5: What is the seriousness of the consequences? Considerations: What degree of disability or premature death occurs? What are the potential burdens to your community such as economic or social burdens? What happens if we don t respond? Criteria #6: What is the feasibility of addressing? Considerations: Is it amenable to intervention? Is the problem preventable? Are there scientifically feasible (evidence-based) interventions available? Is intervention acceptable to the community (i.e. are there economic, social, cultural or political issues that may influence the communities ability to address the health need)? Does intervention have the potential to produce measurable outcomes? Are there adequate technology, knowledge, human and financlal resources to effect change? Criteria #7: Does the need tie to Fairview Strategy? Considerations: Fairview Strategy is defined as prevention, awareness and treatment of conditions related to cardiovascular, orthopedics, oncology, mothers/children and behavioral health.

9 Appendix D: Definition of Community Zip Codes by Hospital Primary Service Area, 2012 Fairview Lakes Medical Center Fairview Ridges Hospital University of Minnesota Medical Center, Fairview/ Amplatz Children s Hospital Zip Code Community Zip Code Community Zip Code Community Center City Elko St. Paul Downtown Chisago City Farmington Midway Lino Lakes Lakeville MacGroveland Forest Lake New Market Falcon Heights Harris Rosemount New Brighton Hugo Eagan Roseville Lindstrom Eagan Como/Hwy North Branch Eagan Highland Park Pine City Apple Valley Mpls North Loop Rock Creek Burnsville Mpls Downtown Rush City Burnsville Mpls Loring Scandia Prior Lake Mpls Franklin Shafer Savage Mpls Cedar Stacy Fairview Southdale Hospital Mpls East Lake Taylors Falls Zip Code Community Mpls Phillips Wyoming Hopkins Mpls LynLake Fairview Northland Med Ctr Chanhassen Mpls Harriet Zip Code Community Chaska Mpls Linden Hills Dalbo Excelsior Mpls Near North Big Lake Hopkins Mpls Camden Elk River Eden Prairie Mpls Central NE Princeton Minnetonka Mpls SE Zimmerman Eden Prairie Mpls Downtown Bock Eden Prairie St. Louis Park Foley Victoria Mpls Nokomis Foreston Wayzata Mpls Northeast Milaca Mlps Harriet Mpls SW Oak Park Mlps Linden Hills Columbia Heights Ogilvie St. Louis Park Richfield Pease Mpls Nokomis Fridley Fairview Range Regional Mpls SW Cedar Riverside Health Services Zip Code Community East Bloomington University Angora Richfield Bovey Edina Britt Bloomington Chisolm St. Louis Park Cook Bloomington Forbes Edina Goodland Edina Hibbing Bloomington Iron Bloomington Elmer Edina Mountain Iron Nashwauk Pengilly Side Lake

10 Appendix E: Qualitative Data Tools & Questions Focus Group Notes Fairview Health Services 2012 CHNA Fairview Health Services Community Health Needs Assessment Focus Group Summary Hospital: Name of Group: Date Held: Summary by: Questions: 1. What current health issues trouble you and your family? 2. What is the number one health issue for you or (your clients) your family? 3. What roadblocks do you experience when you are working to maintain your health? 4. Now tell us what roadblocks you experience when seeking healthcare from a professional? 5. To whom do you turn or where do you go when you need help with a health issue? 6. What is needed in our community to help you maintain or improve your health? 7. What is the role of the hospital to help you or others maintain or improve your health? 8. What do you see as your role in maintaining or improving your health?

11 Appendix E: Qualitative Data Tools & Questions Stakeholder Interview Summary Fairview Health Services 2012 CHNA Fairview Community Health Needs Assessment 2012 Fairview Health Services Community Health Needs Assessment Stakeholder Interview Summary Hospital: Name of Individual: Date Held: Summary by: Background: 1. What do you believe to be the number one health issue in our community? 2. What are the difficulties, challenges and roadblocks faced by community members when they seek healthcare from a professional? 3. When community members seek help about a health issue, where do you think they go for help? 4. What do you think is needed in your community to help individuals like yourself maintain or improve your health? 5. What do you see as the health systems/hospitals role? 6. What do you see as your role in these improvements?

12 Appendix F: Top 10 Health Conditions by Population and Hospital University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children s Hospital Primary Service Area All Population Top 10 Reasons for Hospitalization, All Population With Birth Data Without Birth Data 1. Birth, vaginal ^ 1. Pneumonia (nos) 2. Birth, cesarean 2. Blood poisoning (nos) 3. Pneumonia (nos) 3. Osteoarthritis, lower leg (nos) 4. Birth, second degree laceration 4. Hardening of the heart arteries 5. Overdue pregnancy 5. Irregular heart beat 6. Blood poisoning (nos) 6. Chest pain (nec) 7. Osteoarthritis, lower leg (nos) 7. Kidney failure (nos) 8. Hardening of heart arteries 8. Rehabilitation (nec) 9. Birth, previous cesarean 9. Urinary tract infection (nos) 10. Birth, first degree laceration 10. Obstructive chronic bronchitis Source: Minnesota Hospital Association, nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category) Top 10 Reasons for ER Visits Not Resulting in Hospitalization, All Population 1. Upper respiratory infection (nos) 2. Middle ear infection (nos) 3. Headache 4. Chest pain (nos) 5. Altered mental status (symptom of other ^ illness) 6. Lower back pain 7. Fever (nos) 8. Chest pain (nec) 9. Abdominal pain (nec) 10. Abdominal pain (nos) Source: Minnesota Hospital Association, nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category) Top 10 Causes of Death, All Population 1. Cancer 2. Heart diseases 3. Mental disorders ^ 4. Symptoms, ill-defined conditions ^ 5. Stroke 6. Chronic obstructive pulmonary disease 7. Alzheimer s disease 8. Diseases of nervous system/sense organs 9. Diabetes 10. Kidney diseases Source: Minnesota Department of Health,

13 Appendix F: Top 10 Health Conditions by Population and Hospital University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children s Hospital Primary Service Area Children Top 10 Reasons for Hospitalization, Children Ages 18 and under With Birth Data Without Birth Data 1. Birth, vaginal ^ 1. Pneumonia (nos) 2. Birth, cesarean 2. Dehydration 3. Birth, cesarean (twins) 3. Asthma (nos) ^ 4. Pneumonia (nos) 4. Bronchiolitis 5. Dehydration 5. Depression (nec) 6. Asthma (nos) 6. Appendicitis (nos) 7. Bronchiolitis 7. Bronchiolitis (nec) 8. Depression (nec) 8. Pneumonia, bacterial (nos) ^ 9. Appendicitis (nos) 9. Mood disorder (nos) 10. Bronchiolitis (nec) 10. Respiratory failure ^ Source: Minnesota Hospital Association, nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category) Top 10 Reasons for ER Visits Not Resulting in Hospitalization, Children 18 and Under With Birth Data 1. Middle ear infection (nos) 2. Upper respiratory infection (nos) ^ 3. Fever (nos) ^ 4. Vomiting ^ 5. Strep, sore throat ^ 6. Inflammation, gastrointestinal (nos/nec) ^ 7. Asthma (nos) ^ 8. Sore throat 9. Head injury (nos) 10. Cough ^ Source: Minnesota Hospital Association, nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category) Top 10 Causes of Death, Children Ages 18 and Under With Birth Data Without Birth Data 1. Perinatal conditions ^ 1. Birth defects ^ 2. Birth defects ^ 2. SIDS ^ 3. SIDS ^ 3. Homicide ^ 4. Homicide ^ 4. Other accidents (e.g. falls, poison) 5. Other accidents (e.g. falls, poison) 5. Residual (other) ^ 6. Residual (other) ^ 6. Motor vehicle accidents 7. Motor vehicle accidents 7. Suicide 8. Suicide 8. Cancer 9. Cancer 9. Heart diseases 10. Heart diseases 10. Diseases of nervous system/sense organs Source: Minnesota Department of Health,

14 Appendix F: Top 10 Health Conditions by Population and Hospital University of Minnesota Medical Center, Fairview/ University of Minnesota Amplatz Children s Hospital Primary Service Area Seniors Top 10 Reasons for Hospitalization, Ages 65 and Over 1. Pneumonia (nos) 2. Blood poisoning (nos) 3. Irregular heart beat 4. Osteoarthritis, lower leg (nos) 5. Urinary tract infection (nos) 6. Kidney failure (nos) ^ 7. Hardening of the heart arteries 8. Obstructive chronic bronchitis 9. Stroke (nos) 10. First heart attack Source: Minnesota Hospital Association, nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category) Top 10 Reasons for ER Visits Not Resulting in Hospitalization, Ages 65 and Over 1. Chest pain (nos) 2. Chest pain (nec) ^ 3. Dizziness and giddiness 4. Fainting 5. Urinary tract infection (nos) 6. General discomfort, fatigue (nec) 7. Nose bleed 8. Limb pain ^ 9. Head injury (nos) ^ 10. Headache ^ Source: Minnesota Hospital Association, nos = not otherwise specified (unspecified diagnosis) nec = not elsewhere classified (diagnosis does not fit into a different category) ^ Top 10 Causes of Death, Ages 65 and Over 1. Cancer 2. Heart diseases 3. Mental disorders ^ 4. Symptoms, ill-defined conditions ^ 5. Stroke 6. Chronic obstructive pulmonary disease 7. Alzheimer s disease 8. Diseases of the nervous system/sense organs 9. Kidney diseases 10. Accidental falls Source: Minnesota Department of Health, designates a 0.5% or higher percentage of difference between hospital and state of MN