Butler Memorial Hospital Community Health Needs Assessment 2013

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1 Butler Memorial Hospital Community Health Needs Assessment 2013 Butler County best represents the community that Butler Memorial Hospital serves. Butler Memorial Hospital (BMH) has conducted community health assessments for over 20 years to guide resource allocation and service development. Major past initiatives that have been started or programs that have received ongoing support due to recognized community needs have been: Maternal Services Program 1990 Family First (support) 1992 Mammography Outreach 1996 Women s Imaging Center 1999 Cardiovascular Surgery 1999 Community Hospital Comprehensive Cancer Program 2006 Tumor Registry 2006 Community Health Clinic (support) 2008 Health statistics and qualitative data, as well as a BHS sponsored survey of 673 households have been reviewed within the framework of Pennsylvania State Health Improvement Plan, Healthy People 2010, and Healthy People 2020 goals. See appendix A for details. Priorities Premature death is a priority. Many health statistics focus on mortality due to certain conditions. Since death is not preventable, statistics of this kind can lead to a focus on diseases that have little or no chance of being changed for the better. We believe that no one would disagree that death at an age less than 65 would be considered premature. The population greater than age 65 will also benefit from a focus on conditions that cause premature death. Large numbers of people affected by a specific measurable morbidity. The opportunity to make a small impact on a large number of people, especially children, is seen as a priority.

2 Findings: Adult Deaths from Disease Healthy People 2020 Goal Coronary Heart Disease Death rate Stroke Death rate Cancer death rate Since all people will die, overall death rates are less meaningful than a measure of premature deaths. For each age group, in 5 year increments, the number of deaths is multiplied by 65 minus the age to represent years of life lost prematurely. These years of life lost are summed for each disease category and shown as a point on the line chart.

3 1400 Years of Life Lost to Premature Death, age< Years Life Lost 1995 Years Life Lost 2000 Years Life Lost 2005 Years Life Lost 2010 Heart Disease Cancer Stroke COPD Cancer ranks first and heart disease second as causes of lost lifetime before age 65. These diseases will be the focus of our efforts. Cancer in Butler County Cancer can be divided into two groups: those for which screening is available and shown to improve outcomes and those that cannot be screened for. Medical science is always developing, for this analysis potentially amenable to screening cancers are: lung cancer, colon cancer, breast cancer, prostate cancer and melanoma. Lifetime lost is calculated by adding the years of life lost from age of death to age 65 for each cancer type in each of the years displayed on the chart to show the trends in lost lifetime to these diseases.

4 250 Years of Life Lost from Premature Death, by Cancer Type, age < Colon Cancer Lung Cancer Breast Cancer Prostate Cancer Melanoma All Ages, Deaths by Cancer Type, %, Lung Colon Breast Pancreas Leukemia Non Hodkins Lymphoma 18.8 Esophagus

5 All Ages, Deaths by Cancer Type, %, Lung Colon Breast Pancreas Leukemia 10.9 Non Hodkins Lymphoma 14.2 Esophagus Overall, from 2000 to 2010, the proportion of deaths due to breast and colon cancer has declined while the proportion due to lung cancer has remained unchanged. The purpose of cancer screening is early detection. For solid tumors, early detection may be associated with better treatment outcomes and higher cure rates. The stage of cancer at the time of diagnosis is shown here comparing 2001 to 2010 and adjusted for the population growth of Butler County Bronchus and Lung Bronchus and Lung Cancer Local Regional Distant Unknown Normalized to 2001 pop

6 Lung cancer may be cured if it is diagnosed early enough for surgical removal. Between 2001 and 2010, the number of cases of lung cancer has decreased but it is being detected when it is more advanced Female Breast Female Breast Cancer In Situ Local Regional Distant Unknown Normalized to 2001 pop The incidence of breast cancer has risen slightly but many more are detected early even though 25% of female survey respondents had not had a mammogram within the last 2 years. According to the Behavioral Risk Factor Surveillance Study (BRFSS) in 2001, 76% of women age 50 or more reported having mammograms, in 2010, only 75% (according to BMH survey, not asked in 2010 BRFSS). In spite of earlier detection, lost lifetime has not improved.

7 160 Colon and Rectum Cancer Colon and Rectum In Situ Local Regional Distant Unknown Normalized to 2001 pop The use of colonoscopy to remove polyps (pre cancers) has resulted in a dramatic decline in colon cancer and lifetime lost to this disease. Butler County cancer death rates for all ages (not less than 65 years of age)are compared to Healthy People 2020 Goals. A ratio of 1 or less is at or better than goal. A ratio more than 1 means we have not met the goal yet Goal Actual vs. Goal Cancer death rate per 100,000 population Lung Breast Colorectal Prostate Melanoma Cancer Interventions: Melanoma screening in

8 Receive and implement the recommendation from BMH Cancer Committee regarding screening for lung cancer with low radiation dose CT. 25% of female survey respondents did not have a mammogram in the last 2 years; therefore BHS increase outreach education for screening. Improved outcomes from cancers that cannot be detected by screening depend on better treatment: BHS will partner with other organization to bring more sophisticated cancer treatment to Butler County. Coronary Heart Disease and Stroke 30 Butler County Coronary Heart Disease Deaths by Age Group Significant progress has been made against coronary heart disease (CHD) as shown by fewer deaths in 2010 than in 2000 by age groups. Risk factors that can be changed to reduce CHD are smoking, high blood pressure, and high cholesterol. In the BHS sponsored survey, 45.4 % said that they had high blood pressure and 43.6% high cholesterol. 88% said that they had cholesterol screening in the last 5 years. CHD/Stroke Intervention:

9 Provide feedback to patients and providers on their blood pressure and cholesterol measurements compared to Healthy People goals. Measure and report on primary and secondary prevention for cholesterol profiles done by BMH lab. Ongoing outreach screening. Children s Health: Children s deaths Goal Ratio By age group DSU DSU DSU=data statistically unreliable

10 45% of adults do not know where services for children can be obtained if they cannot afford traditional locations of care. Children s Interventions: Provide list of children s services to Butler County school nurses, church groups, and day cares. Collaborate with schools on disease and injury prevention education. Lobby PA Butler County Health Department to offer vaccine clinics at more off-hour times and at locations accessible by bus. Data gap: collaborate with Butler County School Nurses to define use patterns of psychiatric medications in school age children. Lifestyles: Obesity and Smoking Butler, Beaver Region BRFSS Healthy People 2020 Obesity (BMI>30) Daily Smoker % Butler County obesity rates are below 2020 goals. Effective community based obesity interventions are not well understood. Therefore adult obesity will not be addressed in our plan.

11 One third of smokers are trying to quit, this should continue the trend toward lower rates of smoking. Less than half of survey respondents know where to get help for drug problems. Accidental Deaths: Firearm Related Unintentional Injury Death rate MVA Death Rate per 100,000 population

12 Osteoporosis related disease: COUNTY Goal Hospitalization rate for hip fracture among females 65+ (per 100,000) (age-adjusted to 2000 std population) Butler Hospitalization rate for hip fracture among males 65+ (per 100,000) (age-adjusted to 2000 std population) Butler BMH has conducted outreach screening for osteoporosis since Over the last 5 years, the population adjusted rate of hip fractures has decreased 8% for women and 3.5% for men. The proportion of people with abnormal screening results who have follow up with a medical provider is unknown. Lifestyle and Accident Interventions: Collaborate with schools on seatbelt and fitness education. Build system to close diagnosis and treatment gap between osteoporosis screening and treatment. Disseminate information on drug treatment programs. Access to Care Barriers: Services that care for people who have recurring or frequent medical appointments to manage chronic diseases such as heart failure or wound care indicate that transportation issues are a frequent barrier for patients. Financial: The BMH sponsored survey respondents are more likely to have better access to care from the financial perspective than the general population of Butler County because 96% had health insurance and only 2.4% of survey repondents were unemployed. Nonetheless, 24% said that they experienced financial barriers to care for both doctor visits and buying prescription medicines. Time: 15.4% of respondents to the BMH survey indicated that time constraints were barriers to care. 7.3% healthcare hours did not fit personal schedule, 4.2% can t time off from work, and 3.9% don t have time to see a doctor.

13 Interventions: Enhance access to transportation. Financial barriers cannot be addressed due to CMS and Insurance contractual rules that preclude forgoing copayments. Access times for minor acute problems has been enhanced by the BHS FastERcare centers, expand hours for access to care for chronic disease management which may also alleviate some transportation barriers. Disparities of Heath Outcomes: All hospital admissions in Pennsylvania are categorized for severity of illness on admission. The diagnosis and severity of illness are used to predict the likelihood of death. Actual death rates can be compared to expected death rates: this is called the mortality ratio. For patients with Medicaid Insurance, the mortality ratio is 0.84; these patients are 16% less likely to die than expected. For patients with non-medicaid insurance, the mortality ratio is 0.72 or 28% less likely than expected to die based on diagnosis and severity of illness. This difference is significant p<0.001(chi square test) and appears to represent a care disparity. Intervention: The Medical Staff is to analyze and perform tests of change in care processes to decrease or eliminate this disparity.

14 Appendix: Data Sources: 2011 BHS sponsored survey of 673 households Behavioral Risk Factor Surveillance Study, Butler Beaver region Pennsylvania Department of Health: Health Statistics Interviews with Butler County school nurses Healthy People 2010 and 2020 goals and statistics. The Butler County State Health Improvement Plan (SHIP) district is undergoing reorganization Butler Memorial Hospital Cancer Registry and Cancer Committee Letters and comments to BHS leadership. Advisors with public health expertise: Tripp Umbaugh, Inc Prometheus, LLC

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