SHC Community Health Needs Assessment. Shriners Hospitals for Children - Honolulu. Prepared by: Pat Miyasawa and Jaclyn Pang

Transcription

1 SHC Shriners Hospitals for Children - Prepared by: Pat Miyasawa and Jaclyn Pang

2 Mission and Vision Mission: Provide the highest quality care to children with neuromusculoskeletal conditions, burn injuries and other special healthcare needs within a compassionate, familycentered and collaborative care environment. Provide for the education of physicians and other healthcare professionals. Conduct research to discover new knowledge that improves the quality of care and quality of life of children and families. Vision: Shriners Hospitals for Children will be the unquestioned leader, nationally and internationally, in caring for children and advancing the field in its specialty areas. Table of Contents 3 Commitment to the Community 9 Process and Methods 15 Key Findings 27 Action Plan 30 Acknowledgements 31 Exhibits Shriners Hospitals for Children 1310 Punahou Street, HI Tel.: shrinershospitalsforchildren.org Shriners Hospital for Children - CHNA Page 2

3 Our Commitment to the Community Who we Are Driven by the passion to enhance the lives of children who are affected by special health care needs, Shriners Hospitals for Children (SHC) has been providing philanthropic care for 90 years. The groundbreaking of the first hospital in Shreveport, Louisiana in 1922 was rooted in the pressing need for orthopedic care, due to the after effects of the widespread polio virus at the time. Since then, Shriners unwavering commitment to care, research, and education, has expanded into a program of twenty-two hospitals in three countries, caring not only for orthopaedic conditions, but also burns, spinal cord injuries, and cleft lip and palate, regardless of a family s ability to pay. Shriners Hospital for Children - CHNA Page 3

4 Within the United States, the Hospital serves the state of Hawaii, where 78% of the Hospital s treated children reside. The Hospital, established in 1923, is the second Hospital established within the Shriners twenty-two hospital system. The Hospital is a state-of-the-art, 24-bed pediatric orthopedic hospital situated in the heart of the main island, Oahu, in the Makiki district. The Hospital treats children through the age of twenty-one with neuromusculoskeletal conditions and certain other health care needs. The State of Hawaii Figure 1 The state of Hawaii is an island chain comprised of eight main islands: Hawaii, Maui, Molokai, Lanai, Kahoolawe, Oahu (where SHC is located), Kauai, and Niihau. Islands are classified into four counties, all of which SHC serves. The four counties are Kauai,, Maui, and Hawaii. SHC s service area excludes three islands: 1) Kahoolawe, as it is still a developing island and 2) Niihau and Lanai, as they are privately owned. Figure 1 above shows the categorization of islands by county. Shriners Hospital for Children - CHNA Page 4

5 Bridging Access Gaps for Our Children 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 80% 70% 60% 50% 40% 30% 20% 10% 0% Hawaii Kauai Maui Population Distribution by Children served by Hawaii Kauai Maui Population Distribution by Children served by Figure 2 Aware of access to care challenges that our neighbor island children face, SHC provides on-site outreach clinics and arranges or assists with travel and lodging expenses for patients to Oahu, where the Hospital is situated, as necessary. By offering this all-encompassing support, the population distribution of children throughout the counties is a close match to the percentage distribution of children served per county by SHC, as seen in Figure 2, indicating that outreach programs are bridging access gaps. The percentages are based on 2012 data. Shriners Hospital for Children - CHNA Page 5

6 Our International Children Figure 3 To date, SHC- has treated over 30,000 children. Approximately 20% of our patients reside outside the continental United States and Hawaii. Beyond the United States, the location cares for children from the Asia Pacific region. As with our neighbor island children, this population is reached via outreach programs and sponsored travel. Figure 3 is a map of the outlying areas that SHC serves. Shriners Hospital for Children - CHNA Page 6

7 The Purpose of this (CHNA) As part of the 2010 Patient Protection and Affordable Care Act (PPACA), all organizations, including tax exempt Internal Revenue Service code 501(c)(3) entities, operating one or more state-licensed hospital facilities, are required to adhere to newly established mandates. Under the PPACA, a hospital organization is required to conduct a CHNA for each of its hospital facilities once every three years. The CHNA must be in writing and made available to the general public. A hospital organization is also required to adopt an implementation strategy to meet the needs identified through the CHNA. The implementation strategy is a written plan that describes how the facility plans to meet the CHNA identified health need(s) or conversely, a plan that explains why the facility does not intend to meet certain identified need(s). The implementation strategy is considered adopted on the date the strategy is approved by the organization s board of directors or by a committee of the board or other parties legally authorized by the board to act on its behalf. The formal adoptation of the implemenation strategy must occur by the end of the taxable year in which the written CHNA report was made available to the public. The CHNA requirements are effective for taxable years beginning after March 23, These requirements are encapsulated on the IRS Form 990, Schedule H. The Shriners Home Office has elected to make the first CHNAs available to the public on our website by June 30, Transcending the essential purpose of the CHNA; however, is SHC s ultimate vision of the report. Shriners Hospital for Children - CHNA Page 7

8 Our Vision of the CHNA Although SHC- s mission is to serve children with neuromusculoskeltal conditions, the community that we service is more broadly, children with special needs. In concert and collaboration with our sister hospitals in the state, we are committed to meeting the special health-care needs of this community, a large portion of which are medically underserved, low-income, and minority populations, including populations with specific needs associated with chronic diseases. As a result, we are partnering and soliciting input from passionate experts who advocate on behalf of Hawaii s special needs pediatric population. These experts represent broad interests of the community that we serve and are individuals with special knowledge and expertise in public health. The CHNA findings will be used as a springboard for the development of initiatives that can be undertaken to enhance the health status of our community. The CHNA will be the catalyst that guides us toward evolving and/or enhancing our services to meet the disparate needs of the pediatric specialneeds communities that we serve. Shriners Hospital for Children - CHNA Page 8

9 Process and Methods Internal Processes and Methodologies Forming the Assessment Advisory Committee The Healthcare Association of Hawaii (HAH), the state s hospital and provider trade association, spearheaded the community-wide CHNA which included ALL hospitals and hospital systems in Hawaii that were subject to the PPACA CHNA requirements. The Chief Financial Officers of each hospital were the charter group in the initial HAH collaborative launch. In line with the HAH community-wide approach, the Assessment Advisory Committee at Shriners was also centralized within the Fiscal Department. In addition to topic expertise, the department is familiar with the Internal Revenue Service s Schedule H Form 990 requirements. Beyond the immediate team, the Hospital Administrator, Gene Raynaud, provided critical oversight to the Assessment Advisory Committee. Shriners Organization-Wide Collaboration The Shriners Home Office s Department of Planning and Business Development led the systematic coordination effort by providing milestone maps, demographic data, website links, templates, online discussions, and weekly teleconferences. This discussion amongst facilities was vital in promoting idea diffusion, particularly of data collection methodology. For process consistency, the Home Office purchased a comprehensive toolkit that was made available for use by all hospitals. This toolkit provided step-by-step guidance for completing the assessment. The Home Office also developed a report template for use by all hospitals. Ultimately; however, the completion of the report s narrative and data presentation (within the template-established sections) was the responsibility of and at the discretion of each hospital. Board approval of each hospital s report is required prior to posting on the Shriners website. Shriners Hospital for Children - CHNA Page 9

10 Internal Assessment Continuously attuned to the health needs of the children with special needs population that we serve, SHC conducted an abbreviated, internal CHNA back in September Our facilityinitiated assessment captured the prevalence of developmental issues our children face, a dire need we became aware of in part due to our constant and ongoing interfacing with our community partners. The PPACA mandated external assessment, the CHNA, required analysis of our hospital s served population from a broad perspective so that all other community disparities could be uncovered. The findings from the PPACA mandated CHNA corroborated our initial assessment findings, and deepened our understanding of all issues faced by our served population. Shriners Hospital for Children - CHNA Page 10

11 External Processes and Methodologies Key Informants SHC s CHNA community partners are all well-respected and knowledgeable individuals with special expertise in public health. Additionally, they represent the broader interests of and are advocates for Hawaii s pediatric special needs community, served by SHC. They provided rich information into the community health needs of the special needs population. Secondary data findings statistically validated the information that we received from our key informants. A brief synopsis of their biographies are as follow: Louise Iwaishi, MD: Dr. Iwaishi is Shriners s Chief of Pediatrics. She is acutely versed to the needs of the pediatric population and was a critical partner in solidifying the infrastructure and the direction of the assessment. Her expert roles include being Director of the Community Pediatrics Institute at the University of Hawaii s John A. Burns School of Medicine. Additionally, she is the Medical Director at the State of Hawaii Department of Health (DOH), Family Health Services Division and the Principle Investigator for the state health department s Maternal Child Health (MCH) Leadership Education in Neurodevelopmental Disabilities (LEND) program, a federally funded interdisciplinary graduate training program. Dr. Iwaishi also provides consultation to the State Departments of Health, Education and Human Services and participates in numerous local, state and national organizations related to children with special health care needs especially those who are medically fragile. Leolinda Parlin: Working closely with Dr. Iwaishi, Ms. Parlin is the co-director of the Hawaii MCH LEND Program. Ms. Parlin also serves as the Project Director of the HRSA (Health Resources and Services Administration) funded Hilopaʻa Family to Family Health Information Center (F2FHIC) and is the State Coordinator for Family Voices of Hawaii, an advocacy organization for Hawaii s CSHCN and their families. The F2FHIC serves as the Hawaii State Medicaid Ombudsman, assisting consumers and providers across the state in accessing services. As Project Director of the F2FHIC, Ms. Parlin represents members of medically underserved, low income, minority populations and populations with chronic disease needs. Shriners Hospital for Children - CHNA Page 11

12 Dorothy Colby, RN, MPH: Dorothy Colby is the DOH Children with Special Health Needs Branch, Children and Youth with Special Health Needs Section supervisor. She and her staff were instrumental in conducting the children with special health care needs surveys and planning activities in the statewide assessment that the DOH Family Health Services Division leads every five years for the Maternal and Child Health Services Title V Block Grant Program. She provided the SHC team with a copy of the assessment, which was one of the team s main secondary resources. Shriners Hospital for Children - CHNA Page 12

13 Statewide Collaboration SHC was part of the statewide collaborative assessment effort spearheaded by the HAH (Healthcare Association of Hawaii). Working with the state s Department of Health, HAH contracted a Californiabased consultant firm, the Healthy Communities Institute (HCI), who produced county and statewide level assessment reports on behalf of twenty-six (26) of twenty-eight (28) Hawaii hospitals. The results of this joint effort allowed for a consensus of community needs to be established and discussed between SHC and the state s twenty-five other local non-profit hospitals. The results of HCI s reports provided SHC with a global perspective of the demographics and healthcare needs of Hawaii s entire population. Despite the comprehensiveness of the reports, most statistics provided were not applicable to SHC s served population, as the data was based on the population-at-large and was not pediatric special needs specific. However, indicators applicable (to our population) within the report were selected and incorporated into SHC s CHNA. Also, the broad topic areas of disparities were beneficial from a comparative stance, as it served as a foundation to determine whether needs pertinent to the pediatric community were already being addressed and/or will be addressed by SHC. Secondary Sources Data for indicators pertinent to the pediatric population were captured from multiple sources, each source in agreement with one another. Basic demographic data was acquired from the market analysis conducted by Shriners Home Office in conjunction with statistics provided in the HCI s report. Data specific to our community was captured from the National Survey of Children with Special Health Care Needs, which was published by the Hawaii Department of Health s Maternal and Child Health Branch, who are required to conduct a state wide assessment every five years to facilitate the allocation of Federal Title V funds. Findings from these key sources aligned with needs emphasized by key informants, as well as the state s education department reports. Shriners Hospital for Children - CHNA Page 13

14 Kaiser Permanente s (KP) CHNA Toolkit SHC was fortunate to receive copies of KP s toolkit, a print resource utilized by KP to guide their many facilities through the CHNA process. SHC utilized the format of Kaiser s appendix Common Indicators table as a template for data collection and presentation. The Kaiser Common Indicators table roughly included a hundred categorized indicators. This format was an invaluable resource to the team as it was well categorized and easy to understand - an effective way of presenting the findings. Categories and indicators from the KP toolkit were omitted, modified and/or added based on their pertinence to SHC s pediatric special needs community. Community Resources The collaborative work product of the HAH led assessment was a fundamental resource widely utilized by Hawaii s nonprofit hospitals. Concurrence of the resource s role as a foundation for future initiatives within the community-at-large was reached at HAH conferences, which included Hawaii hospital representative attendees. Exhibit A, located at the end of this assessment, presents the community resource list provided by the statewide HAH assessment; for relevancy purposes, only pediatric-specific community resources are included in the attached exhibit. In close proximity to our facility is the Kapiolani Medical Center for Women and Children, a fullservice pediatric hospital. Respective assessments will serve as a baseline for post collaborative initiatives, to merge & maximize resources and to minimize duplication of efforts. Shriners Hospital for Children - CHNA Page 14

15 Key Findings Primary Data Face-to-face Interviews and follow-up teleconferences with our key informants disclosed that there is a prevalence of developmental disorders in Hawaii s pediatric population, as well as a dire shortage of pediatric neurologists and developmental pediatricians in Hawaii. These key informant findings were corroborated by the HAH CHNA Statewide report, which identified two priorities for children with special health care needs: To promote the identification of children with developmental delay and To promote the transition of adolescents with special health care needs to adult health care. Several secondary datasets further corroborated the information from our key informants and the HAH summary of findings. Shriners Hospital for Children - CHNA Page 15

16 Secondary Data Findings The secondary data findings for SHC were primarily derived from five central sources (listed on page 19), all of which cross-validated one another. Table A summarizes the secondary data findings. TABLE A Topic/ Category Subcategory Indicator % # Total Population 100.0% 1,380,057 Total Population, Male 51.0% 703,829 Total Population, Female 49.0% 676,228 Total Population, % 258,071 Total Population, % 52,442 General Total Child Population, % 310,513 Total Child Population (0-17) with special needs that include emotional, behavioral or developmental issues 3.7% 11,489 Demographics Social & Economic Factors Ethnic Composition Language/Origin Education Poverty Insurance Total Child Population (0-17) with special health care needs (CSHCN) 12.3% 38,193 White 25.0% 345,014 African American 1.9% 26,221 American Indian and Alaska Native 0.3% 4,140 Native Hawaiian and Other Pacific Islander 9.3% 128,345 Asian 38.1% 525,802 All Others 1.3% 17,941 Two or more races 24.1% 332,594 Linguistically Isolated People 6.2% 85,564 Foreign born People 17.7% 244,270 High school graduates 89.8% 1,239,291 Bachelor's degree or higher 29.4% 405,737 Below Federal Poverty Level 9.6% 132,485 Children in Poverty 12.3% 38,193 Child Population Uninsured 2.3% 7,142 CSHCN Population Uninsured 1.0% 382 CSHCN Insured with coverage that is not adequate 25.9% 9,892 Shriners Hospital for Children - CHNA Page 16

17 Health Behaviors Health Status of CSHCN Consumption Physical Inactivity BMI Morbidity CSHCN who are not screened early and continuously for special health care needs 18.9% 7,218 CSHCN (ages 0-2) that have not received Early Intervention Services 68.5% 26,162 CSHCN (ages 0-2) that have not received Special Education Services 74.5% 28,454 CSHCN who have unmet preventative dental care needs 6.7% 2,559 CSHCN who don't receive services needed for transition to adulthood (ages only) 62.7% 7,929 CSHCN who have unmet needs for physical, occupational or speech therapy 3.6% 1,375 Children (ages 1-5) who were not screened for being at risk for developmental, behavioral and social delays using a parentreported standardized developmental behaviors screening tool during a health care visit 67.6% 5,234 Adolescents (grades 9-12) who did not eat fruit or drink 100% fruit juices during the 7 days before the survey 6% 3,147 Adolescents (grades 9-12) who did not eat vegetables during the 7 days before the survey 7% 3,671 Adolescents (grades 9-12) who drank a soft drink three or more times per day during the 7 days before the survey 6% 3,147 Adolescents (grades 9-12) who do not participate in at least 60 minutes of physical activity on any given day 18% 9,440 Adolescents (grades 9-12) considered obese 13% 6,817 Allergies 47.40% 18,103 Asthma 41.70% 15,926 Shriners Hospital for Children - CHNA Page 17

18 ADD or ADHD 22.90% 8,746 Developmental delay 15.50% 5,920 Behavioral or conduct problems 12.70% 4,851 Food allergies 12.10% 4,621 Prevalence of anxiety problems 11.40% 4,354 Autism or other autism spectrum disorder 8.10% 3,094 Depression 7.20% 2,750 Migraine headaches 7.10% 2,712 Intellectual disability or mental retardation 4.50% 1,719 Epilepsy or seizure disorder 2.30% 878 Heart problem or heart disease 2.20% 840 Arthritis or joint problems 1.50% 573 Brain injury or concussion 1.50% 573 Cerebral Palsy 0.90% 344 Blood problems 0.80% 306 Diabetes 0.70% 267 Down syndrome 0.40% 153 Cystic fibrosis 0.20% 76 Muscular dystrophy 0.10% 38 Orthopedic Impairment 0.50% 191 Conditions highlighted in red font in the Table A "Health Status of CSHCN" category are developmental issues that our target CSHCN population face. These developmental issues, SHC s prioritization process to assess and rank these Table A developmental needs and SHC s implementation strategies to address those needs that were ranked and prioritized for action are further discussed in Table C on pages Shriners Hospital for Children - CHNA Page 18

19 The five data sources utilized to create Table A were: 1. The 2010 National Survey of Children with Special Health Care Needs (NS-CSHN) report: Data for this report is collected by each state s Department of Health (DOH) Maternal and Child Health Branch (MCHB) to facilitate the allocation of Federal Title V funds. The data is initially gathered to produce a health needs assessment report, which is required of states MCHBs every five years. The data from all reports can be viewed at 2. The State of Hawaii Maternal and Child Health Needs Assessment: This assessment was prepared by Hawaii s DOH Family Health Services Division, which is the state s maternal and child health agency. It is from this published report that the NS-CSHN report is produced. Detailed narrative within this CHNA provided rich insight into the issues afflicting SHC s served population. 3. The Health Association of Hawaii s State of Hawaii : Conducted in , this CHNA was the collaborative work product of all Hawaii nonprofit hospitals. It provided substantial information regarding the state s health status via indicators and key informant reports. SHC weighted the primary data in this report heavily, as the informants were selected by Hawaii s top public health experts. 4. Home Office provided 2012 Demographic Snapshot: Characteristics of SHC s catchment area were presented by this data source. It offered the most recent data of Hawaii s demographics, as well as a breakdown of the state s population distribution. The data was generated by purchased software from the The Neilson Company. 5. The 2011 Hawaii Youth Risk Behavior Survey (YRBS): The Center of Disease Control conducts the YRBS survey biannually. The findings capture the risk status of each state s youth population by monitoring six types of health risk behaviors. SHC s Table A Topic/Category Heath Behaviors indicators on page 17 were based on this data source. Shriners Hospital for Children - CHNA Page 19

20 TABLE B The table below contains the data produced by the Hawaii Department of Education s most recent performance report for the period of January 2012-June It is based off of Special Education eligibility, and is broken down by disability categorizations. Children receiving services and educational support under the Individuals with Disabilities Education Act (IDEA) comprise 12% of enrollment within Hawaii s public schools. This report was not utilized as a principle source, as it was only representative of half of Hawaii s CSHCN population (19,380 out of 38,193). Although some of the categories don t differentiate between specific conditions (e.g. multiple disabilities), the data that is specific (e.g. autism spectrum disorder) further corroborates the significant prevalence of children in Hawaii with developmental disabilities. Disability # % Specific Learning Disability % Developmental Delay % Other Health Disability % Autism Spectrum Disorder % Intellectual Disability % Emotional Disability % Speech or Language Disability % Multiple Disabilities % Hard of Hearing ("Deaf") % Orthopedic Disability % Visual Disability including Blindness % Traumatic Brain Injury % Deaf-Blindness 9 0.0% Shriners Hospital for Children - CHNA Page 20

21 Prioritization Process Table C summarizes the secondary data findings from Table A into broader categories of community need. The areas of greatest health disparities, listed below are based on key informant interviews and community partner input. Organizing key findings and considerations into the format below proved beneficial, as it served as the baseline for discussion during the prioritization stage of the assessment. TABLE C Category of Need Discussion SHC Unaddressed Need? SHC Prioritization Ranking OBSERVATIONS: Yes 1 An unmet care need, about 19% of CSHCN are not screened early and continuously for special health care needs. The 2010 MCHB report states that promoting "the identification of children with developmental delay" is another priority amongst Hawaii children. Early Screening/ Developmental Disability conditions amongst CSHCN Conditions distinguished in red font within the "Health Status of CSHCN" category Table A indicator comprise developmental issues that our CSHCN face. Early identification of the "right" diagnosis is important, as it is the key through which a child may access appropriate, required services- including early intervention services and special education services, which are a high, unmet care needs amongst our CSHCN population. A child's ability to lead a fulfilled life is enhanced with early identification and the subsequent interventions. SHC'S CONTRIBUTION: The results of the HAH collaborative community CHNA and our review of the secondary data sets listed on pages validated the results of an earlier, abbreviated CHNA conducted by the Hospital in Shriners Hospital for Children - CHNA Page 21

22 The abbreviated CHNA highlighted significant unmet developmental and behavioral needs, including dire shortages of developmental screenings and assessments, currently faced by CSHCN. The results of this current, comprehensive CHNA corroborates our initial CHNA findings. We are therefore adding pediatric neurology and developmental pediatrics to the services presently offered by SHC. (Pediatric neurologists and developmental pediatricians specialize in diagnosing developmental issues). OBSERVATIONS: The 2010 MCHB report states that promoting "the transition of adolescents with special health care needs to adult health care" should be a priority for Hawaii children with disabilities. There are nearly 8,000 (63%) CSHCN who don't receive services needed for transition to adulthood. Yes (for developmental disorders) 2 Transitional Services Vulnerable Populations Hawaii's Department of Human Service's Division of Vocational Rehabilitation reports that their largest served age bracket, at 23%, is comprised of year old children. This division provides support services to individuals with disabilities who are seeking employment. SHC'S CONTRIBUTION: SHC has an existing transition program for our currently served children. This program will be enhanced to serve the unmet developmental needs of CHSCN that surfaced during SHC s CHNA. OBSERVATIONS: No None Vulnerable populations include ethnic minority groups, uninsured and low-income persons. SHC'S CONTRIBUTION: Shriners mission and philanthropic philosophy guides us to provide care without regard to race, color, creed, sex or sect, disability, national origin or the ability of a patient or family to pay. SHC s financial assistance program assists families who cannot afford to pay for their child's treatment. Shriners Hospital for Children - CHNA Page 22

23 OBSERVATIONS: No None Dental Care In 2010, the State of Hawaii received an "F" grade from the Pew Research Center, as only one out of their eight key policy indicator benchmarks were met. This observation was referenced in the HAH CHNA report. (The Pew Research Center is a nonpartisan organization that conducts public opinion polling and demographic research. ) SHC'S CONTRIBUTION: At SHC, our goal is to comprehensively treat the whole child so as to reduce surgical complications and to maximize outcomes. In 2012, SHC launched its dental program to treat and/or remove the infected teeth of patients prior to their operations. Subsequently, the need for certain dental services in our community has decreased. OBSERVATIONS: No None Another known area of concern, the obesity epidemic is driven by poor health behaviors. According to the 2010 state health department's Maternal and Child Health Branch's (MCHB) assessment report, one of the state's priorities include "reducing the rate of overweight and obesity among young children ages 0-5." Childhood Obesity Unaddressed poor health behaviors can eventually lead to conditions, such as heart disease, stroke, and diabetes, which are ranked as the most severe, and the fourth most severe health topics in Hawaii respectively, by the HAH CHNA report. SHC'S CONTRIBUTION: Bettering the lives of our children from an allencompassing approach is what SHC strives to do. SHC is staffed with a Clinical Dietician who performs nutritional assessments. The dietitian also plans customized diets and educational activities to teach our children and their families about healthy eating, with the hope of instilling dietary knowledge and empowerment that will transcend their care at SHC and be applied towards their daily lives. Shriners Hospital for Children - CHNA Page 23

24 As an added measure, SHC's onsite Family Center and Recreation Therapy department has programs in place to encourage patients to eat wisely and get them involved in physical activity. The Family Center also routinely purchases locally grown fresh produce for patients and their families to consume. OBSERVATIONS: No None Neighbor Island residents face access challenges due to: (1) the concentration of health services on the Oahu island and (2) financial constraints (in part due to vulnerable population status and/or travel expenses to receive care on Oahu). In Hawaii, the shortage of physicians and causal factors are well documented, particularly in the "Hawaii Physician Workforce" report published in 2010 by the University of Hawaii's John A. Burns School of Medicine (JABSOM). This report highlights the magnitude of the state's shortage issue in which 600 physicians, or 20% of the total supply is needed. Access to Care According the JABSOM report, there exists a high prevalence of unmet need for the Pediatric specialty, especially for our Neighbor Island children. For example, on the island of Hawaii, general pediatrics ranks as the fourth highest unmet need amongst the 39 specialties listed, with a 40% physician shortage. The disparity is projected to widen significantly within the next ten years. SHC'S CONTRIBUTION: SHC has been providing Outreach clinics to Neighbor Island children since 1971 to address the access issues that our children face. A fourth surgeon will soon be joining SHC's team of compassionate care providers. Subsequently, two medical doctors will be on site at all times, which will enhance care access for Neighbor Island and all the children that we serve. Shriners Hospital for Children - CHNA Page 24

25 Allergies Respiratory Diseases Behavioral / Mental Health & Mental Disorders To further improve the coordination of care services, SHC has approved plans to implement a centralized scheduling system. Instead of independent scheduling of care services amongst departments, appointments will be scheduled centrally, enhancing access to care by making the scheduling process seamless for our children. OBSERVATIONS: According to secondary source findings, allergies are cited as the most prevalent condition amongst our served population. SHC S CONTRIBUTION: SHC does not currently have any initiatives or resources in place to address the allergy needs of CSHCN. Yes N/A* OBSERVATIONS: Yes N/A* According to secondary source findings, asthma is cited as the second most prevalent condition for CSHCN. SHC S CONTRIBUTION: SHC will treat respiratory problems that arise in conjunct with treating an orthopedic condition. However, we presently do not have stand-alone initiatives or resources In place to treat asthma and other respiratory needs of CSHCN. OBSERVATIONS: No None According to secondary source findings, ADD (attention deficit disorder), ADHD (attention deficit hyperactivity disorder), behavioral or conduct problems and depression are listed as prevalent conditions for CSHCN. SHC'S CONTRIBUTION: While SHC does not have a behavioral health program per se, we have a consulting psychiatrist on staff to address the needs of our patients. Shriners Hospital for Children - CHNA Page 25

26 *Rationalization for Prioritization Process Categories marked with an N/A*in the SHC Prioritization Ranking column indicate a lack of existing resources and/or expertise to treat at SHC. In regards to the CHNA conducted by SHC, the prioritization process was based on discussions, evaluations, and other deliberations with our key informants, community partners, and internal assessment team. The evaluation criteria was naturally driven by availability of internal resources and available expertise. A team decision was made to focus on developing plans to address developmental disabilities and transitional planning needs for our community CHCSN. We recognized and acknowledged that we did not have the resources or expertise to address needs such as allergies, which also surfaced during the assessment process. Shriners Hospital for Children - CHNA Page 26

27 Implementation Plan Developmental Disabilities GOAL: OBJECTIVE: TACTICS/ TIMELINE: To increase the availability of care for children with developmental disabilities in Hawaii. By August 2013, begin offering pediatric neurological care services to children with developmental disabilities in Hawaii. By July 2013, Public Relations specialist will implement marketing strategies to inform community-at-large of anticipated pediatric neurologist and developmental pediatric services. By August 2013, begin offering services to Hawaii children with developmental disabilities. EVALUATION MONITORING PLAN: Analyze referrals of patients with developmental disabilites to determine whether there is a need to reinforce or enhance communications for specific groups Gauge communication effectiveness through post-service line public opinion survey Evaluate patient satisfaction and patient experience metrics for operational trouble-shooting, admission process and patient care improvements Shriners Hospital for Children - CHNA Page 27

28 Transition Services GOAL: OBJECTIVE: TACTICS/ TIMELINE: To enhance current transitional service offerings for Hawaii s children with special health care needs. By August 2013, expand exisiting transitional service program to cover larger population of Hawaii s children with special health care needs. By August 2013, the Care Coordination department will finalize transition program revision plans to assure consistency of information that is distributed to and collected from current base of patients. By August 2013, the Care Coordination department will enhance the transition program to include information and assistance that is developmental disability-specific. EVALUATION MONITORING PLAN: On a case-by-case basis, internally assess effectiveness of transition assistance via direct discussion with patients and their families. Distribute surveys to patients and their families to gauge satisfaction ratings towards transition services that they received. Shriners Hospital for Children - CHNA Page 28

29 Internal Partners for Transition Expansion Merlene Jose, RN: Ms. Jose s health care knowledge is comprehensive and includes direct patient care, as well as education and supervision in the healthcare setting. She is familiar with the needs of the medically fragile pediatric community, and applies this invaluable expertise as the Care Coordination Manager at Shriners. Shriners current transitional program is managed by Ms.Jose. Ms. Jose will be the operational leader for the transitional program s expansion efforts. Lisa Abbott, APRN: Ms. Abbott has over 20 years of experience in the healthcare field with a wide range of knowledge in working with clients with complex medical conditions, as well as vulnerable populations. Ms. Abbott is currently a Family Nurse Practitioner at Shriners. She was the Choices program nurse under an initiative piloted at Shriners Hospitals for Children at Lexington. The Choices program was part of a nationwide initiative to raise awareness about the medical home, ages and stages appropriate care throughout childhood including transition to adult care in the community. The Choices program was a precursor to the hospital s Care Coordination department. With her rich insight, Ms. Abbott was an integral resource during the evaluation process. Shriners Hospital for Children - CHNA Page 29

30 Acknowledgements External Partners: Healthcare Association of Hawaii Louise Iwaishi, MD Leolinda Parlin Dorothy Colby, RN, MPH Internal Partners: Merlene Jose, RN Lisa Abbott, APRN Shriners Hospital for Children - CHNA Page 30

31 Exhibits Exhibit A The HAH HCI report included a state-wide list of Identified Community Resources as an appendix. The appendix contained lists that were provided by three state organizations - Aloha United Way, the Hawaii Department of Health, and the Centers for Medicare and Medicaid Services. Exhibit A excerpts the HAH HCI appendix so that only pediatric specific community health care facilities and resources are listed. Shriners Hospital for Children - CHNA Page 31

32 Appendix D: Identified Community Resources Statewide Health-Related Resources Identified from Aloha United Way 1 The following list includes selected resources available to residents of the State of Hawaii, as identified from Aloha United Way. However, it is not an exhaustive directory of all statewide programs. To find more resources, please visit Topic Area(s) Organization/Program URL Phone Children's Health CHILD & FAMILY SERVICES Children's Health HAWAII KIDS COUNT ts/kidscount/home.aspx Children's Health PREVENT CHILD ABUSE HAWAII (808) Diabetes AMERICAN DIABETES ASSOCIATION - HI Diabetes NATIONAL KIDNEY FOUNDATION OF HAWAII - OAHU (808) Diabetes; Children's Health Injury Prevention & Safety; Substance Abuse Maternal, Fetal & Infant Health JUVENILE DIABETES RESEARCH FOUNDATION INTERNATIONAL - HAWAII CHAPTER MADD HAWAII H-KISS (808) (808) (808) Oral Health HAWAII DENTAL ASSOCIATION (808) Other Chronic Conditions AUTISM SOCIETY OF HAWAII (808) Other Chronic Conditions EPILEPSY FOUNDATION OF HAWAII (808) Data was accessed February 2013

33 Health-Related Resources Identified by Hawaii Department of Health The following list includes organizations that have active contracts with the Hawaii Department of Health in Geography Topic Area(s) Organization/Program Hawaii Hawaii Hawaii Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning BAY CLINIC, INC. FAMILY PLANNING EDUCATION SERVICES HAMAKUA HEALTH CENTER Hawaii Maternal, Fetal & Infant Health; Children's Health FAMILY SUPPORT SERVICES OF WEST HAWAII Hawaii Mental Health ALAKAI NA KEIKI, INC (EAST HAWAII) Hawaii Mental Health ALAKAI NA KEIKI, INC (WEST HAWAII) Hawaii Substance Abuse; Family Planning BISAC Hawaii State Access to Health Services; Family Planning AIDS COMMUNITY CARE TEAM Hawaii State Children's Health; Access to Health Services EASTER SEALS HAWAII Hawaii State Children's Health; Access to Health Services UNITED CEREBRAL PALSY ASSOCIATION OF HAWAII Hawaii State Hawaii State Hawaii State Hawaii State Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning HEALTHY MOTHERS, HEALTHY BABIES COALITION OF HAWAII PLANNED PARENTHOOD OF HAWAII UNIVERSITY OF HAWAII AT MANOA/LEEWARD COMMUNITY COLLEGE UNIVERSITY OF HAWAII HILO Hawaii State Maternal, Fetal & Infant Health; Children's Health BOYS AND GIRLS CLUB OF HAWAII Hawaii State Maternal, Fetal & Infant Health; Children's Health CATHOLIC CHARITIES OF HAWAII

34 Geography Topic Area(s) Organization/Program Hawaii State Maternal, Fetal & Infant Health; Children's Health CHILD AND FAMILY SERVICE Hawaii State Maternal, Fetal & Infant Health; Children's Health CHILD AND FAMILY SERVICE KAUAI Hawaii State Maternal, Fetal & Infant Health; Children's Health FAMILY SUPPORT SERVICES OF WEST HAWAII Hawaii State Maternal, Fetal & Infant Health; Children's Health THE INSTITUTE FOR FAMILY ENRICHMENT Hawaii State Maternal, Fetal & Infant Health; Children's Health YWCA OF HAWAII ISLAND Hawaii State Mental Health CHILD AND FAMILY SERVICE Hawaii State Substance Abuse BOYS AND GIRLS CLUB OF THE BIG ISLAND Hawaii State Substance Abuse; Family Planning CHILD & FAMILY SVCS Hawaii State Substance Abuse; Teen & Adolescent Health BOYS AND GIRLS CLUB OF HAWAII Children's Health; Access to Health Services ACES Children's Health; Access to Health Services ALAKAI NA KEIKI, INC. Children's Health; Access to Health Services B.C.P., INC. DBA BAYADA HOME HEALTH CARE Children's Health; Access to Health Services CARE HAWAII, INC. Children's Health; Access to Health Services COMPREHENSIVE AUTISM SERVICES & EDUCATION, INC. DBA C.A.S.E., INC. Children's Health; Access to Health Services DEBORAH T. TOM DBA DEBORAH T. TOM, MS, PT Children's Health; Access to Health Services DR. BRENDA LOVETTE DBA LOKAHI CONSULTING GROUP, INC. Children's Health; Access to Health Services EASTER SEALS OF HAWAII - HONOLULU CENTRAL Children's Health; Access to Health Services EASTER SEALS OF HAWAII - HONOLULU EAST Children's Health; Access to Health Services EASTER SEALS OF HAWAII - KAILUA Children's Health; Access to Health Services EASTER SEALS OF HAWAII - KAPOLEI Children's Health; Access to Health Services HAWAII BEHAVIORAL HEALTH, LLC Children's Health; Access to Health Services HELPING HANDS HAWAII Children's Health; Access to Health Services IMUA FAMILY SERVICES

35 Geography Topic Area(s) Organization/Program Children's Health; Access to Health Services JIHEE KIM NGUYEN Children's Health; Access to Health Services JUNE UYEHARA ISONO, INC. DBA AUDIOLOGY CONSULTANT AND SERVICES Children's Health; Access to Health Services KAPIOLANI MEDICAL SPECIALISTS Children's Health; Access to Health Services Children's Health; Access to Health Services PACIFIC GATEWAY CENTER MARY MARASOVICH DBA OAHU SPEECH LANGUAGE PATHOLOGY CONSULTANTS Children's Health; Access to Health Services QUALITY BEHAVIORAL OUTCOMES, LLC Children's Health; Access to Health Services SAYURI'S NUTRITIONAL CONSULTATION, LLC Children's Health; Access to Health Services THE INSTITUTE FOR FAMILY ENRICHMENT, LLC Children's Health; Access to Health Services WAIANAE COAST EARLY CHILDHOOD SERVICES, INC. - WAIANAE Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning CHILD AND FAMILY SERVICE COMMUNITY CLINIC OF MAUI KALIHI PALAMA HEALTH CENTER KOKUA KALIHI VALLEY KOOLAULOA HEALTH AND WELLNESS CENTER MOLOKAI GENERAL HOSPITAL WAIANAE COAST DISTRICT COMPREHENSIVE WAIKIKI HEALTH CENTER

36 Geography Topic Area(s) Organization/Program Maternal, Fetal & Infant Health; Children's Health CHILD AND FAMILY SERVICE Maternal, Fetal & Infant Health; Children's Health THE INSTITUTE FOR FAMILY ENRICHMENT Maternal, Fetal & Infant Health; Exercise, Nutrition, & Weight Maternal, Fetal & Infant Health; Exercise, Nutrition, & Weight WAIANAE COAST COMPREHENSIVE HEALTH SERVICES WAIMANALO HEALTH CENTER Mental Health ALAKAI NA KEIKI, INC (CENTRAL OAHU) Mental Health ALAKAI NA KEIKI, INC (HONOLULU) Mental Health ALAKAI NA KEIKI, INC (LEEWARD OAHU) Mental Health CHILD AND FAMILY SERVICE (CR - CRISIS MOBILE) Mental Health CHILD AND FAMILY SERVICE Mental Health CHILD AND FAMILY SERVICE (CR - CRISIS MOBILE) Mental Health HALE KIPA, INC. Mental Health HAWAII FAMILIES AS ALLIES (BG30&31) Mental Health HAWAII FAMILIES AS ALLIES(PK) Mental Health HELPING HANDS HAWAII Mental Health PARENTS AND CHILDREN TOGETHER (CR - FFT) Mental Health PARENTS AND CHILDREN TOGETHER (EAST OAHU) Mental Health PARENTS AND CHILDREN TOGETHER (WEST OAHU Mental Health SPECIAL EDUCATION CENTER OF HAWAII Mental Health THE INSTITUTE FOR FAMILY ENRICHMENT (TIFFE) Substance Abuse PARENTS AND CHILDREN TOGETHER Substance Abuse; Family Planning MALAMA NA MAKUA Substance Abuse; Teen & Adolescent Health ALOHA HOUSE, INC.

37 Geography Topic Area(s) Organization/Program Substance Abuse; Teen & Adolescent Health ALU LIKE, INC. Substance Abuse; Teen & Adolescent Health BISAC Substance Abuse; Teen & Adolescent Health CARE HAWAII Substance Abuse; Teen & Adolescent Health FAMILY EDUCATION CENTER OF HAWAII Substance Abuse; Teen & Adolescent Health HALE HO'OKUPA'A Substance Abuse; Teen & Adolescent Health HINA MAUKA Substance Abuse; Teen & Adolescent Health MYFS Substance Abuse; Teen & Adolescent Health OHANA MAKAMAE Substance Abuse; Teen & Adolescent Health PO'AILANI Substance Abuse; Teen & Adolescent Health TIFFE Substance Abuse; Teen & Adolescent Health YMCA Kauai Access to Health Services; Family Planning LIFE FOUNDATION Kauai Access to Health Services; Family Planning MALAMA PONO HEALTH SERVICES Kauai Children's Health; Access to Health Services EASTER SEALS OF HAWAII - KAUAI Kauai Kauai Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning KAUAI COMMUNITY COLLEGE KAUAI RURAL HEALTH Maui Access to Health Services; Family Planning MAUI AIDS FOUNDATION Maui Children's Health; Access to Health Services IMUA FAMILY SERVICES - LANAI Maui Children's Health; Access to Health Services IMUA FAMILY SERVICES - MAUI Maui Maui Maternal, Fetal & Infant Health; Access to Health Services; Family Planning Maternal, Fetal & Infant Health; Access to Health Services; Family Planning LANAI WOMEN'S HEALTH CENTER MAUI COMMUNITY COLLEGE

38 Geography Topic Area(s) Organization/Program Maui Maternal, Fetal & Infant Health; Access to Health Services; Family Planning MOLOKAI GENERAL HOSPITAL Maui Maternal, Fetal & Infant Health; Children's Health MAUI FAMILY SUPPORT SERVICES Maui Maui Maternal, Fetal & Infant Health; Exercise, Nutrition, & Weight Maternal, Fetal & Infant Health; Exercise, Nutrition, & Weight MAUI FAMILY SUPPORT SERVICES, INC. MOLOKAI OHANA HEALTH CARE, INC. Maui Mental Health ALAKAI NA KEIKI, INC (MAUI) Maui Mental Health MAUI YOUTH AND FAMILY SERVICES, INC. Maui Mental Health PARENTS AND CHILDREN TOGETHER (MAUI) Maui Substance Abuse; Teen & Adolescent Health MAUI YOUTH AND FAMILY SERVICES unknown unknown ALAKAI NA KEIKI, INC (EAST HAWAII) unknown unknown CHILD & FAMILY SVCS unknown unknown CHILD AND FAMILY SERVICE unknown unknown CHILD AND FAMILY SERVICE KAUAI unknown unknown FAMILY PLANNING EDUCATION SERVICES unknown unknown FAMILY SUPPORT SERVICES OF WEST HAWAII unknown unknown HEALTHY MOTHERS, HEALTHY BABIES COALITION OF HAWAII unknown unknown MAUI FAMILY SUPPORT SERVICES unknown unknown PARENTS AND CHILDREN TOGETHER (CR - FFT) unknown unknown PLANNED PARENTHOOD OF HAWAII

39 State of Hawaii Licensed Health Care Facilities Reported by the Centers for Medicare & Medicaid Services 2 The following list includes the places of service reported by the Centers for Medicare & Medicaid Services for the State of Hawaii. However, it is not an exhaustive directory of all facilities in the county. Facility Type Facility Sub-Type Facility Name Address Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Federally Qualified Health Center Federally Qualified Health Center Federally Qualified Health Center Federally Qualified Health Center Federally Qualified Health Center FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER BAY CLINIC FAMILY HEALTH CENTER KA U FAMILY HEALTH CTR KEAAU FAMILY HEALTH CENTER KOHALA FAMILY HEALTH CENTER PAHOA FAMILY HEALTH 73 PU'UHONU PLAZA, ROOM 204 HILO HI MAMALALOA HWY NAALEHU HI PILIMUA STREET KEAAU HI AKONI PULE HIGHWAY KAPAAU HI GOVERNMENT ROAD PAHOA HI Home Health Agency HOME HEALTH AGENCY HILO HOSP HHS-KONA SUB-UNIT P O BOX 69 KEALAKEKUA HI Home Health Agency HOME HEALTH AGENCY HILO MEDICAL CENTER HOME CARE Home Health Agency HOME HEALTH AGENCY INTERIM HEALTHCARE HILO Home Health Agency HOME HEALTH AGENCY INTERIM HEALTHCARE KONA Home Health Agency Home Health Agency HOME HEALTH AGENCY HOME HEALTH AGENCY KOHALA HOME HEALTH CARE OF NORTH HI COMM HOSP WEST HAWAII HOME HEALTH SERVICES 45 MOHOULI STREET, SUITE 201 HILO HI MANONO STREET HILO HI KUAKINI HIGHWAY SUITE KAILUA KONA HI MAMALAHOA HIGHWAY KAMUELA HI P O BOX 69 KEALAKEKUA HI The Centers for Medicare & Medicaid Services published this list in the 4 th Quarter of 2012.

40 Facility Type Facility Sub-Type Facility Name Address Hawaii Home Health Agency Federally Qualified Health Center Federally Qualified Health Center Federally Qualified Health Center HOME HEALTH AGENCY FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER FEDERALLY QUALIFIED HEALTH CENTER WEST HAWAII HOME HEALTH SVCS KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES WAIPAHU FAMILY HEALTH CENTER Home Health Agency HOME HEALTH AGENCY CARERESOURCE HAWAII Home Health Agency HOME HEALTH AGENCY CARERESOURCE HAWAII Home Health Agency HOME HEALTH AGENCY CASTLE HOME CARE Home Health Agency HOME HEALTH AGENCY HOSPICE HAWAII INC Home Health Agency HOME HEALTH AGENCY INTERIM HEALTHCARE HONOLULU Home Health Agency HOME HEALTH AGENCY KAHUKU HOSPITAL HHA Home Health Agency Home Health Agency HOME HEALTH AGENCY HOME HEALTH AGENCY KAISER HOME HEALTH AGENCY - OAHU KAPIOLANI HOME HEALTH SERVICES Home Health Agency HOME HEALTH AGENCY KOKUA NURSES INC OLD GOVERNMENT ROAD CAPTAIN COOK HI LINAPUNI STREET, BLDG A, #105 HONOLULU HI GULICK AVENUE HONOLULU HI MOKUOLA STREET, SUITE 108-B WAIPAHU HI IWILEI ROAD, SUITE 660 HONOLULU HI SOUTH BERETANIA ST, SUITE 3-A HONOLULU HI KAMEHAMEHA HIGHWAY, SUITE 212 KANEOHE HI IWILEI ROAD HONOLULU HI KAPIOLANI BLVD SUITE 1320 HONOLULU HI PUALALEA STREET KAHUKU HI PA'A STREET #2048 HONOLULU HI UKE'E STREET, SUITE 201 WAIPAHU HI ARTESIAN STREET, SUITE 201 HONOLULU HI 96826

41 Facility Type Facility Sub-Type Facility Name Address Kauai Kauai Home Health Agency HOME HEALTH AGENCY MALUHIA HOME HEALTH CARE Home Health Agency Home Health Agency HOME HEALTH AGENCY HOME HEALTH AGENCY PRIME CARE SERVICES HAWAII INC ST FRANCIS HOME CARE SERVICES Home Health Agency HOME HEALTH AGENCY STRAUB HOME HEALTH AGENCY Home Health Agency HOME HEALTH AGENCY UPJOHN HOME HEALTH AGENCY 1027 HALA DRIVE HONOLULU HI KOAPAKA STREET, SUITE I- 570 HONOLULU HI LILIHA STREET, SUITE 505 HONOLULU HI KAILUA ROAD KAILUA HI WARD AVE HONOLULU HI Home Health Agency HOME HEALTH AGENCY WAHIAWA GENERAL HOSP HHA 128 LEHUA ST WAHIAWA HI Home Health Agency Home Health Agency HOME HEALTH AGENCY HOME HEALTH AGENCY WAHIAWA GENERAL HOSPITAL HHA WAIANAE COAST COMPREHENSIVE HEALTH CTR Hospital VA PACIFIC ISLANDS HCS Hospital Hospital Hospital Home Health Agency Childrens Childrens HOME HEALTH AGENCY WAIMANO TRAINING SCHOOL & HOSP KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN SHRINERS HOSPITAL FOR CHILDREN HAWAII PROFESSIONALS HOMECARE SERVICES, INC Home Health Agency HOME HEALTH AGENCY INTERIM HEALTHCARE LIHUE 1008 CALIFORNIA AVENUE, UNIT A101 WAHIAWA HI FARRINGTON HIGHWAY WAIANAE HI PATTERSON ROAD HONOLULU HI PEARL CITY HI PUNAHOU STREET HONOLULU HI PUNAHOU STREET HONOLULU HI KELE STREET, SUITE 213 LIHUE HI KUKUI GROVE STREET SUITE LIHUE HI 96766

42 Facility Type Facility Sub-Type Facility Name Address Kauai Maui Maui Maui Maui Maui Maui Home Health Agency Home Health Agency HOME HEALTH AGENCY HOME HEALTH AGENCY ST.FRANCIS HOME CARE SERVICES - KAUAI HALE MAKUA HOME HEALTH SERVICE Home Health Agency HOME HEALTH AGENCY INTERIM HEALTHCARE KAHULUI Home Health Agency HOME HEALTH AGENCY INTERIM HEALTHCARE MOLOKAI Home Health Agency HOME HEALTH AGENCY KAISER PERMANENTE HOME HEALTH AGENCY MAUI 4473 PAHE'E STREET, SUITE N LIHUE HI EAST MAIN STREET WAILUKU HI PAPA PLACE SUITE 205 KAHULUI HI ALA MALAMA STREET KAUNAKAKAI HI MAUI LANI PARKWAY WAILUKU HI Home Health Agency HOME HEALTH AGENCY LANAI HOME HEALTH AGENCY P O BOX 763 LANAI CITY HI Home Health Agency HOME HEALTH AGENCY MOLOKAI HOME HEALTH AGENCY 65 MAKAENA STREET KAUNAKAKAI HI 96748